Perspectives on the Side Effects of Hormonal Contraceptives Among Women of Reproductive Age in Kitwe District of Zambia: A Qualitative Explorative Study

doi:10.21203/rs.3.rs-2085787/v1

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Research Article

Perspectives on the Side Effects of Hormonal Contraceptives Among Women of Reproductive Age in Kitwe District of Zambia: A Qualitative Explorative Study

https://doi.org/10.21203/rs.3.rs-2085787/v1

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published 18 Aug, 2023

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Background

Globally, hormonal contraceptives have proved to be effective in the prevention of unwanted pregnancy. However, despite evidence suggesting the many benefits associated with the use of hormonal contraceptives, concerns related to their safety and side effects have been reported. We conducted a study to explore the perspectives on the side effects of hormonal contraceptives among women of reproductive age in the Kitwe district of Zambia.

Methods

An explorative qualitative study was done among 32 women of reproductive age (18-45years) in the Kitwe district of Zambia. Participants were selected conveniently as they accessed family planning services at a designated reproductive, maternal, and child health facility in Kitwe. Data collection was done through In-depth interviews. Recruitment of participants and data collection continued until saturation point. In-depth interviews were recorded, translated, and transcribed verbatim. Data were imported into NVivo.x64 for coding and node generation after which categories and themes were developed manually.

Results

Overall, participants demonstrated a considerable amount of family planning knowledge, recounting the economic and health benefits as well as demerits of family planning use. The main reasons for discontinuation and switching of hormonal contraceptive methods were the desire to get pregnant and the fear of unpleasant side effects which included excessive bleeding or prolonged menstruation, headache, dizziness, lower abdominal/back pain, and weight gain. Most importantly, participants cited concerns about the delay in the resumption of fertility after the termination of contraception and how the side effects disrupted their daily activities at home.

Conclusion

There is a need for family planning providers to offer family planning services that address the side effects of hormonal contraceptives during counseling and how women can manage them. Family planning services should adopt a patient-centered approach that takes into consideration the concerns regarding side effects and how this affects the quality of life among women. There is a need to extend family planning services to scheduled follow-up, and clinical management of contraceptive side effects among women.

Hormonal

Contraceptives

Family Planning

Perspectives of side effects

Contraception or birth control is the intentional prevention of conception or pregnancy through the use of different devices, chemical agents, drugs, sexual practices, and surgical operations [1]. The various forms of contraceptives include oral contraceptive pills, implants, injectables, patches, vaginal rings, intrauterine devices, condoms, male and female sterilization, lactational amenorrhea methods, withdrawal, and fertility awareness-based methods [2]. Substantial evidence suggests that side effects associated with contraceptive use are a potential deterrent to their consistent use among women [3]. Also, inconsistent use of contraceptives among women often results in unintended pregnancies which have been linked to postnatal depression, abortion-related morbidity, poor child nutrition, and incomplete vaccination [4].

Globally, the use of modern contraception has slightly risen from 54% in 1990 to 57.4% in 2015 [5]. However, whilst modern methods such as hormonal contraceptives are efficacious in improving the reproductive and sexual health of women as well as reducing the maternal and child mortality rates [6], low usage continues to be reported in low resource settings, with a prevalence of 25% reported in Middle and Western Africa, and 43% in East Africa [7]. Additionally, Mwansa and colleagues reported a 2.5 and 4.6 Total Fertility Rate (TFR) for global and Sub-Sahara Africa respectively [8]. Lack of access to contraceptives, male partner influence, lack of education, and negative attitudes by providers have been shown to influence the uptake and utilization of contraceptives among women [6]. Most importantly, perceived and experienced side effects associated with modern contraceptives contribute largely to discontinuation and switching among women. [9].

Hormonal contraceptives can prevent conception by stopping ovulation. They contain one or two female sex hormones like those naturally produced in a woman’s body. Their use has been a part of clinical practice for more than 50 years [10]. This includes methods such as injectables, implants, and oral contraceptives [11]. Despite modern advances in contraceptive methods and evidence of their efficacy, up to 214 million women had unmet needs for family planning [9]. Additionally, there are reported alterations in the normal menstrual pattern which is associated with hormonal contraceptive use [12]. Most importantly, they are unable to offer protection against sexually transmitted infections (STIs) and can contribute to risk compensation, especially among teenagers and young adolescents [13].

Concerns over experienced and perceived side effects of hormonal contraception such as menstrual disruption have been highlighted [14]. Fear of infertility which is attributed to prolonged use of hormonal contraceptives such as injectables has also been documented as a negative experience among women [6, 9]. Important to note is a growing number of studies that have highlighted the influence of culture on women’s perception and utilization of hormonal contraceptives [15, 16]. Specifically, constructed social and cultural norms elevate men’s status in societies and give rise to a relationship power inequity where men become sole decision-makers [17]. This can lead to disagreements between partners about whether to use contraception potentially resulting in gender violence, with women being victims [15, 18].

