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Original Articles
Open Access

Introduction of the levonorgestrel intrauterine system in Kenya through mobile outreach: review of service statistics and provider perspectives

David Hubacher, Vitalis Akora, Rose Masaba, Mario Chen and Valentine Veena
Global Health: Science and Practice February 2014, 2(1):47-54; https://doi.org/10.9745/GHSP-D-13-00134
David Hubacher
aFHI 360, Research Triangle Park, NC, USA
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  • For correspondence: dhubacher@fhi360.org
Vitalis Akora
bMarie Stopes/Kenya, Nairobi, Kenya
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Rose Masaba
aFHI 360, Research Triangle Park, NC, USA
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Mario Chen
aFHI 360, Research Triangle Park, NC, USA
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Valentine Veena
aFHI 360, Research Triangle Park, NC, USA
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Figures & Tables

Tables

    • View popup
    TABLE 1. Comparing the LNG IUS and the Copper IUD
    Points of ComparisonLNG IUSCopper IUD
    Main differenceHormonal (levonorgestrel)Nonhormonal
    Main effects on menstruationGenerally decreasesmenstrual blood lossGenerally increasesmenstrual blood loss
    Duration of use5 years10–12 years
    Noncontraceptive benefits (stemming from reduced uterine bleeding)Treats menorrhagia, increases hemoglobin, and likely alleviates anemia and problems with uterine fibroids…
    EffectivenessBoth in the highest tier of contraceptive effectiveness
    Continuation ratesBoth have similar, high continuation rates
    • Abbreviations: IUD, intrauterine device; LNG IUS, levonorgestrel intrauterine system.

    • View popup
    TABLE 2. LARC Insertions Performed by 11 Outreach Teams of Marie Stopes/Kenya, 2011
    DeviceTotal No.Meana (range)
    Copper IUD26,070201 (20, 509)
    Subdermal implants40,146309 (25, 772)
    LNG IUS1,0308 (0, 116)
    • Abbreviations: IUD, intrauterine device; LARC, long-acting reversible contraceptive; LNG IUS, levonorgestrel intrauterine system.

    • ↵a Per outreach team, per month.

    • View popup
    TABLE 3. Mean Number of Monthly LARC Insertions and Proportion of IUD Insertions per Marie Stopes/Kenya Outreach Team, by LNG IUS Availability,a 2011
    TeamLNG IUS Not AvailableLNG IUS Available
    No. of MonthsImplantsCopper IUD% IUDbNo. of MonthsImplantsCopper IUDLNG IUSTotal IUDc% Total IUDb
    1456622729.58424242524737.3
    21032916538.31416147315026.5
    4527316443.56352138914729.5
    7827815937.44368174317732.8
    8128519340.4112271281414243.0
    91044718831.423062051021542.7
    11639121533.56408291930041.9
    12214726866.4102292813831960.7
    13625431059.163283141432852.1
    14218548672.4101812051922454.9
    1592107226.9327345105519.2
    Total6332219138.9672962101522544.3
    • Abbreviations: IUD, intrauterine device; LARC, long-acting reversible contraceptive; LNG IUS, levonorgestrel intrauterine system.

    • ↵a P value = .08 for testing whether the relative monthly distribution of IUD vs. implants is different depending on availability of the LNG IUS.

    • ↵b Mean of the proportion of women receiving IUDs per month.

    • ↵c Total IUD is the sum of copper IUD and LNG IUS insertions.

    • View popup
    TABLE 4. Experiences With the LNG IUS Among Marie Stopes/Kenya Providers (N = 27)
    Provider Experiences% Distribution
    Number of LNG IUS insertions performed since completing training
     011
     1–1026
     11–5015
     51+48
    Method most comfortable describing and providing
     Copper IUD0
     Subdermal implant48
     LNG IUS0
     All the same52
    Method least comfortable describing and providing
     Copper IUD4
     Subdermal implant0
     LNG IUS44
     All the same52
    Do you think clients easily understand the difference between the copper IUD and the LNG IUS?
     No30
     Yes70
    Is the 10+ years duration of use for the copper IUD a significant reason women will choose it instead of the LNG IUS that only lasts for 5 years?
     No52
     Yes44
     Do not know4
    Did you ever have a stockout of the LNG IUS?
     No4
     Yes96
    If the LNG IUS is not available, what method do women choose instead?
     Subdermal implant70
     Copper IUD30
     Other0
    Will the LNG IUS attract new clients to long-acting contraception?
     No0
     Yes100
    How important are noncontraceptive benefits of the LNG IUS to your clients?
     Very important70
     Somewhat important30
    • Abbreviations: IUD, intrauterine device; LNG IUS, levonorgestrel intrauterine system.

    • View popup
    TABLE 5. Main Attributes of LNG IUS Cited by Marie Stopes/Kenya Providers (N = 27)
    Attribute% Distribution
    Key information provided to clients to distinguish the LNG IUS from the copper IUDa
     Hormonal product85
     Reduces bleeding52
     Duration of use44
     Works locally in uterus15
     Prevents cancer15
    Aspects of the LNG IUS that are attractive to clientsa
     Reduction of excessive menstrual bleeding59
     5-year product15
     Hormonal effect15
     Plastic/nonmetallic15
     Duration of use15
    Aspects of the LNG IUS are unattractive to clientsa
     Contains hormones44
     Insertion procedure/modesty issues22
     Strings cause discomfort during sex19
    What are the most important noncontraceptive benefits of the LNG IUS?a
     Reduces menstrual blood loss52
     Prevents cancer/uterine disease22
     Prevents anemia22
     Treats heavy menstrual blood loss22
     Alleviates pain during menses15
    • Abbreviations: IUD, intrauterine device; LNG IUS, levonorgestrel intrauterine system.

    • ↵a Multiple responses allowed; only responses garnering at least 15% (n = 4) are shown.

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Global Health: Science and Practice: 2 (1)
Global Health: Science and Practice
Vol. 2, No. 1
February 01, 2014
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Introduction of the levonorgestrel intrauterine system in Kenya through mobile outreach: review of service statistics and provider perspectives
David Hubacher, Vitalis Akora, Rose Masaba, Mario Chen, Valentine Veena
Global Health: Science and Practice Feb 2014, 2 (1) 47-54; DOI: 10.9745/GHSP-D-13-00134

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Introduction of the levonorgestrel intrauterine system in Kenya through mobile outreach: review of service statistics and provider perspectives
David Hubacher, Vitalis Akora, Rose Masaba, Mario Chen, Valentine Veena
Global Health: Science and Practice Feb 2014, 2 (1) 47-54; DOI: 10.9745/GHSP-D-13-00134
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  • Expanding Contraceptive Method Choice With a Hormonal Intrauterine System: Results From Mixed Methods Studies in Kenya and Zambia
  • Experiences With the Levonorgestrel Intrauterine System Among Clients, Providers, and Key Opinion Leaders: A Mixed-Methods Study in Nigeria
  • Expanding Access to a New, More Affordable Levonorgestrel Intrauterine System in Kenya: Service Delivery Costs Compared With Other Contraceptive Methods and Perspectives of Key Opinion Leaders
  • The Levonorgestrel Intrauterine System: A Pragmatic View of an Excellent Contraceptive
  • The Levonorgestrel Intrauterine System: Reasons to Expand Access to the Public Sector of Africa
  • Trends in the Contraceptive Method Mix in Low- and Middle-Income Countries: Analysis Using a New "Average Deviation" Measure
  • A bright future for IUD use in Africa?
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