Postpartum implanon/nexplanon uptake in a tertiary hospital in West Africa

Authors

  • Kwaku Asah-Opoku Department of Obstetrics and Gynecology, University of Ghana School of Medicine and Dentistry (UGSMD), Korle-Bu, Accra, Ghana
  • Kareem Mumuni Department of Obstetrics and Gynecology, University of Ghana School of Medicine and Dentistry (UGSMD), Korle-Bu, Accra, Ghana
  • Vincent J. Ganu Department of Medicine-Fevers Unit, Korle-Bu Teaching Hospital, 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.ijrcog20191925

Keywords:

Etonorgestrel containing implant, Extended postpartum, Delayed, Immediate, Implanon/Nexplanon, Uptake

Abstract

Background: The postpartum period is viewed as an opportune period for uptake of contraception. Ghana has an unmet need for family planning of 30%. This study sought to determine the postpartum Implanon/Nexplanon uptake among women at a tertiary hospital.

Methods: This was a retrospective study that analysed 391 Implanon/Nexplanon insertions between 2012 and 2015 at the reproductive health and family planning unit at the Korle-Bu teaching hospital.

Results: Almost 69% (391/565) of all Implanon/Nexplanon insertions conducted between 2012 and 2015 were conducted in the postpartum period. Out of these postpartum insertions, 2.3% were done in the immediate postpartum period, 27.6% were done during the interval postpartum period and 70.1% were in the delayed postpartum period. Age and implant insertion status (first time ever or continuing) were significant determinants of postpartum Implanon/Nexplanon insertions. Compared to women less than 20 years of age, women in the age group 20-29 and 30-39 were 76% (AOR=0.24, CI=0.62-0.97) and 80% (AOR=0.20, CI=0.05-0.86) respectively less likely to have postpartum Implanon/Nexplanon  insertions done. Continuing users of implant insertions were 45% (AOR=0.55, CI=0.37-0.82) less likely to have post-partum Implanon/Nexplanon insertions done compared to first ever users.

Conclusions: There is a high uptake of postpartum Implanon/Nexplanon use among patients who receive implant insertions at the Korle-Bu Teaching Hospital. However immediate postpartum Implanon/Nexplanon insertions are low. There is the need to educate women and couples on the benefits of immediate postpartum implant insertion to avoid rapid repeat pregnancies.

References

World Health Organization. Birth Spacing. Geneva, Switzerland; 2005.

Rutstein SO. Effects of preceding birth intervals on neonatal, infant and under-five years mortality and nutritional status in developing countries: evidence from the demographic and health surveys. Int J Gynecol Obstet. 2005;89:S7-S24.

Sedgh G, Singh S, Hussain R. Intended and unintended pregnancies worldwide in 2012 and recent trends. Stud Fam Plann. 2014;45(3):301-14.

Bearak J, Popinchalk A, Alkema L, Sedgh G. Global, regional, and subregional trends in unintended pregnancy and its outcomes from 1990 to 2014: estimates from a Bayesian hierarchical model. Lancet Glob Heal. 2018;6(4):e380-9.

Sridhar A, Salcedo J. Optimizing maternal and neonatal outcomes with postpartum contraception: impact on breastfeeding and birth spacing. Matern Heal Neonatol Perinatol. 2017;3(1):1.

Ahmed S, Ahmed S, McKaig C. The effect of integrating family planning with a maternal and newborn health program on postpartum contraceptive use and optimal birth spacing in rural Bangladesh. Stud Fam Plann. 2015;46(3):297-312.

Hubacher D, Mavranezouli I, McGinn E. Unintended pregnancy in sub-Saharan Africa: magnitude of the problem and potential role of contraceptive implants to alleviate it. Contraception. 2008;78(1):73-8.

Brito MB, Ferriani RA, Quintana SM, Mehd Y, Silva de Sá MF, Vieira CS. Safety of the etonogestrel-releasing implant during the immediate postpartum period: a pilot study. Contraception. 2009;80(6):519-26.

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

Eggebroten J. Patient uptake and outcomes: an immediate postpartum IUD and implant program. Obstet Gynaecol. 2016;127(5):2016.

Ghana statistical service (GSS), Ghana Health Service (GHS), and ICF Macro International 2009. Ghana Demographic and Health Survey. 2014.

Wilson S, Tennant C, Sammel MD, Schreiber C. Immediate postpartum etonogestrel implant: a contraception option with long-term continuation. Contraception. 2014;90(3):259-64.

Gariepy AM, Duffy JY, Xu X. Cost-effectiveness of immediate compared with delayed postpartum etonogestrel implant insertion. Obstet Gynecol. 2015;126(1):47-55.

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. Contraception. 2014;90(3):253-8.

Bryant AG, Bauer AE, Stuart GS, Levi EE, Zerden ML, Danvers A, et al. Etonogestrel-releasing contraceptive implant for postpartum adolescents: a randomized controlled trial. J Pediatr Adolesc Gynecol. 2017;30(3):389-94.

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.e1-481.e7.

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.e1-24.e7.

Guazzelli CAF, De Queiroz FT, Barbieri M, Torloni MR, De Araujo FF. Etonogestrel implant in postpartum adolescents: Bleeding pattern, efficacy and discontinuation rate. Contraception. 2010;82(3):256-9.

Wulifan JK, Brenner S, Jahn A, De Allegri M. A scoping review on determinants of unmet need for family planning among women of reproductive age in low and middle income countries. BMC Womens Health. 2016;16:1-15.

Balogun O, Adeniran A, Fawole A, Adesina K, Aboyeji A, Adeniran P. Effect of male partner’s support on spousal modern contraception in a low resource setting. Ethiop J Health Sci. 2016;26(5):439.

Peipert JF, Zhao Q, Allsworth J, Petrosky E, Madden Tessa, Eisenberg D, et al. Continuation and satisfaction of reversible contraception. Obstetrics Gynecol. 2013;117(5):1105-13.

Downloads

Published

2019-04-29

Issue

Section

Original Research Articles