From 1987 to 1997, approximately four million Indonesian women had a Norplant insertion. Concerns have been raised about the timely removal of the implant within a few days of the user's request or at the end of the recommended five years of use and about the possibility of a large and rapidly increasing backlog of removal cases developing. This study of 2,979 Indonesian women in 14 provinces, all of whom had had Norplant inserted five or more years before they were interviewed, reveals that 66 percent had obtained removal by the end of the fifth year of use and 90 percent had done so by the end of the sixth year of use. The data from this study strongly suggest that no large backlog of removal cases exists, particularly after the sixth year of use. The major reason for the underreporting of removals is probably clients' use of nurse/midwives, of caregivers in the private sector, and of mass safari camps, because records from each of these sources are poor or nonexistent.
PIP: Approximately 4 million Indonesian women received Norplant contraceptive implants in 1987-97. Concerns have been raised about the timely removal of the implants within a few days of the user's request or at the end of the 5-year recommended period of use. According to some estimates, a backlog of 467,000-650,000 overdue removals exists. To assess the validity of these concerns, 2979 Indonesian women from 14 provinces who had Norplant inserted five or more years earlier (1987-91) were interviewed in 1996. 27% had undergone removal and had a second implant inserted, 41% had undergone removal and switched to another contraceptive method, 25% had undergone removal and were currently not using any method, and 8% had not yet undergone removal. Major reasons for not having the implants removed included forgetting the recommended removal date, fear of the removal process, and the high cost of removal. Given the finding that 66% of removals were performed by nurses or midwives and 23% occurred in safari camps, it is possible that a sizable number of removals were not recorded in the service statistics system. Although many women may use Norplant past the recommended time for removal, these findings suggest that there is no large backlog of removal cases, particularly after the 6th year of use. Creating service delivery conditions that allow women their right to easy access to removal is essential, however.