FAMILY PLANNING

CHEENETTE T. TORRICER
NATURAL FAMILY PLANNING
METHODS

The natural family planning

methods do not include any
chemical or foreign body
introduction into the human
body.
Abstinence

• This natural method involves abstaining from

sexual intercourse and is the most effective
natural birth control method with an ideal 0%
fail rate.
• It is also the most effective way to avoid STIs.
• However, most people find it difficult to
comply with abstinence, so only a few of them
use this method.
• MOST EFFECTIVE (100%)
Calendar Method
 Also called the rhythm method, this natural method of
family planning involves refraining from coitus during the
days that the woman is fertile.
 According to the menstrual cycle, 3 or 4 days before and 3
or 4 days after ovulation, the woman is likely to conceive.
 The process of calculating the woman’s safe days is
achieved when the woman records her menstrual cycle for
six months.
 Here’s how you do it: Mark the first day of your period (this
is day 1). Then mark the first day of your next period. Count
the total number of days between each cycle (the number
of days between the first days of each period).
 It has an ideal fail rate of 5%, but when used it has a typical
What are the safe days to
have sex when using the
calendar
 To predict method?
the first fertile day (when you can get
pregnant) in your current cycle:
• Find the shortest cycle in your past record.
• Subtract 18 from the total number of days in that
cycle.
• Count that number from day 1 of your current cycle,
and mark that day with an X. (Include day 1 when
you count.)
• The day marked X is your first fertile day.
For example: if your shortest cycle is
26 days long, subtract 18 from 26 —
you get 8. Then, count 8 days starting
from day 1 (the first day of your
period). If day 1 was on the 4th of the
month, you’ll mark X on the 11th. So
the 11th is your first fertile day of this
cycle — you should stop having
vaginal sex on this day or start using
another method of birth control.
 To predict the last fertile day in your current cycle:
• Find the longest cycle in your record.
• Subtract 11 from the total number of days in that
cycle.
• Count that number from day 1 (the first day of
your period) of your current cycle, and mark that
day with an X. (Include day 1 when you count.)
• The day marked X is your last fertile day.
For example, if your longest cycle is
30 days long, subtract 11 from 30 —
you get 19. Then, count 19 days
starting from day 1. If day 1 was on
the 4th of the month, you’ll mark X
on the 22nd. So the 22nd is your last
fertile day of this cycle — you can
start having unprotected sex the next
day.
Basal Body Temperature

• The basal body temperature is the woman’s temperature at rest.

• BBT falls at 0.5⁰F before the day of ovulation and during ovulation, it
rises to a full degree because of progesterone and maintains its level
throughout the menstrual cycle, and this is the basis for the method.
• The woman must take her temperature early every morning 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 a typical use fail rate
of 25%.
Cervical Mucus Method
• 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 are 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%.
Symptothermal Method

• The symptothermal method is simply a combination of the

BBT method and the cervical mucus method.
• The woman takes her temperature every morning before
getting up and also takes note of any changes in her cervical
mucus every day.
• She abstains from coitus 3 days after a rise in her
temperature or on the fourth day after the peak of a mucus
change.
• Symptothermal method has an ideal failure rate of 2%.
Lactation Amenorrhea Method

• Through exclusive breastfeeding of the infant, the woman is

able to suppress ovulation through the method of lactation
amenorrhea method.
• However, if the infant is not exclusively breastfed, this
method would not be an effective birth control method.
• It is also best to advise the woman that after 3 months of
exclusive breastfeeding, she must make plans of choosing
another method of contraception.
Coitus Interruptus

• This is one of the oldest methods of contraception.

