Injectable Contraceptives Dominate Modern Method Choices in Urban Eastern Uganda

Injectable contraceptives dominate modern family planning use among women across urban centers in Eastern Uganda, accounting for thirty-six percent of all active method uptake despite persistent structural imbalances and distinct socioeconomic disparities in sustained utilization. Drawing from comprehensive empirical investigations conducted in Jinja City and Iganga Municipality within the Busoga region, a mixed-methods research initiative evaluated both client-side adoption patterns and facility-level service delivery capacities. While no single family planning technology crossed the fifty-percent threshold required to define single-method skew, mathematical evaluation using the average deviation index demonstrated a ten-percent distribution imbalance across modern options. Injectable methods contributed twenty-seven percent of this systemic imbalance, followed in overall prevalence by subdermal contraceptive implants at twenty-four percent and male condoms at twenty percent. These observations highlight that although urban environments are conventionally presumed to offer superior reproductive healthcare access, reliance remains concentrated within a narrow band of popular commodities, leaving broader rights-based method options unevenly distributed across socioeconomic strata.

The investigation utilized secondary datasets assembled through the Urban Thrive Project, an implementation science initiative executed between November 2021 and March 2022 to examine voluntary family planning coverage in rapidly expanding municipal jurisdictions. The study design employed a convergent parallel mixed-methods framework combining a cross-sectional household survey of 1,023 reproductive-aged women between fifteen and forty-nine years old, a systematic health facility assessment of 150 healthcare delivery points, and qualitative inquiries. The sampling strategy spanned five administrative divisions across Jinja and Iganga, selecting five parishes per division and half of all constituent villages through Lot Quality Assurance Sampling protocols. Field teams interviewed twenty households per village alongside workers in high-density informal commercial venues, including salons and open-air markets, to incorporate commuter populations. Qualitative dimensions incorporated twenty key informant interviews with municipal health directors and clinical providers, twenty-four in-depth interviews with reproductive-age community members, and focus group discussions stratified by gender and age cohorts to contextualize decision-making realities.

Supply-side evaluations across the 150 mapped health service delivery points showed widespread baseline availability of modern methods alongside pronounced structural disparities linked to facility tiers. Overall, ninety-seven percent of surveyed health facilities stocked or provided at least one modern contraceptive method at the time of physical audit. Male condoms were accessible in eighty to one hundred percent of facilities, while oral contraceptive pills were available across seventy-three to one hundred percent of service delivery sites. Injectables exhibited consistent cross-tier distribution, with depot medroxyprogesterone acetate administered intramuscularly stocked in fifty-seven to one hundred percent of sites and subcutaneous formulations available in sixty to one hundred percent of facilities. However, long-acting reversible contraceptives exhibited steep institutional concentration. Implants were universally available at Health Centre IVs, while intrauterine devices were universally available in hospitals. Clinical counseling regarding the fertility-awareness Standard Days Method was reported by thirty-five percent of private clinics and drug shops, sixty-seven percent of Health Centre IIIs, half of Health Centre IVs, and all hospitals.

Demand-side analyses revealed that the composition of contraceptive method use shifts noticeably across women’s demographic and socioeconomic characteristics. Younger women aged fifteen to twenty-four predominantly used male condoms and injectables, which contributed twenty-seven percent and seventeen percent respectively to their group’s deviation index of twelve percent. By contrast, among mature adult women aged thirty-five to forty-nine, injectable uptake reached forty-seven percent, while condom utilization dropped to eleven percent, resulting in an average deviation index of ten percent where injectables accounted for forty-one percent of overall deviation. Educational attainment mirrored these structural divergences, as women without formal schooling exhibited an average deviation index of fifteen percent, with injectables representing seventy-seven percent of all recorded modern contraceptive use and half of the subgroup’s total imbalance. Conversely, women who attained secondary or higher education demonstrated a more balanced method profile with an index of nine percent, incorporating injectables at thirty-three percent, implants at nineteen percent, and condoms at twenty-one percent.

Household economic status and residential geography further structured method selection across the study populations. Women occupying the poorest socioeconomic tertile, established through principal components analysis of durable physical assets, home construction materials, and water infrastructure, showed an average deviation index of eight percent. This lower deviation reflected a relatively uniform distribution across injectables at twenty-eight percent, implants at twenty-two percent, and condoms at twenty percent. Among the wealthiest tertile, overall method imbalance rose to twelve percent, driven primarily by high proportional uptake of injectables at thirty-eight percent and implants at twenty-seven percent. Geographical stratification revealed that women residing in informal landing-site slum settlements experienced an average deviation index of twelve percent, higher than mainland slums and upper-income residential quarters, though injectable utilization contributed equally across all zones. Marital status presented contrasting method drivers: unmarried respondents relied predominantly on condoms, which represented fifty-five percent of method use and forty-six percent of subgroup deviation, whereas married women favored injectables, which constituted forty-five percent of use and thirty-five percent of deviation.

Modern contraceptive discontinuation represented a critical primary outcome, with an overall past-year discontinuation rate of seven percent identified among the 727 eligible women who initiated or used modern methods during the preceding twelve months. Method-related physiological side effects and associated health concerns constituted the predominant driver of cessation, reported by ninety percent of women who ceased method use. Interpersonal and domestic dynamics also exerted substantial influence, as direct opposition from male partners or extended family members accounted for forty-one percent of recorded terminations. In contrast, technical method failures leading to unintended pregnancy were cited by nine percent of discontinuing participants, while sociocultural misconceptions regarding permanent fertility impairment were articulated by five percent.

