- Cassel Charlie Mathale, Mr | South African Government
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Oh, I see, I heard that is not good at all, most of the people will tell you if it can be lost inside your body.
Cassel Charlie Mathale, Mr | South African Government
I will never use it because I do not want problems. Those who inserted Implanon seem to enjoy it as they no longer had to visit the clinic frequently and they could plan for their future because it protected them from falling pregnant for up to 3 years.
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They thought it was good to use Implanon because it meant that, as young girls, they could complete school. They also realized that it could reduce teenage pregnancies. If you know what you want in life Implanon is the way. Most of the girls were afraid of having Implanon inserted because they were afraid that it might get lost in their bodies or that it might damage their arms.
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In addition, there are rumors that Implanon that you can fall pregnant while on Implanon and that the arm fitted with Implanon will swell when doing house chores. Moreover, those who had the Implanon removed early also specified that fear and irregular menses, weight loss, severe headaches, and weight gain were reasons for early removal. This is one of the reasons many young girls are afraid to insert Implanon. From the transcription and analysis of the interviews, it became clear that there are a variety of experiences faced by adolescent girls during the use of Implanon.
Poor quality training of nurses on the insertion and removal of Implanon plays a role in the low uptake of Implanon insertion. Some participants reported that they wanted to insert Implanon but every time when they went to the clinic the nurses said, they were not trained to insert it. Many participants who had had Implanon inserted wanted to have it removed but nurses refused to remove it, saying that they were not trained in its removal.
The findings reveal that teenagers do not have a choice of the type of contraception they want to use.
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Health professionals and parents play a role in the removal of Implanon and some participants had it removed because they were forced to insert Implanon by their parents. The study reveals that adolescents experience several side effects when they are on Implanon.
These include weight gain, irregular menses, and some complains of weight loss.
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The study also found that the side effects differ from individual to individual, with irregular bleeding being the most common side effect mentioned. These findings are supported by different studies, which report that most women discontinued Implanon because of emotional liability, weight gain, depression, acne. However, while some discontinue Implanon because of the side effects, some discontinued for no apparent reason [ 32 - 34 ]. Lack of effective treatment of irregular bleeding has been outlined as the primary justification for the early removal of Implanon amongst adolescents [ 35 ].
Nevertheless, the study carried out by Patel indicates that girls who experience hemorrhage patterns discontinue the implant partly because they were not properly counselled prior to and post insertion [ 35 ]. The study also reveals the knowledge gap about Implanon and how it works. Moreover, the lack of knowledge contributes to the low uptake of adolescent girls of Implanon.
The study of Elsenburg et al. In contrast, some adolescents knew about the use of Implanon. They describe Implanon as one of the most effective contraception methods as it means that they do not have to visit clinics frequently because it protects them from falling pregnant for up to 3 years.
Additionally, they said Implanon enables them to plan for their future and finish their schooling without worrying about an unplanned pregnancy. Similar results in a literature review study reveal that women like the implant as it has long-term benefits for family planning for them as individuals and their families [ 37 ]. The adolescent girls who might like to use Implanon were afraid because of the myths and the presumed experiences of the previous users.
They alleged that they had heard that Implanon might get lost in their bodies which might result in an unplanned pregnancy, regarding and that the arm might swell while doing household chores. Similar to the current findings, previous studies also reveal that there are rumors and misconceptions specifically on the side-effects and effectiveness of Implanon in preventing pregnancy [ 38 - 42 ] Merck, the manufacturer of Nexplanon, notes that reported pregnancies amongst implant users have been primarily due to unrecognized pregnancies at the time of insertion or failure to insert the device properly [ 35 ].
In a similar context to this study, an informal investigation conducted by the Bhekisisa Centre for Health Journalism in SA, Mpumalanga reports that it was rumoured that poor outcomes of the use of Implanon could also be because of poor training of nurses, which has led to severe reactions of girls using new contraceptive devices [ 43 , 44 ]. Furthermore, it also documents that in Mpumalanga Vukuzahke clinic nurses are no longer inserting Implanon but only removing them [ 45 ].
Consequently, the reported pregnancies could be associated with the following factors, which might contraindicate Implanon use: epilepsy, infectious diseases, such as pulmonary tuberculosis, antiretroviral medication, poor screening and different lifestyle factors like abuse and alcohol consumption [ 46 ].
