1. 2 When introducing a new contraceptive technology, it is particularly important to: [ identify...

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When introducing a new contraceptive

technology, it is particularly important

to:

identify factors that influence

contraceptive choice and potential use

of new contraceptive technology

understand users’ attitudes towards

new contraceptive technology and other

contraceptives

understand users’ views on the service

delivery systemprg i lbert / vw -sep98

Introducing a New Technology

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Identify the service delivery,

training and management

requirements for providing good-

quality new contraceptive

technology services

use the results of these enquiries to

develop a strategy for introducing a

new contraceptive technology and

eventually making it widely

availableprg i lbert / vw -sep98

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Ideally, a new technology such as emergency

contraception should be introduced as part of

the range of contraceptive methods offered

by the national reproductive health

programme.

Then information on the new technology e.g.

Emergency contraception methods should be

included in the basic and ongoing training

curricula of providers, in the IEC materials

and in the planning and preparation of the

logistic and distribution systems.


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Involving providers and managers

Strategies for introducing new

contraceptive technology into

reproductive health programmes

need to be discussed with providers

and managers responsible for

implementing and others involved

in policy decisions.


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Involving the community

Involving the community in the

design of reproductive heath

programmes and services is a key

factor in their success. The needs

and concerns of clients and

potential users must be taken into

consideration.


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Steps in the introductory

process

The following steps are

recommended:

the order may vary

depends on the stage of

development of programme and

the cultural environment within

which it is being introducedprg i lbert / vw -sep98

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Assess users’ needs and attitudes

Assess the regulatory requirements

Assess the service capabilities -

providers’ views and knowledge of

the method; the mechanisms already

available; the need for training


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Enlist support at appropriate

levels

Select a product and

develop a distribution plan

Train the managers and the

providers


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Meet clients’ information

needs

Introduce the product at the

different service levels

Monitor and evaluate the

services

Disseminate the results of the

evaluation

Do post marketing surveyprg i lbert / vw -sep98

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Barriers to the

introduction of a new

contraception

Client-related barriers

Provider-related barriers

Cultural barriers

Product-related barriers


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Client-related barriers

Lack of knowledge about the new contraceptive

Risk-taking behaviour common among young people

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Provider-related barriers:

Lack of knowledge among providers, programme managers and policy-makers is an obstacle to the introduction of the new contraceptive in reproductive health programmes

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may not have a clear understanding of the role of the new contraceptive can play may be reluctant to provide the new contraceptive because of:

insufficient training personal biases their own beliefs or value systems association with certain situations such as

prostitution and rape

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Providers may also be

anxious about safety and

risks such as missing

pregnancy and STDs

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Cultural barriers

the influence of traditional religious groups who oppose FP programmes

influence reflected by politicians, policy-makers, health providers, teachers, school counsellors and the media

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Certain contraceptives may be especially controversial since they may be wrongly perceived as abortifacients e.g. IUD and Emergency Contraception

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Product-related barriersProduct cost, or appearance programme costs and opportunity costs may be factors that hinder the use of a new contraceptive e.g. costs of LNG-20, counselling time required for Norplant users, appearance of the female condom etc.


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The quality of the counselling given to women or couples greatly affects their satisfaction with IUDs and their continued acceptance and use of the method.

A good follow-up and referral system reassures clients that their questions will be answered and that any problems relating to IUD use will be effectively dealt with.

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When individuals or couples decide where to go for services or contraceptives, the factors that they will take into consideration will include:

Service Quality related factors:

their perception of the quality of care provided;

the cost of services;

the attitudes of the personnel of the services;

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Service Quality related factors: Cont’d…

the extent to which privacy is ensured and anonymity (when required) guaranteed;

the availability of supplies and other needed services at the same place;

the distance to alternative services; and

the experiences of their peers

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When clients decide which of the variety of methods offered to choose, they will take a number of factors into consideration, including:

Method related factors:

the effectiveness of the method; the side-effects; the safety of the method; cultural and religious

acceptability;

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Method related factors: Cont’d…

the mode of administration;

the ease and frequency of administration;

reversibility;

the need for close medical supervision; and

the cost

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Costs

The cost of providing IUDs through a family planning programme vary widely from one country to another and from one type of programme to another, and are affected by many factors, including the cost of:

staff (salaries, etc.) and training;

medical supplies;

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Costs Cont’d…

transportation and storage of supplies;

maintenance of premises and equipment;

utilities (electricity, fuels, etc.);

the logistic system

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Other determinants of the total cost of contraceptive provision include:

the development of information materials;

the location of the services;

the size of the services (the cost per client is generally lower where the

case- load is high);

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The treatment and management of method related side-effects;

the costs associated with changes in contraceptive method mix: methods that

require regular re-supply, e.g. injectable, oral and barrier contraceptives, are likely to be more expensive over time than permanent (sterilization) or long-term methods (IUDs and implants);

the cost of treating conditions revealed during

client screening

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Managers can improve the overall quality of their family planning programmes by improving service delivery procedures and logistics and thereby:

ensure a dependable flow and adequate stock of supplies;

maintain the quality of supplies; and

keep an adequate stock of materials and instruments for administering the IUDs

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They should also ensure that:

unbiased counselling is available;

well-trained staff are available;

a reliable follow-up and recall system is provided; and

good quality care is provided

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Development of a community information programme

