Published by the Philippines Department of Health and The Social Acceptance Project – Family Planning (TSAP-FP), the Philippines family planning guidelines is based on the 2004 Medical Eligibility Criteria (MEC) from the World Health Organization (WHO), the most up-to-date MEC at the time of publishing these guidelines. (Since then, WHO published updated guidelines in 2009.) Technical experts from EngenderHealth and Family Health International who reviewed these and other country guidelines included the Philippines guidelines in the Implants Toolkit as an acceptable example from the Asia region.

Below are errors in the guidelines that the technical expert review committee noted:

• The guidelines describe implants incorrectly as being inserted under the skin in a woman’s upper arm or forearm. Implants are inserted under the skin in a woman’s upper arm only, not in her forearm (the region between the elbow and the wrist).
• The description of Norplant implants indicates that approximately 30 µg of levonorgestrel is released each day. This is true starting in the second year of use of Norplant implants. However, the rate of levonorgestrel release is much higher in the first year of use. It starts slightly above 100 µg each day and decreases to slightly over 60 µg each day at the end of the first year. Also, consistent information is not provided for Jadelle and Implanon in terms of the size of the rods, amount of progestin hormone, and average daily release rate of the progestin.
• In the sections on who can and cannot use the method, distinctions in the WHO MEC between initiation and continuation of the method are not always accurate. Also, the MEC checklist provided in an appendix focuses on Norplant implants. This should be updated for the newer implants and according to the updated 2009 WHO MEC. For example, viral hepatitis is now a category 1 in the MEC (use the method in any circumstances).
• A possible complication under the “immediate and lasting effects of using the method” is stated as, “Implants may be expelled hence the woman will not have any protection from pregnancy.” The language used is too strong and should be revised to make allowances for implants with varying numbers of rods/capsules. For example, with Norplant implants, expelling one of six capsules will not cause a loss of protection from pregnancy.
• In the section on how the method is used, instructions are given to, “Coaptate the wound…”, after the implants are inserted. The meaning is unclear as “coaptate” is not an English word.
• The following are issues that the technical expert review committee deemed as undesirable in presentation:
• In the list of advantages of using the method, the first item listed is that the method is reversible. The technical experts suggest the first item that should be mentioned is that the method is highly effective.
• The technical experts judged some of the items listed as disadvantages of using the method to be mislabeled. For example, “discomfort up to several days after insertion,” “does not protect against sexually transmitted infections including HIV/AIDS,” and “more difficult to remove than to insert” are all factual statements but are better classified as considerations than as disadvantages.
• A photo is included of Norplant implants but not of the other, newer implants. In any updated guidelines, photos of the other implants would be more appropriate given that Norplant implants are no longer available.
• Information about “who can use the method” provides a long list of categories of women with certain conditions grouped by WHO MEC categories 1 and 2; this is cumbersome and unnecessary. The technical experts recommend instead starting with a general statement that almost all women can use implants and then listing the specific categories of women who can and cannot use the method.
• In the section on “when to start using the 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.
• The guidelines cover Norplant, Jadelle, and Implanon implants. It should be mentioned that Jadelle and Implanon are replacing Norplant implants.
• The technical experts noted some awkward terminology used throughout the guidelines. For example, side effects were described as “immediate and lasting effects of using the method” and key counseling messages that should be provided to clients were called “counseling tips.”