Self-Study Post-Test for
Injectable Contraceptives

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Section 1: Injectables: An Overview

1. The following statements pertain to injectable contraceptives. Please indicate whether each
statement is True (T) or False (F).

T / F
	a. Injectables are nearly as effective as female sterilization in preventing pregnancy.
	b. Injectables depend to a large extent on daily user compliance.
	c. The primary mechanism of action of injectables is suppression of ovulation.

2. Typical one-year pregnancy rates in clinical trials for injectable contraceptives are:
   a. 0.4% or less.
   b. 1%.
   c. 10%.
   d. 15%.

Section 2: Progestin-only Injectables - DMPA

3. The following statements pertain to the advantages and disadvantages of DMPA as a
contraceptive method. Please indicate whether each statement is True (T) or False (F).

T / F
	a. DMPA is a reversible method of contraception.
	b. DMPA increases the risk of ectopic pregnancy.
	c. DMPA provides protection from endometrial cancer.
	d. DMPA does not have a negative effect on lactation; however, it is recommended that a woman who is breastfeeding wait until her child is six weeks old before using it.
	e. DMPA does not cause menstrual changes.

4. Which of the following are not potential health benefits of DMPA?
   a. Reduced risk of vaginal yeast infections.
   b. Reduced risk of acute pelvic inflammatory disease (PID).
   c. Reduced symptoms of endometriosis.
   d. Reduced risk of heart disease.
   e. Protection against STDs, including HIV.

5. Which of the following are typical menstrual changes for women taking DMPA? Check all
    that apply.
   a. Over 40% of women experience prolonged or irregular bleeding after the first DMPA
             injection.
   b. By the end of the first year, 90% of women have no menstrual bleeding.
   c. Bleeding changes are rarely seen in women taking DMPA.
   d. Infrequent bleeding and amenorrhea become more common as the duration of DMPA use
             increases.

6. On average, women can become pregnant how many months after their last DMPA infection?
   a. 2-4 months.
   b. 6-8 months.
   c. 9-10 months.
   d. 12-24 months.

7. Check all that apply. It is safe for a breastfeeding woman to begin using DMPA:
   a. When her infant is six weeks old, preferably.
   b. Only when her milk supply is completely developed.
   c. Sooner than with combined injectables.
   d. Immediately after birth, if necessary.

8. As a provider, what issue might keep you from recommending DMPA to adolescent girls?
   a. Concerns about bone density and osteoporosis.
   b. Concerns about return to fertility.
   c. Risk of ectopic pregnancy.
   d. Loss of privacy.

9. Check all that apply. According to World Health Organization (WHO) guidelines, DMPA and
    NET-EN are not recommended for or should not be used by:
   a. Women with low blood pressure.
   b. Women who have diabetes with vascular complications.
   c. Women with active hepatitis.
   d. Women who have a sexually transmitted disease.
   e. Women who have breast cancer.

10. A 32-year-old woman has three children and is not planning to have more. She has suspicious,
    unexplained bleeding and is showing clinical signs of anemia. She would like to use DMPA.
    What would you recommend and why?
   a. Recommend DMPA. According to WHO Guidelines, she falls under Category 1, which
             means there are no health concerns.
   b. Recommend NET-EN as a preferable solution, because it causes less bleeding changes.
   c. Recommend another contraceptive option. According to the WHO guidelines, this woman
             falls under Category 4, which means she should not use DMPA until the bleeding has
             been evaluated.
   d. None of the above.

11. A 37-year-old woman who smokes heavily wants to use DMPA as a method of contraception.
    What would you recommend and why?
   a. She can use DMPA because smoking is not a contraindication for progestin-only
             injectables.
   b. Recommend Cyclofem instead because smoking is not a contraindication for combined
             injectables.
   c. Recommend another contraceptive option. According to the WHO guidelines, this woman
             falls under Category 3, which means she should not use DMPA unless other methods are
             not available or acceptable.
   d. None of the above.

Section 3: Progestin-only Injectables - NET-EN

12. Please indicate whether each statement regarding NET-EN is True (T) or False (F).

T / F
	a. NET-EN is effective for a shorter period of time than DMPA.
	b. NET-EN can be initiated only during the first seven days of the menstrual cycle.
	c. NET-EN should be initiated no sooner than six weeks postpartum for breastfeeding women.
	d. Women who use NET-EN are more likely to have amenorrhea than those who use DMPA.
	e. It is possible to provide NET-EN to women immediately postabortion.

