Beyond Side Effects: Rethinking the Role of Contraceptive Induced Menstrual Changes in the Measurement of Contraceptive Use and Unmet Need

Contraceptive induced menstrual changes (CIMCs) have been inadequately considered in the context of measuring contraceptive usage and unmet need. Using contraceptives for non-contraceptive purposes is not unusual, though data on prevalence is limited. The studies that do exist show that a large proportion of users employ hormonal contraceptives at least partly for non-contraceptive purposes, particularly to manage menstruation.

Traditionally, CIMCs have been overlooked in the family planning literature, primarily mentioned as unwanted, minor "side effects" of contraceptive usage, if at all. However, CIMCs are not necessarily minor nor “side effects”, and they are not universally unwanted; for some, specific CIMCs may constitute the primary motivation for using modern contraceptives. This perspective is absent from prevailing indicators of contraceptive use and unmet need as well as the emerging discourse on redesigning family planning indicators.

In this paper, I show how current survey questions used to measure contraceptive prevalence often ignore the possibility of contraceptive usage for non-contraceptive purposes. I also illustrate that this is a problem for the conceptualization and measurement of unmet need. In particular, the concept of unmet need must grapple not only with both method misalignment and dissatisfaction, but also with the use of contraceptives for non-contraceptive reasons.