Background: Long-acting reversible methods of family planning methods are assumed to be safe and highly effective and it serves the need of the users for a long period of time. In Ethiopia, despite the huge investment being incurred in these commodities by the government and partners, a premature removal of the Long-acting Reversible Family Planning (PR-LARFP) method has been increasing or not decreasing as expected. Therefore, the purpose of this study was to explore the reasons and contributing factors for the premature removal of the LARFP methods in Ethiopia.

Method: A qualitative study was employed in seven selected regions and city administration including Oromia, Somali, Afar, Gambela, Harar, Addis Ababa and Dire Dawa based on the level of premature removal of LARFP from the Health management information system (HMIS) report of the Federal Ministry of Health. We conducted 81 in-depth interviews and key informant interviews with women who had prematurely removed a LARFP method, women who adhered to using the LARFP method, family planning providers, husbands, community influential, and family planning key stakeholders from various organizations with different levels of involvement. The tape-recorded interviews were transcribed and translated in to English. The transcripts were coded and analysed using the QCAmap2020 software. The inductive content analysis was conducted in which subcategories were grouped under identified outstanding categories.

Results: Study participants have pointed out that side effects, husband’s imposition, desire to get pregnant, misconceptions and myths about LARFP methods, pressure from friends and close family members, and being divorced were the main reasons for premature removal of LARFP methods. The study also revealed poor quality counselling service, provider bias, intolerance for the early phase of the side effects by the clients and low attention by the responsible bodies as some of the contributing factors that are associated with the premature removal of LARFP methods.

Conclusion: Although LARFP utilization is being improved, premature removal of LARFP methods appears to be one of the factors obscuring the achievements. On top of the communities’ poor attitude towards family planning due to misconceptions and rumours, poor quality of counselling on the benefits and possible side effects of LARFP methods put the women in difficult decision, the choice to remove the method as early as possible. Findings from the present study suggests the need for coordinated and comprehensive interventions aimed at addressing challenges of premature removal of LARFP methods among all stakeholders including family planning clients, family, community, providers, and health facility level factors.