This paper investigates the importance of women's physiological condition, alongside sociocultural factors, for predicting the risk of discontinuation of the injectable contraceptive due to side effects in Ethiopia. Contraceptive calendar data from the 2016 Ethiopian Demographic and Health Survey were analyzed. Women aged 15–49 who had initiated the injectable contraceptive in the last two years were included in the analysis (n = 1,513). Physiological factors investigated were body mass, iron status, reproductive depletion, and physical strain. After checking for reverse causality, associations between physiological and sociocultural risk factors and discontinuation due to side effects (DSE) or discontinuation due to other reasons (DOR) were estimated using multivariate Cox proportional regression analyses. Anemia status was associated with DSE, but not DOR. Anemic women were two times more at risk of DSE compared with nonanemic women (adjusted hazard ratios [aHR] = 2.38, confidence interval [CI] = 1.41–4.00). DOR was predicted by religion, wealth, and relationship status. Accounting for diversity in physiological condition is key for understanding contraceptive discontinuation due to side effects. To reduce side effects, family planning programs might benefit from providing hormonal contraception within an integrated package addressing anemia.

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Introduction This paper investigates the importance of women's physiological condition for predicting the risk of discontinuation due to side-effects of the injectable contraceptive in Ethiopia, where side-effects account for around 20% of all discontinuations. Methods Contraceptive calendar data from the 2016 Ethiopian Demographic and Health Survey were analysed. Women aged 15-49 who had initiated the injectable contraceptive in the two years prior to interview were included in the analysis (N=1,513). After checking for reverse causality, the associations between physiological risk factors and discontinuation of the injectable contraceptive due to either side-effects (DSE) or other reasons (DOR) were estimated using multivariate Cox proportional regression analyses. Results In 2016, 10% of women had initiated the injectable in the last two years, and 1 in 4 had discontinued use by the time of the interview. Of these, 1 in 5 discontinued due to side-effects. Women with anaemia were at twice the risk of DSE compared with non-anaemic women, while anaemia status was not associated with DOR. The association between anaemia and experience of side-effects is likely driven by iron-deficiency anaemia, as having taken iron supplements during last pregnancy is found to decrease the risk of DSE. Sociocultural factors including religion, wealth and relationship status were significant predictors for DOR, but not for DSE. Conclusion Accounting for diversity in physiological condition is key for understanding contraceptive discontinuation due to side-effects. To reduce side-effects and thereby unmet need for contraception, family planning programs may benefit from providing an integrated service package addressing anaemia as well as supplying hormonal contraception.

Introduction This paper investigates the importance of women’s physiological condition for predicting the risk of discontinuation due to side-effects of the injectable contraceptive in Ethiopia, where side-effects account for around 20% of all discontinuations. Methods Contraceptive calendar data from the 2016 Ethiopian Demographic and Health Survey were analysed. Women aged 15-49 who had initiated the injectable contraceptive in the two years prior to interview were included in the analysis (N=1,513). After checking for reverse causality, the associations between physiological risk factors and discontinuation of the injectable contraceptive due to either side-effects (DSE) or other reasons (DOR) were estimated using multivariate Cox proportional regression analyses. Results In 2016, 10% of women had initiated the injectable in the last two years, and 1 in 4 had discontinued use by the time of the interview. Of these, 1 in 5 discontinued due to side-effects. Women with anaemia were at twice the risk of DSE compared with non-anaemic women, while anaemia status was not associated with DOR. Sociocultural factors including religion, wealth and relationship status were significant predictors for DOR, but not for DSE. Conclusion Accounting for diversity in physiological condition is key for understanding contraceptive discontinuation due to side-effects.