The introduction and scale-up of contraceptive implants have unequivocally increased access to family planning (FP) method choice around the world. Late last year, Jhpiego and Impact for Health (IHI) collaborated to document the experience of contraceptive implant introduction over the last decade (primarily through a desk review and key informant interviews) and identified recommendations to scale up implants in the private sector. This piece summarizes some of the key findings available in the suite of resources available here.
It is just over a decade since world leaders gathered at the 2012 London Summit on Family Planning (FP) and committed to one goal: meeting women’s unmet need for contraception. This goal was operationalized through the creation of Family Planning 2020 (FP2020), a global partnership to empower women and girls by investing in rights-based FP, and extended through FP2030 to reaffirm this global commitment. The emergence of FP2020 also paved the way for the introduction of the Implants Access Program (IAP) in 2013: a public-private partnership to increase access to contraceptive implants for women in low-income countries. The results are awe-inspiring: the IAP led to a 50% price reduction for those procuring implants for FP2020 countries and, over the past decade, annual global procurement of implants for FP2020 countries increased from 3.9 million to 10.6 million and is projected to increase further in the coming years. Implants have also been incorporated into national universal health coverage (UHC) plans, such as those in Ghana and Zambia. Further, an analysis considering recent and longer-term changes found that increases in implant use during this period were the main driver of mCPR gains in 11 countries in Africa. The introduction and scale-up of contraceptive implants have unequivocally increased access to family planning (FP) method choice around the world.
Does this mean we can close the book on implants, considering them fully mainstreamed? Or are there untapped frontiers for expanding method choice – choice that includes implants?
From our analysis (including a desk review and key informant interviews), meeting demand through implants is underpinned by a few key lessons.
For the FP2030 goal to be realized, contraceptive implant availability, acceptability, accessibility and quality need to be maximized; however, a number of challenges remain.
Expanding method choice is an integral component of family planning programs. Some estimates indicate that for each new contraceptive method added to the mix/basket of choice, overall contraceptive prevalence in a country will rise 4-8%. But sustaining such expanded choice over the long term requires attention to method-contextual delivery features – features that, if ignored, could stifle a method’s ability to meet the needs of individuals and couples who wish to use it. For contraceptive implants, such features requiring continued attention include:
Removal access: Improving access to quality implant removal helps to meet clients’ rights, helping ensure that they have full, free, and informed choice to both use and stop using their method. However, data continue to demonstrate a disconnect in access and utilization of quality implant removal services when compared to implant insertion. A recent study using Performance Monitoring for Action (PMA) service delivery point data in 6 countries in sub-Saharan Africa indicates that a substantial proportion (31-58%) of implant-providing facilities report at least one barrier to offering implant removal services.
Developed by the Implant Removal Task Force, these eight standards need to be upheld to satisfy clients’ implant removal needs (further questions program managers can explore to ensure removal-inclusiveness are included here):
A suite of materials to support program managers, technical advisors, and other FP program stakeholders in designing, implementing, and measuring FP programs with an implant removal-inclusive lens is available here.
Private Sector Expansion: The last decade is testimony to how coordinated efforts have transformed women’s access to implants in the public sector. A recent analysis of 36 countries showed that 86% of implant users obtained their implant from a public-sector source. To maximize the private sector’s ability to deliver implants, a similarly coordinated effort, led by national governments and global partners, can release the untapped potential of the private sector to deliver contraceptive implants at greater magnitude and contribute to FP2030 goals. Such efforts should focus on transforming four key areas:
In some ways this debate around contraceptive implants reinforces what we know about new method introduction and sustainable service delivery: the importance of considering mixed health systems actors (their opportunities, abilities and motivations) in new product introduction; using a rights-based lens to inform product introduction and service delivery in all contexts (e.g. not promoting one method over another) and so much more (this article doesn’t touch on the need to expand method choice in humanitarian contexts, for example!). But just because these principles are widely known doesn’t mean they’re easy to deliver.
This begs the question: is this a pivotal moment to reframe how we support implants to ensure sustainable choice and scale?
What could this look like in practice? We’d like to offer two concrete recommendations:
ABOUT: Jhpiego and Impact for Health, as a component of the Expanding Family Planning Choices (EFPC) project, undertook rapid literature reviews and key informant interviews with experts in the contraceptive implant and family planning field, to better understand programmatic learnings, tips, best practices and challenges, including the potential for private sector engagement for implant introduction and scale-up. The results of this review led to the development of a series of products for continued learning and sharing, available here.