Rising to meet the demand for contraceptive implants in West Africa

A piece by our US Country Director Nomi Fuchs-Montgomery.

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As the sun rises in Abjua, Nigeria, and the cool, dry air gives way to the heat of the day, two MSI clinical teams pack up their 4x4 vehicles with a week’s worth of medical supplies and personal items for the long journey ahead. One team will head north to the dry Sahel of Sokoto state to work alongside public-sector providers delivering long-acting and permanent family planning methods (LAPMs) in districts where access to LAPMs is almost non-existent and family planning clients have limited choice in contraceptive methods.  The other team will head south to Abia state to offer clinical and management support to BlueStar clinics, part of MSI’s 162-member social franchise network in Nigeria and MSI’s fastest-growing service delivery channel with more than 3,000 BlueStar clinics across 17 countries.

Much has changed in the family planning landscape since my time as a Peace Corps volunteer. From 1992–1994, I lived and worked in Iboko village in Nigeria’s southeast region, now Ebonyi State. While my volunteer work focused on Guinea Worm eradication, issues around childbirth, contraception, and family size were omnipresent. I remember being impressed to see a large shrine in front of a family compound symbolizing a woman chief, only to learn this honor was earned by having 10 or more children. High birth rates, limited contraceptive availability, lack of trained providers in rural settings, and cultural/religious barriers contributed to women’s challenges in empowerment and decision-making about their fertility.

Today, we are seeing gradual shifts towards smaller desired family size and a growing trend toward healthy spacing and timing of pregnancies. Fertility rates in Nigeria are dropping, albeit slowly, from 6 in 1990 to 5.5 in 2013Unmet need for modern contraception is 20%, revealing a growing demand for modern methods. But ensuring access to voluntary family planning is a challenge, especially for poor women and for those living in remote states and rural areas.

With support from USAID and other donors, MSI Organization Nigeria (MSION) is rising to the challenge of meeting the growing demand for these lifesaving services. Since its inception in 2009, MSION has steadily expanded its footprint across the country, growing from 2 outreach teams to 5 teams in 2013, and currently initiating an expansion to 10 teams that will operate across 20 states. Coupled with its 162-member BlueStar social franchise network and the MSION clinic in Abuja, MSI’s contribution to meeting the vast and rising unmet need for modern methods is growing exponentially, with strong support from the government, to continue to increase voluntary family planning access and availability in this most populous of African nations.

Contraceptive implants are leading the trend in the rising demand for contraception. Greater numbers of Nigerian women with access to a broad range of methods are choosing this convenient, discreet, and highly effective option.  As programming expands, MSION is seeing a sharp increase in its provision of long-acting reversible methods. Implant insertions rose from 12,749 in 2012 to 46,483 in 2013, and IUD insertions rose from 2,948 in 2012 to 10,615 in 2013. Provision of short-acting and voluntary permanent methods is also increasing across both public and private sites.

Across West Africa—where low contraceptive prevalence rates and high maternal mortality persists—MSI is meeting a rising demand for family planning with a 53% growth in couple-years of protection (CYPs) between 2012 and 2013 in the region. (In West Africa, MSI operates in Mali, Burkina Faso, Niger, Nigeria, Ghana, Sierra Leone, and Senegal.) And, across the region, implants are the leading contraceptive of choice among MSI clients, as described in an article published recently in the Global Health: Science and Practice journal.

For example, MSI Mali is providing LAPM options, including 56,524 implants in 2013, to women who had extremely limited options before our services began. This is changing the national landscape of contraceptive usage, as procurement prices drop and high-quality, rights-based service delivery is made available. Preliminary results from the 2013 Malian Demographic and Health Survey show that one-third of women using contraception are now using LAPMs, up from virtually zero three years ago. In Burkina Faso, we see MSI outreach service delivery not only meeting demand but also catalyzing demand. Community mobilization and behavior change communication (BCC) initiatives are yielding results as outreach teams see more and more clients per visit, thereby increasing the health impact and cost-effectiveness of this proven delivery model.

MSI Implants Services

MSI Country Program

2012

2013

% Increase

Burkina Faso

14,386

19,524

36%

Ghana

23,162

40,657

76%

Mali

33,019

56,524

71%

Nigeria

12,749

46,483

265%

Senegal

6,600

11,798

79%

Sierra Leone

37,672

42,357

12%

Throughout West Africa, our infrastructure for programming is playing a critical role in bringing contraceptive choice to women. Within the context of FP2020 country commitments and in strategic alignment with the objectives of the Ouagadougou Partnership, MSI is partnering with government and international stakeholders to support countries in delivering against their implementation plans.  

Barriers to meeting the rising demand for contraceptive implants persist, including challenges of ensuring a reliable supply and distribution of contraceptive commodities and of ensuring adequate numbers of trained health providers, especially in rural areas. As a sector, we must be fully committed not only to quality insertion but also to full availability of removals as well as access to contraceptive continuation if the client chooses.

To address these challenges, in Nigeria MSION has successfully task shifted implant insertion to midwives across outreach, social franchising, and static clinic service delivery channels, and it is also working in partnership with key stakeholders within the Government to explore opportunities for task shifting implant insertion to community health extension workers. Equally, key efforts with stakeholders to forecast and streamline contraceptive commodity procurement and distribution are helping alleviate supply chain pressures.

Women want contraceptive implants, and it’s up to our global public health community to overcome the challenges in providing them. Alongside this, it is critical to ensure choice among a broad range of family planning methods, delivered with excellent clinical quality and a continuum of care that includes client-centered counseling, management of complications, method removal, and postpartum contraception.

As the clinical teams leave the dusty parking lot and part ways on the road, the week ahead is about connecting with the needs of individual women, many of whom will have traveled long distances and overcome other access barriers to reach our teams, all of whom represent the rising tide of demand for contraceptive choice.

Our Global Impact Last Year

32million

women using a MSI
method of contraception

13million

unintended pregnancies
prevented

6.5million

unsafe abortions prevented

34,600

pregnancy-related deaths prevented