• The couple still proceeds with the coitus, but the man
withdraws the moment he ejaculates to emit the
spermatozoa outside of the vagina.
• The disadvantage of this method is the pre-ejaculation fluid
that contains a few spermatozoa that may cause fertilization.
• Coitus interruptus is only 75% effective because of this.
ARTIFICIAL FAMILY PLANNING
METHODS
Chemical Barriers

• Chemical barriers such as spermicides, vaginal

gels, creams, and glycerin films are also used to
cause the death of sperms before they can enter
the cervix and also lower the pH level of the vagina
so it will not become conducive for the sperm.
• These chemical barriers cannot prevent sexually
transmitted infections; however, they can be
bought without any prescription.
• The ideal fail rate of chemical barriers is 80%.
Diaphragm

• A diaphragm works by inhibiting the entrance of the sperm into

the vagina.
• It is a circular, rubber disk that fits the cervix and should be
placed before coitus.
• If a spermicide is combined with the use of a diaphragm, there
is a failure rate of 6% ideally and 16% typically.
• The diaphragm should be fitted only by the physician, and
should remain in place for 6 hours after coitus.
• It can be left in place for not more than 24 hours to avoid
inflammation or irritation.
Cervical Cap
• The cervical cap is another barrier method that is
made of soft rubber and fitted on the rim of the
cervix.
• It is shaped like a thimble with a thin rim, and could
stay in place for not more than 48 hours.
Male Condoms

• The male condom is a latex or synthetic rubber sheath that is

placed on the erect penis before vaginal penetration to trap
the sperm during ejaculation.
• It can prevent STIs and can be bought over the counter
without any fitting needed.
• Male condoms have an ideal fail rate of 2% and a typical fail
rate of 15% due to a break in the sheath’s integrity or
spilling.
• After sexual intercourse, the condom is removed to be
disposed.
Female Condoms

• These are also latex rubber sheaths that are specially

designed for females and prelubricated with spermicide.
• It has an inner ring that covers the cervix and an outer,
open ring that is placed against the vaginal opening.
• These are disposable and require no prescription.
• The fail rate of female condoms is 12% to 22%.
LONG-ACTING REVERSIBLE &
PERMANENT FAMILY PLANNING
METHODS
Intrauterine Device
TCu380A (or Copper T)

 Copper- bearing
 Effective for at least 12 years
 A thin polyethylene string is attached to the bottom of the stem to determine
correct positioning and ensure easy removal
• 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.
• The IUD is fitted only by the physician and inserted after the woman’s
menstrual flow to be sure that she is not pregnant.
• 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.
Effectiveness

 The IUD is a highly effective form of long-term, reversible

contraception, with an associated failure (pregnancy) rate of less
than 1% (0.8%) in the first year of use (Trussell, 2004a)
 in a long-term international study sponsored by the WHO, the
average annual failure rate was 0.4% or less, and the average
cumulative failure rate over the course of 12 years was 2.2%,
ADVANTAGES
  Highly effective and very safe
  Reversible and economical
  May be safely used 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)
  Once inserted, they are convenient and extremely easy to
use, providing worry-free continuous protection
  Allows privacy and control over her fertility (client does not
have to use anything at the time of sexual intercourse)
  Does not interact with medications client may use
  No systemic side effects as its effects are confined to the
uterus
DISADVANTAGES

 Requires a pelvic exam to insert the IUD

 Requires a trained health service provider to
insert/remove the IUD  Does not protect against
STIs
 Increases the risk of PID for women with STIs
 Device may be expelled, possibly without the
woman knowing it (especially for postpartum
insertions)
WHO CAN USE INTRAUTERINE
DEVICE:
 Most women can use IUDs safely and effectively, including women who:
 Have or have not had children
 Are married or are not married
 Adolescents and of women who are over 40 years old
 Have just had an abortion (if no evidence of infection)
 Are breastfeeding
 Do hard physical work
 Have had ectopic pregnancy
 Have had pelvic inflammatory disease
 Have vaginal infections
 Have anemia
 Have HIV clinical disease that is mild or with no symptoms
COUNSEL CLIENT ON THE
FOLLOWING:
 INSTRUCT THE CLIENT TO IMMEDIATELY SEEK CONSULTATION
WHEN:
 ■ She thinks that she may be pregnant. This is when she has
missed a menstrual period and has signs of pregnancy.
 ■ She thinks that the IUD might be out of place.
 ■ She has symptoms of infection like increasing or severe
pain in the lower abdomen, pain during sexual intercourse,
unusual vaginal discharge, fever, chills, nausea and/or
vomiting
THE SIGNS OF COMPLICATION: (P -A-I-N-S)

- Period late
- Abdominal pain
- Infection
- Not feeling well
- Strings missing or longer
IMPLANTS

