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Long-acting and Permanent Methods

Long-acting (intrauterine devices and implants) and permanent methods (female and male sterilization) of contraception are highly safe and provide continuous protection against unwanted pregnancy, have the ability to meet a range of clients’ intentions (i.e., can help them delay, space, or limit births), and promote greater continuation of family planning (FP).

Yet, long-acting and permanent methods (LA/PMs) are the least available and least used methods in the majority of developing countries. FP programs can best meet their goals by responding to existing unmet need, and unmet need for LA/PMs remains particularly high. To do so, however, requires an investment in making available a balanced contraceptive method mix that includes LA/PMs among the choices and options. Only then will a program optimize its reach and effectiveness.

The core indicators presented here can help programs assess their success at expanding contraceptive choice by providing LA/PMs. Indicators related to these methods are best framed in a holistic model such as EngenderHealth’s Supply-Enabling Environment-Demand (SEED) Programming Model . The foundation of the SEED Programming Model is that sexual and reproductive health programs will be more successful and sustainable if they comprehensively address the multifaceted determinants of health and if they include synergistic interventions that:

  • Attend to the availability and quality of LA/PM services and other supply-related issues. Quality LA/PM services rely on adequate infrastructure, supplies, and equipment being in place. The availability of staff well-trained, skilled, motivated, and supported to provide LA/PM services is key; they need to perform to established standards and provide services that are accessible, acceptable, and accountable to the clients and communities they serve.
  • Strengthen health systems and foster an enabling environment to support LA/PM services.  The socio-cultural, economic, and political environment influences the functioning and sustainability of FP programs that provide LA/PMs (supply), as well as the social norms surrounding healthy behavior (demand). An enabling environment requires supportive cultural norms and policies; adequate resources; good governance, management, and accountability; and gender equity.
  • Improve knowledge of LAPMs and cultivate a demand for them. Many barriers can keep people from realizing their sexual and reproductive well-being, and service availability is often the least of these. Individuals, families, and communities must have the knowledge of the full range of FP methods, capacity, and motivation to ensure sexual and reproductive health. Programs need to advance a positive attitude toward sexual and reproductive health, including LA/PMs, address myths and misconceptions, provide evidence-based information about LA/PM issues and risks, and promote available services. LA/PMs need to be included in the range of behavior change communications interventions—from basic health education and counseling to peer promotion, social marketing, and mass media communication.