Recommendations for Contraceptive Use
		CBS (Community Based Services) Checklists

Explanation of DMPA (or NET-EN) Checklist Questions for Trainers

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. Have you ever had a stroke or 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 commonly have been told that they have had this condition. Those who have had this condition will answer "yes," if appropriate.

Question 3. 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 4. Do you have or have you had breast cancer? The intention of this question is to identify women who know they have had or currently have breast cancer.

Question 5. 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 are currently suffering from 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 6. 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 DMPA or NET-EN 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 DMPA or NET-EN use need not be delayed.

Question 7. Are you currently breastfeeding? A breastfeeding woman can be given DMPA or NET-EN 6 weeks after her baby is born.

Question 7a. Is the baby less than 6 weeks old? If clients more easily think of time in terms of months instead of weeks change the question to: "Is the baby less than a month and a half old?"

Question 8. How many days ago did you start your menstrual period? The intention of this question is to determine when the client should start DMPA (or NET-EN). If she has just startedher 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, she will need to wait until her next menstrual period begins before she can be given DMPA 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.