Maternal and Child Health Journal

, Volume 21, Issue 9, pp 1763–1771 | Cite as

Contraceptive Implant Discontinuation in Huambo and Luanda, Angola: A Qualitative Exploration of Motives

  • Mary QiuEmail author
  • Jhony Juarez
  • Adelaide de Carvalho
  • Frederico Joao Carlos Juliana
  • Lucas Nhamba
  • Isilda Neves
  • Vita Vemba
  • Ligia Alves
  • Abreu Pecamena
  • Peter Winch


Introduction The Government of Angola is engaged in ongoing efforts to increase access to contraceptives, in particular contraceptive implants (CIs). Discontinuation of CIs, however, has been identified as being a challenge to this work, hindering the improvement of contraceptive prevalence, and in turn, maternal and child health. The objective of this study was to understand motives for contraceptive implant discontinuation in Luanda and Huambo, Angola. Methods We conducted 45 in-depth interviews and six focus groups amongst former and current contraceptive implant clients and family planning nurses in eight clinics across the provinces of Huambo and Luanda. Data collectors transcribed and translated key information from Portuguese into English. We used a combined deductive/inductive approach to code and analyze data. Results Participants described adverse side effects, desire for pregnancy, partner dissatisfaction, quality of care, alternative or lack of information, and religion as motives for discontinuation. Adverse side effects, including prolonged bleeding, amenorrhea, and headaches were most commonly cited by both clients and providers. Discussion Motives for discontinuation reflect existing findings from other studies in similar settings, in particular the influence of adverse side effects and desire for pregnancy as motivating factors. We contextualize these findings in the Angolan setting to tease out the relationship between cultural norms of ideal family size and the perceived role of women in regards to fertility and child-bearing. We suggest that programs enter into dialog with communities to address these concerns, rather than working exclusively on improving service delivery and quality.


Contraceptive implants Family planning Discontinuation Angola Qualitative research 



This study was funded by the United States Agency for International Development (Grant No. ID-654-A-11-00001). Further support for the study was provided by the Center for Global Health at Johns Hopkins University. The authors would like to gratefully acknowledge the support of Jhpiego staff, in particular Margarita Gurdian, Anaisia Octavo, and Cecília Dembei, the Ministry of Health in Angola, and all of the clinic staff who graciously accommodated the study team.


