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
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/conductingtraining) for ice breaker options.
Resources
Slide 2-3: Objectives
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.
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Contraceptive Implants Module
Facilitator’s Guide
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Pre-Test Questionnaire
(30 min.) Distribute the pre-test.
Evaluation Tool: The
Contraceptive
Implants Pre-Test
What are Implants?
Discussion (30 min.)
Slide 4: What are
Implants?
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:
Handout #1:
FAQ−Effectiveness of
Progestin-Only
Implants Beyond
Labeled Use
• 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
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Facilitator’s Guide
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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.
Key Points for Providers and Clients
Lecturette (5 min.)
• Give an overview of the key points about implants (What are
Slide 5: Key Points
for Providers and
Clients
they, how do they work, What to expect, important points
about implants).
Key Points for Clients
Discussion (5 min.)
Slide 6: Key Points
for Clients
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.
Effectiveness
Discussion (10 min.)
Slide 7: Effectiveness
of Implants
• The purpose of this activity is to emphasize the effectiveness Optional Advanced
of implants.
• The list on this slide categorizes contraceptive methods from
Slide 2: Contraceptive
Method Effectiveness
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
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Facilitator’s Guide
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effectiveness of FP methods during correct and consistent
use and common use.
Relative Effectiveness
Lecturette (5 min.)
• Explain that there is another way to look at effectiveness. In
Slide 8: Relative
Effectiveness of FP
Methods
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.
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.
Handout #2:
Comparing
Effectiveness of
Family Planning
Methods
Handout #3:
If 100 Women Use a
Method for One Year,
How Many will
Become Pregnant?
• 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
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Facilitator’s Guide
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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.
Explaining How Implants Work
Lecturette (5 min.)
Slide 9: Implants:
Mechanism of Action
• 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
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Facilitator’s Guide
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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.
Characteristics of Implants
Brainstorming (10 min.)
Slide 10: Implants:
Characteristics
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.
Health Benefits of Implants
Lecturette (5 min.)
Slide 11: Implants:
Health Benefits
• 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
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Facilitator’s Guide
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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.
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
Slide 12:
Possible Side Effects
of Implants (part 1)
Slide 13: Possible
Side Effects of
Implants (part 2)
to side effects.
Optional Advanced
• Ask the participants: What side effects of implants, have you Slide 3: Menstrual
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—
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
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
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Facilitator’s Guide
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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.
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.
Slide 14: Group
Activity: Implants
Fact Sheet
Handout #4:
Fact Sheet: Implants
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.
• Discuss and clarify as needed.
• Ask participants to consider how they might be able to use
the fact sheet in their work. Remind participants that
although it might be useful for helping providers to
remember important information to share with clients, the
fact sheet is not intended to be used as a brochure to be
distributed to clients.
• Ask participants to review the page two of the fact sheet.
Inform the participants that the next segment of the training
will address the issues outlined on page two of the fact sheet.
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Contraceptive Implants Module
Facilitator’s Guide
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Training Process
Session II: Who Can and Cannot Use Implants
Resources
Session II Objective: Demonstrate how to screen women for medical eligibility to use
implants.
Slide 2:
Characteristics of Implants
Characteristics of
Discussion (10 min.)
Implants
• The purpose of this activity is to ensure that participants
understand how the characteristics of implants might affect a
Handout #5: Implants
client’s choice of or eligibility for implants.
for Adolescents
• Ask participants for reasons why women listed in the slide
might prefer or avoid implants. Click the mouse to reveal the
next example. Move through each case quickly and mention
the following points.
• Breastfeeding mother:
o Because implants do not reduce the quantity of breast
milk or decrease the duration of lactation, they can be
used by breastfeeding mothers.
o After insertion, a woman has three to five years of highly
effective protection from unintended pregnancy, which is
an ideal child-spacing interval for the health of the
mother and the child.
o Note to Facilitator: Slides 2 and 3 represent the
international consensus on the initiation of implants and
breastfeeding as reflected in the WHO MEC. For further
information on the initiation of implants and
breastfeeding, see slide 10. This consideration will be
more fully discussed at that time.
• Adolescent:
o Young women may be especially interested in implants
because there is nothing to do or remember after
insertion.
o Also, fertility returns quickly after implants are removed,
so women who wish to plan a pregnancy can do so
easily.
o Young women can use implants to delay a first
pregnancy or to space subsequent pregnancies.
o Studies show that adolescent mothers who choose
implants over pills have higher rates of continued use
and lower rates of new pregnancy.
o Note to Facilitator: If country guidelines support use of
implants by adolescents, distribute Handout #5: Implants
for Adolescents: An Option Worth Considering for
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Healthy Timing and Spacing of Pregnancy. Some
providers might have biases against providing implants
to adolescents and neglect to mention this contraceptive
option when counseling younger clients.
• Infected with HIV:
o Implants are one of the most effective methods available
and are an excellent choice for women with HIV who
wish to avoid unintended pregnancy.
o Women with AIDS who are on antiretroviral therapy can
use implants effectively because they do not interact
with ARV drugs.
• Little to no access to a health care facility:
o Implants may be a good choice for women with limited
access to health care because routine periodic visits are
not necessary and implants provide long-term protection
from pregnancy. A minor surgical procedure is necessary
for both insertion and removal.
• Desires no more children:
o Implants are an excellent alternative to sterilization for
women who want to stop childbearing.
Implants are Safe for Nearly All Women
Lecturette (10 min.)
• Nearly all women can use implants safely and effectively,
Slide 3: Implants are
Safe for Nearly All
Women
including women who:
o Have or have not had children
o Are not married
o Are of any age, including adolescents and women over
40 years old
o Have just had an abortion, miscarriage or ectopic
pregnancy
o Smoke cigarettes, regardless of age or number of
cigarettes smoked
o Are breastfeeding (after 6 weeks postpartum)
o Have anemia now or in the past
o Have varicose veins
o Are infected with an HIV, whether or not on
antiretroviral therapy
o Most health conditions do not affect safe and effective
use of implants and only few conditions or situations
may affect a woman’s eligibility to use progestin-only
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Facilitator’s Guide
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implants.
• In addition, many women who cannot use contraceptive
methods that contain estrogen can safely use implants.
• WHO medical eligibility criteria were developed to reassure
providers about some conditions that do not interfere with
safe use of contraceptives and highlight all conditions that
might affect women’s eligibility to use any given
contraceptive method.
Who Can and Cannot Use Implants
Discussion (15 min.)
• Explain that most women can safely use implants as
mentioned in the previous slide. Show the slides and discuss
which women should not use implants.
• Ask several participants to share one thing that they know
Slide 4: Who Can and
Cannot Use Implants
(Part 1)
Slide 5: Who Can and
Cannot Use Implants
(Part 2)
about the Medical Eligibility Criteria (MEC) in their
national FP/RH guidelines (if they exist) or the WHO MEC.
• Introduce job aids that help participants understand
eligibility criteria (and that they may also use at their
worksites), such as the WHO Medical Eligibility Criteria
Wheel for Contraceptive Use, or the Quick Reference Chart
for the WHO Medical Eligibility Criteria for Contraceptive
Use.
Medical Eligibility Criteria
Brainstorming (25 min.)
Slide 6: Medical
Eligibility Criteria
This activity has two purposes:
1. To give participants an opportunity to share what they know
about the eligibility criteria used in their national FP
guidelines or the WHO medical eligibility criteria (WHO
MEC) so that the facilitator can determine whether the
participants understand the criteria and how they are used or
whether they need additional background information before
proceeding.
Slides 7 and 8:
WHO’s Medical
Eligibility Criteria,
Categories for IUDs,
Hormonal and Barrier
Methods
2. To introduce job aids that help participants understand
eligibility criteria (and that they may also use at their
worksites), such as the WHO Medical Eligibility Criteria
Wheel for Contraceptive Use, or the Quick Reference Chart
for the WHO Medical Eligibility Criteria for Contraceptive
Use.
Brainstorming instructions:
Training Resource Package for Family Planning
Contraceptive Implants Module
Facilitator’s Guide
Slide 9: Who Can
Start Implants
Slide 10: Who Cannot
Start Implants
Handout # 6: WHO
Medical Eligibility
Criteria Wheel for
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• Use slides 7 and 8 to introduce the concept of medical
eligibility and determine whether participants have an
adequate foundation. Explain the 4 categories.
• List 10-15 medical criteria on a flip chart. Ask participants
to find the appropriate category on the WHO MEC Wheel or
the Quick Reference Chart. If time allows, this exercise can
be made into a game using teams to determine the correct
answers. Ask several participants to share one thing that
they know about the eligibility criteria in their national
FP/RH guidelines (if they exist) or the WHO MEC.

