Approximately 50% of all pregnancies in South Africa are unplanned.
According to the Guttmacher Institute, an American research and policy organisation committed to advancing sexual and reproductive health and rights, 81% of unintended pregnancies in developing countries occur due to a lack of modern contraception. And in South Africa, only approximately 60% of women of child-bearing age are using modern contraception methods, says Dr Judy Kluge, a consultant obstetrician and gynaecologist at Tygerberg Hospital, as well as Head of the Family Planning Unit at Stellenbosch University's Faculty of Medicine and Health Sciences. She also teaches undergraduate and postgraduate students.
"There is a cost involved for society regarding children that are unplanned or unwanted," she says. "People need to realise that contraception is not completely effective. Many women also undergo abortions because contraceptives failed, they experienced side-effects or they were not informed about all the options." In Africa an estimated 34 in every 1 000 pregnancies are aborted, according to the Guttmacher Institute.
Kluge has been involved with the contraceptive implant Implanon NXT since its South African launch in June 2013. She is one of the handful of local specialists selected to be a master trainer for health care professionals regarding the insertion and removal of the implant.
Implanon NXT was officially made available in government health care facilities in February 2014. Kluge says the initial uptake was such that the company had to divert supplies from other countries to keep up with the demand. Unfortunately the demand has since decreased, and Kluge believes the problem might be a lack of counselling of women about their options.
She would like to see this change. "The implant is the most effective contraceptive available. It's even more effective in its ability to prevent pregnancy than sterilisation of a female or a male," she explains.
Kluge answers some frequently asked questions about the device:
What is Implanon NXT?
It is a small rod, some 4cm long and 2mm wide, that contains a synthetic hormone called progestogen. It is implanted just below the skin in the arm of the non-dominant hand. The hormone is then slowly released over a few years. Its registered usage is 3 years.
What is the action mechanism?
It suppresses ovulation. In lay terms it puts your ovaries to sleep and you therefore do not release an egg every month.
How does it compare to other contraceptive methods in terms of preventing pregnancy?
It's the most effective contraceptive available. It has a failure rate of 0,05 % for both typical use and perfect use, which means only 1 in 2 000 women will fall pregnant within the first year of use.
Female sterilisation has a failure rate of 0,5% in preventing pregnancy and male sterilisation 0,15%.
Other effective devices are intra-uterine devices (IUDs). The copper IUD has a 0,8% failure rate and the Mirena 0,2%.
In comparison injections, the most popular contraceptive in South Africa, has a typical failure rate of 6%.
With combined hormone methods such as the hormonal pill, a patch or a vaginal ring, the typical failure rate is 9%, in other words 9 out of 100 women will fall pregnant within the first year of use. The typical failure rate of condoms is 18%.
What are some of the other advantages of this method?
It's useful in the sense that the patient can just fit it and then forget about it.
Another advantage is that it is 100% reversible. As soon as the implant is removed, the hormones disappear from your system within a few days, therefore women regain their fertility almost immediately.
Because it is a progesterone only method and puts the ovaries to sleep, it can also reduce painful periods by 70%.
Lastly, the implant is cost-effective. Although the initial cost may be higher than that of some of the other methods, it still represents a massive cost saving from a public health perspective compared to the cost of an unplanned pregnancy. The cost of a normal delivery in a government hospital is more or less R2 000 per day, while abortions are even more expensive than contraception.
What are some of the concerns and disadvantages regarding this method?
As is the case with any hormonal method, women might experience hormonal side-effects, although they are less compared to those of the injectable method due to the relative small amount secreted.
It also wears out the endometrium, therefore bleeding patterns might be unpredictable. This is usually the most common reason for removal.
Women often want to know if it will affect their weight, but Implanon has no causal association with weight gain. Any hormonal method can affect your appetite, but the effect is highly individual.
Other side-effects with progestogen include possible moodiness and irritability, but it should not cause clinical depression.
Another complication for some women has been the removal of the implant in instances when it was inserted too deep. Training is taking place to improve removal techniques, but any woman who is struggling can be referred by her doctor or clinic to a specialist family planning centre, where the implant can be removed.
The bottom-line is that although some women may experience side-effects, they can be experienced with any method. With Implanon NXT the continuation rate is high. This means that the advantages outweighs the disadvantages for most women.
*Kluge is also the clinical lead for the Leading Safe Choices (LSC) project, a donor-funded initiative led by the British-based Royal College of Obstetricians and Gynaecologists (RCOG), which focusses on family planning. Among other things, the LSC programme trains health care professionals to counsel women on pregnancy options and contraception.
Additional sources: Guttmacher Institute (https://www.guttmacher.org/fact-sheet/induced-abortion-worldwide)
Caption: Dr Judy Kluge, Head of the Family Planning Unit, and Prof Stefan Gebhardt, Head of General Specialist Services at the FMHS' Department of Obstetrics and Gynaecology, are involved in the Leading Safe Choices initiative.
Photo: Damien Schumann
