Progestogens in combined oral contraceptives for contraception
RHL practical aspects by Festin M
FIRST CONTACT (PRIMARY CARE LEVEL)
Health providers in the primary health care level should be aware of the more updated scientific information about the effectiveness and potential side effects of oral contraceptives, especially if many types and preparations are available. The proper information should be provided in the local language using the latest scientific evidence, considering that there may be some sectors opposed to its use who may be providing otherwise. There is also a tendency for some sectors to disseminate scientific information in very technical or mathematical language that may make it difficult for lay users to understand. The supply of oral contraceptives should also be made constant especially in those areas in which these are provided free by the government or donors. Considering that many women who need these are also those who are in under-resourced settings, and the evidence base for choosing one COC over another is weak, preparations that are inexpensive and those for which considerable experience has accumulated over many years of use (such as those containing 30 μg ethinyl estradiol and levonorgestrel) should be promoted.
REFERRAL HOSPITAL (SECONDARY CARE) LEVEL
Secondary or referral hospitals should be prepared to provide care for those women in whom side effects are more difficult to manage at the primary care sites. These centers may also provide other alternatives should women choose to change their methods. Health workers at this level would also need to involve themselves in the initial and continued training of peripheral health care workers.
AT HOME OR IN THE COMMUNITY
Women should be aware of the various options for combined oral contraceptives in terms of the progestogen content, based on what their needs are and what is made available to them. In some communities, COC’s may be available from government health clinics or from private clinics. Some may provide it for free or may charge a certain amount, but this should be minimal. Making these readily available would provide women more opportunities to choose which method would best fit them, being aware also that there may be some side effects, which may be minor and tolerable. Public awareness and information campaigns for this purpose should be undertaken at the community level keeping in mind the local culture.
Acknowledgement: The Social Acceptance Project for Family Planning, Academy for Educational Development, Philippines and the Philippine Evidence Based Reproductive Medicine Network.
This document should be cited as: Festin M. Progestogens in combined oral contraceptives for contraception : RHL practical aspects (last revised: 8 March 2006). The WHO Reproductive Health Library; Geneva: World Health Organization.