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Report: Kenyan women lead in use of implant contraception globally

One in every five married women in Kenya uses implants as a method of contraception, according a global report on health. Data to support this was presented through a review and analysis paper during the annual Reproductive Health Supplies Coalition (RHSC) Conference in Brussels, Belgium, last month.

The paper titled ‘Lift off: The blossoming of contraceptive use in Africa’ draws data from Demographic and Health Surveys (DHS) and the Performance Monitoring and Accountability (PMA) 2020 surveys.

The paper analyses recent changes in contraceptive use among married and sexually active unmarried women in 12 countries – Burkina Faso, Democratic Republic of Congo (DRC), Ethiopia, Ghana, Kenya, Malawi, Niger, Nigeria, Senegal, Tanzania, Uganda and Zimbabwe – that make up 61 per cent of Sub-Saharan Africa’s population.

Number quadrupled

The 2008-09 Kenya Demographics Health Survey (KDHS) showed that implant prevalence rate among married women was only 1.9 per cent. The number quadrupled to 7.4 per cent in 2014 and then more than doubled to 18.1 per cent in 2016. Presenting the paper, Dr Roy Jacobstein, senior medical advisor at Intrahealth International, explained factors that could have contributed to exponential growth in uptake of implants.

“Implants offer convenience with longer duration of action – up to five years – and do not need daily uptake of tablets,” he said. Overall, in the 12 countries, gains in implant use have exceeded combined gains for other family planning methods like IUDs, pills and injectables.

Now, Burkina Faso, Kenya and Malawi have an implant prevalence rate above 11 per cent among married women. The only countries with a rate below 5.9 per cent are Nigeria (3.0 per cent) and Niger (1.7 per cent).

“The uptake of implants as contraceptive is much better in Eastern and Southern Africa compared to Western Africa,” Dr Jacobstein said. According to the FP2020 annual report as of July 2017, 41 national governments (Kenya included) have committed to increase funding and prioritisation for family planning. There has also been a substantial reduction in commodity cost and increases in commodity availability. For instance, in the 1990s implants cost as much as USD20 (Sh2,000).

The 2012 London Summit on Family Planning saw a large-scale collaborative agreement between multiple donors, including the Bill and Melinda Gates Foundation, Norwegian Agency for Development Cooperation, Swedish International Development Cooperation Agency and Children’s Investment Fund Foundation; the implant manufacturers, Bayer (maker of the 2-rod implant, Jadelle) and Merck (maker of the 1-rod implant, Implanon, and its successor, Implanon NXT).

This led to the launch of the Implant Access Programme (IAP) in 2012-13, with halving of implant commodity cost to around USD8.50 (Sh850) per set and assurance of much greater production, funding and availability of implants for the world’s poorest countries.

Bayer and Merck committed to maintaining their implant access pricing through 2023. Between 2013 and 2017, Sub-Saharan Africa was supplied with more than 25.7 million implants from donors, mainly UNFPA and the United States Agency for International Development (USAID).

Over 72 per cent of this total procurement (some still in the pipeline) — more than 18 million implants — was supplied to the 12 countries under review. This includes 4.1 million implants to Tanzania, 4.0 million to Ethiopia, 2.2 million to Nigeria, 1.8 million to Kenya, 1.5 million to DRC and 1.3 million to Burkina Faso.

Rules regarding who can use implants have also been broadened. In 2015 the World Health Organisation ratified new guidelines allowing women to use implants immediately postpartum; whether or not they are breastfeeding.

Women who are yet to be mothers can also use implants, as can adolescents and young women, irrespective of age or marital status. Implants are hormonal contraception methods usually placed under the skin and left in place for as long as five years or a lesser period of time when a woman wants to resume child rearing.

The review also found that 8.1 per cent of sexually active unmarried women in Kenya were using implants for contraception. The review shows that 59.9 per cent of married women in Kenya are currently using a modern method of contraception (implants included). For unmarried sexually active women the portion decreases to 53.7 per cent.

Implants are now the second most used contraception method after injectables, whose prevalence rate is at 27.6 per cent. Out of every 100 married women using contraception, 46 use injectables while 30 use implants. Hence the two methods of contraception account for at least 76 per cent of all contraception by married women.

Glance

Key findings by KDHS 2014 on Family Planning

• 58 per cent of married women in Kenya are using a contraceptive method.

• The public sector remains the major provider of contraceptive methods; 60 percent of modern contraceptive users obtain their contraception from a government source.

• Thirty-one percent of family planning users discontinue use of a method within 12 months of starting its use. Side effects and health concerns are the main reason for discontinuation.

• Eighteen percent of currently married women have an unmet need for family planning services, with 9 per cent in need of spacing and 8 per cent in need of limiting.

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