Introducing Long-Acting Contraceptive Removal Indicators in a Pilot Study in Mozambique: Dynamics of Discontinuation and Implications for Quality of Care.

INTRODUCTION: The recent increase in the use of long-acting reversible contraceptives (LARCs) will result in an equal increase in the need for removals. Few countries monitor the number of LARC removals and even fewer track reasons for removal, discontinuation, and method switching. We conducted a mixed-method study to pilot the introduction of 5 LARC removal indicators in Mozambique: (1) reason for seeking removal, (2) duration of use, (3) removal outcome, (4) reason for referral, and (5) family planning (FP) outcome. We assessed providers' perceptions about the feasibility and utility of tracking these indicators and reviewed the findings to ascertain the quality-of-care concerns. METHODS: We used a purposive, multistage sampling technique to select 19 intervention facilities in Nampula and Sofala provinces. Over 6 months, we abstracted data on the 5 indicators from an FP register addendum to determine when and why clients seek LARC removals and identify service quality issues that need to be addressed in the FP program. We used a supportive supervision checklist to assess the time taken to record data on the indicators and perceived benefits and challenges encountered by providers during record keeping. RESULTS: Of the 795 clients who sought a LARC removal, 112 women (14.1%) opted not to have the removal after counseling. The most frequently reported reasons for seeking a removal were: the method was on-schedule for removal or past its expiration date (29.5%), complaints of side effects (25.8%), and desire to be pregnant (22.9%). Health care providers reported no major challenges in recording information in the addendum. Reasons for and timing of removal pointed to the need for strengthening FP counseling. CONCLUSION: Collecting, synthesizing, and interpreting data from the LARC removal indicators was feasible and provided valuable insights to improve the quality of care to enhance clients' reproductive health care and contraceptive choices.

The role of men as partners and fathers in the prevention of mother-to-child transmission of HIV and in the promotion of sexual and reproductive health.

Despite ample evidence documenting the positive impact of men on the prevention of mother-to-child transmission (PMTCT) and other sexual and reproductive health programs, men's engagement remains very low. This paper examines the current level and nature of male involvement and identifies opportunities for the advancement of men's constructive engagement in PMTCT and sexual and reproductive health. Conceptual and policy barriers have encouraged the inadvertent exclusion of men from PMTCT and other reproductive health services. The historic institutionalization of reproductive health as women's health has generally resulted in health services that are not welcoming of men and has undermined efforts to engage couples. This paper argues that to maximize the health outcomes of PMTCT and sexual and reproductive health programs for women and men, we must move beyond seeing men as simply "facilitating factors" that enable women to access health-care services. Men need to instead be recognized as a constituent part of reproductive health policy and practice. The paper proposes strategies for policy makers and program leaders to engage men and couples to foster communication and shared decision-making. This approach can both help to achieve health goals and engender more equitable relationships between men and women.