Timeliness of Contraceptive Reinjections in South Africa And Its Relation to Unintentional Discontinuation

Baumgartner, Joy Noel; Morroni, Chelsea; Mlobeli, Regina; Otterness, Conrad; Myer, Landon; Janowitz, Barbara; Stanback, John; Buga, G.A.B.

doi:10.1363/3306607

Cited by 32 publications

(34 citation statements)

References 17 publications

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“…Among adolescents, parental consent is often an issue, and in a country such as South Africa where ‘traditional’ values are entrenched, and sex is in many cases still a taboo topic, sexually active adolescents may not easily access contraception even if it were made freely available [38]. On the supply side, efforts should be made to address inadequate logistics and protocols [39] and strengthen the training of front-line health workers in the provision of family planning [36]. Contraceptives should also be made readily available and the demand for the variety of methods should be met, as this is essential to meeting women’s desire to space births.…”

Section: Discussionmentioning

confidence: 99%

Scaling Up Family Planning to Reduce Maternal and Child Mortality: The Potential Costs and Benefits of Modern Contraceptive Use in South Africa

et al. 2015

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IntroductionFamily planning contributes significantly to the prevention of maternal and child mortality. However, many women still do not use modern contraception and the numbers of unintended pregnancies, abortions and subsequent deaths are high. In this paper, we estimate the service delivery costs of scaling up modern contraception, and the potential impact on maternal, newborn and child survival in South Africa.MethodsThe Family Planning model in Spectrum was used to project the impact of modern contraception on pregnancies, abortions and births in South Africa (2015-2030). The contraceptive prevalence rate (CPR) was increased annually by 0.68 percentage points. The Lives Saved Tool was used to estimate maternal and child deaths, with coverage of essential maternal and child health interventions increasing by 5% annually. A scenario analysis was done to test impacts when: the change in CPR was 0.1% annually; and intervention coverage increased linearly to 99% in 2030.ResultsIf CPR increased by 0.68% annually, the number of pregnancies would reduce from 1.3 million in 2014 to one million in 2030. Unintended pregnancies, abortions and births decrease by approximately 20%. Family planning can avert approximately 7,000 newborn and child and 600 maternal deaths. The total annual costs of providing modern contraception in 2030 are estimated to be US$33 million and the cost per user of modern contraception is US$7 per year. The incremental cost per life year gained is US$40 for children and US$1,000 for mothers.ConclusionMaternal and child mortality remain high in South Africa, and scaling up family planning together with optimal maternal, newborn and child care is crucial. A huge impact can be made on maternal and child mortality, with a minimal investment per user of modern contraception.

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Section: Discussionmentioning

confidence: 99%

Scaling Up Family Planning to Reduce Maternal and Child Mortality: The Potential Costs and Benefits of Modern Contraceptive Use in South Africa

et al. 2015

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“…A study in the Western and Eastern Cape provinces found that a large proportion of women who intended to continue using the injection were late for their scheduled re-injection, and in some cases beyond the 'grace period' during which re-injection can still be administered. 6 The high rate of unplanned pregnancies reported in this study may therefore be partially explained by inconsistent or discontinued use of …”

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confidence: 85%

Is 'planning' missing from our family planning services?

