20 Essential Resources: Quality Contraceptive Implant Removal

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Implant Removal Task Force (2017)

QUALITY CONTRACEPTIVE IMPLANT REMOVAL

20 Essential Resources

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Implant Removal Messaging Briefer

Contraceptive implants are a long-acting, reversible method of family planning used by millions around the world to space, time, and limit their pregnancies. Uptake of contraceptive implants has grown globally in recent years, playing a key role in expanding access to, and choice of, family planning. The method requires a health care provider’s support for initiation and removal. Thus, as more users adopt this method, the demand for implant removal services is also rising. To facilitate access to quality implant removals, programs can deliberately deploy certain tactics and tools to expand coverage of this critical service. Doing so ensures reproductive choice and autonomy for FP users, recognizing that their choice to use contraceptives—or not—can change throughout their reproductive years. This collection of essential resources supports program managers, technical advisors, and other FP program stakeholders in designing, implementing, and measuring FP programs with an implant removal-inclusive lens.

Publication

Webpage

Map

Client-Centered Conditions for Quality Implant Removal

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Program Guidance for Program Managers

Implant Removal Task Force (2022)

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Accessible Contraceptive Implant Removal Services

Megan Christofield and Maryjane Lacoste (2016)

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The Implant Removal Task Force & Knowledge SUCCESS

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Background & Advocacy Measurement & Data Service Delivery Country & Programmatic Experience

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Contributors Design: Emily Haynes Writers: Sarah Webb (Jhpiego), Megan Christofield (Jhpiego) Technical input and review: Mark Hathaway (Jhpiego), Alison Bodenheimer (FHI 360), Natalie Apcar (CCP) About Knowledge SUCCESS Knowledge SUCCESS (Strengthening Use, Capacity, Collaboration, Exchange, Synthesis, and Sharing) is a five-year (2019-2024) global project led by a consortium of partners and funded by USAID’s Office of Population and Reproductive Health to support learning, and create opportunities for collaboration and knowledge exchange, within the family planning and reproductive health community. We use an intentional and systematic approach, called knowledge management, to help programs and organizations working in family planning and reproductive health collect knowledge and information, organize it, connect others to it, and make it easier for people to use. About the Implant Removal Task Force Initiated in 2015, the Implant Removal Task Force brings together implementing partners, implant manufacturers, researchers, and donors on issues related to quality implant removal.

This collection was curated and published in March 2022. Resource links were active at the date of publication. Images courtesy of DFID Flickr, Images of Empowerment, USAID Flickr, and World Bank Photo Collection Flickr.

Acknowledgements

This collection is made possible is made possible by the support of the American People through the United States Agency for International Development (USAID) under the Knowledge SUCCESS (Strengthening Use, Capacity, Collaboration, Exchange, Synthesis, and Sharing) Project. Knowledge SUCCESS is supported by USAID’s Bureau for Global Health, Office of Population and Reproductive Health and led by the Johns Hopkins Center for Communication Programs (CCP) in partnership with Amref Health Africa, The Busara Center for Behavioral Economics (Busara), and FHI 360. The contents of this webpage are the sole responsibility of CCP. The information provided on this webpage does not necessarily reflect the views of USAID, the United States Government, or the Johns Hopkins University.

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Jhpiego (2022)

Implant Removal: Rapid Service Readiness Assessment Tool

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Implant Removal Indicator Reference Sheet

Implant Removal Task Force (2022)

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EngenderHealth (2017)

Equipment and Supplies Needed to Provide LARCs

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Contraceptive Implant Removal Bibliography

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Research Priorities for Improving Access to Implant Removal Services

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Liftoff: The Blossoming of Contraceptive Implant Use in Africa

Roy Jacobstein, IntraHealth (2018)

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Performance Monitoring for Action (2019-2020)

Implant Use and Removal Briefs: Kenya, Ethiopia, and Burkina Faso

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Factors Associated with Implanon Removal in Ethiopia

FHI 360 (2017)

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Contraceptive Hormonal Implant Removal Services

EngenderHealth (2016)

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Jacinto, Ronda, Lee, Fikree, Ramirez-Ferrero (2022)

