How Much Do Side Effects Contribute to Discontinuation? A Longitudinal Study of IUD and Implant Users in Senegal.

Dawn Chin-Quee,Mohamed Diadhiou,Margaret Eichleay,John Stanback,Alissa Bernholc,Ahmed Youssef,Mario Chen

doi:10.3389/fgwh.2021.804135

Abstract

IntroductionIn Senegal, discontinuation due to sides effects of long-acting, reversible contraceptives (LARCs) is relatively low; 5% of new implant acceptors and 11% of new IUD acceptors stop using in their first year because of health or side effect concerns. This study investigated factors associated with LARC discontinuation in the first 12 months of use in Senegal and explored how LARC users cope with side effects.MethodsThis mixed-method study involved quantitative interviews at five time points with LARC acceptors recruited from three service channels between February 2018 and March 2019. Qualitative interviews were conducted in August 2018 with a subset of those who experienced side effects. Logistic regression models identified factors associated with discontinuation due to side effects and discontinuation for any reason. Twelve-month discontinuation rates due to side effects were also estimated using a cumulative incidence function (CIF) approach to account for time to discontinuation.ResultsIn logistic models, method choice (IUD or implant) [OR = 3.15 (95% CI: 1.91–5.22)] and parity [OR = 0.81 (95% CI: 0.7–0.94)] were associated with discontinuation due to side effects; IUD users and women with fewer children were more likely to discontinue. Results for all-cause discontinuation were similar: method choice [OR = 2.39 (95% CI: 1.6–3.58)] and parity [OR = 0.86 (95% CI: 0.77–0.96)] were significant predictors. The 12-month side effect CIF discontinuation rate was 11.2% (95% CI: 7.9–15.0%) for IUDs and 4.9% (95% CI: 3.5–6.6%) for implants. Side effect experiences varied, but most women considered menstrual changes the least acceptable. No statistically significant differences across services channels were observed.ConclusionsIn this study in Senegal, the choice between implants and IUDs had a significant impact on continuation, and women with more children continued LARC methods longer, despite side effects.

Highlights

In Senegal, discontinuation due to sides effects of long-acting, reversible contraceptives (LARCs) is relatively low; 5% of new implant acceptors and 11% of new intrauterine devices (IUDs) acceptors stop using in their first year because of health or side effect concerns
The 12-month side effect cumulative incidence function (CIF) discontinuation rate was 11.2% for IUDs and 4.9% for implants
In this study in Senegal, the choice between implants and IUDs had a significant impact on continuation, and women with more children continued LARC methods longer, despite side effects

Summary

Introduction

In Senegal, discontinuation due to sides effects of long-acting, reversible contraceptives (LARCs) is relatively low; 5% of new implant acceptors and 11% of new IUD acceptors stop using in their first year because of health or side effect concerns. Long-acting, reversible contraceptives (LARCs) including subdermal implants and intrauterine devices (IUDs) are increasingly used for voluntary family planning (FP) in Africa, with implants, in particular, seeing marked increases in users. The copper IUD is less popular than implants in sub-Saharan Africa, but because it is a longer-acting, highly effective method, low- and middle-income countries have promoted its voluntary uptake and use [4]. According to a Demographic and Health Survey (DHS) analytical study in low-income countries, 9% of women discontinue implants and 15% discontinue IUDs within the first year of use [5]. Reasons for discontinuation were not provided, but women who were Black (vs. race other than Black or White), under 20 years old and with a prior history of sexually transmitted infections were at higher risk for discontinuation [8]

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