Acceptability of Norplant implants for fertility regulation in Singapore

Abstract

The continuation rate at the end of this five-year clinical study was 60% with no accidental pregnancy occurring throughout the five years. The post-removal conception rate in women desiring pregnancy was 92% at the end of two years. The majority of acceptors described the overall experience with the implants as favourable. In fact, 75% of the women planning to use contraception after removal of the implants were going to use implants again.

PIP: The results of Norplant implants in Singapore in 1985 are reported based on clinic data from 1991. Recruitment of 100 acceptors 18-40 years old in 1985 followed the criteria established by the Population Council's International Committee for Contraception Research: sexually active and having at least 1 birth and medically safe for steroid use. The mean age was 29.5 years, average education 7.8 years, and parity average 2.1 live births. Contraceptive effectiveness was 100% for the 60 continuing for the complete 5 years. There were 40 removals, of which 25 were for planned pregnancy and 12 for menstrual problems. Of the menstrual problems, 9 had complaints of prolonged bleeding or spotting 10 days. 2 had increased menstrual periods. 1 had prolonged amenorrhea. Removals were made within the 1st 3 years. and there is support for prior findings that menstrual disturbances decrease over time. Of the 25% that discontinued to have another child, 44% conceived within 3 months of removal, 64% within 2 months, 84% within a year, and 92% within 2 years. The only 2 women not conceiving were using other means of contraception. All 22 women had full term normal vaginal deliveries; there was 1 induced abortion due to marital difficulties. Acceptor satisfaction was high at 71.2%. None considerable the experience unfavorable. Convenience and ease of use was the most desirable feature followed by the low risk of pregnancy. 6.8% found removal to be painful, but 2 of the 4 had reinsertions. 88.1% recommended Norplant to friends or relatives. 88.1% planned to use contraception after Norplant, of which 75% were going to use implants again. Of the 7 not planning on contraceptive use after removal, 2 were divorced, and the other 5 were planning a pregnancy. The authors conclude that the findings strongly support the Norplant implant system as effective and acceptable and reversible for Singaporean women. The continuation rate of 60% was comparable to other international findings.