Contraceptive implant use is rising rapidly, substantially, and equitably in many sub-Saharan African countries, across almost all sociodemographic categories. Gains in implant use have exceeded combined gains for IUDs, pills, and injectables. Key contributing factors include sizeable reductions in commodity cost, much-increased commodity supply, greater government commitment to expanded method choice, and wider adoption of high-impact service delivery practices that broaden access and better reach underserved populations. Continued progress in meeting women's reproductive intentions with implants calls for further investment in quality services for both insertion and removal, and for addressing issues of financing and sustainability.
Contraceptive implants are extremely effective, long acting, and suitable for nearly all women—to delay, space, or limit pregnancies—and they are increasingly popular. Now, markedly reduced prices and innovative service delivery models using dedicated non-physician service providers offer a historic opportunity to help satisfy women's growing need for family planning.
Progestin-only contraceptive injectables and implants are highly effective, longer-acting contraceptive methods that can be used by most women in most circumstances. Globally, 6% of women using modern contraception use injectables and 1% use implants. Injectables are the predominant contraceptive method used in sub-Saharan Africa, and account for 43% of modern contraceptive methods used. A lower-dose, subcutaneous formulation of the most widely used injectable, depot-medroxyprogesterone acetate, has been developed. Implants have the highest effectiveness of any contraceptive method. Commodity cost, which historically limited implant availability in low-resource countries, was markedly lowered between 2012 and 2013. Changes in menstrual bleeding patterns are extremely common with both methods, and a main cause of discontinuation. Advice from normative bodies differs on progestin-only contraceptive use by breastfeeding women 0-6 weeks postpartum. Whether these methods are associated with HIV acquisition is a controversial issue, with important implications for sub-Saharan Africa, which has a disproportionate burden of both human immunodeficiency virus (HIV) and maternal mortality.
Voluntary family planning is one of the most efficacious and cost-effective means of improving individual health, gender equity, family well-being, and national development. Increasing contraceptive use and reducing unmet need for family planning are central to improving maternal health (UN Millennium Development Goal 5). In less-developed regions of the world, especially Sub-Saharan Africa and South Asia, human and financial resources are limited, modern contraceptive use is relatively low, unmet need for modern contraception is high, and consequently maternal morbidity and mortality are high. However, the international community is showing renewed commitment to family planning, a number of high impact program practices have been identified, and a number of Sub-Saharan African countries (e.g. Ethiopia, Malawi, and Rwanda) have successfully made family planning much more widely and equitably available. The International Federation of Gynecology and Obstetrics (FIGO) has joined with other international and donor organizations in calling for increased funding and more effective programming to improve maternal health and family planning in low-resource countries. Continued engagement by FIGO, its member societies, and its individual members will be helpful in addressing the numerous barriers that impede universal access to modern contraception in low-resource countries.
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