Barriers to contraceptive implant removal among current and prior implant users in Kisumu, Kenya: Results from a cross-sectional population-based survey

There has been increased promotion of long-acting reversible contraception (LARC) in the Global South in recent years. Studies have documented that women face barriers to removal when they desire to discontinue their LARC method, though few have quantified how often such experiences occur. We estimated the proportion of current and prior implant users who experienced or anticipated challenges with method removal using secondary data from a population-based survey administered to reproductive-aged women (18-49 years) in Kisumu, Kenya. We included women who reported current contraceptive implant use (n = 518) or ever using an implant that was later removed (n = 838). We asked current implant users about their anticipated barriers to removal and experiences seeking removal. We asked those who reported prior implant removal about barriers they faced when seeking removal. Around 40% of current implant users anticipated barriers to implant removal. About 2% of current implant users had sought removal unsuccessfully in the last year, with cost being the most common barrier. Of those who had ever had an implant removed, 15% reported facing challenges with removal, with cost again being the most common barrier. Sociodemographic characteristics were not associated with facing challenges with removal. Many women anticipated or experienced barriers to implant removal. Cost was the most common barrier reported, highlighting the importance of eliminating fees associated with removal to ensure all women can discontinue their method when desired.