1. 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

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

3. 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)

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

5. 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).

6. 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.

7. 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.

8. 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.

9. 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.

10. 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)

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

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

13. FP Checklists – Reinjection (DMPA/NET-EN)

14. 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.

16. 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!

17. Thank You!