Improving and widening Norplant use requires an understanding of users' complaints. A study was conducted of factors influencing user attitudes, with the goal of improving service delivery.

METHODS

The study used a questionnaire consisting of 26 queries. An interview pertaining to the attitude of 610 users about Norplant implanted 5 years ago or more, was carried out in villages surrounding Semarang City, Central Java, Indonesia.

RESULTS

Of the 610 Norplant users, 84.59% expressed positive attitudes; 13.93% were neutral and 1.48% expressed negative attitudes. Factors significantly affecting user acceptance were: low socio-economic status; low education; activities in social groups; young age; more experience and knowledge about Norplant; few or no complaints.

CONCLUSIONS

Acceptance of Norplant by villagers, depends on the socio-demographic status and the complaints of users. This information can be used as the basis for improving the service delivery system.

OBJECTIVE

To compare the side effects and time required for Norplant removal between the 'U' technique (using the no-scalpel vas deferens holding forceps) and the standard technique.

METHODS

A randomized controlled clinical trial was carried out of acceptors in family planning clinics in Dr Kariadi Hospital, Semarang, who wanted to have Norplant removal. The Norplant was removed by experienced doctors who had been trained for both the 'U' technique and the standard technique. Removal time, capsule condition and complications were examined.

RESULTS

From 41 clients in the 'U' technique group and 41 clients in the standard technique group, the removal times were 2.75 +/- 1.28 and 6.57 +/- 2.93 minutes, respectively (p < 0.01). One week after Norplant removal, complications were found in 5 clients, 1 from the 'U' technique group (2.44%) and 4 from the standard technique group (9.76%). Two weeks after Norplant removal no complications were found.

CONCLUSIONS

The 'U' technique was quicker and less complicated compared with the standard technique.

OBJECTIVE

The objective of this study was to determine if there are sociodemographic differences between adolescent mothers who choose to use Norplant after delivery and those who do not. We hypothesized that those adolescent mothers who are at highest risk for repeat adolescent pregnancy are least likely to select Norplant as a postpartum contraceptive.

METHODS

We prospectively compared the prevalence of epidemiologic risk factors for repeat adolescent pregnancy in a group of 187 consecutively delivered 13-18-year-olds who were enrolled in a comprehensive, multidisciplinary, adolescent-oriented maternity program. The study subjects were interviewed at delivery; 100 subsequently had a Norplant inserted (Norplant users). Student's t-tests and chi-square analyses were used to compare Norplant users and refusers.

RESULTS

We found no statistically significant differences between Norplant users and refusers with regard to: age, race, Medicaid, or marital or school status. Compared to Norplant refusers, Norplant users were less likely to be primiparous (79% compared to 90%; p = .04) and more likely to have poor school grades (20% compared to 7%; p = .001). Norplant users were more likely to state that they had had trouble remembering to use contraceptives in the past (32% compared to 14%; p = .005).

CONCLUSIONS

These data do not support the study hypothesis and are encouraging because they suggest that Norplant may reduce repeat pregnancy among adolescent parents.

The aim of this study was to reveal changes in serum cortisol levels in users of subdermal levonorgestrel implants (Norplant). The study was undertaken on 18 regularly menstruating females subdermally implanted with 6 silastic rods, each containing 34 +or- 2 mg levonorgestrel, between days M0-M+4 of the menstrual cycle. Venous blood samples were collected between 10:00 and 11:00 a.m. under basal conditions, before and 1, 6, and 12 months after implantation. Sera were analyzed for cortisol by radioimmunoassay procedures. Mean +or- S.E.M. cortisol levels were 15.94 +or- 1.23, 10.20 +or- 0.84, 11.21 +or- 1.14, and 11.14 +or- 1.05 mcg prior to and 1, 6, and 12 months after implantation, respectively. All postimplantation values were significantly lower in comparison to basal levels. However, results obtained fell within the normal range of serum cortisol, with no subjects reporting symptoms of adrenocortical insufficiency.

A choice of a safe and acceptable contraceptive method is an important concern for women who have completed their child-bearing intentions. This paper focuses on 557 women (mean age 35.9 years, mean number of living children 5.8 +/- 1.4, and mean number of living sons 3.1 +/- 1.3) who indicated some desire to limit childbearing, and were seen at the University of Ilorin Teaching Hospital, Family Planning Clinic in 1986/7. During this period, a wide and free choice of contraceptive methods, including the new subdermal levonorgestrel implant method (NORPLANT) and female surgical sterilization, was offered. Contraceptive method choices of women requesting terminal fertility control are: IUD 56%, injectables 15.3%, female sterilization 11.5%, pills 8.6%, NORPLANT 8.1%, others 0.5%. Comparing terminal and nonterminal contraceptors, almost equal proportions adopted the IUD, 56% vs. 60.5%, while terminal contraceptors adopted the injectables and NORPLANT in significantly higher proportions. Within subgroups by contraceptive method, mean age and mean number of living children and of sons are not significantly different, though younger women tend to adopt the pill. Method choice of NORPLANT and tubal ligation was favoured by previous contraceptive use, but not by spousal approval. Years of education had a positive influence on the choice of NORPLANT. The program implications of these findings regarding selective counselling of terminal contraceptors, provision of long-lasting reversible contraceptive methods, and facilities for surgical sterilizations for men and women are discussed.

In this study, patterns of Norplant use in Indonesia are reviewed to assess the implications of this experience for the introduction of new contraceptive methods. Data from the Norplant Use-Dynamics Study and the 1994 Indonesia Demographic and Health Survey are analyzed, and patterns of acceptance, continuation, and removal are described. Acceptance of Norplant has increased steadily since it was first introduced. The method is now used by more than 5 percent of all married women of reproductive age. Continuation rates among Norplant users are higher than among users of the IUD. One factor behind high continuation rates may be that a substantial proportion of acceptors were not told that removal before five years was possible. Results indicate that deficits occurred in the quality of service delivery and that a need exists for improved provider training, better supervision, and clearer and better-enforced guidelines regarding women's right to have Norplant removed on demand.