In the past decades, Zambia has made steady progress in enhancing knowledge and access to contraceptives among women [19]. This led to a decrease in the fertility rate from 6.75 births per woman in 1955 to 5.5 births per woman in 2015. Despite these gains, Zambia is still among the top 10 countries with high fertility rates, with variations in contraceptive uptake observed between women in rural and urban areas [20]. Many of the studies done on modern contraceptives in Zambia have revealed that the age of the woman, the age of the male partner, residence, educational level, working status, desire for more children, and ethnicity are some of the factors associated with modern contraceptives [20]. Also, there is still evidence of a high rate of discontinued use of modern contraceptives among women which have been associated with side effects of hormonal contraception [21].

Whilst many studies have addressed the determinants and side effects of modern contraceptives among women, there is a paucity of studies in Zambia that have highlighted the perspectives of women on the side effects of hormonal contraceptives despite theoretical validation of the evidence regarding the discontinued use [22]. Therefore, this study aimed at exploring women’s perspectives on the side effects of hormonal contraceptives.

Study Site

The study was conducted at Ndeke urban clinic located in Kitwe district in the Copperbelt Province. The township has about three (3) urban clinics. We purposefully chose Ndeke urban clinic as a study site because it has a delivery facility and offers reproductive, maternal, and child health services such as family planning and antenatal services. Ndeke urban clinic covers a catchment area with a population of approximately 100000 people [23]. It is a designated centre for Maternal and Child Health (MCH) services including family planning services. The main socio-economic activities in Ndeke township are mining and small business enterprises.

Target Population

The target population were women aged between 18 years and 45 years who had come to access family planning services at Ndeke Urban clinic in Kitwe. Targeting key informants enabled rich data exploration from the participant's own experience regarding the use of hormonal contraceptives.

Study Design

We employed an explorative qualitative design. The study utilized the naturalistic nature of the explorative research design to gain a deeper understanding of participants' experiences within their social and natural settings.

Sampling Procedure

We employed convenient sampling to select 32 women aged between 18 and 45 years to participate in 32 in-depth interviews. Participants were selected as they accessed family planning services at Ndeke Urban clinic in the Kitwe district. Participant recruitment into the study continued until data saturation.

Inclusion and Exclusion Criteria

We included women aged between 18 and 45 years who came to access family planning services. Only those who consented to participate in the study were included. We excluded those who did not consent and those who were below the age of 18 years or above the age of 45.

Data Collection

Consenting participants were interviewed in a separate room at the facility using in-depth interviews (IDIs). Through prolonged engagement with the participants for more than 4 weeks, we conducted face-to-face in-depth interviews in English and Bemba (common local language), which lasted for 50-60 minutes. The interview guide constituted questions on the contraceptive methods that the women knew; contraceptives used, and side effects experienced and reasons for contraceptive use. All interviews were digitally recorded using a recorder and notes were taken down during the interviews. Interviews continued until the saturation of data and did not proceed thereafter. Data saturation was determined when no new data emerged after the in-depth interview of participant 32

Data Analysis

The digitally recorded interviews were transcribed and translated by a qualified language translator. For participants interviewed in Bemba (Local language), we engaged a qualified language translator who translated bemba transcripts into English and back translated to Bemba for translation accuracy. Content analysis was carried out through code classification and theme identification. All transcripts were reviewed against the recordings for similarity and accuracy[4]. Each researcher had a code book and code books were compared to agree on one single code book. Data were then imported into NVivo.x64 to help in the coding process through the development of nodes. The first and second authors reviewed and coded all narratives from the participants and searched for similarities, commonalities, and patterns. We manually developed categories and established themes and subthemes. As recommended by Granehein and Lundman [24] we employed the following steps.

Transcribing the interviews verbatim and reading through the text several times to obtain a sense of the whole.
Dividing the text into condensed meaning units.
Abstracting the condensed meaning units and labelling with codes.
Sorting codes into categories and subcategories based on comparing their similarities and differences; and
Formulating themes as the expression of the latent content of the text.[25]

Ethical Consideration

Written consent was sought from the Copperbelt University School of Medicine administration. Ethical approval was also obtained from the Tropical Disease and Research Centre (TDRC) (IRB Registration Number: 00002911 & FWA Number: 00003729), and permission was granted by the National Health Research (NHRA) thereafter [Ref No: NHRA000011/10/2022]. Written informed consent was obtained from the participants before the collection of data. They were well informed about the purpose, benefits, and possible harms of the study. Participation was voluntary and those that opted to withdraw were allowed to do so. The information collected from the respondents was kept in a locked cabinet and access to these documents was only limited to the researchers only. We included no identifying information such as the names of the participants, instead, codes were assigned to the participants to help in data collection.