Introducing LARC Removal Indicators in a Pilot Study in Mozambique

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Demonstration Video of Removal of Deeply Placed Contraceptive Implants

Implant Removal Task Force (2017)

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Video

This framework outlines the set of conditions needed for meeting the needs of FP users seeking implant removal services. Centered on the implant user, these eight conditions serve as standards that need to be upheld to satisfy the needs of clients to access implant removal services. The framework is intended to provide a comprehensive snapshot of the various elements considered critical to quality implant removal, ranging from provider competence to having the necessary equipment and supplies in place to support implant removal. The standards also take into consideration accessibility needs, such as the affordability and location of removal services. About the Implant Removal Task Force Initiated in 2015, the Implant Removal Task Force brings together implementing partners, implant manufacturers, researchers, and donors on issues related to quality implant removal.

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The eight conditions detailed in the framework serve as a set of standards for program planners to guide FP programming in a way that ensures that clients have access to quality implant removal services when desired.

Implant Removal Task Force (2017)

Client-Centered Conditions for Ensuring Access to Quality Implant Removal

Why is it essential?

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Why is it essential?

Clear messaging for access to quality implant removals is a vital component of comprehensive family planning services. These talking points can support FP managers/planners in advocating for the inclusion of implant removal in FP programs.

The Implant Removal Task Force developed this brief to clearly articulate the importance of implant removal as a critical component of FP programs that include contraceptive implants. As implant usage continues to increase, current and future users will require removal services, for which programs must actively plan. Approaching implant removal from a rights-based perspective, this brief provides advocacy messaging and talking points for why FP programs must proactively plan for implant removal services. About the Implant Removal Task Force Initiated in 2015, the Implant Removal Task Force brings together implementing partners, implant manufacturers, researchers, and donors on issues related to quality implant removal.

Implant Removal Task Force (2018, updated in 2022)

Implant Removal Messaging Brief

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Why is it essential?

This guide serves as a checklist for FP program managers to consider the various inputs needed to prepare health systems to offer quality implant removal services. It encourages managers to proactively consider the implant removal needs of newly developed or expanding FP programs that include contraceptive implants.

The Implant Removal Task Force conducted a series of member surveys with the goal of developing implant removal implementation considerations. While the formal guidance from this activity is still under review, it produced a series of considerations for program managers planning a contraceptive implant program. Using the eight client-centered conditions for quality implant removals as a framework, this guide presents a series of programmatic questions as FP managers implement or scale implant programs. These questions are intended to serve as a checklist of planning considerations, anticipating the need for implant removal services within new (or growing) FP programs. About The Implant Removal Task Force Initiated in 2015, the Implant Removal Task Force brings together implementing partners, implant manufacturers, researchers, and donors on issues related to quality implant removal.

Implant Removal Task Force (2022)

Program Guidance for Program Managers

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Why is it essential?

This article makes tangible recommendations for how program planners or managers can proactively support or advocate for the collection data associated with implant removals and design programs with removal needs in mind.

This article explores the challenges associated with the rapid expansion of implant services and the difficulty that removals have had in keeping pace with insertions. The article presents existing data on access to implant removals. It makes the case that increased attention is necessary to ensure that FP users have access to quality and accessible implant removal services. The authors present a series of recommendations for action that can be taken to advocate for the inclusion of implant removals within FP programs. About the Implant Access Operations Group The Implants Access Program (IAP) was launched in 2013 with the goal of making contraceptive implants more accessible to women living in low- and middle-income countries. The IAP is a collaborative partnership of NGOs, donors, and manufacturers.

Megan Christofield, Maryjane Lacoste, on behalf of the Implants Access Program Operations Group (2016)

Accessible Contraceptive Implant Removal Services: An Essential Element of Quality Service Delivery and Scale-Up

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Why is it essential?

The list will help guide program planners or facilities in procuring the necessary materials for implant removals and thinking through supply chain and procurement processes as implant programs are scaled.

