Elsevier

Contraception

Volume 85, Issue 5, May 2012, Pages 432-433
Contraception

Editorial
Avoiding controversy in international provision of subdermal contraceptive implants

https://doi.org/10.1016/j.contraception.2011.11.018Get rights and content

Introduction

International agencies work with host country governments to estimate contraceptive needs and to procure commodities at affordable public-sector prices. Depending on the agency and the registration status of the commodity in the given country, three subdermal contraceptive implants are options for purchase: Jadelle® is a two-rod levonorgestrel implant approved for 5 years of continuous use (Bayer HealthCare, Berlin, Germany), Implanon® (Merck & Co., Inc., Whitehouse Station, NJ, USA) is a one-rod etonogestrel implant (approved for 3 years) and Sino-implant (II) (Shanghai Dahua Pharmaceutical Co., Ltd., China) is another two-rod levonorgestrel implant (approved for 4 years).

Section snippets

Implant procurement

Between 2005 and 2009, international agency procurement of implants for sub-Saharan Africa increased 15-fold (Fig. 1). Today, over 30 countries in the region are beneficiaries of the approximately 1.5 million units that arrive each year [1].

This level of implant shipment (5.8 million units over the past 7 years) brings tremendous reproductive health benefit. In terms of protection from just unintended pregnancy, over 20 million years of contraception are generated to prevent approximately 6

Country-specific information

Ten countries in sub-Saharan Africa received at least 100,000 implants in the 4-year period from 2007 to 2010 (Table 1). Depending on the country, this volume of implant procurement represents between 4% and 21% of the estimated national populations of married women of reproductive age [3]. In recent years, the government of Ethiopia, for example, has worked with numerous international agencies to make implants widely available. Uptake has been brisk at the national level. In 2005, the

Future demand for removal services

With increased procurement, demand and uptake of subdermal implants, programs in sub-Saharan Africa will need to provide an ever-increasing volume of removal services. International studies show that approximately 20% of implant users have their product removed in the first year. Each country's service requirement will vary, depending on the wave/timing of insertions, the level of user satisfaction with the products and the length of contraceptive effectiveness (3–5 years) of the specific

Ways to avoid controversy

Some implant users will have difficulty getting the product removed when they wish. As disturbing as this may sound, it is inevitable because the obstacles to removal can be numerous. To minimize the number of problems, programs need to prepare for the increased demand for removal in the following ways:

  • ● Continue to train providers in safe, aseptic removal services.

  • ● Give providers adequate time to render services given their other duties.

  • ● Ensure adequate supplies of forceps, scalpels,

Protecting the reputation and future availability of subdermal implants

The development and refinement of today's implants have been a 30-year journey. Great effort and resources have created these contraceptive options that are now the preferred product for millions of women. Manufacturers play their role to protect the technology and continue to produce high-quality and safe products for worldwide distribution.

At this juncture in the history of implant provision, service delivery programs have the most difficult task: satisfying high demand and making services

References (4)

  • Reproductive Health Supplies Coalition

    RHInterchange Web site

  • N. Corby et al.

    The MSI Impact Calculator: methodology and assumptions

    (2009)
There are more references available in the full text version of this article.

Cited by (0)

View full text