Strengthening implant provision and acceptance in South Africa with the ‘Any woman, any place, any time’ approach: An essential step towards reducing unintended pregnancies

Rees, Helen; Pillay, Yegan; Mullick, Saiqa; Chersich, Matthew

doi:10.7196/samj.2017.v107i11.12903

Cited by 18 publications

(20 citation statements)

References 72 publications

(108 reference statements)

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“…34 Only 20% of private facilities in Kenya supply LARCs, whereas more than 65% supply other methods 20 -an observation reflected in the present data. 34 Only 20% of private facilities in Kenya supply LARCs, whereas more than 65% supply other methods 20 -an observation reflected in the present data.…”

Section: Discussionsupporting

confidence: 51%

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Use of long‐acting reversible contraception in a cluster‐random sample of female sex workers in Kenya

Ampt

Lim

Agius

et al. 2019

Intl J Gynecology & Obste

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Objective To assess correlates of long‐acting reversible contraceptive (LARC) use, and explore patterns of LARC use among female sex workers (FSWs) in Kenya. Methods Baseline cross‐sectional data were collected between September 2016 and May 2017 in a cluster‐randomized controlled trial in Mombasa. Eligibility criteria included current sex work, age 16–34 years, not pregnant, and not planning pregnancy. Peer educators recruited FSWs from randomly selected sex‐work venues. Multiple logistic regression identified correlates of LARC use. Prevalence estimates were weighted to adjust for variation in FSW numbers recruited across venues. Results Among 879 participants, the prevalence of contraceptive use was 22.6% for implants and 1.6% for intra‐uterine devices (IUDs). LARC use was independently associated with previous pregnancy (adjusted odds ratio for one pregnancy, 11.4; 95% confidence interval, 4.25–30.8), positive attitude to and better knowledge of family planning, younger age, and lower education. High rates of adverse effects were reported for all methods. Conclusion The findings suggest that implant use has increased among FSWs in Kenya. Unintended pregnancy risks remain high and IUD use is negligible. Although LARC rates are encouraging, further intervention is required to improve both uptake (particularly of IUDs) and greater access to family planning services.

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Section: Discussionsupporting

confidence: 51%

“…as FSWs, and counseling should be reoriented to emphasize LARCs as a "first-line" contraceptive method. 34 Only 20% of private facilities in Kenya supply LARCs, whereas more than 65% supply other methods 20 -an observation reflected in the present data. Sex worker drop-incenters supplied very few contraceptives (other than male condoms).…”

Section: Discussionsupporting

confidence: 51%

Use of long‐acting reversible contraception in a cluster‐random sample of female sex workers in Kenya

Ampt

Lim

Agius

et al. 2019

Intl J Gynecology & Obste

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“…High rates of contraceptive discontinuation of short-term methods by users in sub-Sahara Africa have, however, prompted expansion of access to longer-acting methods, most recently implants as observed in this study. 19 The continuation rates of implants as reported by Oladipo et al was higher among those who had adequate pre-insertion counseling and encouraging return for side -effects, follow-up phone calls and home visit would also, raise contraceptive rates. 11,12,20 Failure rates are described by the Pearl Index, which refers to the number of failures per 100 women using the contraceptive method for a year (100 women years), 21 however, subdermal implants contraceptive failure was not recorded during the period of review.…”

Section: Discussionmentioning

confidence: 88%

Uptake of hormonal implants contraceptives compared to other forms of contraceptives in Abuja, Nigeria

