Injectable contraceptives are popular with many women. This method can be more widely available when it is offered in the community as well as in clinics.

In 2012 WHO noted that using lay health workers to give injectable contraceptives may increase access to injectables and does not appear to raise safety concerns. WHO suggested that provision of injectables could be added to well-functioning programs that employ lay health workers.

These recommendations are part of a global movement known as task-sharing—empowering more types of health care workers to provide various health services. The goal of task-sharing is to serve more people, especially where there are few highly trained health care providers (see Who Provides Family Planning?). 

Lay health workers, auxiliary nurses, and other community-based providers of injectables should be trained and able to give injections safely. Also, they should be able to screen clients for pregnancy and for medical eligibility. They can inform women about delayed return of fertility and common side effects, including irregular bleeding, no monthly bleeding, and weight gain, and explain the importance of dual protection if a woman is at risk for sexually transmitted infections, including HIV. They also can inform women about the range of methods available, including methods available at the clinic. All providers of injectables need specific competency-based training and supportive supervision to carry out these tasks. WHO recommends specific monitoring and evaluation of the provision of injectables by lay health workers.

Prefilled syringes aid community-based programs

Prefilled single-dose, single-use injection devices make community and home delivery easier because providers do not have to draw a measured dose into the syringe from a vial. Also, these devices cannot be reused. DMPA is available in a number of prefilled single-dose injection systems: The older formulation for intramuscular injection (DMPA-IM) is available in auto-disable syringes. The newer subcutaneous formulation (DMPA-SC), which is suitable only for injection just under the skin, comes in the Uniject injection system under the brand name Sayana Press and in single-use conventional syringes (see Giving the Injection with Subcutaneous DMPA in Uniject).

The new subcutaneous formulation, particularly in the Uniject system, is likely to make delivery of DMPA injections in the community and the home easier. In fact, women can learn to inject themselves with this formulation (see Teaching Clients to Self-Inject).

Working together, in communities and clinics

For success, clinic-based providers and community-based providers need to work together closely. Programs vary, but these are some ways that clinic-based providers can support community-based providers:

  • Managing side effects
  • Using clinical judgment concerning medical eligibility in special cases
  • Ruling out pregnancy in women who are more than 4 weeks late for an injection of DMPA or 2 weeks late for NET-EN (see Managing Late Injections)
  • Responding to concerns of clients referred by the community-based providers

The clinic also can serve as “home” for the community-based providers, where they go for resupply, for supervision, training, and advice, and to turn in their records.