Figures & Tables
Figures
- FIGURE
Flow Chart for Implant and IUD Users’ Removal Experiences in 3 Districts in Senegal
Abbreviations: IDI, in-depth interview; IUD, intrauterine device.
a Ever asked a provider for a removal.
b Ever wanted a removal but never asked a provider for one.
Tables
- TABLE 1.
Participant Characteristics and Counseling Received at Implant and IUD Insertion in 3 Districts of Senegala
Implant IUD Completed Phone Survey
(n=1,362)Eligible for In-person Survey
(n=594)Completed In-person Survey
(n=438)Completed Phone Survey
(n=506)Eligible for In-person Survey
(n=205)Completed In-person Survey
(n=160)Age, years, mean (SD) 31.2 (6.8) 29.8 (6.2) 30.0 (6.4) 36.2 (7.3) 35.6 (8.0) 36.2 (7.7) Marital status, % Single 3.7 2.0 1.6 2.0 1.5 1.3 Married/cohabitating 88.6 91.1 92.7 92.7 90.8 90.6 Divorced/widowed 7.8 6.9 5.7 5.3 7.8 8.1 Parity, mean (SD) 2.6 (1.7) 2.3 (1.5) 2.4 (1.6) 3.3 (1.7) 3.2 (1.7) 3.3 (1.7) Highest education, % None 21.7 19.4 19.9 12.5 12.2 10.6 Primary 30.3 29.0 31.3 32.1 33.7 38.8 Middle 16.9 18.7 15.9 17.4 14.7 16.2 Secondary school 16.7 18.0 18.1 15.3 17.6 16.9 Higher than secondary school 14.5 15.0 14.8 22.7 22.0 17.5 Religion, % Muslim 95.1 95.6 96.4 93.7 94.2 93.1 Christian 4.9 4.4 3.7 6.3 5.9 6.9 Wealth quintilesb, % Lowest 4.5 3.5 3.6 2.1 1.7 1.4 Second 3.6 4.3 4.4 1.2 0.6 0.7 Middle 4.4 4.3 4.1 2.1 1.1 0.7 Fourth 15.2 13.8 12.7 8.5 8.6 10.8 Highest 72.3 74.2 75.1 86.2 88.0 86.3 Months since method inserted, mean (SD) 29.4 (6.4) 30.5 (6.4) 30.7 (6.4) 29.5 (6.2) 29.8 (5.6) 29.5 (5.6) Implant type, % Jadelle 61.2 56.7 57.6 N/A N/A N/A Implanon 17.6 19.2 18.7 N/A N/A N/A Unknown 21.3 24.1 23.7 N/A N/A N/A Contraceptive use history, % Previous use of current method 22.5 18.9 19.4 19.6 18.5 20.0 Previous use of any modern method 75.9 76.4 77.6 90.1 93.2 94.4 Partner knowledge of current method at time of insertion 86.3 86.9 87.0 82.4 83.4 84.4 Told at insertion that removal can be obtained any time 92.9 94.1 93.6 96.2 97.1 97.5 Told at insertion where removal can be obtained Insertion place only, % 55.5 55.1 56.2 55.6 57.1 60.0 Place other than insertion place 0.7 0.8 1.1 0.4 1.0 1.3 Insertion place and another place 27.0 28.3 25.3 24.8 25.9 21.9 Not told about any place 15.4 14.7 16.7 17.8 14.6 15.0 Not sure 1.4 1.2 0.7 1.4 1.5 1.9 Abbreviations: IUD, intrauterine device; N/A, not applicable; SD, standard deviation.
↵a Data are from phone survey participants. Nonresponses varied across items; small amounts of data are missing.
↵b Relative wealth was measured using the EquityTool (https://www.equitytool.org/). The national version of the EquityTool compares participants to the national population.
Implant, %
(n=1,202)bIUD, %
(n=450)bParticipants reporting CIMCs 77.4 53.6 Type of CIMCs reportedc,d Bleed more during period 27.1 55.2 Bleed less during period 12.0 9.1 Period lasts longer 35.6 44.8 Bleeding disturbancese 60.8 46.9 Stopped having period 33.1 11.2 Concern with CIMCsd Very concerned 29.4 27.5 Somewhat concerned 32.5 30.4 Not at all concerned 38.2 42.1 Impact of CIMCs on daily lifed Positive 1.5 0.8 Negative 35.5 33.9 No impact 63.0 65.3 Participants reporting weight gain 37.8 20.1 Participants reporting side effects other than weight gain and CIMCs 37.5 44.2 Type of side effect reporteda,f Headaches 31.1 11.1 Weight loss 25.3 6.6 Abdominal pain 29.3 42.9 Dizziness 22.9 9.1 Vaginal infections N/A 24.8 Pelvic discomfort/pain N/A 14.7 Impact of side effects on daily lifef Greatly impacted 19.6 18.2 Impacted a little 33.4 30.2 No impact 47.0 51.6 Abbreviations: CIMCs, contraceptive-induced menstrual changes; IUD, intrauterine device; N/A, not applicable.