This resource provides a comprehensive list of all basic furniture, equipment, instruments, and expendable supplies needed to insert and remove long-acting reversible and permanent methods of contraception, including contraceptive implants. Broken down by type of contraceptive (e.g., implant or IUD) and by service (including both insertion and removal), the document lists all materials needed for quality insertion and removal services. Finally, the list provides guidance for additional materials needed for difficult removals. About EngenderHealth EngenderHealth is a global health organization focused on advancing sexual and reproductive health and rights and gender equality.

EngenderHealth (2017)

Basic Furniture, Equipment, Instruments, and Expendable Supplies Needed to Provide Long-Acting Reversible and Permanent Methods of Contraception

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Why is it essential?

This resource can serve as a guide in identifying existing perspectives on implant removal issues, including access and programming considerations as well as clinical management.

This bibliography, compiled by the Implant Removal Task Force, captures both peer-reviewed and gray literature on contraceptive implant removal. The bibliography includes content on access and programming as well as clinical management. The literature is organized by setting/location as well as the type of removal issue (e.g., migration, difficult removal, removal techniques, etc.). To supplement this resource, the Implant Removal Task Force also developed a research agenda to further the understanding of challenges and barriers to delivering quality implant removal services. About the Implant Removal Task Force Initiated in 2015, the Implant Removal Task Force brings together implementing partners, implant manufacturers, researchers, and donors on issues related to quality implant removal.

Implant Removal Task Force (2018)

Contraceptive Implant Removal Bibliography

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Why is it essential?

This article provides important context in framing the importance of implant removals through the lens of rapid scale-up of access to contraceptive implants across sub-Saharan Africa. It is against this backdrop of rapid growth of contraceptive implants as a method of choice that implant removal services and system readiness become even more critical.

This article explores the rapid growth in contraceptive implant usage across sub-Saharan Africa. It highlights the need for further investment in quality services for both insertion and removal as well as addresses issues of financing and sustainability. The article indicates that the growth in contraceptive implant usage can, at least in part, be attributed to:

Liftoff: The Blossoming of Contraceptive Implant Use in Africa

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Why is it essential?

This learning agenda outlines several questions that, if answered through research or programming, could contribute to a better understanding of implant removal needs, and thus, better implant services overall.

A better understanding of the challenges and gaps in scaling access to quality implant removal services is needed to improve contraceptive implant programs. This research agenda, developed by the Implant Removal Task Force, consolidates research priorities and learning gaps that, if filled, would contribute to a better understanding of implant removal needs and improved programming of contraceptive implant services. The publication outlines research questions that could either stand alone as research studies or be incorporated into broader learning agendas or programs. The research priorities are organized along the client-centered conditions for quality implant removal, with recommendations for which standards should be a priority for research. About the Implant Removal Task Force Initiated in 2015, the Implant Removal Task Force brings together implementing partners, implant manufacturers, researchers, and donors on issues related to quality implant removal.

Implant Removal Task Force (2017)

Research Priorities for Improving Access to Quality Contraceptive Implant Removal Services

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Why is it essential?

This guidance provides an important reference in considering the collection of a key indicator for implant programs: number of implant removals.

This guidance provides clarity to a standard measurement framework for implant removals. The framework presents the sources, purpose, and possible applications of this indicator for implant removal. The reference sheet includes a definition and description of the indicator as well as ways in which it could be used to inform program planning. Insofar as FP programs seek to meet the needs of all clients, this indicator could be the most relevant and applicable to understanding the needs of FP clients seeking removals. About the Implant Removal Task Force Initiated in 2015, the Implant Removal Task Force brings together implementing partners, implant manufacturers, researchers, and donors on issues related to quality implant removal.

Implant Removal Task Force (2022)

Implant Removal Indicator Reference Sheet

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Why is it essential?

This assessment tool helps program managers gather key information about the status of implant removal services in facilities they support, so that attention and effort can be directed towards the most impactful opportunities to improve services.

