Determinants of Implanon Discontinuation among Women Who Use Implanon at Bahir Dar Town Health Institutions, Northwest Ethiopia, 2019: A Case‐Control Study

Abstract

Background. Implanon is a long-acting reversible contraceptive method that is 99% effective in preventing unintended pregnancy. Despite its effectiveness, the rate of Implanon discontinuation is high. In Ethiopia, there is limited information about determinants of Implanon discontinuation. Therefore, this study aimed to identify the determinants of Implanon discontinuation among women who used Implanon at Bahir Dar town health institutions. Methods. We employed an unmatched case-control study to find out the determinants of Implanon discontinuation at Bahir Dar town health institutions from March to June 2019 using the multistage stratified sampling technique to select study participants. Cases were women who had discontinued Implanon before completion of 3 years, and controls were women who had removed Implanon at the date of appointment (3 years). A pretested, structured questionnaire with face-to-face interviews was used. Binary logistic regression was performed to identify determinants of Implanon discontinuation. In the final model, variables with a p value of <0.05 were considered significant at 95% confidence interval and the strength of association was measured using odds ratio. Results. Primary education (AOR = 0.104, 95% CI (0.02–0.48)), secondary education (AOR = 0.48, 95% CI (0.24–0.952)), women who have no child (AOR = 2.04, 95% CI (1.2–3.4)), women who had no discussion with their partner (AOR = 2.2, 95% CI (1.39–3.57)), mass counseling (AOR = 3.5, 95% CI (1.75–7.01)), women who had no counseling about side effects (AOR = 1.7, 95% CI (1.07–2.07)), women who experienced side effects (AOR = 2.2, 95% CI (1.4–3.4)), and purpose of family planning use (AOR = 2.5, 95% CI (1.14–4.8)) were determinants of Implanon discontinuation. Conclusion. Implanon discontinuation is attributed by multifactorial involvement. Women’s educational status, nulliparity, no counseling, not informed of side effects, and no partner discussion are significant factors. Health sector stakeholders need to tailor counseling services at individual level to bolster family planning utilization until the desired time.

Determinants of implanon discontinuation among women who ever used implanon in Shashamane district, West Arsi zone, Southern Ethiopia: Case-control study

“…Women who did not discussed with their partners are 2.88 times more likely to discontinue Implanon as compared to those who discussed with their partners. This is line with studies conducted in Bahir Dar Town (21), Kucha District Gamo Gofa Zone (33) and Bale Zone (31). This might be due to fear of menstrual disruption which make their husband aware of their contraceptive use and fear of violence because of disobeying her husband.…”

“…The sample size was calculated using two population proportions for unmatched case control study by STATCALC Epi info version 7.2.2. Discussion with partner, side effects and previous history of abortion were the strongest determinant factors of Implanon discontinuation in the previous studies conducted in Bahir Dar town, Mekelle City and Wolaita Zone (20)(21)(22). Sample size was computed for each factors and previous history of abortion was chosen as main exposure variable to calculate optimal sample size.…”

“…Cases-All women of reproductive age group who were discontinued their implanon before 3 years of its expiring date (21,22).…”

“…Controls-All women of reproductive age group who had removed their implanon after using three completed years (21,22).…”

“…Various factors have been reported to be associated with discontinuation of implanon; side effects (20), discussion with partner (21), previous history of abortion (22), having no children (19), women's educational level (22), pre-insertion counselling (23) are the most common associated factors for unscheduled discontinuation of implanon. Despite many studies have been conducted on the discontinuation of implanon, existing evidence has revealed that the discontinuation of contraception varies according to the type of contraceptive used, age, race, ethnic background, and time when the contraception was initially used (24)(25)(26).…”