For women who want to use contraception to avoid or space pregnancies, service delivery barriers related to menstruation can interfere with reliable, same-day provision of family planning. Also, women often discontinue or decide not to use contraceptives because of bleeding changes associated with some methods. FHI 360 addresses these and other issues related to menstruation and contraceptive use through research and development of resources for providers, policymakers and procurement groups.
Pregnancy checklist and pregnancy tests
FHI 360 developed the pregnancy checklist, a job aid with simple questions that a provider can ask a client to rule out pregnancy. The tool, which has been endorsed by the World Health Organization (WHO) and is used in more than 15 countries, can increase women’s access to same-day provision of family planning. The checklist is available in several languages.
Our research also shows that increasing the availability of simple, low-cost pregnancy tests in family planning programs can reduce barriers to access among non-menstruating women. In partnership with Marie Stopes International, FHI 360 conducted a multicountry assessment on the accessibility and affordability of pregnancy tests. A video, produced by FHI 360, Knowledge for Health and the U.S. Agency for International Development (USAID) Center for Accelerating Innovation and Impact, includes results from the assessment.
Two tools can also help providers and procurers with decision-making related to the checklist and pregnancy tests:
- Clinical guidance for providers. Neither the pregnancy checklist nor pregnancy tests will be clinically effective in all situations. A job aid, included in the current edition of WHO’s Family Planning: A Global Handbook for Providers, offers guidance on when each tool should be used.
- Procurement guidance for pregnancy tests. Under the USAID-funded Envision FP project, FHI 360 developed a guidance document summarizing recommendations on quality standards and performance specifications for pregnancy tests.
Counseling tool for menstrual bleeding changes
Fears and misconceptions about menstrual bleeding frequently contribute to discontinuation and non-use of contraception. Although amenorrhea or reduced bleeding can have important noncontraceptive health and lifestyle advantages for women, these potential benefits are often not emphasized in family planning counseling sessions. The NORMAL job aid contains guidance for providers to counsel family planning clients on bleeding changes associated with hormonal contraception and the copper intrauterine device (IUD); it is available in several languages.
Menstrual health and reproductive health
Menstrual health and reproductive health have multiple linkages that are often unexplored. An annotated bibliography presents sources of evidence on potential linkages. It can be used to advocate for the inclusion of menstrual health within an expanded definition of reproductive health.
