Effectiveness and continuation rates of the etonogestrel‐subdermal contraceptive implant versus short‐acting contraceptive methods offered at no cost in Campinas, Brazil

Abstract

ObjectivesTo compare the efficacy, reasons for discontinuation and continuation rates of the etonogestrel (ENG)‐subdermal contraceptive implant when offered at no cost, and the basis of free choice versus short‐acting reversible contraceptive (SARC) methods including combined oral contraceptives (COCs), once‐a‐month injectables, vaginal ring, and patch.MethodsWe conducted a prospective study at the University of Campinas, Brazil, involving women aged 18 to 40 years. They were counseled on various contraceptive methods before entering the study and followed up every 3 months for up to 24 months. Satisfaction was assessed using a Likert scale. Survival rates were estimated using the Kaplan–Meier test, and curve comparisons were performed using the log‐rank test.ResultsWe enrolled 609 women including 358/609 women (58.8%) who chose the ENG‐implant and 251/609 (41.2%) who chose SARC methods. Contraceptive failure and all other reasons for discontinuation were significantly higher in SARC users compared to the ENG‐implant users (P < 0.001 and P = 0.002, respectively). The continuation rate was higher among ENG‐implant users (89.9% and 75.4%) compared to SARC methods users (27.2% and 15.9%) up to 1 and 2 years after study initiation, respectively. Satisfaction was high in both groups (>82%).ConclusionsThe ENG‐implant showed higher contraceptive effectiveness and higher continuation rates than SARC methods up to 2 years after study initiation. Furthermore, users from both groups were highly satisfied with their contraceptive. The main reason for discontinuing use of the ENG‐implant was bothersome uterine bleeding, while for SARC methods it was for personal reasons.