BATAAN PENINSULA STATE UNIVERSITY
MAIN CAMPUS
College of Nursing and Midwifery
PHILIPPINE FAMILY
PLANNING PROGRAM
The Philippine Family Planning Program (PFPP) started in 1970s
as a family planning service delivery component to achieve fertility
reduction. It has evolved to its present-day health orientation of
improving the health of women and children and has been
integrated with other reproductive health programs giving
importance to recognizing choice and rights of family planning
users. This is now a priority public health program for the
attainment of the country's national health development: to
improve the health condition of women and children and other
members of the family. Couples of reproductive ages provided
information and services to plan their family according to their
beliefs and circumstances through legally and medically
acceptable family planning methods.
PROGRAM To provide universal access to FP information,
GOAL education and services whenever and wherever
these are needed.
FOUR PILLARS OF PHILIPPINE FAMILY
PROGRAM OR GUIDING PRINCIPLES
RESPONSIBLE this refers to the will and ability to respond to the
needs and aspirations of the family. It promotes
PARENTHOOD
the freedom of responsible parents to decide on
the timing and size of their families in pursuit of a
better life.
RESPECT FOR The 1987 Constitution protects the life of the
unborn from the moment of conception. FP aims
LIFE
to prevent abortions, thereby saving lives of both
women and children.
BIRTH Proper spacing of 3-5 years from a recent
SPACING pregnancy and to improve her well-being, the
health of the child, and the relationship between
husband and wife, and between parents and
children.
INFORMED Couples and individuals are fully informed on the
different modern family planning methods.
CHOICE
Couples and individuals decide and may choose
the methods that they will use based on informed
choice and to exercise responsible parenthood in
accordance with their religious and ethical values
and cultural background, subject to conformity
with universally recognized international human
rights (DOH, 2006)
Is having the desired number of children and
FAMILY when you want to have them by using safe and
effective modern methods
PLANNING Proper birth spacing is having children 305years
apart which is best for the health of the mother,
her child, and the family.
BENEFITS OF FAMILY PLANNING FOR MOTHER
 Enable her to regain her health after delivery
 Gives enough time and opportunity to love and provide
attention to her husband and children
 Gives more time for her family and own personal advancement
 When suffering from an illness, gives enough time for treatment
and recovery.
BENEFITS OF FAMILY PLANNING FOR CHILDREN
 Healthy mothers produce healthy children
 Will get all the attention, security, love, and care they deserve
BENEFITS OF FAMILY PLANNING FOR FATHER
 Lightens the burden and responsibility in supporting his family
 Enable him to give his children their basic needs (food, shelter,
education and better future)
CSSYNNSRJ CHN RLE- 2ND YEAR 1ST SEM
 Give him time for his family and own personal advancement
 When suffering from an illness, gives enough time for treatment
and recovery.
FAMILY PLANNING METHODS
is the method that uses the body’s natural
Natural Family physiological changes and symptoms to
Planning identify the fertile and infertile phases of the
Method menstrual cycle. Such methods are also known
as Fertility-Based Awareness Methods.
as defined by WHO are methods for planning
or avoiding pregnancy by observation of the
natural signs and symptoms of the fertile and
infertile phase of the menstrual cycle.
Natural Family
Planning (NFP)
EFFECTIVENESS:
The effectiveness of any method of natural
family planning can vary from couple to couple,
and all these methods are less effective for
couples who do not follow the method carefully.
ADVANTAGES
 generally, is the preferred contraceptive method for women
who do not wish to use artificial methods of contraception for
reasons of religion, or who, due to rumors and myths, fear other
methods
 effective when used correctly
 no physical side effects
 inexpensive
 no need for follow-up medical appointments
 couple develops better understanding about their sexual
physiology and reproductive functions
 promotes shared responsibility for family planning
 fosters better communication between spouses
 couple may utilize signs and symptoms of the woman’s fertility
to avoid or achieve pregnancy based on the couple’s decision
DISADVANTAGES
ᵡ are unreliable in preventing unwanted pregnancy.
