TY - JOUR
T1 - Facility readiness to remove subdermal contraceptive implants in 6 sub-Saharan African countries
AU - Performance Monitoring for Action Principal Investigators Group
AU - Senderowicz, Leigh
AU - Karp, Celia
AU - Bullington, Brooke W.
AU - Tumlinson, Katherine
AU - Zimmerman, Linnea
AU - OlaOlorun, Funmilola M.
AU - Zakirai, Musa Sani
N1 - Funding Information:
L.S.’s contribution was supported by a Ruth L Kirschstein National Research Service Award (grant number T32 HD049302) and a Population Research Infrastructure grant (grant number P2C HD047873). B.W.B.’s contribution was supported by a National Research Service Award (grant number T32HD52468) and a Population Infrastructure grant (grant number P2CHD050924). K.T.’s contribution was supported by an infrastructure grant for population research (grant number P2C HD047879) to the Carolina Population Center at the University of North Carolina at Chapel Hill. The Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) of the National Institutes of Health (NIH) awarded these grants. The contents of this article are solely the responsibility of the authors and do not necessarily represent the official views of the NIH/NICHD.
Funding Information:
The PMA project relies on the work of many individuals, both in the United States and in survey countries. The project team is grateful for support from the Bill & Melinda Gates Foundation and would like to thank the country teams and resident enumerators who are ultimately responsible for the success of the PMA project.
Funding Information:
L.S.’s contribution was supported by a Ruth L Kirschstein National Research Service Award (grant number T32 HD049302) and a Population Research Infrastructure grant (grant number P2C HD047873). B.W.B.’s contribution was supported by a National Research Service Award (grant number T32HD52468) and a Population Infrastructure grant (grant number P2CHD050924). K.T.’s contribution was supported by an infrastructure grant for population research (grant number P2C HD047879) to the Carolina Population Center at the University of North Carolina at Chapel Hill. The Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) of the National Institutes of Health (NIH) awarded these grants. The contents of this article are solely the responsibility of the authors and do not necessarily represent the official views of the NIH/NICHD.
Publisher Copyright:
© 2022 The Authors
PY - 2022/11
Y1 - 2022/11
N2 - OBJECTIVE: This study aimed to estimate the proportion of health facilities without the capability to remove contraceptive implants and those that have the capability to insert them and to understand facility-level barriers to implant removal across 6 countries in sub-Saharan Africa. STUDY DESIGN: Using facility data from the Performance Monitoring for Action in Burkina Faso, the Democratic Republic of Congo, Ethiopia, Kenya, Nigeria, and Uganda from 2020, we examined the extent to which implant-providing facilities (1) lacked necessary supplies to remove implants, (2) did not have a provider trained to remove implants onsite, (3) could not remove deeply placed implants onsite, and (4) reported any of the above barriers to implant removal. We calculated the proportion of facilities that report each barrier, stratifying by facility type. RESULTS: Between 31% and 58% of implant-providing facilities reported at least 1 barrier to implant removal in each country (6 sub-Saharan African countries). Lack of trained providers was the least common barrier to implant removal (0%–17% of facilities), whereas lack of supplies (17%–44% of facilities) and the inability to remove a deeply placed implant (16%–42%) represented more common obstacles to removal. Blades and forceps were commonly missing supplies across all 6 countries. Barriers to implant removal were less commonly reported at hospitals than at lower-level facilities in all countries except Burkina Faso. CONCLUSION: This multicountry analysis showed that facility-level barriers to contraceptive implant removal are widespread among facilities that offer implant insertion. By preventing users from being able to discontinue their implants on request, these barriers pose a threat to contraceptive autonomy and reproductive health.
AB - OBJECTIVE: This study aimed to estimate the proportion of health facilities without the capability to remove contraceptive implants and those that have the capability to insert them and to understand facility-level barriers to implant removal across 6 countries in sub-Saharan Africa. STUDY DESIGN: Using facility data from the Performance Monitoring for Action in Burkina Faso, the Democratic Republic of Congo, Ethiopia, Kenya, Nigeria, and Uganda from 2020, we examined the extent to which implant-providing facilities (1) lacked necessary supplies to remove implants, (2) did not have a provider trained to remove implants onsite, (3) could not remove deeply placed implants onsite, and (4) reported any of the above barriers to implant removal. We calculated the proportion of facilities that report each barrier, stratifying by facility type. RESULTS: Between 31% and 58% of implant-providing facilities reported at least 1 barrier to implant removal in each country (6 sub-Saharan African countries). Lack of trained providers was the least common barrier to implant removal (0%–17% of facilities), whereas lack of supplies (17%–44% of facilities) and the inability to remove a deeply placed implant (16%–42%) represented more common obstacles to removal. Blades and forceps were commonly missing supplies across all 6 countries. Barriers to implant removal were less commonly reported at hospitals than at lower-level facilities in all countries except Burkina Faso. CONCLUSION: This multicountry analysis showed that facility-level barriers to contraceptive implant removal are widespread among facilities that offer implant insertion. By preventing users from being able to discontinue their implants on request, these barriers pose a threat to contraceptive autonomy and reproductive health.
KW - Facility-readiness
KW - LARC removal
KW - contraceptive implants
KW - family planning
KW - health systems
KW - reproductive health
KW - women's health
UR - http://www.scopus.com/inward/record.url?scp=85142512577&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85142512577&partnerID=8YFLogxK
U2 - 10.1016/j.xagr.2022.100132
DO - 10.1016/j.xagr.2022.100132
M3 - Article
C2 - 36444203
AN - SCOPUS:85142512577
SN - 2666-5778
VL - 2
JO - AJOG Global Reports
JF - AJOG Global Reports
IS - 4
M1 - 100132
ER -