Contraceptive implant users and their access to removal services in Bangladesh.

A 1990 study of 1151 Bangladeshi women enrolled in clinical trials of Norplant the hormonal contraceptive implant shows that 71% of implant users were from rural areas and that they ranked between users of female sterilization and IUD users in mean number of children and proportion illiterate. Life-table retention rates were 61% at three years. At the time of the survey 33% of users had requested removal of the implant. The most common reason for requesting removal was menstrual disorders (66%). Although 76% of women who requested removal obtained it at the center of insertion 9% had the implant removed elsewhere and 15% still had the implant in place. Nearly half (48%) of the women who had the implant removed obtained removal on first request 22% on second request and 15% on third request; the remaining 15% made more than three requests or went elsewhere for removal. 61% of the women who made more than one request for removal said they were told initially to retain the implant while doctors tried to treat the side effects; others were told that the doctor was too busy to do a removal or that the implant could not be removed for five years. Most of those who obtained removal elsewhere had the implant removed by private doctors or traditional healers unfamiliar with the implant; in a few cases the client removed the implant herself. (authors)