Published in PLOS One on 2026-03-27, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. Health Signal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original authors: Andamlak Gizaw Alamdo, Agnes M. Kotoh, Emefa Judith Modey, Juliana Yartey Enos
Source: PLOS One • DOI 10.1371/journal.pone.0345855
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
The sexual and reproductive health (SRH) service provision in conflict-affected populations has been continually overlooked. International and local relief organizations have begun to recognize the neglect of women’s SRH needs; however, SRH services and humanitarian responses remain suboptimal. Contraceptive discontinuation is a significant public health issue with considerable impact on family planning (FP) programs, as well as on women’s SRH and population growth. There is scarce information regarding the dynamics of contraceptive use in refugee areas. Evidence on contraceptive use dynamics is vital, especially now, as the global refugee crisis grows. Therefore, this study aimed to examine first-year contraceptive discontinuation and associated factors among married women initiating long-acting reversible contraceptives (LARC) and short-acting contraceptives (SAC) in selected refugee populations in Ethiopia.
A retrospective cohort study was conducted among 551 married women in selected refugee populations in Ethiopia. After reviewing FP registries, all eligible women who initiated a contraceptive method 12–18 months before data collection were included in the study. Through computer-assisted face-to-face interviews, data on the socio-demographic, reproductive, and contraceptive use history of women were collected. Key characteristics of SAC acceptors and LARC acceptors were compared using chi-square statistics and t-tests. A multivariable Cox proportional hazards model identified the predictors of time to contraceptive discontinuation during the first year of use. In addition, adjusted hazard ratios (aHR), 95% CI, and P-values were calculated to determine the magnitude and precision of the association.
The 12-month discontinuation rate for all contraceptive methods was 41.2% (95% CI: 37.2–45.4). The discontinuation rate for SAC (44.94%) was higher than LARC (32.32%) (P ≤ 0.001). The factors associated with 12-month discontinuation include method type (aHR = 1.50;95% CI:1.06–2.12), residence (aHR = 1.83;95% CI:1.24–2.70), husband occupation (aHR = 0.49;95% CI:0.29–0.84), length of stay in the refugee camp (aHR = 0.95;95% CI:0.92–0.99), and intention to use contraceptives in the future (aHR = 0.15;95% CI:0.11–0.21).
A high rate of early contraceptive discontinuation was documented among refugee women, with a higher discontinuation rate among SAC acceptors. To improve contraceptive service provision and maintain continuous use of the methods initiated, targeted interventions, such as improved counselling and promotion of long-acting contraceptive methods, especially among urban refugee women, are crucial.
Introduction
Ethiopia is the third-largest refugee-hosting nation in Africa. The country is home to over 1 million officially registered refugees and asylum seekers. South Sudan, Somalia, and Eritrea account for the majority of refugee communities [1]. Women in humanitarian settings are often unable to find contraceptive methods when only a small number would desire to become pregnant [2,3]. In addition, as a strategy for war and conflicts, women and girls are at increased risk of early and forced marriage, sexual and gender-based abuse, sexual exploitation, and transactional sex [3,4]. Therefore, refugee women critically need access to contraception for multiple reasons [4,5]. Contraception can help women plan and space their pregnancies so as not to risk having a very young baby with inadequate medical care [3]. Moreover, contraceptive provision can reduce maternal mortality and morbidity from unwanted pregnancies and unsafe abortions and help to prevent sexually transmitted infections from spreading within the population [6]. Furthermore, access to safe and reliable contraception can empower displaced women to make decisions about their bodies that are otherwise denied by society [4,7].
Reading this evidence
Use the full paper to check the study design, participant selection, comparator and outcome definitions before drawing a practical conclusion. An association does not by itself show cause and effect. A reported performance measure needs its denominator and uncertainty. A finding from a particular facility, sample or time period should retain that scope when it is discussed elsewhere.
This briefing makes the source accessible within the wider research & evidence desk. It does not assess an individual patient or certify a product. When considering relevance to another health system, examine the original authors’ account of context and limitations, then seek local implementation evidence. The related reporting below provides other studies to read alongside this one; it is a topic connection, rather than a claim that their results are directly comparable.
© 2026 Andamlak Gizaw Alamdo, Agnes M. Kotoh, Emefa Judith Modey, Juliana Yartey Enos. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by Health Signal. The researchers are the authors of the source study, not members of Health Signal’s staff.
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