Following adverse widespread publicity in the United Kingdom and the United States, it is commonly believed that discontinuation rates for the contraceptive implants Norplant in the UK are high. We have compared discontinuation rates between new intrauterine device (IUD) users (253 women) and new Norplant implant users (502 women) over 33 months following the introduction of Norplant implants among a population of women attending the same clinic and counseled in the same manner by the same group of providers. Women choosing the IUD were slightly older and were more likely to be changing their contraceptive method because of dissatisfaction with their current method. Nor plant implant users were more likely to have completed their families. Continuation rates for Norplant implants were significantly higher than for IUD at 12, 18, and 24 months after insertion. At 24 months, continuation rates for Norplant implants were 72% compared with rates of 55% for IUD users. Higher continuation rates may be related more to factors associated with the providers than with the users of these two long-acting methods.
PIP: Widespread adverse publicity in both the US and UK about side effects associated with Norplant contraceptive implants is generally assumed to have resulted in high discontinuation rates. The accuracy of this assumption was investigated in a comparative retrospective study of discontinuation rates among new first-time IUD users (n = 253) and new Norplant acceptors (n = 502) attending the same large family planning clinic in Edinburgh, Scotland, and counseled by the same providers in the 33-month period after Norplant introduction (1993-95). The most common reason for Norplant selection was as an alternative to sterilization, while IUD requests tended to be based on dissatisfaction with other methods. IUDs were removed steadily over time, at an average of 3.2/month. Norplant removals increased with time, from a monthly mean of 1.4 in the first 18 months to 7.8 in the subsequent 15 months. Continuation rates at 12, 18, and 24 months were 84%, 80%, and 71.8%, respectively, in the Norplant group compared with 70%, 63%, and 54.6%, respectively, among IUD users. For both methods, the predominant reason for removal was bleeding problems. These findings demonstrate that, contrary to popular assumption, women who have been well counseled manifest high Norplant implant continuation rates.