ᵡ takes time to practice and use them properly, which adds to
their unreliability.
ᵡ do not protect against sexually transmitted infections (STIs),
including the human immunodeficiency virus (HIV).
TYPES OF NATURAL FAMILY
PLANNING METHODS
A. Periodic abstinence (Fertility Awareness) Method
B. Use of breastfeeding or Lactational Amenorrhea Method (LAM)
C. Coitus interruptus (withdrawal or pulling out) Method
A. PERIODIC ABSTINENCE/ FERTILITY-
AWARENESS BASED METHOD
are family planning methods that focus on the awareness of
the beginning and end of the fertile time of a woman’s menstrual
cycle.
These methods involve:
 Determination of the fertile and infertile periods of a woman
within the menstrual cycle
 Observation of the signs and symptoms of infertility and fertility
during the menstrual cycle
Effectiveness: All FAB methods are 95% effective
CERVICAL MUSCUS METHOD (BILLINGS OVULATION METHOD
 is based on the recognition and interpretation of changes in
cervical mucus and sensations in the vagina, due to the effect
of changes in estrogen levels during the menstrual cycle. This
method is also an ovulation method used by women trying to
get pregnant and have a child.
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 BATAAN PENINSULA STATE UNIVERSITY
MAIN CAMPUS
College of Nursing and Midwifery
 The basis of this method is the changes in the cervical mucus
during ovulation.
 To check if the woman is ovulating, the cervical mucus must be
copious, thin, and watery.
 The cervical mucus must exhibit the property of spinnbarkeit,
wherein it can be stretched up until at least 1 inch and feels
 slippery.
 The fertile days of a woman according to this method is as long
as the cervical mucus is copious and watery and a day after it.
 Therefore, she must avoid coitus during these days.
▪ When used typically, it has a fail rate of 25%.
the client is required to observe what she feels
HOW IS THE (wetness or dryness in the vulva) and sees
METHOD (characteristic of the cervical mucus), and to
USED? record her observation daily in a chart. The
husband is also encouraged to do the recording
to promote better cooperation and compliance.
1. Record the menstruation and dry days
2. Check sensation of wetness and dryness while standing and
walking around.
3. Inspect underwear regularly for presence of mucus.
4. Wipe the vulva with a piece of clean tissue paper or clean cloth.
5. Record the most fertile observation / characteristics at the end
of the day.
The following are symbols used in charting to determine the
fertile and infertile days.
R = menstruation or “regla”, spotting
D = dry or no mucus
M = dry with sticky, pasty, or crumbly mucus
X = wet with slippery, clear, or watery mucus
1,2,3, = post peak days / dates of love making
Guidelines For Postponing Pregnancy
 Menstruation days are considered fertile days
 For dry days following menses, advise client to have sexual
intercourse on alternate evenings (Early Days Rule or EDR)
 Any mucus observed following the dry days after menses
signifies the onset of the fertile period. Thus, sexual intercourse
on these days should be avoided. The woman should identify
the peak day as the last day of wetness
 The next 3 days of dry sensation after the last day of wetness
are considered fertile. Sexual intercourse should be avoided on
these 3 days.
 From the 4th day after the peak day, all days are considered
infertile until menstruation. Sexual intercourse on these days
will
 not result in a pregnancy
 For short cycles, (below 25 days), there is no preovulatory
period of relative infertility
Guidelines For Achieving Pregnancy
 Tell your client to determine the mucus pattern to assess fertile
and infertile days
 Intercourse 2-3 times a week even before the fertile days occur
so that the amount of sperms is optimized
 Couple should aim to have intercourse as close as possible to
the peak, the day before, or the day after the peak day. When
several days of fertile type mucus appear, they should try to
have intercourse on these days as well.
BASAL BODY TEMPERATURE
● Identifying the fertile and infertile period of a woman’s cycle by
daily taking and recording of the rise in body temperature
during and after ovulation.
