Hormonal implants are a type of long-acting reversible contraceptive method that provides protection against pregnancy for up to five years. They are highly effective, comparable in reliability to intrauterine devices (IUDs), and more effective than short-term methods. Implants are registered in over 50 countries and can be used by women of any age, whether they have previously given birth or not. Breastfeeding women can also use them, starting as early as six weeks after giving birth.
The main advantage of implants is their ease of reversibility, with fertility returning immediately after removal. There are no restrictions on their use for HIV-positive women. However, a few side effects may prevent the use of implants, including disruption of monthly periods. Despite this, continuation rates of implants are high, with 78-96% of users continuing with the method after one year.
The average duration of use for hormonal implants is 3.6 years, with a range of 2.8 to 4.5 years. Access to implants is limited due to the requirement of trained professionals for both insertion and removal. However, once inserted, routine follow-up care or resupply is not needed for three to five years, reducing the burden on healthcare workers and users.
The use of implants has increased slowly but steadily since their introduction. Implants account for a small percentage of modern method family planning, but this may be due to access issues rather than acceptability. In many countries, implants are not available due to program limitations or lack of outlets. A USAID | DELIVER PROJECT stock assessment in Zambia found that only 30% of districts managed Jadelle, and 70% of service delivery points were out of stock.
Trends in implant use show a gradual increase in selected countries, with 10 out of 14 countries experiencing an increase in use. However, use remained unchanged in two countries, and declined in Colombia and Indonesia. The case in Indonesia is instructive, as implant use declined due to a decline in subsidized implants, resulting from high procurement costs and budget constraints.
In Burkina Faso, implants were a relatively popular method, with a contraceptive prevalence rate (CPR) of 1.2% in 2003. This was a six-fold increase from 1999, when overall CPR was 4.8% and implant use was only 0.2%. Shipments of implants to Burkina Faso show a generally upward trend, but with fluctuations.
The unmet need for long-acting and permanent methods (LAPMs) remains high in sub-Saharan Africa, with a total unmet need of 17-36% in 15 countries. Long-acting methods can reduce unmet need for spacing, and an analysis of four sub-Saharan African countries shows that the percentage of women using LAPMs is significantly lower than short-term methods. Hormonal implants can play a crucial role in reducing overall unmet need.
The cost of implants is decreasing, and the new product designs have fewer rods and are easier to insert and remove, increasing client acceptability. However, the high upfront cost of implants may make implants unattractive to policymakers, but over the long term, they may be a cost-effective option due to their long duration of use, total associated program costs, and increased effectiveness compared to other methods.
Donors may need to increase their financial commitments to support the supply chain management of implants, which requires special attention due to unpredictable demand and high unit costs. Flexible procurements, monitoring of stock levels, and the ability to transfer stocks across the supply chain are necessary to ensure the availability of implants in family planning programs.