Contraceptive implants are small, flexible rods or capsules placed subdermally, usually in the inner aspect of the upper arm. They represent one of the most effective forms of reversible birth control available today. Once inserted, they release progestin steadily into the bloodstream over a period that ranges from three to five years, depending on the specific product. For Nigerian healthcare settings, implants offer a discreet and long-acting solution that helps reduce unintended pregnancies and maternal morbidity without requiring daily adherence from the user.
The contraceptive effect of progestin-only implants relies on three main physiological actions:
Several types of contraceptive implants circulate within the Nigerian health sector, supplied through public health facilities, social marketing, and private clinics.
| Implant Name | Number of Rods | Duration of Action | Hormone Type |
|---|---|---|---|
| Jadelle | 2 rods | 5 years | Levonorgestrel |
| Implanon NXT | 1 rod | 3 years | Etonogestrel |
| Norplant | 6 rods | 5 years | Levonorgestrel |
Norplant is largely phased out in modern clinical practice due to the complex removal process of its six rods, making single-rod and two-rod systems the standard of care.
Healthcare providers use the World Health Organization Medical Eligibility Criteria for Contraceptive Use (WHO MEC) to screen clients. Most women can safely use progestin-only implants, including postpartum and breastfeeding mothers, adolescents, and women with a history of iron-deficiency anemia.
Conditions categorized as WHO MEC Category 3 or 4, where the theoretical or proven risks generally outweigh the advantages, include current breast cancer, acute liver disease, unexplained vaginal bleeding before evaluation, and active thromboembolic disorders.
Comprehensive counseling ensures informed choice and manages expectations, particularly regarding changes in menstrual bleeding patterns, which remain the primary reason for premature discontinuation. Nurses must discuss common side effects openly, rule out existing pregnancy through a careful history or pregnancy test, and check vital signs. Obtaining written or verbal informed consent is mandatory before setting up the sterile field for the procedure.
Proper insertion requires strict aseptic technique. The nurse cleanses the inner side of the non-dominant upper arm, injects a local anesthetic like lidocaine, and uses the specialized trocar provided by the manufacturer to place the rod subdermally just beneath the dermis. Deep insertions must be avoided to prevent nerve or vessel injury and make future removals difficult. Removal requires a small incision near the base of the implant, gentle manipulation to push the tip toward the incision, and extraction with sterile forceps.
Side effects of implants are non-pathological but can cause anxiety if left unexplained. Altered bleeding patterns range from frequent spotting to complete amenorrhea, which many Nigerian clients worry indicates trapped blood or infertility. Reassuring the client that amenorrhea is healthy and normal with progestin methods is critical. Other minor complaints include mild headache, breast tenderness, and localized bruising at the site, which resolve spontaneously without removing the device.
After insertion, the nurse applies a pressure bandage to minimize bruising and swelling, instructing the client to keep the area dry and clean for at least 24 hours. The client should be able to feel the rod under her skin to confirm it remains in place. Routine return visits are scheduled only if problems arise, though clients are encouraged to visit the clinic anytime they experience worrisome symptoms, wish to switch methods, or reach the expiration date for removal.