Multivariable logistic regression analysis demonstrated strong associations between sociodemographic characteristics and modern contraceptive discontinuation. Increasing chronological age was associated with higher odds of stopping method use, with women aged twenty-five to thirty-four showing an adjusted odds ratio of 1.33 (95% CI: 1.10–1.60) and those aged thirty-five to forty-nine recording an adjusted odds ratio of 1.62 (95% CI: 1.33–1.97) relative to younger peers aged fifteen to twenty-four. Economic vulnerability emerged as an acute determinant of discontinued use. When compared against wealthy women, individuals from middle-wealth households had an adjusted odds ratio of 2.16 (95% CI: 1.69–2.75), whereas those in the poorest wealth tertile experienced an adjusted odds ratio of 4.77 (95% CI: 3.76–6.06). Formal educational attainment unexpectedly exhibited a positive association with cessation, as women with primary schooling demonstrated an adjusted odds ratio of 3.26 (95% CI: 1.67–6.36) and those with secondary or tertiary education reached an adjusted odds ratio of 6.46 (95% CI: 3.33–12.55) compared to individuals lacking formal schooling.

Household decision-making structures and access to community information channels yielded pronounced protective effects against modern contraceptive discontinuation. Relative to women whose reproductive health choices were dictated by external acquaintances or relatives, participants making choices jointly with their spouses exhibited an adjusted odds ratio of 0.62 (95% CI: 0.41–0.95), while those whose husbands functioned as primary decision-makers recorded an adjusted odds ratio of 0.58 (95% CI: 0.48–0.69). Exposure to verified family planning information across mass media, digital communication channels, posters, or community health workers proved exceptionally protective, reducing the likelihood of discontinuation by ninety percent (aOR: 0.10; 95% CI: 0.08–0.12). Residential environment also conferred protective benefits, as women living in landing-site slums (aOR: 0.40; 95% CI: 0.32–0.50) and mainland slums (aOR: 0.72; 95% CI: 0.61–0.85) were significantly less likely to discontinue compared to residents of planned commercial and residential neighborhoods. Married women were likewise less likely to stop using contraception than their unmarried peers (aOR: 0.69; 95% CI: 0.58–0.82).

Inductive thematic analysis of qualitative interviews unpacked the complex personal considerations governing modern contraceptive method selection and persistence through four overarching dimensions: accessibility, side effect management, intimate relationship dynamics, and procedural ease of use. Accessibility encompassed not only monetary commodity prices but also geographic reach through village health teams and practical domestic storage conveniences. Injectable contraceptives and condoms were particularly valued due to their widespread availability across both facility and community-based distribution channels. Implants were often viewed cautiously due to concerns about changes in appetite and libido, while injectable methods, particularly DMPA-SC, were perceived as having fewer or more manageable side effects. In contrast, condoms and intrauterine devices were frequently described as acceptable due to minimal or tolerable side effects. Relationship negotiations critically dictated method modalities, with condoms used for dual infection protection in unstable partnerships, while covert injectable use permitted reproductive autonomy in households where male partners actively opposed contraception.

The study authors highlighted several methodological considerations that contextualize these municipal findings. A key structural strength of the investigation was its convergent integration of quantitative household surveys, extensive physical health facility audits, and qualitative narrative transcripts across diverse urban microenvironments. Conversely, the cross-sectional collection of retrospective twelve-month discontinuation data relied on participant recall without prospective time-to-event tracking, limiting causal inference regarding longitudinal adherence pathways. Facility inventories reflected single-visit audits that could not capture episodic commodity stockouts or seasonal supply chain bottlenecks, and broader cultural norms influencing reproductive behavior were not comprehensively modeled. The investigators concluded that addressing urban contraceptive imbalances requires health systems to advance beyond passive product provision. Expanding long-acting reversible method availability within primary healthcare clinics, financing targeted economic subsidies for low-income women, and instituting comprehensive counseling regarding side-effect mitigation represent vital programmatic imperatives to ensure sustained voluntary family planning across urban Eastern Uganda.

Subject of Research: Modern contraceptive method mix and discontinuation factors in urban Eastern Uganda

Article Title: Modern contraceptive discontinuation and demand-and-supply-side method-mix in urban settings in Eastern Uganda: a mixed methods study

Article References: Wasswa, R., Ssanyu, J. N., Birabwa, C., Kizito, F., Waiswa, P., & Kananura, R. M. (2026). Modern contraceptive discontinuation and demand-and-supply-side method-mix in urban settings in Eastern Uganda: a mixed methods study. Contraception and Reproductive Medicine, 11(1), Article 27. https://doi.org/10.1186/s40834-026-00450-2

Image Credits: AI Generated

DOI: 10.1186/s40834-026-00450-2

Keywords: contraceptive discontinuation, method mix, injectable contraceptives, Jinja City, Iganga Municipality, Eastern Uganda, Urban Thrive Project, subdermal implants, male condoms, average deviation index, family planning access, health facility assessment, reproductive health, side effects, partner opposition, slum settlements, mixed methods research