1. IMPLANT usage and associated notes.pptx

Notes

1. Factors associated with early discontinuation of long acting contraceptives among women of reproductive age at FRRH . By Stephen Rwapembe 2022/U/MMU/BNSD/003

2. Problem statement. Despite their proven effectiveness in preventing unintended pregnancies, long-acting reversible contraceptives (LARCs) namely subdermal implants and intrauterine devices face high rates of early discontinuation in Uganda, undermining reproductive health outcomes. At Kawempe National Referral Hospital, a facility-based cross-sectional study of 354 women revealed that 29 % discontinued LARCs within the first year (Author et al., 2023). Among these women, 50.6 % mentioned a desire for pregnancy, 40 % reported method-related side effects, 60 % had fewer than three children, and 30 % did not receive pre-insertion counseling; furthermore, women under age 25 were five times more likely to discontinue than older women (Author et al., 2023). This greatly suggest that a combination of reproductive intentions, demographic characteristics, and service delivery issues significantly contribute to premature LARC discontinuation. This is not different from the situation at fort portal regional referral hospital, where, a contraceptive utilization rate of 44.91 % exists, falling short of the national target of 50 %, with utilization significantly influenced by education level, urban residence, history of abortion, and HIV status (Nabunya, 2024). Even though the government of Uganda has dealt with construction of a family planning unit and ensuring staff with fully stocked packages of long acting contraceptives, utilization at FRRH still remains low and early returns to remove these LARCs remains high. This study therefore will assess the Factors associated with early discontinuation of long acting contraceptives among women of reproductive age at FRRH.

3. Research objectives General Objective To assess the prevalence and factors associated with early discontinuation of long-acting reversible contraceptives among women of reproductive age at Fort Portal Regional Referral Hospital. Specific Objectives. To determine the proportion of women who discontinue early the long-acting reversible contraceptives among women of reproductive age at FRRH. To assess the association between socio-demographic factors and early discontinuation of LARCs among women of reproductive age at FRRH. To evaluate the relationship between reproductive factors like desire for pregnancy, parity, previous contraceptive use, fertility preferences and early LARC discontinuation. To measure the effect of method related factors like type of LARC, side effects, duration of use on early discontinuation at among women of reproductive age at FRRH. To determine the impact of health service factors eg . Pre-insertion counselling, quality of counselling, follow-up support, client satisfaction and method availability on early LARC discontinuation at FRRH. To generate evidence-based recommendations to improve LARC continuation at FRRH.

4. Research questions General Research Question What is the prevalence and factors associated with early discontinuation of long-acting reversible contraceptives among women of reproductive age at Fort Portal Regional Referral Hospital? Specific Research Questions What proportion of women of reproductive age discontinue LARCs early at FRRH?. How do socio-demographic characteristics influence early discontinuation of LARCs at FRRH? What is the association between reproductive factors like desire for pregnancy, parity, previous contraceptive use, fertility preferences and early discontinuation of LARCs. How do method related factors influence the early discontinuation of LARCs at FRRH. Is there any association between health service related factors and early discontinuation of LARCs at FRRH? What interventions can be recommended to reduce early discontinuation of LARCs and improve contraceptive continuation at FRRH?

5. Conceptual frame work Early discontinuation of LARCs. Mediating factors Knowledge and awareness about LARCs, perceived side effects, satisfaction with the method and service delivery, level of follow-up, perceptions of safety and myths. Socio-demographic factors Age, marital status, education, income, parity, residence. Reproductive factors Desire for pregnancy, fertility preferences, previous contraceptive use, Hx of abortion /miscarriage. Socio-cultural factors Partner influence, cultural norms, religious beliefs, peer pressure Accessibility factors Distance to facility, availability of methods, cost of services and waiting time.