ObjectiveThe study aims to determine discontinuation among long-acting reversible contraceptive users at 3, 6, 9 and 12 months after initiation and its associated factors among new long-acting reversible contraceptive (LARC) users.DesignA facility-based multicentre prospective cohort study was conducted with a sample size of 1766 women.SettingThe study was conducted in five large cities of Ethiopia (Addis Ababa, Gondar, Mekelle, Jimma and Harar) between March 2017 and December 2018. Various referral hospitals and health centres that are found in those cities are included in the study.ParticipantsThe study population was all women who were new users of LARCs and initiated LARCs in our selected public health facilities during the enrolment period.InterventionsA pretested structured questionnaire was administered at enrolment and at 6 and 12 months to determine discontinuation proportion and factors associated with discontinuation.ResultFrom the total of 1766 women sampled for the study only 1596 (90.4%) participants completed all the questionnaires including the 12-month follow-up study. The overall proportion of discontinuation of LARCs at 12 months was 21.8% (95% CI 19.8 to 23.9). The overall discontinuation proportions at 3, 6, 9 and 12 months were 2.94%, 8.53%, 3.94% and 6.36%, respectively. Location of method initiation (adjusted HR (aHR)=5.77; (95% CI 1.16 to 28.69)) and dissatisfaction with the method (aHR=0.09; (95% CI 0.03 to 0.21)) were found to be the predictors of discontinuation among intrauterine contraceptive device users. Being satisfied with the method (aHR=0.21; (95% CI 0.15 to 0.27)), initiation after post abortion (aHR=0.48; (95% CI: 0.26, 0.89)) and joint decision with partner for method initiation (aHR=0.67; (95% CI: 0.50, 0.90)) were inversely associated with implant discontinuation.ConclusionThe majority of LARC users discontinue the method in the first 6 months after insertion and dissatisfaction with the method increased the likelihood of removal during the first year of LARC use.
Background Discontinuation of contraception for reasons other than wanting to become pregnant is a public health concern as it affects women’s autonomy in sexual and reproductive health decision making as well as gender equality. Studies identified various factors, including community perception and users’ dissatisfaction that limited the reach and impact of contraceptives, primarily LARCs, on women’s wellbeing. In Ethiopia, however, the reasons for early discontinuation of LARCCs are not adequately explored. Against this backdrop, this study explores the main reasons for the early discontinuation of LARCs among Ethiopian women in selected public health facilities. Methods This study used an institution-based qualitative study design and covered selected university hospitals and health centers in Addis Ababa, Gondar, Mekelle, and Jimma. It involved in-depth interviews with 29 women aged 15–49 to gather data and explore the decision-making processes involved in the early discontinuation of LARCs. It used description, narration and thematic interpretation as data analysis procedures. Results Interviewees reported several reasons for early discontinuation of LARCs, including side effects (eg, weight gain/loss, heavy menses, tiredness, and reduced libido), desire to conceive, and husbands’ disapproval. This study found that women were sufficiently aware of alternative contraceptives, including LARCs. Many reported experimenting before deciding on an option. Conversely, others’ reports reveal the influences of gender roles and community misconceptions on women’s decisions to discontinue LARCs. Discussion and Implications The common threads in interviewees’ narratives highlight the significance of traditional values, gender roles, community perception, and experience with side effects to women’s early discontinuation of LARCs. This study concludes with remarks on how to improve the effectiveness of family planning programming by adopting the gender transformative approach (GTA) in their design and implementation.
Background: Unintended pregnancy remains an important public health problem among teenagers and women in developing countries. Modern family planning methods, particularly Long Acting Reversible Contraceptives (LARCs), are highly effective in addressing the problem and its undesirable outcomes in maternal mortality. But dissatisfaction with contraceptives has contributed to their early discontinuation, but the reasons in Ethiopia are not adequately explored.Objective: This study aims to explore the main reasons of discontinuation of LARCs-use within one year of adoption in selected public health facilities in Ethiopia.Methods: Institution-based, multi-center prospective-cohort study design was used to identify the reasons of discontinuation among LARCs-users in Ethiopia. The study covered four university hospitals and health centers in Addis Ababa, Gondar, Mekelle and Jimma. The main study employed survey and in-depth interviews. But this article is based on qualitative data collected through in-depth interviews. It explored the decision-making processes involved in LARCs-discontinuation based on the experiences of 29 women aged 15-49 who did within a year of insertion. Interview data were thematically organized, coded and analyzed in light of the study objectives.Results: The study found women were sufficiently aware of the various types of contraceptives, including LARCs. Many of them experimented with different types before deciding on their choice. On LARCs, most were satisfied with its benefits while they also mentioned several reasons to discontinue its use including weight gain/loss, heavy menses, tiredness, reduced libido, desire to conceive and husbands’ disapproval. Their decisions to use or not use LARCs reflected the common cultural values about childbirth and myths on contraceptive use.Conclusions: The study found women use (or discontinue use) of contraceptives depends on their knowledge about their options, personal experience with side-effects, and the support from significant others, mainly husbands. As such, any campaign to promote family planning methods has to take into account the status of women in the Ethiopian society and cultural definition of their sexuality.
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