The Future of Contraceptive Implants in Africa

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An assessment of Kenya's experience with contraceptive implants — coupled with the availability of simpler and cheaper implants — suggests a brighter future in sub-Saharan Africa for this long-acting method of family planning.¹

FHI conducted the assessment to better understand the demand for implants and the capacity of providers to offer the method in Kenya. Much of this information was gathered through interviews with 35 policy-makers, donors, and family planning professionals. A modeling exercise was also performed to determine the possible impact that more implant use could have on the nation's public health.

A major finding was that the demand for implants has remained high since implants were first introduced in Kenya more than 20 years ago. Interviewers found that many providers have to keep lists of clients who are waiting for future shipments of implants.

According to data from the Demographic and Health Surveys, knowledge of the method has also increased. Even though the rate of implant use has never exceeded one percent in Kenya, more than half of Kenyan women say they know about the method. More than 1,000 health facilities are providing implants, and the current network of family planning providers appears ready to increase the volume of services offered.

Unfortunately, the facilities that offer implants in Kenya are often short of stock because donors have historically invested more heavily in short-acting methods, such as oral contraceptives, which are less expensive to purchase. However, studies have shown that implants are often more cost-effective than oral contraceptives over time.

The availability of implants is likely to improve. Their costs have been decreasing, and simpler implants are entering the market. Compared with Norplant (which is being phased out), these newer implants are easier for a trained provider to insert and remove. They also have fewer surgical complications. The availability of implants may not be the only barrier to use, but greater access could dramatically affect the number of women who choose the method.

Availability Norplant: Six levonorgestrel-releasing capsules approved for five years of use. Although still available in Africa, Norplant is being phased out. Jadelle: Two levonorgestrel-releasing rods approved for five years of use. Jadelle is already cheaper than Norplant once was, and its public sector price appears to be dropping. Sinoplant-2: Nearly identical to Jadelle, but currently available only in China and Indonesia. If Sinoplant-2 is registered in Africa, its public-sector price is expected to be much lower than that of Jadelle. Implanon: One etonogestrel-releasing rod approved for three years of use. Its public-sector price is similar to that of Jadelle. Photo Credit: John Stanback/FHI A doctor inserts Norplant capsules. Compared with Norplant, the implants just entering the market are easier to insert and remove.

The modeling exercise …

• The exercise used published material on the relationships between different methods of family planning and the rates of discontinuation and unintended pregnancies associated with their use.
• Information on the current population of reproductive-age women in Kenya was used to determine baseline levels of use for the different methods.
• The scientists then estimated the number of unintended pregnancies that could be prevented if some oral contraceptive users chose implants instead.

… And the potential effects on public health

• If just 100,000 oral contraceptive users in Kenya chose implants, roughly 26,000 unintended pregnancies could be prevented over the next five years.
• This decrease in unintended pregnancies would prevent about 260 maternal deaths.

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