Acceptability and Uptake of Long-Acting Reversible Contraceptives in Ethiopia: A Systematic Review and Meta-Analysis

Despite their high effectiveness, the acceptability and utilization of long-acting reversible contraceptives (LARCs) in Ethiopia remain low and vary across population groups and regions. This systematic review and meta-analysis aimed to estimate the pooled levels of LARC acceptability and utilization by method type, population subgroup, and study context to inform reproductive health programming and policy.

A comprehensive search was conducted across PubMed, EMBASE, Scopus, and EBSCOhost (CINAHL), along with grey literature sources including Google Scholar and Google. Studies published between 1st January 2021 and 30th June 2024 that focused on adolescents, reproductive-age women, female healthcare providers, and communities in both rural and urban settings in Ethiopia were included. Pooled estimates were calculated using a random-effects model, and heterogeneity was assessed using the I² statistic. The review protocol was registered with PROSPERO (CRD42024594288). Findings were presented as proportions with corresponding 95% confidence intervals.

Out of 527 records identified, 50 studies comprising a total of 83,082 participants met the inclusion criteria. The pooled acceptability of LARCs (implants or IUCDs) was estimated at 24% (95% CI: 18%-31%), with implants alone showing higher acceptability at 26% (95% CI: 12%-49%) compared to IUCDs at 19% (95% CI: 12%-30%). The overall utilization of LARCs was 20% (95% CI: 15%-27%), with the highest uptake observed among women in the immediate postpartum or postabortion period at 30% (95% CI: 21%-39%). Utilization of implants alone was 15% (95% CI: 11%-20%), while IUCD use remained lower at 5% (95% CI: 4%-7%), with slightly higher usage in urban areas (9%). Considerable heterogeneity was detected across studies, with I² values exceeding 90%.

LARC acceptability and utilization remain suboptimal in Ethiopia, particularly among adolescents and rural populations. Implants are more widely accepted and used than IUCDs. These findings indicate the need for targeted, context-specific interventions to address demographic, cultural, and health system-related barriers to LARC uptake.