Roots of Health

PROGESTIN
SUBDERMAL
IMPLANT (PSI)
UTILIZATION
2016-2019
Executive Summary

Olivia Wood
Monitoring and Evaluation Graduate Fellow
Columbia University Mailman School of Public Health
 TABLE OF CONTENTS
1 Organization Background
Information about the PSI ............................................................... page 3

2 Client Demographic
Percent of Young Adults Using Implants ............................. page 4
Number of Children .................................................................... page 5

Civil Status ..................................................................................... page 6

Previously Used Method of Contraception ........................... page 7

3 Roots of Health Insertions and Removals .................................... page 9

Total Insertions and Removals ........................................................ page 10

4 Reasons for Implant Removal ........................................................ page 11

Reinsertion Rate of Expired Implants .............................................. page 15

5 Summary and Takeaway ................................................................... page 16

 ORGANIZATION
BACKGROUND
Founded in 2009, Roots of Health or
Ugat Ng Kalusugan provides
reproductive healthcare, education,
and family planning resources to
women living across the province of
Palawan. Roots of Health operates
under the simple principle that
healthcare is a human right and it is
every woman’s right to control her
reproductive health.

PROGESTIN SUBDERMAL
IMPLANT (PSI)
The Progestin Subdermal Implant (PSI) is a hormonal
contraceptive method that is extremely effective at
preventing pregnancy due to its ease of use. Inserted
into the patient’s upper arm, the PSI does not interfere
with daily activity and, once inserted, provides
protection for up to three years and can be removed at
any time. Although some sources have claimed the PSI
is abortifacient, it does not cause or induce abortions.
The PSI is a safe and effective method to prevent
pregnancy, especially for women who cannot use
estrogen containing contraceptive methods. Roots of
Health provides contraceptive counseling and implant
insertion at its clinic in Puerto Princesa, as well as on
missions that occur throughout the region. All services
are provided free of charge to clients.

page 3
 CLIENT DEMOGRAPHIC

Percent of Young Adults Using Implants

Women and girls who seek

contraceptive methods must navigate
difficult social barriers, including Roots of Health has offered the
stigma and labeling about one’s sexual PSI in their clinic since 2015 and
activity. Although girls can get was one of the first organizations
contraceptives at Barangay Health to do so. Since 2016, the number
Centers with adult consent, some of young adults ages 13-24 who
midwives will turn girls away who are use implants has increased by
under 17. Because of this, implants are 20%, with only 9.7% of young
primarily utilized by older women who adults using implants in 2016 and
have already had children or are over 30% of young adults in 2019.
married. These norms leave young This is extremely significant when
women and girls exposed to unwanted one considers that a pregnancy
pregnancy. Changing the common that occurs during these years
narrative surrounding contraception has substantial effects on a
and reproductive health will encourage woman’s social and economic
young adults to freely seek out potential, as well as physical
contraception, thus reducing rates of effects if pregnancy occurs in
unwanted or unplanned pregnancies. young girls.

Percent of Young Adults (ages 13-24)

Using Implants
Through education
and advocacy, Roots
of Health has
empowered young
women to take
control over their
health and futures.

page 4
 CLIENT DEMOGRAPHIC

Number of Children

Roots of Health serves women and girls of all ages and socioeconomic statuses,
regardless of whether or not they already have children. As mentioned, there is
stigma associated with contraceptive use in Palawan. Additionally, contraception
is often framed as a family planning method geared towards married couples
who are interested in spacing or limiting the number of births. Very rarely is it
marketed towards young, unmarried women. As a result, the percent of women
without children who utilize contraception has historically been low.

How Many Implant Users Don't Have Average Number of Children Among
Any Children? Implant Users

In 2016, only 0.20% of women who got an implant inserted had

no children, with the average number of children per woman
being 3.08. In 2019, thus far, the number of women who have
sought out an implant has increased greatly to 2.09%. The
average number of children per woman has remained relatively
constant at 2.86. Such a sharp spike in women without children
choosing to have an implant inserted demonstrates the positive
effects of Roots of Health’s efforts to educate and reduce
stigma. Reproductive health norms in Palawan are shifting for
the better.

page 5
 CLIENT DEMOGRAPHIC

Civil Status

Because contraception is overwhelmingly framed as being a birth spacing or

limiting option for couples, most women who have an implant inserted are
already married. Such framing discourages single women from using
contraceptives, even if they are sexually active. Roots of Health has worked
tirelessly to reframe contraceptives as a good option for all women who do not
wish to get pregnant, regardless of age or civil status. These efforts have been
extremely effective in increasing the number of single women who have
implants: in 2016, only 1 single woman had an implant inserted. In 2019, 335
single women sought out the PSI. This is an incredible increase. Not only
does it indicate that women who wished to use contraceptives had their need
met regardless of civil status, but it also demonstrates the empowering effect
of ROH’s work in the community.

Civil Status of Implant Insertions from

2016-2019
A 43% increase in
implant insertions
among single women
was observed from
2016-2019, which
corresponds to
hundreds more
women who are
protected from
unwanted pregnancy.

page 6
 CLIENT DEMOGRAPHIC

Previously Used Method of Contraception

Many women who seek to have an

implant inserted previously utilized
a different form of contraception. Previously Used Method of
Such women are categorized as Contraception 2016
shifters or restarters based on their
contraception status at time of Shifters
implant insertion.

