The INFO Project Blog

Sanjay Chaturvedi from the IndiaCLEN Programme Evaluation Network writes:

Sir,

This is regarding the Jan-Feb 2007 issue of Population Reports – “Expanding services for injectables”. While agreeing with the sentiment and some of the technical assertions made, we wish to register our reservations on the broad messages that (may be inadvertently) go with the cover story, its title, and accompanying photograph.

We, in partnership with Govt. of India and World Bank, have recently conducted a nation-wide study on injection practices.1 It would be relevant to place some of the findings here. The burden of injections was 5.8 injections (95% CI 5.3-6.3) per person per year. Overall 44.1% of all outpatient clients were prescribed injections, and in nearly 80% of them, the oral alternatives were available. Of all the injections administered in India, 31.6% [95% CI 29.4-33.0] carried a potential risk of transmitting Blood Borne Virus. Unsafe injection due to faulty technique was observed in 53.1% [95% CI 50.8-55.4]. This made nearly two third (62.9 %; 95%CI 60.7-65.0) of the injections unsafe.

This is to be emphasized here that we are also striving for the provision of quality injection services in all settings. Our network is engaged in country-wide ‘Model Injection Centre Project’ in program mode for last 2 years (http://www.ipen.org.in/index.php?option=content&task=view&id=237&Itemid=287&parent=225). Nevertheless, our primary objective is to reduce the burden of injections, at the first place. All the health organizations and functionaries working in developing countries need to be extra careful in promoting injectables, wherever effective oral alternatives are available.

We are afraid that while your aim is to stress upon the importance of quality services for injectables (if opted), the message that sticks is – ‘Just go for the injectables!’ This is worrisome, particularly in the context of low and middle income countries.

With best regards,

Yours sincerely,

Sanjay Chaturvedi
on behalf of:
IndiaCLEN Programme Evaluation Network (IPEN), New Delhi

A note from Holly Blanchard:  I wanted to highlight that the preferred site for intramuscular injection is the ventrogluteal [the side of the hip rather than the upper outer quadrant of the buttock (dorsogluteal)]. Planned Parenthood Federation of America recommended the ventrogluteal site especially for DMPA to all of its affiliates.  –Holly Blanchard CNM MS, Technical Advisor for Clinical Service Delivery, ACCESS-FP, JHPIEGO

For further information:

Use this space to exchange information and opinions about injectable contraceptives. We invite you to respond to the editorial that starts below. It presents a strategy for meeting the increasing demand for injectables. What else do programs and providers need to know and do to help women use injectables? Register for the site and you will receive an e-mail with your password. Then log in and share your experience.

John Stanback at Family Health International (FHI) comments that the grace period for DMPA should be a month or more rather than the current two weeks. To read his comment click on ”comment” above. To post a reply, please register and log in, which takes only a few minutes.

How family planning programs and providers can meet clients’ needs for injectables
Robert Lande and Catherine Richey

The increasing demand for injectable contraceptives challenges programs to expand access to good-quality services. Counseling is crucial–especially about changes in monthly bleeding caused by injectables. Providers need to give injections safely and avoid contributing to the estimated 64 million injections for all purposes each year in developing countries that risk transmitting infection. Communication programs need to provide accurate information about injectables and correct common misinformation, such as the false idea that injectables make women permanently infertile. Community distribution of injectables offers another contraceptive choice to women in isolated rural areas.

Help women make an informed choice and be informed users. Good counseling can be the difference between successful and unsuccessful efforts to increase access to injectables. Vietnam used the introduction of injectables to train providers in a client-oriented approach and strengthen their counseling skills. Developing an overall strategy for improving the quality of injectables services can be an opportunity for programs to improve counseling and the quality of care for all contraceptive methods.

To read the full editorial, click here