| a) No. Trained providers other than doctors, including community-based
distribution (CBD) workers, can initiate and resupply COCs both in clinical and
non-clinical situations. Additionally, COCs may be provided "over-the-counter"
if adequate information is given to clients (see "Specific
counseling points for COC use," on last page of the Classification of Selected
Procedures for Low Estrogen Combined Oral Contraceptives section).
Community-based distributors (CBD) and other non-clinical
FP providers should use screening checklists to identify conditions for which the woman
can receive a limited supply of COCs and also be referred to a clinic. These screening
checklists should, ideally, contain only 5 to 10 items. |
a) Studies show that COCs may be
safely and effectively administered through non-clinical distribution.
- Contraceptive social marketing:
Lessons from experience. Population Reports Series J, no. 30, July-August 1985.
- Pharmacists and family planning. Population
Reports Series J, no. 37, November 1989.
- Rosenfield A, Maine D, Gorosh ME.
Nonclinical distribution of the pill in the developing world. International Family
Planning Perspectives 1980;6(4):130-135.
- Zavala AS, Perez-Gonzales M, Miller P,
Welsh M, Wilkens LR, Potts M. Reproductive risks in a community-based distribution program
of oral contraceptives, Matamoros, Mexico. Studies in Family Planning
1987;18(5):284-90.
|
| b) If complaints or symptoms
arise which are of concern to the provider or to the woman (and which may or may not be
due to COCs), the woman should be referred to an appropriate facility. If the woman wants
to continue COCs, they should be continued unless a serious problem with estrogen (such as
excess blood clotting) is suspected. |
b) Much harm can be done by
stopping COCs unnecessarily (e.g., risks of pregnancy and risks of abortion). |
