BACKGROUND. The purpose of this study was to examine specific factors that motivated the request for early removal of Norplant among a group of young, low-income women who were dissatisfied with this contraceptive method. METHODS. Focus groups were conducted to obtain qualitative in-depth attitude and opinion data about Norplant from women who had used this method of contraception for a period ranging from 2 months to 25 months and had requested its removal because of side effects. RESULTS. Patient motivation for requesting Norplant removal was based on side effects. No other reason for early removal requests emerged from the focus group discussions. However, the comments of many participants raised questions about the psychosocial context in which patients obtain information about Norplant and request early removal. Many participants mentioned having felt pressured to accept Norplant and not being fully informed about possible side effects. All but two said they were encouraged to "wait out" side effects and that physicians were reluctant to remove the Norplant capsules. Many participants recalled that they had to request removal several times before their physicians complied with their wishes. CONCLUSIONS. The results of this study suggest that there is a need to review the process of educating patients about Norplant, the situational context of Norplant counseling, and physician practices related to patients' requests for early removal.

PIP: Focus group discussions were utilized to increase understanding of the factors associated with Norplant discontinuation among young, low-income women and identify counseling needs. The 15 participants--all of whom had requested Norplant removal after at least two months of use--were drawn from health clinics in three South Carolina cities. Group participants were 18-26 years old; the mean duration of Norplant use was 13.8 months. Norplant's convenience, effectiveness, long-term duration, and low cost were cited as the major advantages of the method, while prolonged bleeding, headaches, weight gain, hair loss, and mood swings were identified as the worst side effects. These side effects were the reason for requesting early Norplant removal. Although participants had been exposed to a combination of educational methods before Norplant insertion, they noted that the possibility of adverse side effects was minimized. Others felt they had been pressured to agree to Norplant insertion while still in the hospital following a delivery. The majority reported that medical staff responded negatively to their request for removal and were unsympathetic about Norplant-related side effects. As a result, these women developed a mistrust of the medical system. Since young, low-income women comprise a major target population for Norplant use, it is important to develop a counseling protocol that prepares them for side effects and suggests various coping strategies.