IMPLANTS

IMPLANT FAMILY PLANNING AND CONTRACEPTIVE IN KENYA

Contraceptive implants are small rods that are inserted under the skin of a woman’s upper arm to release the hormone progestin slowly and prevent pregnancy.

Types of Implants as a way of family planning and contraceptives

The following table provides information about the implants that are in common use in Kenya.

Device	Design	Hormones	Duration of effectiveness
Jadelle	2 rods	Levonorgestrel 75mg/rod	5 years
Implanon	1 rod	Etonogestrel 68mg/rod	3 years
Sino-implant (ZARINI) 75?mg rod	2 rods	Levonorgestrel	4  years (possibly 5)

Advantages and Benefits of Implants Family Planning and Contraceptives Methods In Kenya

•  As a method of contraception, contraceptive implants are highly effective and safe, and with significant benefits:
• Contraception is immediate if inserted within the first seven days of menstrual cycle or within the first five days for Implanon.
• There is no delay in return to fertility.
•  hey offer continuous, long-term protection

Non-contraceptive Health Benefits of implant family planning and contraceptive

•  Implants do not affect breastfeeding.
• They reduce menstrual flow.
• They help prevent ectopic pregnancy (but do not eliminate the risk altogether)
• They protect against iron-deficiency anaemia.
•  They help protect from symptomatic  peptic inflammatory disease (PID)

Limitations and Side Effects Implants Family Planning and Contraceptive Methods In Kenya

• Contraceptive implants must be inserted and removed by trained providers
• Requires a minor surgical procedure with appropriate infection prevention practices.
• Common side effects of using implants include menstrual changes, such as irregular light spotting or bleeding, prolonged bleeding, infrequent bleeding, and amenorrhea.
• Non-menstrual side effects include headache, dizziness, nausea, breast tenderness, mood changes, weight change, and mild abdominal pain.
• Contraceptive implants do not protect against STIs, including hepatitis B and HIV. Individuals at risk should use condoms in addition to the implants.

Women Who Can Use Implant Family Planning and Contraceptive Implants Without Restrictions In Kenya 

 

This method is acceptable with no restrictions for women of reproductive age, from menarche to menopause, with or without children, including the following:

•   Breastfeeding mothers after four weeks postpartum, or immediate postpartum if not breastfeeding
• Women who prefer not to use or have contraindications to contraceptives that contain oestrogen or have developed oestrogen-related complications while taking COCs
• Women with STIs and pelvic inflammatory disease( PID)
• Women with HIV and AIDS, unless they are on ARV therapy
• Women with adequately controlled or moderate hypertension (BP is less than 160/100) and those with history of hypertension during pregnancy
• Women who have had major and minor surgery without prolonged immobilisation, or varicose veins
• Women who take broad-spectrum antibiotics, antifungal or antiparasitics
• Women with any of the following conditions:

– Valvular heart disease

– Sickle cell disease

– Non-migrainous headache or depressive disorders

– Endometriosis, severe dysmenorrhoea, benign ovarian

Tumours, fibroids

– Benign breast tumours, endometrial and ovarian cancer

– Goiter

– Viral hepatitis (acute/fl are, carrier, or chronic) or mild

(Compensated) cirrhosis

Women Who Can Implants Family Planning And Contraceptives In Kenya with Extra Precautions Upon Consultation With  a  Doctor

•  Irregular, prolonged or heavy bleeding patterns
• Diabetes without or with vascular complications
• Woman with multiple risk factors for cardiovascular disease (e.g., more than 35 years of age, cigarette smoking, diabetes, and hypertension)
• Women with ischemic heart disease or stroke (can initiate implants, but will have to discontinue if they develop these conditions while using the method)
• History of hypertension where BP cannot be measured
• Severe hypertension (BP of 160/100 or higher); or with vasculopathy
• Migraine with or without aura
• History of Deep Venous  Thrombosis ( DVT) or DVT and established on anticoagulant therapy; major surgery with prolonged immobilisation; known thrombogenic mutations
• Gall bladder disease, symptomatic or asymptomatic
• Diagnosed  cervical cancer (risk of sterility)
• Undiagnosed breast mass (prompt evaluation needed—breast cancer  )
• Receiving treatment with certain ARVs, anticonvulsants, and anti-TB drugs that may reduce blood concentration of contraceptive hormones to some degree

Women Who Should Not Use Implant Family Planning And Contraceptive Method In Kenya

• Breastfeeding women less than four weeks postpartum 3
• Women who have severe cirrhosis or liver tumours (hepatocellular adenoma or hepatoma)
• Women who have unexplained vaginal bleeding suspicious for serious underlying condition
• Women who have breast cancer or
• Women with a history of breast cancer
• Women who currently have Deep Venous Thrombosis or who developed ischaemic heart initiation and continuation; disease or stroke while using
• Women whose migraine with aura became worse while using implants

Timing for implant insertion

Situation		Action
The woman is having her menstrual cycles	Implant inserted within 7 days after the start of woman’s menstrual bleeding (within the first 5 days for Implanon). No additional contraceptive protection is needed. Implant  insertion any other time can be done  if woman is reasonably certain that she is not pregnant If a woman has been more than 7 days since menstrual bleeding started (within the first 5 days for Implanon); you will need additional contraceptive protection for the next 7 days (e.g., condoms, FAM or Coitus Interruptus.
The woman is amenorrhoeic.	implant insertion any time if woman is reasonably certain that she is not pregnant. She will need additional contraceptive protection for the next 7 days.
The woman is breastfeeding.	Between 4 weeks and 6 months postpartum and she is amenorrhoeic, insert implant any time. If she is fully or nearly fully breastfeeding, no additional contraceptive protection is needed If  more than 4 weeks postpartum and her menstrual cycles have returned, implant insertion  as advised for other women having menstrual cycles.
The woman is switching from another hormonal method.	The implant can be inserted immediately if she has been using her hormonal method consistently and correctly, or if it is reasonably certain she is not pregnant. There is no need to wait for her next menstrual period. If her previous method was an injectable, she should have the implant inserted when the repeat injection would have been given. There is no need for additional contraceptive protection.
The woman is switching from a non-hormonal method (not IUCD).	The implant can be inserted immediately if it reasonably certain that she is not pregnant. There is no need to wait for her menstrual period If she is within 7 days of the start of her menstrual bleeding (within 5 days for Implanon), no additional contraception is needed. If it has been more than 7 days since menstrual bleeding started (5 days for Implanon), she will need to abstain from sex or use additional contraceptive protection for the next 7 days.
The woman is switching from an IUCD (including hormonal).

Instructions to Women After Implant Family Planning and Contraceptive Method Insertion In Kenya

• Expect some soreness or bruising (or both), after anesthetic wears off. This is common and does not require treatment.
• Keep insertion area dry for four to five days.
• Remove the gauze bandage after one or two days, but leave the adhesive plaster in place for an additional five days.
• Return to the clinic if the rods come out or if soreness develops after the removal of the adhesive plaster.
• Return to the clinic if she experiences pain, heat, pus, or redness at the insertion site, or if she sees a rod come out. 
•  Implants must be removed by the due date
• Woman knows where to go in case of problems with the implants.

Instructions for Clients Following Removal of Contraceptive Implants in Kenya

•  Keep removal area dry for four to five days.
• Remove the gauze bandage after one or two days, but leave the adhesive plaster in place for an additional five days.
•  Return to the clinic if swelling and pain develops after the removal of the adhesive plaster

END IMPLANTS