Discontinuation of family planning use among women of reproductive age in Rwanda: analysis from three Rwandan Demographic Health Survey (RDHS) 2010-2020.

Background: Family planning (FP) is fundamental in addressing unwanted pregnancies, unplanned pregnancies, unsafe abortions, maternal and child mortalities. It plays a crucial role in achieving the Sustainable Development Goals (SDGs), especial Goal 3. However, despite a high FP discontinuation percentage of 30% in Rwanda, there is limited studies on the contributing factors. Thus, the purpose of this study was to assess the discontinuation of FP use and associated factors among women aged 15-49 years in Rwanda.

Methods: A pooled data analysis of three consecutive Rwandan Demographic and Health Surveys (RDHS) for the years 2010-11, 2014-15, and 2019-20 was performed using Stata Version 17.0. A multistage stratified sampling method was used to select study participants, and weighted analysis was conducted. Both bivariate and multivariate logistic regression models were used to identify factors associated with FP discontinuation. A statistical significance was determined at p < 0.05.

Results: The findings showed that 17%, 28%, and 29% of Rwandan women of reproductive age discontinued using FP in 2010-11, 2014-15, and 2019-20, respectively. Pooled multivariate analysis indicated that FP discontinuation rates was more than double folds higher in 2014-15 (AOR: 2.17; 95% CI: 2.01 to 2.35) and 2019-20 (AOR: 2.71; 95% CI: 2.49 to 2.93) compared to 2010-11. The odds of FP discontinuation were higher among women aged 20-34 years (AOR: 7.71; 95% CI: 5.87 to 10.13) and women aged 35-49 years (AOR: 3.43; 95% CI: 2.59 to 4.55); those with four or more children (AOR: 1.38; 95% CI: 1.28 to 1.49); women from poor households (AOR: 5.19; 95% CI: 1.85 to 14.57); those who attending a health facility in the last year (AOR: 1.56; 95% CI: 1.46 to 1.66); women with a history of pregnancy termination (AOR: 1.17; 95% CI: 1.09 to 1.26); those with no education (AOR: 1.39; 95% CI: 1.28 to 1.51) and currently married women (AOR: 11.57; 95% CI: 10.21 to 13.10). Additionally, the most common reasons for FP discontinuation were fear of side effects (31.2%) and the desire to become pregnant (27.5%).

Conclusions: The trend of FP discontinuation among reproductive-age women in Rwanda has significantly increased from 200 - 11 to 2019-20. Key contributing factors include region, older age, higher parity, poor household status, health facility attendance, history of pregnancy termination, lack of education, being married and fear of side effects. Therefore, interventions should focus on addressing these factors to reduce FP discontinuation rates.