8.4 Fertility Regulation (Contraception)

Part II: Guidelines for Client Services and Clinic Management

All FDA approved methods of contraception must be available to family planning clients on site or by formal referral. All reversible contraceptives must be FDA approved, except for fertility awareness methods and abstinence. Written protocols and procedures must be in place for all reversible contraceptive methods. Current FDA guidelines regarding method contraindications should be followed when prescribing contraceptives.

For all methods of contraception, appropriate client education must be provided and should be client focused. The goals of client education are to ensure the consistency and accuracy of information provided, to present information in an unbiased manner and to present education that is appropriate to the client's age, level of knowledge, language, and socio-cultural background.

More than one method of contraception may be used simultaneously by a client and may be particularly indicated to minimize the risks of STD, HIV and pregnancy. Consistent and correct use of condoms should be encouraged for all persons at risk for STDs and HIV.

Reversible Contraception:

Delegate agencies must offer the following currently available reversible methods of contraception to clients enrolled in the family planning program:

  • Abstinence
  • Hormonal Methods:
    • Oral Contraceptives
    • Implant
    • Injectables
    • Transdermal contraceptive patch
    • Vaginal Contraceptive Ring
    • Emergency Contraception
  • Intrauterine Device/System (IUD/IUS)
  • Barrier Methods (female and male condoms, cervical cap, sponge, diaphragms, spermicides)
  • Fertility Awareness Methods

Emergency Contraception (EC):

To maximize the reduction of unintended pregnancies, delegate agencies' protocols are required to include the on site provision of emergency contraception. The protocol must comply with the FDA recommendations for the administration of drugs or devices for emergency contraception.

EC is more effective the sooner it is taken and the FDA recommended window is within 72 hours of intercourse. Recent studies indicate effectiveness up to 120 hours. EC acts by delaying or inhibiting ovulation and/or altering tubal transport of sperm and/or altering the uterine lining thereby inhibiting implantation. These mechanisms are basically the same as occur with the routine use of standard oral contraceptives.

Emergency contraception should not be confused with abortion. EC pills are not effective if the woman is pregnant. Family Planning Programs are prohibited from providing abortions using Title X funds.

Appointments, physical exams, and routine pregnancy testing can be barriers to effective provision of EC. A pregnancy test may be indicated in some instances by the client's history. Thorough birth control counseling must accompany or follow use of emergency contraception to discourage clients from considering this a routine method of contraception. Refer to Appendix I for IDHS EC Client Information Fact Sheet on Emergency Contraceptive Pills.

Non-Reversible Contraception-Sterilization:

The consent and counseling process for sterilization must assure that clients making the decision to undergo sterilization do so completely voluntarily and that the decision is made with the full knowledge of the permanence, risks, and benefits associated with female and male sterilization procedures.

All Federal regulations for sterilization must be met if the procedures are performed or arranged by the delegate, including the following:

  • The individual must be at least 21 years of age;
  • The individual is mentally competent;
  • The individual has voluntarily given informed consent in accordance with the procedures of 50.201, Subpart B, 42 CFR Sterilization of Persons in Federally Assisted Family Planning Projects; and
  • At least 30 days, but not more than 180 days, have passed between the date of informed consent and the date of the sterilization, except in the case of premature delivery or emergency abdominal surgery. Consent to be sterilized at the time of premature delivery or emergency abdominal surgery may be given if at least 72 hours have passed after the informed consent is obtained. In the case of premature delivery, the informed consent must have been given at least 30 days before the expected date of delivery.

Refer to Appendix K for the Illinois Sterilization Program Procedures and the required payment forms.

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