Provision of the levonorgestrel intrauterine system in Nigeria: Provider perspectives and service delivery costs

Abstract

Background: Several organizations in Nigeria are leading pilot introduction programs of the levonorgestrel intrauterine system (LNG-IUS). We conducted a qualitative assessment of providers’ experiences across the five programs and an analysis of service delivery costs in one program. Methods: We conducted 20 in-depth interviews (IDIs) with providers. We used project expenditure records to estimate incremental direct service delivery costs of introducing the LNG-IUS in 40 social franchise clinics supported by the Society for Family Health (SFH). We then compared the direct service delivery costs per couple years of protection (CYP) for the LNG-IUS to other family planning methods. Results: Providers appreciated the therapeutic benefits of the LNG-IUS, especially reduction of heavy bleeding. They said that women generally accepted bleeding changes with counseling but noted complaints about spotting and mixed acceptability of amenorrhea. Providers indicated being comfortable with both the insertion and removal process and believed their equipment and infection prevention protocols were adequate. Lack of awareness among women, limited availability, current pricing, and resistance to uterine placement among some women were perceived as barriers. The estimated direct service delivery cost of introducing the LNG-IUS in pilot settings, inclusive of up-front provider training costs, was USD 34 per insertion. Direct service delivery costs at a ‘steady state’ (i.e., without training costs included for any method) of the LNG-IUS per CYP was similar to that of other contraceptive methods distributed in Nigeria. Conclusion: Providers’ positive experiences with the LNG-IUS and direct service delivery costs per CYP that align with those for other methods suggest that the LNG-IUS could be an important addition to the method mix in Nigeria. Product introduction strategies will need to address both the supply and the demand sides, as well as consider appropriate pricing of the LNG-IUS relative to other methods and particularly the copper IUD.

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

“… 16 Qualitative data in Kenya, Nigeria, and Zambia suggest that key opinion leaders, providers, and users recognise the advantages of the hormonal intrauterine device, and support its inclusion in the contraceptive method mix. 17 , 18 , 19 In this study, we therefore aimed to expand the knowledge about the use of the hormonal intrauterine device, copper intrauterine device, and subdermal implant by measuring continuation rates at 6 months and 12 months and assessing women's experiences and satisfaction using these methods in sub-Saharan Africa in the private sector in Nigeria and the public sector in Zambia.…”

Factors affecting uptake of the levonorgestrel-releasing intrauterine device: A mixed-method study of social franchise clients in Nigeria

“…Findings highlight lack of awareness of the method as a potential barrier to hormonal IUD uptake. This was similarly identified as a constraint by providers in a recent assessment across five service delivery settings in Nigeria [ 29 ]. As demand generation efforts have remained limited to date, knowledge of and demand for the hormonal IUD are largely provider-driven.…”

Comparative study of cervical-vaginal microbial flora changes in women using Cu-T380A contraceptive device and LNG-IUS in Ibadan: a two-centre clinical COHORT study

“…Several countries, including Nigeria, have used this donated product to support pilot introduction activities. 23 At the time, this study was conducted, there were only 2 intrauterine contraceptive devices available in public health facilities in Nigeria the CuT380A in most and levonorgestrel intrauterine devices (LNG-IUS) in a few facilities. However, recently new, more affordable commercial LNG-IUS products have received regulatory approval suggesting that there may be opportunities in the coming years to further access the method within the country.…”

“…However, recently new, more affordable commercial LNG-IUS products have received regulatory approval suggesting that there may be opportunities in the coming years to further access the method within the country. 23,24 The common symptoms noted among the users of either device included heavy vaginal bleeds, severe abdominal pains, foul smelling vaginal discharge and fever. More clients had cervical-vaginal infections among the Cu T380A group at the end of the study (33.3% compared to 5.3% for LNG) and it was statistically significant (p<0.001).…”

“…31 The LNG-IUS is an underused method in Nigeria. 23 A relatively recent market survey in Kenya found that if a more affordable version of LNG-IUS were available, it may increase demand and uptake of the method. 33…”