↵a Data are from phone and in-person survey participants. Nonresponses varied across items; small amounts of data are missing.
b Due to the design of the questionnaires, this information is not available for participants who said in the phone survey that they asked a provider for a removal but who did not complete the in-person interview.
↵c Multiple responses possible, spontaneous mention; responses with values of ≥10% reported.
↵d Among participants who reported CIMCs.
↵e Bleeding disturbances include irregular bleeding, spotting, and having a period more often.
↵f Among participants reporting side effects other than weight gain and CIMCs.
- TABLE 3.
Participant’s Reported Desire to Remove Implant or IUD in 3 Districts of Senegala
Implant, %
(n=1,362)IUD, %
(n=506)Reported desire to remove Never wanted a removal 42.1 46.0 Wanted a removal but have not asked a provider 14.2 13.4 Asked provider for removal 43.6 40.5 Reasons for wanting to stop using methodb,c Desired pregnancy 25.8 36.8 Bleeding disturbancesd 20.6 10.3 Bleed more during period or period longer 11.3 7.4 Reasons for not asking providere,c Busy/no time 44.0 33.8 Changed mind/decided to keep 14.1 16.2 Method came out on own 0.0 13.3 Reasons for wanting to stop using methodb,f Desired pregnancy 29.9 27.6 Bleeding disturbancesc 23.4 12.8 Bleed more during period or period longer 15.4 16.7 Partner disapproved 12.7 7.7 Weight loss 12.3 3.2 Weight gain 11.6 1.3 Timing of removal decisionf Decided before coming to facility 95.6 89.0 Decided at facility visit 4.4 11.0 Social influence reported for removal desiref Self 66.6 75.4 Husband/partner 27.1 18.8 Otherg 6.3 5.8 Abbreviation: IUD, intrauterine device.
↵a Data are from phone and in-person survey participants. Nonresponses varied across items; small amounts of data are missing.
↵b Multiple responses possible, spontaneous mention; responses with values of ≥10% reported.
↵c Among participants who wanted a removal but have not asked a provider.
↵d Bleeding disturbances include irregular bleeding, spotting, and having period more often.
↵e Responses do not total 100% as only responses with at least 10% of participants responding are listed.
↵f Among participants who have asked a provider for a removal.
↵g Includes other relative, friend, colleague, community health worker, and other unspecified.
- TABLE 4.
Association of Factors With Participants Asking a Provider to Remove Implant in 3 Districts of Senegala
AOR (95% CI)
(n=820b)Age group, years 18–24 Reference 25–34 0.72 (0.45, 1.14) 35–49+ 0.65 (0.36, 1.17) Education level None Reference Primary/middle 1.04 (0.67, 1.61) Secondary or higher 0.74 (0.44, 1.24) Religion Christian Reference Muslim 1.51 (0.69, 3.30) Parity 0 Reference 1–2 0.56 (0.19, 1.66) 3–4 0.41 (0.13, 1.28) 5+ 0.34 (0.10, 1.19) Fertility intentions Do not want more children/do not want to have children/unsure Reference Want more children/want to have children 1.24 (0.76, 2.04) Wealth (urban score) Low (quintile 1–3) Reference Middle (quintile 4) 0.89 (0.57, 1.40) High (quintile 5) 1.03 (0.68, 1.56) Previous use of current method 0.74 (0.50, 1.11) Partner knowledge of current method at time of insertion 1.18 (0.74, 1.89) Informed choice 1.42 (1.03, 1.96)c Received method wanted 0.81 (0.45, 1.44) Insertion was free 0.76 (0.54, 1.07) Informed method could be removed at any time 1.00 (0.55, 1.81) Experienced amenorrhea 1.61 (1.12, 2.32)c Experienced bleeding disturbances 1.13 (0.81, 1.56) Experienced shorter or reduced bleeding 0.55 (0.33, 0.91)c Experienced longer or heavier bleeding 1.23 (0.87, 1.75) Experienced weight gain 0.94 (0.68, 1.30) Experienced other side effectsd 2.61 (1.89, 3.60)c Abbreviations: AOR, adjusted odds ratio; CI, confidence interval.
