Task Shifting Provision of Contraceptive Implants to Community Health Extension Workers: Results of Operations Research in Northern Nigeria

Authors: Zulfiya Charyeva, Olugbenga Oguntunde, Nosa Orobaton, Emmanuel Otolorin, Fatima Inuwa, Olubisi Alalade, Dele Abegunde, Saba’atu Danladia

Among family planning methods, long-acting reversible contraceptives (LARCs), consisting of intrauterine devices (IUDs) and implants, have a proven record of high effectiveness and high user satisfaction, and they are not dependent on user adherence. However, despite the many advantages of LARCs, contraceptive implants, which are among the most effective LARCs, make up a very small proportion of the world’s contraceptive use. In Nigeria, only 0.3% of women use implants. Among the 11% of Nigerian women who reported use of any modern method of contraception, injectables, oral contraceptives, or male condoms were most common.

A study that examined 27 years of international data shows that modern contraceptive use increases with the rising number of methods available to a population. In Nigeria, most family planning clinics offer a limited method mix, namely oral contraceptive pills, injectables, and condoms. With 16% of women in Nigeria having unmet need for family planning, providing access to a variety of contraceptive methods may increase the contraceptive prevalence rate (CPR). Access to LARCs is limited in various settings due to several factors such as women’s inadequate knowledge of LARCs, lack of LARC commodities in health facilities, and inadequately skilled health care providers to render the services.

Of these barriers, the dearth of skilled providers capable of providing LARCs has been shown to be one of the most difficult to address. Task shifting provision of contraceptive implants to lower-level health workers may improve access to and use of the method.