Recommendations for Contraceptive Use
		CBS (Community Based Services) Checklists

Question 1. Is your menstrual period late and do you think you could be pregnant now? This question has two parts - both of which should be asked together, and the answer "yes" must apply to both parts of the question. One or more missed periods in combination with the women's own report that she is or might be pregnant is required before a woman should be referred to a higher level health care provider.

Question 2. Are you currently breastfeeding a baby under 6 months of age? This question is intended to identify women who are breastfeeding babies under 6 months of age. A breastfeeding woman can begin COCs 6 months after her baby is born. However, if a client does not plan to continue breastfeeding, she may be an eligible candidate for COCs even before the baby reaches 6 months of age.

Question 3. Do you smoke cigarettes and are you over 35 years of age? This is a two-part question - and both parts need to be asked together and the answer "yes" must apply to both parts of the question. A woman less than 35 years of age who smokes as well as a woman over the age of 35 who is a nonsmoker are not at risk for problems associated with the combination of smoking and older age. The answer "no" to one or both parts of this question means a client may be eligible for COC use.

Question 4. Do you have frequent and very severe headaches that cause you problems; for example, blurred vision or temporary loss of vision, which you get during the headache? This question is intended to identify women with a particular type of headache that may be problematic for COC users. The use of the words "frequent and severe" and the occurrence of other problems during the headache are essential parts of this question. These words help the client distinguish between those types of headaches that make her ineligible for COC use (such as migraines with focal neurologic symptoms) and the less severe (more common) mild headaches for which COCs may still be used.

Question 5. Do you have high blood pressure? The question is intended to identify women who have ever been told that they have high blood pressure, since women with this condition should be referred for further evaluation before receiving COCs.

Question 6. Have you ever had a stroke, blood clot in your legs or lungs, or a heart attack? This question is intended to identify women with already known serious vascular disease, not to determine whether women might have an undiagnosed condition. Women who have had any of these conditions will often have been told that they have had this condition, and will answer "yes," if appropriate.

Question 7. Do you have diabetes (sugar in your blood)? The intention of this question is to identify women who know that they have diabetes, not to assess whether they may have an undiagnosed condition.

Question 8. Do you have or have you had breast cancer? The intention of this question is toidentify women who know they have had or currently have breast cancer.

Question 9. Do you have a serious liver disease or jaundice (yellow skin or eyes)? The intention of this question is to identify women who know that they currently have a serious liver disease and to distinguish between current severe liver disease (such as severe cirrhosis or liver tumors) and past liver problems (such as treated hepatitis).

Question 10. Do you regularly take any pills for tuberculosis (TB), fungal infections or seizures (fits)? The following medications make COCs less effective:

• rifampicin (for tuberculosis)
• griseofulvin (an antifungal medication)
• phenytoin (for epilepsy/seizures)
• carbamezapine (for epilepsy/seizures)
• barbiturates (for epilepsy/seizures)

Question 11. Do you have bleeding between menstrual periods which is unusual for you, or bleeding after intercourse (sex)? The intention of this question is to distinguish between normal bleeding changes (such as those associated with the use of another contraceptive method), and those that are different or unusual for the client, and to identify post-coital bleeding (since bleeding after intercourse may indicate an abnormality). The use of COCs does not make these conditions worse, but may change the bleeding pattern. Unusual bleeding changes can underlie a serious condition which should be evaluated by a higher level health care provider, but COC use need not be delayed.

Question 12. How many days ago did you start your menstrual period? The intention of this question is to determine when the client should start COCs. If she has just started her menstrual cycle and is within days 1 to 7 of the first day of bleeding, she can start the method immediately. If it is more than 7 days since her first day of bleeding, there are two options:

• if she has been using an effective method (correctly and consistently) of contraception which can help a provider rule out pregnancy, she can start taking the pill immediately but use a back-up method for 7 days.
• if she has not been using any effective method of contraception (including abstinence), in order to insure she is not pregnant, she needs to wait until her next menstrual period begins before starting COCs and be given condoms or spermicides 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.