Experiences with the levonorgestrel-releasing intrauterine system in Kenya: qualitative interviews with users and their partners

Abstract

Objectives: The levonorgestrel-releasing intrauterine system (LNG-IUS) is an underused contraceptive method in sub-Saharan Africa. A recent market assessment in Kenya found that if a more affordable version of the method were available it may increase demand and uptake of the method. We therefore aimed to examine attitudes and perceptions around the LNG-IUS and experiences of method use, including exploring attributes such as bleeding changes, contraceptive-related amenorrhoea and perceived non-contraceptive benefits.Methods: Qualitative interviews were conducted among 29 women who were current or recent users of the LNG-IUS, and among a subset (n = 9) of their husbands/partners.Results: Our findings indicate that women’s main reason for choosing the LNG-IUS for contraception was their perception that the method had fewer side effects compared with other contraceptive methods. Women had favourable attitudes towards using the LNG-IUS. Husbands were also very positive about their partner’s use of the method.Conclusion: Understanding the motivations and experiences of early adopters of the LNG-IUS can help inform the development of demand creation and communication strategies to influence uptake and continuation of the LNG-IUS both in Kenya and perhaps more broadly. Communication efforts that emphasise the positive attributes of the LNG-IUS could help promote wider use of the method, especially if new, more affordable product(s) become available.

Experiences With the Levonorgestrel Intrauterine System Among Clients, Providers, and Key Opinion Leaders: A Mixed-Methods Study in Nigeria

“…A perceived lack of side effects was the most frequently mentioned advantage. This finding is similar to results from qualitative interviews with Mirena users in Kenya, which documented that women's main reason for choosing the LNG IUS as their family planning method was the perception that the method had fewer side effects compared with other contraceptive methods 24 . Since the most common reason for non-use of contraception among women in developing countries is concern about side effects and health risks, 25 this is also a product attribute that should be included in counseling and demand-creation efforts.…”

A Global Learning Agenda for the Levonorgestrel Intrauterine System (LNG IUS): Addressing Challenges and Opportunities to Increase Access

“…Among 671 postpartum women offered a range of methods, 16% chose the LNG IUS 31 . After 1 year of use, 89% of LNG IUS users were still using the method and 87% reported being very satisfied; these rates were comparable with those among users of implants 32 . A separate qualitative assessment in Kenya documented experiences among early adopters of the Mirena and their male partners; a key finding was that women's main reason for choosing the LNG IUS was their perception that the method had fewer side effects compared with other contraceptive methods 33 .…”

“…Specifically, questions remain about what demand generation and provider training strategies would be required to overcome potential barriers to uptake and whether the LNG IUS would be cost-effective compared with other long-acting reversible methods, especially if more resources are required to increase awareness and demand for the LNG IUS than are required for other methods. Governments and donors also want to know whether the method would primarily attract new users and/or “switchers.” Preliminary research in Kenya and Nigeria found that among switchers, a portion of LNG IUS users shifted from using short-acting resupply methods 32 , 34 . If this outcome is replicated elsewhere, it will have important public health implications given that long-acting reversible methods like the LNG IUS have higher effectiveness and continuation rates than short-acting methods 35 .…”

“…Members of the LNG IUS Working Group recognized that if all pilot programs introducing the LNG IUS could ask similar questions of women choosing the method as part of routine data collection, the impact of evaluation efforts could be increased. FHI 360 modified 3 questions that had been included in a research study in Kenya conducted by Hubacher and colleagues 31 , 32 (Box 3). Service delivery groups including Jhpiego, Marie Stopes International, Population Services International, and WCG Cares then incorporated the questions into their pilot introduction efforts, with providers administering the questions in Kenya, Madagascar, Nigeria, Zambia, and Zimbabwe.…”

“…Three questions were adapted from a previous research study in Kenya 31 , 32 and were incorporated into programs where LNG IUS introduction activities funded by USAID were underway. In each project, a woman receives comprehensive counseling based on informed choice.…”