● BBT is the temperature of the body at rest after at least 3 hours
of continuous sleep before temperature taking. A woman’s BBT
rises during her ovulation period and stays high until the next
menstruation due to a rise in progesterone level.
● The woman must take her temperature early every morning
CSSYNNSRJ CHN RLE- 2ND YEAR 1ST SEM
before any activity, and if she notices that there is a slight
decrease and then an increase in her temperature, this is a
sign that she has ovulated.
● The woman must abstain from coitus for the next 3 days.
● The BBT method has an ideal fail rate of 9% and has a typical
use fail rate of 25%.
Effectiveness:
Perfect use - 99% Typical use – 80%
1. Used BBT or ovulation thermometer, although
a fever thermometer, may also be used.
2. Take the temperature every morning upon
waking up and before any activity at the same
time every day and in the same manner
throughout the menstrual cycle, after least 3 hrs.
of undisturbed rest.
3. Take the thermometer under the tongue or
HOW IS THE axilla. The temp. Should be taken in the same
METHOD manner/site throughout the menstrual cycle.
USED? 4. Read and record the temp immediately on the
BBT chart.
5. Determine the cover line (by placing a
horizontal line across the highest temp. from
days 6 to 10 of the menstrual cycle in the chart)
to identify the thermal shift (the three consecutive
temperatures above the cover line which are
labeled as days 1, 2, 3).
6. Establish the pattern of use for 3 mos. and
discuss with a service provider to assist in
interpreting the data
CALENDAR/RHYTHM METHOD
 Calendar method is a calculation-based approach where
previous menstrual cycles are used to predict the first and the
last fertile day in future menstrual cycles.
 Requires a good understanding of the fertile and infertile
phases of the woman’s menstrual cycle.
 Based on the regularity of the menstrual cycle and the fact that
an ovum (egg) can only be fertilized within 24 hours of
ovulation.
 For regular cycles: (ex. 30-day cycles)
 Subtract 14 from the regular cycle, initially (30-14=16)
 Then, subtract 7 to get the first day of fertile period(16-7=9)
 The, add 2 to get the last day of fertile period (16+2=18)
 For irregular cycles, identify the longest and the shortest cycles
 recorded over six to eight cycles.
 Subtract 18 from the shortest cycle (gives the first day of the
fertile phase).
 Subtract 11 from the longest cycle (gives the last day of her
fertile time).
 Avoid sex, use a barrier method, or use withdrawal during the
fertile phase calculated
SYMPTOTHERMAL METHOD (STM)
Identifying the fertile and infertile days of the menstrual cycle as
determined through a combination of observations made on the
cervical mucus, basal body temperature recording, and other
signs of ovulation such as mittelschmertz, spinnbarkeit, breast
tenderness, increased libido, and mood changes such as
depression and mood swings.
Effectiveness: Perfect use - 98%
STANDARD DAYS METHOD (SDM)
A “new” method of natural FP in which all users with menstrual
cycles between 26 and 32 days are counseled to abstain from
sexual intercourse on days 8-19 to avoid pregnancy. The couple
uses the device, the color coded “cycle beads”, to mark the fertile
and infertile days of the menstrual cycle.
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 BATAAN PENINSULA STATE UNIVERSITY
MAIN CAMPUS
College of Nursing and Midwifery
Effectiveness:
Perfect use : 95% Typical use : 88%
There are 33 colored beads and a moveable rubber
ring on the string.
The first bead is black with a white arrow.
CYCLE The next one is red (menstrual cycle)
The next six are brown (days that a woman cannot get
BEADS pregnant)
The next 12 are white (days that a woman can get
pregnant)
The last13 are brown. (days that a woman cannot get
pregnant)
Each one, except the black one, represents a day.
ADVANTAGES OF FAB METHODS
 Effective when used correctly and consistently
 No physical side effects
 No prescription required.
