Parallel 2 - Abstract presentations (Oral-019 - Oral-021)

Background: The use of modern family planning methods is subpar in Nigeria as only 12% of married and 28% of sexually active unmarried women currently use modern contraception.This study aims to examine factors influencing re-uptake of family planning following removal among women who received implants and IUD removal services in Nigeria.
Method: A retrospective study of Impact and IUD removal reported in Marie Stopes database. Data for 4,550 clients who had received implants or IUD removal services from Marie Stopes Nigeria's outreach between January 2018 to February 2020 were analysed.

results: Implant removal accounted for about 85% of removal services while IUD removal accounted for 15%. Half of the women (50%) took up removal services because the method expired, 15% desired to get pregnant, 22% experienced side effects while 13% had other reasons. On average, IUDs were removed after 8years and 6months of use while the implants. 104 months and 47 months respectively among those whose device expired. Similarly, IUD and Implants were removed after an average of 30 months and 24 months respectively among those desired to have children. 
The overall rate of FP re-uptake among the 4,550 women was 72% while 28% did not re-use or switched to other methods after removal. Almost half (45%) of the women who did not re-uptake any FP methods desired to get pregnant while 31% discontinued due to side effects. Similarly, among the 3861 (91%) who removed Implants, 52% re-inserted implants while 15% switched to IUD, 4% to short term methods, 2% to permanent methods, and 27% did not re-take any FP methods.
Conclusion: The prevalence of implant and IUCD reuse among clients of MSION supported facilities in Nigeria is high (72%). This is indicative of the women's satisfaction with the method, and the quality of service received.

Annually, more than 20 million adolescent girls aged 15- 19 in developing countries become pregnant, and approximately 12 million give birth. Adolescent pregnancy has become a key public health problem, specifically in sub-Saharan Africa where about 10% of girls become young mothers at age 16, leaving them the highest rates in Africa. The 2018 Nigerian Demographic Health Survey showed adolescent birth rate in 2018 was 106 births per 1,000 women. Kano has an adolescent birth rate of 132, while Lagos is 32. Generally, adolescent births seem higher in the North, specifically in North-Western Zone where the median age of first marriage and first intercourse is approximately 16 years. The USAID/YPE4AH project strategy centers around Youth Hubs, safe spaces for youth to access contraceptives and reproductive health information and referrals. The project adapts and scales up evidence-based activities which combine sports and fun-based activities among adolescent boys and girls (married/unmarried in Kano) aged 15-19. The project uses the Hub-Spokes model and one of the spokes is the Primary Health Care Centers. Contraceptive uptake from March 2022 to August in Lagos and Kano state shows 862 contraceptive uptakes across 2 Youth Hubs and 4,033 uptakes from 9 PHCs in Kano.  Average data per hub=431; per PHC=448. In Lagos, contraceptive uptake across 20 PHC= 939; at the 4 hubs= 2,576. Average data per hub=644; per PHC=47. The trends show adolescents in Lagos visit the youth hub more for contraceptive uptake compared to the PHCs while married adolescents in Kano visit both the PHCs and the youth hubs equally to take up contraceptives. One of the reasons the data appear almost the same in the PHC and at the youth hub in Kano is that only married adolescents are expected to take up contraceptives at the youth hub.

Background/Objectives
Self-injection (SI) of DMPA-SC presents a unique value proposition for the use of the product (Osinowo, et al., 2020). Unfortunately, this practice is still low in Nigeria. As important stakeholders at the state level, family planning (FP) managers are key in reducing the bottlenecks to uptake of FP services. This study aims to identify the barriers limiting the SI uptake among women of reproductive age (WRA) in Nigeria using the perspective of FP managers. Results from this study can provide a foundation for health systems strengthening at different levels and support expansion of access to SI among WRA.
Materials/Methods
This is a cross-sectional descriptive study, conducted among FP coordinators from all 37 states of the country. A data collection tool was developed to elicit qualitative responses on the barriers to the uptake of SI. Thematic analysis of the responses was carried out to identify core barriers to SI uptake.
Results
A total of 34 out of 37 respondents from all geo-political zones of Nigeria, completed the data collection tool. Stock-out of DMPA-SC was a major barrier identified by almost all respondents (97.1%), while over one-third (38%) of the respondents identified inadequate provider training (37.8%) and funding for family planning supportive supervision (40.5%) respectively, as the other supply-side barriers to the uptake of SI. Identifiable demand-side barriers include lack of awareness on SI (10.8%), myths and misconceptions about the method (10.8%) and fear of needles (2.7%) . Only one respondent identified staff attrition as a barrier to SI uptake. 
Conclusion 
The result from this study shows that the poor uptake of SI in Nigeria is affected by both supply- and demand-side barriers. It is essential that government and stakeholders at all levels address these service delivery bottlenecks to expand access to SI in Nigeria.