A History: The Progestin Implant

August 14, 2025 | Reproductive Health Access Project

This post was written by a previous RHAP employee in January 2013 and updated by Brandy Bautista and Silpa Srinivasulu, MPH in August 2025.

Nexplanon is a single-rod contraceptive implant inserted under the skin of the inner, upper arm that releases a progestin hormone to prevent pregnancy. The implant is a highly effective form of long-acting reversible contraception (LARC); it is over 99% effective in preventing pregnancy: less than 1 in 100 people using the implant for a year get pregnant.¹ It is FDA-approved for 3 years, but studies show it can work for up to 5 years.^1,2

The long, tumultuous global history of the implant began with Norplant, the first contraceptive implant, in 1966, by scientists Sheldon Segal and Horatio Croxatto at the Population Council.³ They intended to create a contraceptive that combined features of the pill (hormonal control) and IUD (long-lasting) by investigating various synthetic progestins, length, and number of rods.³ The initial trials for the Norplant began in 1975 in Chile, Finland, Denmark, Brazil, Jamaica, and the Dominican Republic.⁴ They determined that implants containing levonorgestrel were the best option in terms of safety and efficacy. This research advanced quickly, and by 1976, there were several studies underway that compared the effects of different synthetic hormones delivered through six contraceptive capsules.³ In 1983, the Finnish pharmaceutical company, Leiras Oy, was licensed by the Population Council to produce Norplant, the contraceptive system made of six silicone capsules containing 216 mg of levonorgestrel, working to prevent pregnancy for up to five years.⁵ In 1984, the World Health Organization (WHO) evaluated and recommended Norplant worldwide as an “effective and reversible long-term method of fertility regulation.”^6,7 It was approved by the US FDA in 1990.⁸ From 1984 to 2022, the Population Council estimated that 10.5 million sets of Norplant had been distributed across the globe.⁹

Norplant was eventually removed from the US market in 2002 because of issues with insertion and removal.^10,11 Patients commonly raised concerns with changes, disruptions, and abnormalities in menstrual bleeding patterns – although the Norplant manufacturer knew and determined this to be an acceptable side effect.⁴ As such, clinicians were told that these changes were normal and did not adequately respond to their patients’ concerns. When inserting Norplant, patients often reported infection, pain, numbness, and scarring at the insertion site.⁴ These problems would sometimes contribute to later issues when removing Norplant, causing hospitalization with long operation times of two hours or more for removal. One woman said the experience of removal was, “excruciating…I’d liken [it] to labor, and labor was easier.”⁴ Other problems with Norplant removal included difficulties in finding a clinician who would agree to remove it, either due to insurance barriers or clinicians intentionally pressuring people to keep it despite complaints of side effects.⁴ Many who claimed that they were not adequately informed about Norplant side effects prior to insertion sought legal action against the manufacturers through several class action lawsuits. By 1996, about 50,000 people had joined these lawsuits. And in August 1999, the parent company of Wyeth-Ayerst agreed to a cash settlement of $54 million.⁴

Partly because of the issues with the six-rod Norplant, the Population Council developed a newer 2-rod system called Jadelle®/Norplant II. While approved by the FDA in 1996, it was never marketed in the US.^11,12 Jadelle is effective at preventing pregnancy for five years and consists of two silicone rods that also release levonorgestrel. Compared to Norplant, Jadelle was preferred by patients and clinicians due to having fewer rods and reduced visibility within the arm.¹³ Jadelle and Norplant are almost identical when it comes to efficacy, side effects, and duration of use. While Norplant and Jadelle are not available in the US, both are still available outside the US.

The Levoplant®/Sino-Implant (II) is another two-rod implant that contains 75 mg of levonorgestrel with a three-year duration.¹⁴ It was designed to imitate Jadelle at a lower cost, making this option ideal for increasing access in resource-limited settings.¹⁴ The Sino-Implant (II) was manufactured in China by Shanghai Dahua Pharmaceutical Co., Ltd, and received regulatory approval in China in 1994 and in Indonesia in 2002.¹⁵ WHO prequalified Sinoplant in June 2017, enabling global procurement agencies to distribute the implant.^14,16While 11 million units have been sold since 1994, the Sino-Implant (II) is not available in the US and is not FDA approved.^14,17

In 1998, Implanon was manufactured by Organon USA (a division of Merck), a single-rod implant containing the progestin hormone etonogestrel.¹⁸ This single-rod design made it faster and easier to insert and remove compared to previous implant designs. Implanon was approved by the FDA in 2006.⁸ Implanon suffered from fewer problems than its predecessors, but insertion errors, like placing the Implanon too deeply, reduced its efficacy to prevent pregnancy.¹⁹ These errors also caused the Implanon to migrate in the arm, making it difficult to find.¹⁹

