1. Session I, Slide #11 Contraceptive Implants Session I: Characteristics of Implants

2. Session I, Slide #22 Objectives At the end of this session, participants will be able to: 1.Describe the characteristics of implants in a manner that clients can understand: a.What implants are and how they work (mechanism and onset of action) b.Effectiveness c.Side effects d.Non-contraceptive health benefits e. Possible health risks (complications) f.Other characteristics (STI/HIV protection, ease of use, return to fertility, when to initiate and discontinue)

3. Session I, Slide #33 Objectives (continued) 2.Demonstrate the ability to: a.Screen clients for medical eligibility for implants b.Explain to clients the insertion, removal, and follow-up procedures c.Explain when to return to the clinic d.Address common concerns, misconceptions, and myths e.Conduct follow-up for implant clients in a way that enhances continuing safety, satisfaction, and acceptance 3.Describe when to initiate use of Implants (postpartum, switching from another method). 7. Demonstrate on anatomical models how to insert and remove implants. 4.Explain how to manage side effects. 5. Identify conditions that require switching to another method. 6.Identify clients in need of referral for implant-related complications.

4. Session I, Slide #44 What Are Implants? Progestin-filled rods (each about the size of a match stick) that are inserted under the skin –Jadelle: 2-rod system, effective for 5 years –Sino-implant (II): 2-rod system, effective for 4 years (possibly 5) –Implanon: 1-rod system, effective for 3 years –Norplant: 6-capsule system, effective for 5 years (possibly 7); no longer manufactured but some women are still using it

5. Session I, Slide #55 Key Points for Providers and Clients What it is: – Small tubes placed under the skin of inner, upper arm. – Hormones from the tubes blocks sperm from reaching egg and prevents release of egg. How to use: – Specially trained provider inserts and removes implants. – Nothing to remember to do after insertion. What to expect: – Changes in monthly bleeding including irregular bleeding, spotting, heavier bleeding or no monthly bleeding, are common and safe. Important to remember: – Use another method if waiting for appointment. – Use condoms if you need protection from STIs or HIV/AIDS.

6. Session I, Slide #66 Key Points for Clients Safe to use One of the most effective methods Lasts for 3 to 5 years Can be removed any time if you want to get pregnant

7. Session I, Slide #77 Effectiveness of Implants In this progression of effectiveness, where would you place implants? Male Sterilization Female Sterilization IUDs Progestin-Only Injectables Combined Oral Contraceptives Male Condoms Standard Days Method Female Condoms Spermicides Less effective More effective Less effective More effective Implants

8. Session I, Slide #88 Relative Effectiveness of FP Methods Method # of unintended pregnancies among 1,000 women in 1 st year of typical use No method 850 Withdrawal 220 Female condom 210 Male condom 180 Pill 90 Injectable 60 IUD (CU-T 380A / LNG-IUS) 8 / 2 Female sterilization 5 Vasectomy 1.5 Implant 0.5 Source: Trussell J., Contraceptive Failure in the United States, Contraception 83 (2011) 397- 404, Elsevier Inc.

9. Session I, Slide #99 Implants: Mechanism of Action Thickens cervical mucus to block sperm Implants work in two ways Implants have no effect on an existing pregnancy. Suppresses hormones responsible for ovulation

10. Session I, Slide #1010 Implants: Characteristics Have side effects Require minor surgery to insert and remove Cannot be initiated and discontinued without provider’s help Provide no protection from STIs/HIV Source: Hatcher, 2007; WHO, 2010; CCP and WHO, 2011. Very safe and 99.95% effective Easy to use Fertility returns without delay when removed Can be used by breastfeeding women Offer health benefits

11. Session I, Slide #1111 Implants: Health Benefits Reduced risk of symptomatic pelvic inflammatory disease (PID) Reduced risk of iron-deficiency anemia Reduced risk of ectopic pregnancy –6 per 100,000 in implant users –650 per 100,000 in women using no contraception Source: CCP and WHO, 2011; Task Force for Epidemiological Research on Reproductive Health, 1998.

12. Session IVA, Slide 12 Some users report changes in bleeding patterns: Possible Side Effects of Implants (part 1) First several months: Lighter bleeding and fewer days of bleeding Irregular bleeding Infrequent bleeding No monthly bleeding After about one year: Lighter bleeding and fewer days of bleeding Irregular bleeding Infrequent bleeding How would you feel about these side-effects? *Implanon users are more likely to have no monthly bleeding than irregular bleeding.

13. Session I, Slide #1313 Possible Side Effects of Implants (part 2) Headaches Lower abdominal pain Acne (can improve or worsen) Weight change Breast tenderness Dizziness Mood changes Nausea, nervousness

14. Session I, Slide #1414 Group Activity Implants Fact Sheet Review the fact sheet. What additional questions or comments do you have about the characteristics of implants?