Family Planning Films: Fact or Fiction? A Qualitative Study Assessing Changes in Knowledge, Attitudes, and Intentions to use Family Planning After Watching Documentary and Drama Health Education Films

Background: There is a paucity of literature on the effectiveness of drama or documentary films in changing knowledge, beliefs, attitudes, and behavior of people towards family planning. This study aimed to compare and assess the acceptability of health promotion films based on documentary or drama, and their effect on knowledge, attitudes, and intention to use family planning.Methods: We developed short documentary and drama films about contraceptive implants, using the person-based approach. Their acceptability was assessed in focus group discussions with younger women below 23 years, women over 23 years, men of reproductive age, and health workers in four different areas of Uganda (Bwindi/Kanungu, Walukuba/Jinja, Kampala, and Mbarara). Transcripts of the focus group discussions were analyzed using thematic analysis, to generate themes and examine the key issues. We assessed changes in knowledge, attitudes, and intentions to use family planning after watching the films. Results: Sixteen focus groups with 150 participants were carried out. Participants said that the documentary improved their knowledge and addressed their fears about side effects, myths, and implant insertion. The drama improved their attitudes towards the implant and encouraged them to discuss family planning with their partner. The final versions of the documentary and the drama films were equally liked. Conclusions: Viewing a short documentary on the contraceptive implant led to positive changes in knowledge, while a short drama improved attitudes and intentions to discuss the implant with their partner. The drama and documentary have complementary features, and most participants wanted to see both.

Three-year observational study of immediate post-abortion insertion versus menstrual insertion of etonogestrel contraceptive implant

Objective This study aimed to estimate the difference in vaginal bleeding pattern, discontinuation rate, and satisfaction between immediate after abortion and menstrual insertions of etonogestrel contraceptive implants. Study design Between May 2013 and November 2015, 66 women were recruited in the abortion group who selected etonogestrel implants as their contraceptive immediately after induced abortion. 84 women who underwent the placement of the etonogestrel implant during their menstrual period were enrolled as the menstrual group. The two groups participated in 3-year follow-up outpatient visits at 1, 6, 12, 24, and 36 months after implantation. The vaginal bleeding pattern, discontinuation rate, satisfaction rate were recorded and compared. Results No woman had pregnancy over the study period of 3 years. The incidence of amenorrhea/infrequent bleeding did not differ between the two groups after 12, 24, and 36 months of implantation (53.0% vs. 58.4%, 47.8% vs. 51.6%, and 48.6% vs. 55.6%, respectively). In the abortion group, the incidences of frequent/prolonged bleeding were 15.1%, 32.6%, and 27.0% after 12, 24, and 36 months of implantation, respectively, while the other group showed 27.3%, 25.8%, and 20.4%, respectively. After 12 and 24 months, the continuation use rates were 69.7% and 56.1% in the abortion group and 73.8% and 64.2% in the menstrual group. The 12-month satisfaction rate between abortion group and menstrual group was 69.6% versus 72.6%. Statistical analyses show that there was no difference in vaginal bleeding pattern, discontinuation rate or satisfaction between the two groups. Conclusions Immediately post-abortion may be also a favorable time to undergo etonogestrel implantation.

Early contraceptive implants removal and its associated factors among women using implants at a National Referral Hospital, Kampala Uganda