Category 1: For women with these conditions or
characteristics, the method presents no risk and can be
used without restrictions. According to the MEC,
implants can be used without any restrictions by women
with category 1 conditions. For example, progestin-only
implants can be used freely by women of any age,
including those who are less than 18 years old; women
who are breastfeeding a baby older than six weeks (to be
discussed later); women who are heavy smokers; or
women who have complicated valvular heart disease,
endometriosis, endometrial or ovarian cancer, or thyroid
disease.

Category 2: For women with these conditions or
characteristics, the benefits of using the method
generally outweigh the theoretical or proven risks.
Women with Category 2 conditions generally can use the
method, but careful follow-up may be required. For
women with category 2 conditions, the advantages of
using this method outweigh the theoretical or proven
risks. Progestin-only implants can generally be used by
women with category 2 conditions, but careful follow-up
may be required in some cases. Examples of such
conditions include blood pressure above 160/100 mm
Hg, a history of deep venous thrombosis/pulmonary
embolism (DVT/PE), diabetes with vascular
complications, heavy or prolonged vaginal bleeding
patterns, or multiple risk factors for cardiovascular
disease.

Category 3: For women with these conditions or
characteristics, the theoretical or proven risks of using
the method usually outweigh the benefits. Women with
Category 3 conditions generally should not use the
method. However, if no better options for contraception
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Contraceptive Use
Handout # 7: The
Quick Reference
Chart for the WHO
Medical Eligibility
Criteria for
Contraceptive Use
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are available or acceptable, the provider may judge that
the method is appropriate, depending on the severity of
the condition. In such cases, ongoing access to clinical
services and careful follow-up will be required.

Category 4: For women with these conditions or
characteristics, the method presents an unacceptable
health risk and should not be used.
• In some cases, a particular condition or characteristic is
assigned to one category for initiation and another for
continuation of the method. In other words, the category
may depend on whether a woman with the condition wishes
to initiate the contraceptive method or was already using that
method when she developed the condition.
• Demonstrate how to use the WHO MEC Wheel or the Quick
Reference Chart. Explain that implants are safe for the
overwhelming majority of women. Use slides 9-10 to
provide an overview of the medical eligibility criteria for
implants.
• Although progestin-only implants are safe for most women,
there are some exceptions.
o According to the MEC, progestin-only implants are not
generally recommended for women with category 3
conditions. In these situations, the risks of using this
method usually outweigh the advantages. Category 3
conditions include:

Acute blood clot in deep veins of legs or lungs,
unexplained vaginal bleeding, history of breast
cancer, severe liver disease and most liver tumors,
certain cases of systemic lupus and breastfeeding
before 6 weeks postpartum.

The condition of breastfeeding before 6 weeks
postpartum is a special case that merits further
consideration. Based on theoretical (i.e. not proven)
reasons having to do with the concern that
progestogens may negatively affect the neonatal liver
or brain, the WHO MEC has classified breastfeeding
before 6 weeks postpartum as a category 3. WHO
also notes that “in many settings pregnancy
morbidity and mortality are high, and access to
services is limited. Progestin-only contraceptives
may be one of the few types of methods widely
available and accessible to breastfeeding women
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immediately postpartum.” Reflecting this
consideration, after careful evaluation of the
evidence and their own health systems and settings,
some countries have made different classifications.
The United States Center for Disease control (CDC)
gives the condition of breastfeeding at 0-4 weeks a
Category 2 and from 4-6 weeks a Category 1. The
United Kingdom’s Royal College of Obstetricians
and Gynaecologists: Faculty of Sexual and
Reproductive Health Care give it a Category 1 from
birth onward. The materials in this training package
reflect the WHO classification.

Women who develop ischemic heart disease, have a
stroke, or develop migraine headaches with an aura
while using implants should generally not continue
using progestin-only implants.
o Women with category 4 conditions should not use
implants. Current breast cancer is the only category 4
condition.
o WHO also notes that, in settings where clinical judgment
is limited, category 2 conditions should be treated in the
same manner as category 1 conditions. This means that
women with category 1 and category 2 conditions should
be able to obtain and use progestin-only implants
without restrictions.
Implant Use by Women with HIV
Discussion (10 min.)
Slide 11: Implant Use
by Women with HIV
• Ask participants: Let us take a closer look at the conditions
and categories pertaining to clients with HIV or AIDS.
• Use slide to present the following:
o According to the MEC, progestin-only implants can be
used without restrictions by women with HIV who may
or may not have AIDS. These are considered category 1
conditions. This table shows the specific WHO
recommendations.
o HIV-positive women who are on antiretroviral (ARV)
therapy can generally use progestin-only implants, but
follow-up may be required in some cases. This is
because progestin blood levels are slightly reduced by
some ARVs. However, these reductions are probably not
enough to affect contraceptive efficacy because implants
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provide a consistent dose of hormone over time.
o As with other hormonal methods, progestin-only
implants do not provide protection from STIs.
• Ask participants: What advice should you give to clients
with HIV who choose implants? <accept responses from
several participants; click the mouse to reveal the next
bullet>
o Women with HIV who choose to use implants should be
counseled about dual method use and should consider
using condoms in addition to hormonal methods.
Condoms provide additional protection from pregnancy
in the event that the effectiveness of progestin-only
implants is reduced. Condoms also provide protection
against STI/HIV transmission.
o WHO classifies nucleoside reverse transcriptase
inhibitors (NRTIs) as category 1 and non-nucleoside
reverse transcriptase inhibitors (NNRTIs) and ritonavir
and ritonavir-boosted protease inhibitors as category 2
conditions for progestin-only implants. Because ARV
therapy is a multidrug regimen that always contains a
category 2 drug, ARV therapy is a category 2 condition.
This means that women on ARV therapy can generally
use progestin-only implants, although follow-up may be
required in some cases.
Implant Use by Postpartum Women
Lecturette (5 min.)
• Ask participants: Let us take a closer look at the conditions
Slide 12: Implant Use
by Postpartum
Women
and categories pertaining to postpartum clients.
• Use slide to present the following:
o Non-breastfeeding women can initiate implants
immediately postpartum.
o We have also discussed the different recommendations
adopted by WHO and countries such as the US and UK
regarding the use of implants earlier than 6 weeks
postpartum based on theoretical concerns about possible
negative effects of progestins on the fetal liver and
brain. WHO has classified use at 0-6 weeks postpartum
a classification of 3, while others have given it a lower
classification (1 or 2). Unlike Combined Oral
Contraceptives (COCs), implants do not have an effect
on breast milk production.
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• Ask participants about what they encounter with postpartum
women. Is it easy or difficult for them to come back for
insertion at 6 weeks postpartum?
Understanding the Implant Checklist
Experiential Learning Exercise (15 min.)
The purpose of this activity is to introduce participants to the
Checklist for Screening Clients Who Want to Initiate Contraceptive
Implants, to provide an overview of its purpose, and to show how to
use it.
• Distribute an implant checklist to each participant.
• When introducing the checklist, mention that it should be
used by providers to determine whether a client is medically
eligible to use the method that she selected during an
informed decision-making process.
• The questions on the checklist identify women who have
health conditions—WHO category 3 or 4—that make it
unsafe for them to use progestin-only implants. The
checklist also incorporates questions that allow a provider to
determine with reasonable certainty that a client is not
pregnant.
Slide 13:
Understanding the
Implant Checklist
Handout #7:
Quick Reference
Chart for the WHO
Medical Eligibility
Criteria for
Contraceptive Use
Handout #8: Checklist
for Screening Clients
Who Want to Initiate
Contraceptive
Implants
• To use the checklist, providers ask the questions on the
checklist and follow the instructions based on the client’s
responses. Explain that the medical eligibility questions,
questions 1–6, are at the top of the checklist.
• Ask participants to pair themselves with the person sitting
next to them and take turns reading questions 1–6 on the
checklist and finding the condition on the Quick Reference
Chart for the WHO Medical Eligibility Criteria for
Contraceptive Use. Ask the pairs to verify that all the
category 3 and 4 conditions for implants on the MEC chart
are represented in the questions on the checklist. Allow
participants about three to four minutes to examine the
checklist questions and compare them with the MEC chart.
• Ask participants:
o After examining the checklist and the MEC chart, are
you confident that the checklist questions address the
conditions that prohibit safe use of progestin-only
implants? Explain why.
o How have you determined a client’s medical eligibility
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for implants in the past and how might the checklist
facilitate that process?
