What are

injectable
contraceptives?
What are injectable
contraceptives?
 The Injectable Contraceptives
contain synthetic hormones
resembling the natural female
hormones.
What are injectable
contraceptives?
 When administered (IM/SC) there is
a slow release of hormone into the
blood stream and it provides
protection from pregnancy for a
long duration of time to the client.
What are the various
injectable
contraceptives
available?
Various injectable contraceptives available

 There are two main types of injectable contraceptives:

1) Progestogen-only Injectables (POI):
 Contain only synthetic progesterone.
 Two types:
a) Depot MedroxyProgesterone Acetate (DMPA)(3-monthly inj.)
b) Norethisteroneenanthate (NET-EN)(2-monthly inj.)

2) Combined Injectables Contraceptive (CIC):

 Contain estrogen (usually ethinylestradiol) +
progesterone (1-monthly inj.)
Various injectable contraceptives available

 Under the National Family Planning

programme, DMPA injectable
contraceptive has been added to the
basket of choice.

 Henceforth we will learn and discuss

about.. .
Injectable Contraceptive (MPA)
a new method of contraception for women

Dr.Sonali Sooda
Medical Officer,
Primary Health Centre,
Konar, Bhatkal
What is Antara?

 It is a new method approved by

Government of India for use in
Government facilities which will
increase the choice of methods
available to women in your
community.
What is Antara?

 A contraception that can be given

every 3 months through an injection:
called Medroxyprogesterone
Acetate (MPA), given at Government
health facilities through a
programme called Antara.

 This contraceptive can be given by a

trained provider (Doctor, Nurse,
ANM) in the health facility.
How does Antara
packaging look?
Packaging

 1 box packaging contains - 8 injections

Packaging

 1 box packaging contains - 8 injections

Packaging
 Packaging

Box with product information leaflet

(inside the box)

Alcohol wet wipe swab

MPA injection vial

2ml syringe
Packaging
Packaging

 Each Antara vial

contains 150mg/ml of
injectable
contraceptive -
Metdroxyprogesterone
Acetate (MPA).
What is
MPA or
DMPA?
What is MPA or DMPA?

 DMPA (Depot Medroxy-Progesterone

Acetate) is a synthetic progesterone,
first developed in 1954 for treatment
of endometriosis and habitual or
threatened abortions.

 It is now a widely used contraceptive

and is approved for use in more than
130 countries.
What is MPA or DMPA?

 MPA is given every 3 months by

injection.

 It prevents pregnancy over a long

period of time and helps in achieving
spacing between children.
How is it stored?
Storage:

 DMPA injection vials are to be stored

preferably at room temperature between
15 to 300C in a dry, dust free place and
not exposed to extreme heat and cold.

 Do not keep the injection vials in the

refrigerator/freezer; instead keep
outside in a cupboard away from direct
sunlight in a dry place.
Who can use Injectable
Contraceptive MPA??
Eligibility for Antara:
 Women of any age, including
adolescents and women over 45 years
old, irrespective of whether they have
children or not.

 Unmarried women in reproductive age

group.

 Women who recently had an abortion

or miscarriage.
Eligibility for Antara:
 Women who are breastfeeding (it can
be started as early as 6 weeks after
childbirth).

 Women who are HIV infected,

irrespective of whether they are on
medicines or not.
What are the benefits of
Antara?
Benefits of Antara:
 Requires to be taken only once in
three months, rather than daily.

 Can be used by women who are not

able to take hormonal oral
contraceptive pills like Mala N/ Mala D
etc.
Benefits of Antara:
 Pelvic examination not required prior
to use.

 Does not require any laboratory

investigation before starting the dose.

 Reduces menstrual cramps (in some

cases).
Benefits of Antara:
 Does not interfere with any medicine.

 Protects from uterine and ovarian

tumors and cancer.

 The privacy of client can be ensured.

Benefits of Antara:
 Safe for breast feeding mothers as it
does not affect quality and quantity of
milk.

 It does not cause problems with

getting pregnant after stopping. After
discontinuing the method, the woman
can get pregnant.
Benefits of Antara:
 It causes changes in the menstrual
cycle, sometimes by stopping the
monthly bleeding which is not
harmful.

 This takes care of anemia by reducing

menstrual blood loss.

 Does not interfere with sexual act.

Benefits of Antara:
 Decreases benign breast disease and
symptomatic pelvic inflammatory
disease (PID).

 Protects against ectopic pregnancy

(since ovulation does not occur).
What are there any side
effects of Antara?
Effects of Antara:
Some women could experience the following:
 Menstrual Irregularities- Irregular
bleeding, prolonged heavy bleeding or
amenorrhea.
 Weight gain
 Headaches
 Mood changes
Are there any limitations
for use of Antara?
Limitations of Antara:

 It does not protect from HIV and STI.

