There is now more public access to the implant

By Joyce Nyakato

She was married off at 14. Her mother had died and she had no-one else to take care of her. She was married off immediately. “I did not want, but I had nothing to do,” admits a gaunt 26-year old Kate Tumuhimbise. She conceived immediately.

Three children later and with a fourth pregnancy, she doesn’t know how she is going to cope because she doesn’t have work. She had thought of going for family planning to delay the fourth pregnancy but was talked out of it by her friends.

They alleged that the pills would make her barren forever, and she didn’t want the injection. She had heard of the implant but she had no idea how it worked and wasn’t willing to venture into the unknown. After weeks of no birth control, a pregnancy was imminent. Though now, after developing complications, she wishes that she had waited to get pregnant again.

When it comes to choosing the best family planning method for women in Uganda, it is never clear. Whereas a number of women are okay with swallowing a daily pill, others look to the injectable.

However, most women, especially those who have had many children, prefer to use longer-lasting methods such as Implants that give them more years of protection.

“They find it disturbing to swallow a pill daily,” explains Jon Cooper, Country Director of Marie Stopes Uganda, a major Family planning service provider.

With a public-private partnership, Jadelle implant, a long time reversible contraceptive implant, has been made available to more than 27 million women in the world's poorest countries, to women like Tumuhimbise. Starting this year, the implants are available at a 50% price reduction over the next six years.

Bayer HealthCare AG, the manufacturers, have partnered with the Bill & Melinda Gates Foundation, the Clinton Health Access Initiative, the Governments of Norway, the United Kingdom, the United States and Sweden, and the Children’s Investment Fund Foundation (CIFF) and the United Nations Population Fund (UNFPA).

In the 2012 State of World population report by the United Nations Population Fund (UNFPA), women in most developing countries have far fewer options, from family planning methods to choose from.

“In the more rural centers, the demand for long term family planning methods is larger than the actual demand,” the report spelled out.

In Uganda, 41% of women want to space or stop having children but they lack access to contraceptives, information and the services themselves. Globally, the implant has been one of the underutilized methods of family planning.

That’s why there has been a global massive shift towards a rights-based approach to family planning. This necessitates the need to empower women with family planning services and available information to make a choice.

“As long as the individual has services, means and all the available methods at their disposal, they should have the capacity to make an informed decision about their family planning,” says Dr Ismail Ndifuna the National Program Officer, United Nations Population Fund.

Under a signed agreement, the manufacturer reduced the current price of its contraceptive implant, shs 46,000 to shs 22,000 per unit, effective this year January.

This is a follow-up of the July 2012 London Summit on Family Planning, where global leaders pledged to provide an additional 120 million women in developing countries with contraceptive access by 2020.

According to Cooper, this news comes as good news to Ugandans as the need to widen the family planning methods looms large. “The cheaper the cost of obtaining the family planning method, the more stock becomes available to the public,” he says.

The reduction means that with the same money, donors and governments are able to purchase more contraceptives thereby reaching more rural women.

Lesser purchasing costs of the contraceptive will make it more affordable to those who are buying it. The partnership was in a bid the make this underutilized method of family planning more affordable and accessible to women globally, ultimately helping to expand contraceptive options.

With this method of contraception, a capsule is implanted under the skin in the upper arm of a woman, by creating a small cut.

The capsules can sometimes be seen under the skin, although usually they look like small veins. Once inserted, the Jadelle implant works within 24 hours and lasts up to five years.

Implants are becoming more popular as more women are demanding for them. Last year alone, Marie Stopes provided implants to 143,762 women who chose it out of the comprehensive method mix offered.

“After a woman has had many children she will opt for a longer term family planning method,” Cooper notes.

Dorothy Busingye, a Midwife at Kihiihi Health Centre in Kanungu District, Southwest of Uganda agrees that rural women are becoming more receptive to implants, after originally being hostile towards them.

This is because, they have become more available and more women are being educated about them. However, the scares of the side effects are still there.

Dr Simon Peter Lugolobi, of Reproductive Health Uganda explains that when counseling is well done, the uptake of implant increases. He reasons that the side effects can be managed but the health workers need to be capacitated to deal with them.

Additionally, the implant manufacturer, Bayer HealthCare AG is also working with other partner groups to develop a plan for improving service delivery infrastructure and training health providers to ensure that women have safe, quality access to proper insertion and removal services, as well as counseling.

Hopefully, this will address all myths and fears women have of the family planning method.