Determinants of contraceptive discontinuation among sexually active women in Nigeria: a systematic review

Abstract Introduction Contraceptive use is critical for improving reproductive health and reducing unintended pregnancies, yet many women discontinue its use despite the need for it. In Nigeria, the total fertility rate remains high at 4.8 children per woman, while modern contraceptive prevalence among women of reproductive age is only 17–20%, highlighting persistent gaps in family planning. This systematic review aimed to synthesize evidence on the prevalence, patterns, and determinants of contraceptive discontinuation among Nigerian women. Methods A systematic review was conducted focusing on studies from Nigeria involving sexually active women aged 15–49 years who had previously used contraceptives. Multiple databases were searched using keywords for family planning, discontinuation, and Nigeria. Eligible observational, qualitative, and mixed-methods studies were screened and selected using the PRISMA framework. Data extraction included prevalence, method-specific discontinuation, and reasons for cessation. After screening 12,768 records and removing duplicates, 48 studies were included in the review. Results Discontinuation rates varied by method type. Condoms were discontinued primarily due to behavioral factors, such as inconsistent use, discomfort, or misconceptions, with 12-month discontinuation rates around 17–18%. Oral contraceptives were discontinued within the first 12 months by 21–59% of users, largely due to side effects, daily regimen demands, and personal fertility intentions. Injectables showed discontinuation rates of 19.8–53.3%, mostly within the first 3–6 months, driven by side effects and the desire for pregnancy. Long-acting reversible contraceptives, including implants and intrauterine devices, had lower discontinuation rates (7%–42.9% at 12 months), though early discontinuation was associated with menstrual irregularities, desire for pregnancy, or method-specific side effects. Key determinants of discontinuation included side effects, fertility desires, spousal opposition, cultural or religious beliefs, and poor-quality counselling. Conclusion Contraceptive discontinuation in Nigeria undermines the effectiveness of family planning programmes and contributes to unintended high fertility rates. Policymakers should strengthen national counselling standards, while donors should invest in provider training, follow-up systems, and commodity supply and implementers, including healthcare providers and non-governmental organizations should prioritize client-centered counselling, management of side effects, and community engagement to support sustained contraceptive use. Coordinated action across these levels is essential to reduce unmet need and improve reproductive health outcomes.