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  • Title: Acceptance, efficacy, and side effects of Norplant implants in four counties in north China.
    Author: Tu P, Qiu S, Fang H, Smith HL.
    Journal: Stud Fam Plann; 1997 Jun; 28(2):122-31. PubMed ID: 9216032.
    Abstract:
    This report attempts to present a comprehensive analysis of the acceptability, side effects, and efficacy of Norplant as used in rural areas, based on a field experiment conducted in four counties in Hebei and Shandong Provinces, China. The initial acceptance of Norplant was relatively high but waned after the first year in three of the four counties. Compared with clinical trials, the current study shows a lower prevalence but similar patterns of side effects. The pregnancy rate during the first two years of use is similar to that found in large-scale clinical trials conducted in China, but discontinuation due to other reasons is lower. A three-level logistic regression analysis shows significant variation in the probability of discontinuation due to side effects across counties. It also indicates an increase in the conditional probability of discontinuation with the duration of use. Whereas introducing Norplant and achieving a very low failure rate and high continuation rate in rural areas is feasible under diverse socioeconomic conditions, the results vary significantly across different areas. Particular attention should be paid to the local factors that may affect results. Field research conducted in 24 rural townships in four counties (Zunhua and Leting in Hebei Province and Boshan and Yiyuan in Shandong Province) in China identified potential local-level obstacles to widespread use of Norplant contraceptive implants. A total of 1556 women received the implants between June 1992 and June 1993. In 1992, Norplant represented 20% of total contraceptive use in the study area; however, in 1993, this statistic dropped to 10% in 3 of the 4 counties. About 49% of Norplant acceptors experienced at least 1 side effect in the first 6 months, primarily menstrual disorders, headache, vertigo, and nausea. The gross discontinuation rate due to menstrual disorder was 1% at 6 months, 3% at 12 months, and 8% at 24 months; the overall discontinuation rates were 2%, 4%, and 10%, respectively. There were only 3 pregnancies due to method failure in the 24-month study period. Despite the high acceptability and effectiveness of this method, family planning workers complained that the required acceptor screening, insertion, follow-up visits, counseling, and treatment of side effects associated with Norplant increased their work loads. The decline in the method's popularity from 1992 to 1993 is presumed due to local program-related factors such as decreased implementation of an informed choice policy, unavailability of daily Norplant insertion services, the slow response of family planning workers to requests for treatment of side effects or capsule removal, and the improved availability of alternative contraceptive choices. However, demand for Norplant remained stable in Yiyuan County, where there was widespread resistance to sterilization and a willingness on the part of family planning workers to accept the increased work load associated with this method.
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