Experiences of women using etonogestrel contraceptive implant and reasons for removal in Tshwane District, Gauteng
Etonogestrel, also called Implanon, is one of the new contraceptive implant methods that is highly effective and convenient. Regardless of several benefits, women still access health facilities to request removal of this contraceptive implant before the expiry date. South Africa reported early removals of Implanon by users after a successful launch in the Public sector in 2014, with high uptake. Tshwane district in Gauteng, specifically, experienced high rates of Implanon removal before expiry date. However, no study has been conducted in Tshwane District to assess implementation of the new contraceptive method and focuses on the experiences of the users and the reasons for early removal. Therefore, the aim of the study was to describe women’s experiences of using the etonogestrel contraceptive implant and to determine the reasons for early removal of the implant among women in Tshwane District. This was a qualitative research study using in depth interviews to collect data from 22 women aged between 18 to 49 years. These women had accessed primary health care services in Tshwane District for removal of the Implanon and voluntarily consented to participate in the study. An interview guide was used to elicit the information and data was analysed using thematic content analysis. The study revealed that women chose the contraceptive implant because it was convenient and effective. Regardless of the benefits of Implanon, women decided to remove the contraceptive implant before the expiry date due to intolerable side effects such as irregular bleeding, dizziness, headache, weight gain or weight loss. The study also established gaps in counselling services rendered by professional nurses, management of side effects and follow up thereafter, which is similar to what was found in other studies. There is therefore a need for health care providers to be trained adequately on counselling, management of side effects and further follow up to help improve the sustained use of this contraceptive implant by women. Additionally, clear guidance on the post insertion follow up process, counselling and management of side effects specific to the etonogestrel contraceptive implant should be incorporated in the training. This is currently not outlined in the National Contraceptive Clinical guidelines.
A research report submitted in partial fulfilment of the requirements for the degree of Master of Public Health (Maternal and Child Health) to the Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, 2021