Contraceptive Implant Discontinuation in Huambo and Luanda, Angola: A Qualitative Exploration of Motives

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Study Justification:
The study aimed to investigate the reasons behind the discontinuation of contraceptive implants in Huambo and Luanda, Angola. This research was important because the government of Angola has been striving to increase access to contraceptives, particularly contraceptive implants. However, the discontinuation of these implants has posed a challenge to this effort, impeding the improvement of contraceptive prevalence and subsequently impacting maternal and child health.
Highlights:
– The study conducted 45 in-depth interviews and six focus groups with former and current contraceptive implant clients and family planning nurses in eight clinics across Huambo and Luanda.
– Participants identified several motives for discontinuation, including adverse side effects, desire for pregnancy, partner dissatisfaction, quality of care, alternative or lack of information, and religious beliefs.
– Adverse side effects, such as prolonged bleeding, amenorrhea, and headaches, were the most commonly cited reasons for discontinuation.
– The findings of this study align with previous research conducted in similar settings, emphasizing the influence of adverse side effects and the desire for pregnancy as motivating factors.
– The study also highlighted the importance of considering cultural norms and the perceived role of women in relation to fertility and child-bearing when addressing contraceptive discontinuation.
Recommendations:
Based on the study findings, it is recommended that programs and policies focus on engaging in dialogue with communities to address the concerns surrounding contraceptive implant discontinuation. This approach should go beyond solely improving service delivery and quality. By understanding and addressing cultural norms, ideal family size, and the role of women in fertility and child-bearing, programs can effectively address the motives for discontinuation and promote sustained contraceptive use.
Key Role Players:
– Government officials and policymakers responsible for reproductive health and family planning programs
– Community leaders and representatives
– Healthcare providers and family planning nurses
– Researchers and academics specializing in reproductive health and contraception
Cost Items for Planning Recommendations:
– Community engagement and awareness campaigns
– Training and capacity building for healthcare providers on addressing contraceptive discontinuation concerns
– Research and data collection on cultural norms and perceptions related to fertility and family planning
– Development and implementation of culturally sensitive educational materials and resources
– Monitoring and evaluation of program effectiveness and impact on contraceptive prevalence and maternal and child health outcomes

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The study conducted in-depth interviews and focus groups with former and current contraceptive implant clients and family planning nurses in eight clinics across two provinces in Angola. The data was transcribed and translated, and a combined deductive/inductive approach was used to analyze the data. The study identified several motives for contraceptive implant discontinuation, including adverse side effects, desire for pregnancy, partner dissatisfaction, quality of care, alternative or lack of information, and religion. The findings are consistent with existing research in similar settings. To improve the strength of the evidence, the study could have included a larger sample size and conducted a quantitative analysis to provide more statistical evidence. Additionally, the study could have included a control group to compare the motives for discontinuation with those who continued to use contraceptive implants.

Introduction The Government of Angola is engaged in ongoing efforts to increase access to contraceptives, in particular contraceptive implants (CIs). Discontinuation of CIs, however, has been identified as being a challenge to this work, hindering the improvement of contraceptive prevalence, and in turn, maternal and child health. The objective of this study was to understand motives for contraceptive implant discontinuation in Luanda and Huambo, Angola. Methods We conducted 45 in-depth interviews and six focus groups amongst former and current contraceptive implant clients and family planning nurses in eight clinics across the provinces of Huambo and Luanda. Data collectors transcribed and translated key information from Portuguese into English. We used a combined deductive/inductive approach to code and analyze data. Results Participants described adverse side effects, desire for pregnancy, partner dissatisfaction, quality of care, alternative or lack of information, and religion as motives for discontinuation. Adverse side effects, including prolonged bleeding, amenorrhea, and headaches were most commonly cited by both clients and providers. Discussion Motives for discontinuation reflect existing findings from other studies in similar settings, in particular the influence of adverse side effects and desire for pregnancy as motivating factors. We contextualize these findings in the Angolan setting to tease out the relationship between cultural norms of ideal family size and the perceived role of women in regards to fertility and child-bearing. We suggest that programs enter into dialog with communities to address these concerns, rather than working exclusively on improving service delivery and quality.

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Based on the provided information, here are some potential innovations that could be recommended to improve access to maternal health:

1. Community Engagement Programs: Develop community-based initiatives to engage with local communities and address concerns related to contraceptive implant discontinuation. This could involve conducting awareness campaigns, organizing community dialogues, and involving community leaders to promote understanding and acceptance of family planning methods.