Trustworthiness of the study

We employed Guba and Lincoln’s criteria of credibility, transferability, dependability and confirmability to enhance the trustworthiness of the study findings [26]. Credibility in the study was achieved through prolonged engagement with the participants to understand the context setting of the phenomenon. To achieve this, we spent more than 4 weeks at the health facility engaging the participants and services providers as we recruited and interviewed the participants. This helped us to build trust and rapport with the participants. We also conducted peer debriefing where we invited a qualitative research expert who evaluated and critiqued our field notes. Further, we invited 2 qualitative research experts to cross-check the data across categories of participants to enhance triangulation. We achieved transferability through the thick description and robust data through accurate descriptions of the participants in their natural settings. This was also achieved through continuous recruitment of participants and data collection until data saturation. In this regard, interviewing additional participants was critical in increasing the scope, adequacy, and appropriateness of the data [27]. Dependability was achieved by having our transcript validated by 2 qualitative research experts in reproductive and sexual health. The experts reviewed the themes and the descriptors to note similarities. Confirmability was achieved through an audit trail. This was done by a qualitative research expert who examined the qualitative processes we had taken from data collection, transcription up to interpretation. This was also done through reviewing the documents and transcripts and all the interview notes that we had collected.

Study Limitations

Our study was limited to the only health facility. However, Ndeke clinic offers reproductive, maternal, and child health services allowing for meaningful, timely, and rich-contextual information.

Participant Characteristics

The IDIs were conducted with 32 female respondents ranging from 18 and 45 years of age (Table 1). As all respondents were female, the age range was categorized into 2 groups: 18-35 and 36-45 years of age. The characteristics are tallied with the age ranges, marital status, level of education, and occupation. Most of the respondents were married and between the age range of 18-35 i.e., 36 and 45 respectively. Most of the women interviewed had obtained some form of education, with only 5 not attending school at all.

Table 1: Study Participant Characteristics

	Age group (years)
	18-35 (22) (n=%)	36-45 (10) (n=%)
Marital status
Married	16 (50 %)	9(28.1)
Single	6 (18.7%)	1(3.1%)
Divorced	0	0
Widowed	0	0
Level of education
Junior Secondary Level (G8-G9)	3 (9.3%)	0
No Formal Education	4 (12.5%)	1 (3.1%)
Primary Level (G1-G7)	3(9.3%)	2(6.2%)
Senior Secondary Level (G10-G12)	6(18.7%)	1(3.1%)
Tertiary Level	6(18.7%)	6 (18.7%)
Occupation
Accountant	1(3.1)	0
Banker	0	1 (3.1%)
Businesswoman	3 (9.3%)	5 (15.6%)
Farmer	3(9.3%)	0
Health worker	1(3.1%)	4(12.5%)
Housewife	10(31.2%)	0
Student	1 (3.1%)	0
Teacher	3(9.3%)	0

Theme 1: Contraceptive knowledge

Methods known

Most participants were knowledgeable about contraceptive methods available namely, pills, injectables, implants, and intra-uterine devices. The most common method known by the women were pills, injectables, and implants.

“The methods that I know are pills, loop, jadelle and injections…” (27-year-old, currently using the injection)

Benefits of family planning

Despite inherent side effects associated with contraceptive use, some participants held positive views of modern contraceptive methods and their benefits. The most cited benefit was the ability to space the children through the prevention of pregnancy. One of the participants, a 34-year-old who had an implant had this to say.

“If you’re not using family planning, you’ll be having children without any child spacing…… it helps you to plan for your future and your children’s future” (34-year-old, currently using an implant)

Demerits of contraceptive use

However, some participants had concerns regarding prolonged menstruation and how it affected the quality of life and their health

“Family planning is very important because it helps you pace up your children, however, it also has negatives such as having prolonged menses and affecting one’s blood pressure” (37-year-old, currently on the pill)

Table 2: Perspectives of women on the side effects associated with contraceptive use

THEMES	SUB-THEMES
Attitudes towards contraceptive use	Opinions of the women It is good/important to use family planning (encourage other women). Contraceptives are unsafe (discourage others from using). Family planning has to do with women, men cannot have issues with it. Perceptions of others Contraceptives can affect the ability to conceive in the future.
Perceptions of attributed side effects	Disruption of health Excessive or prolonged bleeding Hindrance to performance of normal daily duties Severe pain such as headache, cramping/lower abdominal pain, and back pain. Linked contraceptives to other illnesses/conditions It took a while for me to get pregnant They can cause certain uterine conditions
Contraceptive knowledge	Methods known Hormonal contraceptives (pills, implants, injectables, IUDs) Benefits of family planning Child spacing Helps with planning/preparing for the next child Preventing pregnancy Demerits of contraceptive use Attributed side effects

The responses from the interviews exhibited five global themes. These themes as well as the emerging sub-themes are depicted in Table 2 below.

Perceptions of attributed side effects

There were variations in the perceived side effects of hormonal contraceptives among women (Table 3), but all hormonal contraceptives were generally linked to menstrual irregularity, prolonged bleeding, cramping or stomach pain, and infertility. Women also outlined headaches, dizziness, irregular periods, weight gain, and weight loss as side effects of hormonal contraceptives.

