Long Acting Reversible Contraception: The Promise of Contraceptive Implants

The technology has made significant progress since the introduction of the first generation Norplant in 1983. Some of the latest versions offer contraception for as long as five years after insertion. Global experience indicates that contraceptive implants are readily accepted by women in places where they are made available. Implant insertion procedures are short and uncomplicated, and fertility is restored soon after removal of the implant since the continuous-release hormones in implants have a short half-life. This is particularly helpful for women who have yet to complete their family. As implants do not contain estrogen, they do not affect production of breast milk and are thus suitable for breastfeeding women in the immediate postpartum period. They are also a good choice for women who do not want more children but are not willing to adopt a permanent method. Contraceptive implants can be used by almost all women, and a new implant can be inserted at the same time as the previous one is removed. They are a user-independent contraceptive method. The only major side-effect is a change in the frequency, amount, and duration of menstrual bleeding, which may lead to discontinuation of the method, especially if not accompanied by good quality counseling of the client. However, any associated side effects resolve soon after removal due to the short half-life of the hormone. Subdermal contraceptive implants are now used by 11 million women around the world. Implants are registered and approved for use in more than 100 countries, including the United States, Western European countries, as well as many middle- and low-income nations. In India, contraceptive implants have not yet been registered for manufacture and marketing by the Drugs Controller General of India (DCGI). The issue of introduction of implants into the basket of choice of contraceptives is under the active consideration of the Government of India. The country has missed the National Population Policy Goal of a Total Fertility Rate (TFR) of 2.1 by 2010, and in the year 2013, the national TFR stood at 2.3. Although many states have reached replacement level or low fertility, the others have a long way to go. Recent results from the National Family Health Survey 4 (NFHS 4) indicate that married women are less likely to be using modern family planning methods in eight of the States/Union Territories covered in the first phase. The NFHS 4 has reported some increase in the use of modern family planning methods only in Meghalaya, Haryana, and West Bengal. The decline in use of these methods is highest in Goa followed by Karnataka and Tamil Nadu.