A Randomized FiveYear Comparative Study of Two LevonorgestrelReleasing Implant Systems: Norplant® Capsules and Jadena® Rods

Objective: To provide a randomized comparison between Jadena® and Norplant® in terms of efficacy and acceptability among Indonesian women. Method: This study was a phase IV, open label, randomized, multicenter study throughout Indonesia. Subjects were Indonesian adult women who were randomized to receive Jadena® or Norplant® as their contraceptive method. The subjects were recruited from 6 large cities in Indonesia, such as Medan, Palembang, Jakarta, Semarang, Surabaya, and Makassar. Result: Of 600 subjects, 301 women getting to Jadena® and 299 women to Norplant® were enrolled between August 1998 and February 1999. The mean age was 29.8 (SD 5.3) years old, ranging from 18 to 40 years old. We did not find the pregnancy during the study. Non-pregnancy probability at the end of one year was similar between Jadena® (0.920 (SD 0.016)) and Norplant® users (0.916 (SD 0.084)). The continuation rates of Jadena® at one and three-year were 95.3% and 66.8%; whereas, the continuation rates of Norplant® was 94.3% at year-1 and 70.2% at year-3. Conclusion: The new two rod levonorgestrel subdermal system (Jadena®) showed similar efficacy with the old six capsule levonorgestrel subdermal system (Norplant®) in term of birth control. Both implant systems also have similar tolerability profile. Jadena® is easier to insert and remove than Norplant®. Keywords: birth control, efficacy, implan

Global knowledge/local bodies: Family planning service providers’ interpretations of contraceptive knowledge(s)

Contraceptive technologies and the knowledges that are constructed around them are simultaneously global and local. Family planning methods in the context of international development interventions are interpreted and understood as part of the relationship between meanings that are at once embodied and remote. While quality of care issues have been raised over nearly two decades, the interactive relationship between policy/program, supply, and interpersonal relations in forming identities has not been analyzed. This paper is based on two years of qualitative fieldwork conducted in Tanzania over a period between the mid-1990s and the mid-2000s. It will examine Tanzanian service providers’ perceptions of contraceptives to shed light on questions of local level dissemination of population knowledge(s) and shaping of identities. The findings suggest that the family planning program serves in a process of differentiation between two groups of “local†women: the service providers and their clients. This differentiation subsequently shapes the implementation of the family planning program.anthropological demography, contraceptives, family planning, foreign aid, international development, population, reproductive health, service providers

Implant users: Over five years after insertion (Further analysis of previous study data)

This secondary analysis report presents the characteristics of a subgroup of 235 women who are overdue in getting Norplant® implants removed after five years, factors related to the risk of nonremoval after five years, and issues related to accessing information about removal of implants. The main source of data for the present study is the “Norplant Implants® Assessment Study: Insertion, Use, and Removal” carried out in Indonesia in April 1996. This study consisted of a representative sample of 2,979 current and former Norplant users who had an insertion from April 1, 1987, to March 31, 1991, five or more years prior to 1996. The selected sample represented 14 provinces, 50 districts, 150 subdistricts, and 300 villages using stratified, multistage probability proportional to size. The secondary analysis used simple cross tabulations of characteristics and the current use status to study the characteristics of the sample women. The relative risk ratio values were calculated to understand factors related to the risk of not getting implants removed after five years

Indications for removal of etonogestrel implant within two years of use in Jos, Nigeria

Background: Implanon® is a new long-term and reversible sub-dermal contraceptive implant in Nigeria. It is a single rod containing 68mg of etonogestrel meant to offer contraception for three years and marketed by Organon.Objective: To determine the indications for removal of lmplanon® rods from clients within a two-year period.Design: A retrospective review of 30 consecutive lmplanon® removals within the study period.Setting: The fertility regulation unit of the department of obstetrics and gynaecology ofthe Jos University Teaching Hospital, North-Central Nigeria.Results: A total of 30 clients requested for and had their lmplanon® rods removed out of 669 insertions constituting 95.5% crude continuation rate in the second year. The clients were of mean age 31.4 ± 6.2 years, mean parity 2.9 ± 1.8 and mean number of living children 2.7 ± 1.6. There was an average weight gain of 1.9 kg. The most common indication for removal was menstrual disruption (33.3%). Desire for another pregnancyclosely followed (30.0%). Weight gain was another indication for discontinuation (13.3%). Two women were pregnant at insertion of the implant. There was one failure of the method with pregnancy as a result. Spousal disapproval was an indication for removal in two cases.Conclusion: Like all progestin-only contraceptive methods, menstrual disruption was the most common indication for removal of implants. Inadvertent insertion of implants with existing pregnancy is of concern and should be avoided as much as is possible. In doubtful cases at insertion, this insertion should be deferred or serum â-HCG should be assessed to exclude chemical pregnancy

Experience d'introduction de l'implant contraceptif Jadelle® en Cote D'Ivoire: Analyse de l’efficacité, des incidents et des effets indésirables chez 300 femmes.