et al. 2010

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The benefits of family planning, in developing countries in particular, extend beyond decreasing fertility and include poverty reduction, improved health for both mother and child, the promotion of gender equality by increasing women's opportunities beyond reproductive and domestic activities, and environmental sustainability. 1 In addition, prevention of undesired pregnancies among HIV-positive women by eliminating unmet need for contraception is a highly cost-effective means of preventing mother-to-child transmission. 2In South Africa, free contraceptives are available at public sector health care facilities, and contraception use is high: an estimated 65% of sexually active women use a method.3 The method mix comprises predominantly short-acting methods -primarily injectable contraceptives. Long-acting contraceptives, such as the intra-uterine device (IUD), are highly effective among typical users owing to consistency of function, yet are underutilised in South Africa's public sector facilities. Of importance, especially in South Africa's high HIVprevalent setting, is that the IUD can be safely used on clinically well HIV-positive women. 4 The 2004 Demographic and Health Survey showed that 10% of sexually active women were sterilised, while less than 1% of women were using the IUD. 3 In preparation for an intervention aimed at improving contraceptive options, including long-acting and permanent methods (LAPM), for all postpartum women, we assessed women's knowledge and attitudes to LAPM. We report on findings from our baseline survey, which have prompted the question: Where is the 'planning' in family planning services? MethodsA cross-sectional study, approved by the University of Cape Town Health Science Faculty Human Research Ethics Committee, was conducted at five public sector primary care facilities in Cape Town between February and April 2009. Trained interviewers using a structured questionnaire collected data on: socio-demographics, contraceptive use, future fertility desires, and knowledge and attitudes towards LAPM, from 538 women of whom 265 were HIV-positive and 273 HIV-negative. The sample included HIV-positive and negative women to enable a comparison to be made of the uptake of an LAPM promotion intervention between prevention of motherto-child transmission (PMTCT) and non-PMTCT clients. All study participants were attending child health services, had received antenatal care during their most recent pregnancy, and had delivered less than 6 months before the interview. ResultsThe median age of the women was 26 years (interquartile range (IQR) 22 -31), 63.9% had achieved Grade 8 -12 without matric, 29.5% had post-matric qualifications, and the vast majority (94.2%) reported to be either married or single but in a stable relationship. Participants had a median number of 2 (IQR 1 -2) living children. Overall, 67.3% of the women did not want another child in the future, 39% reported that their partners did not want another child, and 62.4% reported that their most recent pregnancy was unplanned. Of ...

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“…[1] The policy narrative states that injectable contraceptives account for half of contraceptive use nationally and for up to 90% in some areas, [1] and that this predominance of short-term methods has several drawbacks. Many women discontinue injectable methods, or return late for their next injection, [1,2] placing them at risk for unintended pregnancy. Introducing the Implanon NXT, a long-acting subdermal contraceptive implant, in the public sector in 2014, thus aimed to provide a more effective contraceptive alternative.…”

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confidence: 99%

Gaps in monitoring systems for Implanon NXT services in South Africa: An assessment of 12 facilities in two districts

et al. 2017

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Background. Implanon NXT, a long-acting subdermal contraceptive implant, was introduced in South Africa (SA) in early 2014 as part of an expanded contraceptive method mix. After initial high levels of uptake, reports emerged of frequent early removals and declines in use. Monitoring of progress and challenges in implant service delivery could identify aspects of the programme that require strengthening. Objectives. To assess data management and record keeping within implant services at primary care facilities. Methods. We developed a checklist to assess the tools used for monitoring implant services and data reporting to district offices. The checklist was piloted in seven facilities. An additional six high-volume and six low-volume implant insertion clinics in the City of Johannesburg (CoJ), Gauteng Province, and the Dr Kenneth Kaunda District, North West Province, were selected for assessment. Results. All 12 facilities completed a Daily Head Count Register, which tallied the number of clients attending the clinic, but not information about implant use. A more detailed Tick Register recorded services that clinic attendees received, with nine documenting number of implant insertions and six implant removals. A more specific tool, an Insertion Checklist, collected data on insertion procedures and client characteristics, but was only used in CoJ (five of six facilities). Other registers, which were developed de novo by staff at individual facilities, captured more detailed information about insertions and removals, including reasons. Five of six low-volume insertion facilities used these registers, but only three of six high-volume facilities. No facilities used the form specifically developed by the National Department of Health for implant pharmacovigilance. Nine of 12 clinics reported data on numbers of insertions to the district office, six reported removals and none provided data on reasons for removals. Conclusion. For data to inform effective decision-making and quality improvement in implant services in SA, standardised reporting guidelines and data collection tools are needed, reinforced by staff training and quality assessment of data collection. Staff often took the initiative to fill gaps in reporting systems. Current systems are unable to accurately monitor uptake or discontinuation, or identify aspects of services requiring strengthening. Lack of pharmacovigilance data is especially concerning. Deficiencies noted in these monitoring systems may be common to family planning services more broadly, which warrants investigation.

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Timeliness of Contraceptive Reinjections in South Africa And Its Relation to Unintentional Discontinuation

Cited by 32 publications

References 17 publications

Scaling Up Family Planning to Reduce Maternal and Child Mortality: The Potential Costs and Benefits of Modern Contraceptive Use in South Africa

Scaling Up Family Planning to Reduce Maternal and Child Mortality: The Potential Costs and Benefits of Modern Contraceptive Use in South Africa

Is 'planning' missing from our family planning services?

Gaps in monitoring systems for Implanon NXT services in South Africa: An assessment of 12 facilities in two districts

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