Contraceptive and family planning

What is contraceptive and family planning?

Contraceptive: is the deliberate use of artificial methods or other

technique to prevent pregnancy as a consequence of sexual
intercourse.

Family planning: is the practice of controlling the number of

children one has and the intervals between their births, particularly
by means of contraception or voluntary sterilization.
Why?
• The rapid population growth in Ethiopia is a serious challenge
to the development efforts of the nation.
• Ethiopia has one of the highest rates of population growth in
the world and is the second most populous country is Sub-
Saharan Africa
• Two out of three married women want to space or limit the
number of children they have but are not using a family
planning method.
• So the unmet need for family planning remains high.
Factors to consider in choosing method

 Counseling in FP
Informed choice
Confidentiality
privacy

 GATHER approach
G- greet
A- asses knowledge
T- tell the client about all the methods
H- help the client approach to make choice
E- explain about the chosen method
R- return visit
Cont..

• Efficacy
• Convenience
• Duration of action
• Reversibility and time to return of fertility
• Frequency of side effects and adverse events
• Affordability
• Protection against sexually transmitted diseases
Methods

1.Barriers
o Condoms
o Diaphrams
o Cervical caps
o Spermicides
 Cont…
2.Non hormonal
o Coitus interuptus
o Breastfeeding
 Fertility Awareness
o Calendar method
o Symptothermal
Cont…

3.Hormonal
o Pills- COC, progesterone only, continuous or extended
o Injectable – DMPA (Depomedroxy Progesterone Acetate)
o Implants
IUCD
PERMANENT BTL(Bilateral Tubal Ligation) AND
VASECTOMY
 Barriers
o Condoms: a thin rubber sheath worn on a man's penis
during sexual intercourse as a contraceptive or as a
protection against infection.
There is male and female type.
 Cont…
Advantage : effective, protect from STI/ AIDS.
Disadvantage : breaking, slippage, allergy, claim of dulling sexual
sensation.
 Cont…
o Diaphragm: cap is a barrier method of contraception. It fits inside your vagina and
prevents sperm passing through the cervix and needs to be used with spermicidal
gel.

Advantage: cap when you want to have sex. you can put it in at a convenient time
before having sex there are usually no serious associated health risks or side effects.
Disadvantage: inappropriate of the method, increased incidence of UTI, usage of
longer than 24 hrs might cause toxic shock syndrome.
 Cont…
Cervical caps
Fits only the cervical external os
Provide continuous protection for 48 hrs.
The diaphragm covers the cervix and the area around it. The cap fits
more snugly on the cervix itself.
• Advantage: can be inserted in advance without interrupting intimacy,
can be used multiple times, low cost, no side effects from hormones
• Disadvantage: doesn’t protect against sexually transmitted infections
(STIs), easy to use incorrectly, can slide, or be pushed out of place,
during intercourse
 Cont…
Spermicides:  a contraceptive substance that destroys sperm, inserted
vaginally prior to intercourse to prevent pregnancy. As a contraceptive,
spermicide may be used alone. However, the pregnancy rate
experienced by couples using only spermicide is higher than that of
couples using other methods.. Placed 10 -15 min prior to intercourse
Various preparations like Cream, foaming, Tablet and aerosol foams.
Advantage: are easy to use, don't require a prescription, do not affect
the menstrual cycle
Disadvantage: allergy, irritation to vagina, doesn't offer any protection
against STDs,UTI
 Non hormonal
Coitus interrupts: AKA withdrawal, is a traditional family planning
method in which the man completely removes his penis from the vagina,
and away from the external genitalia of the female partner before he
ejaculates.
Drawback: aside the risk of withdrawal on time, as a contraceptive involves
the pre-ejaculatory fluid that appears after the penis becomes erect; a few
drops of semen, containing sperm, may be deposited into the vagina
without the knowledge of either partner.
Advantage: no economic cost or use of chemicals and has no directly
associated health risks.
 Cont…

Breastfeeding: for the 1st 6 month.