This assessment tool walks family planning program managers through key elements to explore whether a facility is prepared to offer quality implant removal services. It can be used by program managers to gain a deeper understanding of a service delivery site’s readiness to provide quality implant removal services. Facility managers may also use this tool for self-assessment. The tool can be customized for one’s context as needed. It is not meant to disqualify sites from service provision, but rather prioritize actions to optimize services. About Jhpiego Jhpiego, an affiliate of Johns Hopkins University, is a nonprofit organization that creates and delivers transformative health care solutions that save lives. Jhpiego partners with national governments, health experts, and local communities to build health providers’ skills and develop systems that save lives now and guarantee healthier futures for women and their families.

Jhpiego (2022)

Contraceptive Implant Removal: Rapid Service Readiness Assessment Tool

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Why is it essential?

Working with an expected number of implant removals for a given country (or region) gives program managers and other stakeholders context for their FP program monitoring efforts. Better understanding the expected number of removals will allow programs to assess the overall quality of removal services and make data-informed decisions about programming.

This memo, developed by Track20, offers and explains methods to calculate anticipated numbers of “expected removals,’ by combining HMIS data on insertions with survey data on discontinuation of implant use. Monitoring removal data has been difficult, and the number of removals recorded often falls short of what would be expected from insertion data. The memo explains an approach to calculating anticipated implant removal numbers and provides guidance to programs for using this data to assess the quality of removal services. About Track20 The Track20 Project, implemented by Avenir Health, monitors progress towards achieving the goals of the global FP2020 Initiative. Track20 works directly with governments in participating FP2020 countries to collect, analyze, and use data to monitor annual progress in family planning and to actively use data to improve family planning strategies and plans. About Avenir Health Avenir Health is a global health organization that works to enhance social and economic development by providing tools and technical assistance in policy, planning, resource allocation, and evaluation.

Kristin Bietsch, Emily Sonneveldt, Track20/Avenir Health (2021)

Memo: Expected Removals of Long-Term Reversible Methods of Contraception in Routine Service Statistics

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Why is it essential?

This article offers several important insights on the usefulness of implant removal indicators and the ease of use in collecting these indicators. Those interested in expanding their HMIS to include indicators for implant removal would benefit from learning from this experience in Mozambique.

The Implant Removal Task Force developed indicators to support the collection and monitoring of implant removal data, one of the client-centered conditions for quality implant removal. These indicators include: reason for the client visit, reason for seeking removal, duration of use, removal outcome, reason for referral, and family planning outcome. This journal article describes the implementation experience of adding five of the indicators as an addendum to Mozambique’s existing national FP register. The article shares insights from providers in the pilot study and focuses on the ease of collection of these indicators as well as their overall usefulness for FP programs. The experience indicates that the implant removal indicators overall were easy to use and productive in understanding issues related to quality of care. About Evidence to Action (E2A) The Evidence to Action (E2A) Project was USAID’s global flagship for strengthening family planning and reproductive health service delivery. E2A was implemented by Pathfinder International and a consortium of partners.

Ana Jacinto, Adalgisa Viola Ronda, Connie Lee, Fariyal F. Fikree, and Eric Ramirez-Ferrero (2022)

Introducing Long-Acting Contraceptive Removal Indicators in a Pilot Study in Mozambique: Dynamics of Discontinuation and Implications for Quality of Care

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Why is it essential?

This course provides critical updates and skills training for FP trainers and service providers (including a comprehensive set of training materials and proposed agendas/programming) in offering quality implant removals and counseling on implant-related side effects.

This course was developed to serve as an update for family planning trainers and service providers to manage implant-related side effects and conduct implant removals. The course includes three different programs: an implementation guide, a facilitator guide, and a learner workbook. The theoretical content of the course is intended to be delivered as a 1-day session (on- or offsite), with a second part intended to include client practice at the service delivery site. The course includes an optional third module on difficult removals, which is considered more advanced and should only be completed after modules one and two, and a pre-test. Finally, this course includes relevant content for all three types of contraceptive implants. About Jhpiego Jhpiego, an affiliate of Johns Hopkins University, is a nonprofit organization that creates and delivers transformative health care solutions that save lives. Jhpiego partners with national governments, health experts, and local communities to build health providers’ skills and develop systems that save lives now and guarantee healthier futures for women and their families.

Jhpiego (2018)

Learning Resource Package: Skills Update for Contraceptive Implant Side Effect Management and Removal

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Why is it essential?