In 2010, Organon USA introduced a replacement named Nexplanon, the version available in the US today.⁸ Nexplanon was designed to address Implanon’s insertion and location issues.⁸ For example, Nexplanon’s insertion device made it faster, easier, and more accurate. The rod also contains 15 mg of barium sulphate to allow for detection by X-ray,¹⁹ if not palpable in the arm. And, the FDA requires clinicians to complete a specialized in-person training from Organon USA in order to offer Nexplanon to patients.⁸

Although contraceptive implants have allowed people to control their reproductive lives, there is a darker side to the history of these devices with historical roots in population control, eugenics, and oppression. For example, the Population Council, the organization that spearheaded the development of Norplant, was primarily concerned with controlling reproduction for international population control rather than empowering people to exercise reproductive autonomy.⁴

In the US, Norplant was part of harmful conversations around using incentives to intentionally and disproportionately control the reproduction of low-income and disadvantaged women. For instance, just two days after Norplant was FDA-approved, an editorial from the Philadelphia Inquirer suggested that incentives and other benefits could be used to encourage women on welfare to use Norplant.⁴ There was immediate backlash, calling the use of incentives for poor women coercion, leading the Philadelphia Inquirer to publish a formal apology.²⁰Yet, the idea of using incentives to encourage Norplant use among low-income women gained traction. In Mississippi, the state legislature considered a bill that included a requirement for women with four or more children to use the implant in order to receive public aid.⁴ Several states also introduced coercive legislation incentivizing the use of Norplant, though none of these measures passed. A judge in California even tried to force a woman convicted of a crime to get the implant in order to receive a reduced prison sentence, another decision that received much backlash and did not come to fruition.^4,21

Today, the implant is slowly growing in popularity as a contraceptive option. As of 2018, the most recent year with national data, 3.1% of women ages 15-49 use the implant.²² Though it is most common among adolescents, with 16% of 15-19 year-olds using the implant.²² It may be more popular among teens as it is long-lasting, less painful to insert than an IUD, and no pelvic exam is required.²³ The future of the implant is ever-changing as Organon USA’s patent on Nexplanon expires in 2027, and other pharmaceutical companies are actively working on developing new designs, including a biodegradable contraceptive implant.⁸

Regardless, barriers to the contraceptive implant still exist. Insertion and removal require in-person clinic visits, which can be difficult to access for people with compounding barriers to accessing health care. Not all clinics offer implants, and some that do may not offer same-day insertion or removal due to high up-front costs of stocking devices and challenges in training staff, managing clinic flow, and scheduling.⁸ Clinicians may also still seek to encourage patients to maintain the implant despite their wishes for removal.²⁴ The Trump administration is significantly increasing barriers to access by rolling back protections for family planning programs. The 2025 spending bill aims to cut $880 billion from Medicaid and specifically targets Planned Parenthood health centers. An estimated ten million people will lose their health care coverage through this bill.²⁵ And, in a world where reproductive health care is increasingly politicized, persistent misinformation and disinformation about how the implant works and its safety and side effects may influence people’s contraceptive attitudes and decision-making.

To ensure people can exercise true reproductive autonomy and access the contraceptive methods that work best for them, health care professionals must provide person-centered contraceptive counseling and avoid practices that coerce people toward a specific method. Such practices are harmful because they invalidate patients’ experiences, preferences, and their right to freely make decisions about their own reproductive health care.^20,26 This has been especially true for patients with marginalized backgrounds, as Black, Indigenous, Hispanic, disabled, and low-income communities have experienced a long history and legacy of sterilization abuse, contraceptive coercion, and medical experimentation. In response, the LARC Statement of Principles was developed by the National Women’s Health Network and SisterSong to center reproductive justice within contraceptive care. These principles include offering appropriate education and counseling for all birth control methods, not just LARC, and supporting patients’ choices when they seek LARC removal.

Learn more about the history and legacy of reproductive justice by reading Killing the Black Body by Dorothy Roberts or exploring the following articles on the politics of Norplant and the history and legacy of sterilization. To learn more about contraceptive options, including the implant, check out the resources on our website or the further reading list below.

*Many of the studies and reports cited in this post use the term “women” and refer to cis-gender women. The Reproductive Health Access Project recognizes that people of all genders may use contraceptive implants.

Further Reading:

The Long Shadow of Eugenics in America

Female inmates sterilized in California prisons without approval

KFF: Contraceptive Implants

Guarding Against Coercion While Ensuring Access: A Delicate Balance

Race Culture: Recent Perspectives on the History of Eugenics

Introducing Norplant: Politics of Coercion

Norplant: A New Contraceptive with the Potential for Abuse

Maker of Norplant Offers a Settlement In Suit Over Effects

RHAP Resources:

Your Birth Control Choices Fact Sheet

Progestin Implant Fact Sheet