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

Abstract

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.

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Acknowledgements

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.

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Correspondence to Mary Qiu.

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Qiu, M., Juarez, J., de Carvalho, A. et al. Contraceptive Implant Discontinuation in Huambo and Luanda, Angola: A Qualitative Exploration of Motives. Matern Child Health J 21, 1763–1771 (2017). https://doi.org/10.1007/s10995-017-2349-1

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  • DOI: https://doi.org/10.1007/s10995-017-2349-1

Keywords

  • Contraceptive implants
  • Family planning
  • Discontinuation
  • Angola
  • Qualitative research