Liftoff: The Blossoming of Contraceptive Implant Use in Africa

Abstract

This article draws from national surveys of every sub-Saharan African country with at least 1 recent survey published between 2015 and 2017 and 2 prior surveys from 2003 to 2014. Twelve countries comprising over 60% of the region's population met these inclusion criteria. The analysis considers recent and longer-term changes in 3 key variables: modern contraceptive prevalence rate (mCPR), method-specific prevalence, and a method's share of the current modern method mix. As recently as 2011, implant CPR in sub-Saharan Africa was only 1.1%. Since then, sizeable price reductions, much-increased commodity supply, greater government commitment to rights-based family planning, broader WHO eligibility guidance, and wider adoption of high-impact service delivery practices have resulted in expanded client access and marked increases in implant prevalence and share of the method mix. Ten of the 12 countries now have an implant CPR around 6% or higher, with 3 countries above 11%. Increased implant use has been the main driver of the increased mCPR attained by 11 countries, with gains in implant use alone exceeding combined gains in use of injectables, pills, and intrauterine devices. In countries as diverse as Burkina Faso and Ethiopia, Democratic Republic of the Congo and Ghana, Kenya and Senegal, implant use now accounts for one-fourth to one-half of all modern method use. Implants have become the first or second most widely used method in 10 countries. In the 7 countries with multiple surveys conducted over a 2- to 3-year span between 2013-14 and 2016-17, average annual gains in implant prevalence range from 0.97 to 4.15 percentage points; this contrasts to historical annual gains in use of all modern methods of 0.70 percentage points in 42 sub-Saharan African countries from 1986 to 2008. Implant use has risen substantially and fairly equitably across almost all sociodemographic categories, including unmarried women, women of lower and higher parity, women in all 5 wealth quintiles, younger and older women, and women residing in rural areas. A notable exception is the category of nulliparous married women, whose implant use is mostly below 1%. These attainments represent a major success story not often seen in family planning programming. With continued program commitment and donor support, these trends in implant uptake and popularity are likely to continue for the next few years. This implies even greater need for the international family planning community to maintain its focus on rights-based programming, ensuring reliable access to implant removal as well as insertion services, and addressing issues of financing and sustainability.

FIGURE 1.

Marked Increases in Implant Use by Married Women, 2008–14 to 2015–17 Abbreviations: DHS, Demographic and Health Survey; DRC/K, Democratic Republic of the Congo/Kinshasa only; PMA2020, Performance Monitoring and Accountability 2020. Data sources: For earlier year (middle survey), DHS surveys for each country; for later year (latest survey), most recent DHS or PMA2020 survey as of December 31, 2017, as indicated in Table 1. Left-hand and right-hand bars for each country correspond respectively to their middle- and upper-row values in Table 1, Column 3.

FIGURE 2.

Implants Have Markedly Rising Share of Method Mix Among Married Women, 2003–2017 Abbreviations: DHS, Demographic and Health Survey; DRC/K, Democratic Republic of the Congo/Kinshasa only; PMA2020, Performance Monitoring and Accountability. Data sources: For 2003–07 and 2008–13, DHS surveys for each country; for 2015–17, most recent DHS or PMA2020 survey as of December 31, 2017, as indicated in Table 1.

FIGURE 3.

Comparable Increases in Implant Use by Sexually Active Unmarried Women, 2008–14 to 2015–17 Abbreviations: DHS, Demographic and Health Survey; DRC/K, Democratic Republic of the Congo/Kinshasa only; PMA2020, Performance Monitoring and Accountability 2020. Note: Niger's survey reports did not include data on specific method use by unmarried women, and thus are not included in this figure. Data sources: For earlier year (middle survey), DHS surveys for each country; for later year (latest survey), most recent DHS or PMA2020 survey as of December 31, 2017, as indicated in Table 1. Left-hand and right-hand bars for each country correspond to their middle- and upper-row values in Table 1, Column 6.

FIGURE 4.

Injectables Share of Method Mix Plateauing or Falling Among Married Women, 2003–2017 Abbreviations: DHS, Demographic and Health Survey; DRC/K, Democratic Republic of the Congo/Kinshasa only; PMA2020, Performance Monitoring and Accountability. Data sources: For 2003–07 and 2008–13, DHS surveys for each country; for 2015–17, most recent DHS or PMA2020 survey, as of December 31, 2017, as indicated in Table 4.

FIGURE 5.

IUD Use Low in All 12 Countries, With Recent Modest Gains, 2008–2017 Abbreviations: DHS, Demographic and Health Survey; DRC/K, Democratic Republic of the Congo/Kinshasa only; PMA2020, Performance Monitoring and Accountability. Data sources: For earlier year (middle survey), DHS surveys for each country; for later year (latest survey), most recent DHS or PMA2020 survey as of December 31, 2017. Left-hand and right-hand bars for each country correspond respectively to middle- and upper-row values in Table 4, Column 7. Data for married women only.