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The Philippine Clinical Standards Manual on Family Planning Tool The Philippine Clinical Standards Manual on Family Planning 2014 Edition About the DOH and the FP Program The goal of the family planning (FP) Program is to provide universal access to FP information and services whenever and wherever these are needed. To achieve this goal, the DOH FP Program will (1) address the need to help couples and individuals achieve their desired family size within the context of responsible parenthood and improve their reproductive health to attain sustainable development and (2) ensure that quality FP services are available in DOH-retained hospitals, LGU-managed health facilities, NGOs, and the private sector. © 2006, 2014 Department of Health ISBN: 978-971-92174-7-3 ISBN: Contact address: Department of Health, San Lazaro Compound, Rizal Avenue, Sta. Cruz, Manila, Philippines Suggested citation: Department of Health. The Philippine Clinical Standards Manual on Family Planning (2014 Edition). Manila, Philippines: DOH. 2014. 437 pages. TABLE OF CONTENTS Foreword vii Acknowledgments ix What Are the Updates? xi List of Acronyms and Abbreviations xiii List of Tables xv List of Figures xvii Chapter 1. Informed Choice and Voluntarism 1 Chapter 2. Counseling for Effective Contraception 7 Chapter 3. Client Assessment 17 Chapter 4. Combined Hormonal Contraceptives 29 4.1 Combined Oral Contraceptives 39 4.2 Combined Injectable Contraceptives 45 4.3 Transdermal Patch 57 4.4 Vaginal Ring 60 Chapter 5. Progestin-only Contraceptives 63 5.1 Progestin-only Pills 63 5.2 Progestin-only Injectables 74 5.3 Subdermal Implants 87 Chapter 6. Intrauterine Devices 101 6.1 Copper Intrauterine Device 102 6.2 Intrauterine System 128 The Philippine Clinical Standards Manual on Family Planning iii Chapter 7. Barrier Methods 135 7.1 Male Condoms 135 7.2 Female Condoms 142 7.3 Diaphragm 147 7.4 Cervical Cap 151 7.5 Spermicide 155 Chapter 8. Fertility Awareness-based Methods 159 8.1 Calendar-based Method: Standard Days Method 164 8.2 Symptoms-based Methods 168 a. Two-Day Method 170 b. Billings Ovulation Method 172 c. Basal Body Temperature Method 174 d. Symptothermal Method 176 Chapter 9. Lactational Amenorrhea Method 177 Chapter 10. Long-acting and Permanent Methods 181 10.1 Bilateral Tubal Ligation 181 10.2 No-scalpel Vasectomy 196 Chapter 11. Special Populations 209 11.1 Contraception for the Adolescent 209 11.2 Contraception for Women with Obesity 213 11.3 Contraception for Women Smokers 217 11.4 Contraception for Postpartum Women 219 11.5 Contraception for the Perimenopause 227 11.6 Contraception for Women-Victims of Violence 231 11.7 Contraception in Disaster and Crisis Situations 240 iv The Philippine Clinical Standards Manual on Family Planning Chapter 12. Sexually Transmitted Infections and Contraception 245 Chapter 13. Management of Family Planning Services 259 References 285 Appendices A. Current Thrusts of the National Family Planning Program 295 B. Anatomy and Physiology of Human Reproductive Tracts 313 C. Pregnancy Checklist 325 D. PhilHealth Requirements and Benefits Related to Family 329 Planning E. Summary Tables and Checklists: WHO Medical Eligibility Criteria 333 for Contraceptive Use F. Samples of Department of Health Family Planning Forms 385 G. Sample Informed Consent Forms 403 H. Method Effectiveness 405 Glossary 407 Index 413 The Philippine Clinical Standards Manual on Family Planning v FOREWORD One of the key components for achieving Universal Health Care or Kalusugan Pangkalahatan is the full implementation of Republic Act No. 10354: “Responsible Parenthood and Reproductive Health Act of 2012” (RPRH Act). This law ensures universal access to reproductive health services, including family planning. The RPRH Act and its implementing rules require the government to promote and provide information and access, without bias, to all modern methods of family planning, whether natural or artificial, which have been proven medically safe, legal, non-abortifacient, and effective in accordance with scientific and evidence- based medical research standards. In this context, the DOH and its partners must ensure that family planning services are available, accessible, affordable, and of high quality by making clinical practices uniform and by adapting the best medical science currently known. As the gold standard for family planning and contraceptive services in the Philippines, the Philippine Clinical Standards Manual on Family Planning provides updated content on clinical practice using existing family planning methods as well as information on new ones. Through this manual, the DOH affirms its commitment to ensuring quality family planning services by instituting practices that are at par with international standards. Together with the contributors, reviewers, and editors