Abstract

The recent increase in the use of long-acting reversible contraceptives (LARCs) will result in an equal increase in the need for removals. Few countries monitor the number of LARC removals and even fewer track reasons for removal, discontinuation, and method switching. We conducted a mixed-method study to pilot the introduction of 5 LARC removal indicators in Mozambique: (1) reason for seeking removal, (2) duration of use, (3) removal outcome, (4) reason for referral, and (5) family planning (FP) outcome. We assessed providers' perceptions about the feasibility and utility of tracking these indicators and reviewed the findings to ascertain the quality-of-care concerns. We used a purposive, multistage sampling technique to select 19 intervention facilities in Nampula and Sofala provinces. Over 6 months, we abstracted data on the 5 indicators from an FP register addendum to determine when and why clients seek LARC removals and identify service quality issues that need to be addressed in the FP program. We used a supportive supervision checklist to assess the time taken to record data on the indicators and perceived benefits and challenges encountered by providers during record keeping. Of the 795 clients who sought a LARC removal, 112 women (14.1%) opted not to have the removal after counseling. The most frequently reported reasons for seeking a removal were: the method was on-schedule for removal or past its expiration date (29.5%), complaints of side effects (25.8%), and desire to be pregnant (22.9%). Health care providers reported no major challenges in recording information in the addendum. Reasons for and timing of removal pointed to the need for strengthening FP counseling. Collecting, synthesizing, and interpreting data from the LARC removal indicators was feasible and provided valuable insights to improve the quality of care to enhance clients' reproductive health care and contraceptive choices.

Highlights

  • The recent increase in the use of long-acting reversible contraceptives (LARCs) will result in an equal increase in the need for removals

  • Conducted from December 2018 to May 2019, this mixed-methods study used quantitative data extracted from the family planning (FP) register addendum for 6 months as well as qualitative data collected from health care provider interviews during monthly supportive supervision visits regarding their perspectives on the feasibility and utility of the removal indicator suite

  • We reviewed and thematically analyzed information from the supportive supervision checklist to assess providers’ perspectives on the benefits of collecting LARC removal data, including their usefulness to improve quality of care, as well as feasibility, including ease of recording the removal indicator suite, time taken to record, perceived burden, and challenges encountered during record keeping

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Summary

Introduction

The recent increase in the use of long-acting reversible contraceptives (LARCs) will result in an equal increase in the need for removals. We conducted a mixed-method study to pilot the introduction of 5 LARC removal indicators in Mozambique: (1) reason for seeking removal, (2) duration of use, (3) removal outcome, (4) reason for referral, and (5) family planning (FP) outcome. Over 6 months, we abstracted data on the 5 indicators from an FP register addendum to determine when and why clients seek LARC removals and identify service quality issues that need to be addressed in the FP program. Conclusion: Collecting, synthesizing, and interpreting data from the LARC removal indicators was feasible and provided valuable insights to improve the quality of care to enhance clients’ reproductive health care and contraceptive choices. Christofield and Lacoste[3] noted that the rapid increase in client uptake of implants in recent years has not been matched with commensurate attention to implant removals

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