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Progestin-Only Injectables1 |
Combined Injectables |
| Key Points |
| Support clients using injectables |
- Give the injection safely and safely dispose of used equipment (see Checklist).
- Tell the client the name of the injection and when she needs to have her next injection. Give her an appointment card or reminder card, if possible.
- Help her manage any side effects and continue with the injectable if she wishes, or, if she is not satisfied, help her choose a different method.2
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| "Come on time for the next injection" |
| Help the client choose a date for the next injection |
- In 3 months for DMPA or in 2 months for NET-EN.
- Discuss how to remember the date, perhaps tying it to a holiday or other event. Suggest that her partner help her remember the date.
- Remind the client that she can come up to 2 weeks early or 2 weeks late. She should return even if she is more than 2 weeks late. She still may be able to have her injection.
- Discuss using a backup method3 or oral contraceptives (OCs) or emergency contraceptive pills when more than 2 weeks late.
- Invite her to come back any time she has problems or questions.
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- In 4 weeks for combined injectables.
- Discuss how to remember the date, perhaps tying it to a holiday or other event. Suggest that her partner help her remember the date.
- Remind the client that she can come up to 7 days early or 7 days late. She should come back even if she is more than 7 days late. She still may be able to have her injection.
- Discuss using a backup method3 or oral contraceptives (OCs) or emergency contraceptive pills when more than 7 days late.
- Invite her to come back any time she has problems or questions.
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| Counsel the client when she returns for injections |
| "How are you doing?" |
- Ask if she has any questions or anything to discuss. Ask especially about bleeding changes. Give her any information, help, or reassurance she needs.
- If she is having problems, let her know that you may be able to help. If she does not want to continue injectables, help her choose another method.
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| "Any trouble returning on time?" |
- If she has trouble returning on time, discuss reasons and solutions and discuss using a backup method3 or OCs or emergency contraceptive pills when late.
- If she often returns later than the grace period permits (2 weeks for progestin-only injectables and 7 days for combined injectables), help her consider whether another method would better suit her—perhaps implants or an IUD or, if she does not want more children, female sterilization (or vasectomy for her partner).
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| If the client is early or late for the injection |
- If she is 2 weeks early or less, she can receive her injection.
- If she is 2 weeks late or less, she can receive her injection. No need for tests, evaluation, or a backup method.
- If she is more than 2 weeks late, she can receive her injection if (1) she has not had sex since the day she would have been two weeks late, (2) she has used a backup method during this period, or she has taken emergency contraceptive pills within 5 days after any unprotected sex, or (3) she is fully or nearly fully breastfeeding and she gave birth less than 6 months ago. She will need a backup method3 for the first 7 days after the injection.
- If the client is more than 2 weeks late and does not meet these criteria, consult a family planning handbook for ways to be reasonably sure she is not pregnant.2
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- If she is 7 days early or less, she can receive her injection.
- If she is 7 days late or less, she can receive her injection. No need for tests, evaluation, or a backup method.
- If she is more than 7 days late, she can receive her injection if (1) she has not had sex since the day she would have been 7 days late, or (2) she has used a backup method during this period, or she has taken emergency contraceptive pills within 5 days after any unprotected sex. She will need a backup method3 for the first 7 days after the injection.
- If the client is more than 7 days late and she does not meet these criteria, she can receive her next injection anytime it is reasonably certain she is not pregnant (see Checklist, questions 8–13).
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| Plan the next injection |
- Agree on a date for her next injection. Remind her that she should try to come on time, but she should come back no matter how late she is.
- Give her condoms or emergency contraceptive pills if needed.
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| Check for major life changes once a year |
| Every year, at a routine re-injection visit, ask about changes that could affect her use of contraception |
- Ask if she has had any new health conditions. Check whether any of these conditions would make use of injectables less safe (see Checklist).
- Ask about major life changes that may affect her needs—particularly plans for having children and her STI/HIV risk. If a DMPA user plans to have a baby, remind her that she may need a few more months to become pregnant than women who have stopped other contraceptives.
- Check blood pressure, if possible. She may need to choose another method:
- If she is using a progestin-only injectable and systolic blood pressure is 160 mm Hg or more, or diastolic blood pressure is 100 or more.
- If she is using a combined injectable and systolic blood pressure is 140 mm Hg or more, or diastolic blood pressure is 90 or more (212).
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1Guidance is for both intramuscular and subcutaneous injection of DMPA.
2For help, see Table 3, Key Resources for Program Managers and Providers, in the companion issue of Population Reports.
3Backup methods include abstinence, male and female condoms, spermicides, and withdrawal. Tell her that spermicides and withdrawal are the least effective contraceptive methods. If possible, give her condoms. |
