A New Frontier in Self-Care?: Self-Removal Options for Long-Acting Contraceptives
Post written by Alice Cartwright, FHI 360
As new sexual and reproductive health products become available, people increasingly want to take an active participatory role in their own health. Self-care, as defined by the World Health Organization (WHO), highlights the ability of people to manage their own health with or without the support of a health care provider.
The recently released WHO Guidelines on Self-Care Interventions focused on sexual and reproductive health and rights (SRHR) include new self-care recommendations related to use of family planning, including self-injection of injectable contraceptives and provision of oral contraceptive pills (OCPs) over the counter.
The WHO Guidelines also highlight the link between self-care and a greater experience of autonomy when people have the ability to control what happens to their own bodies. While access to family planning is increasing around the world, equitable and timely access to removal services for long-acting and reversible contraceptives (LARCs) is still a challenge. LARCs are highly effective at preventing pregnancy and increasingly popular, but unlike short-acting methods, they generally require intervention by a health care provider for their removal.
However, there are emerging opportunities for self-care and LARC removal. Studies in the United States have shown that women who use intrauterine devices (IUDs) are open to the concept of self-removal and for those that have tried, about 20% have been successful in their removal attempt. Evidence also suggests that women may be more willing to recommend an IUD to others knowing they have control over discontinuation of the method through self-removal and are less likely to consider discontinuation themselves. More evidence is needed about the feasibility and potential impact of self-removal of IUDs including in low-resource settings. This includes better understanding of women’s willingness and ability to try self-removal, as well as the potential impact on demand, particularly in settings where uptake of the copper IUD has traditionally been low.
In addition to considering options for self-removal of existing LARCs, new contraceptive technologies under development could place LARC removal in women’s control. For example, FHI 360 is supporting the development of biodegradable implants, which could potentially be removed for some period of time but would then dissolve in the body over the course of a few months, eliminating the need to find a provider with the skills and willingness to remove it. For other new methods in the contraceptive R&D pipeline, it is essential to consider the potential for self-administration and self-removal at the very beginning of development. Target Product Profiles, which outline characteristics of a method that the research team hopes to achieve, should reflect women’s desires to control when and how to stop using a method, as this is a key consideration in women’s method choice.
Having self-removal options or eliminating the need for removal altogether may make LARCs a more attractive option for those who do not want to or are not able to reach a provider. These additional options for self-care with LARCs could support women’s autonomy to use or discontinue a method at the time she determines is best. Women want more control over their own reproduction and self-removal is another a step in reaching that goal, both now and into the future.