Although modern contraceptive use lags in sub-Saharan Africa, where only 1 in 6 married women uses it, contraceptive use has recently increased substantially in a number of Eastern and Southern African countries.13 While this has been mainly due to increased use of injectables, implants use has also increased notably over a short time span in countries such as Ethiopia, Malawi, Rwanda, and Tanzania (see Box and Figure). For example, 1 in every 7 women using modern contraception in Rwanda currently relies on an implant, compared with less than 1 in 25 in 2005.14 These trends suggest that wider availability of implants could lead to much greater use in other African countries and elsewhere where implants currently cannot be accessed widely or easily. High rates of user satisfaction (79%) and continuation (around 84% at 1 year of use) further support this likelihood.6,17
Box. Implants Use on the Upswing in Eastern and Southern African Countries
Ethiopia, Malawi, Rwanda, and Tanzania have recently achieved notable increases in their modern method contraceptive prevalence rates (CPR), including for implants. As seen in the Figure, in only 5 to 6 years, implants use doubled in Malawi, quadrupled in Tanzania, and rose more than 15-fold in Rwanda and 17-fold in Ethiopia.14 Implants have become the second most popular method in Ethiopia and the third most popular method in Rwanda. One of every 7 married women using modern contraception in Rwanda and 1 in every 8 in Ethiopia relies on an implant for her contraceptive protection. The CPR for implants in Rwanda is 6.3% among currently married women, 5.9% among sexually active unmarried women, and 6.4% among rural women. These are the highest rates in sub-Saharan Africa and among the highest in the world.
What accounts for this success? Among the most important factors have been:
An enabling environment, with strong policy commitment from the highest levels downward, as manifested most recently by the Prime Ministers of Ethiopia and Rwanda at the London Summit,15 and supportive service policies that encourage task sharing and task shifting;
On the supply side, training to ensure widespread insertion and removal skills and substantial donor support for purchase of commodities (3.7 million implants valued at US$72 million were purchased for these 4 African countries between 2009 and 2012)16; and
On the demand side, a marked rise in implants knowledge, stimulated by communication activities in programs as well as by diffusion of knowledge among women themselves. In Ethiopia, knowledge of implants among married women ages 15–49 increased to 69% in 2011 from only 20% in 2005, and knowledge was even higher among sexually active, unmarried women (82%).14 In Rwanda, where only half of married women knew of implants in 2005, such knowledge became universal (97%) by 2010.14