of this manual, I hope that this updated version serves as an easy-to-use and reliable guide for all frontline healthcare professionals. Through this guide, we are ensuring the success of our health programs by safeguarding the right kind and quality of service for those who are most in need. Enrique T. Ona, MD, FPCS, FACS Secretary of Health The Philippine Clinical Standards Manual on Family Planning vii viii The Philippine Clinical Standards Manual on Family Planning ACKNOWLEDGEMENTS Contributors and Reviewers Members of the DOH Expert Panel in Family Planning Lourdes Capito, MD Cesar Maglaya, MD Honorata Catibog, MD Enrico Gil Oblepias, MD Maria Cristina Crisologo, MD Jessica Ona-Cruz, MD Francis Floresca, MD Rosalie Paje, MD Cynthia Garcia, MD Rebecca M. Ramos, MD Jocelyn Ilagan, MD Lylah Reyes, MD Esmeraldo Ilem, MD Alejandro San Pedro, MD Enriquito Lu, MD External Reviewer Rebecca M. Ramos, MD Technical Editor Orville Solon, PhD Carlo Irwin Panelo, MD Annie Asanza, MD Kirth Asis, MD Desdemona Diwata Espina Maria Elinor Grace Sison, MD Lubalin Buhawi Espina Chamuel Michael Joseph Santiago, RN Eras Bathala Espina Technical Support Copy editing, Layout, Graphic Design The Philippine Clinical Standards Manual on Family Planning ix DOH Panel of Reviewers Esperanza Anita Arias, MD, Quezon City Health Department Rosario Benabaye, MD, InterCA-LuzonHealth Luzviminda Calajate, RM, Women’s Health Care Foundation Rose Camacho, RM, Integrated Midwives Association of the Philippines, Inc. Joseph Carillo, RN, DOH-RHO VI Virginia Dacpano, RM, Tumana Health Center Joy Dinalo, RN, DOH-RHO XI Joyce Encluna, MD, Health Policy Development Program Gliceria Enjambre, RN, Vicente Sotto Memorial Medical Center Mary Ann Evangelista, MD, Health Policy Development Program Isabel Ferrer, MD, Paulino J Garcia Talavera Extension Hospital Jovette Guinal, MD, DOH-RHO VII Liezel Hermosilla, RN, Quezon City Health Department Mickhael Langit, MD, Health Policy Development Program Vilma Maglaque, RM, Dr Jose Fabella Memorial Hospital Ingrid Magnata, MD, InterCA-LuzonHealth Carmelita Manlutac, RN, Quirino Memorial Medical Center Faith Obach, MD, Health Policy Development Program Cherry Pangilinan, MD, InterCA-VisayasHealth Kristine Romorosa, RN, Health Policy Development Program Nanette San Diego, RM, Tumana Health Center Dionica Saquilon, RM, DOH-RHO VII Cheryl Sarmiento, MD, DOH-RHO IX Rhoda Tiongson, Health Policy Development Program Patricia Tobias, MD, West Visayas Medical Center Robert Totanes, MD, Health Policy Development Program Rochelle Venzon, RM, Tumana Health Center Eugene Yu, MD, Zamboanga City Medical Center This manual was developed with the generous support of the American people through the United States Agency for International Development (USAID). The contents are the responsibility of the contributors, reviewers, and editors herein listed and do not necessarily reflect the views of the UPecon Foundation, Inc., the USAID, or the United States Government. The mention (if any) of specific companies or of certain manufacturer’s products does not imply that they are endorsed or recommended by the DOH in preference over others of similar nature. Articles may be reproduced in full or in part for non-profit purposes without prior permission, provided that credit is given to the DOH and/or the individual authors for original pieces. A copy of the reprinted or adapted version will be appreciated. x The Philippine Clinical Standards Manual on Family Planning WHAT ARE THE UPDATES? The updates featured in this version were adapted from the latest evidence-based recommendations and guidelines, including the (1) Medical Eligibility Criteria for Contraceptive Use (4th Edition, 2010), the (2) Selected Practice Recommendations for Contraceptive Use: 2008 Update of the WHO, and the (3) 2013 CDC Practice Recommendations. Specific questions on how to use different contraceptive methods were addressed. This manual provides updates on the following: • New chapter on informed choice and voluntarism (p. 1) • Continuous and extended use of combined oral contraceptives (p. 41) • Quick start of contraceptives (pp. 37, 42, 51, 58, 61, 68, 81, 95, 105, 122, 129, 166, 168, 172, 189, 233, 238) • Late reinjections for progestin-only injectables (p. 83) • Correction of misconceptions about each FP method (pp. 73, 104, 116, 156, 168, 172, 212) • New subcutaneous DMPA (p. 74) • Guidelines on the insertion and removal of contraceptive subdermal implants (pp. 91, 95) • Guidelines on pelvic examination prior to IUD insertion (p. 107) • Guidelines on postplacental and immediate postpartum insertion of TCu IUD (pp. 111, 115) • Endoscopic and hysteroscopic bilateral tubal ligation (pp. 182, 183) • When to start relying on the effectiveness of vasectomy after surgery (p. 206) • Effect of increased
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