Clinical Update: Contraceptive Pearl
(October 2002)

The "Contraceptive Pearls" offer answers to commonly asked questions about family planning. These "Pearls" were prepared by Dr. James D. Shelton, Senior Medical Scientist, Office of Population and Reproductive Health, United States Agency for International Development (USAID). They are reprinted with permission. To view archives of Jim Shelton's Pearls online, visit Jim Shelton's Pearls online

Non-Clinical Provision of Injectables

In a previous Pearl "Injectable Quality Elements", Dr. Shelton listed four key elements for quality provision of injectables: 

• Counseling about common bleeding side effects
• Simple eligibility screening
• Sterile needle and syringe (and proper disposal)
• Follow-up plan (including next injection and dealing with possible side effects).

Question: Those elements you listed for quality provision of injectable contraceptives such as Depo-Provera seem pretty simple and are not "clinical" in nature. Does that mean it is reasonable to provide such injectables in non-clinical settings such as community-based distribution (CBD) programs and pharmacies?

Answer: Yes, it can be. The key is provision of injectables with sufficient quality, not the setting. Providers with very basic skills can effectively provide injectables, including basic injection technique. Moreover, Family Health International has developed a simple screening checklist that can be used by providers such as CBD providers. There is a text version of the checklist or a graphic version can be found on the Family Health International website¹ at:

http://www.fhi.org/en/RH/Pubs/servdelivery/checklists/dmpachecklists/index.htm

Information in French and Spanish is also available at: www.fhi.org/en/fp/checklistse/chklstfpe/index.html 

Source: Stang A, Schwingl P, Rivera R. New contraceptive eligibility checklists for provision of combined oral contraceptives and depot-medroxyprogesterone acetate in community-based programmes. Bull World Health Organ 2000;78(8):1015-23. 

¹Note: To view the document in this format, you will need Adobe Acrobat software. Acrobat can be downloaded for free from www.adobe.com/products/acrobat/readstep.html.

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