Assessing trends and reasons for unsuccessful implant discontinuation in Burkina Faso and Kenya between 2016 and 2020: a cross-sectional study
,
Celia Karp,
Solomon Shiferaw,
Peter Gichangi,
Elizabeth Omoluabi,
Assefa Seme,
Mary Thiongo,
Leigh Senderowicz,
Georges Guiella,
Linnea Zimmerman,
Fredrick Edward Makumbi,
Katherine Tumlinson,
Brooke W Bullington,
Stephanie Chung,
Emilia Goland,
Simon Kibera
Affiliations
School of Medicine, Cardiff University, Cardiff, UK
Celia Karp
Department of Population, Family & Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
Solomon Shiferaw
2 School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
Peter Gichangi
International Centre for Reproductive Health – Kenya (ICRHK), Mombasa, Kenya
Elizabeth Omoluabi
Department of Statistics and Population Studies, University of the Western Cape, Bellville, South Africa
Assefa Seme
2 School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
Mary Thiongo
International Centre for Reproductive Health Kenya, Mombasa, Kenya
Leigh Senderowicz
Department of Obstetrics and Gynecology, University of Wisconsin-Madison, Madison, Wisconsin, USA
Georges Guiella
Institut Supérieur des Sciences de la Population/University of Ouagadougou, Ouagadougou, Burkina Faso
Linnea Zimmerman
Department of Population, Family & Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
Fredrick Edward Makumbi
Katherine Tumlinson
University of North Carolina, Chapel Hill, North Carolina, USA
Brooke W Bullington
Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
Stephanie Chung
Department of Maternal and Child Health, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
Emilia Goland
Department of Maternal and Child Health, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
Objectives Contraceptive implant use has grown considerably in the last decade, particularly among women in Burkina Faso and Kenya, where implant use is among the highest globally. We aim to quantify the proportion of current implant users who have unsuccessfully attempted implant removal in Burkina Faso and Kenya and document reasons for and location of unsuccessful removal.Methods We use nationally representative data collected between 2016 and 2020 from a cross-section of women of reproductive age in Burkina Faso and Kenya to estimate the prevalence of implant use, proportion of current implant users who unsuccessfully attempted removal and proportion of all removal attempts that have been unsuccessful. We describe reasons for and barriers to removal, including the type of facility where successful and unsuccessful attempts occurred.Findings The total number of participants ranged from 3221 (2017) to 6590 (2020) in Burkina Faso and from 5864 (2017) to 9469 (2019) in Kenya. Over a 4 year period, the percentage of current implant users reporting an unsuccessful implant discontinuation declined from 9% (95% CI: 7% to 12%) to 2% (95% CI: 1% to 3%) in Kenya and from 7% (95% CI: 4% to 14%) to 3% (95% CI: 2% to 6%) in Burkina Faso. Common barriers to removal included being counselled against removal by the provider or told to return a different day.Conclusion Unsuccessful implant discontinuation has decreased in recent years. Despite progress, substantial numbers of women desire having their contraceptive implant removed but are unable to do so. Greater attention to health systems barriers preventing implant removal is imperative to protect reproductive autonomy and ensure women can achieve their reproductive goals.
