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Closing the Effectiveness Gap |
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| June 2007 Issue No. 13 |
The INFO Project • Johns Hopkins Bloomberg School of Public Health • Center for Communication Programs • 111 Market Place, Suite 310 • Baltimore, Maryland 21202, USA • 410-659-6300 • 410-659-6266 (fax) • www.infoforhealth.org • infoproject@jhuccp.org | |
How Programs Can Improve Contraceptive Effectiveness
The quality of services that family planning programs provide often influences how well a client’s method protects against unintended pregnancy (7, 88). Providing good-quality services ensures that a range of contraceptive methods are available and easily accessible. Good quality services also emphasize informative contraceptive counseling (56, 88). To improve effective use of contraception, programs can:
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Provide access to a range of contraceptive methods. When programs offer a range of methods from which to choose, clients are more likely to find a method that suits them—one that they will be able to use correctly and consistently.
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Help clients address contraceptive side effects. When programs help clients address common side effects of the methods they are considering, they can enable many clients to deal successfully with concerns that often interfere with correct and consistent use.
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Provide supplies conveniently. When clients can easily obtain oral contraceptives, condoms, and other supply methods, they are more likely to continue using contraception without interruption.
 In Ethiopia, a community-based reproductive health agent serves as a source of contraceptive information and methods while selling vegetables in markets. Offering contraceptive supplies conveniently can encourage consistent contraceptive use. Pills, condoms, and even injectable contraceptives can be provided in the community, since some clients have difficulty returning to the clinic for resupply. © 2006 Jennifer Wilder/Pathfinder International |
Provide Access to a Range of Contraceptive Methods
Offering a full range of methods, kept continuously in stock, allows clients to choose the methods they prefer and to use them consistently (49). In contrast, relying too heavily on one family planning method over others can make it difficult for many clients to find the method they would prefer (52). The more methods available, the more clients will be able to choose one that they can continue using effectively.
When many contraceptive methods are readily available, programs are better able to help continuing clients switch to another method if their current method proves difficult to use effectively, or no longer meets their needs (14, 91). Programs that focus on helping clients find the method that best suits their individual circumstances and meets their reproductive health needs can help clients continue to prevent unintended pregnancy effectively over the course of their reproductive lifetime (68).
Family planning programs can help ensure a reliable supply of contraceptives by setting up good logistics management systems. Many country programs now forecast demand for contraceptives and maintain adequate stocks by using computerized logistics management information systems, especially at the central level (71). Family planning programs in over 20 countries of Africa, Asia, and Latin America rely on PipeLine, a free logistics software program, to help program managers with forecasting and plan procurement of contraceptive supplies (26). (See Population Reports, “Family Planning Logistics: Strengthening the Supply Chain,” Series J, No. 51, Winter 2002.) Adequate donor funding and coordination among national governments and donors play a key role in ensuring a consistent supply of contraceptives (86).
Help Clients Address Contraceptive Side Effects
Of the method characteristics that can interfere with correct and consistent use, the most important is side effects (32, 42, 100, 106, 112, 132). Fear of side effects is one of the main reasons that women give for not using certain contraceptive methods, especially some of the more effective long-acting methods such as inject able contraceptives and implants (113). Side effects also are the most commonly reported method-related reason—and sometimes the most common reason overall—that women discontinue a contraceptive method (2, 3, 14, 15, 35, 57, 67, 97, 116, 124, 132).
Programs can help clients address common side effects. Clients need to be aware of possible side effects in advance and be prepared to wait a few months for them to subside if they occur, or else to return to the health care provider for help in managing them (91, 101). Women who receive in-depth information about side effects when they are starting contraceptive use and are encouraged to return to the clinic if they face problems continue using their methods longer than women who receive little information about side effects (22, 57, 73).
Common side effects include menstrual bleeding changes with hormonal methods and IUDs, and headaches and nausea with hormonal methods. Some contraceptive users switch to a less effective method because of such side effects (89, 100, 129). Also, in an attempt to relieve menstrual bleeding changes and nausea from use of oral contraceptives, women sometimes skip pills, thinking that doing so will relieve these side effects. In fact, inconsistent use can worsen such side effects, as well as reduce effectiveness (11, 17, 87, 117).
Provide Supplies Conveniently
Family planning programs can encourage consistent contraceptive use by giving clients an adequate supply of their chosen methods right at the start. For example, women given a full year’s supply of oral contraceptives are more likely to use the method effectively, without interruption, than women given only three pill packs at a time (40). WHO advises that clients using oral contraceptives receive up to one year’s supply of pills (13 cycles) at the first visit (141).
Programs also can encourage consistent contraceptive use by offering oral contraceptives, condoms, and other supply methods in the community—for example, through community-based staff or volunteers—rather than requiring clients to return to the clinic for resupply (74). Even injectable contraceptives provided in the community through mobile, village, or temporary outreach clinics or at the homes of clients or community-based workers have proved feasible. The percentage of clients receiving their repeat injections on time has been comparable between both community and clinic sources (1, 71, 107).
In addition, governments and programs can improve access to contraceptive supplies by offering supply methods, such as oral contraceptives and condoms, through the commercial sector, including physicians, clinics, pharmacies and hospitals. In Latin America and the Near East some countries have developed a strong commercial market in family planning supplies and services—with trained commercial providers, a dependable supply system for commodities, and a pool of potential customers that enable the commercial supply system to succeed (38).
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