The Norplant Paradox in Low-Resource Settings: High Efficacy Versus Low Adoption Across India and Neighbouring Countries – A Systematic Review

Abstract Background: Norplant, a subdermal contraceptive implant, has seen variable adoption across Asia despite its high efficacy (>99%). This review evaluates its current position in India/Asia, analyzing utilization trends, advantages, and challenges. Methods: A systematic search of PubMed, Scopus, and ICMR databases (2010–2023) identified 42 studies meeting inclusion criteria (PRISMA guidelines). Data were synthesized thematically. Results · Norplant use remains low (<5% contraceptive share) in India but is rising in Southeast Asia (e.g., Indonesia: 12% uptake). · Key advantages: Long-term efficacy (5 years), non-estrogenic, and user independence. · Major barriers: Cost (₹8,000–12,000 in India), irregular bleeding (reported in 60% of users), and provider training gaps. Conclusion: Norplant is underutilized in India/Asia despite its benefits. Policy interventions addressing cost, side-effect management, and provider education are needed to expand access.