Dataset Information

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

ABSTRACT:

Introduction

Contraception discontinuation is a major public health issue that leads to unwanted pregnancies and unsafe abortions. Therefore, this systematic review and meta-analysis aimed to estimate discontinuation of contraceptives and its determinants in Ethiopia.

Methods

PubMed, Google Scholar, Scopus, Science Direct, and Addis Ababa University online library were searched. Data were extracted using Microsoft Excel and analyzed using STATA statistical software (v. 14). Publication bias was checked by forest plot, Begg's rank test, and Egger's regression test. To look for heterogeneity, I² was computed, and an overall estimated analysis was carried out. Subgroup analysis was done by region, study setting, and publication. The pooled odds ratio for associated factors was also computed.

Results

Out of 654 studies assessed, 20 met our criteria and were included in the study. The total number of study participants was 8,780. The pooled prevalence of discontinuation of long acting reversible contraceptive use was 36.94% (95% CI: 28.547-45.326). According to sub-group analysis, Amhara region (45%) and institution-based studies (47.9%) had the highest prevalence. The most common reason for contraceptive discontinuation was negative side effect (42.3%).Women experienced side effects (AOR = 2.833:95% CI:2.005-4.003), didn't receive counseling on side effects (AOR = 2.417; 95% CI: 1.591-3.672), didn't appoint follow up (AOR = 2.820; 95% CI: 2.048-3.881), dissatisfied with the given service (AOR = 5.156; 95% CI: 3.644-7.296), and a desire to be pregnant (AOR = 2.366; 95% CI: 1.760-3.182) were predictors of discontinuation of contraceptives.

Conclusion

In Ethiopia, the pooled prevalence of long acting contraceptive discontinuation was high. Side effects, not being informed about side effects, dissatisfaction with the provided service, no insertion follow-up, and a desire to become pregnant were all associated factors. Healthcare professionals should focus on the client's reproductive goals, proper management of side effects, counseling, and post-insertion visits.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022347860, identifier CRD42022347860.

SUBMITTER: Gebeyehu NA

PROVIDER: S-EPMC9763286 | biostudies-literature | 2022

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

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

Gebeyehu Natnael Atnafu NA Tegegne Kirubel Dagnaw KD Biset Gebyaw G Sewuyew Dagne Addisu DA Alemu Biresaw Wassihun BW Yitayew Alemker Mola AM

Frontiers in public health 20221206

<h4>Introduction</h4>Contraception discontinuation is a major public health issue that leads to unwanted pregnancies and unsafe abortions. Therefore, this systematic review and meta-analysis aimed to estimate discontinuation of contraceptives and its determinants in Ethiopia.<h4>Methods</h4>PubMed, Google Scholar, Scopus, Science Direct, and Addis Ababa University online library were searched. Data were extracted using Microsoft Excel and analyzed using STATA statistical software (v. 14). Public ...[more]

PMID: 36561863

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Project description:ObjectiveThis study aimed to identify the determinants of early discontinuation of long-acting and reversible contraceptive methods among women within childbearing age in Ethiopia, 2019.MethodsThe institutional-based case-control study design was implemented from June to August 2019. Eligible study participants were sampled using systematic random sampling technique. Data were collected using structured and pre-tested questionnaire and entered into Epi Info and exported to SPSS version 20 for further analysis. All variables with a p value of <0.05 at odds ratio of 95% confidence interval in multivariable logistic regression analysis were considered as determinants of early discontinuation of long-acting and reversible contraceptive methods.ResultsA total of 825 study participants (206 cases and 619 controls) were included in the study. Decision-making on the use of contraception (adjusted odds ratio: 4.8, 95% confidence interval: 1.4-16.8 and adjusted odds ratio: 5.6, 95% confidence interval: 1.7-18.8), the women who got counseled about side effects of contraceptive methods being 84% less likely to discontinue long-acting and reversible contraceptive methods compared to the women of their counterpart (adjusted odds ratio: 0.16, 95% confidence interval: 0.15-0.4), having two or more children (adjusted odds ratio: 10, 95% confidence interval: 3.7-28), and desire to be pregnant (adjusted odds ratio = 0.15 95% confidence interval: 0.06-0.4) were determinants of early discontinuation of long-acting and reversible contraceptive methods.ConclusionAccording to the findings of this study, decision-maker on utilization of contraceptive methods, being counseled on side effects of contraception, number of children, and desire of woman to be pregnant were found to be determinants of discontinuation of long-acting and reversible contraceptive methods. Health care providers should strengthen providing pre-insertion counseling in accordance with the national guideline for family planning services, with an emphasis on potential contraceptive side effects and consideration of counseling on decision-making.

