BARRIERS TO UTILIZATION OF LONG ACTING REVERSIBLE AND PERMANENT CONTRACEPTIVE METHODS IN ETHIOPIA: SYSTEMATIC REVIEW

Abstract

ABSTRACT BACKGROUND Globally the use of Long-Acting Reversible and Permanent Methods (LARPMs) has been recommended as the first-line, highly effective options for pregnancy prevention. They have greater efficacy than short acting contraceptive methods and are associated with lower rates of unwanted pregnancy. Ethiopia has made significant progress in family planning (FP); however, one fourth of married women still have unmet need for FP and nearly three-fourth of family planning users depend on short acting injectable contraceptives. The aim of this study was to review existing researches to identify barriers to long acting reversible and permanent contraceptive use in emerging regions of Ethiopia.
METHOD: Published and unpublished literatures were searched using major search engines and different search terms related to the topic. Literature search was carried out from March to May 2016. Six selection criteria were prepared to summarize the findings using PRISMA protocol. A checklist of eight-item quality assessment criteria was used to rate the quality of studies independently by two investigators, and the third investigator cross checked and decided on agreements. The studies were critically appraised, and thematic analysis was used to synthesize the data.
RESULTS: Using the screening criteria, 69 eligible full-text articles and reports were reviewed; of which 34 articles and 8 policy/strategy documents were considered for data synthesis. The review has included policy related, individual, socio-cultural and health facility related barriers/factors affecting LARPMs use in emerging regions. Lack of strategies to reach the mobile population of emerging regions, facility readiness to provide LARPMs and quality of care were major policy and health care factors contributing for the low utilization of LARPMs. Low knowledge of LARPMs, health concerns, fear of side effects, and lower education were among individual level barriers identified through the review. Moreover, the review showed that men’s (partner’s) objection, desire for more children (especially by the male partner), absence of male involvement, lack of women’s decision-making power and lack of discussion with partners were gender related barriers.
CONCLUSION: The regional disparity in LARPM use, particularly in emerging regions, requires targeted policy and strategic direction to address the prevailing inequality in family planning use and method mix. To improve the utilization of LARPMs, efforts should be made to address the key demand and supply side barriers. More context specific research evidences should be generated to understand barriers that are specific to these regions. (Ethiopian Journal of Reproductive Health 2018; 10; 3: 1-24)