Factors influencing preference for short-term over long-term contraceptives among women in northern Uganda. A mixed-methods study.

introductionModern contraceptives have contributed to reduction of unintended pregnancy among the women of reproductive age (15 to 49) globally. Use of long-term reversible contraceptives is low (13%) in Uganda yet they are cost-effective. This study aimed to identify factors influencing preference of short-term reversible contraceptives over long-term methods among women of reproductive age attending the family planning clinic at Lira Regional Referral Hospital (LRRH).

methodWe performed a mixed-methods cross-sectional study, in which structured interviews were administered to 220 family planning users from December 2022-February 2023, data were analyzed using IBM SPSS Statistics version 29 and cleaned prior to analysis. Descriptive statistical analyses were performed to summarize participant characteristics and contraceptive preferences, and results were presented using tables and figures. Frequencies, percentages, and cross-tabulations were computed. Bivariate analysis using binary logistic regression was conducted to assess associations between independent variables and preference for short-term versus long-term reversible contraceptive methods. Crude odds ratios (CORs) with 95% confidence intervals (CI) were reported. Variables with a p-value ≤ 0.05 at bivariate analysis were included in a multivariate binary logistic regression model to identify independent predictors of contraceptive method preference. Adjusted odds ratios (AORs) with 95% CI were calculated, and statistical significance was set at p-value ≤ 0.05. Qualitative data were audio-recorded, transcribed verbatim, and analyzed using applied thematic analysis. Atlas.ti version 23 was used to support data organization and coding. Analysis followed an iterative process involving open coding, development of summary memos, and construction of a structured codebook. Related codes were grouped into overarching domains, with sub-themes used to organize emerging patterns. Coded transcripts were reviewed and synthesized, and representative participant quotes were selected to provide contextual understanding of factors influencing women's contraceptive method preferences. Discrepancies in coding and interpretation were resolved through consensus discussions among the research team. Ethical approval was obtained from Gulu Research and Ethics Committee (GUREC), and administrative clearance from Lira Regional Referral Hospital and Informed consent /assent from study participants.

resultsOf 220 women 63.6% preferred short term, 36.4% preferred long-term reversible contraceptive methods. Age between 25-34 years were 47.7%, 91.8% were married, and 70.5% attained primary education. Reasons for preference of short-term contraceptives were; less side effects 50%, protection for a short period of time 21.4%, confidentiality 28.6%. Partners approval (AOR: 0.253, 95% CI: 0.194-0.680, P=0.006), was significantly associated with short term preference. Providers cited confidentiality, quick return to fertility, and of methods availability as influence for short-term preference.

conclusionThis study found that women of reproductive age predominantly preferred short-term reversible contraceptive methods. Despite the effectiveness and cost-efficiency of long-acting contraceptives, their uptake remains low due to socio-cultural factors, misconceptions, and health system barriers. Strengthened client-centered counseling, consistent method availability, community education, and male engagement are essential to improve informed choice and increase uptake of long-acting reversible contraceptives.