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Series J, Number 55
Family Planning Programs

Developing a Continuing-Client Strategy

How to meet clients' changing family planning needs

CONTENTS

New Perspectives on Continuing Clients

Table 1: Discontinuation of Contraceptive Methods

Realigning Program Goals to Assist Continuing Clients

Table 2: Key Resources for Developing and Maintaining a Continuing-Client Strategy

Adapting Service Delivery to Continuing Clients

Spotlight: In Mali CBD Helps People Continue Family Planning

The Initial Visit: Establishing a Relationship

Continuing Clients: Women's Stories

The Continuing Relationship

Also See: "Family Planning: A Global Handbook for Providers"

From INFO's Toolbox
• Checklist: Suggested Provider Checklist for New Clients
• Checklist: Suggested Provider Checklist for Continuing Clients
• Table 3: WHO Medical Eligibility Criteria That Differ for Initiation and Continuation of a Contraceptive Method

Quick Look
• Table 4: Managing Method Changes
• Table 5: Follow-up Guidance for Continuing Users

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See companion INFO Reports, Measuring Success of a Continuing-Client Strategy
See INFO Reports, FOCUS ON...Improving Hormonal Method Continuation
See more Population Reports

Table 3. WHO Medical Eligibility Criteria That Differ for Initiation and Continuation of a Contraceptive Method

The method can be safely started if the condition already exists, but it should be discontinued if the condition develops during use.
Combined oral contraceptives, combined injectable contraceptives, combined patch, and combined vaginal ring
Discontinue use if client starts to have migraine headaches without aura or such migraines worsen. (An aura is usually a bright area of lost vision in the eye, often before a migraine headache begins.)
Progestin-only pills and Implants
Discontinue use if client develops: Heart disease due to blocked or narrowed arteries (ischemic heart disease) Stroke Migraine headaches with aura
Progestin-only injectables (DMPA and NET-EN)
Discontinue use if client of any age develops migraine with aura.
Levonorgestrel-releasing IUD
Discontinue use if client develops: Heart disease due to blocked or narrowed arteries (ischemic heart disease) Migraine headaches with aura
The method should not be started if the condition already exists, but it can be continued if the condition develops during use of the method.
Copper-bearing IUD or levonorgestrel-releasing IUD
Re-evaluate possibility of use once the following conditions have been evaluated and/or treated. Client may now be eligible for the method.
Unexplained vaginal bleeding before evaluation Cervical cancer awaiting treatment Endometrial cancer Ovarian cancer Pelvic inflammatory disease¹ Purulent cervicitis, chlamydia, or gonorrhea¹	Very high individual likelihood of exposure to gonorrhea or chlamydial infection Pelvic tuberculosis AIDS² Antiretroviral therapy³
Note: For detailed guidance please see the Medical Eligibility Criteria for Contraceptive Use. 3rd Edition http://www.who.int/reproductive-health/publications/mec/index.htm Sources: WHO 2004 (131), WHO 2007 (134) ¹ Continued use of an IUD depends upon the woman's informed choice and her current risk factors for sexually transmitted infections and pelvic inflammatory disease. ² IUD users with AIDS should be closely monitored for pelvic infection. ³ There is no known drug interaction between antiretroviral medications and IUD use. If a woman is clinically well on antiretroviral medications, both insertion and continuation of an IUD are generally acceptable. The advantages of using the IUD generally outweigh the theoretical or proven risks.

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