A mixed-methods cross-sectional study on early contraceptive implant removal and its associated factors among women implanted attending family planning settings in Bangladesh

Early contraceptive implant removal before the projected duration of use leads to not only high costs and resource wastage but also disclosures women to the risk of unintended pregnancies and accompanying difficulties, resulting in the threat of maternal mortality and morbidity if an alternative contraceptive is not immediately employed. Therefore, we aimed to assess and determine the prevalence and explore the associated factors for early implant removal among the women who had discontinued attending the family planning settings in Bangladesh. A cross-sectional mixed methods study was conducted between January and June 2025 at four government family planning settings. We collected both quantitative and qualitative data using a pretested structured questionnaire on sociodemographic, obstetric, contraceptives, and implant usage and its early removal through in-depth interviews. Additionally, we performed key informant interviews with the providers. We defined early removal as the discontinuation of the implant prior to the intended duration of three years. Out of 370 participants, 116 removed subdermal implants with a mean age of 28.33 ± 4.5 years (95% CI: 27.50-29.16). The proportion of implant discontinuation was 31.35% (n = 116, 95% CI: 26.84–36.25%) and the factors associated with implant discontinuation before the intended duration were irregular menstruation and dysmenorrhea (adjusted prevalence ratio [aPR] = 3.16, 95% CI: 2.39–4.19), desire to conceive (aPR = 2.10, 95% CI: 1.68–2.63), husband’s opposition (aPR = 2.69, 95% CI: 2.07–3.49), switch to alternative contraceptives (aPR = 2.10, 95% CI: 1.58–2.81) and self-reported side effects (aPR = 2.86, 95% CI: 2.09–3.93). From qualitative interviews, we found self-reported side effects and husband’s disapproval as the main reasons for early implant removal. Approximately one-third of the study women had contraceptive implants removed early. Healthcare providers should be more focused on pre- and post-insertion counseling in client-centered communication and common side-effects management. Moreover, male partners should be encouraged, and community women in awareness programs must be engaged to reduce socio-cultural resistance.