Citation
Cartwright, Alice F.; Callahan, Rebecca L.; Beksinska, Mags E.; Kasaro, Margaret P.; Tang, Jennifer H.; Milford, Cecilia; Wong, Christina; Velarde, Marissa; Maphumulo, Virginia; & Fawzy, Maria, et al. (2023). Contraceptive Continuation and Experiences Obtaining Implant and IUD Removal among Women Randomized to Use Injectable Contraception, Levonorgestrel Implant, and Copper IUD in South Africa and Zambia. Studies in Family Planning, 54(2), 379-401. PMCID: PMC10239327Abstract
Few longitudinal studies have measured contraceptive continuation past one year in sub-Saharan Africa. We surveyed 674 women who had been randomized to receive the three-month intramuscular contraceptive injectable (DMPA-IM), levonorgestrel (LNG) implant, or copper intrauterine device (IUD) during the Evidence for Contraceptive Options and HIV Outcomes (ECHO) trial in South Africa and Zambia and were subsequently followed for two additional years to explore method continuation, reasons for discontinuation, and access to implant and IUD removal services. We also conducted in-depth qualitative interviews with 39 participants. We estimated cumulative discontinuation probabilities using Kaplan-Meier estimates and assessed factors associated with discontinuation using Cox-proportional hazards models. The LNG implant continuation rate over the maximum 44-month study period was 60 percent, while rates for the copper IUD and DMPA-IM were 52 percent and 44 percent, respectively. Reasons for method discontinuation included side effects, particularly menstrual changes, and method stock-outs. Most implant and IUD users who sought removal were able to access services; however, room for improvement exists. In this cohort originally randomized to receive a contraceptive method and attend regular study visits, implants and IUDs continued to be highly acceptable over an additional two years, but facilities should continue to ensure that insertions and removals are available as requested.URL
http://dx.doi.org/10.1111/sifp.12222Reference Type
Journal ArticleYear Published
2023Journal Title
Studies in Family PlanningAuthor(s)
Cartwright, Alice F.Callahan, Rebecca L.
Beksinska, Mags E.
Kasaro, Margaret P.
Tang, Jennifer H.
Milford, Cecilia
Wong, Christina
Velarde, Marissa
Maphumulo, Virginia
Fawzy, Maria
Chinyama, Manze
Chabu, Esther
Mudenda, Mayaba
Smit, Jennifer
Article Type
RegularPMCID
PMC10239327Data Set/Study
Evidence for Contraceptive Options and HIV Outcomes (ECHO) TrialContinent/Country
South AfricaZambia