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

Figures & Tables

TABLE 1. Contraceptive Prevalence Among Married Women of Reproductive Age in Kenya, 1988–2015

Percentage of Married Women Using:
Survey Year	Any Modern Method	Injectable	Copper IUD	Implant
1988–1989	17.9	3.3	3.7	0.0
1993	27.3	7.2	4.2	0.0
1998	31.5	11.8	2.7	0.8
2003	31.5	14.3	2.4	1.7
2008–2009	39.4	21.6	1.6	1.9
2014	53.2	26.4	3.4	9.9
2015	63.1	29.2	4.8	16.1

Abbreviation: IUD, intrauterine device.
Source of data: 2015 survey from Performance Monitoring and Accountability 2020 (PMA2020)¹⁵; all other surveys from Demographic and Health Surveys.¹⁶

TABLE 2. Per Unit Costs of Commodities, Consumable Supplies, and Instruments Included in the Model (US$)

Method	Commodity	Consumables for Insertion/Initial Provision	Consumables for Resupply	Consumables for Removal	Instruments
COCs	$0.27	NA	NA	NA	NA
Copper IUD	$0.35	$0.90	NA	$0.90	$0.13
DMPA injectable	$0.72	$0.34	$0.34	NA	NA
Female condom	$0.45	NA	NA	NA	NA
Female sterilization	NA	$6.64	NA	NA	$0.15
Implanon implants	$8.50	$1.32	NA	$1.32	$0.03
Jadelle implants	$8.50	$1.32	NA	$1.32	$0.03
LNG IUS	$15.00	$0.90	NA	$0.90	$0.13
Male condom	$0.03	NA	NA	NA	NA
Male sterilization	NA	$4.67	NA	NA	$0.03
NET-EN injectable	$1.15	$0.34	$0.34	NA	NA
Sayana Press injectable	$1.00	$0.34	$0.34	NA	NA
Sino-implant (II) implants	$8.00	$1.32	NA	$1.32	$0.03

Abbreviations: COCs, combined oral contraceptives; DMPA, depot medroxyprogesterone acetate; IUD, intrauterine device; LNG IUS, levonorgestrel intrauterine system; NA, not applicable; NET-EN, norethisterone enanthate.
Source of data: UNFPA AccessRH Product Catalog,²³ IDA Foundation E-catalogue,²⁴ Stephens,¹⁰ and personal communication with international medical supplier Shendu Pak (for cost of instruments required for long-acting and permanent methods). Supply and commodity costs can fluctuate over time; the prices used in the model were accessed in September 2015.

TABLE 3. Total Labor Time Included in the Model for Counseling, Insertion, Removal, and/or Resupply by Method and Provider Cadre

	Nurse-Midwife			Physician	Unpaid Health Worker
Method	Counseling and Method Provision	Follow-up or Resupply	Removal	Method Provision	Counseling and Method Provision	Resupply
COCs	25 min	5 min	NA	NA	NA	NA
DMPA injectable	25 min	5 min	NA	NA	NA	NA
Female condom	20 min	5 min	NA	NA	NA	NA
Female sterilization	60 min	10 min	NA	30 min	NA	NA
Implanon implants	35 min	10 min	15 min	NA	NA	NA
Copper IUD	35 min	10 min	10 min	NA	NA	NA
Jadelle implants	35 min	10 min	15 min	NA	NA	NA
LNG IUS	35 min	10 min	10 min	NA	NA	NA
Male condom	NA	NA	NA	NA	20 min	5 min
Male sterilization	60 min	10 min	NA	30 min	NA	NA
NET-EN injectable	25 min	5 min	NA	NA	NA	NA
Sayana Press injectable	25 min	5 min	NA	NA	NA	NA
Sino-implant (II) implants	35 min	10 min	15 min	NA	NA	NA

Abbreviations: COCs, combined oral contraceptives; DMPA, depot medroxyprogesterone acetate; IUD, intrauterine device; LNG IUS, levonorgestrel intrauterine system; NA, not applicable; NET--EN, norethisterone enanthate.
Source of data: Futures Institute.²⁵