User perspectives on Implanon NXT in South Africa: A survey of 12 public-sector facilities

Abstract

Background. Implanon NXT, a long-acting reversible contraceptive, was introduced in South Africa (SA) in early 2014, aiming to expand the method mix and increase its effectiveness. Initial uptake was high, but has since declined considerably. In these early years after the implant's introduction, it is important to identify reasons for the decline, and remedy gaps in services. Objectives. To determine periods of use, reasons for the use and early removal of the implant Implanon NXT. Methods. In 2016, we recruited 152 women from six clinics in the City of Johannesburg, and six in North West Province, SA. A semistructured interview was administered to 91 women currently using the implant and 61 previous users. We examined user perspectives, factors influencing women's experiences with the implant and reasons for discontinuation. Results. The participants' mean age was 30 years, with only 15% aged <25. Implant uptake was motivated by convenience (less frequent visits required than for short-acting methods) and by favourable views of the method among friends, family and healthcare providers. Only about a quarter of women recalled being counselled pre-insertion about implant effectiveness, and half about side-effects pre-insertion. Among discontinuers, the median time to device removal was 8 months (interquartile range 6 -12), and this was primarily as a result of sideeffects (90%), especially bleeding-pattern changes and headaches. Removals were most common among married and cohabiting women, often ascribed to the effects of bleeding on their sexual relationships. Rumours and misinformation contributed to some removals. Overall, women's experiences with the implant were rated 'good' or 'very good' by 74% of those continuing use, many of whom reported not having experienced any side-effects or that these had diminished over time. Conclusion. Levels of acceptability among continuing users were high, mainly linked to the method's convenience. While early favourable views drove uptake, negative perceptions, if unaddressed, may now undermine services. Deficiencies in counselling around effectiveness and side-effects may extend to contraceptive services more generally. Women require more intensive support when experiencing sideeffects, including effective systematic approaches to ameliorating bleeding and headaches. Implant services could specifically target young women and first-time contraceptive users. These actions together could reverse the persistent decline in implant use in SA.

Strengthening implant provision and acceptance in South Africa with the ‘Any woman, any place, any time’ approach: An essential step towards reducing unintended pregnancies

“…[30] SA data also indicate that training that is too short and does not include management of side-effects and removals, may be inadequate to support implant provision. [31,32] Pre-insertion counselling and ongoing support Adopt a 'LARC first' structured approach to contraceptive counselling. The content of contraceptive counselling heavily influences method selection, especially among younger women.…”

Introduction of the contraceptive implant in South Africa: Successes, challenges and the way forward

“…This was not always the case, as pointed out by Pillay et al [3] in this issue of SAMJ. For example, only about half of the clients interviewed in Johannesburg and the North West Province recalled being warned about side-effects, the principal cause of implant discontinuation.…”

“…In many settings, the implant is considered as 'first-line' for women within 48 hours of childbirth or after an abortion, as well as for adolescents and young women. [6,[11][12][13] The study by Pillay et al, [3] however, found no evidence that the youth were being targeted; only ~15% of participants were aged 18 -24 years, the age group with the highest unmet need for contraception. [1,14] Targeted implant provision is needed and creative approaches are called for.…”

“…These issues need to be foregrounded in counselling for this group of women. [9,10] Encouragingly, Pillay et al [3] found that many women had negotiated implant insertion, and indeed removal, with their partners. Others chose clandestine use, allowing them to use the implant without knowledge of their partners.…”

“…Use of the implant has since declined, but currently accounts for ~7% of all contraceptive use -a not insignificant achievement for a 'new' method . [1,2] In this edition of SAMJ, three articles [3][4][5] take stock of the early years of implant provision in SA. The articles, based on research in 2016, capture women's motivations for using the implant and their perspectives towards the method; and healthcare providers' competencies and experiences with service provision.…”