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[Unpublished] . 9 p.IPPF relies on its International Medical Advisory Panel (IMAP), formed in 1979, for advice on safety and acceptability of contraceptive methods; service delivery; training of service delivery staff; and scientific aspects of the manufacture of contraceptives. The specializations of IMAP members include contraceptive technology, gynecology endocrinology, public health, and family planning program management. Whereas there was a relatively high demand in the first couple of years after IPPF issued its statement approving Norplant in 1985, and Norplant was added to the commodities list, after 1989 the requests by FPAs for Norplant have diminished, as it is now (1991) considered to be too expensive. The cost of training doctors to insert and remove Norplant is also high and many FPAs are reluctant to train doctors because of the expense. In Pakistan the nearly 100% effectiveness of this method makes it an ideal contraceptive and it can be compared with the IUD, which has 2-4% failure rate. The FPA of Bangladesh Annual Report 1990 stated that 304 cases had been recruited in Rangpur and 308 cases in Dhaka, of which 549 were continuing for 1-3 years. The Thai government is aware that Norplant is expensive and is limiting its use to the rural hilly areas. On an optimistic note, PROFAMILIA, Colombia, plans to expand access to Norplant services at its clinics, which will require additional trained personnel and Norplant implants. The plan is to start this project in January 1992. In Eastern Europe, the Bulgarian FPA expressed an interest in introducing Norplant into its programs. Although the trials concluded that it is an acceptable, long-acting and effective method of contraception, IPPF has only had requests from three countries in 1991 for the supply of Norplant (Indonesia, Bahamas and Kenya). The major constraints on the use of Norplant are its cost, lack of trained personnel, and difficulties in licensing.
[Unpublished] 1991 May 9.  p.Norplant is an effective, long-lasting, reversible contraceptive that provides protection for five years. It consists of six thin, flexible Silastic capsules filled with 36 mg of levonorgestrel, inserted just under the skin of a woman's upper arm in a minor surgical procedure. To date (1991), more than 55,000 women in 46 countries have used it in clinical trials and pharmacological evaluations. The pregnancy rate is 0.2 per 100 continuing users for the first year. The most frequently reported side effect is change in the menstrual bleeding pattern. In addition, headache, nervousness, nausea, dermatitis, acne, weight gain, and some effects on hair as hirsutism and hair loss may be associated with Norplant use. The net continuation rate is over 77% of new acceptors the first year and 35% after five years. Any specially trained physician, nurse, nurse-midwife, or trained health worker can do insertions and removals. To make sure the woman is not pregnant, Norplant should be inserted within seven days after the onset of menstrual bleeding or immediately postabortion. Norplant may be used by almost any woman who is in good health. It is particularly suited for women who want long-term birth spacing or cannot use contraceptives that contain estrogen. It can also be an appropriate method for lactating women starting at least six weeks after childbirth. At present more than half a million women have used Norplant in countries where it has been approved for widespread distribution: Finland (1983); Sweden, Ecuador, Indonesia (1985); Thailand, Dominican Republic, Colombia (1986); Peru, Venezuela, Sri Lanka (1987); Chile (1988); and Kenya, China, Czechoslovakia (1990). Among several other countries, Haiti, Nepal, and Tunisia have also authorized Norplant in their national family planning program. With approval of Norplant by the United States Food and Drug Administration in 1990, the method faces potentially greater demand in the future.