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Contraceptive Implants

Contraceptive Implants

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Contraceptive Implants

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Presentation Transcript

  1. Contraceptive Implants Session II: Who Can and Cannot Use Implants

  2. Characteristics of Implants Why might these women be interested in using implants? • Breastfeeding mother • Adolescent • Infected with HIV • Has little to no access to a health care facility • Desires no more children

  3. Implants Are Safe for Nearly All Women • Almost all women can use implants safely, including women who: • Have just had an abortion, miscarriage or ectopic pregnancy • Are breastfeeding (starting as soon as 6 weeks after childbirth, WHO/MEC) • Have anemia now or in the past • Have varicose veins • Have or have not had children • Are not married • Are of any age including adolescents and women over 40 years old • Are infected with HIV • Most health conditions do not affect safe and effective use of implants. • Many women who cannot use methods that contain estrogen can safely use implants.

  4. Who Can and Cannot Use Implants (part 1) Most women can safely use implants But usually cannot use implants if: Breastfeeding 6 weeks or less/WHO MEC Some other serious health conditions May be pregnant

  5. Who Can and Cannot Use Implants (part 2)

  6. Medical Eligibility Criteria What are medical eligibility criteria? Define the categories. Review the job aid.

  7. WHO’s Medical Eligibility Criteria Categories for IUDs, Hormonal and Barrier Methods Source: WHO, 2010.

  8. WHO’s Medical Eligibility Criteria Categories for IUDs, Hormonal and Barrier Methods Source: WHO, 2010.

  9. Category 1 and 2 Examples (not inclusive):Who Can Start Implants Implants are safe for nearly all women. Source: WHO, 2010.

  10. Category 3 and 4Who Should Not Start Implants A small number of women may not be able to use implants. Source: WHO, 2010.

  11. Implant Use by Women with HIV • Women with HIV or AIDS can use without restrictions • Some ARV drugs reduce blood progestin level • Efficacy is not affected because implants provide consistent dose of hormone over time • Dual method use should be encouraged Source: WHO, 2010; Mildvan, 2002.

  12. Implant Use by Postpartum Women • Non-breastfeeding women can initiate immediately postpartum • Breastfeeding women • Before 6 weeks postpartum (WHO/MEC) • No restrictions after 6 weeks postpartum Source: WHO, 2010.

  13. Understanding the Implant Checklist Read questions 1–6 in the checklist and match them with the conditions and categories on the MEC quick reference chart. This set of questions identifies women who should not use implants. This set of questions identifies women who are not pregnant. The checklist also gives instructions about initiating implants.

  14. When to Start Implants (part 1) • Anytime a provider is reasonably certain a woman is not pregnant. • Pregnancy can be ruled out if any of these situations apply: • Is fully breastfeeding, has no menses, and baby is between 6 weeks and 6 months old • Abstained from intercourse since last menses or delivery • Had a baby in the past 4 weeks (if not breastfeeding) • Started monthly bleeding within the past 7 days (5 days for Implanon) • Had a miscarriage or abortion in the past 7 days (5 days for Implanon) • Is using a reliable contraceptive method consistently and correctly • If none of the above apply, pregnancy can be ruled out by pregnancy test, pelvic exam, or by waiting till next menses. Source: WHO, 2004 (updated 2008).

  15. When to Start Implants (part 2) • First 7 days of menstrual cycle (5 days for Implanon), no backup method needed • After 7th day of menstrual cycle (5th for Implanon), rule out pregnancy and use backup method for 7 days • Postpartum • Not breastfeeding: immediately (no need to rule out pregnancy until 4 weeks postpartum) • Breastfeeding: delay 6 weeks (WHO/MEC) Source: WHO, 2004 (updated 2008).

  16. When to Start Implants (part 3) • Postabortion or miscarriage: immediately; without backup • Switching from a hormonal method: immediately if it was used consistently and correctly • Injectable users can have implants inserted within the reinjection window; without backup • After using emergency contraceptive pills: • Insert within 7 days after start of next menstrual period (5 days for Implanon); provide with backup method during interim Source: WHO, 2004 (updated 2008).