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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
Start for Injectable Contraceptives
Question: According to WHO, when can a woman who is having menstrual cycles start the injectable contraceptive DMPA or NetEN without backup protection?
- 1st day of her cycle only
- through day 4 of her cycle
- through day 5 of her cycle
- through day 7 of her cycle
- as long as she continues bleeding
Answer: D. Through day 7.
Actually, she can also have her first injection at any time in the cycle it is reasonably certain she is not pregnant, provided she is advised to abstain from sex or use an additional contraceptive method for 7 days.
Reference: WHO, Reproductive Health and Research, Selected practice recommendations for contraceptive use. Geneva, 2002.
Pelvic Exam Prior to Injectables?
Question: In our program we do not require a pelvic exam for a woman to begin oral contraceptives. But what about injectables such as Depo-Provera. Is a pelvic exam required?
Answer: No. According to WHO, a pelvic exam for injectable contraceptives (including monthly injectables) is a Category C. That is [a pelvic exam] "does not contribute substantially to the safe and effective use of the contraceptive method."
Reference: WHO, Reproductive Health and Research, Selected practice recommendations for contraceptive use. Geneva, 2002.
Injectable Quality Elements
Question: Thanks for clarifying that a pelvic exam is not necessary to receive an injectable contraceptive, but what are the key elements of quality for injectable provision?
Answer: Assuming the client choice is an injectable, in my view
they are these:
- 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).