2019

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Background: Subdermal implants are a long-term, efficacious, and easily reversible contraceptive with few adverse effects that pose no risk to the health of the users. It is increasingly accepted as a method of contraception in sub-Sahara Africa like ours. Despite this, its uptake in Nigeria has not reached optimum level. This study is aimed at evaluating the socio-demographic characteristics of subdermal implants users in Abuja, Nigeria, its acceptance rate, efficacy, and discontinuation rate.Methods: The case notes of all the women from the family planning unit were studied. Data on socio-demographic characteristics, uptake rate, side effects profile and the discontinuation rates between January 2013 and December 2017 were retrieved and analyzed using SPSS software and results expressed in numbers and percentagesResults: Out of a total of 1,716 clients that were for contraception during the period under review, 786 accepted Jadelle/Implanon accounting for 45.8% of the implants acceptance rate. Of the 786 acceptors, 485(28.3%) chose Implanon, whereas 301(17.5%) preferred Jadelle. Discontinuation rate for both implants was 20.7%; the main reasons cited by the women were desire to have more children; 51(31.35%) and irregular vaginal bleeding; 30(18.4%). The Pearl Index for the implants in the study was zero. The peak parity for implant users was para 3. Approximately 72.1% the users of all forms of contraception were Christians, while 25.4% were Muslims. About 74.0% of the users had tertiary education.Conclusions: Jadelle/Implanon uptake was relatively high compared to other forms of contraception.

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“…Injections are the most commonly used and often the only available non‐barrier method in this population but are reported to have acceptability concerns among FSWs due to side effects which interfere with their ability to work . Additional barriers to access and uptake of contraception among FSWs include stigma or refusal of service due to sex work, young age or marital status, limited availability or choice of contraceptive methods, lack of health workers trained in LARC provision and limited knowledge of contraceptive methods .…”

Section: Discussionmentioning

confidence: 99%

HIV pre‐exposure prophylaxis for female sex workers: ensuring women’s family planning needs are not left behind

et al. 2020

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Introduction Female sex workers (FSWs) experience overlapping burdens of HIV, sexually transmitted infections and unintended pregnancy. Pre‐exposure prophylaxis (PrEP) is highly efficacious for HIV prevention. It represents a promising strategy to reduce HIV acquisition risks among FSWs specifically given complex social and structural factors that challenge consistent condom use. However, the potential impact on unintended pregnancy has garnered little attention. We discuss the potential concerns and opportunities for PrEP to positively or negatively impact the sexual and reproductive health and rights (SRHR) of FSWs. Discussion FSWs have high unmet need for effective contraception and unintended pregnancy is common in low‐ and middle‐income countries. Unintended pregnancy can have enduring health and social effects for FSWs, including consequences of unsafe abortion and financial impacts affecting subsequent risk‐taking. It is possible that PrEP could negatively impact condom and other contraceptive use among FSWs due to condom substitution, normalization, external pressures or PrEP provision by single‐focus services. There are limited empirical data available to assess the impact of PrEP on pregnancy rates in real‐life settings. However, pregnancy rates are relatively high in PrEP trials and modelling suggests a potential two‐fold increase in condomless sex among FSWs on PrEP, which, given low use of non‐barrier contraceptive methods, would increase rates of unintended pregnancy. Opportunities for integrating family planning with PrEP and HIV services may circumvent these concerns and support improved SRHR. Synergies between PrEP and family planning could promote uptake and maintenance for both interventions. Integrating family planning into FSW‐focused community‐based HIV services is likely to be the most effective model for improving access to non‐barrier contraception among FSWs. However, barriers to integration, such as provider skills and training and funding mechanisms, need to be addressed. Conclusions As PrEP is scaled up among FSWs, there is growing impetus to consider integrating family planning services with PrEP delivery in order to better meet the diverse SRHR needs of FSWs and to prevent unintended consequences. Programme monitoring combined with research can close data gaps and mobilize adequate resources to deliver comprehensive SRHR services respectful of all women’s rights.

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Strengthening implant provision and acceptance in South Africa with the ‘Any woman, any place, any time’ approach: An essential step towards reducing unintended pregnancies

Cited by 18 publications

References 72 publications

Use of long‐acting reversible contraception in a cluster‐random sample of female sex workers in Kenya

Use of long‐acting reversible contraception in a cluster‐random sample of female sex workers in Kenya

Uptake of hormonal implants contraceptives compared to other forms of contraceptives in Abuja, Nigeria

HIV pre‐exposure prophylaxis for female sex workers: ensuring women’s family planning needs are not left behind

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