 Small plastic rods, each about the size of a

matchstick, that release a progestin like the
natural hormone progesterone in a woman’s body.
 Do not contain estrogen, and so can be used
throughout breastfeeding and by women who
cannot use methods with estrogen.
TYPES OF IMPLANTS:
 1. Jadelle: 2 rods containing levonorgestrel, highly effective
for 5 years
 2. Implanon NXT (Nexplanon): 1 rod containing etonogestrel,
labeled for up to 3 years of use (a recent study shows it may
be highly effective for 5 years). Replaces Implanon; Implanon
NXT can be seen on X-ray and has an improved insertion
device
 3. Levoplant(Sino-Implant (II)), 2 rods containing
levonorgestrel. Labeled for up to 4 years of use
 4. Norplant,which consisted of 6 capsules and was effective
for 5−7 years, was discontinued in 2008 and is no longer
available for insertion. A small number of women, however,
may still need Norplant capsules removed.
MECHANISM OF ACTION:

Preventing the release of eggs from

the ovaries (ovulation)
■ Thickening cervical mucus (this
blocks sperm from reaching an egg
SIDE EFFECTS

 Changes in bleeding patterns including:

 First several months to a year
 Lighter bleeding and fewer days of bleeding
 Prolonged bleeding
 Irregular bleeding
 Infrequent bleeding
 No monthly bleeding
 After about 1 year:
 Lighter bleeding and fewer days of bleeding
 Irregular bleeding
 Infrequent bleeding
 No monthly bleeding
 Headaches
 Abdominal pain
 Acne
 Weight changes
 Breast tenderness
 Dizziness
 Mood changes
 Nausea
Health benefits

 Help protect against:

 Risks of pregnancy, including ectopic pregnancy
 Symptomatic pelvic inflammatory disease

 May help protect against:

 Iron deficiency anemia

 Reduces risks of:

 Ectopic pregnancy
WHO CAN USE IMPLANTS

 Women who:
 Have or have not had children
 Are married and are not married
 Adolescents and women over 40 years old
 Have just had an abortion
 Smoking
 Are breastfeeding
 Have anemia
 Have varicose veins
 With HIV
BILATERAL TUBAL LIGATION

 Tubal ligation is surgical procedure to prevent pregnancy. It has

commonly been called "getting your tubes tied." It is also called
a female sterilization.
• Tubal refers to the fallopian tubes. Each month, an egg is
released from an ovary and travels through the fallopian tube to
the uterus.
• Ligation means to tie off. This prevents the egg and male
sperm from connecting to prevent pregnancy.
What are the risks of a tubal
ligation?
• Bleeding from an incision or inside the abdomen
• Infection
• Damage to other organs inside the abdomen
• Side effects from anesthesia
• Ectopic pregnancy (an egg that becomes fertilized outside the
uterus)
• Incomplete closing of a fallopian tube that results in pregnancy
Vasectomy

  The service provider makes a puncture in the man’s

scrotum and ties and cuts the two vasa. The 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.
 Male sterilization
ADVANTAGES

 Very effective.
 ■ Permanent. A single decision leads to lifelong, safe, and
effective contraception.
 ■ 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.
 ■ Increased sexual enjoyment because no need to worry about
pregnancy.
 ■ No supplies to get, and no repeated clinic visits required.
 No known long-term side effects or health risks.
 ■ Compared to BTL, vasectomy is:
  More effective
  Safer
  Easier to perform
  Less expensive
  Able to be tested for effectiveness at any time
  If pregnancy occurs in the man’s partner, less likely to be
ectopic
DISADVANTAGES

 Requires minor surgery by a specially trained health care

provider.
 ■ Not immediately effective. The couple should use another
effective family planning method for at least three months after
the procedure.
 ■ Must be considered as permanent. Reversal surgery is more
difficult, expensive, may not be available in some areas, and
success is not guaranteed. Men who may want to have more
children in the future should choose a different method.
 ■ Does not protect against STIs including HIV/AIDS.
WARNING SIGNS

■ Severe bleeding or blood clots after the

procedure
■ Redness, heat, swelling, pain at the incision
site
■ Pus at the incision site
■ Pain lasting for months
THANK YOU!