Associated Factors in the Declining Trend in the Use of Progestogen Only Injectable Contraceptive in a Niger Delta University Teaching Hospital, Nigeria

Background: Progestogen-only injectable contraceptive (POIC) is a reversible and widely accepted contraceptive method. In an earlier study in the University of Port Harcourt Teaching Hospital, it was the contraceptive method of choice for the clients; a recent review however showed a declining acceptance and increasing discontinuation hence the study.

Objectives: To determine the associated factors in the declining acceptance and growing discontinuation of progestogen only injectable contraceptives in our centre.

Materials and Methods: A retrospective study of clients who accepted and used POIC at the family planning clinic of the University of Port Harcourt Teaching Hospital (UPTH) between 1st January 2004 and 31st December 2013. The case files of these clients were retrieved. Their data, which included socio-demographic characteristics and reasons for discontinuation of POIC was extracted, entered into a data bank and analyzed using SPSS for windows 19.0 version.

Results: During this study period, the main methods of contraception available and proportion of clients who accepted them were: condom-male and female- (44.52%), intrauterine contraceptive device (15.98%), POIC (15.35%), implants (8.20%), oral contraceptive device (7.63%), bilateral tubal ligation (2.66%), foam tablets (0.43%).

There were 1075 (15.35%) new acceptors of POIC out of the 7001 total new acceptors of contraception during this period. Secondary amenorrhea was the most common side effect occurring in 781 (72.7%) women. Eight hundred and fifty six (79.6%) were lost to follow up while 57(5.3%) discontinued POIC use due to pregnancy, a change to intrauterine device and implant; and complications such as weight gain and irregular vaginal bleeding. Other reasons for the decline in the use of POIC were multiple injections involved and frequent visits to the health care facility. No pregnancy was reported among these women during the study period.

Conclusion: There was appreciable drop in the use of progestogen only injectable contraceptive and reasons such as its side effects, increasing acceptance of intra uterine devices and implants; and dislike based on frequent visits to the health care provider and concerns on possible impact of the repeated injections were noted.