A scoping review on the use of long-acting reversible (LARCs) in Nigeria

p class="content-c text-justify">Unplanned pregnancies and births are becoming prevalent in Nigeria [1]. In 2003, 14% of births in Nigeria were unplanned—mistimed (9%) or unwanted (5%) [2]. This is a higher proportion than in 1990, when 11% were unplanned [3]. Henshaw et al. [4] also estimated that 12% of all pregnancies in Nigeria (not including those that result in spontaneous abortion) end in induced abortion, and another 9% result in unplanned births. Unplanned pregnancies can reduce parents’ educational attainment and earning potential [5], burden hospital systems, and government funds [1]. Hence, the need for increased use of contraceptives by Nigerian women.

A variety of contraceptive options are available. These can be grouped into three broad categories: short-acting contraceptives like pills and condoms, long-acting reversible contraceptives (LARCs) and permanent contraceptive methods (e.g. sterilization) [6].

LARCs refer to contraceptives that are reversible and require administration less than once per cycle (ie per month) [5]. They include copper and progestogen only intrauterine devices (IUDs), and progestogen-only methods of contraception (Injectables and Implants) [7,8].

LARCs have varied advantages and are among the foremost effective contraceptives. They can prevent pregnancy for 3 to 10 years independent of user action [1]. Their 'typical use' failure rates are less than 1% each year, which is about the same as their 'perfect use' failure rates [9]. When compared to other contraceptives, LARCs are statistically less likely to result in an unintended pregnancy than with short-acting reversible contraceptives and permanent contraceptive methods (e.g. vasectomy, tubal ligation) [10][11]. The primary benefit of LARCs is that their effectiveness is not dependent on client’s daily adherence [12]. They are the ideal safe, long-acting, reversible, convenient contraceptives for most women including adolescents [12]. As a plus to the afore-mentioned advantages, they also provide benefits beyond contraception, by reducing heavy menstrual bleeding and menstrual pain [13].

Irrespective of their associated advantages, LARCs are still underutilized by Nigerian women as compared to other short-acting reversible contraceptives [2,3,14–16]. Studies in other African countries also documented deep-seated resistance to the use of modern contraceptives [17,18]. Political, religious, ethical, safety concerns, misconceptions, lack of knowledge or skills by healthcare provider, low awareness of the benefits of LARCs, and high upfront costs are major barriers to heightened use [12]. For instance, due to poor information on the use of LARCs, many healthcare providers were found reluctant to offer intrauterine contraceptive devices to women who have never had a live birth [19,20]. It is very crucial that misconceptions about LARCs are dispelled based on current evidence to increase the uptake especially among Nigerian women.