Howett Rebecca, Krogstad Emily A, Badubi Opelo, Gertz Alida M, Bawn Caitlin, Mussa Aamirah, Kgaswanyane Tiroyaone, Malima Sifelani, Maotwe Tshego, Mokganya Lesego, Ramogola-Masire Doreen, Morroni Chelsea
Botswana-UPenn Partnership, Gaborone, Botswana.
Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa.
Front Glob Womens Health. 2021 Jun 25;2:684694. doi: 10.3389/fgwh.2021.684694. eCollection 2021.
This study explored implant user and healthcare provider experiences of accessing and providing contraceptive implant removal services in Gaborone, Botswana, following introduction of the implant in the public sector in 2016. We sought to understand reasons for satisfaction and dissatisfaction with services and their potential impact on wider perceptions of the implant, including influence on future uptake. Qualitative data were collected through in-depth interviews. Participants comprised ten women who had previously undergone implant removal, and ten providers whose work included provision of implant insertion and removal. Data were analyzed using thematic content analysis. Seven of the ten users in this study had experienced a delay between initial request and undergoing implant removal. This interval ranged from <1 week to 3 months. Users identified the principal barriers to accessing implant removal services as lack of access to trained removal providers, inconvenient appointment times, and provider resistance to performing removal. Nine of the ten providers in this study had experienced barriers to providing implant removal, including insufficient training, lack of equipment, lack of time, and lack of a referral pathway for difficult removals. Despite experiencing barriers in accessing removal, users' perceptions of the implant remained generally positive. Providers were concerned that ongoing negative user experiences of removal services would damage wider perceptions of the implant. Introduction of the contraceptive implant in Botswana has been an important strategy in increasing contraceptive choice. Following an initial focus on provision of insertion services, the development of comparable, accessible removal services is critical to ensuring that the implant remains a desirable contraceptive option and is vital to upholding women's reproductive health rights. The experiences of users and providers in this study can inform the ongoing development of services for implant insertion and removal in Botswana and other lower-resource settings.
2016年博茨瓦纳公共部门引入避孕植入物后，本研究探讨了哈博罗内植入物使用者及医疗服务提供者在获取和提供避孕植入物取出服务方面的经历。我们试图了解对服务满意和不满的原因及其对植入物更广泛认知的潜在影响，包括对未来采用率的影响。通过深入访谈收集定性数据。参与者包括十名曾接受植入物取出的女性和十名工作包括提供植入物植入及取出服务的医疗服务提供者。使用主题内容分析法对数据进行分析。本研究中的十名使用者中有七人在最初提出请求到接受植入物取出之间经历了延迟。这个间隔从不到1周至3个月不等。使用者认为获取植入物取出服务的主要障碍是难以找到受过培训的取出提供者、预约时间不方便以及提供者拒绝进行取出操作。本研究中的十名医疗服务提供者中有九人在提供植入物取出服务时遇到障碍，包括培训不足、设备缺乏、时间不足以及复杂取出操作缺乏转诊途径。尽管在获取取出服务方面遇到障碍，但使用者对植入物的认知总体上仍保持积极。医疗服务提供者担心取出服务持续的负面用户体验会损害对植入物更广泛的认知。在博茨瓦纳引入避孕植入物一直是增加避孕选择的一项重要策略。在最初侧重于提供植入服务之后，开发可比且可及的取出服务对于确保植入物仍然是一种理想的避孕选择至关重要，对于维护妇女的生殖健康权利也至关重要。本研究中使用者和医疗服务提供者的经历可为博茨瓦纳及其他资源匮乏地区正在开展的植入物植入和取出服务的发展提供参考。
