Returning Late or Early
Programs in Guatemala, Indonesia, Jamaica, Kenya, and other
countries report that the vast majority of clients return on time
for their injections (48, 127, 188). Many programs help clients
return on time by giving them an appointment card. In Indonesia,
for example, providers write the date of the next injection on a
family planning identification card that the client keeps, and
providers are encouraged to remind clients twice during
counseling of the specific day to return (188).
To ensure informed choice, providers should tell clients
that they may return late or early for an injection and still be
protected against pregnancy. Without this information, clients
may assume that they have no choice but to return on a specific
day. If they miss an appointment, they may assume that they
cannot get another injection, and they may discontinue use (167).
Providers may tell women, however, that if they have not returned
by the end of the grace period and it is not reasonably certain
that they are not pregnant, they may need a pregnancy test or to
wait for their next menstrual period before they can get another
injection. They should use condoms or another barrier method
until then. In areas with reliable telephone service, some
providers do not tell users about the grace period unless users
call to say that they cannot come on the scheduled day.
Providers should not tell clients that the grace period is
shorter than it actually is. Once users find out the truth, they
may distrust providers. Studies are needed to assess the effect
of information about the grace period on clients' adherence to
the injection schedule.
Clients who are often late can be given appointments earlier
than usual—for example, after 2 months and three weeks for DMPA
rather than the full 3-month interval. Providers should try to
determine why clients are late—for example, they may fear
getting an injection or they may have trouble getting to the
clinic—and help them to overcome any problems (116).
