Figures & Tables
Figures
- FIGURE 1.
Study Sample of Women, Aged 18–49 Years Old, Who Had a Contraceptive Implant Inserted in Public and Outreach Regions, Ghana
Abbreviations: CLIC, Client Information Center; IDI, in-depth interview; RA, research assistant; rsLog, Reproductive Services Log.
- FIGURE 2.
Outcomes Among Women Who Attempted to Have Contraceptive Implants Removed in Public and Outreach Regions, Ghana
aPercentages are adjusted for sampling weights.
Tables
- TABLE 1.
Contraceptive Implant Acceptor Phone Survey Participants’ Demographic Characteristics by Context, Ghana
Publica(N=1,159) Outreach(N=1,073) Age, years, mean (SD) 29.6 (6.6) 28.4 (6.2) 18–29, % 53.8 63.1 30–39, % 36.8 30.7 40–49, % 9.4 6.2 Marital status Never married, % 21.4 19.5 Married/cohabitating, % 73.0 76.4 Divorced/widowed, % 5.6 4.2 Parity (n=1152) (n=1062) Mean (SD) 2.3 (1.6) 2.6 (1.6) 0, % 10.2 3.9 1–2, % 49.0 50.1 3–4, % 31.5 33.3 5+, % 9.4 12.7 Highest education (n=1072) None, % 6.7 5.5 Primary, % 11.0 15.5 Middle, % 51.8 58.4 High school, % 21.7 15.9 >High school, % 8.9 4.7 Religion Christian, % 92.3 93.6 Muslim, % 7.4 4.9 Other/none, % 0.3 1.5 Have health insurance, % 64.7 42.6 Wealth quantiles (n=1155) (n=1073) Lowest, % 16.3 23.9 Second, % 18.2 22.1 Middle, % 21.1 20.3 Fourth, % 22.4 18.0 Highest, % 22.0 15.8 Months since implant inserted Mean (SD) 19.5 (10.8) 14.5 (7.4) 0–6, % 4.9 12.6 7–12, % 34.0 46.3 13–18, % 19.4 13.4 19–24, % 18.7 22.4 25–36, % 18.9 4.9 >36 months, % 4.1 0.5 Implant typeb Jadelle, % 61.9 86.3 Implanon, % 29.8 6.3 Unknown, % 8.3 7.4 Abbreviations: SD, standard deviation.
↵a Frequencies are unadjusted; percentages and means are adjusted for sampling weights.
↵b Implant type determined by comparing participant responses to number of rods in their implant and the duration of protection. Response combinations that do not describe any available implant are categorized as unknown.
- TABLE 2.
Phone Survey Participants’ Reported Knowledge of Contraceptive Implant Removal Services by Context, Ghana
Publica(N=1,159) Outreach(N=1,073) % 95% CI % Aware implant can be removed before labeled duration 88.2 85.8, 90.3 84.3 Told by provider at insertion that implant can be removed before labeled duration (n=1020) 88.9 86.0, 91.3 (n=905) 88.4 Reasons provider mentioned that implant can be removed before labeled durationb (n=923) (n=800) Want children 69.3 N/A 62.6 Side effects 60.5 N/A 62.0 Any reason 26.0 N/A 24.9 Partner disapproves 9.9 N/A 9.5 Told at insertion where removal can be obtained Insertion place only 46.5 N/A 33.3 Place other than insertion place 3.2 N/A 15.2 Insertion place and another place 40.5 N/A 38.1 Not told about any place/don’t know 9.8 N/A 13.4 - TABLE 3.