 Inexpensive; no medication involved
 No follow-up medical appointments required
 Better understanding of the couple about their sexual
physiology and reproductive functions.
 Shared responsibility between partners.
 All FAB methods can be used for spacing, limiting, and
achieving pregnancy.
DISADVANTAGES OF FAB METHODS
ᵡ May inhibit sexual spontaneity.
ᵡ Except for SDM, need extensive training – it takes 2-3 cycles to
accurately identify the fertile period & how to effectively use it.
ᵡ Require consistent and accurate record keeping and close
attention to body changes.
ᵡ Require periods of abstinence from sexual intercourse, which
may be difficult for some couples.
ᵡ Require rigid adherence to daily routine of awaking at a fixed
time, without any disturbance before taking the temperature (for
BBT and STM)
ᵡ Can be used only by women whose cycles are within 26-32
days (for SDM) Offer no protection against STI, HIV/AIDS.
B. LACTATIONAL AMENORRHEA METHOD (LAM)
● The use of breastfeeding as a temporary introductory
postpartum method of postponing pregnancy based on
physiological infertility experienced by breastfeeding women
● “Lactational” – means R/T breastfeeding
● “Amenorrhea” – not having menstrual bleeding
Effectiveness:
Perfect use: 99.5 % Typical use: 98 %
CRITERIA FOR LAM USE
1. Amenorrhea (menses have not yet returned)
2. Fully or nearly fully breastfeeding
3. Infant is less than 6 mos.
HOW DOES The normal physiology of breastfeeding and the
IT WORK? hormonal response of a woman’s body to her
infant’s suckling at her breast suppresses
ovulation.
ADVANTAGES OF LAM
 Universally available
 Does not require physical examination
 Protection from an unplanned pregnancy begins immediately
 postpartum
 Contributes to improved maternal and child health and nutrition
 Encourages optimal breastfeeding and weaning practices
 Serves as bridge to the use of other FP methods
DISADVANTAGES OF LAM
ᵡ Full or nearly breastfeeding pattern may be difficult for some
women to maintain.
ᵡ The duration of the method’s effectiveness is limited to a brief
CSSYNNSRJ CHN RLE- 2ND YEAR 1ST SEM
six-month postpartum period. If a mother and child are
separated for extended periods of time, the breastfeeding
practice required for LAM cannot be followed.
ᵡ There is no protection against STI, including HIV.
ᵡ In addition, it may be difficult to convince some providers who
are unfamiliar with the method that LAM is a reliable
contraceptive
CATEGORIES OF CHOICE OF FP MATHEODS FOR POST-
PARTUM BREASTFEEDING WOMEN
1st choice IUD, condom, BTL, NFP or vasectomy (for the
woman’s partner)
2nd choice DMPA and Progestin-Only Pills which can be
initiated after 6 weeks postpartum.
3rd choice Combined Oral Contraceptives (COC) only after 6
mos. When complementary foods are introduced
and the baby is less dependent on breast milk.
Estrogen can reduce breast milk volume
C. COITUS INTERRUPTUS (WITHDRAWAL/
PULLING OUT METHOD)
● is a traditional family planning method in which the man
withdraws or pulls out his penis from his partner’s vagina and
ejaculates outside, keeping his semen away from her genitalia
● Coitus interruptus prevents fertilization by stopping contact
between spermatozoa in the sperm and the ovum or egg.
Effectiveness of withdrawal method
It is the least effective method because it depends on the man’s
ability to withdraw before he ejaculates. However, it is about 73%
effective if used correctly.
ADVANTAGES
 costs nothing and requires no devices or chemicals.
 available in any situation and can be used as a back-up method
of contraception
DISADVANTAGES
ᵡ may result in the incorrect or inconsistent use of this method
because of interruption of the excitement of sexual intercourse,
as well as decreasing sexual pleasure for both partners.
ᵡ a high failure rate may be due to a lack of self-control, and
semen containing sperm may leak into the vagina before the
person ejaculates. There is a further possibility of premature
ejaculation by the man. In addition, the couple is not protected
from STIs, including HIV.
