Case records and commentaries in Obstetrics and Gynaecology

Abstract

Premature removal and discontinuation of contraceptive implants (Norplant) is a cause of a sizeable national expenditure in Kenya. Understanding the factors that influence the decision to remove the implants and being able to predict which users are likely to elect discontinuation prematurely could provide useful information for counselling patients as they are considering contraceptive implants so that potentially enormous long-term savings could be achieved.

The objective of the study was to determine reasons for removal and discontinuation of Norplant contraceptive implants among users as seen at the Moi Teaching and Referral Hospital's family welfare clinic. Study design This was a cross-section descriptive survey that was carried out at the Moi Teaching and Referral Hospital's family welfare clinic between 1st march 2003 and 28th February 2004 both days inclusive. A structured questionnaire was administered to eligible clients after a written consent had been obtained. Other details were obtained from clinical records.

A total of 147 eligible clients were enrolled in this study. Most of the clients seen were young, of low parity and in a married relationship. Over 70% of them were below 35 years of age. All the clients had attained at least primary school level of education, with 57.1% having attained secondary education and only 1.4-% College/ University. 83% of the clients' spouses knew that they were using Norplant contraceptive and supported them in doing so. Majority of the clients were of low to moderate income bracket, with 81.7 earning less than 10,000 Ksh per month as combined household income. The mean duration ofNorplant contraceptive implant use was 23 months. There was no major immediate complication following Norplant contraceptive implant insertion in 98.6% of the clients. Most of the clients, 78.9%, interviewed found Norplant to be effective and reliable. The leading reason for Norplant contraceptive implant removal was found to be menstrual irregularities and this accounted for 41.5%. Other reasons included desire for pregnancy 22.5%, headache 9.5%, weight changes 6.1%, pain and numbness of the hand 6.8%, chest pain 3.4%, palpitations 4.8%, and backache 2.7%, and skin changes 2.7%. The operative procedure for Norplant contraceptive implant removal was relatively easy, simple and had little morbidity. The mean duration of the operation procedure was 7.53 minutes. Most of the clients preferred to switch immediately to another method of contraception after Norplant removal. The most popular method of choice was oral contraceptive pills in 22.1% followed by injectable methods (Depo provera) in 15%. Despite their desire to have Norplant implants removed, 34% of the clients would still recommend this method to a friend. It was impressive to note that 98.0% of the clients understood that Norplant contraceptive method prevented unplanned pregnancies but not sexually transmitted diseases including HIV/AIDS.