Norplant insertions, removals remain low
Norplant insertions, removals remain low
Norplant contraceptive implants offer a very low dose of progestin and no estrogen, and research has shown that their cumulative seven-year pregnancy rates are comparable to those of women who have been surgically sterilized.1 Despite the advantages, however, few women are selecting Norplant implants, say participants in Contraceptive Technology Update’s 2000 Contraception Survey.
More than 70% of those responding to the annual survey have not performed any Norplant insertions in the last year, comparable to 1999 statistics (72.4% in 1999 vs. 73.8% in 2000). (See charts, below right.)
More than 16% reported performing one to five insertions, and 7.3% had inserted six to 10 implants, which is consistent with 1999 survey statistics. Only 1.8% of survey respondents had performed 11 to 25 insertions, and less than 1% reported 25 or more insertions, declining from 1999’s 3.4% and 1.6% respective numbers.
Number of removals remains steady
The number of Norplant removals remained consistent with 1999 statistics, as well. Nearly 72% reported no removals, compared with 69.3% in 1999; 15.7% removed one to five implants, as did 14.2% in 1999; and 7.3% logged six to 10 removals vs. 6.5% in 1999. More than 4% removed 11 to 25, and less than 1% removed more than 25 implants in 2000, a reduction from 1999’s 6.5% and 3.4% figures.
Diana Lithgow, RN, FNP, family nurse practitioner at Laguna Beach (CA) Community Clinic, has performed six to 10 Norplant insertions in the last year, and she logged an equal number of removals. Has that figure changed in the last year? Are women undergoing Norplant remov-als requesting new contraceptive implants?
"That is about the same rate — no difference, really," she notes. "Re-insertions are not common."
Norplant implants in the United States cost health care providers from $365 to $375, with the patient’s cost of insertion ranging from $500 to $700, which may include a physical exam and pregnancy test.2
It might be that the provision of Norplant is becoming more concentrated, says Anita Nelson, MD, professor in the obstetrics and gynecology department at the University of California in Los Angeles (UCLA) and medical director of the women’s health care clinic and nurse practitioner training program at Harbor-UCLA Medical Center in Torrance.
"I removed and replaced three sets today and inserted a fourth set," says Nelson. "In states with the Contraceptive Equity Act, I expect that there should be more interest in the more expensive methods, since the cost is covered." (Iowa is the 11th state to enact legislation requiring private-sector insurance coverage of all prescription contraceptives approved by the Food and Drug Administration.3 Other states with such legislation are California, Connecticut, Georgia, Hawaii, Maine, Maryland, Nevada, New Hampshire, North Carolina, and Vermont.)
References
1. Norplant found highly effective up to seven years. Population Briefs 2000; 6:3.
2. Hatcher RA, Trussell J, Stewart F, et al. Contraceptive Technology. 17th ed. New York City: Ardent Media; 1998.
3. Dalal A, Nash E, Sonfield A. The states at midyear: Major actions on reproductive health-related issues. Guttmacher Report on Public Policy 2000; 3:9.
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