The document discusses guidelines for who can and cannot use contraceptive implants. It states that implants are safe and appropriate for nearly all women, including adolescents, women living with HIV/AIDS, and women who have had abortions or miscarriages. However, some women should not use implants, such as those who are pregnant or breastfeeding within the first 6 weeks after giving birth, or who have certain medical conditions like blood clots, breast cancer, or serious liver disease. The document reviews the WHO medical eligibility criteria for contraceptive methods and provides guidance on when implants can be initiated for different groups of women.

1. Session 2, Slide 1
Contraceptive Implants
Session 2:
Who Can and Who Cannot Use
Implant
s

2. Session 2, Slide 2
Characteristics of Implants
Why might these women be interested in using
implants?
• Breastfeeding mother
• Adolescent
• Infected with HIV
• Has little to no access to a health care facility
• Desires no more children

3. Session 2, Slide 3
Implants Are Safe for Nearly All
Women
– Have just had an abortion,
miscarriage or ectopic pregnancy
– Are breastfeeding (starting as
soon as 6 weeks after childbirth,
WHO/MEC)
– Have anemia now or in the past
– Have varicose veins
• Almost all women can use implants safely, including
women who:
– Have or have not had children
– Are not married
– Are of any age including
adolescents and women over
40 years old
– Are infected with HIV
• Most health conditions do not affect safe and effective use of
implants.
• Many women who cannot use methods that contain estrogen
can safely use implants.

4. Session 2, Slide 4
But usually cannot use
implants if:
Most women can safely
use implants
Breastfeeding
6 weeks or
less/WHO MEC
May be pregnant Some other serious
health conditions
Who Can and Who Cannot Use Implants
(part 1)

5. Session 2, Slide 5
Who Can and Cannot Use Implants
(part 2)
Most women can safely use implants. But usually cannot
use implants if:
Breastfeeding 6
weeks or less
• Ask her to come back when baby is 6 weeks old.
Urge her to keep breastfeeding. (Based on WHO MEC
categorization)
May be pregnant • If in doubt, use pregnancy checklist or perform pregnancy
test.
Some other
serious health
conditions
• Has blood clot in lungs or deep in legs.
• Women with superficial clots (including varicose veins)
CAN use implants.
• Ever had breast cancer.
• Unexplained vaginal bleeding. If the bleeding suggests a
serious condition, help her choose a method without
hormones to use until unusual bleeding is assessed.
• Serious liver disease or jaundice (yellow skin or eyes).
• Takes pills for tuberculosis (TB), fungal infections, or
seizures (fits).

6. Session 2, Slide 6
Medical Eligibility Criteria
What are medical
eligibility criteria?
Define the
categories.
Review the
job aid.

7. Session 2, Slide 7
WHO’s Medical Eligibility Criteria
Categories for IUDs, Hormonal and Barrier Methods
Source: WHO, 2010.
Category Description With clinical judgment
1 No restriction for use
Use the method under any
circumstances
2
Benefits generally outweigh
risks
Generally use the method
3
Risks usually outweigh
benefits
Use of method not usually
recommended, unless other
methods are not
available/acceptable
4 Unacceptable health risk Method not to be used

8. Session 2, Slide 8
WHO’s Medical Eligibility Criteria
Categories for IUDs, Hormonal and Barrier Methods
Source: WHO, 2010.
Category
When clinical judgment
is limited
1
Use the method
2
3
Do not use the method
4

9. Session 2, Slide 9
Category 1 and 2 Examples (not inclusive):
Who Can Start Implants
WHO Category Conditions (selected examples)
Category 1
Adolescents, post-abortion, postpartum in
non-breastfeeding women, heavy smokers,
women being treated for high blood
pressure, valvular heart disease,
endometriosis, endometrial or ovarian
cancer, thyroid disorders
Category 2
Blood pressure ≥160/100, history of blood
clots in legs or lungs, diabetes with vascular
complications, heavy or prolonged vaginal
bleeding patterns, multiple risk factors for
cardiovascular disease
Implants are safe for nearly all women.
Source: WHO, 2010.

10. Session 2, Slide 10
Category 3 and 4
Who Should Not Start Implants
A small number of women may not be able to use implants.
WHO Category Conditions (selected examples)
Category 3
Acute blood clots in deep veins of legs or lungs,
unexplained vaginal bleeding, history of breast
cancer, severe liver disease, infection or tumors,
and certain cases of systemic lupus.
Breastfeeding before 6 weeks postpartum.
Continuation only: ischemic heart disease,
stroke, migraine with aura.
Category 4 Current breast cancer
Source: WHO, 2010.

11. Session 2, Slide 11
Implant Use by Women with HIV
• Women with HIV or AIDS
can use without
restrictions
• Some ARV drugs reduce
blood progestin level
• Efficacy is not affected
because implants provide
consistent dose of
hormone over time
• Dual method use should
be encouraged
Source: WHO, 2010; Mildvan, 2002.
WHO Eligibility Criteria
Condition Category
HIV-infected 1
AIDS 1
ARV therapy 2

12. Session 2, Slide 12
Implant Use by Postpartum Women
• Non-breastfeeding women
can initiate immediately
postpartum
• Breastfeeding women
– Before 6 weeks
postpartum (WHO/MEC)
– No restrictions after
6 weeks postpartum
Source: WHO, 2010.
WHO Eligibility Criteria
Condition Category
Non-
breastfeeding
1
Breastfeeding
<6 weeks
3
Breastfeeding
≥6 weeks
1

13. Session 2, Slide 13
Understanding the Implant Checklist
Read questions
1–6 in the
checklist and
match them with
the conditions
and categories on
the MEC quick
reference chart.
This set of
questions
identifies
women
who
should not
use
implants.
This set of
questions
identifies
women
who are
not
pregnant.The checklist also
gives instructions
about initiating
implants.

14. Session 2, Slide 14
When to Start Implants (part 1)
• Anytime a provider is reasonably certain a woman is not
pregnant.
• Pregnancy can be ruled out if any of these situations apply:
– Is fully breastfeeding, has no menses, and baby is between 6 weeks and 6
months old
– Abstained from intercourse since last menses or delivery
– Had a baby in the past 4 weeks (if not breastfeeding)
– Started monthly bleeding within the past 7 days (5 days for Nexplanon)
– Had a miscarriage or abortion in the past 7 days (5 days for Nexplanon)
– Is using a reliable contraceptive method consistently and correctly
• If none of the above apply, pregnancy can be ruled out by
pregnancy test, pelvic exam, or by waiting till next menses.
Source: WHO, 2004 (updated 2008).

15. Session 2, Slide 15
When to Start Implants (part 2)
• First 5 days of menstrual cycle no backup method
needed.
• After 5th day of menstrual cycle rule out pregnancy
and use backup method for 7 days.
• Postpartum
– Not breastfeeding: immediately (no need to rule out
pregnancy until 4 weeks postpartum)
– Breastfeeding: delay 6 weeks (WHO/MEC)
Source: WHO, 2004 (updated 2008).

16. Session 2, Slide 16
When to Start Implants (part 3)
• Post abortion or miscarriage: immediately; without
backup
• Switching from a hormonal method: immediately if it
was used consistently and correctly
– Injectable users can have implants inserted within the
reinjection window; without backup
• After using emergency contraceptive pills:
– Insert within 5 days after start of next menstrual
period .provide with backup method during
Intermenstural periods if not pregnant.
Source: WHO, 2004 (updated 2008).