Using a Chord Diagram to Visualize Dynamics in Contraceptive Use: Bringing Data Into Practice

A chord diagram is an innovative tool that can be used to visualize switching and quitting in contraceptive use between 2 discrete time points. It complements existing analysis of contraceptive failure rates and provides a richer understanding of contraceptive discontinuation and method switching that can lead to fresh insights to improve family planning programs.
We applied a novel approach to visualizing contraceptive histories from the Demographic and Health Surveys (DHS) contraceptive calendar to elucidate patterns of contraceptive switching and discontinuation (e.g., “churn” in contraceptive use across 2 points in time). Taking the contraceptive calendar from the 2014 Kenya DHS, we used R, an open source statistical programming platform, and the chorddiag package to create interactive chord diagrams to visualize contraceptive use trajectories, including switching and discontinuation, for all contraceptive types queried in the DHS. We present screenshots from the interactive version. We also tested the usefulness of our chord diagram with potential users, including family planning researchers and advocates. Chord diagrams are visually appealing and provide users with the ability to investigate unique patterns in contraceptive discontinuation using publicly available data from the DHS. After receiving a brief orientation to a chord diagram, users found the chord diagram easy to understand and manipulate. The chord diagram is a potentially powerful way for family planning researchers, advocates, and program managers to visualize women’s contraceptive trajectories and provides insights into the churn in contraceptive use between 2 discrete time periods.