2. Counseling and Education: Strengthen counseling and education services for contraceptive implant clients and their partners. This could include providing comprehensive information about the benefits, side effects, and alternatives to contraceptive implants, as well as addressing misconceptions and concerns.

3. Quality of Care Improvement: Focus on improving the quality of care provided by family planning nurses and clinics. This could involve training healthcare providers on client-centered counseling, ensuring respectful and non-judgmental care, and addressing any issues related to the provision of contraceptive implants.

4. Side Effect Management: Develop strategies to effectively manage and address the adverse side effects associated with contraceptive implants. This could involve providing additional support, counseling, and medical interventions to minimize side effects and improve client satisfaction.

5. Partner Involvement: Encourage the involvement of partners in family planning decision-making and counseling sessions. This could help address partner dissatisfaction as a motive for contraceptive implant discontinuation and promote shared responsibility for family planning.

6. Collaboration with Religious Leaders: Engage with religious leaders and organizations to promote understanding and acceptance of family planning methods, including contraceptive implants. This could involve conducting sensitization programs, addressing religious concerns, and highlighting the compatibility of family planning with religious values.

It is important to note that these recommendations are based on the specific context of Angola and the findings of the study mentioned. Further research and assessment of the local context would be necessary to determine the most appropriate and effective innovations for improving access to maternal health in other settings.
AI Innovations Description
Based on the provided description, the recommendation to develop into an innovation to improve access to maternal health is to engage in community dialogue to address the concerns related to contraceptive implant discontinuation. This approach suggests moving beyond solely focusing on improving service delivery and quality and instead involves actively involving the community in the conversation. By understanding the motives for discontinuation, such as adverse side effects, desire for pregnancy, partner dissatisfaction, quality of care, alternative or lack of information, and religion, programs can tailor their efforts to address these specific concerns. This community dialogue can help to dispel misconceptions, provide accurate information, and address cultural norms and beliefs surrounding ideal family size and the role of women in regards to fertility and child-bearing. By actively engaging with the community, programs can work towards improving access to contraceptives, increasing contraceptive prevalence, and ultimately improving maternal and child health in Angola.
AI Innovations Methodology
Based on the provided description, here are some potential recommendations to improve access to maternal health in Angola:

1. Addressing Adverse Side Effects: Develop strategies to minimize and manage the adverse side effects associated with contraceptive implants. This could include training healthcare providers to provide comprehensive counseling on potential side effects and offering support services to address any concerns or complications.

2. Increasing Awareness and Information: Implement community-based education programs to increase awareness about contraceptive implants and their benefits. This could involve conducting workshops, distributing informational materials, and utilizing local media channels to disseminate accurate and culturally sensitive information.

3. Engaging Partners and Families: Involve partners and family members in discussions about contraceptive use and family planning. This could be done through couple counseling sessions or family planning education programs that emphasize the importance of shared decision-making and support.

4. Strengthening Quality of Care: Enhance the quality of maternal health services by improving the training and skills of healthcare providers. This could involve regular refresher courses, mentoring programs, and ensuring the availability of necessary equipment and supplies.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could be developed as follows:

1. Baseline Data Collection: Gather data on the current state of access to maternal health services, including contraceptive implant usage, discontinuation rates, and reasons for discontinuation. This could involve surveys, interviews, and analysis of existing health records.

2. Intervention Implementation: Implement the recommended interventions in selected clinics or communities. This could be done through a phased approach, allowing for monitoring and evaluation at each stage.

3. Monitoring and Evaluation: Collect data on the implementation of the interventions, including the number of individuals reached, changes in knowledge and attitudes, and any challenges encountered. This could involve regular monitoring visits, interviews with healthcare providers and community members, and analysis of program data.

4. Impact Assessment: Analyze the collected data to assess the impact of the interventions on improving access to maternal health. This could involve comparing pre- and post-intervention data, conducting statistical analysis, and identifying trends or patterns.

5. Recommendations and Scaling Up: Based on the findings, make recommendations for further improvements and scaling up of successful interventions. This could involve sharing best practices, advocating for policy changes, and securing additional resources for expansion.

By following this methodology, it would be possible to simulate the impact of the recommendations on improving access to maternal health in Angola and inform future interventions and policies.

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