Premature discontinuation of long acting reversible contraceptives: A cross sectional study in Harare.

Abstract

Long acting reversible contraceptives (LARC) are very effective, with an unintended pregnancy rate of less than 1 per 100 women during the first year of use. Discontinuing contraception while still in need leaves a woman at risk of unwanted or ill-timed pregnancy. This study investigated reasons for premature discontinuation of LARC among women in Harare. Objectives: To determine the reasons for premature discontinuation of the long acting reversible contraceptives. To identify gaps in the provision of LARC services. Method: A cross sectional descriptive study was carried out at five major family planning clinics in Harare. Convenient sampling was used to identify 148 women who had prematurely discontinued the implants (Jadelle and Implanon) and intrauterine contraceptive devices (CuT380A and Mirena). Results: LARC were discontinued by 46% of the women due to side effects while 36% desired pregnancy. Abnormal bleeding was the reason for discontinuation in 40.9%,43.5% and 14.3% of Jadelle, Implanon and CuIUD users respectively. Desire for pregnancy was leading discontinuation reason in CuIUD and second for implants users. Partner discomfort at sexual intercourse, abdominal pain and vaginal discharge were the other side effects leading to CuIUD discontinuation. Half of the women who received medical treatment for side effects felt it was ineffective. The combined oral contraceptive pill was chosen by 62% of the women after discontinuing LARC. Menstrual irregularities associated with LAR Care the commonest reason for discontinuation of the contraceptive methods. Improving pre-insertion counselling and management of undesirable side effects will decrease premature discontinuation.