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.
Lay health workers, auxiliary nurses, pharmacists, and other community-based providers of injectables should be trained and able to give intramuscular injections safely. They should also be able to screen clients for pregnancy and for medical eligibility for different contraceptives. 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 STIs, including HIV. They also can inform women about the range of methods available, including methods only available at a 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 (see Who Provides Family Planning?).
Prefilled syringes aid community-based programs
Prefilled single-dose, single-use injection devices make community and home delivery easier and faster because providers do not have to draw a measured dose into the syringe from a vial. Also, these devices cannot be reused, preventing the spread of infection. DMPA is available in a number of prefilled single-dose injection systems. DMPA for intramuscular injection (DMPA-IM) is available in auto-disable syringes. The newer subcutaneous DMPA formulation (DMPA-SC), which is suitable only for injection just under the skin, comes in both the Uniject injection system (under the brand name Sayana Press) and the prefilled single-dose conventional disposable hypodermic syringes (marketed as Depo-SubQ Provera 104) (see DMPA for Subcutaneous Injection). DMPA-SC, particularly in the Uniject system, is likely to make delivery of DMPA injection in the community and at 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 more than 2 weeks late for a NET-EN injection (see Managing Late Injections)
- Responding to the concerns of clients referred by the community-based providers.
The clinic also can serve as a “home” for the community-based providers, where they can go for resupply, for supervision, training, and advice, and to turn in their records.