Contributions of side effects to contraceptive discontinuation and method switch among Kenyan women: a prospective cohort study

Objective To determine the contribution of specific contraceptive side effects to method switch and modern‐method discontinuation among Kenyan women. Design A prospective cohort study. Setting Five counties in Western Kenya. Participants Women aged ≥18 years old and emancipated female minors ≥14 years old using modern, reversible contraception were recruited while attending 10 public health facilities. Methods Patient‐reported adverse effect symptoms, method switch and discontinuation were reported through weekly text message‐based surveys for 24 weeks. Main outcome measurements Prevalence, hazards ratio (HR). Results Among 825 women, 44% were using implants, 43% injectables, 7% an intrauterine device and 6% oral contraceptive pills at enrolment. Most (61%) women were continuing a method used in the previous month. During the 24‐week follow up, incidence of contraceptive switch was 61.3 per 100 person‐years (95% confidence interval [CI] 52.4–71.8) and incidence of discontinuation was 38.5 per 100 person‐years (95% CI 31.6–47.0). On average, one‐quarter (prevalence [Pr] 0.24, 95% CI 0.22–0.26) of participants reported side effects or method problems weekly, with sexual side effects the most prevalent symptom (Pr 0.15, 95% CI 0.13–0.16). Lack of expected bleeding was associated with higher risk of method switch (adjusted hazard ratio [aHR] 2.36, 95% CI 1.22–4.57). Risk of all‐modern method discontinuation was higher among women experiencing irregular bleeding (aHR 2.39, 95% CI 1.20–4.77), weight changes (aHR 2.72, 95% CI 1.47–4.68) and sexual side effects (aHR 2.42, 95% CI 1.40–4.20). Conclusions Addressing irregular bleeding, weight changes and sexual side effects through development of new products that minimise these specific side effects and anticipatory counseling may reduce method‐related discontinuation. Tweetable Bleeding, weight changes, sexual problems associated with discontinuation of #contraception, but many continue despite side effects. Tweetable Bleeding, weight changes, sexual problems associated with discontinuation of #contraception, but many continue despite side effects.