Contraceptive discontinuation rate and associated factors among reproductive-age women in Ethiopia: evidence from the 2023 performance monitoring for action cross-sectional survey

Contraception is used to prevent unintended pregnancies, space births, improve reproductive health, and enhance quality of life. Despite increased use of modern contraceptive methods in Ethiopia, contraceptive discontinuation remains a major public health challenge. It increases the risk of unintended pregnancies and related adverse reproductive health outcomes. However, updated evidence on contraceptive discontinuation rate and its determinants using recent nationally representative data is limited. Therefore, this study aimed to assess the 12-month contraceptive discontinuation rate and identify associated factors among reproductive-age women in Ethiopia using Performance Monitoring for Action (PMA) data. This study used data from the 2023 Ethiopia PMA cross-sectional survey, which included a retrospective 24-month contraceptive calendar, to assess discontinuation within 12 months of method initiation. Analyses were conducted in Stata 17. We estimated discontinuation rates and used multilevel binary logistic regression to identify independent factors. The intraclass correlation coefficient (ICC) was calculated to assess the need for multilevel modeling. Variables with p-values < 0.25 in bivariable analysis were included in the multivariable model, and p-values < 0.05 was considered statistically significant. Model comparison was performed using the log-likelihood ratio (LLR). A total of 1,552 women (weighted n = 1,590), contributing 1,756 contraceptive-use episodes (weighted n = 1,816), were included in the analysis. The 12-month contraceptive discontinuation rate was 22.39% (95% CI: 19.98–25.00%), with the highest discontinuation observed among injectable users. The null model indicated significant between-woman variation in contraceptive discontinuation (ICC = 50.51%). In the fixed-effects model, the use of long-acting contraceptive method (AOR = 0.16; 95% CI: 0.08–0.31), experiencing reproductive coercion (AOR = 2.18; 95% CI: 1.17–4.05), and being multiparous (AOR = 0.20; 95% CI: 0.10–0.42) were significantly associated with contraceptive discontinuation rate. Contraceptive discontinuation remains an important public health concern in Ethiopia. Contraceptive method type and reproductive characteristics were associated with discontinuation. Strengthening informed contraceptive choice and improving women’s reproductive autonomy may support contraceptive continuation.