Table 3: Side Effects associated with hormonal contraceptive use

Hormonal Contraceptive	Side Effect	Respondent Age group
		18-35	36-45
Injection	Cramping/ lower abdominal pain	X	X
	Dizziness	X
	Excessive/prolonged bleeding	X	X
	Headache	X	X
	Infertility		X
	Missed menses	X	X
	Weight gain		X
	None experienced		X

Pills	Headache	X
	Irregular periods	X	X
	Weight loss	X
	None experienced	X	X

Implant	Lower abdominal pain	X
	Menstrual irregularity	X	X
	Infertility	X
	Weight gain	X
	None experienced		X

IUD	Back pain	X	X
	Excessive bleeding		X
	None experienced		X

Perceptions of the attributed hormonal contraceptive side effects varied among the respondents. Respondents mainly expressed concerns about how the side effects would affect their normal day-to-day activities and disrupt their health or well-being. Some participants linked the side effects to the development of infertility and uterine conditions. These are summarized in Table 4 below.

Table 4: Perceptions of attributed side effects

SUB-THEME	EXCERPTS
Excessive bleeding	“A friend of mine would continuously bleed after insertion of the implant. She went to the clinic to have it removed but she was told it couldn’t be done as it was just inserted. She later became anaemic and it was removed” (34-year-old implant user).
Hindrance to performance of normal daily tasks	“I would experience some dizziness and headaches. I would also feel weak and I would have to rest at home” (28-year-old, currently using Depo-Provera) “I experienced some cramps similar to the ones I would get when I am going to start my period. I would also have headaches. These would stop after some time and I did not face challenges getting tasks of the day done” (43-year-old, previous injectable user)
Side effects linked to Infertility	"The challenge I can say I had with the 3-year implant was taking long to conceive after its removal. 1 year passed before I got pregnant" (28-year-old mother of 2, currently not using any method of contraception) “I did use Depo-Provera as well but it gave me secondary infertility. I could not conceive for 9 years. It was so serious that I thought I would only have 1 child. These 2 boys I have are truly a blessing” (39-year-old mother of 2, currently on Sayana Press)

Themes regarding perceived side effects of hormonal contraceptives

Theme 2: Perceived side effects (Excessive bleeding, cramps, headaches)

Participants cited side effects which ranged from pain, headaches, weight gain, and prolonged bleeding. Some participants linked the attributed side effects to other health conditions as depicted in the excerpt below.

“I continued to bleed after insertion of the implant. I went to the clinic to have it removed but I was told it couldn’t be done as it was just inserted. I later became anaemic and it was removed” (34-year-old implant user).

Also, some women recounted the side effect associated with hormonal contraceptive use such as cramps, dizziness, weight gain, and headaches.

“I experienced, dizziness, weight gain, cramps like the ones I would get when I am going to start my period. I would also have headaches. These would stop after some time and I did not face challenges getting tasks of the day done” (43-year-old, previous injectable user)

Because of associated side effects such as headaches and waist pain, some participants resorted to discontinuation and switching of contraceptives which resulted in an unplanned pregnancy.

"I used to take the pill called Safe plan but I feared missing the time. I changed to another pill called Microgynon but I would get headaches. So I started getting the three-month injection and I would have cases where my period would start from nowhere plus I went for 3 months without my period. I then tried the intra-uterine device but got terrible waist pain. I had it removed and then went back to the pill (Oralcon) but it run out of stock. I didn't take it for a while and I became pregnant (34-year-old current implant user).

Theme 3: Hindrance to performance of normal daily duties

Participants recounted how the attributed side effects affected their ability to perform daily domestic activities at home such as cooking and caring for the children as depicted in the following excerpt by a 43-year-old woman who had previously used injectables.

“I experienced some cramps like the ones I would get when I am going to start my period. I would also have headaches. These would stop after some time and I did not face challenges getting tasks of the day done” (43-year-old, previous injectable user)

Similarly, A 38-year-old, mother of 2 who had an implant narrated how she could fall sick the entire day and would require resting whenever pain could kick in.

“I would feel strong pulls like those that I experience when I am about to start my period, but I would not bleed. I would feel sick the entire day and require some time to sit or rest whenever the pain kicks in” (38- year-old, mother of 2, currently with an implant).

Theme 4: Infertility/ Menstrual disruption

Most participants linked the side effects of contraceptives to infertility. Specifically, participants narrated how their menstruation cycles became irregular after they had stopped using hormonal contraceptives. Participants narrated how it became difficult for them to conceive after they had stopped using hormonal contraceptives.

"The challenge I can say I had with the 3-year implant was taking long to conceive after its removal. 1 year passed before I got pregnant" (28-year-old mother of 2, currently not using any method of contraception)

However, some participants narrated how they later conceived despite the delay in the resumption of their menstrual cycle after contraceptive discontinuation.

