Introduction of NORPLANT^® implants in a predominantly rural community in Sri Lanka and its subsequent withdrawal

Abstract

Objectives: To study the characteristics. Of acceptors of the NORPLANT® sub-dermal contraceptive implants and acceptability and complications of this relatively new method in a predominantly rural district in Sri Lanka. Methodology: Acceptors of NORPLANT® implants in the Hingurakgoda health division from 1991 to 1996 were studied retrospectively using an interviewer administered questionnaire. Public Health Midwives were used to collect data by tracing family planning clinic records and it was possible to obtain information on acceptors of NORPLANT® implants from 172 eligible clients. Results: Forty percent of the clients were between 26-30 years of age. The majority (50.6%) had two children at the time of acceptance and mean parity was 2.13 (+0.9) years. Approximately fifty percent of the clients had an educational level above grade 8. Fifty nine percent of the acceptors of NORPLANT® were using a modem family planning method before, while thirty three percent was not using any method. The mean age of the last child was 6.7 (+3.9) years and in a majority (62.2%) the last child was between 3-5 years. The majority (55.8%) of the clients liked the method for its convenience, five years protection with single insertion. Most common persistent side effects were menstrual disorders (48.1 %). Premature discontinuation of the method was relatively high (56%) and it was mostly due to side effects. Irrespective of the relatively high incidence of side effects most (64%) clients showed a favourable opinion towards NORPLANT®. Conclusion and recommendations: NORPLANT® implants are an acceptable and effective long active contraceptive that could be introduced to rural communities in Sri Lanka. Proper counselling before acceptance and follow up would be of extreme importance in minimising the incidence of side effects and premature discontinuation of the method, In view of lack of facilities for sterilization NORPLANT® implants could be considered as an alternative, provided appropriate clients are selected.