These study findings provide a greater understanding of client experiences with contraceptive implants, and in particular, their experience in seeking removal services. The findings provide additional insights into some of the gaps in providing quality implant removal services and also put forward a series of recommendations that could be applied to contexts beyond Ghana.

This final report explores a study done by the Ghana Health Service, FHI360, Population Council, and Marie Stopes Ghana. Together, these partners aimed to collect evidence on implant removal service accessibility in Ghana, looking at mobile outreach programs throughout the country. The study findings include both quantitative data (via phone survey) and qualitative data (via interviews) and provide insights into experiences that FP users had in accessing removal services. The results include a variety of different insights, ranging from the overall experience of using a contraceptive implant to accessibility of removal services. The report closes with a series of recommendations. About FHI 360 FHI 360 is a nonprofit organization that aims to improve lives in lasting ways by advancing integrated, locally driven solutions for human development.

FHI 360, Ghana Health Service, Population Council, Marie Stopes Ghana (2019)

Final Report: Access to Contraceptive Implant Removal in Ghana

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Why is it essential?

Expanding the pool of providers who understand the techniques that can be used for “difficult” implant removals (when an implant is deeply placed or is not palpable) is critical to ensuring that all clients have access to implant removal services. This resource serves as an important learning aid for clinicians on these techniques.

This video guides clinicians on how to locate implants for removal that are either deeply palpable (felt with some manipulation and moderate pressure) or non-palpable (cannot be felt), including different localization techniques by type of implant as well as techniques for localization using ultrasound sonography. The video and paper-based manual walk clinicians through these different techniques using animation, ultrasound and x-ray images, and live video demonstrations. There is also a paper-based manual of the video available in both English and French. About The Implant Removal Task Force Initiated in 2015, the Implant Removal Task Force brings together implementing partners, implant manufacturers, researchers, and donors on issues related to quality implant removal. This video and corresponding paper-based manual were developed by a subset of task force members including Jhpiego, PSI, EngenderHealth, USAID, and Merck.

Implant Removal Task Force (2017)

Skills Demonstration Video of Localization and Removal of Deeply Placed Contraceptive Implants

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Why is it essential?

The evidence summary and policy brief recommend actions needed to minimize service disruptions that are applicable beyond the COVID-19 pandemic.

Kenya

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The implant use and removal memos provide data and insights into why clients seek implant removal, whether they are able to access removal services, and facility readiness for providing implant removals. While these data are specific to Kenya, Burkina Faso, and Ethiopia, they could be valuable to other country contexts as FP program managers plan for new implant programs or scale-up of existing ones.

These memos provide a snapshot of implant use and removal in three countries: Burkina Faso, Kenya, and Ethiopia. The memos present a variety of characteristics of implant users in these different countries and provide context about where FP users are getting implants (e.g., public or private facilities). The memos also pull available data on implant removals and clients who were unable to obtain a removal when they sought one. The memos also explore clients’ reasons for implant removal, when available, and assess facility readiness for implant services, including removals. About the Performance Monitoring for Action The Performance Monitoring for Action (PMA) project aims to revolutionize the way global family planning and health data are collected. PMA promotes effective data use for decision-making.

Performance Monitoring for Action (PMA) (2019-2020)

PMA 2019 and 2020 Implant Use and Removal Briefs: Kenya, Ethiopia, and Burkina Faso

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Why is it essential?

This brief provides important country-level experiences, including perceptions by clients who used contraceptive implants. It also details a holistic approach to ensuring that the necessary program elements are proactively in place for implant removals

This brief shares experience from the Expand Family Planning (ExpandFP) project’s approach to expanding both implant insertion and removal services in three countries: the Democratic Republic of the Congo, Tanzania, and Uganda. The brief also offers a holistic approach that can be used to ensure that everything is in place for implant removals. It also includes country-level experiences from the three countries and includes data from clients about their experiences with contraceptive implants. About EngenderHealth EngenderHealth is a global health organization focused on advancing sexual and reproductive health and rights and gender equality.

