Contraceptive side-effect counselling: women’s experiences in Ethiopia and Kenya

Abstract

The magnitude of contraceptive non-use attributed to side effects globally merits concerted attention to ensure women receive quality side effect counseling and support in line with their goals. Evidence shows comprehensive contraceptive counseling can help women navigate side effects, yet survey data reveal consistent gaps in side effect counseling quality. To elucidate women’s lived experiences with side effect counseling and management, we examined how women in Kenya and Ethiopia manage contraceptive side effects with and without help from healthcare providers, and what their preferences are for support.

We conducted in-depth interviews with sexually active women of childbearing age (N = 83) in Nairobi and Kisumu, Kenya, and Addis Ababa and Amhara region, Ethiopia. Participants were asked about their contraceptive experiences, including side effects, how they managed side effects, what support they received, and their preferred approaches for receiving support when experiencing side effects. We utilized a modified grounded theory approach for data collection and analysis.

We found gaps in reported counseling quality among women in our sample, and a desire for more comprehensive counseling on side effects during initial and follow-up visits. After experiencing side effects, most participants described enduring and self-managing with over-the-counter remedies, and seeking clinical advice only when they worried about how their contraceptive method was affecting their overall health. Follow-up services often addressed participants’ immediate needs, but rarely offered additional information or comprehensive counseling. A few participants were denied a desired contraceptive device removal or shamed for not using contraception.

We identified a need to improve anticipatory contraceptive side effects counseling and proactive follow-up approaches that support women to choose methods they prefer and then navigate their use or switching. Such counseling would help health systems become more responsive to patient needs in contexts where women’s suffering is often considered acceptable, rather than cause for intervention.

Introduction

Globally, many women are deterred from using contraception due to fear of side effects [1–4] or discontinue contraception when side effects are uncomfortable or difficult to manage [5–8]. Sub-Saharan Africa is an area in which many women who do not desire pregnancy are not using contraception [9,10], with two recent systematic reviews highlighting side effect fears as a common barrier to contraceptive use among both younger and older women in the region [11,12]. In Ethiopia, 16% of women who are not trying to get pregnant cite health concerns, including side effects, as a reason for not using contraception [13], while a recent study in Kenya found that 61% of participants who reported a reason for switching contraceptive methods cited side effects as their main concern [5].

Notably, while contraceptive use can convey many direct and indirect health benefits [14–17] by enabling women to choose when and how to have children, some women may make an informed decision that the benefit of preventing pregnancy does not outweigh the potential side effects or social consequences associated with using contraception [18]. However, nonuse or discontinuation of contraception due to lack of high-quality information or support for managing side effects represent missed opportunities to better enable women to manage fertility in line with their preferences. Indeed, contraceptive counseling that includes information on potential side effects has been associated with continued use of family planning among women wanting to prevent pregnancy [19]. Further, evidence shows that when providers counsel specifically on side effects, clients are significantly more likely to use contraception and to seek care if they experience side effects [20–22].