• Accept responses from several participants and discuss any
concerns that participants may raise.
• Draw attention to questions 7–12 and emphasize that
providers should follow the instructions for this set of
questions to identify women who are not pregnant or those
who might be pregnant and require a pregnancy test to rule
out pregnancy.
• Tell providers that the final set of instructions provides
details about initiating the method, especially whether the
client will need to use a backup method initially.
Implant Eligibility Checklist (1)
Brainstorming (10 min.)
The purpose of this exercise is to give participants a
chance to use Handout #8, the Contraceptive Implant Checklist.
• Describe the following scenario (1): Your client is a healthy
24-year-old woman who gave birth to her first child five
months ago. She has been fully breastfeeding and has not
had a menstrual period since giving birth. She is returning to
work in two weeks and will begin supplementing with
formula.
• Ask participants to consider the client description when
answering these questions:
1. Which question(s) on the checklist address this client’s
condition or situation?
Encourage participants to review the checklist and locate
the question(s) relevant to this client’s situation. Ask
them to read the explanation for questions #6 and #8.
Although the client is breastfeeding, in this situation she
would reply “NO” to question 6 because she is more
than six weeks postpartum.
Handout #7:
Quick Reference
Chart for the WHO
Medical Eligibility
Criteria for
Contraceptive Use
Handout #8: Checklist
for Screening Clients
Who Want to Initiate
Contraceptive
Implants
Handout #9: Using the
Implant Eligibility
Checklist
2. Considering the client’s condition and the explanation
provided in the checklist, is this client a good candidate
for progestin-only implants?
Review with the participants why the client is medically
eligible for implants. Because the client is healthy and
her infant is older, she would answer “NO” to questions
#1–6. She would also answer “YES” to question #8, so
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the provider can be reasonably sure that she is not
pregnant because she is still protected from pregnancy
by the lactational amenorrhea method (LAM).
3. What would be your course of action for this client?
Discuss with participants why the correct course of
action is to counsel the client about using progestin-only
implants. If everything is acceptable to the client, the
provider may proceed with implant insertion.
Implant Eligibility Checklist (2)
Brainstorming (10 min.)
The purpose of this exercise is to give participants a
chance to use Handout #8, the Contraceptive Implant Checklist.
• Describe the following scenario (2): Your client is a 30-

Handout #7:
Quick Reference
Chart for the WHO
Medical Eligibility
Criteria for
Contraceptive Use
year-old woman who is married, monogamous, and has three
children. She has HIV but has no symptoms and has no other
health problems. She has been using condoms consistently
and correctly but is still concerned that she might become
pregnant.
Handout #8: Checklist
for Screening Clients
Who Want to Initiate
Implants
Ask participants to consider the client description when
answering these questions:
Handout #9: Using the
Implant Eligibility
Checklist
1. Which question(s) on the checklist address this client’s
condition or situation?
Encourage participants to review the checklist and locate
the question(s) relevant to this client’s situation. Ask
them to read the explanation for question #12.
2. Considering the client’s condition and the explanation
provided in the checklist, is this client a good candidate
for progestin-only implants?
Review with the participants why the client is medically
eligible for implants. Although the client has HIV, HIV
and AIDS are not conditions that limit use of implants.
Because the client is otherwise healthy, she would
answer “NO” to questions #1–6. She would also answer
“YES” to question #12, so the provider can be
reasonably sure that she is not pregnant because she has
been using condoms consistently and correctly.
3. What would be your course of action for this client?
Discuss with participants why the correct course of
action is to counsel the client about using progestin-only
implants. The client should also be encouraged to
continue using condoms to prevent sexually transmitted
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infections. If everything is acceptable to the client, the
provider may proceed with implant insertion.
Implant Eligibility Checklist (3)
Brainstorming (10 min.)
The purpose of this exercise is to give participants a
chance to use Handout #8, the Contraceptive Implant Checklist.
• Describe the following scenario (3): Your client is a 42year-old woman with five children. Six months ago, she was
admitted to the hospital with severe chest pain and shortness
of breath. She was diagnosed with a blood clot in her lung.
She is now on anticoagulant therapy (blood thinners). She
has no other health problems. She has not had sex since her
last menses.

Ask participants to consider the client description when
answering these questions:
Handout #7:
Quick Reference
Chart for the WHO
Medical Eligibility
Criteria for
Contraceptive Use
Handout #8: Checklist
for Screening Clients
Who Want to Initiate
Implants
Handout #9: Using the
Implant Eligibility
Checklist
1. Which question on the checklist addresses this client’s
condition or situation?
Encourage participants to review the checklist and locate
the question(s) relevant to this client’s situation. Ask
them to read the explanation for questions #2 and #9.
2. Considering the client’s condition and the explanation
provided in the checklist, is this client a good candidate
for implants?
Review with the participants why the client is medically
eligible for implants. She should answer NO to question
#2 because she does not currently have blood clots in her
legs or lungs and she is on anticoagulant therapy.
However, because of her history with blood clots, she
may answer YES to the question. If so, the provider has
the opportunity to probe further and confirm that she
does not currently have clots in her legs or lungs as she
has been on anticoagulant therapy for six months. The
provider can be reasonably sure the client is not pregnant
because she has not had intercourse since her last
menses.
3. What would be your course of action for this client?
Discuss with participants why the correct course of
action is to counsel the client about using progestin-only
implants. The client should also be encouraged to
continue with her anticoagulant therapy and inform other
health care providers whom she sees that she is using
implants and taking blood thinners. If everything is
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acceptable to the client, the provider may proceed with
implant insertion. If her menses started more than seven
days ago (five days for Implanon), tell her to use
condoms or abstain for the next seven days.
When to Start Implants (part 1)
Discussion (10 min.)
Slide 14: When to
Start Implants (part1)
Remind participants that questions #7–12 in the Checklist for
Screening Clients Who Want to Initiate Contraceptive Implants are
used to rule out pregnancy as part of the screening process for
initiating implants.
• Ask participants: If a woman is medically eligible and wants
to use implants, when can she initiate them? <participants
brainstorm; accept responses from several participants>
• Let us compare your responses with the information on the
next several slides. <click the mouse to reveal each bullet on
the slide>
• Progestin-only implants can be initiated anytime during the
menstrual cycle as long as the provider can be reasonably
sure the woman is not pregnant.
• A provider can be reasonably certain that a woman is not
pregnant if any of these situations apply:
o The woman is fully breastfeeding, has no menses, and
her baby is less than six months old.
o She has abstained from intercourse since her last menses
or since delivery.
o She has given birth in the past four weeks.
o Her monthly bleeding started within the past seven days.
o She had a miscarriage or an abortion in the past seven
days.
o She has been using a reliable contraceptive method
consistently and correctly.
• If none of these situations apply, a provider can use a urine
pregnancy test or conduct a bimanual pelvic exam to
determine if the woman is pregnant. If no other means to rule
out pregnancy are available, a provider can ask a woman to
come back at a time of her next menses and use a backup
contraceptive method in a meantime.
When to Start Implants (part 2)
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Lecturette (5 min.)
Start Implants (part 2)
• Remind participants that the instruction boxes below the
questions on the Checklist for Screening Clients Who Want
to Initiate Contraceptive Implants also provide guidance
about when to initiate implants for women who are eligible.
• If two rod-implant systems, like Jadelle or Sino-implant (II),
are initiated during the first seven days of the menstrual
cycle—where day one is the first day of bleeding—no
backup contraceptive method is necessary. With Implanon,
no backup method is needed if it is initiated within the first
five days of the menstrual cycle.
• If progestin-only implants are initiated more than seven days
after the start of woman’s monthly bleeding (more than five
days for Implanon), she should be counseled to use a backup
contraceptive method such as condoms for the first seven
days following insertion.
• A woman who is not breastfeeding may have implants
inserted immediately after delivery. If a woman who is not
breastfeeding wants to start using implants more than four
weeks after she has given birth, it is necessary to rule out
pregnancy before they can be inserted.
• Ideally, women who are breastfeeding should not start using
implants until six weeks postpartum because of theoretical
concern that hormones in breast milk may have an adverse
effect on a newborn during the first six weeks after birth.
When to Start Implants (part 3)
Discussion (5 min.)
Slide 16: When to
Start Implants (part 3)
• Implants can be initiated immediately following an abortion
or miscarriage without need for a backup method.
• If a woman is switching to implants from a hormonal
method, she can have the implants inserted immediately
provided that she has been using the hormonal method
consistently and correctly or if it is otherwise reasonably
certain that she is not pregnant. There is no need for her to
wait for her next monthly bleeding. There is no need for her
to use a backup method.
