Continuing Medical Education

Lessons learnt from the introduction of the contraceptive implant in South Africa

M Pleaner, C Morroni, J Smit, N Lince-Deroche, M F Chersich, S Mullick, D Pillay, M Makua, H Rees

Abstract


In 2014, South Africa (SA) introduced the subdermal contraceptive implant with the aim of expanding the contraceptive method mix and availability of long-acting reversible methods in the public sector. Three years on, concerns have been raised about the decline in uptake, early implant removals and challenges in service delivery. This article explores the lessons learnt from the introduction of contraceptive technologies elsewhere and applies these to the SA context. Drawing on the World Health Organization’s conceptual framework for the introduction of new contraceptive methods, and subsequent literature on the topic, lessons are classified into six cross-cutting themes. Recommendations highlight the need for SA to review and explore strategies to strengthen current implant services, including the provision of improved provider training aimed at sensitive, client-centred approaches; increased community engagement; and improved systems for programmatic monitoring and evaluation. With implementation of these recommendations, worrying trends in the provision of implants could be reversed.


Authors' affiliations

M Pleaner, Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

C Morroni, Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Women’s Health Research Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, South Africa; EGA Institute for Women’s Health and Institute for Global Health, University College London, UK; The Botswana-UPenn Partnership, Gaborone, Botswana

J Smit, Maternal Adolescent and Child Health (MatCH) Research Unit, Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, KwaZulu-Natal; and School of Health Sciences, University of KwaZulu-Natal, Durban, South Africa

N Lince-Deroche, Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

M F Chersich, Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

S Mullick, Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

D Pillay, Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

M Makua, National Department of Health, Pretoria, South Africa

H Rees, Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

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Keywords

Subdermal contraceptive implants; Long-acting reversible contraception (LARCs); Family planning; Quality of contraceptive care; Rights; South Africa

Cite this article

South African Medical Journal 2017;107(11):933-938. DOI:10.7196/SAMJ.2017.v107i11.12805

Article History

Date submitted: 2017-10-31
Date published: 2017-10-31

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