256-260 Kalmuss


term use more appropriate. While the cost of most reversible contraceptives is distributed fairly evenly throughout the period of use, the implant carries a substantial initial expenditure: The median cost of implant insertion ranges from $425 to $550.2 Thus, its cost-effectiveness is directly related to the duration of its use.3 These distinctions highlight the need to understand what factors might predict early implant discontinuation. Women seeking long-term contraceptive protection are likely to find that the benefits of this method outweigh the costs. However, women who opt for early removal undergo two surgical procedures and incur the same expense as women who use the method for a full five years, yet they reap little contraceptive benefit. Moreover, discontinuation of the implant—or of any contraceptive method— heightens the risk of unintended pregnancy, an outcome that may prove costly to the women and to society at large.4 Nonetheless, early implant discontinuation has received surprisingly little study. The limited information available is based primarily on data from developing countries5 or from clinical trials in the United States.6 Other studies of implant discontinuation in the United States have been based on relatively small samples or have focused on adolescents.7 Those U. S. studies that have employed larger samples and wider age distributions have not examined the determinants of implant discontinuation within a multivariate framework.8 Debra Kalmuss is associate professor of public health, Andrew R. Davidson is associate professor of public health and Linda F. Cushman is assistant professor of public health at the Center for Population and Family Health, Columbia University School of Public Health, New York. Stephen Heartwell is associate professor of public health in the Department of Obstetrics and Gynecology and director of the Division of Maternal Health and Family Planning, University of Texas Southwestern Medical School, Dallas. Marvin Rulin is professor, Department of Obstetrics, Gynecology and Reproductive Sciences, Magee Women’s Hospital, Pittsburgh. This research was supported by grant R01-HD29638 from the National Institute of Child Health and Human Development and by grant 93-1071 from the Henry J. Kaiser Family Foundation. Wyeth-Ayerst Laboratories provided Norplant kits free of charge for a portion of the study participants. Determinants of Early Implant Discontinuation Among Low-Income Women

4 Figures and Tables

Cite this paper

@inproceedings{Kalmuss2003256260K, title={256-260 Kalmuss}, author={By Debra Kalmuss and Andrew Robert Davidson and Linda F. Cushman and Stephen F. Heartwell and Marvin Rulin}, year={2003} }