• If she is switching from injectables, she can have implants
inserted anytime during the reinjection window. There is no
need for a backup method.
• If a woman has taken emergency contraceptive pills, it is
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recommended that she delay implant insertion until her
menses return to ensure that emergency contraception was
effective. Implants can be inserted within the first seven
days after the start of her menstrual period (within five days
for Implanon) or any other time it is reasonably certain that
she is not pregnant. Give her a backup method such as
condoms, or oral contraceptives to start the day after she
finishes taking the emergency contraceptive pills, until the
implants can be inserted.
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Session III: Providing Implants
Session III Objective: Demonstrate how to provide implants.
When to Start Implants (A Review)
Group Work (15 min.)
The purpose of this activity is to allow participants to think about
how they would apply what they have learned about when to initiate
implants. The activity can be conducted in a large group or small
groups as long as participant responses are monitored by a
facilitator. Encourage participants to use the job aid, Checklist for
Screening Clients Who Want to Initiate Contraceptive Implants, to
help them determine what to do in each case.
• Ask participants to explain what they would do in each case.
The correct approaches for each case are outlined below.
Resources
Slide 2: When to Start
Implants (A Review)
Handout #8:
Checklist for
Screening Clients
Who Want to Initiate
Contraceptive
Implants
o In day 4 of menstrual cycle—can have implants
inserted immediately, no need to rule out pregnancy
or use a backup method (regardless of type of
implant being inserted)
o Condom user in day 8 of menstrual cycle—ensure
client has used condoms consistently and correctly,
can have implants inserted immediately, instruct her
to continue using condoms for 7 more days
o 2½ weeks postpartum, not breastfeeding—can have
implants inserted immediately, no need to use a
backup method
o 2½ weeks postpartum, currently breastfeeding and
wishes to continue—must be at least six weeks
postpartum before initiating implant use because of
the theoretical concern that progestin from the
implant that gets into the breast milk may have an
adverse effect on a newborn during the first six
weeks after birth.
o Injectable user, amenorrheic, within reinjection
window—can have implants inserted immediately,
no need to rule out pregnancy or use a backup
method.
o IUD user, mid-cycle, has had sex since her last
menses—can have implants inserted immediately,
remove IUD during the next menstrual cycle (this is
because ovulation may have already occurred and
viable sperm may be present in her fallopian tubes so
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implants even in combination with a back-up method
would not be effective).
o After taking emergency contraceptive pills (ECPs)—
can be inserted within seven days after the start of
her next monthly bleeding (within five days for
Implanon) or any other time it is reasonably certain
she is not pregnant; give her a backup method, or
oral contraceptives to start the day after she finishes
taking the ECPs, to use until the implants are
inserted.
Key Counseling Topics for Implant Users
Discussion/Role Play (30 min.)
• Ask participants: What are the key counseling
Slide 3: Key
Counseling Topics for
Implant Users
topics for new Implant users? <allow participants to
respond, affirm correct responses and click mouse to reveal
the list>
• Use slide to present the following:
o After a client makes an informed choice to use implants,
and you determine that she has no known conditions that
would prohibit use, you and the client should discuss in
greater detail how to use implants and address any
additional questions or misconceptions that the client
may have about the characteristics of implants.
o Specifically, you should discuss how safe and effective
implants are, how efficacy is affected by a woman’s
ability to take pills on time, how implants work, health
benefits, and possible side effects
o You should also discuss the fact that implants do not
protect against STIs/HIV.
o During counseling, help the client to assess her risk of
acquiring or transmitting infection and discuss the
benefits and feasibility of condom use to reduce that risk.
Explain how to use condoms correctly and consistently
and, if needed, help women develop and practice
strategies to negotiate condom use with their partners.
o Tell the client that if she is diagnosed with any serious
new health problem she should inform her health care
provider she has a contraceptive implant in place.
o Finally, discuss when to return, and tell the client about
the warning signs of possible complications. We will
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discuss the warning signs in a few moments.
• Role play instructions:
o Divide participants into groups of three. Ask the members of
each group to choose who will play the role of client,
provider, or observer.
o The observer will observe the roleplay and then make
suggestions for improvement.
o Explain that each participant will play each role during the
activity.
o The “provider” will explain about what implants are,
effectiveness, how they work, advantages and disadvantages,
client instructions, and when to return to the provider. The
“provider” may use local counseling material if available.
Correcting Rumors and Misunderstandings about
Implants
Brainstorming (20 min.)
• Explain that rumors are unconfirmed stories that are
transferred from one person to another by word of mouth.
In general, rumors arise when:
o An issue or information is important to people, but it has
not been clearly explained.
Slide 4: Correcting
Rumors and
Misunderstandings
Handout #10:
Correcting Rumors
and Misconceptions
about implants
o There is nobody available who can clarify or correct the
incorrect information.
o The original source is perceived to be credible.
o Clients have not been given enough options for
contraceptive methods.
o People are motivated to spread them for political
reasons.
• A misconception or misunderstanding is a mistaken
interpretation of ideas or information. If a misconception is
imbued with elaborate details and becomes a fanciful story,
then it acquires the characteristics of a rumor.
• Ask participants: What are some common misconceptions
about implants? <participants brainstorm; write the answers
on a flip chart>
1. Discuss methods for counteracting rumors and
misinformation
2. When a client mentions with a rumor, always listen
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politely. Don't laugh.
3. Define what a rumor or misconception is.
4. Find out where the rumor came from and talk with the
people who started it or repeated it. Check whether there
is some basis for the rumor.
5. Explain the facts.
6. Use strong scientific facts about FP methods to
counteract misinformation.
7. Always tell the truth. Never try to hide side effects or
problems that might occur with various methods.
8. Clarify information with the use of demonstrations and
visual aids.
9. Give examples of people who are satisfied users of the
method (only if they are willing to have their names
used). This kind of personal testimonial is most
convincing.
10. Reassure the client by examining her and telling her
your findings.
11. Counsel the client about all available FP methods.
• Refer back to the flipchart and ask participants how they
could counteract each rumor or misconception.
Additional Key Counseling Topics
Brainstorming and Discussion (10 min.)
• Ask participants: in addition to providing
Slide 5: Additional
Key Counseling
Topics
information on the characteristics of implants—including
side effects, assessing the client’s eligibility, and addressing
client misconceptions or questions—what are some other
key counseling topics related to implants? <participants
brainstorm; accept responses from several participants>
• Let us compare your responses with the slide. <click the
mouse to reveal the list>
• In addition to the topics we have already discussed, it is
imperative that during counseling about implants providers
also:
• Explain the procedure used to insert and remove the
implants. Use illustrations if possible. Include the length of
time it takes to complete the procedure, who will perform it,
and that it may be somewhat uncomfortable but not painful.
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We will review a job aid that can be used for this purpose.
• Provide post-insertion instructions so that a client knows
how to care for the incision and when to return to the clinic
if something does not seem right. We will also review these
instructions in more detail.
• Explain how long the implants protect against pregnancy.
Help women remember when they should come back to have
the implants removed or replaced. All clients should be
provided with the following information:
o Type of implant
o Date of insertion
o Month and year when implants will need to be removed
o Where to go in case of questions or problems
• A reminder card like the one shown on the slide can be
useful for this purpose.
• Finally, the provider should advise a client about
circumstances that require her to return, which are described
in more detail on the next slide.
Counseling About Side Effects
Lecturette (10 min.)
Slide 6: Counseling
About Side Effects
• Use the slide to present the following important points:
o Counseling—both prior to insertion and for women
already using implants—is the best way to help women
manage the side effects associated with progestin-only
implants.
o The most common side effects of implants are irregular
bleeding, prolonged bleeding, infrequent bleeding, or no
bleeding at all. Headaches, mild abdominal pain, and
breast tenderness are examples of less common side
effects.
o Women who are considering using implants should be
counseled that menstrual changes are expected and that
they are not signs of disease or health problems. For the
majority of women, side effects will become less
pronounced or will stop within the first year. Some
women may not have any side effects.
o After an implant is inserted, the practitioner should tell
the client to come back with any questions or concerns.
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Ongoing counseling and reassurance should be provided
if needed.
o If the user continues to be concerned or finds the side
effects unacceptable, it may be necessary to manage the
side effects or remove the implants.
Implant Insertion and Removal
Discussion and Role Play (20 min.)