Phone Survey Participant’s Reported Desire to Remove Contraceptive Implant, by Context, Ghana
Publica(N=1,159) Outreach(N=1,073) % % Report wanting removal 31.8 21.5 Main reason for wanting removal/obtaining removal (n=373) (n=231) Other side effects/ health concerns 37.7 49.4 Bleeding side effects 24.4 22.9 Wanted children 18.7 10.4 Partner disapproved 4.9 5.2 Lost partner/partner away/infrequent sex 3.5 2.6 Other 2.7 4.8 Implant expired 2.5 0.0 Afraid of becoming infertile 2.2 1.3 Sexual side effects 1.4 1.3 Became pregnant 1.1 1.3 Too old/ menopause/ infecund 0.7 0.4 Don’t know 0.2 0.4 ↵a Frequencies are unadjusted; percentages and means are adjusted for sampling weights.
- TABLE 4.
Phone Survey Participants’ Reported Contraceptive Implant Side Effects and Social Influence by Context and Desire to Remove Implant, Ghana
Publica(N=1,159) Outreach(N=1,073) Ever Wanted Removal(n=373)% Never Wanted Removal(n=786)% Ever Wanted Removal(n=231)% Never Wanted Removal(n=842)% Reported experiencing bleeding side effects 85.2 75.6 (n=230) 90.0 (n=840) 77.3 Most commonly mentioned bleeding side effectsb (n=315) (n=597) (n=208) (n=651) Stopped having period 39.3 37.2 46.6 48.9 Bleed more during period 37.6 25.7 19.7 14.8 Bleed less during period 23.8 25.5 22.1 24.3 Period lasts longer 26.0 23.0 26.4 24.3 Period is shorter 13.8 15.4 18.3 18.0 Reported experiencing side effects (other than bleeding) (n=372) 59.6 (n=784) 40.3 (n=230) 70.0 (n=840) 38.0 Most commonly mentioned other side effectsb (n=227) (n=315) (n=161) (n=320) Dizziness 47.1 26.5 50.3 38.4 Weight change 43.2 40.1 40.4 33.4 Headaches 23.8 26.4 15.5 13.1 Abdominal pain 11.1 21.9 14.9 15.9 Reported someone influenced to stop using implant 40.5 31.8 51.5 29.8 Person(s) influenced byb (n=154) (n=237) (n=118) (n=215) Neighbor or friend 54.9 83.5 54.2 76.9 Husband or partner 42.1 14.4 31.4 12.0 Mother 9.7 7.2 14.4 6.8 Other person/unspecified 3.8 9.9 10.2 10.8 - TABLE 5.
Phone Survey Participants’ Responses on Barriers to Contraceptive Implant Removal and Satisfaction With Services Among Women Who Attempted a Removal by Context, Ghana
Publica(n=339) Outreach(n=132) % % Reason women reported they could not get a removal when they wanted tob Provider counseled to continue using 20.6 16.7 Provider not available 8.6 16.7 Provider would not remove 11.5 10.6 Provider unable to remove despite trying 0.7 4.6 Implant not palpable 4.4 13.5 Problems at removal site on armc (n=314) (n=101) Temporary pain at time of removal 43.6 46.0 Pain that lasted a few days 43.6 54.1 Scarring 35.2 35.1 Infection/swelling 5.1 5.4 Continue pain 5.2 21.6 Other unspecified 0.0 5.4 Ease of removal experience (among women who had a removal) (n=314) (n=101) Very easy 53.0 55.5 Somewhat easy 20.8 12.9 Somewhat difficult 17.4 16.8 Very difficult 8.8 14.9 - TABLE 6.
Phone Survey Participants’ Reported Costs Associated With Contraceptive Implant Removal Services Reported by Respondents Who Removed Implant by Context, Ghana
Publica(n=307) Outreach(n=101) Reported incurring cost for removal services not associated with transportationb, % 75.0 84.2 Mean cost incurred, US$c (SD) 3.2 (1.8) 5.0 (1.9)d Reported incurring cost for transportation, % 70.6 55.5 Mean cost incurred, US$c (SD) 1.1 (0.7) 1.1 (1.0) Abbreviation: SD, standard deviation.
↵a Frequencies are unadjusted; percentages and means are adjusted for sampling weights.
↵b Costs includes fees for supplies, provider, and other facility-associated costs.
