Contraception with subdermal levonorgestrel implants as an alternative to surgical contraception at Ilorin, Nigeria

Tolerability and reasons for discontinuation of Norplant in an inner city population

We carried out a retrospective analysis of the continuation rates of 142 Norplant acceptors. Follow-up data was available on 110. We assessed the relative impact of side effects on discontinuation. No serious complications (immediate or late) were observed during the 3-year study period and no pregnancies occurred. The 3-year continuation rate was 88%. The commonest reported side effect was cycle disruption (64% of users). However this only accounted for 31% of discontinuations. This we attribute to thorough counselling about menstrual disruption. On the other hand androgenic side effects accounted for 12% of discontinuations but were experienced by 10% of users-perhaps because some users did not expect them. We conclude that Norplant is highly acceptable when offered with specialist counselling and support. Non-bleeding side effects accounted for relatively higher discontinuations and may need to be emphasised in counselling. A dedicated service enhanced acceptability.

Reproductive health: an international perspective

The twentieth century began with approximately 1.6 billion human beings in the world and, with an increase of 96 million people per year, will end with over 6 billion people. Unless this trend is directly confronted by the world governments and their citizens, there will be nearly 8 billion by 2025 and over 11 billion by 2050. Thus, reproductive health is and will remain an issue of critical importance for all countries to realize and study. Part of this trend is because of the many pregnancies which occur in adolescents around the world. A number of issues have developed this century contributing to the many pregnant teenagers. For example, India has one of the world's largest populations of teenagers--over 23 million, representing over 26% of the total in the world. Effective methods for contraception and sexually transmitted diseases prevention are available, but not to all sexually active humans. However, many barriers to effective contraception exist around the globe. This article discusses some of them and also reviews use of contraceptive methods in various countries. These include oral contraceptives, emergency contraceptives, injectable and implantable contraceptives, intrauterine devices, barrier contraceptives and others. Reproductive health remains a critical, universal issue for all humans in the world. We all must examine the many pitfalls to controlling the world's populations, including lack of sex education, limited access to effective contraceptives, and others. We cannot afford to let the population continue unchecked. Effective strategies are needed at this time; otherwise, the population will continue to run out of control, negatively damaging the world for the coming generations. There is need to leave a positive, and not negative legacy for the next generation.

Norplant implants acceptability and user satisfaction among women in two African countries

An analysis of 350 users of Norplant contraceptive subdermal implants from six centers in two African countries (Ghana and Nigeria) indicates that method acceptability remained high among the women who used the method for five years. Overall, 90.1% of the 155 five-year users in these countries reported having a very favorable experience and 9.9% a favorable experience with Norplant implants. Ease of use was cited by 56.1% and duration of use by 13.6% of the women as the most liked characteristics of the method at study completion after five years. Menstrual disturbance was the least liked aspect, by 41.9% of the women. On average, women who discontinued early from the study had fewer living children and were more likely to desire additional children at method adoption than those who completed five years of use; the differences were statistically significant. Differences in level of education and previous use of contraception were not found to be statistically significant between completers and non-completers. Differences in age were not significant in Nigeria, but were marginally significant in Ghana, with completers being older than non-completers. Of the clients who completed this study, 79.2% indicated a desire to continue with contraception and 43.9% planned to have a second set of implants inserted. These findings have important implications for counseling, method access and service sustainability in African countries.

One-year experience with subdermal contraceptive implants in the United States

Women who received Norplant contraceptive implants from any of fifteen clinical settings in southeast Texas, U.S.A., were followed for one year to determine their reactions to the method. Of 1,385 who enrolled to receive Norplant implants, 1,253 had implants inserted. Side effects were reported by 78% of those receiving implants and 70% described changes in bleeding patterns. Spotting or irregular bleeding, weight gain and headaches were the conditions reported most frequently. Nine pregnancies were reported during the study period. Six of these, however, existed before the implants were inserted. At the one year anniversary, 143 of women receiving implants had had them removed. Those who discontinued method use were less satisfied, reported more side effects and were more likely to have planned to have another child, thus using the method for spacing, or to have had a change in their marital status while they were using the contraceptive. Providers should counsel patients to focus attention on plans for the future in selecting their contraceptive method. In addition, we recommend, as does the product's distributor, that providers confirm that patients are not pregnant prior to inserting implants.