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Expanding Services for Injectables,” Population Reports, Series K, No Population Reports December 2006 Expanding Services INFO Project Center for Communication Programs for Injectables How family planning programs and providers can meet clients’ needs for injectable contraceptives Bangladesh/CCP Key Points More than twice as many women are using injectable contraceptives today as a decade ago, and the numbers keep growing. Injectables appeal to the many women who seek a family planning method that is effective and long-acting and can be used privately. Family planning services can meet the rising As services expand, maintaining good quality demand for injectables by: remains an obligation to clients for all family • Keeping enough supplies on hand. planning methods. For injectables, attention to Anticipating demand for injectables and quality includes: placing accurate and timely orders helps • Giving injections safely. Applying safe injec- programs maintain adequate supplies and tion technique and the universal precautions, avoid stockouts. including disposing of used syringes and • Mobilizing a range of providers to offer needles properly, helps prevent infection. injectables. With training, any health care • Helping clients decide about injectables. worker can give contraceptive injections. Good counseling helps women decide if an • Taking injectables into the community. injectable contraceptive suits their preferences Offering injectables in community programs and their situation. Providers must tell women increases access and can be as safe as clinic that injectables change bleeding patterns. services. • Helping clients use injectables successfully. • Organizing services efficiently. Programs can Women who choose injectables keep using hold down cost increases by organizing work them longer when they know that bleeding more efficiently, purchasing supplies at the changes are normal and understand lowest available prices, and encouraging staff the importance of returning for injections on time. Series K, Number 6 to increase productivity. Injectables and Implants • Informing the public. Communication pro- grams can tailor messages to address women See companion INFO who know about injectables but hesitate to Reports, “Injectable try them. Contraceptives: Tools POPULATION REPORTS for Providers” This report was prepared by Robert Lande and Catherine Richey, MPH. Ward Rinehart, CONTENTS Editor. Design by Mark Beisser, Francine Mueller, Linda Sadler, and Rafael Avila. Production by Injectables Today and Tomorrow John Fiege and Monica Jiménez. Surveys find that more women are choosing injectable contraceptives, and The INFO Project appreciates the assistance of 3 governments, donor agencies, and family planning programs are responding. the following reviewers: Jacob Adetunji, Kim Best, Richard Blackburn, Marc G. Boulay, Steve Supply Meets Demand With Forecasting and Ingenuity Brooke, Gloria Coe, María del Carmen Cravioto, Successful injectables services require well-run logistics systems, accurate Juan Díaz, Maxine Eber, Douglas Huber, Barbara 6 forecasting, and the ability to avoid threatened stockouts quickly. Janowitz, Sophie Logez, Enriquito R. Lu, Kuhu Maitra, Kavita Nanda, Fredrick Ndede, Carib Training to Meet Demand Nelson, Paula Nersesian, Gael O’Sullivan, Joseph F. Perz, James Phillips, Roberto Rivera, Ruwaida More health care providers need the skills to offer injectable contraceptives. Salem, Hilary Schwandt, Stephen Settimi, James 7 Training and supervision can be adapted to suit program needs. D. Shelton, Jenni Smit, Cathy Solter, J. Joseph Speidel, Jeff Spieler, Tara M. Sullivan, Jagdish Give Injections and Dispose of Waste Safely Upadhyay, Ushma Upadhyay, Marcel Vekemans, Giving safe injections with sterile equipment and ensuring proper disposal Irina Yacobson, and Vera Zlidar. 8 keeps clients, clinic staff, and communities safe. Suggested citation: Lande, R. and Richey, C. With Training, a Range of Providers Can Give Contraceptive “Expanding Services for Injectables,” Population Reports, Series K, No. 6. Baltimore, INFO Project, Injections Johns Hopkins Bloomberg School of Public 10 Allowing pharmacists, auxiliary nurses, and community health workers to Health, December 006. give injections can increase access to injectables. Available online: Community Programs Can Safely Increase Access to Injectables http://www.populationreports.org/k6/ Providing injectables in the community offers women in isolated areas an- 12 other contraceptive choice. Meeting Rising Demand Efficiently Programs can increase services without greatly increasing costs by serving 14 clients efficiently, procuring supplies at low cost, and increasing productivity. INFO Project Injectables Tomorrow: Subcutaneous DMPA and Home Injection Center for Communication