Technical experts from EngenderHealth and Family Health International who reviewed these and other country guidelines found the Malawi national guidelines to be generally worthy, but somewhat limited in scope. While much of the key information is provided in the guidelines in the form of bullet points, such as effectiveness, benefits and side effects, and who can and cannot use, the guidelines do not provide much explanation about these points.

The guidelines cover Norplant, Implanon, and Jadelle/Sino-implant (II). Jadelle/Sino-implant (II) is referred to as Norplant 2 in the guidelines, which is not the current terminology.

Other errors and/or omissions include:

• The guidelines indicate incorrectly that one of the mechanisms of action of implants is that they “decrease tubal motility.”
• The guidelines do not include women with HIV/AIDS or with diabetes in the list of “who can use implants.” The technical expert review committee considered this a significant omission.
• In the section on contraceptive benefits, the guidelines indicate that implants are “rapidly effective (< 24 hours).” This creates a wrong impression because if the woman is not within the first 7 days of her menstrual cycle (5 days for Implanon) when starting the method, she will not be protected from the method right away or within 24 hours. She will need to use a backup method for 7 days after insertion before implants can be considered effective.
• In the section on noncontraceptive benefits, the guidelines indicate that implants protect against endometrial cancer. However, this has not been proved in clinical studies.
• In the table of conditions for which providers should screen, the guidelines do not mention two conditions: (1) unusual vaginal bleeding and (2) breastfeeding mothers who are less than 6 weeks postpartum.
• In the section on “when to initiate method,” the information presented does not pertain to Implanon although Implanon is mentioned elsewhere throughout the guidelines. For example, if a woman is having menstrual cycles, she can start Implanon within 5 days after the start of her menstrual bleeding compared with within 7 days for other implants. Also, for postpartum women who are not breastfeeding, the guidelines indicate that they can start using implants immediately or within 3 weeks. It should say that they can start using implants immediately or at any time. (They do not need to wait 3 weeks.)