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.
- 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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