Contraceptive implant removal: service availability and readiness assessments in Uganda and Kenya

Facility readiness to remove subdermal contraceptive implants in 6 sub-Saharan African countries

“…Some previous research studies, although limited, have identified that high percentages of providers have struggled to remove implants or received removal training that did not include practice on actual patients. 19 Limitations in training and infrequent opportunities to apply skills may contribute to provider hesitancy to remove implants. 20 However, to the best of our knowledge, neither provider confidence nor provider willingness to remove methods on request is currently measured by any publicly available survey.…”

What is needed to improve quality of implant removal services in Nigeria? results of a landscape assessment

“…Non-standard training content, lack of structured mentorship programs, and low coverage of supportive supervision for providers in implant removal suggests areas where investments are needed to ensure providers can perform quality implant removal, especially in cases of difficult implant removal and where task-shifting strategies are adopted. Training opportunities that foster clinical competency are needed for training in removals: Christofield et al reported that a substantial percentage of providers in Uganda and Kenya never practiced implant removal on a client during training ( 18 ). In Senegal, Lebetkin et al reported substantially higher percentages of providers who felt confident in performing uncomplicated removals (96 percent) than in our Nigeria assessment, but 15 percent did not feel confident removing non-palpable implants and an additional 15 percent did not provide this service ( 36 ).…”

“…A lack of required infection prevention materials in three-quarters of the survey facilities, as well as infrastructural deficiencies like lack of running water, compromise quality of care and increase the risk of adverse client outcomes. Supply stockouts are common challenges in providing implant removal services: a study from Uganda found that only 8 percent of facilities providing implant removal services had the necessary instruments and consumables for the procedure, and in Ethiopia, service providers identified stockouts of appropriate supplies as the reason for their inability to provide removal services ( 18 , 43 ). Of particular concern in this Nigerian study context is the scarcity of specialized equipment needed to manage difficult removals, including ultrasound and x-ray, and the fact that no facilities had modified vasectomy forceps.…”

“…However, mounting evidence indicates that women often lack access to high-quality implant removal services ( 18 , 19 ). Generally, implants are easy to remove through a small opening in the skin.…”