Presentation on theme: "Long-acting Reversible Contraception (LARC)"— Presentation transcript:
1Long-acting Reversible Contraception (LARC) David Hubacher, PhDSenior EpidemiologistFHI
2Outline of TalkDescription of long-acting reversible contraception (LARC)Worldwide use of long-actingAdvantages and DisadvantagesService delivery factorsComparison to short-acting reversible
3Characteristics of Long-acting Reversible Contraception (LARC) Device is insertedProducts lasts from 3 to 10+ yearsRemoval is required at some pointSimple clinic environment for servicesNurse practitioners can insert/remove
4Two body locations, three products Intrauterine contraceptionCopper IUD: ParaGard® yearsT-shaped plastic frame with copper attachedNon-hormonal
5ParaGard – Copper intrauterine device (IUD) How it works:Prevents fertilization by creating intrauterine environment hostile to spermCopper ions enhance anti-sperm action
6Two body locations, three products Intrauterine contraceptionCopper IUD: ParaGard® yearsT-shaped plastic frame with copper attachedNon-hormonalIntrauterine system (IUS): Mirena® - 5 yearsT-shaped plastic frame with reservoir to release progestin (levonorgestrel)Levonorgestrel absorbed in genital tract
19Program Advantages of LARC Fewer commodities neededMore cost effectiveMore effective at preventing unintended pregnancyOne visitOne LARC insertion =39 to 65 to 130 packs of pills…or9 to 20 to 30 injectionsMore LARC fewer stock-outs of methods
20Service Provision Requirements Trained personnelEquipment and suppliesAutoclave for sterilizing equipmentClinic needs electricity supplyContraceptive commodities
21Cost of LARC Cost varies tremendously ParaGard copper IUD: Mirena: $1 for international donors but $800 in USMirena:$850 in US, $200 in Kenya, limited donationsJadelle and Implanon implants$25 to international donorsSino-implant (II)$8 to international donors
22LARC vs. Short-acting Methods Injectables and Oral ContraceptivesGreat methods if used consistently and correctly40-60% of users stop within 12 monthsFor variety of reasons, not always by choiceThis can lead to unintended pregnancy
23Cumulative Probability of Discontinuation months
24Some obstacles to perfect use Commodity stock-outs at public sector clinicsCost at pharmacies/private facilitiesAmbivalence toward contraception/pregnancyMotivation can wane over timeGreat effort requiredAbstinence episodesPartner oppositionSide effects: who wants another dose?The FP queue: who wants to be seen there?
26Estimating Impact *18M users of injectable/orals in sub-Saharan AfricaIf 20% switched to implantIf apply regular discontinuation patternsPrevent 1.8M unintended pregnancies in 5 yr* Hubacher D, Mavranezouli I, McGinn E. Unintended pregnancy in sub-Saharan Africa: magnitude of the problem and potential role of contraceptive implants to alleviate it. Contraception 2008;78(1):73-78.
27Conclusions Long-acting reversible contraception Underused in many countriesWomen need more choicesExpanded use could have tremendous benefitEssential components: Voluntary uptake and removal on demand