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

doi:10.9745/GHSP-D-13-00134

Figures & Tables

Tables

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TABLE 1. Comparing the LNG IUS and the Copper IUD

Points of Comparison	LNG IUS	Copper IUD
Main difference	Hormonal (levonorgestrel)	Nonhormonal
Main effects on menstruation	Generally decreasesmenstrual blood loss	Generally increasesmenstrual blood loss
Duration of use	5 years	10–12 years
Noncontraceptive benefits (stemming from reduced uterine bleeding)	Treats menorrhagia, increases hemoglobin, and likely alleviates anemia and problems with uterine fibroids	…
Effectiveness	Both in the highest tier of contraceptive effectiveness
Continuation rates	Both have similar, high continuation rates

Abbreviations: IUD, intrauterine device; LNG IUS, levonorgestrel intrauterine system.

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TABLE 2. LARC Insertions Performed by 11 Outreach Teams of Marie Stopes/Kenya, 2011
Device Total No. Mean^a (range)
Copper IUD 26,070 201 (20, 509)
Subdermal implants 40,146 309 (25, 772)
LNG IUS 1,030 8 (0, 116)
Abbreviations: IUD, intrauterine device; LARC, long-acting reversible contraceptive; LNG IUS, levonorgestrel intrauterine system.
↵a Per outreach team, per month.

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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

Team	LNG IUS Not Available				LNG IUS Available
Team	No. of Months	Implants	Copper IUD	% IUD^b	No. of Months	Implants	Copper IUD	LNG IUS	Total IUD^c	% Total IUD^b
1	4	566	227	29.5	8	424	242	5	247	37.3
2	10	329	165	38.3	1	416	147	3	150	26.5
4	5	273	164	43.5	6	352	138	9	147	29.5
7	8	278	159	37.4	4	368	174	3	177	32.8
8	1	285	193	40.4	11	227	128	14	142	43.0
9	10	447	188	31.4	2	306	205	10	215	42.7
11	6	391	215	33.5	6	408	291	9	300	41.9
12	2	147	268	66.4	10	229	281	38	319	60.7
13	6	254	310	59.1	6	328	314	14	328	52.1
14	2	185	486	72.4	10	181	205	19	224	54.9
15	9	210	72	26.9	3	273	45	10	55	19.2
Total	63	322	191	38.9	67	296	210	15	225	44.3

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.

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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
0	11
1–10	26
11–50	15
51+	48
Method most comfortable describing and providing
Copper IUD	0
Subdermal implant	48
LNG IUS	0
All the same	52
Method least comfortable describing and providing
Copper IUD	4
Subdermal implant	0
LNG IUS	44
All the same	52
Do you think clients easily understand the difference between the copper IUD and the LNG IUS?
No	30
Yes	70
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?
No	52
Yes	44
Do not know	4
Did you ever have a stockout of the LNG IUS?
No	4
Yes	96
If the LNG IUS is not available, what method do women choose instead?
Subdermal implant	70
Copper IUD	30
Other	0
Will the LNG IUS attract new clients to long-acting contraception?
No	0
Yes	100
How important are noncontraceptive benefits of the LNG IUS to your clients?
Very important	70
Somewhat important	30

Abbreviations: IUD, intrauterine device; LNG IUS, levonorgestrel intrauterine system.

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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 IUD^a
Hormonal product	85
Reduces bleeding	52
Duration of use	44
Works locally in uterus	15
Prevents cancer	15
Aspects of the LNG IUS that are attractive to clients^a
Reduction of excessive menstrual bleeding	59
5-year product	15
Hormonal effect	15
Plastic/nonmetallic	15
Duration of use	15
Aspects of the LNG IUS are unattractive to clients^a
Contains hormones	44
Insertion procedure/modesty issues	22
Strings cause discomfort during sex	19
What are the most important noncontraceptive benefits of the LNG IUS?^a
Reduces menstrual blood loss	52
Prevents cancer/uterine disease	22
Prevents anemia	22
Treats heavy menstrual blood loss	22
Alleviates pain during menses	15

Abbreviations: IUD, intrauterine device; LNG IUS, levonorgestrel intrauterine system.
↵a Multiple responses allowed; only responses garnering at least 15% (n = 4) are shown.