Contraception, or birth control, can take a number of forms including drugs, devices, or surgery to prevent pregnancy. Methods can be long-acting or short-acting. Obasanjo Bolarinwa, who teaches public health and global healthcare management, unpacks his research into the use of long-acting contraceptives among sexually active women in 26 sub-Saharan African countries.

What are the advantages of long-acting reversible contraceptives?

Long-acting reversible contraceptives are among the most effective birth control options. They offer protection from pregnancy for several years without the need for regular attention. They include contraceptive implants, placed just under the skin of the upper arm, and intrauterine devices, which may be hormonal or copper-based.

They can last from three to 10 years. Unlike short-term options such as pills, condoms or injectables, they work continuously once inserted. As a result, the failure rates of intrauterine devices and implants are extremely low at less than 1% per year. The failure rates are measured by counting the number of unintended pregnancies among women using these methods, dividing by the total number of users over a set period. The figure is then expressed per 100 women-years of use.

The “reversible” feature means that once it is removed, fertility usually returns quickly, making them suitable for women who want long-term protection but may still wish to have children later.

In high-income countries, their use has increased steadily. This is driven by policies promoting access, public awareness campaigns and routine integration into reproductive health services. Within just 15 months of introducing the policy, the number of women receiving long-acting reversible contraception rose by nearly 50% compared with what would have been expected without the change.

There are some risks and side effects though. These can include changes in menstrual bleeding patterns, such as heavier or lighter periods, pelvic pain and, in rare cases, iron-deficiency anaemia.

Some women discontinue use due to discomfort or side effects, while others are discouraged by myths that long-acting reversible contraceptives cause infertility or harm sexual health.

These misconceptions are powerful barriers in some communities.

Read more: Why family planning matters for maternal deaths and child survival

What’s the prevalence of use in Africa?

I led a study across 26 sub-Saharan African countries into the use of long-acting reversible contraceptives. These included intrauterine devices and implants used by sexually active women aged 15 to 49.

The study analysed recent Demographic and Health Survey data from 26 countries between 2010 and 2019.

The evidence shows that long-acting reversible contraceptives remain underused in much of Africa. And their use among sexually active women using modern contraception varies dramatically across sub-Saharan Africa.

The study found that on average, 21.73% of all sexually active women used these contraceptives.

This means that nearly four in five women in the region still rely on short-term methods.

The highest prevalence rates were recorded in Benin (54.96%), Mali (48.52%) and Tanzania (43.95%). In these countries, nearly half or more of women using modern contraception choose a long-acting method, suggesting strong acceptance and availability.

At the other end of the scale, Namibia had the lowest prevalence at 1.94%, followed by Togo at 4.50% and Niger at 4.80%. In these countries, short-term methods dominate, and long-acting options remain a small fraction of contraceptive use.

Why the big differences in use?

These differences highlight the uneven progress in integrating these contraceptives into national family planning strategies.

High-use countries often have active government and NGO programmes that make long-acting reversible contraceptives widely available and affordable. They also tend to provide regular community outreach and education, helping women understand the safety, reversibility and benefits of these methods.

In addition, higher uptake is often linked to strong national family planning programmes, regular supply of devices, and community education.

Low-use countries may face gaps in service delivery, such as limited numbers of trained providers, stock-outs, higher out-of-pocket costs, and weaker public awareness campaigns. Cultural and social norms that discourage contraception can also play a role, making it harder to build demand.

This points to women lacking access to trained providers or accurate information. Others face cultural and social barriers, including myths about infertility and health risks.

The contrast between high- and low-use countries offers valuable lessons. By learning from successful programmes, countries with low uptake can identify practical strategies to expand access and promote informed choice.

For example, high use in countries such as Benin, Mali and Tanzania is usually the result of sustained investment in family planning services and strong political commitment. In these settings, they are integrated into routine reproductive health care, including antenatal and postnatal services.

They are also provided by trained health workers at multiple service points. Public campaigns actively promote their benefits and address common misconceptions. These countries also have supply systems that minimise stock-outs, ensuring women who want one can get one without delay.

In low-use countries such as Namibia, Togo and Niger, barriers are often more complex. Health facilities may not have the equipment or trained staff needed for insertion and removal. Supply chains may be unreliable, leading to stock-outs. Women may need to travel long distances to find services, and in some cases, they face out-of-pocket costs that make them less accessible.

Cultural factors can also reduce uptake. Misconceptions about infertility, fear of health risks, and social expectations about childbearing can discourage women from choosing long-acting methods. Without targeted community education and supportive policies, these barriers remain entrenched.

Read more: Nigeria’s cities are growing fast: family planning must be part of urban development plans

What needs to be done?

A multi-pronged approach is needed. This should include improving the supply of devices, training more providers, running culturally sensitive public education campaigns and ensuring affordability.

Understanding what long-acting reversible contraceptives are, how they work, and why they are safe is essential for increasing their use.

Expanding access requires investment in supply chains, training for health workers, and culturally sensitive awareness campaigns. With sustained effort, they could play a much larger role in reducing unintended pregnancies and improving maternal health across the region.

Overcoming fears, including misconceptions about these contraceptives, requires accurate counselling by trained providers and public health messaging tailored to local cultures. When women are fully informed and have access to quality services, their benefits outweigh the risks.

Ensuring women can make an informed choice is essential to maintaining confidence in these methods and improving long-term satisfaction and continuation rates.

This article is republished from The Conversation, a nonprofit, independent news organization bringing you facts and trustworthy analysis to help you make sense of our complex world. It was written by: Obasanjo Bolarinwa, York St John University

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Obasanjo Bolarinwa does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.