↵a Data are from phone and in-person survey participants. Nonresponses varied across items; small amounts of data are missing.
↵b Sample size of implant users (n=1,362) is reduced to n=820 in the multivariable regression model due to missing data.
↵c Statistically significant (P≤.05).
↵d Other side effects include any mentioned non-bleeding side effects other than weight gain.
- TABLE 5.
Experience Seeking Removals Among Participants Who Asked a Provider for an Implant or IUD Removal in 3 Districts of Senegala
Implant
(n=438)IUD
(n=160)Location of first removal attempt, % Same place as insertion 81.5 80.7 Different place 18.5 19.4 Reported facing challenges accessing facility or at facility 53.5 55.1 Challenges faced,b,c % Long line/long wait 67.1 75.6 Difficulty getting away from house 29.4 31.4 Difficulty finding money to pay for transport and services 23.8 19.8 Provider was not available 17.8 10.5 Difficulty finding transport 10.8 4.7 Outcome of first removal attempt, % Method removed, reported satisfied to remove 53.3 63.6 Method removed, reported would have preferred to keep 4.0 3.9 Still has method, reported satisfied to keep 9.9 9.7 Still has method, reported would have preferred to remove 32.2 22.7 Partial/failed removal 0.7 0.0 Reasons provider did not remove at first interaction,b,d % Provider counseled to keep method 33.9 50.0 Qualified provider not available 30.6 22.0 Equipment/supplies not available for removal 12.0 2.0 Consultation period over/client arrived late to clinic 11.5 2.0 Provider refused to remove 6.6 14.0 Outcome of most recent removal attempt, % Method removed, reported satisfied to remove 81.0 82.1 Method removed, reported would have preferred to keep 6.9 6.4 Still has method, reported satisfied to keep 5.9 6.4 Still has method, reported would have preferred to remove 5.7 5.1 Partial/failed removal 0.5 0.0 Number of attempts until complete removal, mean (SD) 1.4 (0.7) 1.3 (0.5) Abbreviations: IUD, intrauterine device; SD, standard deviation.
↵a Data are from in-person survey participants. Nonresponses varied across items; small amounts of data are missing.
↵b Multiple responses possible, spontaneous mention; responses with values of ≥10% reported.
↵c Among participants who reported facing a challenge accessing facility or at facility.
↵d Among participants who reported still having method after first removal attempt.
- TABLE 6.
Implant and IUD Removal Procedures and Post-Removal Contraceptive Use Among Participants Who Had Their Method Removed at the Time of the Survey in 3 Districts of Senegala
Implant
(n=379)IUD
(n=136)Had method removed during first clinical procedure, % 99.7 100.0 Reported complication at removal, % 58.1 36.0 Complications reported,b,c % Temporary pain at time of removal 63.6 85.7 Pain/discomfort that lasted throughout the day 33.6 22.5 Pain/discomfort that lasted a few days 21.8 8.2 Told by provider there were difficulties during removal, % 17.7 4.4 Reported duration of removal procedure, mean (range), minutes 14.5 (0–120) 11.3 (0–75) Reported time spent at facility for removal, mean (range), minutes 81.0 (1–420) 77.7 (0–360) Reported cost of removal, mean (range), CFA [US$] 1891 (0–20000) [3.21 (0–33.96)] 1327 (0–17000) [2.25 (0–28.86)] Reported cost of insertion, mean (range), CFA [US$] 1491 (0–9000) [2.53 (0–15.28)] 1118 (0–12000) [1.90 (0–20.37)] Actual cost for removal compared to removal cost told at time of insertion, % More expensive 1.1 0.0 Same price 3.3 2.3 Less expensive 1.4 0.0 Was not told price at insertion 93.3 96.2 Reported ease of overall removal experience, % Very easy 36.9 58.8 Somewhat easy 38.0 28.7 Somewhat difficult 17.9 10.3 Very difficult 7.1 2.2 Did not obtain another contraceptive method after removal, % 66.2 64.7 Reasons reported,b,d % Afraid of side effects 19.1 18.2 Partner disapproved 10.4 8.0 Any reason other than desired pregnancy, sexual inactivity, or infecundity 21.9 17.7 Abbreviations: CFA, West African CFA franc; IUD, intrauterine device.
↵aData are from in-person survey participants except for cost of insertion which is from the phone survey. Nonresponses varied across items; small amounts of data are missing.
↵bMultiple responses possible, spontaneous mention; responses with values of ≥10% reported.
cAmong participants who reported complications at removal.
↵dAmong participants who did not obtain another contraceptive method after removal.
