Last revised: 24 September 2012
Contraceptive Implants (Implants): Session Plan
Notes to Facilitator:
The slides and session plan provide presentation support for conveying technical information and for conducting the interactive learning activities.
To use this presentation most effectively, please:
• Read the Contraceptive Implants Facilitator’s Guide (available on the TRP website at: http://www.fptraining.org/content/faciliatators-guide-implants) for guidance on selecting and adapting TRP materials for the learning needs of your audience.
• Next read this session plan, which includes detailed learning objectives for this module and describes how to use this presentation and other materials required to prepare for and conduct the learning activities
Training Process / Resources /Session I: Characteristics of Implants
Session Objective: Describe the characteristics of implants.
Welcome and Introduction (10 min.)
• Greet participants and introduce yourself.
• See the Conducting Training tab in the TRP website (available at: http://www.fptraining.org/content/conducting-training) for ice breaker options.
Objectives
Discussion (5 min.)
Explain:
• Contraceptive implants are a safe and highly effective family planning (FP) option for most women.
• This presentation provides an overview of the characteristics of this method. It also provides training on how to counsel, screen, and provide follow-up to clients who are interested in using implants as a way to regulate their fertility.
• The session is designed to address the implant-related objectives listed in the Facilitator’s Guide and on the slide set.
• During this training you will learn and demonstrate these skills during role plays and other activities. You will also be encouraged to think about what it will be like to perform these tasks on-the-job.
• Review objectives with participants.
• Solicit input about whether the planned objectives match participant’s expectations of the training. / Slide 2-3: Objectives
Pre-Test Questionnaire
(30 min.) Distribute the pre-test. / Evaluation Tool: The Contraceptive Implants Pre-Test
What are Implants?
Discussion (30 min.)
Ask the participants: Which brands of implants are available in the facility where they work (or in their country, pharmacy, or program). Allow participants to answer and add to the participants’ responses as needed.
Explain:
• Implants are hormone-filled rods (sometimes referred to as capsules) that are inserted under the skin in a woman’s upper arm.
• Jadelle®, Sino-implant (II)®, Implanon®, and Norplant® are types of implants.
• Jadelle is a two-rod system that is effective for up to five years. It was designed to deliver the same daily dose of levonorgestrel as Norplant.
• Sino-implant (II) is a two-rod system that is identical to Jadelle, but labeled for up to four years of use, although efforts are under way to extend the labeled use to five years. Sino-implant (II) is marketed under various names in different countries.
• Implanon is a single-rod system that continually releases a low, steady dose of the progestin etonogestrel for up to three years.
• Norplant was the first progestin-only implant system developed. It consisted of six thin, flexible capsules made of silicone. Norplant is no longer being manufactured but many women who had it inserted are still relying on it for contraceptive protection. Norplant is labeled for five years of use, but studies have found that it is effective for seven years which may provide current users with additional years of protection.
• The newer implant systems—Jadelle, Sino-implant (II), and Implanon—have fewer rods than Norplant, making insertion and removal much easier. The newer implants are also more comfortable for the user.
• For the remainder of this presentation and in other collateral materials, we will refer mostly to one-rod or two-rod systems rather than specific brands.
• Distribute the handout FAQ−Effectiveness of Progestin-Only Implants Beyond Labeled Use. Participants can use this FAQ to respond to clients’ questions about the duration of effectiveness for the various implant systems.
• Introduce the types of implants available in the country.
• Provide copies of the tools/job aids that providers will be using at their workplace during interactions with clients. Throughout this presentation, encourage providers to look at the sections that they can use to support efforts to counsel and provide information on implants. / Slide 4: What are Implants?
Handout #1: FAQ−Effectiveness of Progestin-Only Implants Beyond Labeled Use
Key Points for Providers and Clients
Lecturette (5 min.)
• Give an overview of the key points about implants (What are they, how do they work, What to expect, important points about implants). / Slide 5: Key Points for Providers and Clients
Key Points for Clients
Discussion (5 min.)
