With a population density of more than 300 persons per square kilometer, coupled with high poverty levels, a high fertility rate and high unmet need for family planning, there is a glaring need for Burundi to avail birth control methods to its population in order to attain sustainable development. In addressing these challenges, the Government of Burundi in conjunction with the United States Government developed the Global Health Initiative Strategy (2011-2015).
Woman from Western Kenya getting an implant under the Packard Western Kenya project
One of the key interventions in this strategy is the promotion of voluntary family planning through provision of information and a variety of family planning methods so that individuals can make informed decisions regarding family planning. Earlier in 2010 and in line with the principle of increasing choices among family planning clients, the Government of Burundi introduced Jadelle, also known as Levonorgestrel Implants, in many health facilities across the country. These implants have been proven to be quite effective in preventing pregnancy — evidence shows that only up to 1 percent of women using them can conceive over a period of five years.
Implant availability for all?
However, owing to limited resources, the Ministry of Health in Burundi could not introduce the Jadelle implant services to all health facilities in the country. This led to partial and non-implementation of the intervention in Kayanza and Muyinga Provinces. In order to complement the government effort, the Evidence to Action for Strengthened RH for Women and Girls (E2A) Project through its country partner, Pathfinder International-Burundi, stepped in to fill the gap.
E2A developed a Jadelle Implant Implementation Project in Kayanza and Muyinga Provinces. The project worked to provide technical assistance to the public sector family planning programs with the ultimate goal of increasing the number of community and facility family planning sites and users within the two provinces in Burundi. This technical assistance included training service providers and managers in family planning services and counseling.
Implementing implants:
The first step to fully integrate implants into the family planning services offered in Burundi was to assist the Ministry of Health to develop national guidelines and protocols for family planning and reproductive health programs that included implants. The included the finalization of the national policy on community-based distribution of contraceptives.
The second step was to train a group of trainers in Bujumbura. These trainers were selected from Kayanza, Muyinga and three other provinces (Gitega, Makamba and Ruyigi) where Jadelle implants had been introduced by the Ministry of Health. These trainers later taught service providers in both Kayanza and Muyinga Provinces using selected practicum sites. Providing Jadelle implant services at the study sites started in September 2012 and continues today.
Good news for family planning in Burundi?
A review of the clinical records of the women who have been visiting the sites for the past year where the new family planning implant method has been available shows that after just five months of availability, Jadelle Implants emerged as the third most accepted family planning method after injectables (60.6%) and oral pills (16%). In fact, 13.2% of women accessing family planning methods chose the implant method. Other less popular methods, included the intra-uterine device (IUD) (8.3%), condom (1.7%) and the natural family planning method (0.2%). In many health centers, Jadelle implants are already the second most used method after injectables as many clients find it more convenient compared with oral pills. Many service providers found that most family planning clients prefer to “experiment” first with injectables before accepting implants. This means that there is great potential for the method and with an increased number of health facilities that can offer an expanded method mix that includes Jadelle, the method could be one of the most used methods in the two regions.
Pushback and myths:
However, acceptance of implants is being threatened by some propaganda against the method. In both Kayanza and Muyinga Provinces, the Catholic Church is the dominant denomination and discourages women from using artificial family planning methods. Furthermore, pronatalists and other traditionalists are spreading incorrect information about implants including that the Jadelle implants cause health problems including cancer and that the implants can move through the veins from the arm to the brain.
What’s next?
The evidence we are seeing in Burundi shows the importance of providing family planning clients with a wide choice of methods, which is a key reproductive health right. There is no doubt that scaling up the availability of the implant family planning method, coupled with providing appropriate information to potential users and counteracting myths and misinformation will result in improved healthy spacing and timing of pregnancies in Burundi. This development will ultimately improve the health of women and we are likely to see improvements in a range of reproductive health indicators that will help guarantee sustainable economic development in the region. Beyond the work being done by this specific project (E2A), the Ministry of Health in Burundi should work to ensure adequate supply of FP commodities, training and re-training of FP service providers and provision of information on the importance of family planning—and make sure to include the implant option. Lessons from Burundi should also be shared with other African countries facing similar population challenges so that all countries in the African region can fully benefit from the anticipated demographic dividend.