Ensuring high-quality services is vital to any family planning program that provides injectable contraceptives. A client considering starting a new contraceptive method needs to be informed of the most appropriate contraceptive options and then carefully screened to ensure she is medically eligible to use her chosen method. Injectable contraceptives are safe and suitable for nearly all women, including women who have or have not had children; married and unmarried women; and women of any age, including adolescents and women over 40 years old.
If a woman chooses injectables, her health care provider needs to counsel her about potential side effects and provide strategies to help her continue using the method effectively. For example, providers must be able to carefully explain the grace period before and after a woman’s scheduled reinjection date during which she can receive a reinjection and remain protected from unintended pregnancy. Counseling women about possible bleeding changes and other side effects of injectables is an important part of providing the method. Bleeding changes are among the most common method-related reasons for women discontinuing hormonal contraceptive methods. In addition to determining medical eligibility and counseling clients on injectables, service providers must also know how to give injections safely and how to properly store and manage injectables.
The Service Delivery section of the Injectables Toolkit houses counseling tools, job aids, and reference materials to help service providers perform these tasks well. Many of these resources are also helpful for training service providers on provision of injectables and improving communication between providers and clients. Click on the links below to access materials that will help service providers:
Counsel clients on a range of contraceptive options
Screen clients to determine whether they are medically eligible to use injectable contraceptives
Counter myths and misinformation about injectables with effective and accurate counseling messages
Instruct clients on the importance of returning on time for reinjections and on what to do if they miss their scheduled reinjection appointment
The Balanced Counseling Strategy (BCS) is a practical, interactive, client-friendly counseling strategy that uses three key job aids (visual memory aids) for counseling clients about family planning. The process, tested and refined in several countries, involves a set of steps to determine the method that best suits the client according to her/his preferences and reproductive health intentions.
This 1-page chart compares the effectiveness of various family planning methods, including injectables, and has a few key messages on how to make ones method more effective which could be useful to providers and program managers alike.
The information in this document is compiled from the Contraceptive Myths and Counseling Messages Database. It provides evidence-based information and counseling messages that providers around the world have used to dispel commonly-held contraceptive myths and misperceptions. Health care professionals can use this resource to correct misinformation and support informed decisions by helping clients understand the facts on how contraceptive methods work, on who can use them, their possible side effects, and much more.
"Do You Know Your Family planning Choices? Your family planning provider can help. Please ask!" replaces the old wall chart by the same name and will continue to serve as a tool to comply with a requirement of the Tiarht Amendment. Available in English, French, Spanish, and Portuguese.
Providers, clients, and programs all have a role to play in ensuring good client-provider interaction. This brief provides an overview of what these three audiences can do to support good client-provider interaction.
This flipchart is a decision-making aid for clients, a job-aid and reference manual for providers, and a training resource. With one page for the client and a corresponding page for providers, it has helpful pictures, key points and detailed reference information covering 14 family planning methods. It includes medical eligibility criteria, side effects, when to start and how to use each method.
This program brief describes the balanced counseling strategy as an ongoing approach to improving quality of care in a specific setting. It outlines the origin and rationale for developing the strategy, and details its subsequent adaptation for use in other contexts.
This job aid is designed to help community health workers (CHWs) better serve women who return for reinjections of the injectable contraceptive DMPA. The DMPA job aid reflects 2008 guidance from the World Health Organization regarding how many weeks late a woman can be for reinjection without risk of pregnancy -- widely referred to as the extended grace period. The job aid describes the strategies that CHWs can use to rule out pregnancy among women who return outside of the recommended grace periods, so that those who are not pregnant can receive same-day reinjections.
This job aid is designed to help community health workers (CHWs) better serve women who return for reinjections of the injectable contraceptive NET-EN. The job aid describes the strategies that CHWs can use to rule out pregnancy among women who return outside of the recommended grace periods, so that those who are not pregnant can receive same-day reinjections.
Injectables can be used by almost all women of reproductive age. This brief outlines the World Health Organization's Medical Eligibility Criteria for who can (categories 1 and 2) and cannot (categories 3 and 4) use progestin-only injectables and combined injectables.
This job aid is designed to help clinical health care providers better serve women who return for reinjections of the injectable contraceptive DMPA. The DMPA job aid reflects 2008 guidance from the World Health Organization regarding how many weeks late a woman can be for reinjection without risk of pregnancy -- widely referred to as the extended grace period. The job aid describes the strategies that clinicians can use to rule out pregnancy among women who return outside of the recommended grace periods, so that those who are not pregnant can receive same-day reinjections.
This job aid is designed to help clinical health care providers better serve women who return for reinjections of the injectable contraceptive NET-EN. The job aid describes the strategies that clinicians can use to rule out pregnancy among women who return outside of the recommended grace periods, so that those who are not pregnant can receive same-day reinjections. Also available here are job aids adapted to the specific policies and guidelines of Kenya and South Africa.
This wheel contains the medical eligibility criteria for starting use of contraceptive methods. It is based on the Medical Eligibility Criteria for Contraceptive Use, 3rd edition and its 2008 Update, one of WHO’s evidence-based guidelines. It tells family planning providers if a woman presenting with a known medical or physical condition is able to use various contraceptive methods safely and effectively. The wheel includes recommendations on initiating use of six common types of contraceptives.
This simple checklist can be used by both clinical and non-clinical health care providers, including community health workers, to help them screen clients who have made an informed decision to use DMPA or NET-EN. The checklist consists of 14 questions designed to identify medical conditions that would prevent safe DMPA or NET-EN use or require further screening and assess whether a client may be pregnant. It also provides guidance and directions based on clients' responses.
The Pregnancy Checklist contains a series of questions to rule out pregnancy. These questions are based on criteria established by the World Health Organization (WHO) for determining with reasonable certainty that a woman is not pregnant. To access country-adapted checklists, click on the links for Kenya and Uganda.
The World Health Organization (WHO) develops detailed criteria that health care workers can follow to determine which contraceptive methods are medically suitable for their clients. These criteria are based on the most current scientific knowledge about the effectiveness, risks, and benefits of various family planning methods, and they can help providers guide their clients in making safe and informed decisions. The WHO recently revised the criteria in response to recommendations made by an expert working group who met in Geneva, Switzerland, in April 2008.
This handbook, based on WHO’s Medical Eligibility Criteria for Contraceptive Use, offers clinic-based health care professionals the latest comprehensive guidance on providing family planning. Chapter 4 focuses on progestin-only injectables and includes information on all aspects of provision, including screening for medical eligibility, instructions for correct use, and explanations of common myths about injectables and how a provider can support continued use of the method. Chapter 5 focuses on providing monthly injectables.
The purpose of this toolkit is to promote implementation of safe practices associated with the following medical procedures:
intradermal, subcutaneous and intramuscular needle injections
intravenous infusions and injections
dental injections
phlebotomy
lancet procedures
Within this report is the "Checklist for Giving Intramuscular Contraceptive Injections" which includes instructions and diagrams to help family planning providers give injections safely.
New Study on Use of Injectable Contraceptives and HIV Risk
A new study published in The Lancet Infectious Diseases suggests that use of injectables may double the risk of uninfected women acquiring HIV and of HIV-infected women transmitting the virus to their uninfected partners.
For now, international health organizations and donors, including WHO, UNAIDS, and USAID, caution against making hasty changes to contraceptive policy or practice. (See also USAID's statement in French or Spanish.) WHO is convening a Technical Consultation from 31 January to 1 February 2012 to examine all evidence related to the potential effects of hormonal contraception on HIV acquisition, transmission, and disease progression, and will decide whether modifications need to be made to current WHO guidance. [read more]