Quality matters: the role of service quality in discontinuation of long-acting reversible contraceptives in Sub-Saharan Africa; systematic review and meta-analysis.

Background: Long-acting reversible contraceptives (LARC) are safe, reliable, and convenient for women in low and lower-middle-income countries with limited access to healthcare. Despite the progress in the uptake of LARCs, early discontinuation remains a significant issue. Discontinuation is an important indicator of the quality and effectiveness of family planning services; however, no reviews investigate this relationship in Africa. This systematic review and meta-analysis aimed to assess the effect of the quality of family planning services on LARC discontinuation in Sub-Saharan Africa.

Methods: We conducted a comprehensive search using electronic databases, including EMBASE, Medline, Web of Sciences, Scopus, CINAHL, and ProQuest, which was supplemented by manually searching relevant articles. The Newcastle- Ottawa Scale (NOS) assessment tool was used for quality appraisal. The I² statistic and Cochrane Q test were used to assess the heterogeneity of the studies. The results were reported per the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. To assess publication bias, funnel plots and Egger's test were employed. A random-effects meta-analysis was conducted to estimate the overall effect size.

Result: Twenty articles with 9,774 reproductive-aged women were included in this systematic review and meta-analysis. Women who did not receive family planning counselling services had 2.59 times the odds of discontinuing LARC use than those who received counselling services (POR = 2.59; 95% CI = 1.81 to 3.72). Moreover, women dissatisfied with their family planning services had 4.67 times the odds of discontinuing LARC use than those who were satisfied (POR = 4.67; 95% CI: 3.11 to 7.01).

Conclusion: Enhancing the quality of family planning counselling and addressing client dissatisfaction are essential strategies for reducing LARC discontinuation in Sub-Saharan Africa. Policymakers and healthcare providers should prioritise improvements in service quality by strengthening counselling services and promoting a more client-centred approach to enhance client satisfaction. Given the persistent issue of FP discontinuation in the region, these findings underscore that further research using robust, quality measures and a longitudinal or interventional design is needed to understand causal relationships and guide service improvements.