  1. Ahmed, S., Li, Q., Liu, L., & Tsui, A. O. (2012). Maternal deaths averted by contraceptive use: An analysis of 172 countries maternal deaths averted by contraceptive use: An analysis of 172 countries. Lancet, 380, 111–125. doi: 10.1016/S0140-6736(12)60478-4.CrossRefPubMedGoogle Scholar
  2. Ali, M. M., Cleland, J. G., & Shah, I. H. (2012). Causes and consequences of contraceptive discontinuation: evidence from 60 demographic and health surveys, Geneva. Retrieved from
  3. Angola Ministry of Health, National Office of Public Health, Advance Africa, and USAID/Angola. (2003). Qualitative factors determining poor utilization of family planning services in Angola, Luanda.Google Scholar
  4. Azmat, S. K., Hameed, W., Mustafa, G., Hussain, W., Ahmed, A., & Bilgrami, M. (2013). IUD discontinuation rates, switching behavior, and user satisfaction: Findings from a retrospective analysis of a mobile outreach service program in Pakistan. International Journal of Women’s Health, 5, 19–27.CrossRefPubMedPubMedCentralGoogle Scholar
  5. Blanc, A. K., Curtis, S., & Croft, T. N. (2002). Monitoring contraceptive continuation: Links to fertility outcomes and quality of care. Studies in Family Planning, 33(3), 127–140.CrossRefPubMedGoogle Scholar
  6. Caldwell, J. C., & Caldwell, P. (1987). The cultural context of high fertility in Sub-Saharan Africa. Population and Development Review, 13(3), 409–437. doi: 10.2307/1973133.CrossRefGoogle Scholar
  7. Chebet, J. J., Mcmahon, S. A., Greenspan, J. A., Mosha, I. H., Callaghan-koru, J. A., Killewo, J., … Winch, P. J. (2015). “Every method seems to have its problems”—Perspectives on side effects of hormonal contraceptives in Morogoro Region, Tanzania. BMC Women’s Health, 15(97), 1–12. doi: 10.1186/s12905-015-0255-5.Google Scholar
  8. Cotten, N., Stanback, J., Maidouka, H., Taylor-thomas, J. T., … Turk, T. (1992). Early discontinuation of contraceptive use in Niger and The Gambia. International Family Planning Perspectives, 18(4), 145–149.CrossRefGoogle Scholar
  9. Chin-Quee, D. S., Janowitz, B., & Otterness, C. (2007). Counseling tools alone do not improve method continuation: Further evidence from the decision-making tool for family planning clients and providers in Nicaragua. Contraception, 76(5), 377–382. doi: 10.1016/j.contraception.2007.07.003.CrossRefPubMedGoogle Scholar
  10. D’Antona Ade, O., Chelekis, J. A., D’Antona, M. F. L., de, T., & Siqueira, A. D. (2009). Contraceptive discontinuation and non-use in Santarém, Brazilian. Cadernos de Saúde Pública, 25(9), 2021–2032.CrossRefPubMedGoogle Scholar
  11. Eva, G., & Ngo, T. (2010). MSI mobile outreach services: Retrospective evaluations from Ethiopia, Myanmar, Pakistan, Sierra Leone and Vietnam, London.Google Scholar
  12. Instituo Nacional de Estatistica. (2014). Recenseamento Geral da População e Habitação (RGPH) 2014, Luanda.Google Scholar
  13. Instituo Nacional de Estatistica. (2015). Projecção anual da população total por província e género, Angola, 2015. Retrieved November 12, 2015, from
  14. Jhpiego. (2014). Jhpiego in Angola, Baltimore.Google Scholar
  15. Kassebaum, N. J., Bertozzi-Villa, A., Coggeshall, M. S., Shackelford, K. A., Steiner, C., Heuton, K. R., … Lozano, R. (2014). Global, regional, and national levels and causes of maternal mortality during 1990–2013: A systematic analysis for the Global Burden of Disease Study 2013. Lancet, 384(9947), 980–1004. doi: 10.1016/S0140-6736(14)60696-6.CrossRefPubMedPubMedCentralGoogle Scholar
  16. Kim, Y. M., Davila, C., Tellez, C., & Kols, A. (2007). Evaluation of the World Health Organization’s family planning decision-making tool: Improving health communication in Nicaragua. Patient Education and Counseling, 66(2), 235–242. doi: 10.1016/j.pec.2006.12.007.CrossRefPubMedGoogle Scholar
  17. Langston, A. M., Rosario, L., & Westhoff, C. L. (2010). Structured contraceptive counseling-A randomized controlled trial. Patient Education and Counseling, 81(3), 362–367. doi: 10.1016/j.pec.2010.08.006.CrossRefPubMedGoogle Scholar
  18. National Research Council. (1993). Factors affecting contraception use in sub-Saharan Africa. Washington, DC: The National Academies Press. doi: 10.17226/2209.Google Scholar
  19. Family Planning 2020. (2015). Contraceptive discontinuation: Reasons, challenges, and solutions. Retrieved August 5, 2016, from
  20. Prata, N., Bell, S., Fraser, A., Carvalho, A., Neves, I., & Andrade, B. (2015). Partner support for family planning and modern contraceptive use in Luanda, Angola. In Population Association of America. Retrieved from
  21. Sivin, I., Nash, H., & Waldman, S. (2002). Jadelle levonorgestrel rod implants: A summary of scientific data and lessons learned from programmatic experience. New York: Population Council.Google Scholar
  22. The World Bank. (2011). Reproductive health at a glance, Angola. Washington, DC.Google Scholar
  23. The World Bank. (2013). Fertility rate, total (births per woman).Google Scholar
  24. The World Bank. (2015). Mortality rate, under-5 (per 1,000 live births). Retrieved August 15, 2015, from
  25. Tolley, E., Loza, S., Kafai, L., & Cummings, S. (2005). The impact of menstrual side effects on contraceptive. International Family Planning Perspectives, 31(1), 15–23.CrossRefPubMedGoogle Scholar
  26. Vohra, D., Tait, A., & Prata, N. (2013). Pregnancy intentions and need for contraception among women in Luanda Province, Angola. In 2013 PAA Annual Meeting, New Orleans.Google Scholar
  27. Wang, H., Liddell, C. A., Coates, M. M., Mooney, M. D., Levitz, C. E., Schumacher, A. E., … Murray, C. J. L. (2014). Global, regional, and national levels of neonatal, infant, and under-5 mortality during 1990–2013: A systematic analysis for the Global Burden of Disease Study 2013. Lancet, 384(9947), 957–979. doi.: 10.1016/S0140-6736(14)60497-9.CrossRefPubMedPubMedCentralGoogle Scholar
  28. Zhou, J., Tan, X., Song, X., Zhang, K., Fang, J., Peng, L., … Yan, C. (2015). Temporal trends of copper-bearing intrauterine device discontinuation: A population-based birth-cohort study of contraceptive use among rural married women in China. Asia-Pacific Journal of Public Health, 27(2), 2433–2442. doi: 10.1177/1010539513517259.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Mary Qiu
    • 1
    Email author
  • Jhony Juarez
    • 2
  • Adelaide de Carvalho
    • 3
  • Frederico Joao Carlos Juliana
    • 4
  • Lucas Nhamba
    • 5
  • Isilda Neves
    • 3
  • Vita Vemba
    • 6
  • Ligia Alves
    • 7
  • Abreu Pecamena
    • 8
  • Peter Winch
    • 1
  1. 1.Department of International Health, Bloomberg School of Public HealthJohns Hopkins UniversityBaltimoreUSA
  2. 2.Jhpiego AngolaLuandaAngola
  3. 3.Ministry of HealthLuandaAngola
  4. 4.Ministry of HealthHuamboAngola
  5. 5.Faculty of MedicineJose Eduardo dos Santos UniversityHuamboAngola
  6. 6.Management Sciences for HealthHuamboAngola
  7. 7.Augusto Ngangula HospitalLuandaAngola
  8. 8.Lucrecia Paim MaternityLuandaAngola

Personalised recommendations