When good contraception goes bad

Why the rumour mill may have killed demand for SA’s latest scientifically proven birth-control implant

Inserted in about the time it takes to make two-minute noodles, South Africa’s latest contraceptive implant promised to help women to avoid unwanted pregnancies for up to three years. Now, research may finally reveal why, three years after Implanon NXT was introduced in the country, women still aren’t lining up for the scientifically proven and seemingly easy to use birth control.

Inserted under the skin of the upper arm, Implanon NXT was launched in 2014 in South Africa’s public sector as part of the health department’s continuing quest to broaden the number of birth control methods women can choose from in the country in line with the latest national guidelines.

The contraception uses progestin, a type of synthetic hormone, to prevent pregnancy and can be inserted by trained nurses.

The device initially proved popular, a recent study published in the South African Medical Journal says. But soon after Implanon NXT reached clinics, widespread reports made headlines about women who opted to have the birth control device removed not long after insertion.

In fact, 60% of women asked for the implant to be removed after less than a year, according to a small study among 156 women, also published in the October edition of South African Medical Journal. Although about three out of four women reported having had good experiences with the implant, most of those who discontinued it early cited side effects, predominantly longer and heavier periods.

Irregular bleeding is the most common side effect associated with Implanon NXT and about 11% of users experienced this in clinical trials conducted by drug-maker Merck, according to prescribing information published by the pharmaceutical company.

But rumours also appeared to exaggerate the frequency and severity of side effects and falsehoods may have spread quickly among users, the small study found.

At Zithulele Hospital outside Mthatha in the Eastern Cape, clinical manager Ben Gaunt estimates that about 80% of Implanon NXT patients asked to have their devices removed early.

Gaunt believes false rumours, including that the implant would lead to infertility, played a major role in driving women to ditch the contraceptive method.

Implanon NXT does not cause infertility and people have fallen pregnant within as little as a week after discontinuing use, prescribing information for the drug says.

“We found a widespread fear developing and a very poor understanding of exactly what [the implant] was,” Gaunt explains.

Nationally, there may have been little standardisation about how women were educated about Implanon NXT. In Gauteng and the North West, what women report being told about the birth control method before use varied widely and may have included more information on the implant’s effectiveness than on its potential side effects, the South African Medical Journal research reveals.

Because of concerns like this, Gaunt says South Africa may not have been ready for the new contraceptive method.

“If we look back at what happened, I think that we ran ahead of ourselves. We got so excited about a product that we, as healthcare workers, know is excellent … and I think we left our patients behind,” he says.

“We should have done more education. It’s not that no education happened, but we just ... weren’t expecting the kind of rumours and things that came up.”

These lessons haven’t been lost on the national health department. In 2016, the department revised its training package for nurses and developed similar materials for doctors and community healthcare workers.

But it may take more than that — and even a little help from the Twittersphere — to get people to believe in Implanon NXT again.

Saiqa Mullick is director of implementation science at the research organisation Wits Reproductive Health and HIV Institute.

She says there should be a national relaunch of the implant and a concerted social media campaign to create demand for it and to combat misinformation.

Gaunt agrees it is time to move beyond pamphlets to get the word out about the country’s latest contraception method.

“We are now on the back foot. We lost ground, and there’s widespread suspicion of Implanon where there needn’t be. We should address the rumours: Get the message out that there is this exciting new contraceptive and yes, it’s got side effects, but this is how it works.

“We should do a lot of talking before we do any doing.”

60% of women asked for the implant to be removed after less than a year