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. 2025 Mar 18;10(1):21.
doi: 10.1186/s40834-025-00354-7.

"I felt my rights were violated": Challenges with the discontinuation of provider-dependent contraceptive methods in Eastern Uganda

Agnes Nabulondera  1 , Madeline Powers  1 , Rose Chalo Nabirye  1 , Sarah Racheal Akello  2 , Munanura Turyasiima  3 , Joshua Epuitai  4
Affiliations

"I felt my rights were violated": Challenges with the discontinuation of provider-dependent contraceptive methods in Eastern Uganda

Agnes Nabulondera et al. Contracept Reprod Med. .

Abstract

Background: The right to autonomy in family planning is a cornerstone of reproductive health. Yet, many women face challenges when seeking to discontinue provider-dependent contraceptive methods, such as implants and intrauterine devices (IUDs). This study explored the experiences of women in Eastern Uganda regarding the discontinuation of implants/IUDs.

Methods: Using a qualitative descriptive design, we conducted 15 in-depth interviews with women and six key informant interviews with healthcare providers. The study obtained ethical clearance and used a thematic analysis.

Results: Two themes were identified: (1) reasons for refusal and (2) women's reactions to refusal to discontinue IUDs/implants. Women were denied to discontinue IUDs/implants because the due date had not been reached, insertion cards were missing, and there were healthcare constraints, especially inadequate equipment. Early removal or discontinuation before the due date was considered as a waste of resources, unjustifiable, and it was seen to increase risk of pregnancy among young girls. Healthcare workers preferred to first counsel for side effects instead of heeding women's requests to discontinue IUDs/implants. Women often felt betrayed and powerless when they were denied to discontinue using IUDs/implants. They felt that their reproductive rights were undermined which fostered mistrust towards future use of provider-dependent contraceptives. Women reported physical, social, and mental health struggles including strained marital relationships following denial to discontinue IUDs/implants. Most of the women incurred costs in discontinuing the use of IUDs/implants in private facilities.

Conclusion: The findings underscore the need to uphold women's autonomy by improving access to removal services, and addressing systemic and provider-level barriers to discontinuation of IUDs/implants. Insertion cards should not be a mandatory requirement during discontinuation of contraceptives, while enhancing record-keeping systems can address the need for insertion cards. Respecting women's rights to discontinue contraceptives is essential for ensuring voluntary and sustained family planning use.

Keywords: Contraceptive discontinuation; Human rights in family planning; Provider-dependent methods; Reproductive autonomy.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate : We obtained ethical clearance from the Research and Ethics Committee of Busitema University Faculty of Health Sciences (reference number: BUFHS-2024–193). Administrative clearance was also granted by the Mbale Regional Referral Hospital. Study participants provided a written informed consent before enrolment in the study. Participants were assured of confidentiality, and all information was anonymized and securely stored. Consent for publication: The authors consent to the publication. Competing interests: The authors declare no competing interests.

References

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