Anemic Women are More at Risk of Injectable Contraceptive Discontinuation due to Side Effects in Ethiopia

Abstract

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.

Misconceptions, Misinformation, and Misperceptions: A Case for Removing the “Mis‐” When Discussing Contraceptive Beliefs

“…Early research has suggested that women with poorer nutritional status and harsher workloads may be more at risk of negative bodily experiences (Stevens et al. 2022; Alvergne and Stevens 2021; Vitzthum and Ringheim 2005). Thus, following efforts to personalize health technologies (Harvey et al.…”

“…Thus, beliefs about the risk of side‐effects experiences are also likely to vary greatly in their seriousness as a concern (Vitzthum and Ringheim 2005; Alvergne and Stevens 2021; Stevens et al. 2022).…”

“…However, women's bodies and possible physiological responses to contraception vary between individuals and across the world (Nanda et al 2016;Bick et al 2021). Thus, beliefs about the risk of sideeffects experiences are also likely to vary greatly in their seriousness as a concern (Vitzthum and Ringheim 2005;Alvergne and Stevens 2021;Stevens et al 2022).…”

How to Use Simplified Reproductive Calendar Data from the Demographic and Health Survey

“…Most commonly, the data are used to study contraceptive use, such as factors affecting contraceptive discontinuation (e.g., Stevens et al. 2022), method switching (e.g., Ali and Cleland 2010) and contraceptive failure (e.g., Bradley et al. 2019), and to illuminate the dynamics (Maxwell et al.…”

“…The few publications based on calendar data demonstrate the material's usefulness. Most commonly, the data are used to study contraceptive use, such as factors affecting contraceptive discontinuation (e.g., Stevens et al 2022), method switching (e.g., Ali and Cleland 2010) and contraceptive failure (e.g., Bradley et al 2019), and to illuminate the dynamics (Maxwell et al 2018) and health consequences (Kannaujiya et al 2020) of birth spacing. Pregnancy termination (e.g., Jain and Winfrey 2017) and patterns of infecundity (e.g., Mascarenhas et al 2012) are also analyzed using calendar data.…”