Contraceptive Research, Introduction, and Use Lessons From Norplant, Summary (1998) / Chapter Skim
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2. Data Review
2. Data Review
Pages 3-7
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From page 3... ...
The report to the workshop was that at present, the quality of the available data does not permit any such conclusions but that until better human studies become available, clinical management of highrisk clients should emphasize protection from sexually transmitted infections through condom use and other safe sexual practices, with optimal contraceptive protection accorded secondary priority. User Profiles The characteristics of the women in international samples differed too substantially from country to country to permit easy generalizations.
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From page 4... ...
The overall pattern is that continuation rates are generally high through the first 2 years of use and not strikingly dissimilar from sample to sample, except in those studies that found discontinuation correlated with negative media coverage. Although there are great differences by country and although the data for the United States are scanty (partly because of low utilization)
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From page 5... ...
Both women continuing use and those discontinuing saw the best features of Norplant as its convenience and effectiveness; fewer Depo-Provera and pill-users, whether they were continuing use or had discontinued, cited those attributes as those methods' best features. Postmarketing Surveillance The report from the 5-year Postmarketing Surveillance of Norplant confirmed its value not only as a source of knowledge on adverse effects that cannot be identified in clinical trials, but as evidence that large-scale, longer-term surveillance studies using cohort methodology can now be considered feasible in developing countries.
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From page 6... ...
The great preponderance of the method's difficulties were those that have to do with larger, systemic difficulties in assuring provider training and evidence of competency, delivery system capacity for assuring the quality of all required services, the adequacy and appropriateness of counseling and communication, and the character and timing of consumer involvement. Providing and Receiving Training in New Contraceptive Methods Are Equally Critical Complicated implant removals were the basis, in 1994, of the first lawsuit involving Norplant and the subsequent flood of media coverage and litigation.
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From page 7... ...
The lesson here is a description of what communication about contraceptive choice would ideally be: a continuum spanning appropriate and intelligible product labeling; adequate provider training, collaboration between provider and client at the point of method choice; and support for clients in dealing with side effects and possible discontinuation, all the way to removal on demand or as approved efficacy ends and a new contraceptive choice must be made. This would optimally occur as truly twoway dialogue; information exchanged and necessary understandings would be complete and unconstrained by time; dialogue would be ongoing across tl~e fill course of contraceptive use; client participation in contraceptive choice would be truly voluntary; and the hierarchical distinctions between provider and client would be muted to the extent necessary for all this to happen.
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