Background Early discontinuation of implant contraceptive methods and reasons for discontinuation remains a major concern for family planning programs. Early discontinuation is related to higher rates of the overall fertility rate, unwanted pregnancies leading to possibly induced abortion. There is paucity of data on the practice of discontinuation of contraceptives in developing countries. The objective of the study was to determine the magnitude of early implants discontinuation among women receiving implants services in the study area and the factors associated with it. Methods A cross-sectional study was conducted from 2nd January to 3rd March 2020. Data were collected from 207 women who had come to remove implants on socio-demographic characteristics, obstetric history, duration of implant, and reasons for wanting to remove the implant. We computed the proportion of those who removed the implant before 18 months (early discontinuation). To assess the factors associated with early discontinuation, we estimated the prevalence ratios with a generalized linear model of the poisson family with a log link and robust error variance. Results The proportion of early implant discontinuation was 87/207(42%). Factor associated with early implant discontinuation included; experience of side effects (PR = 1.1; 95% CI 1.03–1.24; P = 0.001), not having received pre-insertion counseling about the benefits and side effects of contraceptive implants (PR = 1.5; 95% CI 1.02–1.30; P = 0.019) and staying in rural areas (PR = 1.1; 95% CI 1.03–1.27; P = 0.014). Conclusion Nearly one in every two mothers have early discontinuation of contraceptive implants. Factors associated with early implant removal include; experience of side effects, lack of counseling services, and staying in rural areas. There is a need for intervention to address high prevalence of early contraceptive removal through improving on counselling services about possible side effects.

Minimally invasive removal of deep contraceptive implants under continuous ultrasound guidance is effective, quick, and safe

Objectives The aim of this study was to assess the feasibility, performance, and complications of a non-surgical, minimally-invasive procedure of deep contraceptive implant removal under continuous ultrasound guidance. Methods The ultrasound-guided procedure consisted of local anesthesia using lidocaine chlorhydrate 1% (10 mg/mL) with a 21-G needle, followed by hydrodissection using NaCl 0.9% (9 mg/mL) and implant extraction using a Hartmann grasping microforceps. The parameters studied were the implant localization, success and complication rates, pain throughout the intervention, volumes of lidocaïne and NaCl used, duration of the procedure, and size of the incision. Between November 2019 and January 2021, 45 patients were referred to the musculoskeletal radiology department for ultrasound-guided removal of a deep contraceptive implant and were all retrospectively included. Results All implants were successfully removed en bloc (100%). The mean incision size was 2.7 ± 0.5 mm. The mean duration of the extraction procedure was 7.7 ± 6.3 min. There were no major complications (infection, nerve, or vessel damage). As a minor complication, 21 patients (46.7%) reported a benign superficial skin ecchymosis at the puncture site, spontaneously regressing in less than 1 week. The procedure was very well-tolerated, with low pain rating throughout (1.0 ± 1.5/10 during implant extraction). Conclusions Minimally invasive removal of deep contraceptive implants under continuous ultrasound guidance alone is feasible, effective, and safe. In the present cohort, all implants were successfully removed, whatever the location, with short procedural time, small incision size, low pain levels, and no significant complications. This procedure could become a gold standard in this indication. Key Points • Minimally invasive removal of deep contraceptive implants under continuous ultrasound guidance alone is feasible, which led to a success rate of 100% whatever the location (even close to neurovascular structures), with only a small skin incision (2.7 ± 0.5 mm). • The procedure was safe, quick, without any major complications, and very well tolerated in terms of pain. • This minimally invasive ultrasound-guided procedure could become the future gold standard for the removal of deep contraceptive implants, as an alternative to surgical extraction, even for implants in difficult locations such as subfascial ones or those close to neurovascular structures.

Factors Associated with the Selection of Contraceptive Implants for Family Planning Acceptors in Jambi City

In several decades, based on the results of the census, Indonesia has experienced significant population growth. In the last ten years, the population has increased by 32.56 million. The KB I program was initiated to reduce the birth rate by using several methods, one of which is the hormonal contraceptive implant method. However, data from the Jambi health office shows that there are still quite a few family planning acceptors who use implant contraceptives, even though it is known that this type of contraception is very effective, with a long duration of use, and an affordable price. This study aims to analyze what factors are related to the choice of implant type contraceptives for family planning acceptors in the work area of ​​Putri Ayu Health Center, Jambi City. This type of research is analytic Observational with a cross sectional design. The population of this study was 3,029 people. Samples were taken by quota sampling as many as 96 respondents. Data collection was carried out using a questionnaire. Data analysis was carried out bivariately using the chi square test with a significance level of 0.05. The data collected is based on research variables, namely knowledge, attitudes, perceptions, and motivations of family planning acceptors. The results of Chi Square analysis showed that knowledge with p-value 0.002, attitude p-value 0.224, perception p-value 0.173, and motivation with p-value 0.005. Factors related to the selection of contraceptive implants for mothers of family planning acceptors in the working area of ​​Putri Ayu Health Center are knowledge and motivation