Ask the participants: “What do you think are the most important messages to give clients about implants.” Allow participants to answer and add to the participants’ responses as needed. / Slide 6: Key Points for Clients
Effectiveness
Discussion (10 min.)
• The purpose of this activity is to emphasize the effectiveness of implants.
• The list on this slide categorizes contraceptive methods from most effective to least effective as commonly used. In this list, spermicides are the least effective method and the most effective methods are sterilization and IUDs.
• Ask participants: Where would you put progestin-only implants on this list? after participants respond, click the mouse to reveal the answer
• Conclude by emphasizing that implants would be in top tier of methods, as they are one of the most effective reversible methods available. As commonly used, implants are more effective than sterilization and IUDs.
• Use Optional Advanced Slide 2 to review and compare the effectiveness of FP methods during correct and consistent use and common use. / Slide 7: Effectiveness of Implants
Optional Advanced Slide 2: Contraceptive Method Effectiveness
Relative Effectiveness
Lecturette (5 min.)
• Explain that there is another way to look at effectiveness. In this slide we look at how effective FP methods are as they are commonly used.
• The slide shows the number of women who would get pregnant if 1,000 women used a method for one year. So, if 1,000 fertile women who were having sex, but not using any protection from pregnancy, 850 of them would become pregnant.
• But, if the same 1,000 women were using an implant, fewer than one would become pregnant.
• As a part of good counseling, it is important to inform clients about how effective each method is.
Ask participants:
• What if these same women were using an injectable? How many would become pregnant. / Slide 8: Relative Effectiveness of FP Methods
Method Effectiveness
Role Play (20 min.)
The purpose of this activity is to give participants an opportunity to practice explaining the effectiveness of implants using two job aids: Comparing Effectiveness of Family Planning Methods and If 100 Women Use a Method for One Year, How Many Will Become Pregnant?
• Explain that one of the charts shows the number of women who would be pregnant if they used the method perfectly (perfect use) or if they occasionally used the method incorrectly or forgot to use it sometimes.
• Ask participants: Why is it difficult to use a method perfectly? Is it realistic to think that all methods will be used perfectly? Why or why not? How can a provider influence how effectively a woman uses the method she is given? (Answers should include how counseling about a method influences its use).
• Distribute copies of these job aids for participants to use.
• Remind participants that clients consider method effectiveness a key factor when making a decision about which method to use.
• Explain that the chart on the previous slide is not necessarily easy for clients to understand. These two job aids present the information in a more understandable format.
• Explain that: If 100 women use implants for 1 year, less than 1 woman will become pregnant.
• Before practicing with the tools, ask participants to answer following questions:
1. How might you use these tools to help explain how effective implants are compared to other contraceptive methods?
2. How do these job aids compare with other ways you have explained method effectiveness to clients?
• Allow the groups to role play how to explain using the two job aids with clients for about 15 minutes.
Role Play Instructions:
• Instruct participants to pair off with a person sitting next to them.
• One person should play the role of the provider, while the other pretends to be a client.
• Providers should use one of the job aids to explain implant effectiveness as if they were interacting with an actual client. Encourage “clients” to ask questions.
• Give partners several minutes to practice.
• To conclude the activity, ask participants to gather as a large group and talk about the experience. Find out how well they thought the tools worked, whether they were helpful to the clients, and what they learned from this experience.
• Remind participants that they will have various opportunities to practice client-provider interaction and counseling, rotating client and provider roles, throughout the session. / Handout #2: Comparing Effectiveness of Family Planning Methods
Handout #3:
If 100 Women Use a Method for One Year, How Many will Become Pregnant?
Explaining How Implants Work
Lecturette (5 min.)
• Explain that implants prevent pregnancy in two ways:
1. They prevent the release of eggs from the ovaries by suppressing the hormones that cause ovulation. When there is no egg, there is nothing for sperm to fertilize.
2. Implants also cause the cervical mucus to thicken. The thicker mucus acts as a barrier, making it more difficult for sperm to enter the uterine cavity. In the unlikely event that a woman does ovulate, this barrier of mucus greatly reduces the chance that the egg will be fertilized.
