What Have We Learned? Implementation of a Shared Learning Agenda and Access Strategy for the Hormonal Intrauterine Device

Kate H. Rademacher; Tabitha Sripipatana; Kendal Danna; Deborah Sitrin; Aurélie Brunie; Katie M. Williams; Kayode Afolabi; Francia Rasoanirina; Saumya Ramarao; Anne Pfitzer; Devon Cain; Morgan Simon; Elaine Menotti; Anna Hazelwood; Anthony Adindu Nwala; Zainab Saidu; Raveena Chowdhury; Anne Taiwo; Agnes Chidanyika; Gathari Ndirangu; Markus J. Steiner; Marie Chantale Lepine; Rick Homan; Abdulmumin Saad; John Vivalo; Laneta J. Dorflinger

doi:10.9745/GHSP-D-21-00789

Key Findings

In this review of early experiences providing the hormonal intrauterine device (IUD) in sub-Saharan Africa, we found:

Continuation and satisfaction were high among hormonal IUD users in pilot settings and generally comparable to those of other long-acting reversible contraceptives.
Hormonal IUD users reported positive attributes of the method including its effectiveness, long duration, convenience, potential for reduced bleeding, and fewer side effects compared to other hormonal methods.
Coordination across diverse organizations, including alignment on a shared learning agenda and access strategy, ultimately contributed to expanded access to the method.

Key Implications

As several countries in sub-Saharan Africa are preparing to introduce the hormonal IUD on a wider scale, the addition of the hormonal IUD to the catalogs of the United States Agency for International Development and the United Nations Population Fund will help expand public-sector access.
Additional investments in method introduction—including provider training, demand creation, robust implementation research, and monitoring and evaluation—will be critical to understanding how best to scale the method.

ABSTRACT

In 2015, a global learning agenda for the hormonal intrauterine device (IUD) was developed with priority research questions regarding use of the method in low- and middle-income countries. In addition, members of the Hormonal IUD Access Group aligned on a strategy to expand access in the context of volunteerism and contraceptive method choice. This article synthesizes evidence generated since then and describes steps taken to address demand- and supply-side barriers to access. Findings demonstrated high continuation rates and satisfaction among hormonal IUD users that are comparable to other long-acting reversible contraceptives (LARCs). Across studies, a sizable number of users reported they would have chosen a short-acting method or no method at all if the hormonal IUD were not an option, which suggests that women did not see the hormonal IUD as interchangeable with other LARC options and thus it may fill an important niche in the market. With several countries now poised to scale up the method, resource mobilization will be key. On the demand side, investments in implementation research will be critical to understanding how best to launch and scale the method, while ensuring the sustainability of multiple quality-assured suppliers with affordable public-sector pricing will be necessary on the supply side.

Received: April 30, 2022.
Accepted: August 23, 2022.
Published: October 31, 2022.

This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly cited. To view a copy of the license, visit https://creativecommons.org/licenses/by/4.0/. When linking to this article, please use the following permanent link: https://doi.org/10.9745/GHSP-D-21-00789

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