High Burden of Contraceptive Failure among pregnant women in Addis Ababa: A Facility-Based Study

Abstract Background Contraceptive failure is a major global reproductive health issue, refers to the occurrence of unexpected pregnancy despite the use of a contraceptive method. It is associated with factors such as age, education, marital status, contraceptive method, parity and adherence. In Ethiopia, contraceptive failure rates are reported at 9.1–10.3%, but studies are limited and mainly focus on women seeking abortions, overlooking those who continue pregnancies. The current study aims to provide updated data on magnitude and associated factors of contraceptive failure among pregnant women attending ANC in Addis Ababa, Ethiopia. Methods A cross sectional study was conducted among 385 pregnant women attending ANC with prior contraceptive use. Data was collected through structured interviewer-administered questionnaires addressing sociodemographic characteristics, contraceptive practices, and adherence. Statistical analysis was performed using SPSS version 27. Bivariate and Multivariate logistic regression analysis were performed with p- values of < 0.25 and < 0.05 respectively. Results Women younger than 25 years accounted for 23.1% of the participants. Two-third had completed secondary education and beyond. Second-tier contraceptive were the most commonly used method, reported by over two-third women. The overall contraceptive failure rate was 19.2%(CI: 15.3% – 23.1%). Significant factors included use of third-tier methods (AOR = 5.6, CI: 1.7–18.2), first-tier contraceptive methods (AOR = 0.07, 95% CI: 0.01–0.29), medium adherence (AOR = 8.2, CI: 3.2–21.9), low adherence (AOR = 5.6, CI: 1.9–16.1), prior failure (AOR = 3.0, CI: 1.2–7.7), and having three or more children was associated with vastly increase odds (AOR = 22.2), though with very wide confidence interval (CI: 2.2–285.3). Conclusion The current study revealed a high prevalence of contraceptive failure among pregnant women attending ANC. Contraceptive tier, adherence, parity, and prior failure were strongly associated. Promoting first and second tier contraceptive method, strengthening user education, ensuring adherence and follow-up support for women with past failures may help reduce risk of future contraceptive failure.