Slide 7: Implant
Insertion and Removal
• A client who has chosen an implant needs
to know what will happen during insertion. Clients will want
to know the following:
o Implants usually only take a few minutes to insert, but
can sometimes take longer.
o Complications related to the insertion are rare.
o The provider will carefully clean the area on the arm and
will use sterile gloves and equipment.
o The client will receive a small injection under the skin so
that she will not feel the implant being inserted. The
injection may sting a bit.
o The client will be awake during the procedure.
o The provider will make a small incision on the inside of
the upper arm.
o The provider will insert the implant (1 or 2 rods,
depending on the type.
o After the implant has been inserted the provider will put
on a small bandage and then gauze will be wrapped
around the arm to keep the area clean.
• Role play instructions: ask for 2 volunteers to do a short
role play on explaining implant insertion to a client.
What Clients Need to Remember After Insertion
Lecturette (10 min.)
Slide 8: What to
Remember
• Use slide to present the following:
o Key messages that clients remember.
o Scheduled follow-up visits are not necessary for implant
users, but clients should be advised to return to the clinic
anytime they have questions or concerns.
o Discuss how to remember when to have the implant
removed.
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o Having contact with the client within the first two to six
months may improve continuation among women
experiencing side effects, because this is when such
problems are most likely to occur.
o The provider should also ask whether the client’s
reproductive goals have changed, as she may want to
become pregnant or desire a long-acting or permanent
method.
o If the client reports or complains about side effects, the
provider should assess her symptoms and, if appropriate,
reassure her that the side effects are not harmful and
discuss ways to manage them.
o If the client has developed any conditions that are
contraindications for continuing to use implants, or if the
client finds side effects unacceptable, the provider
should help her choose another method.
Supporting Method Continuation: Question to
Consider
Brainstorming (10 min.)

Ask participants to share any strategies that they have
developed to support method continuation among their
clients.

Assure clients that they are welcome to come back any time
for any reason. Although there is no need for a routine
follow-up visit, there are some reasons that an implant user
might want to or should return.

Clients should be advised to come back for the following
reasons:
o If she has problems or questions related to side effects or
other issues or if she wants to try another method.
o If she experiences pain, heat, pus, or redness at the
insertion site that becomes worse or does not go away—
this may indicate an infection.
o If she notices a rod is coming out—since the implant
should be replaced after ensuring there is no infection or
treating the infection if present.
o If she is concerned that she may be pregnant—since the
implant should be removed if she plans to carry the
pregnancy to term. But, it would be very rare to get
pregnant with the implant in place, unless it is left in too
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long.
o If she has gained a lot of weight. This may decrease the
length of time the rod is effective.
o If she suddenly feels that something is seriously wrong
with her health; although, it is unlikely that the implant is
the cause of the condition.
Slide 9: Helping
Helping Continuing Users
Continuing Implant
Discussion (5 min.)
Users
• Explain that no routine visit required for implants, but if she
returns, ask:
o Whether satisfied with method or has questions.
o If she is concerned about bleeding changes.
o About new health problems or major life changes (plans
for more children, change in STI/HIV risk).
o About significant weight changes (if using Jadelle,
significant weight gain may affect the duration of the
implants’ effectiveness).
o If she wants to continue using implant and has no new
medical condition, remind her how much longer her
implant will protect her.
Management of Implant Side Effects: Bleeding Changes
Lecturette (10 min.)
• Ask participants: What is the most important thing that you
can do for women who experience side effects?
<participants brainstorm; accept responses from several
participants> Compare responses with the slide.
Slide 10: Management
of Implant Side
Effects: Bleeding
Changes
• As we have discussed, the best way to reduce the anxiety
some women feel when they experience side effects is to
provide detailed information about possible side effects
before implant insertion. If side effects occur, the first step is
to address the client’s concerns through follow-up
counseling.
• If a client complains about irregular or breakthrough
bleeding, the provider should explain that implants make the
uterine lining thinner, sometimes causing it to shed earlier
than usual, resulting in this type of bleeding. It is also
important to reassure the woman that this bleeding does not
mean that anything is wrong and remind her that it will
likely diminish with time.
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• If the irregular bleeding is unacceptable to the client, the
provider may recommend up to 800 mg of ibuprofen, or an
equivalent amount of another non-steroidal antiinflammatory drug (NSAID) other than aspirin, three times
per day for five days. Women who are experiencing
irregular bleeding should not take aspirin, since it may
increase bleeding, not decrease it.
• If an NSAID does not provide relief, the provider can give a
low-dose combined oral contraceptive (COC) containing the
progestin levonorgestrel for 21 days. An alternative to COCs
is to give 50 µg ethinyl estradiol daily for 21 days. If
bleeding is prolonged or heavy—twice as long or twice as
much as usual—the provider can suggest that the woman
take iron tablets to help prevent anemia. If irregular or heavy
bleeding continues to bother the client or starts after several
months of normal monthly bleeding or amenorrhea, the
provider should rule out a possible underlying condition
unrelated to method use, such as uterine fibroids, an STI,
genital cancer, or pregnancy.
• Amenorrhea is another common side effect of implants.
Providers can reassure their clients that it does not indicate a
health problem and no medical treatment is necessary. This
side effect is similar to not having monthly bleeding during
pregnancy.
• If side effects persist and are unacceptable to the client, the
provider should help her choose another contraceptive
method.
Management of Implant Side Effects: Non-Menstrual Problems
Lecturette (10 min.)
• There are several non-menstrual side effects that clients who
are using implants may experience.
o If a client experiences frequent headaches that are not
migraines, reassure her that ordinary headaches do not
indicate dangerous conditions and usually diminish over
time. Standard doses of painkillers such as aspirin,
ibuprofen, paracetamol, or other pain relievers may be
used to alleviate symptoms. However, if headaches get
worse or occur more often after insertion of implants,
they should be evaluated.
Slide 11: Management
of Implant Side
Effects: NonMenstrual Problems
Optional Advanced
Slide 6: Jadelle:
Continuation Rates
and Reasons for
Discontinuation
o Mild abdominal pain may be caused by many conditions,
including enlarged ovarian follicles or cysts. Reassure
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the client that ovarian follicles or cysts usually disappear
on their own and standard doses of painkillers or other
local remedies will usually alleviate discomfort. To be
sure the problem is resolving, see the client again in six
weeks. There is no need to treat enlarged ovarian
follicles or cysts unless they grow abnormally large,
twist, or burst. However, if abdominal pain becomes
severe, refer at once for immediate diagnosis and care.
This is especially true if the severe abdominal pain
occurs with other signs or symptoms of ectopic
pregnancy such as abnormal vaginal bleeding or no
monthly bleeding (especially if this is a change from her
usual bleeding pattern), light-headedness, dizziness, or
fainting. Ectopic pregnancy is rare but can be lifethreatening.
o Clients who experience breast tenderness may try
wearing a supportive bra and can apply hot or cold
compresses. They can also take standard doses of
painkillers such as aspirin, ibuprofen, or paracetamol.
o In case of weight gain, review the client’s diet and
counsel her about healthy eating habits and exercise as a
way to better control her weight.
o If side effects persist and the client wants to stop using
implants, health care providers should counsel about
non-hormonal options and help the woman choose
another method.
o If appropriate, for more advanced providers, discuss
Optional Advanced Slide 6: Jadelle: Continuation Rates
and Reasons for Discontinuation.
Management of Implant Side Effects: Problems
Related to Insertion
Brainstorming/Discussion (10 min.)
• Clients may sometimes experience problems related to the
Slide 12: Management
of Implant Side
Effects: Problems
Related to Insertion
insertion of implants.
• Ask participants to brainstorm what side effects may occur
as a result of insertion and what advice would they give to
the client. These problems can usually be addressed easily.
• For pain after insertion, check that the bandage on the
client’s arm is not too tight. Put a new bandage on the arm
and advise the client to avoid pressing on the site for a few
days. Standard doses of aspirin, ibuprofen, paracetamol, or
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other pain reliever may also be helpful.
• If the woman experiences redness, heat, pain, or pus at the
insertion site, this may indicate an infection. In this case, do
not remove the implants. Clean the infected area with soap
and water or antiseptic. Give oral antibiotics for 7 to 10
days. Instruct the client to take all the antibiotics. If the
infection has not cleared after completing the course of
antibiotics, ask the client to return for removal of the
implants.
• In some cases, the client may develop an abscess—a pocket
of pus under the skin caused by an infection. If this happens,
clean the area with antiseptic. Cut open and drain the
abscess, and treat the wound. Give the woman oral
antibiotics for 7 to 10 days. Instruct the client to take all the
antibiotics. If she still has signs of infection—such as heat,
redness, pain, or drainage of the wound—after completing
the antibiotics, ask the client to return for removal of the
implants.
