Uptake and early removals of Implanon NXT in South Africa: Perceptions and attitudes of healthcare workers

Abstract

Background. The South African (SA) government introduced Implanon NXT, a long-acting subdermal contraceptive implant, in 2014 to expand contraceptive choice. Following an initial high uptake, its use declined considerably amid reports of early removals and frequent side-effects. We examine providers' perceptions of training and attitudes towards Implanon NXT, as well as their views on the causes of early removals and the impact on the implant service. Objective. To assess healthcare providers' perceptions and attitudes towards implant services in SA. Methods. In-depth interviews were conducted with eight nurses providing implant services in public facilities in Gauteng and North West Province. Emerging themes were identified, manually coded and thematically analysed following an interpretivism approach. Results. Nurses lacked confidence in providing implant services effectively, particularly removals, which they ascribed to the brief, cascade-type training received. Nurses generally held negative views towards the method. They also reported that side-effects are the most common reason for early removals -particularly irregular bleeding -and that men often do not support their partners who use the method. Lastly, it was found that providers require guidance on counselling regarding the method and standardised guidelines on the management of side-effects. Conclusion. Retraining and support of providers are needed to address competency gaps and negative attitudes towards the method. Assessment of providers' readiness to perform removal procedures is also important. Finally, effective plans are necessary to improve implant continuation rates, especially among women whose partners are unsupportive.

User perspectives on Implanon NXT in South Africa: A survey of 12 public-sector facilities

“…The methods used to select the facilities and the results of other components of the evaluation have been detailed elsewhere. [9,10] We extracted contact details of women aged >18 years who had had an implant inserted since 2014 (n=751). In total, 262 of these women agreed to be interviewed, with the remainder either not contactable (telephone number not recorded or invalid), or not willing to participate.…”

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

“…[30] SA data also indicate that training that is too short and does not include management of side-effects and removals, may be inadequate to support implant provision. [31,32] Pre-insertion counselling and ongoing support Adopt a 'LARC first' structured approach to contraceptive counselling. The content of contraceptive counselling heavily influences method selection, especially among younger women.…”

“…[53] Although health workers in SA commonly prescribe treatment for bleeding and headaches related to the implant, medication regimens vary considerably and a standardised approach is needed. [31,32] Health workers' resistance to removals, or other failures in accessing removal services, will rapidly tarnish the implant's image and potentially undermine the entire family planning programme. Service delivery capacity for removals is a problem in many places [54] and women often resort to private sector providers.…”

Introduction of the contraceptive implant in South Africa: Successes, challenges and the way forward

“…Providers could raise this as an option, but then must inform women to consider the possibility of conflict with their partner, even violence, should the device be discovered. Clearly, providers' confidence and competence to deliver a new contraceptive are critical to its success, as discussed by Adeagbo et al [4] in a study of nurses in this edition of SAMJ. They found that providers generally felt inadequately prepared to carry out counselling, offer follow-up support and undertake removals.…”

“…Use of the implant has since declined, but currently accounts for ~7% of all contraceptive use -a not insignificant achievement for a 'new' method . [1,2] In this edition of SAMJ, three articles [3][4][5] take stock of the early years of implant provision in SA. The articles, based on research in 2016, capture women's motivations for using the implant and their perspectives towards the method; and healthcare providers' competencies and experiences with service provision.…”