Our results show that two out of ten women discontinued MCM. Implants and contraceptive injection were the methods most frequently discontinued. Side effects, product expiration and desire for pregnancy were the main reasons for giving up MCM. Short-acting methods, lack of informed explanation before using MCM, side effects, lower parity and unemployment were factors associated with discontinuation of MCM use.
The main reasons for discontinuation cited by women were side effects (59%), expiration of the the product (mostly for the implant) (14.5%), desire for pregnancy (13.3%) and poor perception of MCM (9.6%). Several studies have reported side effects as the main reason for discontiuation (13;24;27;48;51;52).
Our result showed a higher implant discontinuation rate (60.2%) compared to many other studies. For example, Barden et al,2018; Rachidul et al, 2015 and Njoku et al, 2014 reported 6.3%; 0.72% and 11% as implant discontinuation respectively (11;13; 24;27;50;51).
Many women in our study with an implant (67%) reported side effects, mainly menstrual disorders. The lack of optimal FP counseling about potential side effects, prior to insertion, can negatively influence the retention of the implant (56; 57).
Similar to other studies, the desire to become pregnant was also an important reason for discontinuation (54; 55). Product (MCM) expiration was reported as the second main reason for withdrawal. However, this was only reported by women with an implant. This could be due to insufficient follow up of women on MCM as well as poor pre-MCM counseling. Clients’ follow-up offers the possibility for additional advice and early management of possible side effects. Improved monitoring of MCM use will ensure the success of the FP strategy (55).
Five factors were significantly associated with the discontinuation of MCM (Table 4). Women who used short-acting MCM were more likely to discontinue than those who were on long-acting MCM. A similar result was found by Sara Casey et al. in North Kivu and Simmons R et al. in the USA (13, 52). This association could be due to the fact that stopping short-term MCM, in contrast with long-acting MCMs, does not require provider's assistance (27). In addition, contraceptive injections and oral contraceptive , may produce side effects leading to discontinuation (13) as also reported by .Nigisti B et al. in northern Ethiopia (49).
Similar to the Ethiopian study, women who did not receive sufficient explanations about MCM were more likely to abandon MCM. Improving the quality of contraceptive counseling is one of the strategies to reduce contraceptive discontinuation and unwanted pregnancies (49).Women who use MCMs with no or only one child were more likely to abandon the method than those who had more children as was also reported in many other studies (24, 50, 53).Unemployed women were more likely to abandon MCM than those with a profession as was also previously reported (32;33). Women with a profession are likely to have a higher level of education, allowing them to have more access to FP services and information. Moreover they more likely to want to keep their job than to have an unwanted pregnancy. Our study has some limitations. In our retrospective study, in some medical charts information such as client age, profession and parity and follow up information was missing. All missing data were imputed by the mean for quantitative variable, or the mode for qualitative variables. During the interviews in the community may be responses were influenced by social desirability.