 It takes 7-10 months from the date of

last injection for return of fertility.
Where can women get MPA
and how it should be
taken?
 Women, who decide to start taking
MPA, require repeat injections
every three months.
 You know from previous
introductory session that it is
important to use contraceptives
regularly.
 MPA is available at the facilities
where providers have been trained
in using the method.
 The first dose can be administered
by a trained doctor or a trained
staff nurse/ ANM under the
supervision of a doctor.
 Once a woman in your community
starts the first dose, ANM & ASHA
must follow up with the woman, to
understand if she has any side
effects, to remind her when the
next dose is due and motivate her
to visit the health facility where
trained provider is available for the
repeat dose.
Schedule & Dosage
Schedule:

 One injection provides contraception for

at least 3 months.
 Can be started on any day within 7 days of
menstrual cycle with no need for a backup
method.
 It is best to take the injection exactly 3
months after the previous dose.
 However, it can be taken 2 weeks before
or 4 weeks after the scheduled date as
well.
Schedule:

 Just like you have details of those women

who are on any method of contraception,
you should help every woman who
receives MPA to get an MPA card.
 The card should have information about
the details of the woman, it includes
dates of current dose and the next due
dose.
MPA Card: Client Copy
Schedule:

 Every client should be encouraged to carry

this card to the facility where repeat
doses are given.
 This card helps in remembering the date
of next dose.
Schedule:

 The counterfoil of this card is maintained

at the facility providing the first dose of
Injectable MPA.
MPA Card: Institution Copy
Pre-injection preparation:

 Ensure client is properly counselled and

has chosen DMPA.
Pre-injection preparation: Counselling

 Helps build confidence & maintain

confidentiality.
 Explain all available options.
 Let the client choose.
 Counsel about benefits and effects.
 Explain the procedure and follow-up care.
 Proceed to MPA administration after
informed verbal consent.
Pre-injection preparation:

 Ensure client is properly counselled and

has chosen DMPA.
 Check vial for expiry date.
 Shake the vial well.
 If the vial is cold, warm to body
temperature by rubbing between palms
before giving injection.
Pre-injection preparation:

 Ensure that all the microcrystals are

dissolved completely in the fluid of the
vial.
 Wash hands with soap and water.
 Withdraw full quantity of solution from
the vial into the disposable syringe with
needle, taking care not to push any
outside air into the vial.
Dosage & administration:

 150mg/ml, 1ml injection is given in -

 Upper arm
 Bttocks or
 Thigh

 Route: under the muscle or skin (IM or SC)

Dosage & administration:

 150mg/ml, 1ml injection is given in -

 Upper arm
 Bttocks or
 Thigh

 Route: under the muscle or skin (IM or SC)

Dosage & administration:

 Clean the skin at the site of the injection

with an antiseptic, removing any visible
dirt or soil.

 Allow the antiseptic to dry before

administering the injection.

 Insert sterile needle deep into the chosen

site for injection.
Dosage & administration:

 Aspirate first to ensure that the needle is

not in a vein.

 Inject the contents of the syringe fully.

Dosage & administration:

 After the woman gets the

injection, she should be
cautioned not to massage the
injection site or apply hot
fomentation.
What post injection advise
will you give??
Post-injection advice:
 Instruct client not to massage or apply hot
fomentation to the injection site as the drug
needs to stay there for a long time and
release very slowly for the next three
months.
 Instruct client that she must come after 90
days for a repeat injection and give her the
scheduled date.
Post-injection advice:
 Hand over the DMPA Client Card to her after
explaining its content to her.
 Inform the client that the effect of injection
is immediate if given between ‘day one’ to
‘day seven’ of her menstrual cycle.
 But if given after ‘day seven’ - a backup
contraceptive method (e.g. condom) should
be used for 7 days.
Post-injection advice:
 Assure the client that she is welcome to
come back any time, if she feels any
problem, wants another method, has a
major menstrual change, has a major change
in health status or thinks might be pregnant.
 Ensure post injection counselling.
What is to be done during
follow up care??
Follow up care:
 One experience from countries where MPA
is commonly used is that sometimes
women, who start MPA, can discontinue
the method after a few injections.
 They either forget the date, lose
motivation to continue, or are not able to
cope with the side effects.
 Your role is to support all women who
start MPA to continue with the method
and reassure them about the side effects.
Follow up care:
 With help of ASHA and ANMs, maintain the
list of women who opt for MPA as a
contraceptive option.
 Discuss the importance of follow up visits
with the clients and remind them just
before the due date, to go the facility.
Follow up care:
 Visit women who taking MPA at least once
a month to discuss her experiences with
the method and reassure her regarding
her concerns.
 If she is very concerned about side
effects, motivate her to consult the
medical officer who has given the
injection for counselling.
Follow up care:
 One concern that women may have is
related to the changes in the menstrual
cycle.
 These include irregular or heavy bleeding.
 Some women may complain that their
monthly period has stopped.
 Tell them that these changes are normal.
Follow up care:
 They need to be told that the 'period' may
completely stop because that is the way
the method works and is not harmful.
 Reassure the woman that the menstrual
cycle will start when they decide they
want to get pregnant again and
discontinue the contraceptive.
Follow up care:
Follow up care:
What is done???
Follow up care:
What is done???
Follow up care:
What is done???
How to make it most
effective?
Effectiveness:

