Modern contraceptive discontinuation and demand-and-supply-side method-mix in urban settings in Eastern Uganda: a mixed methods study

Family planning (FP) is a key public health intervention with broad health, social, and economic benefits. However, access and sustained use remain limited in many low- and middle-income countries. In Uganda, rapid urbanization presents new challenges, including inequities in modern contraceptive access and continuity. We examined how demand- and supply-side factors influence method mix and discontinuation in the urban settings of Jinja and Iganga in Eastern Uganda. We used secondary data from the Urban Thrive Project collected from November 2021 to March 2022 in Jinja City and Iganga Municipality. The dataset included 1,023 women (15–49 years), a health facility assessment (N = 150), and qualitative data from 24 in-depth interviews and 12 focus group discussions. Quantitative analysis assessed modern contraceptive method mix using method skew and the average deviation (AD) index, with logistic regression used to identify factors associated with discontinuation. Qualitative data were thematically analyzed using an inductive approach to explore factors shaping modern contraceptive method choice and discontinuation. Demand-side modern contraceptive method mix was dominated by injectables (36%), implants (24%), and condoms (20%) with AD index (10%) confirming an imbalance in method use. Condom use was more common among younger and unmarried women, while implants were reported mostly by wealthier and more educated women. Qualitative findings underscored accessibility, affordability, and relationship dynamics as key determinants of modern contraceptive method choice and continuity. Modern contraceptive method discontinuation rate was 7%, mainly due to side effects and partner opposition and was more likely among women aged 35–49 (aOR = 1.33; 95% CI: 1.13–1.57), the poor (aOR = 4.77; 95% CI: 3.76–6.06), and those with secondary/higher education (aOR = 8.84; 95% CI: 4.60–16.98). Conversely, being married (aOR = 0.86; 95% CI: 0.75–0.99) and exposed to FP information (aOR = 0.18; 95% CI: 0.16–0.21) were protective. The imbalance in method mix and the reported discontinuation rate reflect supply- and demand-side limitations, with implications for voluntary FP. Addressing these through broader method availability, better counseling, and accurate information is key to supporting informed and sustained use.