Factors associated with use and discontinuation of Implanon contraceptive in Jos, Nigeria

Abstract

Background: the contraceptive prevalence (CPR) in sub-Saharan Africa is low at 8-10% for over a decade. There is also the dominance of the less effective short-acting methods such as pills and injectables. The low CPR is the direct cause of the high total fertility of 5.7 in Nigeria. The use of contraception is the single most dominant contributory factor in fertility declines world-wide. This is especially more true with the use of long acting reversible contraceptive methods like implanon which has the potential to reduce the global burden of disease and mortality associated with a high total fertility rate.
Objective: our aim was to analyse and determine the socio-demographic profiles of implanon acceptors and the factors associated with continuation or discontinuation of its use in the family planning programme of the Jos University Teaching Hospital, Jos Nigeria.
Materials and Methods: This was a retrospective review carried out between March 2007 and March 2014 at the Jos University Teaching Hospital, Jos Nigeria
Results: during the study period, 1482 women accepted implanon with about 85.8% having regular menstrual cycles. Sixty-one percent of these women were breastfeeding at insertion. Their mean age was 31 years with a range of 16 to 53. Christianity was the religion of 87.8% with 12.2% being Muslims. Just under half had tertiary education with over a third having attended secondary school. About 26.7% had no future fertility desires. Over 75% had previously used a contraceptive method. The mean parity in this study was 3.2 with a range of 0 to 12. The mean number of children alive was 2.9. Both the systolic and diastolic blood pressures were little affected by the use of implanon. However there was a mean weight gain among 900 of the women who came for follow up of 2.4 kg. However the weight change was highly variable with about a third of women losing between 1 to 30 kg, 10% not having any net changes and over 61% having a net weight gain of between 1 to 26 kg. About 3.8% had their implanon removed because of weight gain. The percentage loss to follow up was 28.2%. The 900 women who had follow up were exposed to the implanon for 2006.6 woman-years or 24,079 cycles. The mean number of months of exposure to the implant was 27.0 ± 14.7 months. The commonest reason for discontinuation was desire for pregnancy (36.1%) followed by those who changed to other methods (27.6%). Menstrual irregularity was the commonest side effect of implanon that led to removal. Seven in-treatment pregnancies occurred giving a pearl index of 0.35 although only one pregnancy was ultrasonographically-proven to be a method failure of the device.
Conclusion: Accepting implanon was influenced by the educational attainment and religion of the women in our unit. The desire for another pregnancy was the commonest reason for discontinuation. However, menstrual irregularity was the commonest side effect of the implant that led to its removal especially in the first six months after insertion.

Keywords: Implanon (etonogestrel) contraceptive, continuation rates, discontinuation, reason for discontinuation.