Job Aids for the Reinjection of Injectable Contraceptives

FHI and IntraHealth International have field tested and co-branded two job aids designed to help health care providers better serve women who return for reinjections of the contraceptives depot medroxyprogesterone acetate, or DMPA (2009, PDF, 294 KB) and norethisterone enantate, or NET-EN (2009, PDF, 289 KB). Research that FHI conducted in South Africa, with support from the U.S. Agency for International Development, revealed that approximately half of injectable users were late for their reinjections, and a substantial portion of those who arrived within the approved grace period were denied a reinjection.

Many of the women were not given an alternative contraceptive method or were told to return to the clinic only after they had begun menstruating. A follow-on study in South Africa conducted by FHI demonstrated that clinics where job aids for providers were introduced experienced much higher reinjection rates among clients than control sites did. The easy-to-use job aids were modified for a global audience after being field-tested in Senegal.

The DMPA job aid reflects 2008 guidance from the World Health Organization regarding how many weeks late a woman can be for reinjection without risk of pregnancy -- widely referred to as the extended grace period. Both job aids describe the strategies that clinicians can use to rule out pregnancy among women who return outside of the recommended grace periods, so that those who are not pregnant can receive same-day reinjections. French versions of the DMPA (2009, PDF, 374 KB) and NET-EN (2009, PDF, 371 KB) job aids for clinicians are available.

Simplified versions designed for use by community health workers (CHWs) who provide DMPA (2009, PDF, 289 KB) and NET-EN (2009, PDF, 284 KB) are also available. The CHW versions provide only one strategy -- a pregnancy checklist -- for ruling out pregnancy.

For checklists adapted to the policies and guidelines of specific countries, please see:

• Senegal DMPA for clinicians (French, 2009, PDF, 426 KB)
• South Africa DMPA for clinicians (2009, PDF, 504 KB)
• South Africa NET-EN for clinicians (2009, PDF, 475 KB)

The reinjection job aids are meant to be companion pieces to the Checklist for Screening Clients Who Want to Initiate DMPA (or NET-EN), a simple provider tool designed to help screen clients who have made an informed decision to initiate DMPA or NET-EN.