It’s Not Just About Access! On World Contraception Day, Let’s Not Forget a Woman’s Right to Stop Using Contraception Too

BY Candace Lew September 23, 2016

We at Pathfinder celebrate the fact that women around the world increasingly have more contraceptive choice. Access to a wide range of methods is critical because the “right” type of contraception differs from person to person and may change as an individual enters new stages in life.

Yet, our celebration is mixed with a lingering concern: have sufficient investments been made to ensure that safe removal services are available to all women whenever they decide to stop using their implant?

Recent research suggests that the answer is ‘no.’ The capacity to remove implants in 69 of the world’s poorest countries falls well below what is needed. When removal services are inaccessible, the right to stop using contraception—which is equally as important as the right to access contraception in the first place—is jeopardized.

Recently, a colleague told me about a young Tanzanian woman named Sarah. Growing up, Sarah knew that she wanted wait to have children until she finished school. But with limited contraceptive options available to her, she discovered she was pregnant at 17 and dropped out of school.

After having her baby, we introduced Sarah to a young mother’s group. She sought contraception from a Pathfinder-trained health provider and selected an implant. I’m happy to report that Sarah now plans to go back to school.

Globally, contraceptive implants are growing in popularity. Millions of women like Sarah have chosen implants because of their effectiveness, long-acting nature (they are effective for 3-5 years), and the relatively simple method of implant insertion (placed under the skin of the upper arm). In the last decade, use of the implant has more than doubled in Tanzania, Rwanda, Ethiopia, and Malawi.

But efforts to increase access to contraceptives don’t fully serve women in need unless there is equal emphasis on accessible removals. I know Sarah’s story doesn’t end here; eventually, she may decide that the implant no longer meets her needs. That’s why we are we are proud to be leading the way in ensuring women are able to exercise their right to contraception—including implant removals.

Removals in Ethiopia

In Ethiopia, for example, we embedded a focus on removals from the very start of our efforts to increase access to implants. Since 2009, through the Integrated Family Health Program, we have trained nearly 10,000 health extension workers (a formal cadre of frontline health workers) to insert implants. These health extension workers are stationed at health posts in the communities—providing critical access for people who live far away from major health centers.

Health extension workers, however, are not permitted to perform removals because it is a surgical procedure. So Pathfinder worked with the government to come up with a plan to offer removal services closer to the community. We trained health providers at the health centers – which oversee the health posts – to remove implants. We then arranged for these higher-level providers to visit communities at regular intervals to remove implants, letting communities know that removal services will be available on a certain date. From September 2011 to September 2015, nearly 90,000 women sought contraceptive services through these health provider visits. Of these women, 40% had an implant or IUD inserted and 24% (over 21,000 women) had an implant or IUD removed. Other organizations have looked to this program as an example of how to integrate removal services into their contraceptive programs.

Innovations in Tanzania

And in Tanzania, we are working with the government and with Merck to oversee training and rollout of Nexplanon, a new contraceptive implant that is easier to insert and remove. Over the course of the next six months we will train more than 1000 Tanzanian providers on both implant insertion and removal.

We are proud of these innovative programs, but we know that the need is greater than what we can do alone. Which is why we recently worked with a coalition to create a Global Consensus Statement reinforcing the importance of making all contraceptive methods and services—including removal services—fully available to all people, especially adolescents.

join us

As we approach World Contraception Day 2016, we reflect on the importance of contraceptive removal services for achieving its goal: making sure that “every pregnancy in the world is a planned one.” If you share our commitment to uphold the sexual and reproductive rights of women around the globe, join us and sign the Global Consensus Statement.