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Research |
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Unintentional Discontinuation of Injectable Contraceptives Can Be Prevented |
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USAID-supported research from Family Health International, the University of Cape Town, and the Walter Sisulu University in South Africa shows that being late for a re-injection can lead to unintentional discontinuation of injectable contraceptives. Results of the study also suggest that family planning providers can take certain steps to help clients who do not wish to stop using the method. The study included more than 1,000 users of DMPA and NET-EN who were receiving a re-injection of DMPA or NET-EN at one of 10 family planning clinics in two South African provinces. Approximately half of the women were late for their injections. Nearly a third were late by two weeks or less. At the time of the study, recommendations from the World Health Organization stated that a woman may receive a re-injection without the need to rule out pregnancy even if she was up to two weeks early or up to two weeks late for her appointment. In 2008, the World Health Organization extended the recommended "grace period" for DMPA to four weeks for women who arrive late for re-injections. A woman who returns to the clinic after the 4-week grace period for DMPA may be at risk of an unintended pregnancy. In this case, the World Health Organization recommends that a woman should not receive another injection until pregnancy is ruled out. In South Africa, a substantial portion of women who returned to clinics within the approved grace period were denied a re-injection. Many were not given an alternative contraceptive method or were told to return to the clinic only after they had begun menstruating. Providers should counsel the users of injectable contraceptives about the timing of their next injection and the consequences of being more than four weeks late for DMPA or two weeks late for NET-EN. They should also be careful not to deny a woman a re-injection if she returns to the clinic within the recommended grace period. If a woman is more than four weeks late for DMPA or two weeks late for NET-EN, providers should attempt to rule out pregnancy during the visit. If pregnancy is ruled out, same-day re-injections should be provided. If pregnancy cannot be ruled out, providers should offer effective contraceptive alternatives to the client until pregnancy is ruled out. Read more (PDF, 255 KB) about this study, published in International Family Planning Perspectives. Source |
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