13. Both DMPA and NET-EN can be started:
   a. At any point in a woman's menstrual cycle, as long as a woman is not pregnant and it is
             used with a backup method if starting after day seven.
   b. Six weeks postabortion or postpartum, if not breastfeeding.
   c. Only in the first seven days of a woman's menstrual cycle.
   d. None of the above.

14. The injection schedule for NET-EN:
   a. Is once every month.
   b. Is once every two months.
   c. Is once every four months.
   d. Varies for each woman.

15. A 36-year-old woman is using NET-EN as a method of contraception. She is three weeks late
    for her next injection. What do you do?
   a. If you can be reasonably sure that the woman is not pregnant, give her the next injection.
   b. Even if you can be reasonably sure that the woman is not pregnant, tell her she must use
             a condom until her next menstrual cycle begins, after which she should return for another
             injection.
   c. Advise her to choose an alternate method of contraception as injectables cannot be
             given late.
   d. None of the above.

Section 4: Summary - Combined Injectable Contraceptives

16. The following statements refer to combined injectable contraceptives. Please indicate whether
each statement is True (T) or False (F).

T / F
	a. The window for subsequent injections is up to five days early and five days late.
	b. Breastfeeding women should postpone the use of combined injectables until six months postpartum.
	c. Women who use combined injectables never experience changes in their menstrual cycles.
	d. Irregular bleeding due to combined injectables use is most common during the first three months of use and then decreases over time.

17. Which two of the following are the commercial names for newer, widely studied combined
    injectable contraceptives?
   a. DMPA.
   b. Cyclofem.
   c. Mesigyna.
   d. Topasel.

18. Which three of the following are advantages of combined injectables?
   a. They are safe and highly effective.
   b. Their use can be kept private since bleeding is more regular than with progestin-only
             injectables.
   c. They do not have to be administered as often as progestin-only injectables.
   d. They require no action at time of sexual intercourse.

19. Check all that apply. According to WHO guidelines, combined injectables are not
    recommended for use by women:
   a. Who are heavy smokers over 35 years of age.
   b. With sexually transmitted diseases.
   c. With high blood pressure.
   d. With breast cancer.

20. A 25-year-old woman gave birth to her third child six weeks ago. She is breastfeeding, but does
    not want to rely on the Lactational Amenorrhea Method (LAM) for contraception. She wants to
    use another method, possibly Cyclofem. What would you recommend and why?
   a. Assure her that it will be fine to begin Cyclofem at six weeks postpartum.
   b. Counsel her on the availability of progestin-only injectables (DMPA or NET-EN) and other
             methods such as oral contraceptives, barrier methods and IUDs. Explain that if she still
             wants to use Cyclofem, she can initiate this method at six months postpartum.
   c. Counsel her against using any injectable contraceptives while she is breastfeeding,
             because they affect the quantity and quality of breastmilk and may harm her baby's health
             and development.
   d. None of the above.

Section 5: Providing Injectables

21. Check all that apply. Counseling messages for women before beginning injectable
    contraceptive use include:
   a. Injectables do not provide protection against sexually transmitted diseases, including HIV.
   b. It is important not to massage the injection site.
   c. No bleeding is likely to occur in the month after the first injection.
   d. The need for regular, timely injections.
   e. The timing of return to fertility.

22. Which two of the following demonstrate the correct technique for administering DMPA?
   a. The vial must be lightly shaken before injecting.
   b. All the solution must be drawn into the syringe, especially for DMPA and Cyclofem.
   c. Injections may be given in the forearm, upper leg or back.
   d. The preferred injection location for most women is the deltoid muscle of the upper arm or
             the gluteus muscle of the buttocks.

23. Which three of the following demonstrate the sterile conditions needed to deliver injectable
    contraceptives?
   a. A sterile needle and syringe must be used for each injection.
   b. The injection site should be cleaned with a new piece of cotton for each client.
   c. There are no special waste disposal instructions for maintaining a sterile environment.
   d. The provider should wash hands before each injection.

24. Choose the best answer. Delivery of injectables can be provided:
   a. In clinics by nurses.
   b. In pharmacies by pharmacists.
   c. In homes by community-based workers.
   d. All of the above.

25. The following statements refer to providing injectable contraceptives. Please indicate whether
each statement is True (T) or False (F).

T / F
	a. If a family planning clinic cannot maintain adequate supplies of all injectable contraceptives, it is preferable to offer only one type of injectable.
	b. Injectable contraceptives may be used for four to six months past their expiration date.
	c. Health workers who provide injectable contraceptives need to be trained in both technical skills and counseling skills.