Recommendations for Contraceptive Use
		CBS (Community Based Services) Checklists

Please ask the client all these questions:	Check the correct box:
Is your menstrual period late and do you think you could be pregnant now?	Yes	No
Have you ever had a stroke or heart attack?	Yes	No
Do you have diabetes (sugar in your blood)?	Yes	No
Do you have or have you had breast cancer?	Yes	No
Do you have a serious liver disease or jaundice (yellow skin or eyes)?	Yes	No
If the client answers YES to any of the above questions, refer her to the clinic/physician, and give her condoms and/or spermicide to use in the meantime. If the client answers NO to all the above questions, continue with the questions below.
Do you have bleeding between menstrual periods which is unusual for you, or bleeding after intercourse (sex)?	Yes	No
(If the client answers YES, she can be given DMPA now, but refer her to the clinic/physician for further evaluation of bleeding. Continue with question 7.)
If the client answers NO to all the questions, she can use DMPA, but to find out when she can start, ask:
Are you currently breastfeeding?	Yes	No
If the client answers YES, go to question 7a. If client answers NO, go to question 8.
. Is the baby less than 6 weeks old?
If client is breastfeeding a baby [less than 6 weeks old], instruct her to return for DMPA as soon as possible after the baby is 6 weeks old.
If client is breastfeeding a baby 6 weeks old or older and her menstrual periods have not returned, she can be given DMPA now. If her menstrual periods have returned, go to question 8.
How many days ago did you start your last menstrual period?		_________ # days
If the client began her last menstrual period within the past 7 days, she can be given DMPA now.
If the client started her last menstrual period more than 7 days ago, and if: she has been using an effective method of contraception (including abstinence), she can be given DMPA now, but instruct her that she must use condoms and/or spermicides or abstinence for the next 7 days. Give her condoms and/or spermicides. she has not been using an effective method of contraception (including abstinence), she must wait until her next period to be given DMPA. Give her condoms and/or spermicide to use in the meantime.

Any part of Recommendations for Updating Selected Practices in Contraceptive Use may be reproduced or adapted to meet local needs without prior permission from the TG/CWG Secretariat, provided the TG/CWG is acknowledged and the material is made available free of charge or at cost.