THE BARRIER METHODS
The Barrier Methods involve the use of devices that mechanically
or chemically prevent fertilization. These include male condoms,
female condoms, diaphragms, cervical caps, and spermicides.
A. MALE CONDOM
A condom is a sheath made of thin, latex rubber designed to fit
over a man’s erect penis.
Mechanism of Action:
● Prevents entry of sperm into the vagina
● Sperm and disease-causing organisms including HIV do not
pass through intact latex rubber or polyurethane condoms
● Some condoms have a spermicidal coating which adds to its
effectiveness
Effectiveness:
Perfect use – 98% Typical use: 85%
ADVANTAGES
 Safe and no hormonal side effects
 Protection against STI’s/HIV
 Encourages male participation in Family Planning
 Easily accessible
 Used in managing premature ejaculation
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College of Nursing and Midwifery

DISADVANTAGES mucus to limit the sperm’s access to the ova.

ᵡ May cause allergy to people who are sensitive to latex or ● To use the pill, it is recommended that the woman takes the
lubricant first pill on the first Sunday after the beginning of a menses
ᵡ Decrease sensation, making sex less enjoyable for either soon as it is prescribed.
partner
ᵡ Interrupts sexual act Mechanism of Action:
ᵡ Requires a man’s cooperation for its use Low-dose COCs prevent ovulation by suppressing follicle-
ᵡ Males with penile implants (bolitas) should take special stimulating hormone (FSH) and luteinizing Hormone (H). It causes
precaution in using condoms, since the implant can break or thickening of the cervical mucus, which makes it difficult for sperm
tear condom. to pass through.
ᵡ Use a new condom in every sexual act to prevent STI
ᵡ Slipping off, tearing, spillage of sperm can occur, esp among Effectiveness:
inexperienced users Perfectly used: 99.7% Typically used: 92%
ᵡ Deteriorates quickly when storage conditions are poor ADVANTAGES
ᵡ Causes some men difficulty in maintaining erection  Safe as proven by extensive studies
B. FEMALE CONDOMS  Reversible, rapid return of fertility
A thin sheath made of soft transparent polyurethane plastic, about  Convenient, easy to use, no need to do anything at the time of
7-8 cm in diameter and 17 cm. long. It has two flexible rings-the sexual intercourse
ring with a smaller diameter is found in the closed end of the  Has significant contraceptive benefits
condom, w/c aids the woman in inserting high in the vagina near  Monthly periods regular and predictable
the cervix and the other end is a flexible ring found at the open  Reduces symptoms of gynecologic conditions such as
end covering the vulva. painful menses and endometriosis
 Reduces the risk for ovarian and endometrial cancer
Effectiveness:  Decreases risk of iron-deficiency anemia
Perfect use: 95% Typical use: 79%  Can be used at any age from adolescence to menopause
ADVANTAGES DISADVANTAGES
 Dual protection – both prevents pregnancy and transmission of ᵡ Require regular and dependable supply
STI’s ᵡ Client-dependent; effectiveness depends on the client’s
 No hormonal side effect and medical precautions compliance to the daily routine of taking the pills. Often not
 Does not alter the milk production of a breastfeeding woman used correctly and consistently, which lowers its effectiveness
 No allergic reaction reported since the plastic is not rubber ᵡ Offers no protection against STIs/HIV
 The use of the method is under the control of the woman ᵡ Not most appropriate choice for lactating women as it can
DISADVANTAGES suppress lactation.\Effectiveness maybe lowered when taken
ᵡ Not yet locally marketed with certain drugs such as rifampicin and most anti-
ᵡ Expensive and can be used just once convulsants.
ᵡ A woman must touch her genitals in inserting the condom ᵡ Increased risk for users over 35 years old who smoke and have
other health problems.
