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PROGRAMMATIC REVIEWS & ANALYSES
Open Access

Liftoff: The Blossoming of Contraceptive Implant Use in Africa

Roy Jacobstein
Global Health: Science and Practice March 2018, 6(1):17-39; https://doi.org/10.9745/GHSP-D-17-00396
Roy Jacobstein
aIntraHealth International, Chapel Hill, NC, USA.
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Contraceptive implant use is rising rapidly, substantially, and equitably in many sub-Saharan African countries, across almost all sociodemographic categories. Gains in implant use have exceeded combined gains for IUDs, pills, and injectables. Key contributing factors include sizeable reductions in commodity cost, much-increased commodity supply, greater government commitment to expanded method choice, and wider adoption of high-impact service delivery practices that broaden access and better reach underserved populations. Continued progress in meeting women's reproductive intentions with implants calls for further investment in quality services for both insertion and removal, and for addressing issues of financing and sustainability.

Abstract

This article draws from national surveys of every sub-Saharan African country with at least 1 recent survey published between 2015 and 2017 and 2 prior surveys from 2003 to 2014. Twelve countries comprising over 60% of the region's population met these inclusion criteria. The analysis considers recent and longer-term changes in 3 key variables: modern contraceptive prevalence rate (mCPR), method-specific prevalence, and a method's share of the current modern method mix. As recently as 2011, implant CPR in sub-Saharan Africa was only 1.1%. Since then, sizeable price reductions, much-increased commodity supply, greater government commitment to rights-based family planning, broader WHO eligibility guidance, and wider adoption of high-impact service delivery practices have resulted in expanded client access and marked increases in implant prevalence and share of the method mix. Ten of the 12 countries now have an implant CPR around 6% or higher, with 3 countries above 11%. Increased implant use has been the main driver of the increased mCPR attained by 11 countries, with gains in implant use alone exceeding combined gains in use of injectables, pills, and intrauterine devices. In countries as diverse as Burkina Faso and Ethiopia, Democratic Republic of the Congo and Ghana, Kenya and Senegal, implant use now accounts for one-fourth to one-half of all modern method use. Implants have become the first or second most widely used method in 10 countries. In the 7 countries with multiple surveys conducted over a 2- to 3-year span between 2013–14 and 2016–17, average annual gains in implant prevalence range from 0.97 to 4.15 percentage points; this contrasts to historical annual gains in use of all modern methods of 0.70 percentage points in 42 sub-Saharan African countries from 1986 to 2008. Implant use has risen substantially and fairly equitably across almost all sociodemographic categories, including unmarried women, women of lower and higher parity, women in all 5 wealth quintiles, younger and older women, and women residing in rural areas. A notable exception is the category of nulliparous married women, whose implant use is mostly below 1%. These attainments represent a major success story not often seen in family planning programming. With continued program commitment and donor support, these trends in implant uptake and popularity are likely to continue for the next few years. This implies even greater need for the international family planning community to maintain its focus on rights-based programming, ensuring reliable access to implant removal as well as insertion services, and addressing issues of financing and sustainability.

  • Received: 2017 Oct 27.
  • Accepted: 2018 Jan 30.
  • Published: 2018 Mar 21.
  • © Jacobstein.

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 http://creativecommons.org/licenses/by/4.0/. When linking to this article, please use the following permanent link: https://doi.org/10.9745/GHSP-D-17-00396

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Global Health: Science and Practice: 6 (1)
Global Health: Science and Practice
Vol. 6, No. 1
March 21, 2018
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Liftoff: The Blossoming of Contraceptive Implant Use in Africa
Roy Jacobstein
Global Health: Science and Practice Mar 2018, 6 (1) 17-39; DOI: 10.9745/GHSP-D-17-00396

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Liftoff: The Blossoming of Contraceptive Implant Use in Africa
Roy Jacobstein
Global Health: Science and Practice Mar 2018, 6 (1) 17-39; DOI: 10.9745/GHSP-D-17-00396
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  • Factors Associated With Delayed Contraceptive Implant Removal in Ethiopia
  • Scaling Up Access to Implants: A Summative Evaluation of the Implants Access Program
  • What Goes In Must Come Out: A Mixed-Method Study of Access to Contraceptive Implant Removal Services in Ghana
  • The Open Birth Interval: A Resource for Reproductive Health Programs and Women's Empowerment
  • Increasing Family Planning Access in Kenya Through Engagement of Faith-Based Health Facilities, Religious Leaders, and Community Health Volunteers
  • Postabortion Care and the Voluntary Family Planning Component: Expanding Contraceptive Choices and Service Options
  • Are Procured Quantities of Implants Adequate and Appropriate? Modeling Procurement, Inventory, and Consumption of Contraceptive Implants During Rapid Uptake
  • Regaining Momentum in Family Planning
  • Experiences With the Levonorgestrel Intrauterine System Among Clients, Providers, and Key Opinion Leaders: A Mixed-Methods Study in Nigeria
  • A Global Learning Agenda for the Levonorgestrel Intrauterine System (LNG IUS): Addressing Challenges and Opportunities to Increase Access
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  • Provider Bias in Family Planning Services: A Review of Its Meaning and Manifestations
  • Family Planning in the Democratic Republic of the Congo: Encouraging Momentum, Formidable Challenges
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    • Family Planning and Reproductive Health
US AIDJohns Hopkins Center for Communication ProgramsUniversity of Alberta

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