Problems and prospects of implants as a contraceptive method in Bangladesh

To assess the quality of Norplant service provision in Bangladesh 1327 acceptors (half the countrys total number of acceptors) from seven centers were selected for interviews in late 1991; a total of 1151 were successfully interviewed. The mean age of acceptors was 28.6 years and the mean number of living children was 3.1. Two-thirds did not desire any additional children. Past Norplant users were the most frequently cited (61%) source of information about the method; 86% selected the implants because of their long duration of action. Acceptors received thorough pre-insertion counseling about side effects and two-thirds adhered to the recommended follow-up appointment schedule. The method continuation rate was 99% at one month 97% at six months 92% at one year 75% at two years and 61% at three years. There was a significant positive correlation between method retention and user satisfaction. A third of acceptors had requested Norplant removal by the time of interview primarily due to menstrual disorders and 90% of these women were able to have the implants removed--with no provider opposition--at the center where they were inserted. 88% of acceptors were highly satisfied or satisfied with the services received; 10% were somewhat satisfied and 2% were dissatisfied. Clients who were visited in the home in addition to attending the clinic expressed higher rates of satisfaction. Although these results indicate that Norplant acceptors in Bangladesh are generally receiving good quality care the findings that some women faced obstacles in accessing method removal and many of those who had the implants removed were not provided with an alternate contraceptive method merit consideration.