Microprogestative and Other Hormonal Contraceptives Use: Exploring the potential Impact on Ectopic Pregnancy among Women of reproductive age in Eastern Democratic Republic of Congo

Objective To examine the use of hormonal contraceptives, particularly microprogestative oral pills, injectables, and implants, and their potential association with ectopic pregnancy risk among women in Eastern Democratic Republic of Congo (DRC), amid challenges like inconsistent access, biological mechanisms, usage patterns, and contextual health system factors. Design Narrative literature review synthesizing peer-reviewed journals, institutional reports, and grey literature. Setting Eastern DRC provinces (North and South Kivu, Ituri), characterized by conflict, weak health infrastructure, and limited diagnostic resources. within the broader context of sub-Saharan Africa. Population or Sample Women of reproductive age using hormonal contraceptive methods in Eastern DRC, with particular attention to young, postpartum, and unmarried women relying on progestin-only pills, injectables, and implants. Methods Peer-reviewed articles, institutional reports, and grey literature published between 2010 and 2025 were reviewed using databases including PubMed, Scopus, and Google Scholar, alongside data from UNFPA, DKT-RDC, and the Congolese Ministry of Health. Sources were selected based on relevance, methodological rigor, and applicability to the DRC context. Main Outcome Measures Ectopic pregnancy incidence (0.8–4% of pregnancies in sub-Saharan Africa); relative risk among progestin-only contraceptive failures; contraceptive adherence, access barriers, and contextual amplifiers like supply disruptions and sociocultural factors. Results Ectopic pregnancy accounts for approximately 0.8% to 2–4% of reported pregnancies in sub-Saharan Africa, though underdiagnosis is likely in Eastern DRC due to limited diagnostic capacity. Progestin-only contraceptives are widely used because of their accessibility and suitability during lactation; however, inconsistent use, missed doses, and supply interruptions are common. When contraceptive failure occurs, progestin-only methods may be associated with a higher proportional risk of ectopic implantation compared with combined oral contraceptives, due to altered tubal motility and incomplete ovulation suppression. Sociocultural barriers, weak counseling, stockouts, and high prevalence of confounding factors such as pelvic inflammatory disease further increase risk.. Conclusions Progestin-only contraceptives offer key benefits in Eastern DRC but require improved education, supply chains, screening, and data systems to minimize ectopic pregnancy risks from misuse; prospective studies needed for confirmation.