In 2016, among shifters, or those

who immediately switch from a
different method of contraception,
the most popular previously used
method was the pill. Among
restarters, or those who opt to take
a break from using any
contraceptive method, the most
popular previously used method Restarters
was also the pill. In 2017, most
shifters utilized the pill, while the
majority of restarters used DMPA. In
2018, both shifters and restarters
utilized the pill prior to using the PSI.
Finally, in 2019, DMPA was the
contraceptive of choice among
shifters and the pill was used most
frequently among restarters.

page 7
CLIENT DEMOGRAPHIC

Previously Used Method of Contraception

Previously Used Method of

Contraception 2017

Shifters Restarters

Previously Used Method of

Contraception 2018
Shifters Restarters

Previously Used Method of

Contraception 2019
Shifters Restarters

page 8
 INSERTIONS AND REMOVALS

Roots of Health

Prior to 2015, it was extremely

difficult for women to get a PSI
inserted. Although the ROH Clinic Insertions and Removals
government offered implants to
women, conservative and
religious groups in Palawan
impeded all efforts to distribute
them to women until 2016.
However, in response to the
great unmet need, Roots of
Health began to offer the PSI
to clients in 2015. Since that
time, the Roots of Health clinic
has provided thousands of
women with implants. In 2016,
163 implants were inserted in
the clinic. In 2017, this number Insertion Venue
greatly increased, with 899
women receiving an implant
from the clinic. In 2018, ROH
performed 555 insertions. In
2019 thus far, ROH has inserted
252 implants.

While many implants are

inserted at the clinic, many more
are inserted during missions. In
fact, since 2016, over 10,000
women have been able to
receive necessary care because
of ROH's missions.

page 9
 INSERTIONS
Number AND
of ROH REMOVALS
Insertions and
Removals
Total

Combined insertion and removal data also illuminates trends in implant

utilization across organizations like Roots of Health as well as the government
and private clinics. In 2016, 5,488 women had an implant inserted and only 23
had one removed. In 2017, the number of insertions doubled, with 11,610
insertions and only 296 removals. In 2018, the number of insertions decreased
to 6,313 and removals increased to 734. So far in 2019, there have been 1,524
insertions and 420 removals. While it appears that the number of insertions has
decreased significantly, it is important to note that implants last for three years
and the large wave of clients who had an implant inserted in 2017 are not due
for reinsertion until 2020. Additionally, the number of removals also includes
the removal of expired implants, which are often reinserted immediately
following removal.

Since 2016, Total Insertions and Removals

over 24,935
women have
had an implant
inserted, thus
protecting
themselves
from an
unwanted
pregnancy.

page 10
 REASONS FOR REMOVAL

2016

Throughout the years,

women have reported a
Of the 3 removals that
myriad of reasons for
occurred in 2016, 2 fell
having their implant
under the category of "Not
removed. By analyzing the
Having Sex" and,
most common reasons for
specifically, "Husband is
removal, Roots of Health
Away" and 1 was removed
may be able to better
because the client wanted
frame the implant to
to get pregnant.
women in order to
encourage continued
utilization.

For example, as shown in

the data, a significant
reason women decide to
have their implant removed
is due to side effects like
dizziness and headaches.
Such side effects are
common and may resolve
or diminish over time.
Through targeted
messaging that takes into
account common
complaints women have, it
may be possible to prevent
removals.

page 11
 REASONS FOR REMOVAL

2017

Side Effects
Medical Condition

Problems with Implant

Menstrual Related Conditions

"Side Effects" were

overwhelmingly the most
reported reason for having an
implant removed, with
"Severe Headache" being the
most common subcategory
reported. Not Having Sex

page 12
 REASONS FOR REMOVAL

2018

Medical Condition Side Effects

Menstrual Related Conditions

Shift to Different Method

Problems with Implant Not Having Sex

The most common reason reported

for having an implant removed falls
under the category of "Side Effects"
and "Severe Headache," specifically.

page 13
 REASONS FOR REMOVAL

2019

Side Effects

The most common reason

reported for having an implant
removed falls under the
category of "Problems with
Implant," which was
overwhelmingly due to an
implant expiring.
Menstrual Related Conditions

Problems with Implant

Not Having Sex

page 14
 REINSERTION RATE OF EXPIRED
IMPLANTS

Reinsertion Rates 2017

The PSI is effective for up to

3 years. Once it expires, it
must be removed and a
new implant reinserted in
order to continue being
protected from pregnancy.
In 2017, of the 16 clients
with expired implants, 10 of Reinsertion Rates 2018
them had a new device
inserted immediately. In
2018, of the 151 expired
implants, 108 were
immediately reinserted.
Finally, in 2019, of the 106
expired implants, 64 were
immediately reinserted. Reinsertion Rates 2019
This is significant, as
immediate reinsertion is the
only way to maintain full
protection from unwanted
pregnancy.

page 15
 SUMMARY AND
TAKEAWAY
Since opening its doors in 2009, Roots of
Health has been instrumental in challenging
stereotypes and empowering women and
girls to take control of not only their
reproductive health, but their futures as
well. Through advocacy, education, and the
provision of necessary clinical services,
Roots of Health has enabled thousands of
women to prevent unwanted pregnancies,
and space or limit their births with the PSI.

page 16