↵c Respondents reported costs in Ghana cedis. Costs were converted to US$ using the exchange rate at the time of analysis (21 US cents=1.00 Ghana cedi). Means calculated from women who reported incurring costs only.
↵d One respondent reported a cost of US$52.50, which was an extreme outlier. This response was removed from the analysis.
- TABLE 7.
Phone Survey Participants’ Reported Contraceptive Method Uptake and Unmet Need After Implant Removal by Context, Ghana
Publica(n=314) Outreach(n=101) % % Adopted contraceptive method after removal 35.6 28.7 Method used (n=116) (n=29) Injectable 60.2 72.4 Pill 24.8 24.1 Emergency Contraception 11.1 3.5 Intrauterine device 2.4 0.0 Implant 0.7 0.0 Other 0.8 0.0 Reasons for not adopting method (n=193b) (n=72) Want to get pregnant 37.4 18.1 Side effects/health concerns 34.8 36.1 Lost partner/partner away 11.2 6.9 Partner disapproves 3.9 11.1 Inconvenient 1.3 4.2 Other/unspecified 11.4 23.8 Unmet need for family planning after removalc 33.3 53.5 ↵a Frequencies are unadjusted, percentages and means are adjusted for sampling weights.
↵b Five respondents did not provide a response to this question, thus the reduced sample size.
↵c Unmet need is defined as not adopting a method of family planning after removal for all reasons other than desiring pregnancy, reporting no sexual activity, and reporting infecundity.
- TABLE 8.
Characteristics of Contraceptive Implant Acceptor Exit Interview Participants, Ghana
Interviewees(n=50) Age, years, mean (SD) 31.0 (7.0) Marital status, % Never married 30.0 Married/cohabitating 58.0 Divorced/widowed 12.0 Parity, mean (SD) 3.3 (1.8) (n=47) Highest education, % None 22.0 Primary 36.0 Middle 42.0 Religion, % Christian 92.0 Muslim 6.0 Other/none 2.0 Have health insurance, % 16.0 Wealth quantiles, % (n=49) Lowest 55.1 Second 28.6 Middle 12.2 Fourth 4.1 Highest 0.0 Months since implant inserted, % (n=48) Mean (SD) 51.4 (16.8) ≤ 24 12.5 25–36 12.5 48 8.3 60+ 66.6 Implant typea, % Jadelle 84.0 Implanon 4.0 Unknown 12.0 Adopted contraceptive method after removal, % 66.0 Contraceptive method used, % (n=33) Intrauterine device 3.0 Implant 93.9 Female sterilization 3.0 Reasons for not adopting method, % (n=16b) Want to get pregnant 25.0 Side effects/health concerns 12.6 Partner disapproves 31.3 Inconvenient 18.8 Other/unspecified 12.6 Unmet need for family planning after removalc 24.0 ↵a Implant type determined by comparing participant responses to number of rods in their implant and the duration of protection. Response combinations that do not describe any available implant are categorized as unknown.
↵b One respondent did not provide a response to this question, thus the reduced sample size.
↵c Unmet need is defined as not adopting a contraceptive method after removal for all reasons other than desiring pregnancy, reporting no sexual activity, and reporting infecundity.
- TABLE 9.
Outcome of Either Removal Attempt or Desire to Remove for Contraceptive Implant Acceptor In-depth Interview Participants by Context, Ghana
Public(n=10) Outreach(n=10) No. No. Successful removal at first attempt 3 2 Removal at second or subsequent attempt 6 4 Removal not yet obtained 1 1 Wanted removal but have not attempted 0 3 Public(n=8) Outreach(n=7) No. No. Provider cadre Nurse 1 1 Midwife 2 2 Community health nurse 3 4 Other 2 0 Experience with implant insertion 1–2 years 5 1 3–5 years 0 5 6+ years 3 1 Experience with implant removals No experience 1 0 1–2 years 4 3 3–5 years 0 4 6+ years 3 0
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