Background
Implanon® is a subdermal contraceptive implant that is classified as a long-acting reversible contraceptive. It was initially released in 1998 in Indonesia. Since 1998, more than 3.3 million implants have been dispensed globally [
1]. The 2015 United Nations Trends in Contraceptive Use Worldwide report states that more than one in three married or in-union women globally use long-acting or permanent methods namely sterilisation, intrauterine device, and implants [
2]. According to the FP2020 Momentum at the Midpoint 2015–2016 report, injectables and implants are the fastest growing methods globally [
3]. Implanon® has been reported as a highly efficacious contraceptive [
4‐
8]. However, problems such as adverse effects, early discontinuation of the product, and contraceptive failure have been reported in a variety of studies published globally [
1,
8‐
12].
Despite the reported failures related to Implanon® use, the use of Implanon® is still being promoted globally. Initiatives such as Family Planning 2020 aim to address an unmet need for family planning services through distribution of modern contraceptives like Implanon® [
3]. Their goal is to enable 120 million more females to use contraceptives by 2020 [
3]. According to the FP2020 2015–2016 progress report, there were 30.2 million additional users of modern contraception compared to 2012 [
3]. This movement will help to achieve the sustainable development goals (SDG), which is aimed at preventing unintended pregnancy and reduce adolescent childbearing through universal access to sexual and reproductive healthcare services [
13]. This will also address the SDG, which focuses on gender equality and female empowerment and also aims to ensure universal access to sexual and reproductive health and reproductive rights [
13].
Family planning has been highlighted as a global unmet need [
2,
3,
13]. Implanon® has potentiation to address this unmet need by improving birth control and preventing unwanted pregnancies. The Pearl Index scores reported for Implanon® are similar to other long-acting reversible contraception as well as similar to sterilisation [
4]. Implanon® is convenient, cost-effective, and highly efficacious compared to other contraceptives [
14,
15]. Return to fertility is quick with Implanon®, and it can be safely used while breastfeeding [
4,
7,
14]. It can also be used by women who cannot tolerate estrogen [
4]. However, the challenges and barriers related to usage of Implanon® are not well known. The scoping review is aimed at mapping evidence on challenges and barriers linked to usage of this product since its introduction to the market.
It is anticipated that the results of this study will provide information on challenges and barriers related to Implanon® usage. The study findings will also guide future research as well as inform the policymakers and users of Implanon®.
The objectives of the scoping review are as follows:
-
To review research reports on barriers and challenges of usage of Implanon®
-
To review research reports on Implanon® users’ experiences
-
To review research reports on Implanon®’s adverse effects
-
To review research reports on discontinuation rate of Implanon® and reasons for discontinuation
-
To review research reports on Implanon®’s failure rate
Discussion
The scoping review will be conducted to map the existing peer-reviewed literature for evidence on challenges and barriers related to usage of Implanon®. Studies on problems with the use of Implanon® have been reported in most countries [
1,
5,
9,
10,
21]. However, there is a paucity of literature on the evidence regarding patients’ challenges and barriers related to Implanon®. It is important to investigate the trends and extent of these problems, globally. There is a need to consolidate and evaluate this information to guide future practice and policy regarding Implanon®.
This study only focuses on the contraceptive implant Implanon® and not on other contraceptive options. Evidence from 1998 onwards will be screened. Implanon® was put on the market in 1998. Therefore, this study will map literature evidence on the usage of the product since its introduction on the market. Aspects such as experiences of health practitioners with Implanon® are not of interest to this study. The focus of the study is based on user experience with reference to pharmacovigilance of Implanon®. The perspective of the user is essential in pharmacovigilance reporting [
22].
The findings from this review may be of interest to healthcare practitioners in terms of improving the provision of Implanon®. The review will also inform policy makers and may influence policy and guidelines related to the use of Implanon®. Researchers may also be interested in filling the gaps exposed through the review.
Acknowledgements
The authors are grateful to the College of Health Sciences Scholarship Committee and the staff of the College of Health Sciences Research Office, University of KwaZulu-Natal for funding.
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