PT  - JOURNAL ARTICLE
AU  - Cartwright, Alice F.
AU  - Callahan, Rebecca L.
AU  - Lawton, Anna
AU  - Wong, Christina
AU  - Muchiri, Oliver
AU  - Matan, Samira
TI  - Assessing Acceptability of Biodegradable Contraceptive Implants in Kenya and Senegal
AID  - 10.9745/GHSP-D-23-00503
DP  - 2024 Aug 27
TA  - Global Health: Science and Practice
PG  - e2300503
VI  - 12
IP  - 4
4099  - http://www.ghspjournal.org/content/12/4/e2300503.short
4100  - http://www.ghspjournal.org/content/12/4/e2300503.full
SO  - GLOB HEALTH SCI PRACT2024 Aug 27; 12
AB  - Key FindingsContraceptive implants are a popular method in Kenya and Senegal, but access to removal continues to be a challenge that could be partially alleviated by biodegradable implants (BDIs).Potential users, health care providers, and other stakeholders like that BDIs would not need to be removed, which would save time and money for users and health systems, as well as reduce pain and scarring from removal.Concerns about biodegradation and possible side effects were raised by participants in both Kenya and Senegal.Key ImplicationsUser feedback on BDI prototypes can help refine product characteristics to be more acceptable before the method is brought to market.As BDI products are further refined, additional information will be needed from low- and middle-income countries to determine the system-level needs and user-focused positioning for successful introduction.Background:Contraceptive implants are popular in Africa, but barriers to removal exist. Biodegradable implants (BDIs) offer an alternative to the need for removal. This study explored potential user, provider, and other stakeholder perspectives on 2 BDI prototypes, revealing opportunities and challenges for introduction.Methods:We conducted focus group discussions (FGDs) and in-depth interviews (IDIs) with women, men, family planning (FP) providers, community influencers, and FP policymakers and program staff in Kenya and Senegal. Characteristics of the 2 BDI prototypes were shared, and participants held and interacted with placebo prototypes. Structural coding was used to analyze the data focused on key product attributes, including biodegradation, removal potential, size, material, insertion site, and duration of effectiveness.Results:We conducted 16 FGDs and 35 IDIs with 106 participants in Kenya and 15 FGDs and 43 IDIs with 102 participants in Senegal. Overall, respondents liked the idea of a BDI, noting the avoidance of pain and scarring and reduced transport and costs as benefits of no removal requirement. Kenyan respondents expressed greater understanding of the biodegradation process than those in Senegal, though potential users in both countries expressed concerns about possible side effects associated with the process. In Senegal, mention of cholesterol in a BDI caused concern, while Kenyan participants responded positively to the same BDI being composed of organic materials. The second BDI product was viewed as more similar to existing implants, which providers preferred. Participants suggested increasing the pregnancy protection duration beyond 18 months. No clear preference between products emerged, and participants liked and disliked some characteristics of both.Conclusions:Kenyan and Senegalese participants expressed interest in the BDI concept but expressed some reservations related to biodegradation, material, and side effects. BDIs offer the opportunity to expand contraceptive choice. However, messaging around product characteristics will be required for successful introduction and uptake.