“I did use Depo-Provera as well but it gave me secondary infertility. I could not conceive for 9 years. It was so serious that I thought I would only have 1 child. These 2 boys I have are truly a blessing” (39-year-old mother of 2, currently on Sayana Press)

This study explored the perspectives of women of reproductive age on the side effects of hormonal contraceptives in Kitwe District of Zambia. For women to make informed decisions regarding contraceptive use, a certain amount of knowledge of contraceptive methods is a requirement[28]. In the current study, we found that most women were knowledgeable about various methods of hormonal contraceptives. The most common methods cited were implants, injectables, pills, and IUD (Intrauterine Device). Other studies done elsewhere have shown similar results where high knowledge regarding hormonal contraceptives was recorded [9, 29]. In the current study, all married respondents were able to name more than one method of contraception and had used or were using at least one contraceptive method. Twenty-two (22) out of the 32 participants (1/3) had a considerably good knowledge of methods of contraception which is consistent with the findings of a study in Ethiopia [30]. Contrary, low levels of knowledge on modern contraceptives among women have been reported elsewhere [31, 32]. The region variations in knowledge regarding modern contraceptives could be due to differences in attributable variables such as post-primary education, ethnicity, residence, and discussion of family planning with a spouse[33, 34].

Women’s experiences of unfavourable side effects accord critical constraints to contraceptive usage [3, 6, 35]. Although there are known side effects related to hormonal contraceptive use such as nausea, headaches, weight gain, depression, irregular menstrual bleeding, and fatigue, very serious side effects are generally infrequent and contraceptives are broadly considered safe [6]. In our study, the main side effects highlighted by participants were headaches, lower abdominal/ back pain, cramps, excessive or prolonged bleeding, and delay in the resumption of menstruation. Among these, the most common side effect after discontinuation was prolonged and irregular menstrual bleeding. Similar findings have been reported in Uganda where hormonal contraceptives were associated with severe bleeding during and after discontinuation [3]. However, variabilities exist in how women respond to contraceptive-induced menstrual bleeding which could be shaped by individual and social influences [36]. We suggest that when providing family planning counselling, health care providers should explore the unique needs of each woman and understand how prolonged menstrual bleeding affects their quality of life and how bleeding can be managed.

In the current study, most participants highlighted concerns regarding menstrual bleeding changes and associated abdominal cramps which prevented them from conducting daily routine work at home. Excessive bleeding may also present a practical challenge to menstrual hygiene management among women, this is likely to be a potential barrier to contraceptive use [3, 37–39]. Paralleling this, a previous study has highlighted similar findings in Bangladesh where menstrual bleeding prevented women from participating in religious activities [4]. However, we posit that perceived misconceptions about menstrual bleeding associated with contraceptive use among women are common, which can be due to insufficient information on the role of contraceptives on the human reproductive system, peer influence from male partners, and other close relations[6]. In the current study, most women did not know how contraceptives influence the menstrual cycle and the role of menstruation in reproduction. This can contribute to the discontinuation and switching of contraceptives. Therefore, there is a need for improved family planning counselling before and during the use of contraceptives on the role of menstruation in reproduction among women [40–42]. When women are well informed about the role of contraceptives in pregnancy prevention and anticipated side effects, they are likely to make informed decisions regarding the choice of contraceptives.

Evidence suggests that perceived and experienced side effects of hormonal contraceptives can influence women's perceptions of hormonal contraceptives. This has the potential to affect women’s decisions to commence, change and continue using contraceptives [6, 43]. Despite high knowledge of methods of hormonal contraceptives among women, fear and misconceptions about side effects were a dividing gap between knowledge and attitudes towards the uptake of contraceptives which led to the discontinuation of contraceptives among women. Previous studies have shown that this is the case in most low-income countries [4, 6, 35]. Given this, comprehensive and accurate information about family planning methods and side effects and how they can be managed need to be incorporated into routine family planning counselling programmes [4, 35, 44]. This is likely to improve uptake and enhance the continued use of contraceptives [45]. Most importantly, family planning services should not only aim at giving out contraceptives and explaining the associated side effects but there should also be a deliberately scheduled follow-up plan and clinical management of contraceptive side effects [35].

Delayed return to fertility after discontinuation of hormonal contraceptives is a major concern and a common barrier to contraceptive use among women [46]. This is mainly due to the misconception that hormonal contraceptives may lead to infertility[47]. Literature suggests that this is a potential barrier to utilization of modern contraceptives among women [48]. In the current study, the major concern was the delay in the resumption of fertility after the termination of contraception, with many participants linking it to hormonal contraceptive use. Similar findings have been reported elsewhere [15, 49]. However, to date, there is inconclusive evidence on the effect of parity in the resumption of pregnancy after contraceptive discontinuation[50]. We suggest that besides giving assurance to women to use their preferred contraceptive methods through counselling, there is a need for a patient-centered approach that takes into consideration how side effects affect the quality of life and how they can be managed [51].