C. DIAPHRAGM AND CERVICAL CAP 1. nausea,
A small dome-shaped soft rubber cup with a flexible rim that goes 2. weight gain,
inside the vagina over the cervix. It is fitted by a clinician or trained 3. headache,
health worker and used with spermicidal jelly or cream which 4. breast tenderness,
serves as lubricant. SIDE EFFECTS
5. breakthrough bleeding,
6. vaginal infections,
Diaphragm and cervical cap require pelvic manipulation. They are 7. mild hypertension,
left in place for 6 hours after ejaculation. Not removing the 8. depression.
diaphragm for more than 24 hours and the cervical cap for more
1. breastfeeding,
than 48 hours may result in toxic shock syndrome. (DOH, 2006)
2. age of 35 years and above, with
cardiovascular diseases,
Effectiveness:
CONTRAINDICATIONS 3. smoking,
Perfect use : 94% Typical use : 84%
4. diabetes,
D. SPERMICIDES/ CHEMICAL BARRIERS 5. cirrhosis.
Chemical barriers such as spermicides, vaginal gels and creams, J – jaundice
and glycerin films are also used to cause the death of sperms A – abdominal pain (severe)
before they can enter the cervix and also lower the pH level of the C - chest pain
vagina so it will not become conducive for the sperm. These H – headaches (severe)
WARNING SIGNS
chemical barriers cannot prevent sexually transmitted infections; E – eye problems like brief loss of
however, they can be bought without any prescription. The ideal vision, seeing flashes of light or zigzag
fail rate of chemical barriers is 80%. line.
S – severe leg pains
HORMONAL CONTRACEPTIVE
CONTRACEPTIVE PATCH
METHODS Contraceptive Patch is a form of contraceptive applied to the skin.
COMBINED ORAL CONTRACEPTIVES (COC) It contains estrogen and progestin similar to the natural hormones
● Also known as the pill, oral contraceptives contain synthetic in a woman’s body and released slowly in the bloodstream.
estrogen and progesterone.
● Estrogen suppresses the FSH and LH to suppress ovulation, Mechanism of Action:
while progesterone decreases the permeability of the cervical It works by inhibiting ovulation and thickening of the cervical

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 BATAAN PENINSULA STATE UNIVERSITY
MAIN CAMPUS
College of Nursing and Midwifery
mucus
ADVANTAGES
 Safe, 99% effective, no daily pill intake
 Regulates menstrual flow
 Can be stopped at any time by the client
 Does not interrupt sex, increased sexual enjoyment
 Convenient and simple to use
 Has similar benefits similar to the use of COCs
DISADVANTAGES
ᵡ Maybe less effective in women with body weight greater than
90kg
ᵡ Affects quantity and quality of breastmilk
ᵡ Need to replace patch weekly
ᵡ Does not protect against STIs
ᵡ Increased risk to users over 35 years old who smoke and have
other health problems
HORMONAL INJECTIONS (PROGESTIN-ONLY INJECTABLES)
● A hormonal injection consists of medroxyprogesterone, a
progesterone, and given once every 12 weeks intramuscularly.
● The injection inhibits ovulation and causes changes in the
endometrium and the cervical mucus.
● After administration the site should not be massaged so it could
absorb slowly.
● It has an effectiveness of almost 100%, making it one of the
most popular choices for birth control.
● Advise the woman to ingest an adequate amount of calcium in
her diet as there is a risk for decreased of bone mineral density
and to engage in weight-bearing exercises.
