Marie Stopes International, Washington, DC, USA.
FHI 360, Washington, DC, USA.
Glob Health Sci Pract. 2018 Dec 27;6(4):680-692. doi: 10.9745/GHSP-D-18-00242.
The levonorgestrel intrauterine system (LNG IUS) is one of the most effective contraceptive methods, and it has noncontraceptive health benefits, including treatment for women with heavy menstrual bleeding. In 2016, Marie Stopes International Organisation Nigeria (MSION) expanded LNG IUS provision through training and support to 9 mobile outreach teams, 105 social franchise clinics, and 20 public-sector providers in 17 states. Information about the LNG IUS was added to awareness-raising materials, and community mobilizers provided information on the LNG IUS alongside other voluntary family planning methods.
In 2016, Marie Stopes International, MSION, and FHI 360 examined clients' and providers' experiences with the LNG IUS to assess the potential for further scale-up of the method as part of a comprehensive approach to family planning in Nigeria. A mixed-methods approach was used including analysis of routine service data, supplemental data specific to LNG IUS clients, and in-depth interviews with LNG IUS clients, providers, and key opinion leaders.
Just under 1,000 LNG IUS were inserted from September 2016 to December 2017 in 16 states in channels supported by MSION, representing 0.4% of all long-acting and reversible contraceptive (LARC) services provided by the participating providers during this time frame. The vast majority (82%) of LARCs provided were implants. A small pool of providers was responsible for providing almost half of the LNG IUS services. Common reasons for women choosing the LNG IUS were reduced menstrual bleeding (61%), long-acting duration (52%), effectiveness (49%), and discreetness (42%). Almost 80% of the users first heard about the method from a provider. Almost all users and providers reported positive experiences with the method, noting the noncontraceptive benefits and fewer side effects compared with other methods. All providers who were interviewed said they would continue offering the LNG IUS. Several key opinion leaders mentioned a total market approach incorporating both public and private sectors would be needed to successfully scale up the LNG IUS.
Reduced menstrual bleeding and fewer side effects compared with other methods were identified as important attributes of the LNG IUS by clients, providers, and key opinion leaders. Challenges to uptake of the LNG IUS include difficulty with introducing a new method within a busy service delivery infrastructure and limited awareness and demand-generation activities on the LNG IUS specifically. A comprehensive product introduction approach with coordinated demand- and supply-side activities may be required for this method to reach its full potential.
左炔诺孕酮宫内节育系统（LNG IUS）是最有效的避孕方法之一，它具有非避孕的健康益处，包括治疗月经过多的妇女。2016 年，玛丽斯特普国际组织尼日利亚分会（MSION）通过培训和支持，将 LNG IUS 服务扩展到 17 个州的 9 个流动外展团队、105 个社会特许诊所和 20 个公共部门提供者。宣传材料中增加了有关 LNG IUS 的信息，社区动员人员在宣传 LNG IUS 的同时，还宣传了其他自愿计划生育方法。
2016 年，玛丽斯特普国际组织、MSION 和 FHI 360 评估了客户和提供者使用 LNG IUS 的经验，以评估在尼日利亚综合计划生育方法中进一步扩大该方法规模的潜力。该研究采用了混合方法，包括对常规服务数据的分析、特定于 LNG IUS 客户的补充数据以及对 LNG IUS 客户、提供者和主要意见领袖的深入访谈。
在 2016 年 9 月至 2017 年 12 月期间，MSION 支持的渠道中在 16 个州插入了近 1000 个 LNG IUS，占同期参与提供者提供的所有长效和可逆避孕方法（LARC）服务的 0.4%。提供的大多数（82%）LARC 是植入物。一小部分提供者负责提供近一半的 LNG IUS 服务。妇女选择 LNG IUS 的常见原因是减少月经出血（61%）、长效持续时间（52%）、有效性（49%）和隐蔽性（42%）。近 80%的使用者是从提供者那里第一次听说这种方法的。几乎所有的使用者和提供者都报告说对这种方法有积极的体验，指出与其他方法相比，该方法具有非避孕的益处和较少的副作用。所有接受采访的提供者都表示他们将继续提供 LNG IUS。几位主要意见领袖提到，需要采用公共和私营部门相结合的综合市场方法，才能成功扩大 LNG IUS 的规模。
客户、提供者和主要意见领袖认为，与其他方法相比，LNG IUS 的经血量减少和副作用减少是该方法的重要属性。LNG IUS 的采用面临的挑战包括在繁忙的服务提供基础设施中引入新方法的困难，以及专门针对 LNG IUS 的意识和需求产生活动有限。为了充分发挥该方法的潜力，可能需要采用综合产品引入方法，协调供需双方的活动。