Concerns regarding side effects such as prolonged menstrual bleeding were highlighted by most participants. Further, participants recounted how side effects affected their daily routine work and house chores. Besides influencing the uptake and contributing to a high discontinuation rate of hormonal contraceptive use, side effects can present a practical challenge to menstrual hygiene management among women. Therefore, family planning services should adopt a patient-centered approach that takes into consideration the concerns regarding side effects and how this affects the quality of life among women. There is a need to extend family planning services to scheduled follow-up, and clinical management of contraceptive side effects.

Acknowledgements

We would like to thank the Kitwe district health office for the support rendered to us by granting us permission to conduct the study. We are also thankful to the staff at Ndeke urban clinic for their immense support during the data collection period. Lastly, we thank the Copperbelt University for the support during the preparation of the manuscript.

Ethics approval and consent to participate

All methods were carried out in accordance with relevant guidelines and regulations of the Tropical Disease and Research Centre (TDRC) (IRB Registration Number: 00002911 & FWA Number: 00003729), and the National Health Research Authority (NHRA) [Ref No: NHRA000011/10/2022]. Written informed consent was obtained from the participants before the collection of data. Participants were well informed about the purpose, benefits, and possible harms of the study. Participation was voluntary and those that opted to withdraw were allowed to do so.

Consent for publication

Not applicable.

Funding

The study received no funding

Availability of data and material

The datasets analyzed during this study are available from the corresponding author on reasonable request

Competing interests

The authors declare no competing interests.

Author contributions

N.M; B.M; and V.D; conceived the study and provided guidance on the methodological approach. N.M; and B.M; collected the data. B.M; and M.B; wrote the report. B.M; prepared the manuscript. B.M; and V.D; reviewed the manuscript. T.H.N; reviewed the manuscript and provided guidance on results section of the methodology.

