Accessible Contraceptive Implant Removal Services: An Essential Element of Quality Service Delivery and Scale-Up

Renewed investment in scaling up contraceptive implants has resulted in a dramatic increase in their use since 2012. The surge is due in part to the reduction in price and increases in donor investments made through the Implants Access Program (a collaboration between public and private organizations to make implants accessible to women in the world’s poorest countries) and ministerial prioritization and support to facilities and providers, as well as user preference. Among the 69 Family Planning 2020 (FP2020) focus countries, prevalence of injectables and implants is growing faster than all other contraceptive methods; in Ethiopia, Kenya, Malawi, Senegal, and Zimbabwe, the percentage of women ages 15–49 using implants is growing by over 1 percentage point per year.1 Implants are reaching more women than ever before,2 including those who have traditionally been underserved.3 Implants also now have the potential to meet the needs of postpartum women who are breastfeeding immediately after birth as a result of the World Health Organization’s recent decision to allow their use among this important population, which is reflected in the fifth edition of the Medical Eligibility Criteria for Contraceptive Use.4 Recently, implant manufacturers Merck and Bayer announced plans to sustain their current reduced implant pricing for an additional 5 years, through 2023, creating price parity for all the currently available implant products and further paving the road for potential continued scale-up.

However, emerging data show that service delivery capacity for implant removals has not kept pace with that for insertion. For example, in Kenya, among Ministry of Health facilities offering family planning services in 2015, 86% provided contraceptive implants while only 67% provided removals.6 Furthermore, clients who access removal at private-sector (and some public-sector) facilities can encounter user fees,7 and those who receive their method from a mobile outreach campaign or a community health worker are at times without clear or accurate, up-to-date information on how and where to seek follow-up services and removal. While there is a paucity of evidence regarding access to removal in the peer-reviewed literature, ministries and program managers increasingly cite reports of clients’ failed attempts in obtaining the removal procedure.

With the rapid expansion of implants services, the family planning community—donors, implementers, ministries, advocates, and health care providers—has reached a critical point at which it needs to assure the availability of convenient, quality removal services for clients who want removal for any reason throughout the use of their implant, including those discontinuing contraceptive use, switching to another method, or removing the implant to have a subsequent implant inserted. The family planning community has a responsibility to support method continuation as well as access to quality removal when desired—commensurate to the attention paid to the method’s initiation—such that clients’ reproductive intentions can be realized.9 We need more data visibility into implant removals and adoptable approaches to expanding access to removal services—and it is imperative that we act urgently.