NORPLANT Implants and the TCu 200 IUD: A Comparative Study in Ecuador

Abstract

A comparative study of Norplant implants and Copper T 200 IUDs was carried out from May 1981-January 1982 among 283 acceptors of each in Guayaquil and Cuenca Ecuador to determine the acceptability of Norplant to Ecuadorean women. Initially only 4.5% of all acceptors chose Norplant but the proportion later increased to 16.1%. The pairing of implant and IUD acceptors was reasonably good for parity but implant acceptors were younger. After 1 year the termination rate was 7.3/100 implant acceptors and 2.3/100 IUD acceptors for menstrual problems 1.3 Norplant users and 1.1 IUD users for infection 1.1 Norplant users and no IUD users for steroidal effects 1.4 Norplant users and .5 IUD users for other medical effects and 1.0 Norplant users and .5 IUD users for other method related effects. There were no pregnancies among implant acceptors and 4 among IUD acceptors. The expulsion rate for IUD was 3.8/100. Total termination rates were 12.6/100 for implant acceptors and 12.1/100 for IUD acceptors. Norplant was virtually free of complications other than menstrual disturbances and local infections at the insertion site. Primary acceptance of Norplant increased when women were properly informed about the method and its side effects particularly pronounced bleeding disturbances. The rate of removal of Norplant might have been much higher if it had been easier to remove. Efforts to develop treatment for excessive bleeding caused by Norplant and to develop an implant system without the excessive bleeding should continue while women who are not able to accept the bleeding changes should be excluded. Great care is also needed in training and supervision of insertions.