Which contraceptive side effects matter most? Evidence from current and past users of injectables and implants in Western Kenya

OBJECTIVES: The objectives were to assess experiences of menstrual bleeding and nonbleeding side effects among current and past users of injectables and implants and the associations between side effects and method evaluations by women — satisfaction, perceived suitability, the likelihood of future use and intended duration of use. STUDY DESIGN: We used data on past and current users of injectables and implants from a survey of 1866 married or cohabiting women who participated in the third round of a 2-year prospective longitudinal study conducted in Homa Bay County, Western Kenya. Descriptive and bivariate analysis with χ(2) tests was used to assess statistically significant associations between experience of bleeding/nonbleeding side effects and method-specific attitudes. RESULTS: Self-reported method-related bleeding problems were high among current and past users of injectables (range 69%–79%) and implants (range 55%–60%) and much more common than nonbleeding side effects. For both methods, experience of either bleeding or nonbleeding side effects reduces positive evaluations, but the conjunction of both types had particularly pronounced consequences. Heavy bleeding was more strongly related to method evaluation (satisfaction and the likelihood of future use; p < .001) among past users than other forms of menstrual bleeding disorders. Even among current users, about one third regarded bleeding side effects as very serious. Care-seeking from a healthcare provider for management of contraceptive-related side effects was low among current users (less than 40%) and modest among past users (range 53%–63%). CONCLUSIONS: The results underscore the need to strengthen programs on counseling and information on contraceptive side effects including menstrual bleeding disturbances to improve method satisfaction and reduce discontinuation. IMPLICATION: The experience of contraceptive-related menstrual bleeding and nonbleeding side effects reduces positive evaluation of the method and deters past users from future use of the method.