 Effectiveness depends on:

 Timing of first injection – within 7 days
after menstrual cycle
 Takinginjections regularly on time – every
3 months
 Use of proper injection technique
 Post injection care & follow-up
Take home message
Summary
Summary
 PRE-TEST ASSESSMENT

1. Antara is also known as –

a. MPA

b. DMPA

c. Both a&b
d. None of these
 PRE-TEST ASSESSMENT

1. Antara is also known as –

a. MPA

b. DMPA

c. Both a&b
d. None of these
 PRE-TEST ASSESSMENT

2. Composition of Antara is –
a. Estrogen and progesterone
b. Synthetic
progestin
medroxyprogesterone acetate
c. Norethindrone enanthate
d. Syntheticestrogen derived from
the natural hormone estrogen
 PRE-TEST ASSESSMENT

2. Composition of Antara is –
a. Estrogen and progesterone
b. Synthetic
progestin
medroxyprogesterone acetate
c. Norethindrone enanthate
d. Syntheticestrogen derived from
the natural hormone estrogen
 PRE-TEST ASSESSMENT

3. For maximum efficiency, Antara

must be given at every –
a. 1 monthly interval
b. 2 monthly interval
c. 3 monthly interval
d. None of these
 PRE-TEST ASSESSMENT

3. For maximum efficiency, Antara

must be given at every –
a. 1 monthly interval
b. 2 monthly interval
c. 3 monthly interval
d. None of these
 PRE-TEST ASSESSMENT

4. Dose of Antara given to a client is –

a. 50mg

b. 100mg

c. 150mg

d. 200mg
 PRE-TEST ASSESSMENT

4. Dose of Antara given to a client is –

a. 50mg

b. 100mg

c. 150mg

d. 200mg
 PRE-TEST ASSESSMENT

5. Route of administration of Antara is -

a. IM

b. SC

c. IM & SC
d. IV
 PRE-TEST ASSESSMENT

5. Route of administration of Antara is -

a. IM

b. SC

c. IM & SC
d. IV
 PRE-TEST ASSESSMENT

6. All of the following can administer

Antara except –
a. ASHA
b. ANM
c. CHO
d. MO
 PRE-TEST ASSESSMENT

6. All of the following can administer

Antara except –
a. ASHA
b. ANM
c. CHO
d. MO
 PRE-TEST ASSESSMENT

7. Health benefits of Antara are –

a. Protects against endometrial cancer
b. Helps prevent Iron deficiency
Anaemia
c. May reduce incidence of symptomatic
PID
d. All of the above
 PRE-TEST ASSESSMENT

7. Health benefits of Antara are –

a. Protects against endometrial cancer
b. Helps prevent Iron deficiency
Anaemia
c. May reduce incidence of symptomatic
PID
d. All of the above
 PRE-TEST ASSESSMENT

8. What are the post injection instruction

to be given by the provider to DMPA
Client?
a. Do not massage injection site
b. Do not apply hot fomentation
c. Expect menstrual changes and do not get
unduly alarmed
d. All of the above
 PRE-TEST ASSESSMENT

8. What are the post injection instruction

to be given by the provider to DMPA
Client?
a. Do not massage injection site
b. Do not apply hot fomentation
c. Expect menstrual changes and do not get
unduly alarmed
d. All of the above
 PRE-TEST ASSESSMENT

9. If a woman comes for her DMPA injection on

day 7 of her menstrual cycle
a. She needs to wait for her next menstrual
period before receiving DMPA injection
b. She is given DMPA but needs to use a backup
method for seven days.
c. She needs to be given a higher dose of
DMPA
d. She can be given DMPA injection and do
nothing
 PRE-TEST ASSESSMENT

9. If a woman comes for her DMPA injection on

day 7 of her menstrual cycle
a. She needs to wait for her next menstrual
period before receiving DMPA injection
b. She is given DMPA but needs to use a backup
method for seven days.
c. She needs to be given a higher dose of
DMPA
d. She can be given DMPA injection and do
nothing
 PRE-TEST ASSESSMENT

10. Syringesare disposed off in which of

the following-coloured biomedical
waste bags/bins?
a. Yellow
b. Blue
c. Red
d. Black
 PRE-TEST ASSESSMENT

10. Syringesare disposed off in which of

the following-coloured biomedical
waste bags/bins?
a. Yellow
b. Blue
c. Red
d. Black