What contraceptive side effects are women told about during counseling? Evidence from PMA Ethiopia 2019 cross-sectional survey

Background Despite widespread concerns about contraceptive side effects, few studies explore the specific side effects women are told about during contraceptive counseling. This study explored patterns of counseling on specific side effects by user characteristics in Ethiopia. Methods Data were collected from a nationally representative sample of women between October and December 2019. Analyses were restricted to 2,039 current users of hormonal contraception or the non-hormonal IUD. Descriptive analyses identified the types and number of side effects, across all methods and by the injectable, implant, and pill. Multinomial regression identified factors associated with receipt of counseling on bleeding changes only, non-bleeding changes only, or both, relative to no counseling on side effects, adjusting for method type, source, and socio-economic characteristics. Results Less than 10% of users were told of at least one bleeding and non-bleeding side effect. Relative to implant users, injectable and other method users were less likely to be told about bleeding changes only (aRRR: 0.65, 95% CI: 0.46-0.93 and aRRR: 0.31, 95% CI: 0.16-0.61, respectively) and users of other methods were less likely to be told about both a bleeding and non-bleeding change (aRRR: 0.43, 95% CI: 0.19-0.93). Users who received their method from a non-public source were less likely to receive counseling on any kind of side effect and nulliparous women were less likely to be told about both kinds of side effects. Conclusion There is need to improve counseling in the private sector. Research to understand provider barriers to counseling on side effects is needed.