Family planning in Sub-Saharan Africa: a review of interventions in promotion of long-acting reversible contraception

International non-governmental organizations (INGOs) in the field of sexual and reproductive health (SRH) consider access to family planning services a universal human right. Family planning programs should strive to effectively provide information, counseling, and contraceptive services to allow women and men the ability to freely determine when and how many children they desire to have.\ud \ud In developing regions of the world, women are often unable to obtain or use modern contraception (mC) for many reasons relating to both supply and demand side factors. Use of mC is lowest in Sub-Saharan Africa (SSA). Unmet need (i.e., women who desire to delay childbearing but are not using any methods to do so) is highest in this region as well. Higher rates of unintended pregnancy are directly related to low mC use and high unmet need. The public health significance of this relationship is great: unintended pregnancy has grave health implications for maternal and child morbidity and mortality in the developing world. \ud \ud Women of reproductive age in SSA rely primarily on traditional and short-acting reversible contraception, which are prone to incorrect or inconsistent usage and failure. By contrast, long-acting reversible contraception (LARC) provides up to ten years of highly effective protection against pregnancy. LARC methods are among the safest, most cost-effective, and reliable forms of contraception available today. LARC includes the copper intrauterine device (IUD), levonorgestrel intrauterine system (LNG-IUS), and contraceptive implant. These methods are appropriate for most women, and can be used to space or limit childbearing until the user is ready to have children.\ud \ud LARC methods have historically been underutilized in SSA, where they could benefit millions of women seeking to control their fertility. Relatively few interventions exist within the international development field where LARC has been sustainably introduced into the mC method mix in SSA. This paper reviews and examines the literature on published interventions, and provides international development practitioners with useful recommendations for LARC promotion in family planning programs moving forward. These recommendations include decentralizing health care networks, building capacity in service delivery and skills training, and conducting advocacy and education through social and behavioral change communication (SBCC).\u