When you exclusively breastfeed meaning you nurse at least every 4 hours
during the day and every 6 hours at night, and feed your baby only breast milk
your body naturally stops ovulating. You can't get pregnant if you don't ovulate.
Benfits
• Once you begin nursing, it starts preventing pregnancy right away.
• It’s free.
• It’s safe.
• You don’t need a prescription.
• It doesn’t interrupt sex
Cont…

Fertility Awareness is a method of contraception where a woman

monitors and records different fertility signals during her menstrual
cycle to work out when she's likely to get pregnant.
Calendar method: Before you can use the calendar method as
birth control, you need to keep track of the length of your menstrual
cycles for at least 6 periods. You can do this with a regular calendar
Symptothermal
Combination of calendar & Temperature method. A fertility
awareness method used to predict when a woman might be fertile.
The method uses body temperature and other signs and symptoms
of ovulation.
Hormonal
OCPs
• Oral contraceptives: A pill used to prevent pregnancy. It contains
hormones that block the release of eggs from the ovaries. Most oral
contraceptives include estrogen and progesterone.
• Combinations of estrogen and progestin work by preventing ovulation.
• They also change the lining of the uterus to prevent pregnancy from
developing and change the mucus at the cervix to prevent sperm
from entering.
Types :combined oral contraceptive pill
:progesterone only
Drugs

Oestrogen + Progestogen
mestranol norethynodel
ethinylestradiol norethisterone
norgestrel
gestodene
desogestrel
norgestimate
drospirenone
Cont....

Types
 Monophasic: All 21 active pills contain same amount of
Estrogen/Progestin (E/P)
 Biphasic: 21 active pills contain 2 different E/P combinations
 Pill Free Interval: the pill was formulated for 21 days of active
hormones, followed by seven hormone-free days.
 During the pill-free interval, the superficial portion of the
endometrium was sloughed, producing a withdrawal bleeding
episode that simulated menstruation.
Missed pill
• Missed 1 or 2 pills or started new pack 1 or 2 days late: ◦
o Take a hormonal pill as soon as possible.
o Little or no risk of pregnancy.
• Missed 3 or more pills in 1st / 2nd week? Started new pack 3 or more days late?
o Take a hormonal pill as soon as possible.
o Use a backup method for the next 7 days.
o Also, if she had sex in the past 5 days, use ECP
• Missed 3 or more pills in the third week?
o As above AND
o After finish all hormonal pills in the pack start a new pack the next day without .
Using the 7 nonhormonal pills in the old pack
• Missed any nonhormonal pills? (last 7 pills in 28-pill pack)
o Discard the missed nonhormonal pill(s) continue with the unmissed
o Start the new pack as usual.
• Progestin only pills
are an option for women who want a contraceptive pill, but need
to avoid estrogen
. They are associated with more unscheduled (breakthrough)
bleeding and slightly higher failure rates than COCs.
The "minipill" has a dose of progestin that is close to the
threshold of contraceptive efficacy; therefore, these pills should
be taken at the same time each day and are taken every day
without a pill-free interval
Injection(implant)

The contraceptive injection releases the hormone progestogen into your

bloodstream to prevent pregnancy.
Advantage
• If used correctly, the contraceptive injection is more than 99% effective.
• Used 3to5yrs period
• so you do not have to think about contraception every day or every time you
have sex during this period.
• It's very useful for women who find it difficult to remember to take a pill at
the same time every day
• It can be useful for women who cannot use contraception that contains
oestrogen.
• It's not affected by other medicines
Cont.....