Project description:ObjectivesThe utilization of long-acting reversible contraceptive methods is one of the key factors in protecting women and couples against unwanted pregnancies. The study aimed to assess the determinants of long-acting reversible contraceptive use among women in Northwest Ethiopia.MethodsA community-based unmatched case-control study was conducted from 1 February to 8 March 2017 in Northwest Ethiopia. The cases were women who used long-acting reversible contraceptive methods, and the controls were women who used short-acting contraceptives. Both of them were selected using a systematic sampling method. An interviewer-administered questionnaire was used to collect the data. Epi info and SPSS version 23 were used for data entry and analysis, respectively. Descriptive statistics and association measures were done and presented in texts, tables, and figures.ResultsA total of 882 women were interviewed, with a response rate of 99.3%. Women who were between 15 and 24 years old were two times more likely to use long-acting reversible contraceptive methods than those whose age was ⩾35 (adjusted odds ratio = 2, 95% confidence interval: (1.20, 3.50)). A good level of knowledge about long-acting reversible contraceptive methods (adjusted odds ratio = 11.6, 95% confidence interval: (5.42, 24.80)), a negative attitude toward long-acting reversible contraceptive methods (adjusted odds ratio = 0.31, 95% confidence interval: (0.21, 0.46)), membership in the health development army (adjusted odds ratio = 2.8, 95% confidence interval: (2.12, 3.78)), no discussion with a partner about long-acting reversible contraceptive methods (adjusted odds ratio = 2.3, 95% confidence interval: (1.54, 3.49)), and more than 2 years of desire to wait before another pregnancy (adjusted odds ratio = 23.7, 95% confidence interval: (11.63, 48.55)) were determinants of long-acting reversible contraceptive methods use.ConclusionThis study revealed that attitude toward long-acting reversible contraceptive method use, being a member of the women's health development army, and the desire to space children were determinants of long-acting reversible contraceptive method use. More actions should be taken to increase the utilization of long-acting reversible contraceptive methods by promoting discussion between partners about modern contraceptives and increasing women's participation in being a member of the health development army.

Project description:BackgroundLong Acting Reversible Contraceptives (LARCs) are contraceptives that prevent unplanned pregnancy in a more safer and effective way than other modern short acting methods. However, method discontinuation and switching are still challenges for utilization of LARCs in resource limited countries for several reasons. Thus, the aim of this study was to determine magnitude and factors for method discontinuation and switching among LARCs users in health facilities of Southern Ethiopia.MethodsA Facility based record review was used to collect data from May to June 2019. Three hospitals were randomly selected from five hospitals found in southern Ethiopia. A total of 1050 records were included in the study from long acting family planning registers between 2018 and 2019. Data were entered to Epi-info 3.5.4 and exported to SPSS for windows version 20 for analysis. A descriptive statistics was performed to describe factors and reasons for LARCs discontinuation and switching off. Logistic regression technique with a 95% confidence level was used to determine the association between factors and magnitude of method discontinuation and switching.ResultsOf the 1050, 69.8% of women discontinued long acting reversible family planning method before the recommended duration of use and 30.2% of them switched from long acting family planning methods to any other modern contraceptive methods. Women who shifted from any LARCs to short-acting family planning methods accounted for 38.8% of those who shifted to any other modern methods. Desire to get pregnant and method specific side effect were most common reasons for both method discontinuation and switching. Women with only one child were 1.61 times more likely to discontinue than women who had greater than five number of children.ConclusionDiscontinuation and switching of long acting reversible family planning method was high. Primiparous women were more likely to discontinue use of long acting reversible family planning methods. Re-evaluating family planning services focusing on effective counseling about side effects of LARCs methods is required. Training should also be given for family planning providers including community healthcare workers.