Evaluation of Jadelle use in Teaching hospital in Niger Delta, Nigeria

Background: Jadelle (Norplant 2) is a levonorgestrel contraceptive implants that is safe, reversible, convenient, very effective and suitable for many women. Although it has numerous benefits, its use is still discontinued due to various reasons including side effects in the body of acceptors. Objective: To determine the prevalence rate, side effects, discontinuation rate and reasons for discontinuation of Jadelle at Rivers State University Teaching Hospital (RSUTH), Port Harcourt, Nigeria. Methods: A retrospective study of 874 clients attending birth control clinic at the RSUTH from 1st January, 2015 – 31st December, 2019 was conducted. Their records were recovered from the clinic and studied. Data was extracted, coded and investigated using the statistical package for social sciences (SPSS) IBM version 25.0 (Armonk, NY). Results: Of 874 acceptors of contraceptives within the study period, one hundred and forty two used Jadelle giving an uptake rate of 16.2%. Jadelle use accounted for third most used contraceptive after implanon and intra uterine contraceptive device (IUCD) during the study period. The mean age was 32.9+4.21 years. Most age group was 30-34 years accounting for 57.8%. Age range was 20-48 years and most (81.7%) were multiparous. Christians accounted for 99.3% and 98.4% were married. All the clients had formal education. Thirty nine (27.5%) acceptors discontinued the use. Most were due to menorrhagia (33.3%) and desire for pregnancy (23.1%). Two unintended pregnancies occurred giving a Pearl index of 0.28 per 100 women-year. Conclusion: Jadelle is safe and effective. Menstrual abnormalities were the commonest side effects complained by the clients. Menstrual abnormalities and desire for pregnancy were the commonest reasons for discontinuation of Jadelle use.

Knowledge, Attitude and Practice of Women of Childbearing Age towards the Acceptance of Contraceptive Implants in Akungba-Akoko, Ondo State

Contraceptive implants are progesterone-only contraception that is inserted subdermally. They are readily reversible with a return to fertility within days of removal. NDHS, (2019) recorded that the unmet need for family planning was higher among sexually active unmarried women (48%) than among currently married women (19%). The contraceptive prevalence in Nigeria was 16.6% as against 27% national target and implants accounts for 3.4%. The aim of the study is to investigate into the knowledge, attitude and practice of women of childbearing age towards the acceptance of contraceptive implants in Akungba-Akoko, Ondo State. A descriptive study was conducted on women of childbearing age (15-49 years) in Akungba-Akoko. Simple random technique was used in selecting the 423 respondents. The consent of the respondents were sought before administering the questionnaires. The data was analysed, using the IBM SPSS Statistics version 27.0.1.0. The study showed that 40.67% and 55.32% had secondary and tertiary education respectively. The age of the respondents at first birth was between 15 and 34 years, with the highest between 20-24 years (44.21%), followed by 15-19 years (21.28%). 20.33% were aware of the minimal side effects of contraceptive implants while 79.67% were not. 46.57% knew that contraceptive implants are highly effective while 53.19% did not. 7.57% knew that fertility would be returned immediately after the removal of contraceptive implants whereas 92.43% did not know. The study showed that most of the women who are currently using contraceptive implants did not know much about it Akungba-Akoko. The survey also revealed factors influencing the acceptance of contraceptive implants among women. Recommendations were made to improve the knowledge, attitude and practice of women of childbearing age towards the acceptance of contraceptive implants.