TY - JOUR T1 - Introducing Long-Acting Contraceptive Removal Indicators in a Pilot Study in Mozambique: Dynamics of Discontinuation and Implications for Quality of Care JF - Global Health: Science and Practice JO - GLOB HEALTH SCI PRACT DO - 10.9745/GHSP-D-21-00252 VL - 10 IS - 1 SP - e2100252 AU - Ana Jacinto AU - Adalgisa Viola Ronda AU - Connie Lee AU - Fariyal F. Fikree AU - Eric Ramirez-Ferrero Y1 - 2022/02/28 UR - http://www.ghspjournal.org/content/10/1/e2100252.abstract N2 - Key FindingsSynthesis and interpretation of the long-acting reversible contraceptive (LARC) removals data underscored the need to strengthen family planning (FP) counseling, particularly on method side effects and use-effectiveness periods, in all client-provider interactions.Health care providers perceived “the addendum with LARC removal indicators” as easy to use and useful for understanding quality-of-care issues.Key ImplicationsNational stakeholders and program implementers should ensure routine and robust FP counseling at all client-provider interactions, including before inserting of LARCs and time of removal, to better enable clients to make informed method choices.Governments should consider including LARC removal indicators in their national health management information system to strengthen monitoring of the FP program and the delivery of high-quality FP care.Introduction:The recent increase in the use of long-acting reversible contraceptives (LARCs) will result in an equal increase in the need for removals. Few countries monitor the number of LARC removals and even fewer track reasons for removal, discontinuation, and method switching. We conducted a mixed-method study to pilot the introduction of 5 LARC removal indicators in Mozambique: (1) reason for seeking removal, (2) duration of use, (3) removal outcome, (4) reason for referral, and (5) family planning (FP) outcome. We assessed providers’ perceptions about the feasibility and utility of tracking these indicators and reviewed the findings to ascertain the quality-of-care concerns.Methods:We used a purposive, multistage sampling technique to select 19 intervention facilities in Nampula and Sofala provinces. Over 6 months, we abstracted data on the 5 indicators from an FP register addendum to determine when and why clients seek LARC removals and identify service quality issues that need to be addressed in the FP program. We used a supportive supervision checklist to assess the time taken to record data on the indicators and perceived benefits and challenges encountered by providers during record keeping.Results:Of the 795 clients who sought a LARC removal, 112 women (14.1%) opted not to have the removal after counseling. The most frequently reported reasons for seeking a removal were: the method was on-schedule for removal or past its expiration date (29.5%), complaints of side effects (25.8%), and desire to be pregnant (22.9%). Health care providers reported no major challenges in recording information in the addendum. Reasons for and timing of removal pointed to the need for strengthening FP counseling.Conclusion:Collecting, synthesizing, and interpreting data from the LARC removal indicators was feasible and provided valuable insights to improve the quality of care to enhance clients’ reproductive health care and contraceptive choices. ER -