POIs commercially available in the Philippines:
- Depot Medroxyprogesterone Acetate (DMPA), given every three
months
- Norethisterone Enanthate (NET-EN), given every two months
Mechanism of Action:
Inhibits ovulation and thickens the cervical mucus
Effectiveness:
Perfectly used: 99.7% Typically used: 97.0%
 As per WHO studies, DMPA presents no overall
risks for cancer, congenital malformation, or
infertility
 DMPA exerts a strong protective effect against
endometrial CA
 Its use does not increase the risk of breast Ca
SAFETY
overall
 There is no relation between ovarian Ca and use
of DMPA. Like oral contraceptives, DMPA would
protect women against ovarian Ca
 DMPA does not affect the risk of developing liver
cancer in areas where hepatitis is endemic
ADVANTAGES
 Reversible
 No need for daily intake
 Does not interfere with sexual intercourse
 Perceived as culturally acceptable by some women
 Private since it is not coitally dependent
 Has no estrogen-related side effects such as nausea,
dizziness, nor serious complications such as thrombophlebitis
or pulmonary embolism
 Does not affect breastfeeding - quantity and quality of breast
milk do not seem to be affected
 Has beneficial non-contraceptive effects: helps prevent iron-
 deficiency anemia, make seizures less frequent in women with
epilepsy, reduces risk of ectopic pregnancies, prevents
endometrial cancer
CSSYNNSRJ CHN RLE- 2ND YEAR 1ST SEM
DISADVANTAGES
ᵡ Return to fertility is delayed
ᵡ Requires an injection every two or three months to sustain its
effect.
ᵡ Does not protect against STI/HIV/AIDS.
ᵡ Menstrual irregularity during the first few months of use.
ᵡ Amenorrhea; some women get anxious if they do not have
menses.
ᵡ Not possible to discontinue immediately, until DMPA is cleared
from the woman’s body.
ᵡ There may be a decrease in bone density for long-term users.
ᵡ However, studies show that this condition is reversible after
discontinuation and that bone density loss is greater during
pregnancy.
LONG ACTING AND PERMANENT
METHODS (LAPM)
Contraceptive methods that are considered long-acting and
temporary are IUDs and implants. Female sterilization
INTRA UTERINE DEVICE
● An IUD is a small, T-shaped object that is inserted into the
uterus via the vagina.
● It prevents fertilization by creating a local sterile inflammatory
condition to prevent implantation.
● It is fitted only by the physician and inserted after the woman’s
menstrual flow to be sure that she is not pregnant.
● The device contains progesterone and is effective for 5 to 7
years.
● A woman with IUD is advised to check the flow of her
menstruation every month and the IUD string, and also to have
a pelvic examination yearly.
Mechanism of action:
Copper-bearing IUDs, such as Copper T, act primarily by
preventing fertilization. Copper ions decrease sperm motility and
function by altering the uterine and tubal fluid environment, thus
preventing sperm from reaching the fallopian tube and fertilizing
the egg.
ADVANTAGES
 Highly effective and very safe
 Reversible and economical
 Maybe safely use by lactating and immediate postpartum
women
 Good choice for women who cannot use other methods
 Long duration of use (up to 12 years for TCu380A)
 Does not interact with medications client may use
DISADVANTAGES
ᵡ Requires a pelvic exam to insert IUD
ᵡ Requires a trained health service provider to insert/remove the
IUD
ᵡ Does not protect against STIs
ᵡ Increases the risk of PID for women with STIs
ᵡ Device maybe expelled, possible without the woman knowing it
P – period late
SIGNS OF A – abdominal pain
COMPLICATIONS I – infection
N – not feeling well
S – strings missing or longer
SUBDERMAL IMPLANTS
The subdermal implants are two rod-like implants embedded
under the skin of the woman during her menses or on the 7th day
of her menstruation to make sure that she is not pregnant.
It contains etonogestrel, desogestrel, and progestin.
It is effective for 3 to 5 years. Must be removed and replaced
every three years to continue prevent pregnancy.
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College of Nursing and Midwifery

Subdermal implants have a fail rate of 1%. ectopic pregnancy

Mechanism of Action:
It releases a low, steady dose of a progestational hormone to
thicken cervical mucus and thin the lining of the uterus thus
suppressing ovulation.
ADVANTAGES
 Can be removed at any time, followed by a quick return to
fertility
 Eliminates the need to interrupt sex for contraception
 Contains no estrogen
DISADVANTAGES
ᵡ Does not offer protection from sexually transmitted infections.
