Explain How To Use the Chosen Method, Population Reports, Series J, Number 48

GATHER Elements:	Greet	Ask	Tell	Help	Explain	Return	Charts	Contents

Explain How To Use the Chosen Method

Once your client has chosen a method, explain how to use it correctly. Explain only the method that the client has chosen. These explanations also can help remind returning clients about using their methods correctly.

Low-Dose Combined Oral Contraceptives (The Pill)

You can start the Pill any time it is reasonably sure that you are not pregnant—for example, during the first 7 days after your menstrual period starts.
Take one pill each day until the packet is empty.
Then start the next packet. For 28-pill packets: Take the first pill from the new packet the next day. For 21-pill packets: Wait no more than 7 days and then take the first pill.
If you miss a pill, take it as soon as you can. Then take the next pill at the regular time, even if you take 2 pills at once or on the same day.
Side effects sometimes occur, such as upset stomach, light bleeding between periods, very light menstrual periods, occasional missed periods, mild headaches, tender breasts, and moodiness. These side effects are not signs of serious sickness. They generally become less or stop in a few months. Keep taking one pill each day. Skipping pills makes some of these side effects worse.
See a nurse or doctor if you have severe, constant pain in the belly, chest, or leg; you start to get very bad headaches; you see flashing lights or zigzag lines, or your skin or eyes become unusually yellow.

Condoms

Put a condom on the erect penis before it touches the vagina.
Put the condom on the tip of the penis with the rolled rim up (away from the body). The condom should unroll easily to the base of the penis.
When withdrawing your penis after sex, hold the rim of the condom so that semen does not spill.
Use each condom only once. Throw the used condom in a pit latrine or bury it.
Do not use lubricants with oil in them, such as Vaseline or butter. Oil weakens condoms.

Long-Acting Injectable Contraceptives

Try not to rub the injection site. This could shorten the protection.
Try to come back for another injection in 3 months (for Depo-Provera) or 2 months (for Noristerat). But come back even if you must come early or you are late. If more than 2 weeks late, use condoms or a vaginal method until you can have another injection.
Most women have changes in menstrual bleeding, and their periods may stop after a year. This is normal. It is not dangerous and does not mean you are pregnant.
See a nurse or doctor if menstrual bleeding is twice as long or twice as heavy as usual for you; you start to get very bad headaches; or your skin or eyes become unusually yellow.

Norplant Implants

A specially trained health care provider will place 6 small, plastic capsules under the skin of your upper arm. You will get medicine to prevent pain.
Keep this area dry for 4 days. You can take off the gauze after 2 days and the bandage after 5 days.
Most women have changes in menstrual bleeding, especially spotting or light bleeding between periods. This is normal. It is not dangerous and not a sign of danger.
Come back if your arm is sore for more than a few days; your arm becomes painful, hot, or red; capsules come out; very bad headaches start or become worse; you might be pregnant (especially if you also have bad pain or tenderness in the belly or you feel faint); you have very heavy vaginal bleeding; or your skin or eyes become unusually yellow.

You can have the capsules taken out any time you want. After 5 years you should have them taken out; you can get new capsules then if you want.

Intrauterine Device (IUD)

A specially trained health care provider will insert your IUD. During the procedure, please tell the provider if you feel discomfort or pain. You may feel some cramps for a short time afterward.
To make sure the IUD is still in place, check the IUD strings once a week for the first month and then from time to time after a menstrual period. Wash hands, sit in a squatting position, and insert 1 or 2 fingers into your vagina until you feel the strings. Come back if you cannot feel the strings, the strings feel longer or shorter, or you feel something hard.
Some women have longer, heavier menstrual bleeding, bleeding or spotting between periods, or more cramps. These are not danger signs.
Plan to come back for a check-up in 3 to 6 weeks—for example, after a menstrual period.
Come back if you miss a menstrual period or think you might be pregnant; you might get or have an STD including HIV/AIDS; or you have very bad pain in the belly (especially pain with fever or with bleeding between menstrual periods—signs of pelvic inflammatory disease).

You can have the IUD taken out any time you want.
You will get a written record of your type of IUD, when it was put in, and when you should have it removed. You can get a new IUD then.

Fertility Awareness-Based Methods Including Periodic Abstinence

Be aware of body changes. Remember these rules:
Cervical secretions: Avoid unprotected sex from the first day of any cervical secretions or feeling of vaginal wetness until the 4th day after the peak day of slippery secretions.
Basal body temperature (BBT): Avoid unprotected sex from first day of menstrual bleeding until body temperature has risen and stayed up for 3 full days.
Cervical secretions + BBT: Avoid unprotected sex from the first day of cervical secretions until both the 4th day after the peak day of slippery secretions and the 3rd full day after the rise in body temperature.
Calendar, or rhythm: Avoid sex during the fertile time as figured from calculations based on 6 months of menstrual calendar records.
Providers not trained to teach these methods should refer clients.

