Traditionally, family planning clinics without laboratory facilities have used menstrual bleeding as an indicator that a woman is not pregnant. This had led, in many instances, to policies that prohibit clients from receiving intrauterine devices (IUDs) and other family planning methods unless they are menstruating.
Yet, these policies are medically unnecessary and may result in an unplanned pregnancy if a woman must wait weeks before she is allowed to begin using contraception. Providers can take other steps to make sure family planning clients are not pregnant, including client interviews, physical examinations, or laboratory tests.
Postponing a woman's access to contraception to coincide with menses may even discourage her from using family planning, says Dr. Roberto Rivera, corporate director for international medical affairs at Family Health International. "It requires an extra visit to the family planning clinic. It may mean a sense of frustration for the client. The woman made the decision and took the time to get family planning, and her expectations have not been met. She may not come back, and she may get pregnant during the waiting period."
In a study of IUD use in Kenya, researchers found that usually the first question asked of a client during the registration process dealt with menstruation. "Only one client was told that she could have an IUD inserted if she had refrained from sexual intercourse since her last menses," the study found.1 In Ghana, three-fourths of providers surveyed delayed giving oral contraceptives to nonmenstruating clients who had requested the pills.2
The Technical Guidance Working Group, a committee of practitioners and family planning experts from around the world organized by the U.S. Agency for International Development, has developed the following recommendations for screening clients for pregnancy.3
A clinician can normally find out whether a woman is pregnant by asking the client if she has had any symptoms of pregnancy, such as absent or altered menses, nausea, persistent fatigue, breast tenderness or enlargement, increased frequency of urination, or the perception of movement of the fetus.
Providers also can be reasonably sure a woman is not pregnant if any of the following is true:
- she has not had sexual intercourse since her last normal menses
- she has been correctly and consistently using a reliable contraceptive method
- she is within the first seven days of onset of normal menses
- she is within four weeks postpartum (for nonlactating women); or within seven days after an abortion; or, is correctly practicing the Lactational Amenorrhea Method (is amenorrheic and fully or nearly fully breastfeeding a baby younger than six months).
To determine if a woman is pregnant, providers also may conduct a physical examination, but this is seldom necessary. At or around 18 weeks, providers can hear the fetal heartbeat with a stethoscope and can detect fetal movements.
Laboratory tests can also be used to detect pregnancy. However, tests often are not available or affordable and are often unnecessary.
-- Barbara Barnett
Footnotes
- Stanback J, Omondi-Odhiambo, Omuodo D. Final Report: Why Has IUD Use Slowed in Kenya Part A - Qualitative Assessment of IUD Service Delivery in Kenya. Research Triangle Park: Family Health International, 1995.
- Twum-Baah KA, Stanback J. Provider Rationales for Restrictive Family Planning Service Practices in Ghana. Final Report. Research Triangle Park: Ghana Statistical Service and Family Health International, 1995.
- Curtis KM, Bright PL, eds. Recommendations for Updating Selected Practices in Contraceptive Use: Results of a Technical Meeting, Volume I. Chapel Hill: Technical Guidance Working Group, U.S. Agency for International Development, 1994.
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