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Implantable contraceptives

Implantable contraceptives offer long-acting reversible contraception. They are small, thin, flexible plastic rods, which can be inserted under the skin of the upper arm (subdermally). There are several subdermal implants using different types of progestogens. The first implant Norplant® which was approved in 1983, consists of six silicone capsules while Jadelle® is made up of two silicone rods[1]. Both Norplant® and Jadelle® release levonorgestrel at a similar rate over a period of 5 years. The etonogestrel-releasing implant, Implanon® consists of a single ethyl vinyl acetate rod and releases the drug over 3 years. There are other products currently under development.

Implants are cited to have many advantages over other methods such as high contraceptive effectiveness; better user compliance; long life span; minimal requirements for follow up; low, stable serum hormone levels; and rapid reversibility upon discontinuation. Levonorgestrel-releasing implants are an alternative for women in whom copper IUD are not suitable due to pelvic inflammatory disease, menorrhagia and dysmenorrhoea[2]. However, disadvantages such as high initial cost and need for trained human resource for insertion have hampered the uptake of this method.

Different cadres of health professionals such as nurses, physician, midwives and other paramedical can provide implants. Training should include counselling, insertion and removal of implants. Emphasis should be on strict aseptic techniques and proper disposal of sharps and contaminated waste. While introducing and expanding implant services, reproductive health programs should take this into cost consideration in addition to cost of the product.




[1] Power J, French R, Cowan F. Subdermal implantable contraceptives versus other forms of reversible contraceptives or other implants as effective methods for preventing pregnancy. Cochrane Database of Systematic Reviews 2007, 3.

[2] WHO Model Formulary 2008.

 

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