Colquitt CW, Martin TS. Contraceptive Methods. J Pharm Pract. 2017 Feb;30(1):130–5.
Bansode OM, Sarao MS, Cooper DB. Contraception. StatPearls. 2021 Jul.
Zimmerman LA, Sarnak DO, Karp C, Wood SN, Ahmed S, Makumbi F, Kibira SPS. Association between experience of specific side-effects and contraceptive switching and discontinuation in Uganda: results from a longitudinal study. Reprod Health. 2021 Dec;18(1):1–12.
Jain A, Reichenbach L, Ehsan I, Rob U. “Side effects affected my daily activities a lot”: a qualitative exploration of the impact of contraceptive side effects in Bangladesh. Open access J Contracept. 2017 Jul;8:45–52.
WHO. Family planning/contraception methods. 2020.
Chebet JJ, McMahon SA, Greenspan JA, Mosha IH, Callaghan-Koru JA, Killewo J, Baqui AH, Winch PJ. Every method seems to have its problems”- Perspectives on side effects of hormonal contraceptives in Morogoro Region, Tanzania. BMC Womens Health. 2015 Nov;15(1):1–12. “ .
Atuhaire S, Ngendakumana J, Galadima A, Adam A, Muderhwa RB. Knowledge and attitude towards contraceptive use among adolescents in Africa: a systematic review. Int J Reprod Contraception Obstet Gynecol. 2021 Oct;10(11):4292–303.
Mwansa CJ, Chipokoso T, Mwansa M, Zambwe M. MODERN CONTRACEPTIVE USE AMONG WOMEN IN ZAMBIA: A DESCRIPTIVE SURVEY. medRxiv. 2021 Jul;2021.07.13.21259719.
Schrumpf LA, Stephens MJ, Nsarko NE, Akosah E, Baumgartner JN, Ohemeng-Dapaah S, Watt MH. Side effect concerns and their impact on women’s uptake of modern family planning methods in rural Ghana: a mixed methods study. BMC Womens Health. 2020 Mar;20(1).
Duffy DM, Archer DF. Female contraception. Encycl Reprod. 2018 Jan;255–60.
Adera A, Belete T, Gebru A, Hagos A, Gebregziabher W. Assessment of the Role of Men in Family Planning Utilization at Edaga-Hamuse Town, Tigray, North Ethiopia. undefined. 2015;4(4):174.
Teal S, Edelman A. Contraception Selection, Effectiveness, and Adverse Effects: A Review. JAMA. 2021 Dec;326(24):2507–18.
Nyirenda HT, Mukanga B, Choka N, Jegede AI, Mulenga D, Nyirenda HBC, Nyirenda T. Sexual behaviour and risk compensation among single women of reproductive age using hormonal contraception in Zambia. Eur J Contracept Reprod Health Care. 2021;26(3):255–60.
Bain LE, Amu H, Tarkang EE. Barriers and motivators of contraceptive use among young people in Sub-Saharan Africa: A systematic review of qualitative studies. PLoS One. 2021 Jun;16(6).
Kriel Y, Milford C, Cordero J, Suleman F, Beksinska M, Steyn P, Smit JA. Male partner influence on family planning and contraceptive use: Perspectives from community members and healthcare providers in KwaZulu-Natal, South Africa. Reprod Health. 2019 Jun;16(1):1–15.
Camara BS, Sidibe S, Dioubate N, Analysis A. Non-use of Contraceptives among Married Women. 2020.
Ndinda C, Ndhlovu T, Khalema NE. Conceptions of Contraceptive Use in Rural KwaZulu-Natal, South Africa: Lessons for Programming. Int J Environ Res Public Health. 2017 Apr;14(4).
Closson K, Lee L, Dietrich JJ, Beksinska ME, Hornschuh S, Smith P, Smit JA, Ndung’u T, Brockman M, Gray G, Kaida A. Gender and Power Dynamics of Social Relationships Shape Willingness to Participate in Biomedical HIV Prevention Research Among South African Adolescents and Young Adults. Front Reprod Heal. 2021 May;0:12.
Chola M, Hlongwana K, Ginindza TG. Patterns, trends, and factors associated with contraceptive use among adolescent girls in Zambia (1996 to 2014): a multilevel analysis. BMC Womens Health. 2020 Aug;20(1):1–11.
Lasong J, Zhang Y, Gebremedhin SA, Opoku S, Abaidoo CS, Mkandawire T, Zhao K, Zhang H. Determinants of modern contraceptive use among married women of reproductive age: a cross-sectional study in rural Zambia. BMJ Open. 2020 Mar;10(3).
Haddad L, Wall KM, Vwalika B, Khu NH, Brill I, Kilembe W, Stephenson R, Chomba E, Vwalika C, Tichacek A, Allen S. Contraceptive discontinuation and switching among couples receiving integrated HIV and family planning services in Lusaka, Zambia. AIDS. 2013 Oct;27 Suppl 1(0 1).
Bakibinga P, Matanda D, Kisia L, Mutombo N. Factors associated with use of injectables, long-acting and permanent contraceptive methods (iLAPMs) among married women in Zambia: analysis of demographic and health surveys, 1992–2014. Reprod Health. 2019 Jun;16(1).
CSO. 2014 Zambia Census of Population and Housing. 2014.
Graneheim UH, Lundman B. Qualitative content analysis in nursing research: Concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today [Internet]. 2004 [cited 2022 Sep 20];24(2):105–12. Available from: https://pubmed.ncbi.nlm.nih.gov/14769454/.
Piro TJ, Saeed AA, Abdulla WH, Safari K. Women’s experience and perspectives toward genital cosmetic surgery in Erbil city/Iraq: a qualitative study. BMC Womens Health [Internet]. 2022 Dec 1 [cited 2022 Sep 20];22(1):1–7. Available from: https://bmcwomenshealth.biomedcentral.com/articles/10.1186/s12905-022-01921-9.
Guba EG. Criteria for assessing the trustworthiness of naturalistic inquiries. ECTJ 1981 292 [Internet]. 1981 Jun [cited 2022 Sep 20];29(2):75–91. Available from: https://link.springer.com/article/10.1007/BF02766777.
Cypress BS. Rigor or Reliability and Validity in Qualitative Research: Perspectives, Strategies, Reconceptualization, and Recommendations. Dimens Crit Care Nurs. 2017;36(4):253–63.
Antarini A. Factors influencing the use of modern contraception among reproductive aged women in Bangka Belitung Province, Indonesia. Pan Afr Med J [Internet]. 2021 May 1 [cited 2022 Sep 19];39. Available from: /pmc/articles/PMC8356938/.
