Situational Analysis: Long-acting and Permanent Methods of Family Planning in Angola

These methods include hormonal contraceptive implants and intrauterine devices (IUDs), which can provide continuous protection from pregnancy for many years. Other methods, such as tubal ligation and vasectomy, provide permanent protection from pregnancy and are considered irreversible. The advantages of LAPMs include their ability to provide protection from pregnancy for much longer periods of time, typically between three years and a lifetime. They also require minimal user effort, as the user or their partner does not need to do anything to prevent pregnancy. Additionally, LAPMs are not visible, and there are no visible signs of their use, which can be important in contexts where family members or other community members may not approve of the use of family planning methods. LAPMs are also the most cost-effective methods by couple-year of protection (CYP). The cost of commodities for LARCs is lower than those for short-acting methods. According to Table 1, the relative cost of commodity-based methods available in Angola, the cost of IUDs is $0.63 per unit, while the cost of male condoms is $0.031 per unit. LAPMs are significantly more effective than shorter-acting methods, with an efficacy rate over 99%. The top four most effective methods are all LAPMs: implants, IUDs, tubal ligation, and vasectomy. Each method has an efficacy rate over 99%. The higher protection from pregnancy that LAPMs provide includes the fact that some of their mechanisms of action are inherently more effective, such as surgically blocking the passage of sperm or ova. In Angola, the most frequently used method is the male condom, but a typical condom user is approximately 60 times more likely than an implant user to become pregnant. High-parity women reported their choice as "some traditional method," and only 0.3% report the use of "other modern methods." Furthermore, 0.9% of adolescents 15-19 years old who use family planning use a LARC. The relative efficacy of family planning methods in Angola is shown in Table 2. The efficacy rate of LAPMs is significantly higher than that of shorter-acting methods. The efficacy rate of implants is 99.95%, while the efficacy rate of male condoms is 44%. Graph 1: Determinants of method effectiveness, adapted from Steiner et al., shows that the degree of protection from pregnancy can be influenced by the efficacy of the specific method and client compliance. Client compliance is a significant factor in the effectiveness of shorter-acting methods, but it is almost non-existent with LAPMs. The disadvantages of LAPMs include the fact that they involve some type of procedure performed by a health worker to start and stop method use, and clients cannot stop using the methods on their own. LAPMs also require providers with specialized skills and some surgical instruments, as well as inpatient prevention practices. Tubal ligation requires a surgical setting, and LAPMs require a higher initial investment of resources and time.