Beyond Uptake: High Discontinuation and Missed Reinjection Rates Among Injectable Contraceptive Users in Peri-Urban Ndola, Zambia

Background: Injectable contraceptives are the most commonly used modern contraceptive method in sub-Saharan Africa, including Zambia, where they account for 47% of modern contraceptive use among married women. Despite their popularity, discontinuation rates remain high, with over 30% of users discontinuing within 12 months. Understanding the factors associated with injectable contraceptive discontinuation and missed reinjections is essential for improving reproductive health outcomes. This study assessed factors associated with injectable contraceptive discontinuation, missed reinjections, and overall utilization among women at Chipokota-Mayamba Clinic in Ndola, Zambia. Methods: A cross-sectional study was conducted among 132 women of reproductive age (15-49 years) who were current or former users of injectable contraceptives attending Chipokota-Mayamba Clinic. Systematic random sampling was employed, achieving a 91.7% response rate. Data were collected using a structured interviewer-administered questionnaire assessing sociodemographic characteristics, utilization patterns, medication-related factors, and healthcare system factors. Descriptive statistics and chi-square tests were used for analysis. Results: The majority of respondents were aged 25-34 years (41.8%), married (61.0%), had secondary education (46.6%), and were unemployed (41.8%). A substantial proportion (43.2%) had discontinued injectable use, and 51.5% had delayed or missed a scheduled reinjection. Side effects were experienced by 71.2% of users, with irregular bleeding (71.3%) and weight gain (61.7%) being most common. Healthcare system factors including stockouts (25.8%), inadequate counseling on side effects (18.9% received no explanation), and privacy concerns (26.5%) were prevalent. Factors significantly associated with current use included partner support (p<0.001), knowledge of return schedule (p<0.001), provider-client communication (p=0.002), privacy (p=0.010), educational attainment (p=0.022), household income (p=0.031), and stockouts (p=0.038). Among those who discontinued, side effects (54.4%) and fear of infertility (36.8%) were the main reasons for discontinuation. Conclusion: Injectable contraceptive discontinuation and missed reinjection rates at Chipokota-Mayamba Clinic are associated with multifaceted factors including sociodemographic characteristics, medication-related concerns, and healthcare system challenges. Targeted interventions addressing side effect management, male involvement, health education, and service delivery improvements are urgently needed to enhance contraceptive continuity.