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

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.