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. 2018 Apr 9;13(4):e0195228.
doi: 10.1371/journal.pone.0195228. eCollection 2018.

Leveraging long acting reversible contraceptives to achieve FP2020 commitments in sub-Saharan Africa: The potential of implants

Katherine Thanel  1 , Danielle Garfinkel  1 , Christina Riley  1 , Keith Esch  1 , Woldemariam Girma  2 , Tadele Kebede  3 , Gaby Kasongo  4 , Kayode Afolabi  5 , Amanda Kalamar  1 , Sarah Thurston  1 , Kim Longfield  6 , Jane Bertrand  7 , Bryan Shaw  8 ; FPwatch Group
Affiliations

Leveraging long acting reversible contraceptives to achieve FP2020 commitments in sub-Saharan Africa: The potential of implants

Katherine Thanel et al. PLoS One. .

Abstract

Background: In developing regions, an estimated 214 million women have an unmet need for family planning. Reaching Family Planning 2020 (FP2020) commitments will require a shift in modern contraceptive promotion, including improved access to long-acting reversible contraceptives (LARCs). Until now, a lack of market data limited understanding of the potential of LARCs to increase contraceptive access and choice.

Methods: From 2015, the FPwatch Project conducted representative surveys in Ethiopia, Nigeria, and Democratic Republic of Congo (DRC) using a full census approach in selected administrative areas. In these areas, every public and private sector outlet with the potential to sell or distribute modern contraceptives was approached. In outlets with modern contraceptives, product audits and provider interviews assessed contraceptive market composition, market share, availability, price, and outlet readiness to perform services.

Results: Fifty-four percent of outlets in Ethiopia had LARC commodities or services available at the time of the survey, versus 7% and 8% of outlets in Nigeria and DRC, respectively. When present, LARCs were usually available with at least two other methods (99%, 39%, and 84% of public health facilities in Ethiopia, Nigeria and DRC, respectively). Many public facilities had both implants and IUDs in stock (76%, 47%, and 53%, respectively). Lack of readiness to provide LARCs was mostly due to a lack of equipment, private room, or the commodity itself. Market share for implants in the public sector was 60%, 53%, and 37% of Couple Years of Protection (CYP) in Ethiopia, Nigeria, and DRC.

Discussion: Limited availability of LARCs in Nigeria and DRC restricts contraceptive choice and makes it difficult for women to adopt and use modern contraception consistently. Brand-specific subsidies, task shifting, and promotion of methods that require less equipment and training are promising strategies for increasing uptake. Substantial government investment is required to improve availability and affordability. Investment in implants should be prioritized to make progress towards FP2020 commitments.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. LARC commodity or service availability by outlet type and country.
Fig 2
Fig 2
a: Method availability, among all public health facilities. b. Method diversity, among public health facilities with at least 1 LARC.
Fig 3
Fig 3. Market share of modern contraceptive methods across outlet types.
Fig 4
Fig 4. Proportion of LARCs distributed at no cost to the consumer or with a fee by sector and country.
See this image and copyright information in PMC

References

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