Discontinuation rate and associated factors among contraceptive implant users in Kersa district, southwestern Ethiopia

Abstract

Background Subdermal contraceptive implant is the most widely used method of long-acting reversible contraception among Ethiopian women. Many, however, discontinue use early, which results in unwanted pregnancies and induced abortions and their associated complications. The aim of this study is to determine the rate of and reasons for discontinuation of the contraceptive implant among users in the Kersa district of southwestern Ethiopia. Methods A mixed-method study was carried out between March and April 2019 among 475 women who had been using the contraceptive implant between January 2015 and August 2016 in the Kersa district. Systematic random sampling was used for quantitative data collection and purposive sampling was used for qualitative data collection using 8 focus group discussion and 56 In-depth interviews. A binary logistic regression was carried out for bivariate and multivariable analyses. Results One hundred and ten (23.2 %) contraceptive implant users requested removal before 2.5 years of use. The main reasons for the discontinuation were side effects, followed by a desire for pregnancy or to switch to another contraceptive method and misconceptions. Implant discontinuation was associated with a lack of information prior to insertion on the effectiveness of modern contraception (adjusted odds ratio [OR] 2.0; 95 % confidence interval [CI] 1.13, 3.55), being served by a midwife or nurse (adjusted OR 1.8; 95 % CI 1.04, 3.23), and not being told to return to the health facility if any side effects were experienced (adjusted OR 1.8; 95 % CI 1.01, 3.19) (all p < 0.05). Conclusions Almost a quarter of the study participants discontinued use of the contraceptive implant before the due date. Public health interventions should focus on providing adequate awareness for family planning users, trainings for the health care workers on effective counselling services, especially on side effect and misconceptions.

Discontinuation of long acting reversible contraceptive use and its determinants among women in Ethiopia: Systematic review and meta-analysis

“…Both community and institutional studies were equally represented (10 studies in each). Nine studies conducted in Southern Nations Nationalists and Peoples Region ( 23 , 27 , 31 , 32 , 34 – 37 , 39 ), five in Amhara ( 26 , 28 – 30 , 41 ), three in Tigray ( 40 , 42 , 43 ), and three in Oromia ( 33 , 38 , 44 ). The sample sizes ranged from 222 to 1050.…”

“…As a result, 156 fulltext articles were assessed for eligibility criteria, with 136 studies being excluded due to various factors. Finally, for this systematic review and meta-analysis study, 20 publications (23,(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44) were used as presented by PRISMA diagram (Figure 1). The cross-sectional study type was used in seventeen studies, whereas the retrospective cohort study approach was used in three.…”

Determinants of early discontinuation of long-acting and reversible contraceptive methods among women within childbearing age attending health facilities in Ethiopia, 2019

“…In 2017, an estimated 206 million people in developing countries became pregnant, with 43% of those pregnancies being unwanted because of the early discontinuation of contraceptive methods. 9 This leads to potentially unsafe induced abortions where the access to safe abortion is restricted. 10 According to the 2016 Ethiopian Demographic and Health Survey (EDHS), 35% of modern contraceptive methods users discontinued using the methods before its date of removal, and 11% of them were using LARC methods.…”

“…In 2017, an estimated 206 million people in developing countries became pregnant, with 43% of those pregnancies being unwanted because of the early discontinuation of contraceptive methods. 9 This leads to potentially unsafe induced abortions where the access to safe abortion is restricted. 10 …”

Effect of Picture-based health education and counselling on knowledge and adherence to preconception Iron-folic acid supplementation among women planning to be pregnant in Eastern Ethiopia: a randomized controlled trial

“…In Ethiopia, the contraceptive prevalence rate (CPR) among currently married women is 41 % (4) ; however, 35 % of modern contraception device (medical products including sub-dermal implants, intrauterine devices (IUDs) or loops which are designed to prevent pregnancy) users discontinued them before their removal date (5) . The desire for pregnancy is the second most common reason for early discontinuation and it accounts for almost 27⋅3 % (6)(7)(8)(9) . Any woman who could get pregnant is at a risk of having a baby with neural tube defects (NTDs) (10) .…”