ᵡ Higher chance that pregnancy will be ectopic when conceived
while using contraceptive implant.
ᵡ May experience side effects like: abdominal or back pain,
increased risk of noncancerous ovarian cysts, changes in
vaginal bleeding patterns, amenorrhea, decreased sex drive,
dizziness, headache, mood swings and depression, nausea or
upset stomach, sore breasts, weight gain, vaginal inflammation
or dryness
After the procedure, contact the healthcare provider if you
develop:
- Breast lumps
- Heavy, prolonged vaginal bleeding
- Signs and symptoms of a blood clot in your leg, such as
persistent pain and swelling in the calf
- Signs and symptoms of an infection at the insertion site, such
as tenderness, redness, swelling or discharge
- Signs and symptoms of pregnancy at any time after the
contraceptive implant is inserted
BILATERAL TUBAL LIGATION
● Tubal ligation is performed by occluding the fallopian tubes
through cutting, cauterizing, or blocking to inhibit the passage
of the both the sperm and the ova.
● After menstruation and before ovulation, the procedure is done
through a small incision under the woman’s umbilicus.
● A laparoscope is used to visualize the surgery, and the patient
is under local anesthesia.
Mechanism of Action:
The doctor makes a small incision in the woman’s abdomen and
ties and cuts the two fallopian tubes on each side of the uterus.
These tubes carry eggs from the ovaries to the uterus. With the
tubes blocked, the egg cannot meet the sperm. The woman
continues to have menstrual periods after BTL.
ADVANTAGES
 Very effective; permanent
 Nothing to remember, no supplies needed, no repeated clinic
visits
 No interfere with sex, does not affect woman’s ability to have
sex
 Has no hormonal side effects
 No effect on breastmilk
 Can be performed just after a woman gives birth (immediately /
within 7 days after childbirth)
 For interval cases, can be done 6 weeks after delivery
 Can be performed at any day of the menstrual cycle provided
that the woman is not pregnant
DISADVANTAGES
ᵡ Requires minor surgery
ᵡ Compared with vasectomy, BTL is slightly more risky and often
more expensive
ᵡ Reversal surgery is difficult, expensive and success cannot be
guaranteed
ᵡ If pregnancy happens (very rare), there is a greater risk of
ᵡ Does not protect against STIs
VASECTOMY
● Known as male sterilization, which is executed through a small
incision made on each side of the scrotum.
● The vas deferens is then tied, cauterized, cut, or plugged to
block the passage of the sperm.
● Done with local anesthesia.
● Advise to use a back-up contraceptive method until two
negative sperm count results are performed because the sperm
could remain viable in the vas deferens for 6 months.
● There is a 99.5% accuracy rate for vasectomy and has a few
complications.
Mechanism of Action:
 The doctor makes a puncture in the man’s scrotum and ties
and cuts the two vas (vas carries sperm from the testicles)
 Semen is still produced and found in the tubes after the blocked
vas.
 With the two vas blocked, there will be no sperm in the semen.
 The man continues to have erections and ejaculates semen.
Effectiveness:
▪ 99.9% Effective for correct use
ADVANTAGES
 Very effective, permanent
 Nothing to remember except to use condoms or another
effective method for at least three months after the procedure
 No interference with sex, does not affect the man’s ability to
have sex
 No supplies to get, no repeated clinic visits
 Compared to BTL, vasectomy is more effective, safer, easier to
perform, less expensive, able to be tested for effectiveness at
any time
DISADVANTAGES
ᵡ Requires minor surgery by a specially trained healthcare
provider
ᵡ Not immediately effective (for the next 3 months after
procedure)
ᵡ Must be considered as permanent, reversal surgery is more
difficult, expensive and may not be available in some areas,
success is not guaranteed
ᵡ Does not protect against STIs
COMMON SIDE Discomfort for 2-3 days
EFFECTS Pain in the scrotum, swelling and bruising
which decreases about 2-3 days

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