The evolution of implants

A version of this post originally appeared on Bill & Melinda Gates Foundation's Blog, "Impatient Optimists". Reposted with permission.

The evolution of implants

2013 marks the 30th anniversary of the initial approval of Norplant®, the first long-lasting, reversible contraceptive implant. An innovation in contraception, the Norplant system consisted of six rods implanted in a woman’s upper arm that provided up to five years of pregnancy prevention – offering women the same discrete, highly effective, long-term, and reversible contraception offered by the IUD, without the need for a pelvic examination.

Inserting and removing six rods proved cumbersome, however, so Norplant never gained much traction globally. In the 30 years since its introduction, contraceptive implant technology has continued to evolve. Norplant’s successor, Jadelle offers the same level of pregnancy prevention but only entails two silicone rods.

Excitingly, Jadelle has played a pivotal role in bringing implants to the developing world after being approved by the (US) FDA in 2002. In 2006, another implant came onto the market. Implanon offers three years of pregnancy prevention in a single rod implant. Like Jadelle, Implanon has made an impact in the developing world. Because its delivery system is uniquely “preloaded”, health extension workers in developing countries are able to easily insert the implants.

This approach has been particularly successful in Ethiopia which serves as a model of how to effectively reach remote populations with long-acting contraceptives.

While implant technology has advanced over the years, the cost of implants has remained a barrier to access for women. Until recently, the price of Jadelle and Implanon limited the broad expansion of these methods to meet demand, particularly in the developing world. This began to change with the global introduction of Sino-implant (II), a lower-cost implant offering four years of pregnancy protection at a game-changing price of US$8. Efforts to expand global marketing of Sino-implant were initiated in 2008 by FHI 360. Sino-implant is now registered in 24 countries in Sub-Saharan Africa, Asia, and Latin America.

But easily one of the biggest achievements in the field of contraception in a decade is a recent public-private partnership that has resulted in a more than 50 percent price reduction of Jadelle– from US$18 to US$8.50 per unit– effectively making the cost of Jadelle comparable to Sino-implant (II). The price of Implanon has also dropped markedly but is not currently at the same level as Jadelle and Sino-implant (II).

What does this mean for women in the developing world who don’t want to get pregnant yet lack access to contraceptives? Ultimately, the global community has come together to help ensure that more women have greater access to a variety of contraceptive methods, including long-lasting reversible implants.

Opportunities to advance contraceptive implant technology also continue to be explored. FHI 360 is supporting efforts to develop a biodegradable implant through a USAID-funded project. Such advancement would mean that women would not require clinic services for implant removal; rather the implant would dissolve over time. Others are investigating refinement of removal technologies to make the process faster and less invasive.

Contraceptive implants have made incredible gains in the past 30 years. The strong partnerships that have formed to lower prices and increase access continue to give more women in developing countries the ability to plan their families.

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