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. 2025 May 3;14(1):99.
doi: 10.1186/s13643-025-02827-x.

Barriers and facilitators of acceptability and uptake of long-acting reversible contraceptives in Ethiopia: a systematic review using the COM-B model

Tariku Shimels  1 , Zewdneh Shewamene  2 , Getachew Teshome  3
Affiliations

Barriers and facilitators of acceptability and uptake of long-acting reversible contraceptives in Ethiopia: a systematic review using the COM-B model

Tariku Shimels et al. Syst Rev. .

Abstract

Background: Long-acting reversible contraceptives (LARCs), including implants and intrauterine contraceptive devices (IUCDs), are essential in preventing unintended pregnancies and empowering women by providing long-term, reliable contraception that supports informed decision-making about family planning and reproductive health. However, their uptake and acceptability remain low in Ethiopia due to various individual, social, and systemic barriers. This study systematically reviews the factors influencing LARC acceptability and utilization among Ethiopian women, adolescents, and healthcare providers, using the Capability, Opportunity, Motivation, and Behaviour (COM-B) framework.

Methods: A systematic search of PubMed, Embase, Scopus, African Journals OnLine, and EBSCOhost (CINAHL) was conducted, along with gray literature sources, to identify studies published between January 2021 and June 2024. Inclusion criteria encompassed studies conducted in Ethiopia that examined the acceptability and utilization of LARCs, focusing on implants and IUCDs. The types of studies considered included quantitative, qualitative, and mixed-method designs, focusing on postpartum, post-abortion, and nonpostpartum women, adolescents, and healthcare providers. Data on barriers, facilitators, and associated factors of acceptability and utilization were extracted, and the findings were mapped to the COM-B framework. Atlas.ti v.9 software was used in the analysis process.

Results: A total of 58 cross-sectional, qualitative, and mixed-method studies were included, encompassing diverse Ethiopian populations and geographies. Among immediate and extended postpartum women, barriers included limited awareness and fear of insertion pain for IUCDs, low awareness, and limited access to LARCs, while postpartum counselling emerged as a facilitator. For adolescents, social stigma, male partner disapproval, and misconceptions about LARC side effects were prominent barriers; school-based education and youth-friendly services supported acceptability. Healthcare providers noted inadequate training on family planning methods as a barrier, while targeted training improved their confidence in recommending LARCs. Nonpostpartum women frequently cited partner opposition and cultural beliefs as barriers, but family planning programs with partner engagement facilitated greater acceptance.

Conclusions: The findings highlight an urgent need to expand community-based education programs to dispel myths and misconceptions about LARCs, particularly in rural and pastoral regions. Prioritizing provider training to improve counselling and service delivery, alongside engaging male partners in family planning discussions, is essential for enhancing LARC utilization and meeting reproductive health needs in Ethiopia.

Systematic review registration: PROSPERO CRD42024594288.

Keywords: Acceptability; COM-B framework; Ethiopia; IUCD; Implants; Long-acting reversible contraceptives; Reproductive health; Utilization.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This review was based solely on published data, with no primary data collection involving human participants, thereby not requiring ethical approval. Additionally, none of the included studies explicitly disclosed financial or nonfinancial conflicts of interest. Consent for publication: Not applicable Competing interests: The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA flowchart diagram for search results across various databases
Fig. 2
Fig. 2
COM-B framework-mapped barriers and facilitators of LARC acceptability and uptake in Ethiopia
See this image and copyright information in PMC

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References

    1. Secura G. Long-acting reversible contraception: a practical solution to reduce unintended pregnancy. Minerva Ginecol. 2013;65(3):271–7. - PubMed
    1. Adde KS, et al. Women’s sexual empowerment and utilization of long-acting reversible contraceptives in Ghana: evidence from the 2014 demographic and health survey. BMC Women’s Health. 2023;23(1):421. - PMC - PubMed
    1. Stark EL, Gariepy AM, Son M. What is long-acting reversible contraception? JAMA. 2022;328(13):1362–1362. - PubMed
    1. Haileyes, K.G., et al., Myth and misconception about long-acting reversible contraception use among reproductive age group women in Debre Berhan governmental health centers, Ethiopia: qualitative study. 2023. 8(1): e65.
    1. Geberemariam WT, Mekonnen B, Asfaw HM et al. Acceptance of an immediate post-partum intrauterine contraceptive device and associated factors among women who gave birth in public hospitals of Addis Ababa, Ethiopia: A cross-sectional study. June 2024, PREPRINT (Version 1) available at Research Square. 10.21203/rs.3.rs-4429728/v1.

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