Vaginal Methods (Spermicides, Diaphragm, Cervical Cap)

Put spermicide, or diaphragm or cap with plenty of spermicide, in your vagina before sex.
Spermicide alone can be put in up to an hour before sex. Put in foaming tablets, films, or suppositories at least 10 minutes before sex.
Do not douche for at least 6 hours after sex. Leave a diaphragm or cap in place for at least 6 hours, but not longer than 24 hours for a diaphragm or 48 hours for a cap.
Providers should fit a diaphragm or cap, explain how to put it in and take it out, let the client try putting it in, and check that it is in place.

Sterilization Procedures

Female Sterilization

Procedure: Anesthetic (medicine to stop pain) is injected into the abdomen. You may also be given medicine to help you relax. (Tell the client whether she is going to be awake or asleep. Full sleep—general anesthesia—usually is not needed.) The procedure takes less than 20 minutes. Most women can leave the clinic in a few hours. There are two female sterilization procedures. Describe only what is available. After the procedure: Rest for 2 or 3 days. Do not lift anything heavy for a week. Take paracetamol (Panedol, Tylenol) for pain if needed.
Come back if you have fever; bleeding or pus in the wound; pain, heat, swelling, or redness of the wound that becomes worse or does not stop; abdominal pain or cramping that becomes worse or does not stop; diarrhea; fainting or extreme dizziness.

Minilaparotomy: The provider makes a small incision in the belly just above the pubic hair. He or she moves the womb to bring each fallopian tube to the opening. This may cause discomfort. The provider ties and cuts both fallopian tubes or closes them with a clip or ring. Then the incision is sewn closed. (See picture of female sterilization.) Laparoscopy: The doctor makes a small incision just under the naval and inserts a thin tube. The doctor puts an instrument inside this tube and uses it to close off or block both fallopian tubes. After taking out the instrument and tube, the doctor sews the incision shut or bandages it. (See picture of female sterilization.)

Vasectomy

Procedure: Anesthetic is injected into the scrotum to stop pain. One or two small openings are made in the scrotum. The two tubes that carry sperm to the penis are cut. The ends are tied or closed off. The openings are sewn shut or bandaged. The procedure takes about 15 minutes. (See picture of vasectomy.) After the procedure:
If possible, put cold compresses on the scrotum for 4 hours to reduce swelling. Swelling and discomfort may last 2 or 3 days.
Keep the incision clean and dry for 2 to 3 days. Take paracetamol (Panedol, Tylenol) for pain if needed.
Rest for 2 days and do not do heavy work or exercise for a few days.
Use another effective method for at least 20 ejaculations or 3 months.
Come back if you have high fever; bleeding or pus from the wound; or pain, heat, swelling, or redness at the wound that becomes worse or does not stop.

