Misconceptions or local realities? A biosocial approach to understanding variation in hormonal contraceptive side-effects in Ethiopia

Thesis

Background: Contraceptive side-effects are the main reason for dissatisfaction with and discontinuation of hormonal contraceptives globally. Yet, side-effects are commonly dismissed as misconceptions, in part due to the paucity of data on contraceptive side-effects outside of clinical contexts. This project aims to investigate variation in hormonal contraceptive side-effect experiences and their impacts in Ethiopia using a biosocial approach.

Methods: This DPhil project employed a mixed-methods exploratory sequential design. Primary qualitative research captured how women in Ethiopia describe side-effect experiences and the perceived drivers of side-effect risk. A secondary data analysis investigated physiological risk factors for injectable discontinuation due to side-effects in a large, nationally representative sample. Finally, an observational prospective cohort study of injectable and implant users and non-user controls in central Oromia investigated side-effect prevalence over time and identified predictors of side-effect risk and their impacts.

Findings: Qualitative discussions revealed women’s perceptions that harsh physical workloads and nutritional stress left women at an increased risk of side-effects. These predictions were supported by quantitative findings at both national and a local level. Nationally, anaemic women were twice as likely to have discontinued taking the injectable contraceptive due to side-effects. Locally, in central Oromia, injectable and implant users who had occupations involving physical labour, who had poorer quality diets or were food insecure, or who had symptoms of infection prior to initiation experienced the most side-effects, which negatively impacted their daily activities.

Interpretation: For many women in Ethiopia, contraceptive side-effect experiences were more than misconceptions or minor concerns. Instead, I argue that side-effects should be understood as local realities, with negative side-effect experiences and impacts felt particularly by those already facing conditions of hardship and uncertainty. Building on these findings, we can begin to move away from the current one-size-fits-all model of contraceptive development and prescription to minimise side-effects and better meet women’s contraceptive needs.

Authors: Stevens, R

• DOI: 10.5287/ora-zrw7d07gx
• Type of award: DPhil
• Level of award: Doctoral
• Awarding institution: University of Oxford
• Language: English
• Keywords: reproductive justice; contraceptive side-effectss; local biologies; family planning; contraception; biosocial theory; Ethiopia
• Subjects: Reproductive rights; Anthropology; Reproductive health; Demography