Early Discontinuation of Long Acting Reversible Contraceptives among Married and in Union Women: A Systematic Review and Meta-analysis

Introduction: Despite the improvement in availability and utilization of long acting reversible contraception early discontinuation is becoming a public health concern. Significant proportion of women discontinues the service before its due date which poses a concern in the health system and its consequence may leads to failure of a program. Therefore Estimating the rate of discontinuation from the available reports and identifying the associating factors are important for designing a strategy to overcome the problem. Methods: The review was conducted through a systematic literature search of articles published between 1997 and 2017. Five Most known bibliographic databases and libraries: PubMed/Medline, Global Health Database, Embase, the Cochrane Library, and African Index Medicus were used. After cleaning and sorting, analysis was performed using STATA version 11. The pooled rate of early discontinuation was estimated with a random-effects model. Heterogeneity was assessed by the I2 and publication bias through funnel plot. Results: The 22 studies that were retained for final analysis enrolled a total of 19,805 Married or in union women. Accordingly, 20% (95% CI=17-23%) of women discontinue long acting reversible contraceptives within one year of insertion. There is no significant difference in the rate of discontinuation between IUD and implant users (20.6% (SD=12.7) and 20.2% (SD=7.9)). Side effects and health concerns were main determinants for early discontinuation. Conclusion and recommendation: Contraceptive discontinuation rate in this meta-analysis was found to be much higher than previous studies and world health organization’s report associated with adverse outcomes and inconveniences. There for appropriate counseling, follow up care and management of side effects and clients inconveniences are very important