*Explain How To Use the Chosen Method*
Once your client has chosen a method, explain how to use it correctly. Explain only the method that the client has chosen. These explanations also can help remind returning clients about using their methods correctly.
Low-Dose Combined Oral Contraceptives (The Pill)
You can start the Pill any time it is reasonably sure that you are not pregnant—for example, during the first 7 days after your menstrual period starts. Take one pill each day until the packet is empty. Then start the next packet. For 28-pill packets: Take the first pill from the new packet the next day. For 21-pill packets: Wait no more than 7 days and then take the first pill. If you miss a pill, take it as soon as you can. Then take the next pill at the regular time, even if you take 2 pills at once or on the same day. Side effects sometimes occur, such as upset stomach, light bleeding between periods, very light menstrual periods, occasional missed periods, mild headaches, tender breasts, and moodiness. These side effects are not signs of serious sickness. They generally become less or stop in a few months. Keep taking one pill each day. Skipping pills makes some of these side effects worse. See a nurse or doctor if you have severe, constant pain in the belly, chest, or leg; you start to get very bad headaches; you see flashing lights or zigzag lines, or your skin or eyes become unusually yellow.
Condoms
Put a condom on the erect penis before it touches the vagina. Put the condom on the tip of the penis with the rolled rim up (away from the body). The condom should unroll easily to the base of the penis. When withdrawing your penis after sex, hold the rim of the condom so that semen does not spill. Use each condom only once. Throw the used condom in a pit latrine or bury it. *Do not use lubricants with oil in them, such as Vaseline* or butter. Oil weakens condoms.**
Long-Acting Injectable Contraceptives
Try not to rub the injection site. This could shorten the protection. Try to come back for another injection in 3 months (for Depo-Provera) or 2 months (for Noristerat). But come back even if you must come early or you are late. If more than 2 weeks late, use condoms or a vaginal method until you can have another injection. Most women have changes in menstrual bleeding, and their periods may stop after a year. This is normal. It is not dangerous and does not mean you are pregnant. See a nurse or doctor if menstrual bleeding is twice as long or twice as heavy as usual for you; you start to get very bad headaches; or your skin or eyes become unusually yellow.
Norplant Implants
A specially trained health care provider will place 6 small, plastic capsules under the skin of your upper arm. You will get medicine to prevent pain. Keep this area dry for 4 days. You can take off the gauze after 2 days and the bandage after 5 days. Most women have changes in menstrual bleeding, especially spotting or light bleeding between periods. This is normal. It is not dangerous and not a sign of danger. Come back if your arm is sore for more than a few days; your arm becomes painful, hot, or red; capsules come out; very bad headaches start or become worse; you might be pregnant (especially if you also have bad pain or tenderness in the belly or you feel faint); you have very heavy vaginal bleeding; or your skin or eyes become unusually yellow. You can have the capsules taken out any time you want. After 5 years you should have them taken out; you can get new capsules then if you want.
Intrauterine Device (IUD)
A specially trained health care provider will insert your IUD. During the procedure, please tell the provider if you feel discomfort or pain. You may feel some cramps for a short time afterward. To make sure the IUD is still in place, check the IUD strings once a week for the first month and then from time to time after a menstrual period. Wash hands, sit in a squatting position, and insert 1 or 2 fingers into your vagina until you feel the strings. Come back if you cannot feel the strings, the strings feel longer or shorter, or you feel something hard. Some women have longer, heavier menstrual bleeding, bleeding or spotting between periods, or more cramps. These are not danger signs. Plan to come back for a check-up in 3 to 6 weeks—for example, after a menstrual period. Come back if you miss a menstrual period or think you might be pregnant; you might get or have an STD including HIV/AIDS; or you have very bad pain in the belly (especially pain with fever or with bleeding between menstrual periods—signs of pelvic inflammatory disease). You can have the IUD taken out any time you want. You will get a written record of your type of IUD, when it was put in, and when you should have it removed. You can get a new IUD then.
Fertility Awareness-Based Methods Including Periodic Abstinence
Be aware of body changes. Remember these rules: Cervical secretions: Avoid unprotected sex from the first day of any cervical secretions or feeling of vaginal wetness until the 4th day after the peak day of slippery secretions. Basal body temperature (BBT): Avoid unprotected sex from first day of menstrual bleeding until body temperature has risen and stayed up for 3 full days. Cervical secretions + BBT: Avoid unprotected sex from the first day of cervical secretions until both the 4th day after the peak day of slippery secretions and the 3rd full day after the rise in body temperature. Calendar, or rhythm: Avoid sex during the fertile time as figured from calculations based on 6 months of menstrual calendar records. *Providers not trained to teach these methods should refer clients.*
Vaginal Methods (Spermicides, Diaphragm, Cervical Cap)
Put spermicide, or diaphragm or cap with plenty of spermicide, in your vagina before sex. Spermicide alone can be put in up to an hour before sex. Put in foaming tablets, films, or suppositories at least 10 minutes before sex. Do not douche for at least 6 hours after sex. Leave a diaphragm or cap in place for at least 6 hours, but not longer than 24 hours for a diaphragm or 48 hours for a cap. *Providers should fit a diaphragm or cap, explain how to put it in and take it out, let the client try putting it in, and check that it is in place.*
Sterilization Procedures
Female Sterilization
Procedure: Anesthetic (medicine to stop pain) is injected into the abdomen. You may also be given medicine to help you relax. (Tell the client whether she is going to be awake or asleep. Full sleep—general anesthesia—usually is not needed.) The procedure takes less than 20 minutes. Most women can leave the clinic in a few hours.	There are two female sterilization procedures. Describe only what is available.	After the procedure: Rest for 2 or 3 days. Do not lift anything heavy for a week. Take paracetamol (Panedol, Tylenol) for pain if needed. Come back if you have fever; bleeding or pus in the wound; pain, heat, swelling, or redness of the wound that becomes worse or does not stop; abdominal pain or cramping that becomes worse or does not stop; diarrhea; fainting or extreme dizziness.
Minilaparotomy: The provider makes a small incision in the belly just above the pubic hair. He or she moves the womb to bring each fallopian tube to the opening. This may cause discomfort. The provider ties and cuts both fallopian tubes or closes them with a clip or ring. Then the incision is sewn closed. (See picture of female sterilization.)	Laparoscopy: The doctor makes a small incision just under the naval and inserts a thin tube. The doctor puts an instrument inside this tube and uses it to close off or block both fallopian tubes. After taking out the instrument and tube, the doctor sews the incision shut or bandages it. (See picture of female sterilization.)
Vasectomy
Procedure: Anesthetic is injected into the scrotum to stop pain. One or two small openings are made in the scrotum. The two tubes that carry sperm to the penis are cut. The ends are tied or closed off. The openings are sewn shut or bandaged. The procedure takes about 15 minutes. (See picture of vasectomy.)	After the procedure: If possible, put cold compresses on the scrotum for 4 hours to reduce swelling. Swelling and discomfort may last 2 or 3 days. Keep the incision clean and dry for 2 to 3 days. Take paracetamol (Panedol, Tylenol) for pain if needed. Rest for 2 days and do not do heavy work or exercise for a few days. Use another effective method for at least 20 ejaculations or 3 months. Come back if you have high fever; bleeding or pus from the wound; or pain, heat, swelling, or redness at the wound that becomes worse or does not stop.

GATHER Elements: Greet Ask Tell Help Explain Return Charts Contents

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