BMC Women's Health (Oct 2021)

Family planning providers and contraceptive users in Rwanda employ strategies to prevent discontinuation

  • Hilary Schwandt,
  • Angel Boulware,
  • Julia Corey,
  • Ana Herrera,
  • Ethan Hudler,
  • Claudette Imbabazi,
  • Ilia King,
  • Jessica Linus,
  • Innocent Manzi,
  • Madelyn Merritt,
  • Lyn Mezier,
  • Abigail Miller,
  • Haley Morris,
  • Dieudonne Musemakweli,
  • Uwase Musekura,
  • Divine Mutuyimana,
  • Chimene Ntakarutimana,
  • Nirali Patel,
  • Adriana Scanteianu,
  • Biganette-Evidente Shemeza,
  • Gi’anna Sterling-Donaldson,
  • Chantal Umutoni,
  • Lyse Uwera,
  • Madeleine Zeiler,
  • Seth Feinberg

DOI
https://doi.org/10.1186/s12905-021-01503-1
Journal volume & issue
Vol. 21, no. 1
pp. 1 – 13

Abstract

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Abstract Background In Rwanda, nearly a third of contraceptive users discontinue within the first year of use. Family planning programs often focus more on recruitment of new users as opposed to maintaining use among current users. A focus on sustaining users and minimizing discontinuation is imperative for long-term family planning program success. This study explores the efforts providers and contraceptive users in Rwanda employ to prevent one of the greatest challenges to family planning programs: contraceptive discontinuation. Methods This was a qualitative study conducted in Rwanda between February and July 2018. It included eight focus group discussions with 88 family planning providers and 32 in-depth interviews with experienced modern contraceptive users. Data were collected in two districts with the highest (Musanze) and lowest (Nyamasheke) rates of contraceptive use. Data were analyzed using thematic content approach. Results Family planning providers in this study used the following strategies to prevent discontinuation: counseling new users on the potential for side effects and switching, reminding clients about appointments for resupply, as well as supporting dissatisfied users by providing counseling, medicine for side effects, and discussing options for switching methods. Users, on the other hand, employed the following strategies to prevent discontinuation: having an understanding that experiences of side effects vary by individuals, supporting peers to sustain use, persisting with use despite experiences of side effects, and switching methods. Conclusions The strategies used by family planning providers and users in Rwanda to prevent discontinuation suggest the possibility of long-term sustained use of contraception in the country. Harnessing and supporting such strategies could contribute to sustaining or improving further contraceptive use in the country.

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