Table 3.

Illustrative narratives of user experiences accessing implant removals services.

Narrative A: User 01 is aged 25 years and has one child. She used an Implanon NXT® implant for 15 months but decided to remove it due to associated side effects. She had experienced recurrent headaches, tiredness and weight gain since initiating the implant. She also disliked the loss of her usual menstrual cycle, “I was not getting my period, I just felt dirty.” She felt that providers failed to address her concerns, “I just feel that I was not listened to, both the two nurses did not listen to me.” She attended three different clinics seeking implant removal, “I have been going to clinics for months now looking to remove it.” She encountered provider resistance at the first clinic, “I kept being postponed… [The provider] said that she doesn't know what it is with women, they come running to insert the implant and then they are the very same people who come running to have it removed.” At the second clinic, she could not get an appointment because there was only one implant provider, “When I got there the lady would always yell and put down dates for me that were very inconvenient as I was still working at the time.” She underwent implant removal at the third clinic, the NGO clinic, after a total delay of 3 months.

Narrative B: User 05 is aged 38 years, has three children and lives in a village to the west of Gaborone. She used a Jadelle® implant for 5 months after having it inserted at a government clinic in her neighboring village. She disliked side effects, including lack of menstrual bleeding, and also experienced abdominal pain. First, she went to the clinic where she had the implant inserted, “where I was given the runaround and they just refused and I gave up.” This clinic encouraged her to persist with the implant and advised that it might not be the cause of her symptoms. Then she went to a government clinic in a neighboring town, “where I went several times until I gave up.” She then traveled 40 km to a government clinic in Gaborone, where she encountered further resistance from the providers and made multiple visits to request implant removal. “After going there several times, and only upon realizing that I meant business about removing, the nurse actually removed one [rod] and then she tried removing the second [rod] but realized that she could not because it was too deep.” The nurse referred her to the NGO clinic where the second rod was safely removed. Overall she visited four clinics, two of which on multiple occasions, and had a delay of 3 months from initial request to obtaining implant removal.

Narrative C: User 06 is aged 23 years and has one child. She usually goes to the NGO clinic for family planning services, and this is where she had an Implanon NXT® implant inserted. She had the implant removed at the same clinic two and a half months later due to side effects (headache, irregular vaginal bleeding). She had no delay to removal, having had it removed at her first clinic visit requesting removal (“It was very easy, they didn't give me any grief”).

NGO, non-governmental organization.