Number of implant removals

Definition:

The number of contraceptive implants successfully removed; to be reported for a defined reference period (e.g., one year).

“Successful” removals are complete removals. It does not include attempted removals where the implant is not able to be fully removed.

Data Requirements:

Counts of contraceptive implant removed. Data may be disaggregated by age of client (e.g., 15-19, 20-24, 25-29, etc.), facility, or geographic or administrative area.

Data Source(s):

Service statistics, Family Planning Health Management Information Systems (HMIS)

Evaluators can also obtain implant removal data from surveys (e.g., from the “calendar” used in the Demographic and Health Surveys (DHS) or the Performance Monitoring for Action (PMA) surveys to obtain contraceptive histories retrospectively). Cross-sectional surveys capture removals for all reported episodes of implant use for a defined period before the survey (DHS uses a 5-year history, PMA uses a 2-year history) so evaluators can calculate a discontinuation rate. The PMA survey also captures failed attempts for implant removal and (starting in 2019) includes a longitudinal design so implant removals can be measured prospectively (PMA, n.d.).

Purpose:

All women who receive a contraceptive implant eventually require removal by a trained health care provider. The rapid rise in use of contraceptive implants requires expansion of removal services, yet availability of removals may be lagging (Christofield, 2016). This indicator measures the number of contraceptive implants successfully removed. This indicator can give information on where removal services are conducted (when data are disaggregated by facility or administrative area, such as district) and the volume of removals performed.

This indicator can be compared to the availability and volume of implant insertions. However, implants can be used for multiple years, so it may not be instructive to compare the volume of insertions to removals during periods of expanding implant use or when removals are not routinely captured by all facilities providing removal services. Track20 has developed a methodology for calculating the expected number of removals (Track20, 2021). In this way, programs can compare the number of reported removals to the expected number of removals for the same time period. When the reported number of removals is noticeably lower than the expected number, there may be barriers to removal services that require attention and/or underreporting of removals. When the reported number of removals is noticeably higher than the expected number, there may be high discontinuation or more implant users than expected. There may be more implant users than expected from historical data if there was a period when a substantial number of implant insertions were performed before insertions were recorded in routine FP service statistics data. Poor data quality can also result in a mismatch between expected and reported numbers of removals. For example, there may be sizable underreporting if facilities utilized for removal services do not report data into the data system, as may be the case for private facilities.

Issues:

This indicator only captures a count of the number of removals. Additional indicators for routine monitoring have been proposed and tested by the Implants Removals Task Force. These include (1) reason for client visit, (2) reason for seeking removal, (3) duration of use, (4) removal outcome, (5) reason for referral (if implant was not removed), and (6) family planning outcome (Jacinto, 2022). These additional indicators may be useful for tracking the quality of implant services.

Keywords:

long-acting/permanent methods (LAPM), family planning