Project description: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.

Project description:BackgroundDiscontinuation of contraceptives without any change in fertility intention is often associated with unintended pregnancy which ends up with induced abortion and unplanned birth. Despite the Ethiopian government's emphasis on the provision of long-acting contraceptive methods, little attention has been paid to the study of its discontinuation; particularly, no study has been reported in the study area. Thus, this study aimed to assess the discontinuation rate of long-acting reversible contraceptives and associated factors among reproductive-age women in Butajira town, Central Ethiopia, 2020.MethodsCommunity-based cross-sectional study was conducted from 1 April to 1 May 2020. A systematic random sampling method was used to select 227 women. Data were collected by a structured and pretested questionnaire. Epi-data (version 4.6.2) and Statistical Package for the Social Sciences (version 25) were used for data entry and analysis, respectively. A multivariable logistic regression model was used to predict the relation between dependent and independent variables. Finally, a significant statistical association was assured using an adjusted odds ratio at a 95% confidence interval and p value < 0.05.ResultsThis study revealed that the discontinuation rate of long-acting reversible contraceptives was 50 (22.5%; 95% confidence interval: 17.8-27.2). The main reason for discontinuation was facing side effects 26(52%); from these menstrual disruption 19 (73.1%) was the main reason. Time consumed to reach the health facility (adjusted odds ratio: 6.16, 95% confidence interval: 1.46-25.97), desire to have more children (adjusted odds ratio: 5.3, 95% confidence interval: 1.13-24.81), and counseled about the benefit of long-acting reversible contraceptives (adjusted odds ratio: 0.08, 95% confidence interval: 0.02-0.39) were predictors of discontinuation of long-acting reversible contraceptives.Conclusions and recommendationsThis study showed that the discontinuation rate was high when compared to Ethiopian Demographic Health Survey 2016. Routine pre-insertion counseling about the benefits and side effects of long-acting reversible contraceptives by healthcare providers is highly recommended. In addition, we recommend further trials using larger sample sizes on predictors of discontinuation of long-acting reversible contraceptives.

Project description:BackgroundThe postpartum period is an opportune time for contraception adoption, as women have extended interaction with the reproductive healthcare system and therefore more opportunity to learn about and adopt contraceptive methods. This may be especially true for women who experience unintended pregnancy, a key target population for contraceptive programs and programs to eliminate mother-to-child HIV transmission. Among women in Zimbabwe surveyed in 2014, we examined the relationship between pregnancy intention associated with a woman's most recent pregnancy, and her subsequent postpartum contraceptive use.MethodsIn our analysis we utilized a dataset from a random selection of catchment areas in Zimbabwe to examine the association between pregnancy intention of most recent pregnancy and subsequent postpartum contraceptive use using multinomial logistic regression models. We also explored whether this association differed by women's HIV status. Finally, we examined the association between pregnancy intention and changes in contraception from the pre- to postpartum periods.ResultsFindings suggest that women who reported that their pregnancy was unintended adopted less modern (all non-traditional) contraceptive methods overall, but adopted long-acting reversible contraception (LARC) more frequently than women reporting an intended pregnancy (OR 1.41; CI 1.18, 1.68). Among HIV-positive women, this relationship was particularly strong (OR 3.12; CI 1.96, 4.97). However, when examining changes in contraceptive use from the pre-pregnancy to the postpartum period, women who had an unintended pregnancy had lower odds of changing to a more effective method postpartum overall (OR 0.71; CI 0.64, 0.79).ConclusionsWe did not find evidence of higher modern method adoption in the postpartum period among women with an unintended pregnancy. However, women who were already on a method in the pre-pregnancy period were catalyzed to move to more effective methods (such as LARC) postpartum. This study provides evidence of low modern (non-traditional) method adoption in general in the postpartum period among a vulnerable sub-population in Zimbabwe (women who experience unintended pregnancy). Simultaneously, however, it shows a relatively greater portion specifically of LARC use among women with an unintended pregnancy. Further research is needed to more closely examine the motivations behind these contraceptive decisions in order to better inform distribution and counseling programs.

Dataset Information

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

Introduction

Methods

Results

Conclusion

Systematic review registration

Publications

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

Similar Datasets

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