• Implants do not disrupt an existing pregnancy and have no adverse effect on a woman or a fetus if accidentally inserted in the arm of a woman who is already pregnant.
• However, in the rare event that a woman is found to be pregnant with an implant in place, the device should be removed. / Slide 9: Implants: Mechanism of Action
Characteristics of Implants
Brainstorming (10 min.)
The purpose of this activity is to keep participants focused on how they translate technical information into concepts that their clients can understand.
Brainstorming instructions:
• Ask trainees to brainstorm first a list of positive characteristics (advantages) and then negative characteristics of implants.
• Write these suggested characteristics on a flip chart. Then show the slide of implant characteristics and compare them to the list generated through brainstorming. / Slide 10: Implants: Characteristics
Health Benefits of Implants
Lecturette (5 min.)
• In addition to being an effective way to prevent pregnancy, implants offer other health benefits.
o Physicians have observed that women who use implants tend to have fewer cases of symptomatic pelvic inflammatory disease, or PID. It is not clear if this is due to actual prevention of PID or whether using implants makes PID symptoms less severe.
o Because most implant users experience an overall reduction in the amount of menstrual blood loss, implant use can reduce the likelihood of iron-deficiency anemia.
o Because implants are so effective at preventing pregnancy, they dramatically lower a woman’s chances of having an ectopic pregnancy, which is a potentially life-threatening condition.
§ The risk of ectopic pregnancy is reduced by a factor of more than 100; the rate of ectopic pregnancy among women using implants is 6 per 100,000 women per year compared with 650 per 100,000 women per year among women using no contraceptive method.
§ In the rare event that implants fail and pregnancy occurs, providers must be aware that an ectopic pregnancy is possible and be prepared to treat this life-threatening condition. / Slide 11: Implants: Health Benefits
Side Effects of Implants
Lecturette (10 min.)
• Remind participants that as with many contraceptive methods, there are some side effects associated with implants that are not harmful but may be unpleasant.
• Women’s preferences for certain methods are often related to side effects.
• Ask the participants: What side effects of implants, have you heard about?
• Show slides 12 and 13 on side effects. Explain that many women who use implants experience side effects.
• The most commonly reported side effects are menstrual changes. Light bleeding or spotting, irregular bleeding that occurs frequently, prolonged bleeding that lasts more than eight days, infrequent bleeding, and amenorrhea are the types of menstrual irregularities that women report. In the first year of implant use, the majority of women experience menstrual changes that deviate from their normal bleeding pattern.
• Typically, the frequency of these menstrual changes—especially prolonged bleeding—decreases with time and is less of a problem by the end of the first year of use. These menstrual irregularities are not usually medically harmful, but they may be unacceptable for some women.
• The type of implant can also have an impact on the bleeding pattern that users experience. For example, Implanon users are more likely to experience infrequent or no menstrual bleeding than prolonged bleeding.
• For more detailed information on bleeding side effects see the optional advanced slides. Some providers may be interested to know whether there are any negative metabolic effects of contraceptive implants. A review of the available research on metabolic effects shows that Jadelle and Implanon appear to have no clinically important effects on liver, kidney, or thyroid function. For this information, see Optional Advanced Slide 5. / Slide 12:
Possible Side Effects of Implants (part 1)
Slide 13: Possible Side Effects of Implants (part 2)
Optional Advanced Slide 3: Menstrual Bleeding Patterns in Users of Two-Rod Implants
Optional Advanced Slide 4: Menstrual Bleeding Patterns in Implanon Users
Optional Advanced Slide 5: No Significant Metabolic Effects
Implants Fact Sheet
Brainstorming (10 min.)
The purpose of this activity is to give participants an opportunity to review the characteristics of implants and explore the contents of the fact sheet.
Brainstorming instructions:
• Introduce the fact sheet and ask participants to review the first page.
• Ask participants if there are any additional comments or questions about the characteristics of implants.