LESSON 1 What is DMPA?

LESSON 1 Learning objectives Explain what injectable contraceptives are. Explain what kind of injectable contraceptive DMPA is. Describe how DMPA works. List the different names of DMPA. Explain why women might like or not like DMPA. 1. Tell the participants: Many of you may not be familiar with injectable contraceptives, so in this lesson we will review what you will need to know to be comfortable talking with your clients about what injectable contraceptives are and what they do. 2. Review the learning objectives for this lesson and ask participants if they have any additional objectives or questions.

What are injectable contraceptives? Very effective, long-lasting, reversible, private method of contraception. Are like a natural hormone made by a woman’s body. Injected with a syringe in the muscle (IM) or in the fatty tissue (subcutaneous or SC) Released slowly into the blood from the injection site. Review the characteristics of injectable contraceptives from the slide and the “Progestin-Only Injectables Fact Sheet” with the participants. Ask the participants if they have any questions.

Two types of injectable contraceptives Combined injectables. Made with estrogen and progestin combined. They will not be covered in this training. Progestin-only injectables. Made with progestin. There are two kinds: norethisterone ethanate (NET-EN) and DMPA. Review the two major types of injectable contraceptives with the participants. Tell the participants:   Since this training deals only with the progestin-only injectable contraceptive DMPA, we will focus on this types of contraceptive during the rest of the lesson.

How do progestin-only injectables work? They prevent ovulation (the release of eggs from the ovaries). They prevent implantation of an egg by keeping the walls of the womb thin. They prevent sperm from entering the womb by thickening the mucus at the opening of the womb. Review the slide with the participants.

What is DMPA? DMPA is the most common progestin-only injectable. DMPA is reinjected every 3 months (13 weeks). DMPA can have different brand names or names that show how it is injected (IM or subcutaneous). Some of these names are: Depo-Provera® depo-IM Sayana® Press Review the slide with the participants. Make sure that participants understand that depo-IM and Sayana Press are both the same type of drug (the progestin-only injectable, DMPA). Depo-Provera and Sayana Press are registered trademark of Pfizer, Inc.

Why women might like DMPA Safe Does not interfere with sex Effective Can be used privately Easy to use Can be used by breastfeeding women Long lasting Reversible Eventually most women stop having monthly bleeding Can be discontinued without a provider’s help Tell the participants:   The clients that you will see might already be using depo-IM so might already be aware of its benefits. But it will be helpful to remind the clients of the benefits while you are counseling them. 2. Review the reasons that women might like DMPA with the participants.

Why women might not like DMPA Causes side effects, mainly menstrual changes. Action cannot be stopped immediately. Might take more time to become pregnant after stopping. Provides no protection against STIs/HIV. Review the reasons women might not like DMPA with the participants

GROUP ACTIVITY Practice talking about DMPA Instructions: Review the “DMPA Fact Sheet.” Find a partner. Pretend you are a new client interested in DMPA and ask your partner questions. Use the fact sheet to tell if your partner answers correctly or give her/him feedback as needed. Switch places with your partner when the facilitator signals. Review the instructions for the activity with the participants. Walk around the room while the participants are practicing with the fact sheet to make sure they are giving complete and correct information to each other. Give them suggestions about what to say, if needed. Let the participants know when to switch places so that each partner has the same amount of time to practice talking about injectable contraceptives. Before moving to the next activity, ask the participants if they have any questions about the information in the fact sheet.

LESSON 1 QUIZ What have you learned about DMPA? What are injectable contraceptives? What type of injectable contraceptive is DMPA or Sayana Press? How does DMPA work? What are some different names for DMPA? What are some reasons that women may like DMPA? What are some reasons that women may dislike DMPA? Review the questions one-by-one with the participants. Encourage participants to give the answer aloud. If one participant does not have the correct answer or provides an incomplete answer, try asking if another participant has more information. Encourage discussion if applicable. Below are the answers to the quiz questions. Make sure each concept is covered thoroughly during the quiz: What are injectable contraceptives? (See the “DMPA Fact Sheet” to check the answers to this question. Participants do not need to memorize the section, but they should demonstrate a good understanding of the answers.) What type of injectable contraceptive is DMPA or Sayana Press? Progestin-only. How does DMPA work? Prevents ovulation or the release of the woman’s egg. Thickens the mucus at the cervix to prevent sperm from entering the uterus. Thickens the uterine wall to prevent an egg from attaching and growing there. What are some different names of DMPA? Depo-Provera, Depo-IM, Sayana Press What are some reasons that women may like DMPA? Safe Effective Easy to use Relatively long lasting Reversible Can be discontinued without a provider’s help Does not interfere with sex Can be used privately Can be used by breastfeeding women Eventually most women stop having monthly bleeding What are some reasons that women may dislike DMPA? Causes side effects, mainly menstrual changes Action cannot be stopped immediately Might take more time to become pregnant after stopping Provides no protection against STIs/HIV