Expanding Services for Injectables

CONTENTS

Home (Key Points)

Injectables Today and Tomorrow
Box: Injectables Tomorrow: Subcutaneous DMPA and Home Injection
Web Table 1. Knowledge and Current Use of Injectable Contraceptives Reported by Married Women 15–49, All Surveys 1990–2006
Web Table 2. Knowledge and Current Use of Injectable Contraceptives Reported by Married Women 15–49, Most Recent Surveys 1990–2006
Web Figure. Donor Shipments of Injectables Increasing

Supply Meets Demand With Forecasting and Ingenuity
Web Table 3. Key Resources for Program Managers and Providers

Training to Meet Demand

Box: With Training, a Range of Providers Can Give Contraceptive Injections

Give Injections and Dispose of Waste Safely

Community Programs Can Safely Increase Access to Injectables

Meeting Rising Demand Efficiently

Communication Helps Women Try and Use Injectables

Questions and Answers About Injectables

Box: Women With HIV/AIDS Can Use Injectables

Bibliography

Credits

Coming Soon: "Injectables Toolkit" Web site. Go to http://www.injectablestoolkit.org for job aids and information about injectable contraceptives.

• Table 1: Estimated Worldwide Use of Injectables Among Married Women Ages 15–49, 2006
• Table 2: Formulations, Injection Schedules, and Availability of Injectable Contraceptives
• Table 3: Key Resources for Program Managers and Providers

Tools for Program Managers
• Checklist: Good-Quality Injectables Services
• Checklist: Improving Access to Injectables

Tools for Providers are in the companion INFO Reports. See also Population Reports, "When Contraceptives Change Monthly Bleeding," Series J, No. 54, August 2006.

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See Companion INFO Reports on "Injectable Contraceptives: Tools for Providers"
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With Training, a Range of Providers Can Give Contraceptive Injections

Service delivery guidelines in some countries restrict who can give injections. They limit provision to doctors and nurses. Studies show, however, that many types of health care providers can give injections if they are appropriately trained (36, 66, 183, 200). Such providers include pharmacists, auxiliary nurses, midwives, medical assistants, community health workers, and others who have been specifically trained to provide family planning, as well as those who have general medical education. Training a wider range of providers to give injections safely can expand access to injectables, reduce unsafe unauthorized injections, and save programs money.

In some cases, particularly when scaling up pilot programs, allowing certain groups of providers to give injectables may require changes in national policy. For example, in Honduras service delivery guidelines did not authorize auxiliary nurses to provide DMPA until 1999. Because an auxiliary nurse is often the only provider at a rural health center, women in rural areas who wanted injectables could not obtain the method easily. When a 1997–98 study demonstrated that auxiliary nurses could provide these services safely and cost-effectively, the Ministry of Health changed the service delivery guidelines (200). As a result, use of injectables increased 19% after three months in clinics where auxiliary nurses began offering injectables, and 35% in clinics where the auxiliary nurses offered injectables and also promoted the new services to clients and the community (112).

Formally training those who may be giving unregulated injections is another way to increase safe access to injectables. For example, a 2003 study in Egypt found that women frequently seek injections, both contraceptive and therapeutic, from informal providers, or "health barbers" (187). Because they often charge less than the cost of a new needle and syringe, it is likely that these providers reuse injection equipment. In this situation, changing guidelines to allow such providers to provide injections, training them appropriately, and supplying them with single-use injection equipment could reduce the potential for unsafe injections (86).