Expanding long-acting contraceptive options: a prospective cohort study of the hormonal intrauterine device, copper intrauterine device, and implants in Nigeria and Zambia

Brunie, Aurélie; Stankevitz, Kayla; Nwala, Anthony; Nqumayo, Masauso; Chen, Mario; Danna, Kendal; Afolabi, Kayode; Rademacher, Kate H.

doi:10.1016/s2214-109x(21)00318-1

Cited by 21 publications

(41 citation statements)

References 23 publications

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“…International aid funders, such as the Bill & Melinda Gates Foundation, have prioritized and made investments into developing new contraceptive technologies in order to better address women's reproductive needs. Studies have been done in various countries in Sub-Saharan Africa to explore women's openness and opinions about different characteristics of family planning methods (Brunie et al, 2021;Callahan et al, 2019;Callahan et al, 2021;Cartwright et al, 2020). Similar to our study, one study found that duration of use, and familiarity with methods were important attributes of methods in Burkina Faso and Uganda; however, irregular bleeding emerged as a more important attribute to consider than in our study and discreet use was not as prominently discussed (Callahan et al, 2019).…”

Section: Discussionmentioning

confidence: 99%

Providers’ views on hormonal family planning methods: a qualitative study from Dosso, Niger

et al. 2022

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Background: Family planning (FP) providers play an important role in ensuring that clients are offered a full range of FP methods. This qualitative study explores providers’ views on three hormonal FP methods and why they think women may choose these methods in Niger. Methods: In-depth interviews were conducted with 24 FP providers in 24 government health centers in Dosso region, Niger between February-March 2020. Providers were asked about the suitability of different FP methods for women, including adolescents and married women with children. The interviews were translated and transcribed from Hausa and Zarma into French, thematically coded, and qualitatively analyzed. Results: Many providers believed discretion to be the most important method attribute for women. Providers report preferring implants for young clients because of the more rapid return to fertility. They disagreed on whether implants or injectables are more discrete for clients. That said, providers felt that clients appreciate the implant’s discretion, effectiveness, long-acting nature, and simplicity of use. Providers perceived that the majority of women choose injectables due to familiarity with the method, the fact that it is “invisible” to an outsider, and a lack of awareness of implants. Providers stated that while women may not initially choose the implant, when given more information about it, they were more open to adopting it, or switching from another method, and less likely to believe local myths. Providers believed that women find pills to be indiscreet. Conclusions: The findings highlight that while providers have perspectives on suitable methods for certain women, they also recognize that clients have their own preferences, such as how discreet the method is. As programs continue to expand method choice and new contraceptive technologies undergo research and development, highly desirable features such as discretion need to be considered.

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Section: Discussionmentioning

confidence: 99%

Providers’ views on hormonal family planning methods: a qualitative study from Dosso, Niger

et al. 2022

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“…We conducted a prospective cohort study of long-acting reversible contraceptive users at the 21 SFH-supported public health facilities to measure method-specific continuation rates and assess women’s satisfaction and experiences with LARCs [ 25 ]. The present paper draws on the baseline survey with women ages 16–49 who received the hormonal IUD, copper IUD, implant (any type) or three-month injectable from one of the facilities during the recruitment period and follow-up in-depth interviews (IDIs) with a subset of women.…”

Section: Methodsmentioning

confidence: 99%

What are the prospects for the hormonal IUD in the public sector? A mixed-method study of the user population in Zambia

