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Factors associated with first-year discontinuation of Implanon in Upper Egypt: clients’ and providers’ perspectives
  1. Mirette M Aziz,
  2. Amira F El-Gazzar,
  3. Omaima Elgibaly
  1. Public Health and Community Medicine, Assiut University, Assiut, Egypt
  1. Correspondence to Dr Mirette M Aziz, Public Health & Community Medicine, Assiut University, 71515 Arab Republic of Egypt, Egypt; miretteaziz{at}


Background The etonogestrel implant Implanon is a favourable and cost-effective contraceptive method for women in developing countries, and expansion of its use represents a priority for the family planning (FP) programme in Egypt. We studied the factors affecting first-year Implanon discontinuation from clients' and providers' perspectives.

Methods We used a mixed quantitative-qualitative methodology. We conducted a household survey of Implanon clients and three focus group discussions with FP physicians and directors.

Results We found that 13.5% of Implanon users discontinued its use in the first year. Survival analysis found that clients who had previously used Implanon (HR 0.36, 95% CI 0.15 to 0.88) and whose husbands had secondary or a higher level of education (HR 0.36,95% CI 0.19 to 0.69) were less likely to discontinue Implanon use after the first year, while clients who experienced side effects of Implanon use were more likely to discontinue it (HR 3.6,95% CI 1.60 to 8.11). Other causes of discontinuation which emerged in the qualitative analysis were the unjustified advice for Implanon removal by non-gynaecologists, due to unrelated users' complaints, and deficient pre-insertion counselling.

Conclusions Implanon has a low first-year discontinuation rate as compared with other contraceptive methods. FP clients should be given sufficient pre-insertion counselling about side effects of Implanon and duration of protection. Physicians should offer Implanon mainly to clients seeking long-term contraception in order to decrease its discontinuation rate and increase its cost effectiveness.

  • implants
  • counselling
  • family planning service provision
  • qualitative research
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  • Contributors All the authors contributed to the manuscript as follows: MMA designed the protocol, study tools, and obtained IRB approval. Both MMA and AFE-G were responsible for data collection, data entry, synthesis and analysis of both qualitative and quantitative data, as well as writing the final manuscript. MMA and AFE-G are the guarantors of this manuscript. OE conceived the idea of the study and revised the protocol, tools and manuscript.

  • Funding This research was funded by United Nations Population Fund.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval This study was approved by the Ethical Committee of Assiut University.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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