Programs A new formulation of DMPA will enable some programs to offer clients a self- Johns Hopkins Bloomberg 16 service option. School of Public Health Market Place, Suite 30 Communication Helps Women Try and Use Injectables Baltimore, Maryland 0 USA Women and their partners need complete information and often the chance 40-659-6300 40-659-666 (fax) 17 to talk to a professional about injectables and other contraceptives. www.infoforhealth.org [email protected] Questions and Answers About Injectables Providers need to know the answers to questions that clients are likely to ask Jane T. Bertrand, PhD, MBA, Professor and 20 about the side effects and safety of injectables. Director, Center for Communication Programs Earle Lawrence, Project Director, INFO Project Women With HIV/AIDS Can Use Injectables 21 Injectables can help women with HIV/AIDS avoid unintended pregnancy. Stephen Goldstein, Chief, Publications Division Population Reports is designed to provide Bibliography an accurate and authoritative overview of Note: Italicized reference numbers in the text refer to citations printed on important developments in family planning 23 page 3. These were the most helpful in preparing this report. Other citations and related health issues. The opinions can be found online at http://www.populationreports.org/k6/ expressed herein are those of the authors and do not necessarily reflect the views of • Table 1: Estimated Worldwide Use of Injectables, p. 3 the U.S. Agency for International Development • Table 2: Formulations, Injection Schedules, and Availability of Injectable (USAID) or Johns Hopkins University. Contraceptives, p. 5 Published with support from USAID, Global, GH/POP/PEC, • Table 3: Key Resources for Program Managers and Providers, p. under the terms of Grant No. GPH-A-00-0-00003-00. Tools for Program Managers • Checklist: Good-Quality Injectables Services, p. Cover Photo: A provider gives a client an injection in Bangladesh, where use of inject- • Checklist: Improving Access to Injectables, p. 5 ables has doubled over the last decade. As Tools for Providers are in the companion INFO Reports. See also Population more women choose injectable contracep- tives, programs will need to offer more good- Reports, “When Contraceptives Change Monthly Bleeding,” Series J, No. 54, quality services. August 006. Coming Soon: “Injectables Toolkit” Web site. Go to http://www. injectablestoolkit.org for job aids and information about injectable contraceptives. POPULATION REPORTS Injectables Today and Tomorrow More and more women are using injectable contraceptives private clinics and providers will offer injectables (44, 5). today, and very likely even more will use this method in the More pharmacists will provide injectables in many countries, future as it becomes increasingly available. Women choose often as a part of social marketing programs (35, 36, 45). injectables because they are effective, long-lasting, and More programs will offer injectables in community services, private. For family planning programs, meeting increasing and some women will choose home injection with the new demand while maintaining good quality will be the key to DMPA formulation for subcutaneous injection (under the skin success with injectables. rather than in the muscle) (see box, p. 6). Between 995 and 005 the number of women worldwide using injectable contraceptives more Table 1. Estimated Worldwide Use of Injectables than doubled. About million married women Among Married Women Ages 15–49, 2006 used injectables in 995. In 005 over 3 million were using injectables (108, 163, 194). Injectables % Currently Using % of Modern are the fourth most popular method worldwide, Any Method after female sterilization, the intrauterine device Region & Any Modern Inject- Users Using (IUD), and oral contraceptives. In sub-Saharan Selected Countries Method Method ables Injectables Africa, injectables are the most popular method, DEVELOPING AREAS 58 52 3 7 chosen by 38% of women using modern methods (see Table ). By 05 worldwide use is projected Sub-Saharan Africa 21 15 6 38 to reach nearly 40 million—more than triple the Kenya 2003 38 31 14 46 995 level (163). Lesotho 2004 36 35 15 42 Malawi 2004 31 28 18 64 Greater access largely explains this rapid growth in Namibia 2000 44 43 19 44 use. Approval of the progestin-only injectable DMPA South Africa 2003 60 60 28 47 (depot medroxyprogesterone acetate) in the United Near East & North Africa 52 40 2 4 States in 99 removed a constraint to access and Egypt 2005 62 57 7 12 a source of controversy in many countries over pro- Asia 63 59 3 5 viding a drug that was not approved for contracep- Bangladesh 2004 53 47 10 21 tion in the United States. Also, approval in the United Cambodia 2005 40 27 8 29 States enabled the U.S. Agency for International
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