Postpartum Implanon/Nexplanon continuation rates and associated factors among women who ever used Implanon/Nexplanon in a tertiary hospital in Accra, Ghana

Authors

  • Kareem Mumuni Department of Obstetrics and Gynecology, University of Ghana School of Medicine and Dentistry (UGSMD), Korle-Bu, Accra, Ghana
  • Kwaku Asah-Opoku Department of Obstetrics and Gynecology, University of Ghana School of Medicine and Dentistry (UGSMD), Korle-Bu, Accra, Ghana
  • Vincent Ganu Korle-Bu Teaching Hospital, Department of Medicine–Fevers Unit, Korle-Bu, Ghana
  • Ali Samba Department of Obstetrics and Gynecology, University of Ghana School of Medicine and Dentistry (UGSMD), Korle-Bu, Accra, Ghana

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20193556

Keywords:

Continuation rates, Discontinuation, Implanon/Nexplanon, Post-partum

Abstract

Background: Postpartum Implanon use serves as an important conduit to bridge the wide gap of unmet need for contraception. The study sought to determine the continuation rates of postpartum Implanon/Nexplanon use and factors associated with it.

Methods: A retrospective review of electronic data of 391 women who had received postpartum Implanon/Nexplanon insertions from January 2012 to December 2015 was conducted at a family planning hospital in Accra, Ghana. Continuation rates and factors associated with discontinuation at 6 months, one year and two years post-partum were determined. Data were analysed using IBM Statistical Package for Social Science (SPSS) version 20.

Results: A total of 391 postpartum Implanon/Nexplanon insertions were done during study period. Their mean age was 28.51±5.29 years and median parity was 2.0. Continuation rates of postpartum Implanon/Nexplanon at 6 months, 1 year and 2 years post uptake were 94.9%, 92.8% and 86.4% respectively. Women with tertiary level education were 64% less likely to continue Implanon/Nexplanon use at one-year post uptake (OR=0.36, CI=0.16-0.85). Women with education up to Senior High School were 62% less likely to continue postpartum Implanon/Nexplanon use at 2 years after uptake (OR=0.38, CI=0.18-0.81). Women between ages 20 and 29 years were 53% less likely to continue postpartum Implanon/Nexplanon use at 2 years (OR=0.47, CI=0.26-0.86). Reasons for discontinuation of postpartum Implanon/Nexplanon use were wishes to get pregnant and side effects of the method.

Conclusions: Post -partum Implanon/Nexplanon continuation rates are high and remain as a viable choice for reduction of unplanned pregnancies post- delivery.

References

Ghana Statistical Service (GSS), Ghana Health Service (GHS), and ICF Macro International. Ghana Demographic and Health Survey, 2014. Available at: http://microdata.worldbank.org/index.php/catalog/2373.

Stover J, Ross J. How increased contraceptive use has reduced maternal mortality. Matern child health J. 2010;14(5):687-95.

Ahmed S, Ahmed S, McKaig C, Begum N, Mungia J, Norton M, et al. The effect of integrating family planning with a maternal and newborn health program on postpartum contraceptive use and optimal birth spacing in rural Bangladesh. Studies in Family Planning. 2015;46(3):297-312.

Gurtcheff SE, Turok DK, Stoddard G, Murphy PA, Gibson M, Jones KP. Lactogenesis after early postpartum use of the contraceptive implant: a randomized controlled trial. Obstet Gynecol. 2011;117(5):1114-21.

Han L, Teal SB, Sheeder J, Tocce K. Preventing repeat pregnancy in adolescents: is immediate postpartum insertion of the contraceptive implant cost effective? Am J Obstet Gynecol. 2014;211(1):24-e1.

Bradley SE, Schwandt H, Khan S. Levels, trends, and reasons for contraceptive discontinuation. DHS Analyt Stud. 2009;20.

Azmat SK, Hameed W, Mustafa G, Hussain W, Ahmed A, Bilgrami M. IUD discontinuation rates, switching behavior, and user satisfaction: findings from a retrospective analysis of a mobile outreach service program in Pakistan. International J women's health. 2013;5:19.

Ali MM, Cleland JG, Shah IH, World Health Organization. Causes and consequences of contraceptive discontinuation: evidence from 60 demographic and health surveys. Available at: https://www.who.int/reproductivehealth/publications/family_planning/9789241504058/en/

Haddad LB, Nour NM. Unsafe abortion: unnecessary maternal mortality. Reviews in Obstet Gynecol. 2009;2(2):122.

Woo I, Seifert S, Hendricks D, Jamshidi RM, Burke AE, Fox MC. Six-month and 1-year continuation rates following postpartum insertion of implants and intrauterine devices. Contracept. 2015;92(6):532-5.

Teunissen AM, Grimm B, Roumen FJ. Continuation rates of the subdermal contraceptive Implanon® and associated influencing factors. Euro J Contracept Reprod Heal Care. 2014;19(1):15-21.

Ireland LD, Goyal V, Raker CA, Murray A, Allen RH. The effect of immediate postpartum compared to delayed postpartum and interval etonogestrel contraceptive implant insertion on removal rates for bleeding. Contracept. 2014;90(3):253-8.

Gariepy AM, Duffy JY. Cost-effectiveness of immediate compared with delayed postpartum etonogestrel implant insertion. Obstet Gynecol. 2015;126(1):47.

Tadesse A, Kondale M, Agedew E, Gebremeskel F, Boti N, Oumer B. Determinant of Implanon discontinuation among women who ever used Implanon in Diguna Fango District, Wolayita zone, southern Ethiopia: a community-based case control study. International J Reprod Med. 2017.

Tocce KM, Sheeder JL, Teal SB. Rapid repeat pregnancy in adolescents: do immediate postpartum contraceptive implants make a difference? Am J Obstet Gynecol. 2012;206(6):481-e1.

Lewis LN, Doherty DA, Hickey M, Skinner SR. Implanon as a contraceptive choice for teenage mothers: a comparison of contraceptive choices, acceptability and repeat pregnancy. Contracept. 2010;81(5):421-6.

Muthir JT, Nyango DD. Indications for removal of etonogestrel implant within two years of use in Jos, Nigeria. East African Med J. 2010;87(11).

Mrwebi KP, Ter Goon D, Owolabi EO, Adeniyi OV, Seekoe E, Ajayi AI. Reasons for discontinuation of Implanon among users in Buffalo City Metropolitan Municipality, South Africa: A cross-sectional study. African J Reproduct Heal. 2018;22(1):113-9.

Melkamu Asaye M, Syoum Nigussie T, Mequannt Ambaw W. Early Implanon discontinuation and associated factors among Implanon user women in Debre Tabor town, public health facilities, Northwest Ethiopia, 2016. International J Reproduct Med. 2018.

Downloads

Published

2019-07-26

Issue

Section

Original Research Articles