RT Journal Article SR Electronic T1 Factors Associated With Delayed Contraceptive Implant Removal in Ethiopia JF Global Health: Science and Practice JO GLOB HEALTH SCI PRACT FD Johns Hopkins University- Global Health. Bloomberg School of Public Health, Center for Communication Programs SP 000 OP 000 DO 10.9745/GHSP-D-20-00135 VO 8 IS 3 A1 Costenbader, Elizabeth A1 Cartwright, Alice F. A1 McDowell, Misti A1 Assefa, Berhane A1 Tejeji, Meza Yirga A1 Tenaw, Eskindir YR 2020 UL http://www.ghspjournal.org/content/8/3/000.1.abstract AB Key FindingsWomen receiving implant insertion at the community level were significantly more likely to report keeping their implant for more than 3 years.Task sharing only implant insertion and not removal services to community-based health worker cadres may have inadvertently led to extended implant use, particularly in rural areas or areas far from facilities.Key ImplicationsGovernments and program planners should prioritize efforts to ensure that implant removal services are available at the same health system level as insertions.National stakeholders and implementing partners should consider including implant removal as part of the training for all health care providers who are trained in insertion. Background:In 2009, the Government of Ethiopia initiated the implant scale-up initiative, which expanded contraceptive access by training health extension workers (HEWs) to insert single-rod etonogestrel contraceptive implants (Implanon) at rural health posts. Removals were provided by referrals to higher levels of the health system. However, little was known about whether women were getting their implants removed at the recommended 3-year postinsertion date or what barriers they faced to removal.Methods:Between June and July 2016, 1,860 Ethiopian women, who had a 1-rod etonogestrel implant inserted by either an HEW or another health care provider between 3 and 6 years prior, were surveyed. We describe the characteristics of the sample and use multivariable logistic regression to predict factors associated with keeping implants inserted beyond 3 years.Results:Women who had received their implants from HEWs were significantly more likely to report keeping them inserted for more than 3 years (adjusted odds ratio=2.50; 95% confidence interval=1.19, 5.24), compared with those who got their implant from another health care provider. Women who reported distance to the facility or transportation as a barrier were also significantly more likely to keep their implant for more than 3 years. Married and educated women were less likely to keep their implants for an extended duration. Among women who had their implant for 3 years or less, women who had had it inserted by an HEW were significantly more likely to report that the provider was unable or refused to provide removal as a barrier.Discussion:Efforts to expand lower level and community-based access to contraceptive implants that do not ensure reliable access to removals at the same level as insertions may lead to women using implants beyond the recommended duration.