An Interpretative Study of LARCs Discontinuation in Ethiopia: The Experiences of Women Accessing Contraceptives in Selected Public Health Facilities

Overview

Journal Open Access J Contracept

Publisher Dove Medical Press

Specialty Reproductive Medicine

Date 2023 Feb 24

PMID 36824684

Authors

Getasew Sisay Mihretie

Solomon Mekonnen Abebe

Mikyas Abera

Daniel Tadesse Assefa

Affiliations

Soon will be listed here.

Abstract

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.

References

Wong R, Bell R, Thunuguntla K, McNamee K, Vollenhoven B . Implanon users are less likely to be satisfied with their contraception after 6 months than IUD users. Contraception. 2009; 80(5):452-6. DOI: 10.1016/j.contraception.2009.03.021. View

Valente T, Paredes P, Poppe P . Matching the message to the process: the relative ordering of knowledge, attitudes, and practices in behavior change research. Hum Commun Res. 2002; 24(3):366-85. DOI: 10.1111/j.1468-2958.1998.tb00421.x. View

Bereku T, Habtu Y, Abreham B, Ayele M, Eliso M . Magnitude and factors for method discontinuation and switching among long acting reversible contraceptive users in health facilities of Southern Ethiopia. Reprod Health. 2022; 19(1):47. PMC: 8858462. DOI: 10.1186/s12978-022-01357-2. View

Andersson K, Odlind V, RYBO G . Levonorgestrel-releasing and copper-releasing (Nova T) IUDs during five years of use: a randomized comparative trial. Contraception. 1994; 49(1):56-72. DOI: 10.1016/0010-7824(94)90109-0. View

Starbird E, Norton M, Marcus R . Investing in Family Planning: Key to Achieving the Sustainable Development Goals. Glob Health Sci Pract. 2016; 4(2):191-210. PMC: 4982245. DOI: 10.9745/GHSP-D-15-00374. View

Potter J, Stevenson A, Coleman-Minahan K, Hopkins K, White K, Baum S . Challenging unintended pregnancy as an indicator of reproductive autonomy. Contraception. 2019; 100(1):1-4. PMC: 6919552. DOI: 10.1016/j.contraception.2019.02.005. View

Gipson J, Koenig M, Hindin M . The effects of unintended pregnancy on infant, child, and parental health: a review of the literature. Stud Fam Plann. 2008; 39(1):18-38. DOI: 10.1111/j.1728-4465.2008.00148.x. View

Fekadu G, Omigbodun A, Roberts O, Yalew A . Factors associated with early long-acting reversible contraceptives discontinuation in Ethiopia: evidence from the 2016 Ethiopian demographic and health survey. Arch Public Health. 2020; 78:36. PMC: 7329387. DOI: 10.1186/s13690-020-00419-w. View

Sznajder K, Tomaszewski K, Burke A, Trent M . Incidence of Discontinuation of Long-Acting Reversible Contraception among Adolescent and Young Adult Women Served by an Urban Primary Care Clinic. J Pediatr Adolesc Gynecol. 2016; 30(1):53-57. PMC: 5203808. DOI: 10.1016/j.jpag.2016.06.012. View

10.

Cleland J, Conde-Agudelo A, Peterson H, Ross J, Tsui A . Contraception and health. Lancet. 2012; 380(9837):149-56. DOI: 10.1016/S0140-6736(12)60609-6. View

11.

Mack N, Crawford T, Guise J, Chen M, Grey T, Feldblum P . Strategies to improve adherence and continuation of shorter-term hormonal methods of contraception. Cochrane Database Syst Rev. 2019; 4:CD004317. PMC: 6478403. DOI: 10.1002/14651858.CD004317.pub5. View

12.

Cleland J, Ali M . Reproductive consequences of contraceptive failure in 19 developing countries. Obstet Gynecol. 2004; 104(2):314-20. DOI: 10.1097/01.AOG.0000134789.73663.fd. View

13.

Modesto W, Valeria Bahamondes M, Bahamondes L . A randomized clinical trial of the effect of intensive versus non-intensive counselling on discontinuation rates due to bleeding disturbances of three long-acting reversible contraceptives. Hum Reprod. 2014; 29(7):1393-9. DOI: 10.1093/humrep/deu089. View

14.

Schivone G, Glish L . Contraceptive counseling for continuation and satisfaction. Curr Opin Obstet Gynecol. 2017; 29(6):443-448. DOI: 10.1097/GCO.0000000000000408. View

15.

Samuel M, Fetters T, Desta D . Strengthening Postabortion Family Planning Services in Ethiopia: Expanding Contraceptive Choice and Improving Access to Long-Acting Reversible Contraception. Glob Health Sci Pract. 2016; 4 Suppl 2:S60-72. PMC: 4990163. DOI: 10.9745/GHSP-D-15-00301. View

16.

Harvey C, Seib C, Lucke J . Continuation rates and reasons for removal among Implanon users accessing two family planning clinics in Queensland, Australia. Contraception. 2009; 80(6):527-32. DOI: 10.1016/j.contraception.2009.05.132. View

17.

Hellerstedt W, Pirie P, Lando H, Curry S, McBride C, Grothaus L . Differences in preconceptional and prenatal behaviors in women with intended and unintended pregnancies. Am J Public Health. 1998; 88(4):663-6. PMC: 1508432. DOI: 10.2105/ajph.88.4.663. View

18.

Yazdkhasti M, Pourreza A, Pirak A, Abdi F . Unintended Pregnancy and Its Adverse Social and Economic Consequences on Health System: A Narrative Review Article. Iran J Public Health. 2015; 44(1):12-21. PMC: 4449999. View

19.

Moreau C, Cleland K, Trussell J . Contraceptive discontinuation attributed to method dissatisfaction in the United States. Contraception. 2007; 76(4):267-72. DOI: 10.1016/j.contraception.2007.06.008. View

20.

Blumenthal P, Voedisch A, Gemzell-Danielsson K . Strategies to prevent unintended pregnancy: increasing use of long-acting reversible contraception. Hum Reprod Update. 2010; 17(1):121-37. DOI: 10.1093/humupd/dmq026. View