Although pill manufacturers often produce package inserts for commercially marketed pills, these may be difficult to read and understand for many women (240). Locally produced information and materials can be better because they can be tailored to the clientele. Such inserts can be as simple as an information sheet stapled to the pill packet. In the Dominican Republic studies showing that women often do not take their pills on days when they do not have sex prompted PROFAMILIA, the country's major nongovernmental family planning organization, to develop an information sheet for pill users that emphasizes the need to take the pill daily even when no sexual activity takes place (87).

Reinforcing provider's instructions through pill-pack inserts and in other ways helps women use the pill more consistently—provided that women understand these instructions. A study in Western Europe found that women who had read and understood all of the information in the inserts were least likely to miss one or more pills per packet. About 17% of such women reported missing pills. In contrast, among women who understood little or none of the information, about 30% missed one or more pills per packet (182).

Providing information on pill use in different ways and in formats that allow later review also influences how effectively women use the pill. In a study in the Netherlands some clients took home either an informational brochure or a brochure together with an audiotape, while others received only the usual counseling. Women who received the most information missed significantly fewer pills during the first several pill cycles than women receiving only the usual counseling (40).

A few drugs compromise OC effectiveness (see side-bar, Pill Effectiveness: Unresolved Issues). Take-home information should list these drugs specifically and remind women to use a back-up method or abstain if they are taking any of these medications. Information sheets also should mention that, because severe vomiting and/or diarrhea may diminish the pill's effectiveness, a back-up method of contraception or abstinence may be used for 7 to 14 days in the event of these illnesses.

JHU/CCP

Print materials to take home, such as these pamphlets about the pill from Bolivia, Egypt, Ghana, India, and Pakistan, can help family planning clients in many countries use OCs more effectively.

Clients must know that they can contact a provider at any time and ask any questions, and providers need to ensure that women always feel welcome (85, 175). Providers should welcome any OC user seeking help or advice—whether she initially received supplies from that provider or not. At a follow-up visit providers can reassure women who are experiencing side effects and offer help managing them (see side-bar, Managing Common Side Effects of Combined OCs). If a woman does not want to continue OC use, the provider can help her choose another method. Providers also can assess whether the pill is still medically appropriate for continuing clients.

Women often stop using the pill without consulting their providers (3, 168, 180, 227). Indeed, being able to stop the method without seeing a provider is an advantage of OCs. Nonetheless, appropriate follow-up counseling can help potential discontinuers avoid unintended pregnancies by helping them either continue using pills with satisfaction or switch to a more suitable method.

Follow-up for providers. Like clients, providers also need continuing attention to maintain their knowledge about OCs. In Gujarat, India, for example, studies during the year following training about the pill found that trainees forgot some of the skills they had learned. In response, newsletters and home study courses were introduced to help maintain accurate knowledge (204). Similarly, in Nepal the weekly radio program for community health workers refreshes listeners' knowledge by presenting information on different contraceptive methods, portraying effective provider-client counseling, and offering quizzes about topics presented in the broadcasts (106).