Possible communication channels include the following:

Associations of health professionals and the journals they produce

the mass media, including radio, television, the cinema, newspapers and audio- and videotapes

Printed materials developed specifically for IUDs and designed to be relevant to local conditions

Personal communication. Informal meetings at clinics to set up a network of satisfied IUD users

Traditional or folk media

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Audiences

The largest and most important audience is the general public, including potential users who may be strongly influenced by rumours and misinformation. There are other groups whose views on a new contraceptive method also can greatly influence its ultimate acceptance

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Traditional midwives and healers may be the only

available source of assistance on health-related

matters. Without their cooperation the

programme may not succeed

Health professionals, even those not directly

involved in IUD provision, need to understand the

method so that misinformation is not spread from

sources normally regarded as reliable

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Members of the government, community leaders and religious leaders are traditionally looked to for advice

Women’s organizations

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Media personnel can have a profound influence on the acceptance or rejection of new methods of contraception. Providing them with accurate information can often make the difference between the successful introduction of such a method and failure.

International agencies involved in family planning issues - the policy-makers who allocate funds and establish programmes - need to have accurate and complete information about contraceptive methods particularly new methods.

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Handling Criticism, misinformation and rumours

Neither negative reactions nor misinformation canbe ignored; misinformation is often better remembered than the actual facts, which are usually much less sensational. The best defence is to ensure that everyone who deals with IUDs understands them as thoroughly as possible. Soundknowledge can do much to dispel rumours.

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Obstacles to the introduction of IUDs

Political, cultural and religious attitudes

and beliefs;

professional and social attitudes to family

planing in general and IUDs in particular;

local laws, regulations, medical norms and

codes of ethics

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Side-effects such as prolonged or irregular bleeding

which alter a woman’s normal menstrual cycle, may

prove to be other obstacles to the introduction of IUD

services.

Managers must be aware of local beliefs and

perceptions regarding menstruation and help to allay

unnecessary fears and alarm.

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Studies have shown that educating

men about IUD makes an important

contribution to ensuring overall

acceptability of the method. Men

worry particularly about their partners’

health and the side-effects sometimes

caused by contraceptives.

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Checklist for introduction of IUDs into a family planning programme

Activity1. Survey community; identify potential constraints2. Ensure that national and local legislation and regulations permit use of IUDs; obtain necessary approvals3. Estimate potential demand and expected case-load4. Arrange programme financing; develop budget5. Identify clinic facilities6. Establish essential policies:

* client selection criteria* counselling and informed choice* medical service standards

7. Staff the programme:* staffing requirements - patterns, types, numbers* recruitment and selection

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* training* supervision

8. Arrange for equipment, supplies and services:* procurement of required equipment, instruments, medicines and supplies* storage and inventory control* procedures for decontaminating, cleaning, disinfecting or sterilizing instruments

9. Develop a community information and communication programme10. Develop and print record forms, information materials and documents

* medical history/client record form* client brochures (e.g. fact-sheet)

11. Establish client-flow system and procedures:

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* reception, intake, registration* record of patient history* client medical assessment and counselling* informed decision-making* physical examination and medical screening, including laboratory examinations (if necessary)* referral for further assessment* follow-up procedures

12. Establish client-referral channels; develop links with other medical, family planning and community institutions and professionals13. Other:

* strategies for advertising and use of mass media* financial accounting procedures* data collection (service statistics) and programme evaluation

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Facilities

A comfortable waiting-room or “holding area” forclients;

A room for counselling, preferably isolated or private;

A private examination room, with adequate natural orartificial lighting and a sink, where clients can undergo general and pelvic examinations and IUDs can be inserted and removed;

An area where vaginal and/or cervical specimens can be examined microscopically

A sluice area (cleaning area, utility room, etc.) whereinstruments and reusable gloves can be cleaned andlinen washed;

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Toilet and washing facilities for clients and staff, with adequate water supplies;

An area for high-level disinfection or sterilization of instruments, and space for their storage;

A storage area for medical supplies, which should be cool, dry, secure and well ventilated;

An area for office work, completion and storage of records and storage of information materials.

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Community Client Information and Communication

Health facility

CounsellingClient screening

IUD unacceptable;alternative methods

reviewed

Follow Up Client assessment(physical/pelvic/

microscopic examinations)

IUD unacceptable’alternative methodsconsidered and/orfurther medical

assessmentInsertion/removal

Post-insertion counselling

Client Flow for IUD Services

WHO 96867

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Extracted and Adapted from:

1. Emergency Contraception: A guide for Service Delivery WHO/FRH/FPP/98.19

2. Intrauterine Devices:Technical and Managerial Guidelines for Service, WHO 1997

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