|POST for birth control and other women’s health care
|1. Avoid skin-piercing procedures
||(a) Consider birth control methods that involve little or no risk from reused instruments, such as condoms and oral hormone pills. (b) Avoid Depo-Provera injections for birth control. (c) Avoid implants for birth control (thin tubes put in your arm that dispense hormones for several years). Inserting the implant is an avoidable skin-piercing procedure. (d) If you are not 100% sure that instruments will be sterile, don’t have a tubal ligation (an operation to close the tubes that carry eggs from your ovaries to your uterus).
|2. Use new disposable instruments
||(a) Your provider can insert an intrauterine device (IUD) using only disposable instruments, including a disposable plastic tube to slip the IUD into your uterus, new gloves, disposable specula, etc. (b) If your provider injects local anaesthetic for a procedure – such as a tubal ligation, inserting an IUD, or abortion – ask him or her to take the anaesthetic from a single-dose vial (or new multi-dose vial opened for you), and to use a new disposable syringe and needle (see Injection section). (c) For inserting an IUD, or for a vaginal exam, use a new disposable speculum, or bring your own. (d) For any procedure that involves a provider putting fingers into your vagina, insist that the provider wears new disposable gloves.
|3. You sterilize the instruments
||If you cannot buy a disposable speculum for every vaginal exam (or if you are in a situation where you need frequent vaginal exams), you can buy a metal speculum, which you keep and sterilize at home, and bring for your provider to use.
|4. Ask providers how they sterilize instruments
||(a) During tubal ligations, doctors insert a flexible tube through a small cut in your stomach. Because boiling would hurt this tube, it is cleaned by soaking or misting with special chemicals (this process is called “high level chemical disinfection”). Ask to see where and how this is done, and ask if the tube to be used on you has been treated after the previous patient.(b) If you are having an abortion, ask the provider to autoclave uterine curettes and other instruments.
Additional information about women’s health care
Dangers with hormone injections: Many women in Africa get an injection of Depo-Provera every three months for birth control. This is especially common in countries with the worst HIV epidemics in Southern and Eastern Africa. In the latest available surveys, from 18%-30% of married women of reproductive age in eSwatini (Swaziland), Kenya, Lesotho, Malawi, Namibia, South Africa, Uganda, and Zambia used injected hormones for birth control.[i] Click here for more information on risks and controversies around hormone injections.
Vaginal exams: Vaginal exams are done on an outpatient basis to diagnose many diseases. Sometimes a speculum is used to examine the cervix. Reused metal specula should be sterilized in autoclaves or boiled. Surveys of health facilities in Kenya, Rwanda, and Tanzania during 2004-07 reported that only 1%-32% of specula used in vaginal exams were sterilized (see Service Provision Assessment Surveys). In surveys during 2001-04, sterile gloves were available in only 48%-67% of facilities offering maternal and child healthcare in Ghana, Kenya, and Rwanda (see Service Provision Assessment Surveys) . Healthcare staff who use gloves to protect themselves may not sterilize or discard them between patients.
During vaginal exams, reused and unsterilized specula and plastic gloves as well as unwashed hands may transfer infections from one woman to others. For example, laboratory experiments have shown that herpes simplex virus (HSV) survives on plastic surfaces for several hours.[ii] [iii] The risk to transmit HIV transmission through vaginal exams is probably low because HIV infects relatively inefficiently through vaginal mucosa (skin).
Abortions: Although induced abortions are illegal across most of Africa, they are common. WHO estimated 4.2 million abortions annually (14 per 100 live births) in Africa around the year 2000, and 7.2 million annually (18 per 100 live births) in south-central Asia.[iv]
At the clinic you visit, how many women are HIV-positive? Risk to get HIV during family planning and other women’s heath care depend on how many women in the clinic have HIV. In Southern Africa, you should estimate that 1 or 2 among the 5 women treated before you had HIV infections. In Eastern Africa, you can estimate that 1 or 2 among the 10 women before you have HIV.
Risk to get HIV from birth control injections and other women’s health care
If your provider reuses the syringe and/or needle from an HIV-positive woman without any effort to clean, and takes hormones from an opened multi-dose vial, your risk to get HIV from each injection may be estimated at 3%-10% (see Table on Estimated risks in the Blood-borne Risks section). If the provider uses a new syringe and needle and takes hormones from a single-dose vial (or uses a pre-filled syringe) you have no risk to get HIV from the injection, but the progestogen in Depo-Provera could increase your risk to get an infection if/when you are exposed to HIV.
For procedures that involve more instruments and blood, such as abortions and tubal ligations, your risk to get HIV from reused instruments could exceed 10%-20% if the previous patient was HIV-positive, and if the provider makes no effort to clean them. If the provider sterilizes all reused instruments, you have no risk to get HIV.