|
Research |
||
|
|
||
|
By Kerry Wright Aradhya, Senior Science Writer Family Health International, Research Triangle Park, NC, USA Contraceptive implants are a highly effective, long-acting, reversible method of family planning that can be safely used by the majority of women who wish to space or limit their pregnancies. Yet despite the advantages of implants, far fewer than 1% of the women in sub-Saharan Africa (with the exception of Burkina Faso, Ghana, and Kenya) use the method. Although a lack of availability has been a major problem in the region, that situation could soon improve. Simpler implants Norplant was the first contraceptive implant that was introduced to Africa more than two decades ago. It consists of six progestin-releasing capsules that are inserted under the skin of the upper arm. Although Norplant is being phased out, several new alternatives -- primarily Jadelle and Implanon -- are entering the market. These products generally have the same advantages and disadvantages as Norplant (see Continued use of implants), but they differ in several important ways. All of the implants release progestin from capsules or rods, but Norplant and Jadelle release a slightly different version of the synthetic hormone than Implanon does. The products also differ in the number of capsules or rods they use to deliver the hormone (see Table 1), and in the duration of their contraceptive effects. Norplant is labelled for 5 years of continuous use, although large studies have found it to be effective for up to 7 years. Jadelle has also been approved for up to 5 years of use, and Implanon for up to 3 years.1 The biggest practical difference of the newer implants is that they are easier for a trained provider to insert and remove. Implanon takes only a quarter of the time to insert, with an insertion time of about 1 minute compared to 4 minutes for Norplant.2 The removal times are about 2.5 minutes for Implanon, 5 minutes for Jadelle, and 10 minutes for Norplant.2,3 The newer implants also have fewer surgical complications such as bruising, pain, or broken implants. Table 1. Long-acting implants in Africa
Decreasing costs Cost and donor support have historically been the largest barriers to the availability of implants in Africa. Among global donors in 2005, the average cost of an implant -- US$27 -- was still at least 28 times higher than the cost of a copper IUD, an injectable contraceptive, or a packet of oral contraceptive pills.4 However, as alternatives to Norplant enter the market, the price of implants appears to be dropping. The US Agency for International Development recently secured a public-sector price of US$21 for Jadelle, and public-sector prices are expected to be similar for Implanon.4 Although the upfront costs are higher for implants than for some other methods, over time implants are among the most cost-effective methods for a healthcare system.5,6 Another indicator that availability may soon increase is that the two-rod levonorgestrel-releasing implants were added to the World Health Organization's 'Model List of Essential Medicines' in March 2007. All items on the list -- which are included on the basis of their safety, effectiveness, and cost-effectiveness -- are considered necessary for a basic healthcare system. Potential health impact Scientists at Family Health International recently performed a modelling exercise to determine how improvements in the availability of implants might affect reproductive health.4 Kenya, which was one of the first countries in sub-Saharan Africa to receive Norplant through donor support, is the focus of their exercise. The model is based on the relationships between different contraceptive methods and their associated rates of discontinuation and unintended pregnancies. Using the current number of reproductive-age women and current data on contraceptive use in Kenya, the scientists estimate the number of unintended pregnancies that could be prevented over a 5-year period if some oral contraceptive users switched to implants. If just 100 000 (26%) of the nearly 400 000 oral contraceptive users in Kenya switched to implants, more than 26 000 extra unintended pregnancies could be prevented over 5 years. In addition, about 260 maternal deaths would likely be averted as well. Readiness for change Only a very small percentage of African women use implants, but data from demographic and health surveys suggest that rates of use have slowly been increasing over the course of the past two decades in at least some sub-Saharan countries.7 The availability of implants may not be the only barrier to use, but a simpler and cheaper implant could dramatically affect the number of women who choose this highly effective method. Africa appears ready and poised to benefit from this change. Resources
|
|||
 |
|||
