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  • Title: The introduction and use of Norplant implants in Indonesia.
    Author: Tuladhar J, Donaldson PJ, Noble J.
    Journal: Stud Fam Plann; 1998 Sep; 29(3):291-9. PubMed ID: 9789322.
    Abstract:
    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. Norplant implants, introduced to Indonesia's national family planning program in 1986, are currently used by more than 5% of married women of reproductive age. Most Indonesian Norplant acceptors are rural women 25-34 years of age with some primary education and 2 or more living children; they tend to receive the implants from public health centers, private midwives, and health posts. A substantial proportion of Norplant users had the implants inserted during mass campaigns (safaris) in Indonesia's rural areas. On the basis of continuation rates, Norplant appears to be more popular among Indonesians than the IUD or sterilization. This report, based on data from the Norplant Use Dynamics Study and the 1994 Indonesia Demographic and Health Survey, assesses the service quality associated with introduction of this method. The survey data indicate that, although acceptors are aware of Norplant's 5-year effectiveness, few were counseled about potential side effects or the possibility of early removal. The data further identified deficiencies in terms of provider training, supervision, and clear guidelines regarding a woman's right to have the implants removed on demand. Lacking in Indonesia is the presence of consumer groups and advocates to play a watchdog role and disseminate information to potential acceptors. The inadequate counseling received by many Norplant acceptors requires attention from family planning program managers. Also needed is a policy shift from a preoccupation with increasing the numbers of family planning acceptors to an emphasis on client satisfaction.
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