Norplant contraceptive subdermal implants: a report on the five-year experience in Bangladesh.

A 5-year (1985-90) clinical trial conducted at 3 medical centers in Dhaka Bangladesh confirmed the safety efficacy and moderate acceptability of the Norplant contraceptive implant system. All 600 Norplant acceptors enrolled in February 1995 to February 1996 were followed at 1 3 and 6 months after insertion and every 6 months thereafter until removal or 5 years of use. The mean age of acceptors was 27.1 years; nearly 50% had no formal education. At enrollment 66% of acceptors indicated they desired no more children; 46.7% had never used contraception before. A total of 228 acceptors (38%) completed the study and were available for follow up; the 5-year continuation rate was 41.2/100 women. 154 (45.3%) of the 340 removals were for menstrual problems primarily heavy bleeding; another 34 (10%) were to achieve pregnancy. Most discontinuations due to menstrual problems occurred during the second year of method use. There were 33 cases (9.7%) of removal-related complications attributable to the implants being displaced or deeply embedded. The 2 pregnancies that occurred during the study were conceived prior to insertion. Of the 169 acceptors who completed a study questionnaire 165 (97.5%) rated their overall experience with the implants as very favorable. Respondents cited the methods long duration of contraceptive protection ease of use and high efficacy as major advantages while menstrual disturbances were the main disadvantage. Despite the high acceptability rating only 33% of women planning to continue contraceptive use after the studys end opted for a second set of implants.