Nsubuga H, Sekandi JN, Sempeera H, Makumbi FE. Contraceptive use, knowledge, attitude, perceptions and sexual behavior among female University students in Uganda: a cross-sectional survey. BMC Womens Health. 2016 Jan;16(1).
Tilahun W, Dinkinesh B. Assessment of Knowledge, Attitude and Practice of Contraceptive Use among Postpartum Women in Jimma University Medical Center, Jimma Town, South West Ethiopia. Int J Women’s Heal Wellness. 2021 Dec;7(2):130.
Gosavi A, Ma Y, Wong H, Singh K. Knowledge and factors determining choice of contraception among Singaporean women. Singap Med J. 2016 Nov;57(11):610–5.
van Zyl PM, Brisley C, Halberg L, Matthysen M, Toerien M, Joubert G. The use, knowledge and attitudes regarding hormonal contraceptive products of female first-year students in a Faculty of Health Sciences. https://doi.org/101080/2078619020191643197. 2019 Sep;61(5):190–6.
Sámano R, Martínez-Rojano H, Chico-Barba G, Sánchez-Jiménez B, Sam-Soto S, Rodríguez-Ventura AL, Mejía-Luna L, Sclavo-Melo S. Sociodemographic Factors Associated with the Knowledge and Use of Birth Control Methods in Adolescents before and after Pregnancy. Int J Environ Res Public Health. 2019 Mar;16(6).
Ahinkorah BO, Seidu AA, Appiah F, Budu E, Adu C, Aderoju YBG, Adoboi F, Ajayi AI. Individual and community-level factors associated with modern contraceptive use among adolescent girls and young women in Mali: a mixed effects multilevel analysis of the 2018 Mali demographic and health survey. Contracept Reprod Med 2020 51. 2020 Oct;5(1):1–12.
Schrumpf LA, Stephens MJ, Nsarko NE, Akosah E, Baumgartner JN, Ohemeng-Dapaah S, Watt MH. Side effect concerns and their impact on women’s uptake of modern family planning methods in rural Ghana: A mixed methods study. BMC Womens Health. 2020 Mar;20(1):1–8.
Polis CB, Hussain R, Berry A. There might be blood: a scoping review on women’s responses to contraceptive-induced menstrual bleeding changes. Reprod Heal 2018 151 [Internet]. 2018 Jun 26 [cited 2022 Sep 18];15(1):1–17. Available from: https://reproductive-health-journal.biomedcentral.com/articles/10.1186/s12978-018-0561-0.
Boosey R, Prestwich G, Deave T. Menstrual hygiene management amongst schoolgirls in the Rukungiri district of Uganda and the impact on their education: a cross-sectional study. Pan Afr Med J. 2014;19.
Hennegan J, Nansubuga A, Smith C, Redshaw M, Akullo A, Schwab KJ. Measuring menstrual hygiene experience: development and validation of the Menstrual Practice Needs Scale (MPNS-36) in Soroti, Uganda. BMJ Open. 2020 Feb;10(2):e034461.
Miiro G, Rutakumwa R, Nakiyingi-Miiro J, Nakuya K, Musoke S, Namakula J, Francis S, Torondel B, Gibson LJ, Ross DA, Weiss HA. Menstrual health and school absenteeism among adolescent girls in Uganda (MENISCUS): a feasibility study. BMC Womens Health. 2018;18(1).
Machiyama K, Cleland J. Unmet need for family planning in Ghana: the shifting contributions of lack of access and attitudinal resistance. Stud Fam Plann. 2014;45(2):203–26.
Sedgh G, Hussain R. Reasons for contraceptive nonuse among women having unmet need for contraception in developing countries. Stud Fam Plann. 2014;45(2):151–69.
Staveteig S. Fear, opposition, ambivalence, and omission: Results from a follow-up study on unmet need for family planning in Ghana. PLoS One. 2017 Jul;12(7).
Mekonnen W, Worku A. Determinants of low family planning use and high unmet need in Butajira District, South Central Ethiopia. Reprod Health. 2011 Dec;8(1):1–8.
Bertrand JT, Sullivan TM, Knowles EA, Zeeshan MF, Shelton JD. Contraceptive method skew and shifts in method mix in low- and middle-income countries. Int Perspect Sex Reprod Health. 2014 Sep;40(3):144–53.
Thobani R, Jessani S, Azam I, Reza S, Sami N, Rozi S, Abrejo F, Saleem S. Factors associated with the discontinuation of modern methods of contraception in the low income areas of Sukh Initiative Karachi: A community-based case control study. PLoS One. 2019 Jun;14(7).
Gayatri M, Utomo B, Budiharsana M, Dasvarma G. Pregnancy resumption following contraceptive discontinuation: Hazard survival analysis of the Indonesia Demographic and Health Survey Data 2007, 2012 and 2017. PLoS One. 2022 Feb 1;17(2 February).
Gayatri M, Utomo B, Budiharsana M, Dasvarma G. Pregnancy resumption following contraceptive discontinuation: Hazard survival analysis of the Indonesia Demographic and Health Survey Data 2007, 2012 and 2017. PLoS One [Internet]. 2022 Feb 1 [cited 2022 Sep 18];17(2):e0264318. Available from: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0264318.
Gueye A, Speizer IS, Corroon M, Okigbo CC. Belief in Family Planning Myths at the Individual and Community Levels and Modern Contraceptive Use in Urban Africa. Int Perspect Sex Reprod Health [Internet]. 2015 Dec 1 [cited 2022 Sep 20];41(4):191–9. Available from: https://pubmed.ncbi.nlm.nih.gov/26871727/.
Williamson LM, Parkes A, Wight D, Petticrew M, Hart GJ. Limits to modern contraceptive use among young women in developing countries: A systematic review of qualitative research. Reprod Health. 2009 Feb;6(1):1–12.
Girum T, Wasie A. Return of fertility after discontinuation of contraception: a systematic review and meta-analysis. Contracept Reprod Med [Internet]. 2018 Dec [cited 2022 Sep 18];3(1). Available from: https://pubmed.ncbi.nlm.nih.gov/30062044/.
Le Guen M, Schantz C, Régnier-Loilier A, de La Rochebrochard E. Reasons for rejecting hormonal contraception in Western countries: A systematic review. Soc Sci Med. 2021 Sep;284.

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Perspectives on the Side Effects of Hormonal Contraceptives Among Women of Reproductive Age in Kitwe District of Zambia: A Qualitative Explorative Study

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