The 329 women who had discontinued the use of injectable contraceptives any time up to the time of the interview were probed about their reasons for discontinuation. Findings, presented in Table 3.8, suggest that, as observed in previous studies, the reasons for discontinuation centred largely around the side effects experienced. Some 65 percent of all those who had discontinued the method cited a health-related reason for doing so. The leading side effect, again as noted in other studies, was menstrual disturbances. In total, more than half of
all users (53%) reported that they had discontinued using injectable contraceptives because of irregular menstruation, heavy bleeding or amenorrhoea associated with method use. In addition, some 37 percent reported such other side effects as vaginal discharge, swelling of hands and feet, itching, pain and weight gain. The second most often cited cluster of reasons for discontinuation was method-related:
some 20 percent reported that they had planned to switch to another method, did not like the method, had doubts about it, needed a break from it or that the method was not convenient to use. A third group of reasons were access-related, centring around difficulties in accessing supplies: 16 percent cited these reasons, mostly concerning difficulties in reaching the facility to obtain subsequent doses of injectable contraceptives. Finally, some 10 percent of those who had discontinued cited fertility-related reasons: in order to become pregnant or because they Figure 3.1 Life table continuation rates of injectable contraceptives at the completion of each
tri-monthly dose
Note: Eleven women who returned for a subsequent dose of injectable contraceptives three or more months after the scheduled appointment for re-injection, have been treated as having discontinued the method.
Chapter 3: Experiences of women using injectable contraceptives
table 3.8
Factors underlying discontinuation: Percentage of women who discontinued use of injectable contraceptives by dose after which the method was discontinued and reason(s) for discontinuation
Reasons for discontinuation
All women who had discontinued
injectable contraceptive
use
Women who discontinued injectable contraceptive use by dose after which the
method was discontinued 1st
dose 2nd
dose 3rd
dose 4th–8th doses
Health-related reasons 65.0 70.5 59.3 62.7 51.2
a. Menstrual disturbances 52.6 61.7 35.2 49.0 39.0
Irregular menstruation 18.5 21.3 16.7 13.7 14.6
Heavy bleeding 18.8 25.7 11.1 9.8 9.8
Amenorrhoea 24.3 25.7 13.0 35.3 19.5
b. Other 37.4 38.8 42.6 33.3 29.3
Negative effect on health (includes infection, white discharge, swelling in hands and feet, itching,
abdominal pain, weight gain) 37.4 38.8 42.6 33.3 29.3
Method-related reasons 20.4 19.7 14.8 17.6 34.1
Planned to switch to another method 9.4 9.3 3.7 5.9 22.0
Did not like the method 3.6 4.4 3.7 0.0 4.9
Not convinced/Had doubts about injectable
contraceptives 8.2 8.2 7.4 11.8 4.9
Needed a break from injectable contraceptive use 1.2 0.0 0.0 2.0 7.3
Method not convenient to use 0.3 0.0 1.9 0.0 0.0
Access-related reasons 16.1 13.7 27.8 15.7 12.2
Difficulty in reaching the facility 13.4 12.0 20.4 13.7 9.8
High cost of injectables 1.8 1.6 3.7 0.0 2.4
Health care provider not easily accessible 0.6 0.0 1.9 2.0 0.0
Injectable contraceptives were not available at the
clinic 0.9 0.5 3.7 0.0 0.0
Fertility–related reasons 10.3 10.4 7.4 13.7 9.8
Planning a pregnancy 4.9 3.8 3.7 5.9 9.8
Not having sex/Infrequent sex/Husband away 5.2 6.6 1.9 7.8 0.0
Menopausal/Had a hysterectomy 0.6 0.0 1.9 2.0 0.0
Use failure 0.3 0.5 0.0 0.0 0.0
Number of discontinuers 329 183 54 51 41
Note: Multiple responses possible.
were infecund or not engaging in sexual relations regularly. As noted above, one woman reported use failure as a reason for discontinuation.
What is notable is that irrespective of the duration of use of injectable contraceptives, menstrual disturbances remain the leading reason that women attributed to discontinuation of the method. At the same time, there is an inverse association between duration of use and reported discontinuation attributed to menstrual disturbances:
from 62 percent after the first dose to 39 percent after the fourth or subsequent dose. Other reasons for discontinuation did not vary as widely. For example, other side effects were reported to have influenced discontinuation for 39 percent of users who discontinued after the first dose, as compared to 29 percent of those who discontinued after the fourth or subsequent dose. Other reasons were
typically cited by fewer women and do not show a consistent pattern over the period of use. For example, method-related reasons were cited by 15–20 percent among those who discontinued after the first, second and third doses, respectively, but increased to 34 percent thereafter. Fertility-related reasons ranged from 14 percent to seven percent, while access-related reasons increased from 14 percent to 28 percent among those who discontinued the method after the first and second doses, and fell to 12 percent among those who did so after the fourth or subsequent dose.
Figure 3.2 shows life-table continuation rates among women who had adopted injectable contraceptives, by side effects experienced: notably, any side effect, menstrual disturbances without any other side effect, and both menstrual disturbances and some other side effect (small numbers prevented
Figure 3.2 Life table continuation rates of injectable contraceptives at the completion of each tri-monthly dose by side effects experienced
Chapter 3: Experiences of women using injectable contraceptives
us from conducting the same exercise among those who experienced only other side effects).
Continuation rates were largely similar up to six months of method use. Thereafter, differences emerged. Continuation rates were somewhat higher among those who experienced only menstrual disturbances than among those who experienced both menstrual disturbances and other side effects.
For example, at nine months, 42 percent of those experiencing only menstrual disturbances had continued using the method compared to 34 percent of those experiencing both menstrual disturbances and other side effects; corresponding percentages were 27 percent and 18 percent, respectively, at
month 12; 22 percent and 10 percent, respectively, at month 15; and 18 percent and 6 percent, respectively, at month 18.