CONTENTS
- Using Oral Contraceptives
- Continuation and Switching
- How Mass Media Can Help
- Pill Counseling
- Keeping Guidelines Up to Date
- Improving Access
HIGHLIGHTS
- Common problems using OCs
- When is missing pills riskiest?
- What to do about missed pills
- Quitting without switching
- Men can help
- Key messages for OC users
- Managing common side effects
- Removing unnecessary barriers
- When can a woman start the pill?
- Unresolved issues
Spring, 2000
Series A, Number 10
Oral Contraceptives
Community-Based Distribution
In some countries CBD is an important component of the national family planning program. In Zimbabwe, for example, where rates of OC use are among the highest in the world, the CBD program serves nearly one family planning client in every four (14). In Bangladesh a study projected that in 1993 family planning use in certain areas would have been only 25%, rather than 40%, if CBD had not been a major component of the country's family planning program (155).
CBD is particularly important where there are no health centers or commercial sources of contraception. In 18 villages in Mali where family planning services were not available, for example, only 1% of women used family planning. Six months after a CBD program began in these villages to offer OCs, spermicides, and condoms, contraceptive prevalence had risen to 31% in villages where all three methods were offered and to 21% where spermicides and condoms but not OCs were offered (45).
 Sara A. Holtz |
| In rural Togo a group of women learns about oral contraception from a community health worker. Programs help to make OCs more affordable, convenient, and accessible by reaching out to communitites in a variety of ways. Women often want to discuss the pill with others close to home. |
Regular visits by CBD agents providing supplies and counseling improve OC continuation. In Bangladesh women who had been visited at home by family welfare assistants within the previous 90 days were two-thirds as likely to have discontinued use than women who had not been visited in the last 90 days. The effect of home visits on continuation was strong—and consistent for women of all social and economic backgrounds—even though social marketing outlets and clinics were accessible in the study area (91).
Screening clients. Screening clients to identify which women can safely use hormonal methods is an important part of CBD programs. By using checklists, CBD agents can accurately identify women who should not use a method without impeding access for women wanting to start OCs (210) (see checklist). CBD agents also can use a checklist to assure that continuing clients have not developed a medical condition that makes pill use inappropriate.
In the Dominican Republic PROFAMILIA's CBD agents use a card to screen potential OC users. By checking off the appropriate color-coded boxes as clients respond to eight yes-or-no questions, the agent decides to:
- Provide the pill;
- Provide the pill but ask the client to see a physicianwithin three months for follow-up; or
- Ask the client to see a physician first (87).
Community outreach and participation. Community outreach and participation efforts help provide a supportive social setting that makes it easier for women to use the pill correctly and continuously. One example of such participation is monthly meetings in a community member's home or a community center. At such meetings health care providers and members of the community gather together, creating an opportunity for women to talk about family planning, support one another's family planning use, and receive OCs and other contraceptives. This approach has been successful in Bangladesh, where social support was found to be the strongest motivating factor in women's decisions to use and continue using contraception (113, 156).
Much of the success of the Indonesian family planning program has also been attributed to community outreach and involvement (217).
