Combined Oral Contraceptive Pills (COCs)

1. Combined OralContraceptive Pills(COCs) Session II: Who Can and Cannot Use COCs?

2. COCs Are Safe for Nearly All Women • Almost all women can use COCs safely, including women who: • Have or have not had children • Are not married • Are of any age • Smoke (if under age 35) • Have anemia now or had it in the past • Have varicose veins • Have an STI or HIV/AIDS • Most health conditions do not affect safe and effective use of COCs

3. Who Can and Cannot Use COCs Most women can safely use the pill. But usually cannot use the pill if: • High blood pressure • Smoke cigarettes AND age 35 or older • Gave birth in the last 3 weeks • Breastfeeding 6 months or less • May be pregnant • Some other serious health conditions

4. Who Should Not Use COCs (part 1) My period is late… Breast feeding a baby less than 6 months old Breast feeding a baby less than 6 months old Think they may be pregnant Are pregnant Are pregnant Think they may be pregnant Smoke and are age 35 or older Have or had breast cancer Had a heart attack or stroke Had blood clots in legs or lungs Had blood clots in legs or lungs Had a heart attack or stroke Source: WHO, 2010.

5. Who Should Not Use COCs (part 2) I cannot eat sweets. Take pills for TB, seizures (fits), or HIV Gave birth in last 6 weeks Breast feeding a baby less than 6 months old Have bad headaches with nausea or vision problems Think they may be pregnant Have serious liver disease or gall bladder disease Have high blood pressure Had a heart attack or stroke Have diabetes (high sugar in blood) Have rheumatic disease, such as lupus Had blood clots in legs or lungs Source: WHO, 2010. Source: WHO, 2010; Chu, 2005.

6. Medical Eligibility Criteria What are medical eligibility criteria? Define the categories. Review the job aid.

7. WHO’s Medical Eligibility Criteria Categories for IUDs, Hormonal and Barrier Methods Source: WHO, 2010.

8. WHO’s Medical Eligibility Criteria Categories for IUDs, Hormonal and Barrier Methods WHO’s Medical Eligibility Criteria Categories for IUDs, Hormonal and Barrier Methods Source: WHO, 2010.

9. Category 1 and 2 Examples (not inclusive):Who Can Use COCs Source: WHO, 2010.

10. Category 3 Examples (not inclusive):Who Should Generally Not Use COCs Source: WHO, 2010.

11. Category 4 Examples (not inclusive):Who Should Not Use COCs Source: WHO, 2010; Sekar, 2008.

12. COC Use by Women with HIV • Women with HIV or AIDS can use without restrictions • Women on ARVs can use COCs safely • Should not be used by women who take medications for seizures or rifampacin or rifabutin for tuberculosis (may reduce effectiveness of COCs). • Using low-dose COCs is appropriate • Condom use should be encouraged in addition to COCs Source: WHO, 2010; Sekar, 2008.

13. COC Use by Postpartum Women • Non-breastfeeding women should not initiate COCs before 3 weeks postpartum (3-6 weeks postpartum with VTE risk factors) • Breastfeeding women • Should not use COCs before 6 weeks postpartum • Should not use COCs from 6 weeks to 6 months postpartum unless no other method is available • Can generally initiate COCs at 6 months postpartum Source: WHO, 2010.

14. Group ActivityUnderstanding the Checklist Read questions 1–12 in the checklist. How have you determined medical eligibility in the past? This set of questions identifies women who should not use COCs. This set of questions identifies women who are not pregnant. The checklist also gives instructions about initiating COCs.