Three countries' experience with Norplant introduction

Health Policy Plan. 1997 Sep;12(3):199-213. doi: 10.1093/heapol/12.3.199.


Despite international efforts to plan for Norplant introduction, the method has drawn the attention of critics of family planning programmes, and has raised several issues for debate since it was introduced into family planning programmes. The experiences of three countries with the introduction of Norplant highlight some of the unique features of the method that have affected its introduction. Indonesia, Bangladesh and the United States represent diverse cultural settings and systems of family planning provision. Experience in each country has highlighted the need to focus on quality of care for clients, most notably the need for good counselling and attention to removal as well as insertion. The cost of Norplant also has influenced its introduction in each country. Another issue includes the need to work with women's health advocacy groups, which is illustrated particularly in Bangladesh. Finally, the role of litigation in the United States, and its potential role in influencing Norplant introduction in other countries, is discussed. These three countries' experience illustrate the importance of understanding the programmatic context of contraceptive introduction.

PIP: Norplant has been registered and approved for use in 40 countries and, worldwide, almost 3 million women are estimated to be using the method. Before becoming widely available, Norplant underwent more than 25 years of development and evaluation, with more than 55,000 women participating in clinical or preintroduction trials of Norplant in 46 countries in which safety, efficacy, and acceptability were extensively studied. Attempting to avoid the mistakes made introducing the IUD, international organizations made a concerted effort to plan for Norplant's introduction. Even so, Norplant's introduction has garnered the attention of family planning program critics, fueling debate since it was introduced into family planning programs. The authors discuss Indonesia, Bangladesh, and the US's experiences with the introduction of Norplant, noting some of the method's features which have affected its introduction. Experience in each country has demonstrated the need to focus upon quality of client care, especially the need for good counseling and attention to both device insertion and removal. The cost of Norplant has also influenced its introduction into each country. A need exists to work with women's health advocacy groups, especially in Bangladesh. The role of litigation in the US and its potential to influence Norplant's introduction in other countries are discussed.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.
  • Review

MeSH terms

  • Adolescent
  • Adult
  • Bangladesh
  • Contraceptive Agents, Female / adverse effects
  • Contraceptive Agents, Female / economics
  • Contraceptive Agents, Female / therapeutic use*
  • Drug Industry
  • Family Planning Policy*
  • Female
  • Government Programs / organization & administration*
  • Humans
  • Indonesia
  • International Cooperation
  • Levonorgestrel / adverse effects
  • Levonorgestrel / economics
  • Levonorgestrel / therapeutic use*
  • Liability, Legal
  • Male
  • Patient Education as Topic
  • Quality of Health Care
  • United States


  • Contraceptive Agents, Female
  • Levonorgestrel