Safety, effectiveness and acceptability of the single-rod subdermal contraceptive implant in a public health setting in Argentina: observational cohort study

Abstract

Background and purpose: Teenage pregnancies account for 15% of newborns delivered each year within the public health system in Argentina; 67% of these pregnancies are unintended. The consequences of unplanned pregnancies include social exclusion and an increase in the school drop-out rate. This study presents experience with the use of the single-rod implant in a public health setting in Argentina.
Methods: This prospective observational single-centre cohort study was performed using medical record data on low-income women in whom the Implanon® was placed between February 2015 and September 2019. Follow-up information on side effects, effectiveness, reasons for discontinuation, and patient satisfaction with the method was collected 12 months and 3 years after implant placement.
Results: Within the study period, 995 implants were placed. The median follow-up duration was 998 days (IQR 359–1098 days). The single-rod implant was 100% effective in preventing pregnancy. 75.8% of the women were very satisfied with this contraceptive method. Amenorrhoea was the most commonly reported bleeding pattern (47%). Side effects were documented in 121 women (12%); of which 4.1% (n= 5) corresponded to arm insertion-site infection, which necessitated implant extraction. Weight gain was present in 27.7%, headache was reported in 14.1%, acne worsened in 20.4%, decreased libido was reported by 31.7% of women, and 42.1% presented mood changes. Thirty-seven implants were removed before completing the three years from placement. In 84.2%, this was due to implant- related side effects. The median time to implant removal was 210 days (IQR 136–585 days). The main reason for discontinuation was prolonged bleeding (27%, n=10).
Conclusions: The single-rod subdermal implant is an effective long-term method for reducing unplanned pregnancies. Its side effects are rare and usually mild and it has a high satisfaction rate. The main reason for discontinuation is bleeding - pattern change.

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