Karp Celia, Tumlinson Katherine, Bullington Brooke W, Zimmerman Linnea A, Senderowicz Leigh
Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
Carolina Population Center and Department of Health Planning and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America.
PLOS Glob Public Health. 2025 Jul 9;5(7):e0004478. doi: 10.1371/journal.pgph.0004478. eCollection 2025.
As the use of subdermal contraceptive implants increases across sub-Saharan Africa, the need for person-centered removal services is more critical than ever to safeguard reproductive autonomy. In 2016, Christofield and Lacoste proposed eight conditions for client-centered implant removal, yet the extent to which these conditions have been assessed in large-scale surveys remains unexamined. Our mapping exercise collates survey information from three large data collection platforms fielded in sub-Saharan Africa, including the Demographic and Health Surveys (DHS), Performance Monitoring for Action (PMA), and the Service Availability and Readiness Assessment (SARA), utilizing questionnaire tools implemented among women, health facilities, providers, and clients to map existing data sources against these conditions. Our findings reveal that four of the eight conditions are fully captured, three are partially captured, and one is entirely absent within current population or facility-based surveys. Specifically, among the six facility-based conditions: the three conditions completely captured include the availability of supplies (condition 2), systems for managing difficult removals (condition 3), and the provision of counseling and reinsertion options (condition 5); two conditions partially captured include competent and confident providers (condition 1) and affordability for clients (condition 7), and the one condition that remained absent was measurement systems for monitoring of removal data (condition 8). Among the two individual-level conditions, timely and proximate service (condition 4) was partially captured and knowledge and awareness of where to go for removal (condition 6) was fully captured. Nearly a decade after Christofield and Lacoste proposed these client-centered conditions, the lack of consistent measures for client-centered implant removal poses significant barriers to understanding service accessibility and women's reproductive experiences. To protect the reproductive autonomy of individuals who use long-acting reversible contraceptive (LARC) methods and desire timely discontinuation, it is imperative to develop and implement standardized metrics for their removal.
随着皮下避孕植入物在撒哈拉以南非洲地区的使用增加，提供以患者为中心的取出服务对于保障生殖自主权比以往任何时候都更加关键。2016年，克里斯托菲尔德和拉科斯特提出了八项以客户为中心的植入物取出条件，但这些条件在大规模调查中的评估程度仍未得到检验。我们的梳理工作收集了来自撒哈拉以南非洲地区三个大型数据收集平台的调查信息，包括人口与健康调查（DHS）、行动绩效监测（PMA）和服务可用性与准备情况评估（SARA），利用在妇女、卫生设施、提供者和客户中实施的问卷工具，对照这些条件梳理现有数据源。我们的研究结果显示，八项条件中有四项被完全涵盖，三项被部分涵盖，一项在当前基于人群或设施的调查中完全缺失。具体而言，在六项基于设施的条件中：完全涵盖的三项条件包括用品的可用性（条件2）、处理困难取出情况的系统（条件3）以及提供咨询和重新植入选择（条件5）；部分涵盖的两项条件包括有能力且自信的提供者（条件1）和对客户来说的可承受性（条件7），而缺失的一项条件是监测取出数据的测量系统（条件8）。在两项个人层面的条件中，及时且就近的服务（条件4）被部分涵盖，而对去哪里取出的知识和认知（条件6）被完全涵盖。在克里斯托菲尔德和拉科斯特提出这些以客户为中心的条件近十年后，缺乏以客户为中心的植入物取出的一致衡量标准，对理解服务可及性和妇女的生殖经历构成了重大障碍。为了保护使用长效可逆避孕（LARC）方法且希望及时停用的个人的生殖自主权，制定并实施关于其取出的标准化指标势在必行。
