Side effects, lack of preinsertion and follow-up counselling tied to rising Implanon discontinuation: Study
Family planning is one of the most efficacious and cost effective means of improving individual health, gender equity, family well-being, and national development. It is a key component of basic health services that benefits the health and well-being of women, children, families, and communities. Contraception plays an important role in advancing maternal and newborn health, reducing maternal mortality, and ensuring universal access to reproductive healthcare. It helps women to avoid unplanned and/or unwanted pregnancies and prevents unsafe abortions.
Human and financial resources are limited in less developed regions of the world, particularly sub-Saharan Africa and South Asia, modern contraceptive use is low, the unmet need for modern contraception is high, and maternal morbidity and mortality are high as a result.
Contraceptive discontinuation is common in developing countries (18%–63%), and most of these discontinuations are among women who are still in need of contraception. Implanon is a long-acting contraceptive method that is extremely effective in preventing pregnancy with a clinical failure rate of less than 1%. Despite this, the rate of Implanon discontinuation before its due date is a common problem in various societies and exposes women to unwanted conception and its consequences.
The current study by Zenebe Tefera and team sought to find and consolidate relevant literature on Implanon discontinuation and associated factors in Ethiopia. Medline, PubMed, Cochrane Library, EMBASE, and Google Scholar databases were systematically searched for studies published in English before December 2021. The included studies were critically appraised using the JBI instrument for observational studies. STATA version 16 was used for analysis. The presence of statistical heterogeneity was checked using Cochran’s Q test, and its level was quantified using I2 statistics. A pooled estimate of the proportion of outcome variables was calculated. To measure the effect size, pooled odds ratios with 95% CI were computed.
The pooled prevalence of Implanon discontinuation in Ethiopia was 32.89%, 95% CI: 24.11%, 41.66%. Experiencing side effects (OR = 2:52, 95% CI 1.75, 3.65), having no children (OR = 1:69, 95% CI 1.15, 2.47), not having received preinsertion counselling (OR = 1:65, 95% CI 1.36, 2.00), having no postinsertion appointment (OR = 2:97, 95% CI 2.10, 4.21), and not satisfied with the service (OR = 2:72, 95% CI 2.47, 5.59) were significantly associated with Implanon discontinuation.
Based on this review, women who had not received preinsertion counselling were 1.65 times more likely to discontinue Implanon use before its due date compared to women who had received preinsertion counselling (OR = 1:65, 95% CI 1.36, 2.00). Receiving information on the advantages and side effects of the method is one of the fundamental elements of quality of care, which will enhance the continued use of the method.
In this study, women who had no children were 1.69 times more likely to discontinue the method compared to those who had children (OR = 1:69, 95% CI 1.15, 2.47). This could be due to women who have never had children having a greater desire for pregnancy. As a result, the women will discontinue the method. This review has several strengths, including the following: this review tried to identify all potential determinants of Implanon discontinuation. Moreover, authors used comprehensive search strategies and the PRISMA checklist to improve the quality of the review. The protocol for this manuscript was registered on PROSPERO, whereas this review has limitations, such as the review included studies that were published only in the English language.
This systematic review and meta-analysis study reveals that the national pooled prevalence of Implanon discontinuation is high as compared to other studies. Experiencing the side effects, not being satisfied with the service provided, not receiving preinsertion counselling, having no postinsertion follow-up appointment, and not having a live child were found to be determinant factors for Implanon discontinuation in Ethiopia. Therefore, healthcare providers should offer preinsertion counselling in accordance with national family planning guidelines, emphasizing the method’s advantages and side effects. Implanon retention could be boosted if appointment follow-up services were improved. Working to improve customers’ perceived satisfaction could help to reduce Implanon discontinuation.
Source: Zenebe Tefera, Mandefro Assefaw, Sindu Ayalew; Hindawi International Journal of Reproductive Medicine Volume 2022, Article ID 9576080, 10 pages https://doi.org/10.1155/2022/9576080
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