• Expulsion or partial expulsion of the implants often follows
an infection. Ask the client to return for follow-up care if she
notices an implant coming out.
Handout #11: Implant
Managing Problems Reported as Side Effects
Section of Family
Group Work (45 min.)
Planning a Global
• If the national FP guidelines provide specific
Handbook for
recommendations for management of implants side effects,
Providers
photocopy, distribute, and refer to the guidelines.
• If the national guidelines do not provide specific
recommendations, provide a copy of the pages from the
Global Handbook that providers can use as a job aid. Refer
to the section on Managing Any Problems: Problems
Related as Side Effects or Complications. Divide
participants into several groups. Divide the side effects listed
in the Global Handbook among the groups. Ask the groups
to develop plans for managing each side effect. Allow 30
minutes for the groups to develop their plans and 15 minutes
to report back.
Slide 13: Problems
Problems that May Require Switching from Implants
that May Require
to Another Method
Switching from
Brainstorming/Discussion (20 min.)
Implants to Another
• As a review exercise, write 2 columns on a flip chart. Label
Method (Part 1)
one column side effect and the other management.
Brainstorm the different side effects and their management.
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• Explain that there are some serious health conditions that
may require a client to stop using implants. These include:
o If a client experiences unexplained vaginal bleeding or
heavy or prolonged bleeding that is suggestive of a
medical condition not related to the method, she might
need to discontinue use of implants.
 Refer the client or evaluate by taking her medical
history and doing a pelvic examination. Diagnose
and treat as appropriate.
 If no cause of bleeding can be found, consider
stopping implants to make the diagnosis easier.
Provide the client with another contraceptive method
of her choice until the condition is evaluated and
treated. The alternative method should be something
other than progestin-only injectables or a copperbearing or hormonal IUD.
 If the bleeding is caused by an STI or PID, the client
can continue using implants during treatment.
Resources
Slide 14: Problems
that May Require
Switching from
Implants to Another
Method (Part 2)
o Although women who have migraine headaches with an
aura can initiate implants, implants should be removed if
a woman develops migraines with aura after implants are
inserted. The provider should help her choose a nonhormonal method.
o If a woman develops health conditions such as blood
clots in the deep veins of the legs or lungs, heart disease
due to blocked or narrowed arteries, severe liver disease,
or breast cancer, the implants must be removed.
o Although women with ischemic heart disease and
women who have had a stroke can initiate use of
implants, use of implants should be discontinued if these
conditions develop or get worse while using implants.
 Remove the implants or refer for removal and give
the woman a backup method to use until her
condition is evaluated. Refer her for diagnosis and
care if she is not already receiving treatment.
o Finally, if a woman is pregnant, the implants should be
removed. However, there are no known risks to a fetus
conceived while a woman has the implants in place.
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Complications from Implants are Rare
Lecturette (5 min.)
Slide 15:
Complications from
Implants are
Uncommon or Rare
• Whereas side effects—especially those related to
menstruation—are relatively common with progestin-only
implants, complications are uncommon or rare. They may
include:
o Infection at the insertion site is an uncommon
complication. If an infection occurs, it will most likely
be within the first two months.
o Difficulty with removal may occur if insertion was done
improperly or if removal is attempted by an untrained
provider. However, if implants are properly inserted and
removed by a trained provider, difficulty in removing
implants is rare.
o Expulsion of an implant is a rare complication. If this
occurs, it is most likely to happen in the first four
months. If no infection is present, a fresh implant may be
inserted through a new incision near the other rods or
capsules to replace the one that was expelled.
Explaining Implant Removal to the Client
Discussion (10 min.)
• Provide a copy of the page from the Global Handbook that
providers can use as a job aid while explaining the removal
procedure to clients. This page is a summary of the
procedure; it does not provide the detailed instructions
required for providers who are learning how to remove
implants. Removal training must be done under the
supervision of an experienced mentor.
Slide 16: Counseling
about Implants:
Explain Removal
Procedure to Client
Handout #11: Implant
Section of Family
Planning a Global
Handbook for
Providers
• Prior to removal, a provider should describe for the client
that removing implants usually takes somewhat longer than
insertion. Providers should also reassure clients that
complications related to implant removal are rare.
• The simplified description, from the Global Handbook page
shown on the slide, is designed to explain the removal
procedure to clients. <participants take turns reading the
steps aloud>
o The provider uses proper infection prevention
procedures.
o The woman receives an injection of local anesthetic
under the skin of her arm to prevent pain during implant
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Training Process
o
o
o
o
o
o
Resources
removal. This injection may sting. She stays fully awake
throughout the procedure.
The health care provider makes a small incision in the
skin on the inside of the upper arm, near the site of
insertion.
The provider uses an instrument to pull out each implant.
A woman may feel tugging, slight pain, or soreness
during the procedure and for a few days after.
The provider closes the incision with an adhesive
bandage. Stitches are not needed. An elastic bandage
may be placed over the adhesive bandage to apply gentle
pressure for two or three days and reduce swelling.
If a woman wants to continue using implants, a new set
of implants may be inserted through the same incision,
either in the same or in the opposite direction.
Providers must not refuse or delay when a woman asks
to have her implants removed, regardless of the reason.
All staff must understand and agree that clients must not
be pressured or forced to continue using implants.
Infection Prevention
Discussion (10 min.)
• Inserting and removing progestin-only implants are minor
surgical procedures, and it is important that providers follow
careful infection prevention procedures with every client.
o Use slide 17 to describe infection prevention procedures
prior to implant insertion or removal.
o Use slide 18 to describe infection prevention procedures
after implant insertion or removal.
• Ask participants to brainstorm: “What steps should you
take to prevent infection prior to, during, and after the
insertion or removal procedure?” <participants brainstorm;
accept responses from several participants; click the mouse
to reveal the information on the slide>
Slide 17: Infection
Prevention: Prior to
Implant Insertion or
Removal
Slide 18: Infection
Prevention: After
Implant Insertion or
Removal
Handout #12:
Checklist: Providing
Implants, With
Appropriate Infection
Prevention Practices
• Distribute to each participant a copy of the Handout #12:
Checklist: Providing Implants with Appropriate Infection
Prevention Practices; review each step on page 5 of the
checklist.
Implants: Summary
Lecturette (5 min)
Slide 19: Implants:
Summary
• Summarize the important points about implants.
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Role Plays
(30 min.)
Handout #13:
Facilitating Role
Plays
• Follow the step-by-step instructions in the
Facilitator’s Guide section on facilitating role plays to
prepare for and conduct this activity.
Handout #14:
Role Play Scenarios
1. Discuss the learning objective of the role play activity.
2. Review the instructions for the client, provider, and
observer roles and the other learning resources
developed for the activity.
3. View a demonstration role play and clarify any
questions.
4. Conduct role plays in small groups based on the
scenarios provided and discuss reactions.
5. Discuss the activity as a large group.
• Review Handouts #9 and #10 with participants. These
include:
1. Five different role play scenarios, each with a client
information sheet and observer information sheet.
2.
The instruction sheet that describes the roles of
providers, clients, and observers.
3. The Role Play Observation Checklist for Clinicians.
4. Role play scenario/information sheets for clients and
observers for the role plays you have selected or adapted
from Handout #14: Role Play Scenarios.
• Use the following questions to help the small groups
structure the feedback that they provide to each other after
each role play.
o What was going on between the provider and client?
o What did the provider do that was effective in this
situation?
o What might the provider consider doing differently if this
situation were to happen again?
o How did the provider attend to the items on the
counseling observation checklist and the case-specific
observations included in the role play description?
• After the small groups conduct each role play, encourage the
groups to talk about what happened during the role play
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from the perspective of the provider (self-assessment), the
client (personal satisfaction with the interaction), and the
observer (objective assessment using the Role Play
Observation Checklist included in Handout #14, including
the case-specific observations included in the role play
description).
• Prepare a flip chart to display these discussion questions
where the questions can easily be seen by all the participants
in the small groups.
Case Studies
(45 min.)
• Divide Participants into 4 groups.
• Distribute Handout #15 and #16. Give 2 groups Case Study
Handout #15:
Using Case Studies
Handout #16:
Case Study #1 and #2
#1 and #2. Ask each group to review the case studies and
answer the questions.
• Allow each group 25 minutes to prepare their answers and
five minutes to present their answers to the rest of the group.
The Implants Game Show (Optional)
(1 hour)
• Become familiar with how to run the game before presenting
it to the participants. Review and print the answer key to the
game questions.
