Factors associated with unindicated discontinuation of long-acting reversible contraceptives among refugee women in Rhino Camp and Kyangwali refugee settlements, Uganda

Abstract

Abstract Background: Unindicated discontinuation of long-acting reversible contraceptives (LARCs) poses a growing concern among refugee women residing in Rhino Camp and Kyangwali refugee settlements. This practice is closely linked with unintended pregnancies, short birth intervals, unsafe abortions, and maternal mortality. This study assessed the level and factors associated with the unindicated discontinuation of LARCs among refugee women in these settlements. Methods: A community-based cross-sectional study was conducted from January to March 2022, involving 284 refugee women. Data were collected through structured questionnaires and key informant interviews. Qualitative and quantitative data were analyzed using thematic analysis and STATA 14, respectively. Prevalence ratios and the corresponding 95% confidence intervals were determined. Results: The findings revealed that 90/284 refugee women (32% CI; 22.9%-41.1%) in Rhino camp and Kyangwali refugee settlements had discontinued their LARCs without indication. Notably, users of Implant contraceptives were more prone to discontinuation without a clinical indication. Several factors were associated with unindicated discontinuation, including residing in Rhino camp (adjusted prevalence ratio aPR = = 1.5, 95% confidence interval (CI): 1.01 - 2.30), having an education level up to primary (Upper) level (aPR= 4.9, 95% CI: 2.35 - 10.19), marital status (never married, (aPR = 1.299, 95% CI: 1.088 - 3.001), South Sudanese origin (aPR = 10.2, 95%CI: 1.51 - 68.45), living with all children in one household (aPR= 4.9, 95% CI: 1.26 – 19.16) and having given birth to only one child (aPR = 3.5, 95CI: 1.19 - 10.08). Conversely, women who experienced mild side effects (aPR = 0.24, 95% CI: 0.12 - 0.48), perceived LARC devices as 100% effective in preventing pregnancy (aPR = 0.02, 95%CI: 0.00 - 0.24), lived with their partners (aPR = 0.38, 95% CI: 0.18 - 0.78) and had the support of their spouses in using LARC devices (aPR = 0.42, 95% CI: 0.19 - 0.94) exhibited a lower prevalence of unindicated LARC discontinuation. Additionally, health workers identified domestic violence and fear of side effects as underlying causes of unindicated LARC discontinuation. Conclusions and Recommendations: This study highlights the common occurrence of unindicated LARC discontinuation among refugee women in Rhino camp and Kyangwali refugee settlements, with a higher prevalence in Rhino camp. To address this issue, we recommend implementing comprehensive pre-insertion counselling, particularly for implant users, and launching extensive behavioural change initiatives to combat negative cultural practices, particularly among refugee women from patriarchal communities.