The Side Effects of Contraceptives Elisa Wells, M.P.H. Kristina Gryboski, Ph.D. and Elaine Murphy,Ph.D. Objectives Learn more about side effects Consider side effects from client’s cultural & personal context Understand side effects’ impact on use & continuation Side effects influence: Initial decision to use FP Continuation with method(s) Satisfaction with method & FP Contraceptive discontinuation due to side effects and health concerns in selected countries Country Year Side Effects Health (%)* Concerns (%) Morocco 1992 16.8 6.7 Egypt 1992 30.4 10.2 Dominican 1991 16.8 8.7 Republic Jordan 1991 17.2 4.6 Indonesia 1991 11.4 15.5 Paraguay 1990 19.7 9.3 *Percent of total discontinuation for all methods combined. Other reasons for discontinuation include desired pregnancy and method failure. Source: Outlook 12(3) October 1994 Negative impacts are reduced by: Discussing side effects before method selection Managing side effects promptly Allowing method switching Side Effects vs. Complications SIDE EFFECTS: symptoms or conditions that pose no significant health risk COMPLICATIONS: serious health problems or conditions Side Effects vs. Complications Headache Severe headaches Increased Very heavy bleeding menstruation (twice as long or as Light or no much ) menstruation Severe, constant Menstrual cramping pain in the chest, leg or belly Side Effects vs. Complications Weight gain or loss Skin or eyes that Nausea become unusually Vaginal dryness yellow (jaundice) Local skin irritation Loss of sensation in arms or legs Side Effects: Some Observations Most contraceptives have some side effects Some side effects are common; others are rare Some go away over time Some are easily treated Side Effects: Some Observations It can be unclear if side effects are caused by method Clients may experience one or several Side effects can vary by brand Type & severity vary by method & user The truth about side effects Important to distinguish side effects from rumors or misinformation – Challenge: Clients believe that certain methods will render a woman sterile – Solution: Always discuss returning to fertility as a significant issue Consequences of Side Effects Elicit concerns re possible impact on clients’ lives Pay particular attention to cultural beliefs or taboos Include both positive & negative consequences Positive or negative consequences: client’s responses Feel “unwell” Limit sexual activity Feel too weak to or enhance sexual work pleasure Unable to participate Discontinue in religious contraceptive community activities method or use it Unable to cook irregularly Feel unattractive or more attractive Side effect counseling & method use: Niger & Gambia Women not counseled far more likely to drop out Women fully counseled far more likely to continue with the same or different method Discontinuation of contraception and women’s perception of counseling in Niger and The Gambia 60% Percent of women who discontinued 51% 50% method after 6-8 months 40% 37% 30% 19% 20% 14% 10% 0% Niger (n=178) Gambia (n=139) Felt counseling was inadequate Felt counseling was adequate Source: Cotton N. et al. Early Discontinuation of Contraceptive Use in Niger and The Gambia. International Family Planning Perspectives 18(4):145-149 (December 1992). Side effect counseling & method use: China Women counseled before taking DMPA 4 times more likely to continue 12 months later This research led to new policy to counsel on side effects Effect of pretreatment counseling on discontinuation rates in Chinese women given DMPA for contraception. 45% 42% 40% 35% Percent of women who discontinued method 30% 25% 25% 20% 15% 11% 10% 5% 3% 0% At 3 months at 12 months Rec eived detailed structured pretreatment and ongoing counseling R eceived routine c ounseling only Source: Zhen-Wu, L. et al. Effect of Pretreatment Counseling on Discontinuation rates in Chinese Women Given Depomedroxy Progesterone Acetate for Contraception. Contraception 53(6):357- 361 (June 1996). Side effect counseling & method use Important to pay attention to concerns of client’s partner E.g. , Counseled husbands of Norplant users reassured re partner’s spotting Why providers may not inform clients about side effects Reasons Possible Solutions Too Busy Reassure that counseling can be brief. Provide literature. Worried that clients may reject method(s) Reassure that side effect counseling increases use & continuation. Why providers may not inform clients about side effects Reasons Possible Solutions Unaware of frequency Give providers of sides effects training on common side effects. Lack of support material Provide simple written & AV materials for providers Helping clients know what to expect Say that many clients experience no side effects Give information re how to manage or outlast side effects Make clients feel comfortable returning for assistance, if needed If clients want a specific method: Screen for suitability (medical conditions & HIV/STI risks) If suitable, give side effects information on that method ONLY Helping clients choose a method Describe side effects of various methods, their frequency & duration Reassure re safety of methods Emphasize client satisfaction with methods in general Elicit & answer questions; correct misinformation courteously Helping clients know what to expect: reminders Elicit and respond to client concerns Be concise & clear Be honest re frequency or severity of side effects Provide support material Why help clients manage side effects? Increase client’s comfort, satisfaction with & continuation with the method Discover if side effect is due to incorrect method use Discover if side effect signals a more serious condition Steps to managing side effects Ask how/why the side effect concerns client Respond in clear language Explain usual duration of side effect Explore with client what to do if it persists Steps to managing side effects Help client weigh contraceptive & non- contraceptive benefits versus side effect If client still wants another method, help explore options Steps to managing side effects For some side effects, advising a treatment may be appropriate Some effects may be relieved by switching formulations or brand Steps to managing side effects reminders Different clients have different levels of tolerance for side effects. Respect these differences. Always permit client to discontinue or switch to another method!
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