Disadvantage
• weight gain, headaches, mood swings, breast tenderness and
irregular bleeding.
• Your periods may become more irregular, heavier, shorter, lighter
or stop altogether.
• It can take up to 1 year for your fertility to return to normal after
the injection wears off, so it may not be suitable if you want to
have a baby in the near future.
• It does not protect against sexually transmitted infections (STIs),
so you may need to use condoms as well.
• Requires clinician visits for insertion and removal
IUCD

• Is a small often T shaped birth control device that is inserted

into the uterus to prevent pregnancy. IUDs are one form of long
acting reversible birth control.
Types
o copper IUDs : doesn’t have hormones. It’s wrapped in a tiny bit
of copper, and it protects you from pregnancy for up to 12
years.
o  hormonal IUDs: mucus on your cervix thicker,  can also stop
eggs from leaving your ovaries,
 MOA
• mechanism of the IUD is the creation of an inflammatory
reaction in the endometrial cavity that prevents or disrupts the
implantation of a fertilized egg.
Advantages of IUCD

• Highly effective and very safe

• Does not interfere with intercourse
• Easy to use
• Long-acting
• Easily reversible
• Quick return to fertility
• No systemic effects
• Complications are rare
Disadvantages of IUCD

• Side effects, including cramping and increased or prolonged

bleeding
• Rare complications include perforation and pelvic
inflammatory disease
• Method failure can lead to ectopic pregnancy (extremely rare)
• Insertion and removal require trained provider
• No STI/HIV protection
Emergency contraceptive pills

•Are hormonal methods Sometimes called morning after pills or

post coital pills
• Can be used up to 72 hours Should not be used as regular or on
going basis only emergency.
• Two types-pills containing ethinylestradiol and lovanolgestrol
• Pills containing a progesterone only
• Both types of ECPs work by preventing ovulation, fertilization
or implantation.
Indications

• Condom rupture,slipage,or misuse

• Diaphragm or cup dislogment ,breakage,…
• Failure coitus interuptus
• Miscalculation of periodic abstinance
• IUCD expulsion
• rape
Effectiveness

The overall protection provided by emergency contraception

(all methods) is to be approximately 75%(55 to 94 %).
ECPs, both combined and progestin-only pills, reduce rates of
pregnancy if taken within 72 hours of unprotected intercourse.
 IUD insertion can take place within five to seven days of
unprotected intercourse and can reduce a woman’s chance of
becoming pregnant by 99 %.
Surgical/ permanent
• BTL (bilateral tubal ligation)
is a surgical procedure that involves blocking the fallopian tubes
to prevent the ovum (egg) from being fertilized.
Advantages
• You do not have to remember to take a pill every day.
• After the procedure is complete, it is a private form of birth
control.
• Tubal ligation does not interfere with intercourse.
• There are no significant long-term side effects
Cont...

Disadvantages
• As tubal ligation is permanent, and difficult to reverse, some
people regret having it 
• Tubal ligation does not protect against sexually transmitted
infections (STIs), including infection with the human
immunodeficiency virus (HIV). Condoms are the most effective
method for preventing STIs. 
• There are possible short-term surgery-related complications
such as discomfort, infection, bruising or bleeding at the
operation site, and possible reaction to anesthesia.
Cont...

Vasectomy
is a surgical procedure for male sterilization or permanent
contraception.
 During the procedure, the male vasa deferentia are cut
and tied or sealed so as to prevent sperm from entering
into the urethra and thereby prevent fertilization of a
female through sexual intercourse.
Advantages:
• a vasectomy is more than 99% effective at preventing
pregnancy
• long-term effects on your health are rare
• it doesn't affect your hormone levels, sex drive or interfere
with sex
• it may be chosen as a simpler and safer alternative to female
sterilisation
Disadvantages:
• vasectomy doesn't protect against STIs, so you may need to use
condoms as well
• a vasectomy can't be easily reversed, and reversals are rarely funded by
the NHS
• you need to keep using contraception after the operation until tests
show your semen is free of sperm
• possible complications include a collection of blood inside the scrotum
(haematoma), hard lumps called sperm granulomas (caused by sperm
leaking from the tubes), an infection, or long-term testicle pain (you
may need further surgery)
• the vas deferens tubes can reconnect, but this is very rare