Patterns and Drivers of Contraceptive Discontinuation Among Women of Reproductive Age in Sub-Saharan Africa: A Systematic Review

Background Contraceptive discontinuation remains a major challenge to family planning programs in Sub-Saharan Africa, undermining progress toward reducing unintended pregnancies and improving reproductive health outcomes. Understanding the prevalence and reasons for discontinuation is essential for guiding interventions and policy. Therefore, this systematic review aimed to estimate the pooled prevalence of contraceptive discontinuation among women of reproductive age in sub-Saharan Africa and to identify the most reported reasons for discontinuation. Methods This systematic review was conducted in accordance with PRISMA guidelines and registered with PROSPERO (CRD420261388381). PubMed, Web of Science, Google Scholar, and the Cochrane Library were searched for studies published between January 2000 and December 2025. Eligible studies included women aged 15–49 years who had initiated and subsequently discontinued a contraceptive method. Data extraction was performed independently by two reviewers, and study quality was assessed using the Joanna Briggs Institute checklist for prevalence studies. Contraceptive discontinuation prevalence was calculated as the proportion of women who discontinued a contraceptive method among all contraceptive users in each study. Reported reasons for discontinuation were grouped into six categories: side effects, contraceptive failure, desire for a more effective method, partner opposition, pregnancy intention, and other reasons. Findings were synthesized descriptively. Results Seven studies conducted across five countries met the inclusion criteria, comprising a total sample of 22,636 women. Overall, 7,865 cases of contraceptive discontinuation were identified, yielding a pooled prevalence of 34.7%. Prevalence varied widely across studies, ranging from 25% to 71.9%, with nationally representative DHS datasets reporting consistent estimates between 32% and 36%. Six studies (n = 7,430 discontinuations) reported reasons for discontinuation. Side effects were the most frequently cited reason (21.8%), followed by desire for a more effective method (12.8%) and pregnancy-related intentions (8.2%). Partner opposition (6.9%) and contraceptive failure (3.7%) were less common, while other reasons such as inconvenience, access issues, and medical concerns were variably reported. Conclusions Contraceptive discontinuation is prevalent across Sub-Saharan Africa, with side effects and dissatisfaction with method effectiveness emerging as the leading drivers. These findings underscore the need for improved counseling, expanded method mix, and strengthened health system support to address discontinuation and enhance sustained contraceptive use.