THE Zimbabwe National Family Planning Council (ZNFPC) has dedicated every last
Thursday of each month a free family planning services day.
On Tuesday, the council’s provincial publicist, Percival Kushure, said: “We are mainly
rolling out long-lasting reversible family planning methods on those days cognisant that the
methods are not very common among women in the country, besides them being a long-
lasting solution to family planning.”
He said they were promoting these long-lasting contraceptives, which also include the jadel,
which protects pregnancy for five years and many other Intra Uterine Contraceptive Device,
which prevents pregnancy for up to 10 years.
“We want people to know about these methods. Locally, most of our clients are used to oral
contraceptives, which are pills while others condomise,” he said.
Long-acting reversible contraceptives (LARC) are methods of birth control that provide
effective contraception for an extended period without requiring user action.
They include injections, intra-uterine devices (IUDs), and subdermal contraceptive implants.
They are the most effective reversible methods of contraception because their efficacy is not
reliant on patient compliance. The typical use failure rates of IUDs and implants, less than
one percent a year, are about the same as perfect use failure rates.
LARCS are reportedly, convenient, enjoyable and cost-effective.
Typically, users save thousands of dollars over a five-year period, compared to those who
buy condoms and birth control pills.
About 15.5 percent of women worldwide use IUDs, and 3.4 percent use subdermal implants,
according to World Health Organisation statistics.
They work in women of any age and number of births. Women may consider family planning
advice beforehand.
The effectiveness of LARC methods has been shown to be superior to other types of birth
control.
A study in 2012, with the largest cohort of IUD and implant users to date, found that the risk
of contraceptive failure for those using oral contraceptive pills, the birth control patch, or the
vaginal ring was 17 to 20 times higher than the risk for those using long-acting reversible
contraception.
For those under 21, who typically have lower adherence to drug regimens, the risk is twice
as high as the risk among older participants.
The discrepancy between LARC methods and other forms of birth control lies in the
difference between "perfect use" and "typical use". Perfect use indicates complete adherence
to medication schedules and guidelines. Typical use describes effectiveness in real-world
conditions, where patients may not fully adhere to medication regimens.
LARC methods require little to no user action after insertion; therefore, LARC perfect use
failure rates are the same as their typical use failure rates.
LARC failure rates rival that of sterilisation, but unlike sterilisation LARC methods are
reversible. Other reversible methods, such as oral contraceptive pills, the birth control patch,
or the vaginal ring require daily, weekly, or monthly action by the user.
While the perfect use failure rates of those methods may equal LARC methods, the typical
use failure rates are significantly higher.
Even methods such as the DMPA injection require users to return to their provider every 12
weeks for the intramuscular shot or every four weeks for the subcutaneous shot. So, DMPA
typical use failure rates are also higher than perfect use failure rates as more than 40 percent
of women discontinue DMPA in the first year.
In both effectiveness and continuation, LARC methods are considered the first-line option for
contraception.
However, contraceptive implants may cause irregular bleeding, which some women find
unacceptable as a side effect
Irregular bleeding and spotting is common in the first six months associated with IUS; similar
to side effects observed with IUD, injection or implant. Side effects that are observed less
often may include emotional liability, weight gain, headache, and acne.
Side effects for LARC are mostly similar to combined and progesterone only oral
contraceptives, with a possibility of a small change in mood or libido observed in IUD and
IUS use.
The risk of acne vulgaris may be higher in IUS users, but is an uncommon reason for
stopping use.
Weight gain has been observed with depot medroxyprogesterone acetate (Depo-Provera).
IUDs present a slight risk of infection at the time of insertion but have a low risk of pelvic
inflammatory disease for women at low risk of STIs, and uterine perforation.
If a person becomes pregnant while they have an IUD inserted then the IUD should be
removed within the first 12 weeks of gestation. In such a case, the mother has low risk of
ectopic pregnancy – approximately 1 in 20.
Women, who cease using depot medroxyprogesterone acetate can find that they have a delay
of up to a year before being able to get pregnant, while there is no evidence of a delay in
IUD, IUS or implant users.
Like all contraceptive methods, access to LARC methods can reduce the rate of unintended
pregnancy and result in significant cost savings to publicly funded health systems.
Women switching from short-acting reversible contraceptive to long-acting intra-uterine
systems are likely to generate cost savings from unplanned pregnancy-related expenses and
long term savings in contraceptive costs.
Regardless, the initial out-of-pocket cost is still too high for many patients and is one of the
biggest barriers to LARC use.
