New National Family Planning Guidelines for Service Providers MINISTRY OF PUBLIC HEALTH AND SANITATION New National Family Planning Guidelines for Service Providers Updated to Reflect the 2009 Medical Eligibility Criteria

What’s New in the 4th Edition of the FP Guidelines? 2nd Edition June 1997 3rd Edition March 2005 4th Edition January 2010

The Process Consultative and inclusive of over Literature review of new evidence Technical review of various drafts Key resource: Family Planning: A global Handbook for Providers (WHO,2007)

Content Updated to reflect the 2008 Medical Eligibility Criteria Additional new sections Infection prevention section significantly modified Method-specific changes

What’s New Method-Specific Changes Combined Oral Contraceptive (COC) Pills Only monophasic pills are considered in detail. Biphasic and triphasic pills are not widely used in Kenya. Combined Contraceptive Patches and Ring The combined contraceptive (skin) patch (Evra) and combined contraceptive vaginal ring (NuvaRing) are mentioned in these guidelines. More Recently Registered Methods These guidelines contain information on more recently registered methods in Kenya, (e.g., Sino-implant 11, which is registered as ZARIN).

What’s New Timing of Initiating the Use of Progestin-Only Methods among Breastfeeding Women This timing has been brought down to four weeks postpartum, which is in line with the updated PNC-FP orientation package that requires mothers to come for a postnatal follow-up between four and six weeks. DMPA Reinjection Grace Period The DMPA grace period for a repeat injection of DMPA has been extended to four weeks without requiring additional contraceptive protection. For NET-EN, the repeat injection can be given up to two weeks late without requiring additional contraceptive protection.

What’s New Management of Bleeding or Spotting while Using Progestogen-only Injectables Two non-steroidal anti-infl ammatory (NSAID) drugs, mefenamic acid and valdecoxib, were added to the currently available recommendations for women experiencing and concerned with either spotting or light bleeding, or heavy or prolonged bleeding related to the use of progestogen-only injectables.

What’s new Postpartum Timing for IUCD Insertion The postpartum timing for the insertion of the IUCD has been clarified. The copper IUCD (Cu-IUCD) can be inserted up to 48 hours after delivery, including immediately after delivery of the placenta. If the delivery is by caesarean section, the Cu-IUCD can be placed near the fundus after delivery of the placenta before closing the uterus. In non-breastfeeding women, the LNG-IUS can be inserted as specified above for the Cu-IUCD. Diaphragms, Cervical Caps, and Spermicides Discussions of diaphragms, cervical caps, and spermicides have been omitted in these guidelines because: (a) the diaphragm and cervical cap have been used very little for FP purposes in Kenya, and they are not available in public health facilities here; and (b) spermicides are among the least effective methods; and (c) the use of nonoxynol-9 spermicide has been shown to increase the risk of HIV transmission.

What’s New Fertility Awareness-based Methods (FAMs) A new fertility awareness method, the Two-day Method (TDM), has been added. The rhythm method has been omitted, leaving only the Standard Days Method (SDM ) as a calendar-based method.

New Sections Enhancing male involvement Postpartum FP FP/HIV service integration at various levels Integration of screening for reproductive organ cancers in FP FP services for people with special needs Strengthening FP services at Level 1 through the Community Strategy “How to Identify Migraine Headaches and Auras” (Appendix 3) “Signs and Symptoms of Selected Serious Health Conditions” (Appendix 4) Enhancing male involvement Postpartum FP FP/HIV service integration at various levels Integration of screening for reproductive organ cancers in FP services FP services for people with special needs (e.g., PwD, displaced persons, and women near menopause) Strengthening FP services at Level 1 through the Community Strategy “How to Identify Migraine Headaches and Auras” (Appendix 3) “Signs and Symptoms of Selected Serious Health Conditions” (Appendix 4)

Copper Intra-Uterine Device Combined Oral Contraceptive FP Checklist Copper Intra-Uterine Device Client is not pregnant Combined Oral Contraceptive

FP Checklists (cont’d.) DMPA (or NET-EN) Contraceptive Implant

FP Checklists – Reinjection (DMPA/NET-EN)

Categories of Service Providers: Policy Issues Categories of Service Providers: The Community Midwife has been added to the list of providers of FP services Trained CHWs (CBDs) can initiate oral contraceptives in women with MEC category 2 conditions, and then refer the women to clinicians for evaluation Categories of Service Providers The following changes pertain to categories of service providers: The Community Midwife has been added to the list of providers of FP services. Trained CHWs (CBDs) can, in most cases, initiate oral contraceptives in women with MEC category 2 conditions, and then refer the women to clinicians for evaluation.

It is time to deliver quality family planning services! The policy environment is conducive to provision of Family Planning. The challenge has been made and we know what to do. Now it is time to deliver. Working together with the national and local leaders, we can and we must expand rights-based reproductive choices to address unmet contraceptive need. The cross-cutting influence of reducing unintended pregnancies will accelerate progress toward our Cairo commitments and achievement of all eight MDGs. It is time to deliver quality Family Planning services!

Thank You!