What Goes In Must Come Out: A Mixed-Method Study of Access to Contraceptive Implant Removal Services in Ghana

Abstract

Although most contraceptive implant users in Ghana are able to access removal services, barriers, including cost, provider reluctance to remove, and difficult removals, exist.n Providers express confidence in removing implants, but many are less confident in their ability to perform difficult removals.

“When it comes to time of removal, nothing is straightforward”: A qualitative study of experiences with barriers to removal of long-acting reversible contraception in Western Kenya

“…Our findings corroborate other studies from sub-Saharan Africa that found women encounter barriers to LARC removal prior to expiration [7] , [8] , [9] . Women from Ethiopia and Ghana report challenges obtaining removal of an unexpired implant [ 8 , 9 ]. Like the women who participated in our study, Ethiopian women reported that providers urged them to use medications to manage symptoms [8] .…”

“…Like the women who participated in our study, Ethiopian women reported that providers urged them to use medications to manage symptoms [8] . Almost half of the women in a Ghanaian study reported that removal cost more if the device was unexpired [9] . Unlike in our study, most Ghanaian women obtained removals if they expressed desire to get pregnant or brought husband approval for removal [9] .…”

“…Almost half of the women in a Ghanaian study reported that removal cost more if the device was unexpired [9] . Unlike in our study, most Ghanaian women obtained removals if they expressed desire to get pregnant or brought husband approval for removal [9] . We also note that women attributed beliefs about removal barriers both to personal experience and stories, adding to the evidence that rumor may play a significant role in sexual and reproductive health behaviors [ 19 , 20 ].…”

“…Technical capacity may not be the only barrier to LARC removal. Despite political will to support the infrastructure to ensure LARC removals, women have mentioned provider refusal throughout sub-Saharan Africa in recent qualitative studies about LARC [7] , [8] , [9] . Our objective here is to characterize, in greater depth, women's perceptions of LARC removal in Western Kenya, and how their experiences influence their contraceptive use.…”

Experiences of Accessing and Providing Contraceptive Implant Removal Services in Gaborone, Botswana: A Qualitative Study Among Implant Users and Healthcare Providers

“…Provider resistance to performing removals has been noted in other settings where the implant is a novel method of contraception (27). This has been reported with current implant models, such as Implanon NXT R in South Africa (28), Ghana (18) and the United Kingdom (17), and with historic implant models, such as Norplant R in Indonesia (29) and Senegal (30). In our study, providers cited cost as a factor which dissuaded them from performing early removals because reducing the implant's lifespan decreases its cost-effectiveness.…”