Les implants contraceptifs sont presque inconnus en Côte d’Ivoire comme méthode contraceptive. L’avènement du Jadelle® pourrait contribuer à promouvoir cette méthode de contraception. L’objectif était d’apprécier la possibilité d’introduction de l’implant Jadelle® en Côte d’Ivoire comme méthode contraceptive. Il s’agissait d’une étude prospective pilote qui s’est déroulée du 1er au 31 Mai 2009 dans 10 centres de sanitaires de l’Association Ivoirienne pour le Bien Être Familial (AIBEF). Elle a concerné 300 utilisatrices du Jadelle® comme méthode contraceptive depuis 12 mois. Notre étude a consisté à évaluer l’efficacité, les effets indésirables et les incidents de la contraception par l’implant Jadelle®. La planification familiale était le principal motif de la contraception, soit 96%. Aucune grossesse n’a été rapportée. Des effets secondaires ont été signalés chez 18% des patientes et étaient dominés par les métrorragies (33,3%). Le désir de retrait s’est exprimé chez 05 patientes (01,7%), majoritairement 6 mois après la pose (60%), pour désir de grossesse (60%). Deux (02) cas d’infection du site et un (01) cas de rejet des bâtonnets ont été enregistrés. Le Jadelle® est une méthode contraceptive efficace. La réussite de son introduction en Côte d’Ivoire passe par une formation de tout le personnel soignant sur les méthodes d’introduction et de retrait, et la facilitation de son accessibilité.MOTS CLES: Contraception - Implant Jadelle® - Côte d’Ivoir

Experience with norplant at a Nigerian Teaching Hospital

Objectives: To determine the acceptance of Norplant implants while it was in use and share our experience with other Norplant providers.Design: Retrospective descriptive study.Setting: The family planning clinic of the Jos University Teaching Hospital, Jos, Nigeria.Results: During the 21-year period, January 1985 to December 2005, a total of eighteen thousand, two hundred and ninety one (18,291) new clients accepted various modern contraceptive methods in the family planning clinic of Jos University Teaching Hospital, Nigeria. Norplant was accepted by 1,333 clients (4.9%) as against the intrauterinedevices (IUDs) 25.4%, and Oral Contraceptive Pills (OCP) 22.9%. Female sterilisation was a contraceptive method of choice in 21.2%, the injectables in 13.9%, and the male condom in 9.3%. Failure rate was 0.37% and continuity rate was high among users. The Norplant contraceptive implant was accepted by women of mean age of 29.6 years and women of all parity. The acceptance pattern demonstrated a multi-nodalpattern from the time of introduction in 1985 to December 2005 when supply came to an abrupt stop. The greatest barriers to Norplant use were non- availability and high cost of the commodity.Conclusion: Norplant implants provided contraceptive protection with high reliability, safety, independence from user compliance, rapid return of pre-existing fertility after removal, good tolerability, and relatively simple and quick insertion and removal. The capsules will definitely be used as a reference for similar contraceptive products in the contraceptive market

Assessment of the side effects of progestogen only contraception in the immediate postpartum period: the case of implants with levonorgestrel Jadelle®

Background: The aim of this study was to evaluate the side effects of Jadelle® implants in the immediate postpartum.Methods: To do this, we inserted the implants at two different postpartum period: first, between the first and the seventh day for the immediate postpartum period (IPP) group; second, between the 45th and the 3rd postpartum months for the late postpartum (LPP) group. The variables studied were age, gesture, parity, abortions, number of live children, childbirth, caesarean section, quality of milky climb, age last child, pregnancy-attendant, pregnancy term at time of delivery, complaints, weight.Results: From May 2012 to December 2013, we collected two hundred patients, one hundred from each group (immediate postpartum and late postpartum). The average age of mothers in the IPP group was 28 years and 29 years for LPP group. After insertion, in both group, spotting were the most frequent complaints. The weight variations were between +800 g and -600 g for the group IPP and +260 g and -170 g for the other group; which makes a statistically significant difference. In both groups, at the end of the six months, no patient had menstruation.Conclusions: Our results are encouraging to further promote contraception in the immediate postpartum period in developing countries and thus reach a wide range of users. We can therefore say that the side effects are not different during this period and largely are also tolerated