• Introduce the rules for the game show. Explain that the
purpose of the game show is to provide a fun, light-hearted
review of implants.
o Each team will take turns picking a category and the
level of difficulty of the question. Show the game board,
Slide 2 in the Optional PowerPoint Slide Set: Implants
Game Show, to help with your explanation. Example:
Under the category “Characteristics” there are five
choices ranging in point value from 100 to 500. If your
team picks the 100-point value, you will get a simple
question on a characteristic of implants. If you answer
the question correctly, your team will earn 100 points. If
your team selects a 500-point question, it will be more
difficult. But if you answer correctly, your team will earn
500 points.
o Explain that each team will have 15 seconds to discuss
their response before the game show host (facilitator)
calls time and they must provide an answer.
o If a team answers correctly, the points are awarded. If
the team answers incorrectly, another team gets a chance
to answer the question. To make the game more
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Optional PowerPoint
Slide Set: Implants
Game Show
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interesting and challenging, remove the points when a
team answers a question incorrectly.
• Before starting the game, ask if there are any questions
and provide clarity as needed.
• When a team selects a category and amount, click the
corresponding square on the screen to reveal the
question.
• If a team answers correctly, click the green circle at the
bottom of the screen. The presentation provides positive
feedback and automatically returns to slide 2 to allow
selection of the next category and amount. Notice that
after a category and amount is selected, it is no longer
highlighted as an option.
• If a team answers incorrectly, click the red circle at the
bottom of the screen. The presentation provides negative
feedback and stays on the question to allow another team
to answer.
• If no team answers the question correctly, click the blue
circle, which provides no audible feedback but returns to
slide 2 to allow selection of the next category and
amount.
• Play the game as long as the group has energy or set a
time limit before the start of the game.
• Divide participants into teams of four or five. To
enhance the competition, place participants into groups
from different sectors, regions, facilities, age groups, or
other commonalities.
• Project slides 1 and 2 from the game show presentation
and describe the categories of questions included in the
game.
• Keep score during the game. Clarify questions as needed
and remind participants of key concepts associated with
the questions and answers.
• Keep it quick and fun. Remember that the goal is to
review the session material. Do not feel obliged to
complete the entire game. Continue to play only as long
as the participants’ excitement and energy permit.
• Offer a prize to the winning team.
Post-Test and Course Evaluation (30 min.)
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Evaluation Tool:
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Implants Post-test,
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Training Process
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Applied Learning
Case Studies, and
Course Evaluation
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Session IV: Practicing Insertion and Removal SingleRod Implant
Session Objective: To demonstrate insertion and removal
procedures for single-rod implants.
*Note to trainer: There are slide sets for both single-rod (Session
IV A and IV B) and double-rod implants (Sessions V A and V B).
Choose the appropriate slide set for your program. This presentation
is focused solely on the mechanics of the clinical procedure; refer to
the basic presentation slide sets for guidance about counseling users
and other implant-related issues. A multimedia training guide is
available from:
http://hcp.organon.com/start/implanontrainingV3.asp
One-Rod Implant Insertion: Required Equipment
Lecturette (10 min)
• Implanon is the only one-rod system currently on the
market. Similar to two-rod implants, Implanon is inserted
sub-dermally.
Slide Set:
Session IV A
Slide 2: One-Rod
Implant Insertion:
Required Equipment
Slide 3: Implanon
• The basis for the successful use and subsequent removal of a Applicator
one-rod implant is a correct and carefully performed subdermal insertion. The provider should give special attention
to aseptic technique and careful surgical technique to
minimize tissue trauma and to keep the implant from being
inserted too deeply, thus becoming more difficult to remove.
• Providers with little experience in sub-dermal insertion
should acquire the correct technique under the supervision of
an experienced colleague.
• Use the illustration and the information on Slide 2 to
describe the equipment required for the insertion procedure.
• Use the illustration on Slide 3 and the information below to
describe individual components of the applicator and clarify
their specific functions.
• Explain that insertion of Implanon is performed with the
specially designed applicator (see Slide 3).
• The Implanon insertion procedure is opposite to giving an
injection. When inserting Implanon, the obturator must
remain fixed while the cannula (needle) is retracted from the
arm. For injections, the plunger is pushed and the body of
the syringe remains fixed.
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Steps in Implanon Insertion
Lecturette (30 min.)
Slides 4-16:
Implanon Insertion
Steps 1-13
• Use the illustrations and the information on the slides to
describe each step in the insertion procedure.
• Use Slide 5 to:
o Explain that the insertion of Implanon is performed with
the specially designed applicator. The Implanon insertion
procedure is opposite to giving an injection. When
inserting Implanon, the obturator must remain fixed
while the cannula (needle) is retracted from the arm. For
injections, the plunger is pushed and the body of the
syringe remains fixed.
• Use Slide 8 to:
o Remind providers that the implant can fall out of the
needle prior to insertion. Instruct them to always hold the
applicator with the needle pointed upwards, until the
time of insertion. This will prevent the implant from
dropping out. The needle and the implant must be kept
sterile. If contamination occurs, a new package with a
new sterile applicator must be used.
• Use Slide 12 to:
o Instruct providers to make sure that they do not insert the
implant too deeply. Remind them that if the implant is
placed too deeply, paresthesia (due to neural damage)
and migration of the implant (due to insertion on the
fascia or in the muscle) may occur. Improper insertions
have been associated with rare cases of intravascular
insertion. Moreover, the implant may not be palpable,
and localization or removal can be difficult later.
• Use Slide 16 to instruct providers how to:
o Make sure that they always verify the presence of the
implant by palpation and also have the woman palpate it
herself.
o Apply a sterile gauze with a pressure bandage to prevent
bruising.
o Complete the user card and give it to the client. Explain
that the user card records the batch number of the
implant, the date of insertion, the arm of insertion, and
the intended day of removal.
o Review the post-insertion instructions and key messages
for implant users, and address any final questions that
the client may have. (See basic presentation slide sets
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for details).
o Dispose of the applicator and syringe properly. The
applicator is for single use only and must be disposed of
in a sharps container in accordance with local regulations
for the handling of biohazardous waste.
*Note to trainer: Because Implanon is the only one-rod system
currently on the market, these instructions are specific to Implanon.
This presentation is focused solely on the mechanics of the clinical
procedure; refer to the basic presentation slide sets for guidance
about counseling users and other implant-related issues.
Steps in Implanon Removal
Lecturette (10 min.)
• Slide 2:
Slide Set:
Session IV B
Slides 2-10: Implanon
Removal Steps 1-7
o Use the illustration and the information on the slide to
describe the equipment required for the removal
procedure.
o The removal of Implanon should only be performed by a
provider who is trained to perform the removal
procedure.
o There have been occasional reports of displacement of
the implant, usually involving minor movement from the
original position. This may complicate localization of the
implant and may require a somewhat larger incision and
more time. The precise location of the implant is
specified on the user card given to the woman at the time
of insertion.
o In the rare cases where Implanon has not been inserted
correctly, the implant might not be palpable. If this
occurs, there are other localization techniques that may
be performed. If the implant is not palpable, it may be
appropriate to seek consultation or provide a referral. If a
woman wishes to avoid pregnancy, she may have
another implant inserted―if she is eligible―or choose
another method of contraception.
o A multimedia training guide is available from:
http://hcp.organon.com/start/implanontrainingV3.asp.
• Use Slide 3 to advise providers that:
o If they cannot feel the implant, it should be localized by
ultrasound before removal is attempted. Implanon can
also be located by magnetic resonance imaging (MRI),
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however it is not readily available in most countries.
o If there is suspicion that the implant was expelled
without client noticing, the presence of Implanon can be
verified by measuring the etonogestrel level in a blood
sample from the woman.
o Surgery without knowledge of the exact localization of
the implant is strictly discouraged. Removal of deeply
inserted implants should be conducted with caution in
order to prevent damage to deeper neural or vascular
structures in the arm.
• Slide 10:
o Use the information on the slide to clarify options for
clients who decide to continue or discontinue the
method.
o Remind providers to inform their clients that following
removal, the contraceptive effects reverse quickly and a
woman can become pregnant at a rate similar to women
who have not used the method.
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Session V: Practicing Insertion and Removal DoubleRod Implant
Session Objective: To demonstrate insertion and removal
procedures for double-rod implants.
Two-Rod Implant Insertion Steps
Lecturette/Discussion (30 min.)
• Use the illustration and the information on each slide to
Slide Set Session V A
Slides 2-18
describe each step.
• Two-Rod Implant Insertion: Required Equipment
(Slide 2)
o Use the illustration and the information on the slide to
describe the equipment required for the insertion
procedure.