EngenderHealth (2016)

Contraceptive Hormonal Implant Removal Services: Experiences from the ExpandFP Project in the Democratic Republic of the Congo, Tanzania, and Uganda

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Why is it essential?

This tool is aimed at better understanding the client experience with implant removal. Data generated from this questionnaire can help implant programs be more responsive to client needs and can provide insights into issues (if any) that a client experienced in seeking removal services.

This questionnaire is a brief interview tool meant to be administered directly to clients who just had an implant removed. It could be adopted for general monitoring, or in the context of more rigorous research when ethical protocols are being observed. Included in the questionnaire are questions about duration of use, reason for removal, method switching or continuation, and whether the client had previously attempted to seek removal services. About EngenderHealth EngenderHealth is a global health organization focused on advancing sexual and reproductive health and rights and gender equality.

EngenderHealth (2017)

Implant Removal Client Questionnaire

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Why is it essential?

This study provides insights into the reasons that FP users may seek implant removal services as well as the barriers that they may face when doing so. The report also includes helpful recommendations for addressing barriers to implant removals, which could be applied in other country contexts.

This final report presents findings from a research study in Ethiopia that assessed whether women who received Implanon implants since the scale-up of the Implanon Initiative had experienced any barriers in having them removed. The final report presents the study methods and findings, as well as recommendations to the Federal Ministry of Health for addressing barriers to implant removal. About FHI 360 FHI 360 is a nonprofit organization that aims to improve lives in lasting ways by advancing integrated, locally driven solutions for human development.

FHI 360, USAID, Federal Ministry of Health of Ethiopia (2017)

A Mixed-Methods Study of Factors Associated with Implanon Removal in Ethiopia

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Why is it essential?

Resources are grouped into four categories:

Background & Advocacy

Implant Removal Task Force (2018)

Implant Removal Task Force (2017)

Roy Jacobstein, IntraHealth (2018)

Measurement & Data

Service Delivery

Country & Programmatic Experience

Access to Contraceptive Implant Removal in Ghana

FHI 360 (2019)

Learning Resource Package: Skills Update for Implant Removal

Jhpiego (2018)

EngenderHealth (2017)

Implant Removal Client Questionnaire

Implant Removal Task Force (2022)

Measurement & Data

Service Delivery

Modular LARC Learning Resource Package

Maternal and Child Survival Program (2017)

Modular LARC Learning Resource Package (Modular/Facility-Based)

Maternal and Child Survival Program (2017)

This training package provides trainers, facilitators, and program staff with a comprehensive resource for long-acting reversible contraceptives (LARC) service training. The content also includes an emphasis on capacity-building and mentorship. This training is organized into 10 modules and includes an implementation guide. The different modules are adaptive to different settings and contexts, and provide training materials on a variety of LARC methods, including contraceptive implants. Modules include content on FP counseling, client assessments, quality of care, infection and prevention. About the Maternal and Child Survival Program The Maternal & Child Survival Program was a multi-partner, flagship program in support of USAID’s priority goal of preventing child and maternal deaths.

The best way to mitigate challenges with implant removal is to ensure providers and other stakeholders have a good grasp of implant service provision from the start. Quality insertions, including good counseling about when, whether, and from where to seek support and removal, can reduce difficult removals and prevent challenges with access.

Service Delivery

Background & Advocacy

Télécharger la ressource en français

Background & Advocacy

Reductions in the cost of implants.

Strengthened commodity supply chains.

Enhanced commitment by governments to expand method choice.

The adoption of service delivery practices that have expanded reach to underserved populations.

About IntraHealth IntraHealth is a global health nonprofit that aims to improve the performance of health workers and strengthen the systems in which they work.

Télécharger la ressource en français

Get The Resource in English

Measurement & Data

Track20/Avenir Health (2021)

Expected Removals of LARCs in Routine Service Statistics

Measurement & Data

Service Delivery

Ethiopia

Burkina Faso

Why is it essential?

Country & Programmatic Experience

Background & Advocacy

Get The Resource

Background & Advocacy

Measurement & Data

Télécharger la ressource en français

Service Delivery

Country & Programmatic Experience

Kenya