et al. 2022

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Background The levonorgestrel-releasing intrauterine device (IUD)—also known as the hormonal IUD—is a highly effective contraceptive method that has not been widely available in the public sector in Zambia. Early introduction efforts can provide critical insights into the characteristics of users, reasons for method choice, and experiences getting their method. Methods We conducted a survey with 710 public sector clients who received a hormonal IUD, copper IUD, implant or injectable in two provinces of Zambia, and additional in-depth interviews with 29 women. We performed descriptive analyses of survey data and fitted multivariable logistic regression models to assess factors associated with hormonal IUD use. Qualitative interviews were analyzed thematically. Results Factors associated with hormonal IUD use included full-time or self-employment (relative to both implant and copper IUD use), as well as being older, wealthier, and partner not being aware of method use (relative to implant use only). Common reasons for choosing long-acting methods were duration, perception that the method was “right for my body,” and convenience. In addition, a portion of hormonal IUD acceptors mentioned effectiveness, potential for discreet use, few or manageable side effects, and treatment for heavy or painful periods. Between 83 and 95% of women said that they were counseled about menstrual changes and/or non-bleeding side effects; however, more hormonal IUD acceptors recalled being counseled on the possibility of experiencing reduced bleeding (88%) than amenorrhea (43%). Qualitative interviews indicate that women seek methods with minimal or tolerable side effects. While most women reported their partner was aware of method use, men may be more consistently involved in the decision to use contraception rather than in the choice of a particular method. Qualitative results show an appreciation of the lifestyle benefits of reduced bleeding (especially lighter bleeding), although amenorrhea can be cause for concern. Conclusions Initial efforts to introduce the hormonal IUD can provide valuable learnings that can inform broader method introduction to expand choice and better suit women’s needs in Zambia and elsewhere. Scale-up plans should include emphasis on high quality counseling and demand generation. Plain English Summary The government of Zambia is committed to increasing access to high-quality contraception and making more choices available to users. To date, the hormonal IUD, a highly effective, long-lasting contraceptive has not been widely available in the country. A study in pilot introduction settings provided insights into why women chose the methods, their characteristics, and their experiences getting their methods. The 710 women in the study received family planning services in public sector settings in two provinces in Zambia. Women in the study who received a hormonal IUD, copper IUD, implant, or injectable completed a quantitative survey; in-depth interviews were also conducted with 29 women. Results showed common reasons for choosing the long-acting methods (hormonal IUD, copper IUD or implants) were their duration, perception that the method was “right for my body,” and convenience. In addition, some hormonal IUD acceptors indicated that they were attracted to the method’s effectiveness, potential for discreet use, few or manageable side effects, and treatment for heavy or painful periods. Qualitative interviews with women also showed that women want contraceptive methods that lead to minimal or tolerable side effects. Male partners were typically aware of contraceptive use; however, men were less involved with decisions about the particular method women selected. Use of the hormonal IUD can lead to reduced menstrual bleeding, and in the interviews, women indicated that they liked reduced bleeding (especially lighter bleeding), although amenorrhea (paused bleeding) can be cause for concern. The results can help inform broader method introduction.

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“…CIMCs can also have advantages that motivate individuals to begin and/or continue contraceptive use. Reduced menstrual bleeding, pain, or cramping, as well as paused bleeding can offer increased freedom to engage in regular activities, improved convenience, improved sexual satisfaction, decreased stress and worry, and reduced spending if fewer menstrual materials are needed 2 , 17 . Some individuals choose to use contraception primarily, or at least in part, for the resulting beneficial menstrual changes, including the management of menstrual and gynecologic disorders and symptoms, such as heavy menstrual bleeding, which affects approximately 30 percent of those who menstruate 18 , and endometriosis, which affects an estimated 10% of menstruators worldwide 19 .…”

Section: Contraceptive-induced Menstrual Changesmentioning

confidence: 99%

Global research and learning agenda for building evidence on contraceptive-induced menstrual changes for research, product development, policies, and programs

et al. 2022

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Background: Contraceptive-induced menstrual changes (CIMCs) can affect family planning (FP) users’ lives in both positive and negative ways, resulting in both opportunities and consequences. Despite this, and despite the important links between FP and menstrual health (MH), neither field adequately addresses CIMCs, including in research, product development, policies, and programs globally. Methods: In November 2020, a convening of both MH and FP experts reviewed the existing evidence on CIMCs and identified significant gaps in key areas. Results: These gaps led to the establishment of a CIMC Task Force in April 2021 and the development of the Global Research and Learning Agenda: Building Evidence on Contraceptive-Induced Menstrual Changes in Research, Product Development, Policies, and Programs Globally (the CIMC RLA), which includes four research agendas for (1) measurement, (2) contraceptive research and development (R&D) and biomedical research, (3) social-behavioral and user preferences research, and (4) programmatic research. Conclusions: Guided by the CIMC RLA, researchers, product developers, health care providers, program implementers, advocates, policymakers, and funders are urged to conduct research and implement strategies to address the beneficial and negative effects of CIMCs and support the integration of FP and MH. CIMCs need to be addressed to improve the health and well-being of women, girls, and other people who menstruate and use contraceptives globally. Disclaimer: The views expressed in this article are those of the authors. Publication in Gates Open Research does not imply endorsement by the Gates Foundation.

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Expanding long-acting contraceptive options: a prospective cohort study of the hormonal intrauterine device, copper intrauterine device, and implants in Nigeria and Zambia

Cited by 21 publications

References 23 publications

Providers’ views on hormonal family planning methods: a qualitative study from Dosso, Niger

Providers’ views on hormonal family planning methods: a qualitative study from Dosso, Niger

What are the prospects for the hormonal IUD in the public sector? A mixed-method study of the user population in Zambia

Global research and learning agenda for building evidence on contraceptive-induced menstrual changes for research, product development, policies, and programs

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