• Two-Rod Implant Insertion: Trocar (Slide 3)
o In 2010 USAID released an announcement1 that Jadelle,
which is a commodity offered through USAID’s
procurement system, is now provided with a sterile,
single-use, disposable trocar.
• Two-rod implant insertion steps:
o Step 1: Highlight that the optimal insertion area is in the
inner surface of the upper arm about 8 to 10 cm above
the elbow joint groove. (Slide 4)
o Step 4: Use the insertion card, pictured on the slide, to
explain how the anesthetized areas map to the final
placement of the implants. (Slide 7)
o Step 5: Mention that many providers prefer to insert the
trocar directly through the skin without making an
incision with the scalpel. The bevel of the trocar should
always face up during the insertion. (Slide 8)
o Step 6: Remind providers that the trocar should not be
forced. If they encounter resistance, they should try
another direction. (Slide 9)
o Step 14: Remind providers that suturing the incision is
not necessary. (Slide 17)
o Step 15: (Slide 18) Instruct providers how to:
 Apply a sterile gauze with a pressure bandage to

prevent bruising.
Complete the user card and explain to the client the
information that is included on the card (e.g., batch
number of the implant, the date of insertion, the arm
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of insertion, and the intended day of removal).
 Review the post-insertion instructions and key

messages for implant users, and address any final
questions that the client may have. (See basic
presentation slide sets for details).
Dispose of the trocar and syringe properly. The
trocar is for single use only and must be disposed of
in a sharps container in accordance with local
regulations for the handling of biohazardous waste.
Two-Rod Implant Removal
Lecturette/Discussion (15 min.)
• Use the illustrations and the information on each slide to
Slide Set Session V B
Slides 2-10
describe each step in the removal procedure.
• Step 1 (Slide 3): Advise providers that:
o If the implants cannot be felt, they may be located by
ultrasound or X-ray.
o Surgery without knowledge of the exact localization of
the implant is strictly discouraged. Removal of deeply
inserted implants should be conducted with caution in
order to prevent damage to deeper neural or vascular
structures in the arm.
• Step 2 (Slide 4): Advise providers that:
o Anesthetic injected over the implants will obscure them
and make removal more difficult.
o Additional small amounts of the anesthetic can be used
for removal of the second implant, if required.
• Post-removal Options (Slide 10):
o Remind providers to inform their clients that following
removal, the contraceptive effects reverse quickly and a
woman can become pregnant at a rate similar to women
who have not used the method.
Session VI: Infection Prevention
Session Objective: To demonstrate infection prevention
procedures for implant insertion and removal.
Session VI Infection Prevention
Lecturette (30 min.)
Slide Set Session VI
Slides 2-6
• Although insertion and removal of implants are minor
surgical procedures, careful infection prevention procedures
must be followed with every client.
• Infection prevention during insertion and removal involves
aseptic technique (performing the procedures under sterile
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conditions).
• Proper infection prevention procedures minimize the
chances of blood-borne infections such as HIV and hepatitis
B and of infections at the insertion site.
• Infection at the insertion site may require early removal or
cause spontaneous expulsion of implants.
• Generally, sterilization is required for instruments such as
scalpels and needles that touch tissue beneath the skin. If
sterilization is not possible or practical, instruments must be
high-level disinfected (HLD).
• Preparing for insertion (Slide 2):
o Although insertion and removal of implants are minor
surgical procedures, careful infection prevention
procedures must be followed with every client. Infection
prevention during insertion and removal involves aseptic
technique (performing the procedures under sterile
conditions).
o Proper infection prevention procedures minimize the
chances of blood-borne infections such as HIV and
hepatitis B and of infections at the insertion site.
Infection at the insertion site may require early removal
or cause spontaneous expulsion of implants.
o Generally, sterilization is required for instruments such
as scalpels and needles. Have the client wash her entire
arm and hand (the one she uses less often) with soap and
water, and dry with clean towel or air-dry.
o Cover the procedure table and arm support with a clean
cloth. Ask the client to lie on her back on the table so
that the arm in which the implants will be placed is
turned outwards and bent at the elbow and is well
supported.
o Prepare a clean instrument tray and open the sterile
instrument pack without touching the instruments or
other items.
o For Jadelle and Sino-Implant (II), carefully open the
sterile pouch containing the implants by pulling apart the
sheets of the pouch and, without touching the rods,
allowing them to fall into a sterile cup or bowl.
o For Implanon, remove the sterile applicator with the
preloaded implant from the package by allowing it to fall
on the sterile tray without touching it.
• Before insertion (Slide 3):
o Wash hands thoroughly with antiseptic soap and water
and dry with clean towel or air-dry.
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o Put sterile or high-level disinfected gloves on both hands
before each procedure.
o Clean the insertion site with a cotton or gauze swab
soaked in antiseptic solution and held in a sterile or highlevel disinfected forceps.
o Use sterile surgical drape with a hole in it to cover the
arm. The hole should be large enough to expose the
entire area where the implants will lie once they are
inserted. (If sterile drape is not available, use a clean
drape or linen that has been washed, dried, ironed, and
stored in a clean closet.)
o When giving local anesthetic, use a new disposable
syringe and needle, from a sealed package, if available.
An autodisable syringe is preferable.
• During Insertion, Jadelle and Sino-Plant (Slide 4):
Jadelle and Sino-Implant (II):
o To minimize risk of infection and/or expulsion, make
sure that the ends of the rods nearest to the incision are
not too close (not less than 5 mm) to the incision. If the
tip of the rod protrudes from or is too close to the
incision, it should be carefully removed and reinserted in
the proper position. Also, to enable easy removal of both
rods from a single incision, it is important that the ends
of the rods closest to the incision are not farther apart,
one from the next, than the width (not length) of one
implant.
o While inserting the implants, try not to remove the trocar
from the incision. Keeping the trocar in place minimizes
tissue trauma, decreases the chances of infection, and
minimizes insertion time.
• During Insertion Implanon (Slide 5):
o After confirming that the rod is in the applicator, remove
the needle shield. Without the needle shield, the implant
can fall out, so keep the applicator in the upright position
until the moment of insertion. If it falls out or if
contamination otherwise occurs, use a new package with
a new sterile applicator.
• After Insertion (Slide 6):
o Press down on the incision with gauze for a minute or so
to stop any bleeding, and then clean the area around the
insertion site with antiseptic solution on a swab.
o Use an adhesive bandage or surgical tape with sterile
cotton to cover the insertion site. Check for any bleeding.
Cover with a dry compress and wrap gauze around arm
tight enough to provide some compression to minimize
Training Resource Package for Family Planning
Contraceptive Implants Module
Facilitator’s Guide
Page 48 of 49
Last revised: 24 September 2012
o
o
o
o
o
o
o
o
o
o
o
o
bleeding under the skin (hematoma), but not so tight that
it will cause pain and paleness in the arm.
Dispose of the single-use applicator (for Implanon) and
used disposable syringes and needles in a punctureresistant container.
Immediately after inserting or removing the implants,
decontaminate the trocar, scalpel, syringe and needle,
and any other nondisposable instruments by soaking
them in a 0.5% chlorine solution for 10 minutes.
Decontamination makes them safer for final processing
of the instruments (described below).
Dispose of contaminated objects (gauze, cotton, and
other waste items) in a properly marked leak-proof
container with a tight-fitting lid or in a plastic bag.
If disposable gloves were used, carefully remove gloves
by inverting and place in the waste container.
If reusable gloves were used, immerse both gloved hands
briefly in the chlorine solution to decontaminate the
outside, and then remove the gloves by inverting.
Clean instruments and gloves after they have soaked in
the chlorine solution for 10 minutes (as described
above).
Wash instruments with a brush, using water and either
liquid soap or detergent. Avoid bar soap or powdered
soap, which can stay on the equipment.
Rinse and dry the equipment. While cleaning, wear
utility gloves and an apron.
Sterilize instruments and gloves in a high-pressure steam
autoclave or a dry-heat oven or with
chemicals. If sterilization is not possible or practical,
high-level disinfect them by boiling, by steaming, or
with chemicals.
Decontaminate all surfaces that could have been
contaminated by blood, such as the procedure table or
instrument stand, by wiping them down with 0.5%
chlorine solution.
Wash hands with soap and water and dry with clean
towel or air-dry.
Source: Upadhyay, U.D. and Ramchandran, D., “Implants: Tools for Providers,”
INFO Reports, No. 15, Baltimore, Johns Hopkins Bloomberg School of Public
Health, The INFP Project, October 2007
Training Resource Package for Family Planning
Contraceptive Implants Module
Facilitator’s Guide
Page 49 of 49