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Keeping the “R” in LARC (long-acting reversible contraception): Measuring client-centered implant removal services in sub-Saharan Africa

Abstract:

As the use of subdermal contraceptive implants increases across sub-Saharan Africa, the need for person-centered removal services is more critical than ever to safeguard reproductive autonomy. In 2016, Christofield and Lacoste proposed eight conditions for client-centered implant removal, yet the extent to which these conditions have been assessed in large-scale surveys remains unexamined. Our mapping exercise collates survey information from three large data collection platforms fielded in sub-Saharan Africa, including the Demographic and Health Surveys (DHS), Performance Monitoring for Action (PMA), and the Service Availability and Readiness Assessment (SARA), utilizing questionnaire tools implemented among women, health facilities, providers, and clients to map existing data sources against these conditions. Our findings reveal that four of the eight conditions are fully captured, three are partially captured, and one is entirely absent within current population or facility-based surveys. Specifically, among the six facility-based conditions: the three conditions completely captured include the availability of supplies (condition 2), systems for managing difficult removals (condition 3), and the provision of counseling and reinsertion options (condition 5); two conditions partially captured include competent and confident providers (condition 1) and affordability for clients (condition 7), and the one condition that remained absent was measurement systems for monitoring of removal data (condition 8). Among the two individual-level conditions, timely and proximate service (condition 4) was partially captured and knowledge and awareness of where to go for removal (condition 6) was fully captured. Nearly a decade after Christofield and Lacoste proposed these client-centered conditions, the lack of consistent measures for client-centered implant removal poses significant barriers to understanding service accessibility and women’s reproductive experiences. To protect the reproductive autonomy of individuals who use long-acting reversible contraceptive (LARC) methods and desire timely discontinuation, it is imperative to develop and implement standardized metrics for their removal.