Insertion and Removal of Norplant Contraceptive Implants by Physicians and Nonphysicians in an Indonesian Clinic

Abstract

This paper reports on a study in which the performances of physicians were compared to those of nonphysician health personnel in inserting and removing NORPLANT subdermal contraceptive implants. The study was conducted in Raden Saleh Clinic at the University of Indonesia, Jakarta, from September 1982 to August 1984. In a group of 828 women who accepted NORPLANT 285 insertions were performed by physicians and 543 by nonphysician health personnel. During the study period, 122 removals were performed (43 by physicians and 79 by nonphysicians). This small proportion of removals reflects the high continuation rate for NORPLANT. There was no significant difference between the two groups of acceptors regarding age, parity, education, or side effects. The average insertion times were 7.6 minutes for the physician group and 7.4 minutes for the nonphysician group (p greater than 0.1). The average removal times were 21.7 minutes for physicians and 21.8 minutes for nonphysicians (p greater than 0.9). Complications during and following insertion and removal were minimal for both groups, and no significant differences were found. It was concluded that nonphysician health personnel are qualified to administer the NORPLANT contraceptive implants.

Task Sharing in Family Planning

“…Research also shows that trained lower-level providers (medical assistants, clinical officers, and health workers) can perform vasectomies as well as physicians can (Kols and Lande 2008). Studies in Indonesia show that nonphysicians took about the same amount of time to insert and remove implants as did physicians, and that there were no significant differences in complication rates (Affandi et al 1987;Siswosudarmo 1991). Evidence indicates that less-credentialed providers can match the technical competence of physicians in conducting tubal ligations and inserting IUDs and implants, and can offer better counseling.…”

Why Are U.S. Women Not Using Long-Acting Contraceptives?

“…It was accompanied by a well-documented record of safety and acceptance in developing countries among a range of cultures and demographic groups. 5 The same Additionally, the unpleasant side effects, inconvenience and use-failure rates of most commonly used reversible contraceptives reduce their appeal. For example, while the condom has no side effects, most men dislike using it, and the method has a failure rate of 12-15%.…”

Four Criteria to Evaluate Providers' Service-Delivery Response to New Contraceptive Introduction

“…Whereas this is an essential topic, the methodology employed to address it has been weak. For example, Affandi et al (1987) tested at a teaching clinic in Indonesia whether physicians and nonphysicians could meet certain quality of care standards as they delivered Norplant. To this end, after training physicians, nurses, and midwives in Norplant provision, they assessed whether providers shared with clients what to expect of the method, its risks, and its benefits; paid attention to aseptic technique; made an insertion incision no longer than two millimeters; etc.…”