One participant also believed she had conceived a few weeks after the insertion of Implanon because of the use of ARVs. According to the clinical guidelines in South Africa, Implanon is a progestogen that has several interactions with certain drugs especially in women who are HIV positive. Although the use of condoms is crucial, antiretroviral therapy can lead to drug interactions and modify the efficacy of hormonal contraception. Implants should be used with caution in patients on Efavirenz [ 47 ]. However, in the study carried out on the interactions between hormonal contraception and antiretroviral therapy, even though there were several case reports of contraceptive disappointments from women taking Efavirenz, there were no actual data indicating low efficacy of the implant while co-administrated with HAART [ 50 ].
Furthermore, it was recommended that pending the proven data for a good understanding of the interaction of medications. Implanon should remain accessible to women living with HIV. Health care professionals should counsel HIV-positive women wishing to use Implanon as a contraceptive about the importance of dual contraception [ 51 , 52 ]. Authors in combined information from seven African countries who found minimized effectiveness among women using EFV-based ART and the implant [ 53 ] have supported this.
The study results indicate that adolescents experience challenges concerning informed consent and confidentiality from health care professionals. This was evidenced by adolescent girls who stated that they did not have freedom of choice as to the kind of contraception method they wanted to use. They stated that their parents and health care professionals were the ones who chose contraceptives for them.
Adolescents should utilize contraceptive implants confidentially to prevent parental interference and to improve adherence rates [ 55 , 56 ]. The world movement that supports the rights of women and girls to choose freely for themselves about how many children they want to have, states that it is of great importance to defending the human rights for women and girls [ 57 ]. Additionally, the movement further emphasizes that there should be policies and mechanisms to confirm informed selection from a broad range of high quality, safe, effective, acceptable and reasonable contraceptive methods; fairness and the assurance that women and girls are enlightened and not coerced in any way [ 58 ].
However, arguments have been raised that young girls are still growing and developing and may not really be able to know clearly and make educated calls about something as important as contraception. They may also be unaware of the potential consequences of their actions. They should be able to debate the issue in an honest way with a parent before making a decision [ 59 ].
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Participants reported that they did want to have Implanon inserted but every time when they went to the clinic health care professionals turned them away saying they were not trained to insert Implanon. In a qualitative study on understanding the low uptake of long-acting reversible contraception by young women in Australia, it was found that health care professionals had difficulty in accessing long-acting reversible training and, for those who received training, there was little support or follow-up. This made it difficult for them to maintain competency in inserting the long-acting reversible contraception [ 60 ].
In South Africa, the Deputy Director of the Department of Health has openly admitted that Implanon education provided to the health professionals might not be adequate, resulting in counselling services which might not be up to standard [ 45 ].
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Adolescent girls who removed the Implanon before 3 years indicated that if they had given insertion proper consideration beforehand, they would have opted for other contraceptives. The results are in line with the study, which was conducted in the rural area of Tigray Region, Northern Ethiopia, exploring the prevalence and predictors of Implanon utilization among women of reproductive age.
The study discovered that most women had inappropriate information about Implanon and recommend that well-being extension workers and other health professionals should offer proper counseling and education about Implanon and other contraceptives [ 52 ]. A previous literature review study on the barriers to fertility regulation report that misinformation about contraceptive methods, health issues, language challenges, and health care provider biases are the most common barriers to the initial uptake of Implanon [ 61 ].
It is extremely important that adolescents in search of contraception are given all of the relevant facts prior to the insertion of an implant, and also that health professionals consider their approach and the environment in which counselling is provided [ 57 ].
Furthermore, rich and relevant information will enable clients the time to independently study and reflect on whether or not they wish the implant to be inserted [ 57 , 63 ]. This might improve the method uptake and continue to improve knowledge and compliance. Of note, a study across many Sub-Saharan African countries emphasizes the importance of competency-based coaching on Implanon. The content should include the side effects, management, and regular necessary refresher courses and mentorship should be considered [ 67 ].
Further, it has been documented that these efforts would boost the self-confidence of health professional in the insertion and removal of implants. Furthermore, during follow-up training, it was observed that none of the trained health professionals refused to remove the implants [ 68 , 69 ]. There is still a huge knowledge gap in the understanding of Implanon and its advantages and disadvantages. A lack of sufficiently trained health professionals also has a role to play in the low uptake of adolescent girls of the Implanon contraceptive.
Incompetence in performing Implanon insertion and in counseling skills was also identified as one of the causes of fear and complications, such as unwanted pregnancies. There is a need for more training of the health care professionals on the insertion and removal of Implanon and in counseling skills.
Follow-up training should also be offered to assess the competence of health care professionals. Health education by health professionals should be intensified, especially on initial visits for family planning.