Contraceptive implant continuation among postpartum women at tertiary care center

Abstract

Objective: To evaluate the continuation rates and factors influencing the discontinuation of postpartum etonorgestrel contraceptive implants over a three-year period.

Methods: A prospective cohort study was conducted from November 2017 to December 2022 in the Department of Obstetrics and Gynecology, Services Hospital, Lahore, Pakistan. The patients coming to OPD and emergency were counselled for insertion of long-acting reversible contraception. Those who opted for postpartum etonorgestrel implants were enrolled after informed consent and implant was placed within 48 hours of birth. The patients were followed for three years post insertion. The primary outcome was the continuation rate at three years, and secondary outcomes included reasons for discontinuation. Statistical analysis was performed using SPSS version 23, and p-values < 0.05 were considered statistically significant.

Results: Of 424 participants who were followed up, 254 (59.9%) continued the implant for three years. Doctors counselling played role in choosing implant in 177(41.7%) patients. Continuation was higher among women with prior contraceptive knowledge (AOR: 3.73,95% CI 1.20-6.21), previous contraceptive use (AOR: 8.1, 95%CI 4.2-31.1), and antenatal counselling (AOR 2.24. 95% CI 116-3.54).   The most common reasons for discontinuation were side effects in 77(45.2%) and family pressure 55(32.3%) patients. Women with no side effects were 18 times more likely to continue (AOR: 18.1, 95% CI: 7.5-48).

Conclusion: The postpartum insertion of etonorgestrel implant has high continuation rates. Antenatal counseling and awareness about contraception were key factors in increasing its continuation. Side effects of bleeding irregularities and family pressure were main reasons for discontinuation.