Family Health updated PDF

Introduction to Family Health By: Firehiwot Haile (MPH RH) 2024G.C Learning Objectives  At the end of this session the student is expected to: Define family and family health List and discuss the major components of family health Discuss the charact...

Introduction to Family Health By: Firehiwot Haile (MPH RH) 2024G.C Learning Objectives  At the end of this session the student is expected to: Define family and family health List and discuss the major components of family health Discuss the characteristics of health family Discuss the determinants of family health  Definition of Family What is family?  A group of two or more persons related by birth, marriage, or adoption and residing together in a household  It is a smallest social unit  A basic structure of society centered about replacement  Every family is unique and it is affected by every aspect of community life  Types of family  Nuclear family: a family consisting of a married couples and their children; the children can be born or adopted  Extended family: a nuclear family plus collateral kinship  consisting of parents like father, mother, and their children, nieces, nephews, aunts, uncles, cousins, grandparents etc.  Joint family: a family consisting of two or more married couples staying together with children  Definition of Family Health  Health : a state of complete physical, mental and social well-being and not merely/only the absence of disease and infirmity (WHO, 1958)  Family Health: a state of positive interaction between family members which enables each members of the family to enjoy optimum physical, mental, and social well being  Is part of community health  Is a unit of health care  Major components of family health Reproductive health Safe motherhood,(family planning, antenatal care, obstetric care, post natal care, abortion care and control of STI/HIV/AIDS) Nutritional deficiencies LBW RTIs  Infertility Adolescent health (suicide, depression, STIs) Major components of family health … Child health Child bearing, rearing Child health services: nutrition, immunization, Growth monitoring Mortality and mortality of children Social health problems of children: Child abuse , street children, child labour, Juvenile delinquency, and battered baby syndrome  Major components of family health …  Gender issues in family: Girls trafficking, Gender mainstreaming, Female Genital Mutilation , female feticide (sex-selective abortion)  Aging: Problems of ageing, active ageing  Mental health: situation of mental health, its causes and prevention, National mental health policy  Characteristics of healthy family A healthy family is a stress effective family in that such a family is able to function at its fullest capacity, and is able to cope with demands of daily life Commitment : A family is like an organism, with life and vitality. It is made of many interdependent parts. For the family to survive, those interdependent parts (different roles in the family) must work together, coordinate, and be supportive of each other Togetherness: the family should spend time together in such activities as playing games, taking family vacations, and celebrating birthdays and holidays together Appreciation: high degree of mutual admiration and appreciation between members of families for their job plays important role to have healthy family  Characteristics of health family… Good communication: Good communication creates a sense of belonging, reduces frustration, reduce redundancy, and enhances marital relationships Spiritual well-being: When family members share a common faith, it reassures their mutual support, and tends to be more patient, forgiving, and broadly accepting of each other Our differences in faith create distance between us Coping with crisis and stress : Healthy families are able to face reality and creatively, systematically, and rationally overcome crises together, family members must depend on each other’s mutual trust and interdependence  The determinants of family health Income and Social Status: Healthy families are those in societies which are prosperous and have an equitable distribution of wealth Education: Health status a family improves with level of education , Effective education for children and lifelong learning for adults are key contributors to health and prosperity of the family Employment and Working Conditions: unemployment, stressful or unsafe work are associated with poorer health outcome Social Support Networks: Support from families, friends and communities helps families to solve problems, associated with better health outcome  The determinants of family health…  Social Factor: Availability of resources to meet daily needs, Social norms and attitudes, such as discrimination, Exposure to crime, violence  Physical Environments: an exposure to toxic substances and other physical hazards and , contaminants of air, water, food and soil can cause a variety of adverse health effects  Health Services: Lack of access, or limited access, to health services greatly impacts an individual’s health status  Genetics: Hereditary disease such as sickle-cell anemia, hemophilia, heart disease, and cystic fibrosis Carrying the gene, which increases risk for breast and ovarian cancer  The determinants of family health…  Lifestyle/ individual behaviors: Dietary practice, physical activity , Hygiene , alcohol consumption , cigarette smoking , and other drug use plays a role in family health outcomes  Gender: Gender based domestic violence, male dominating societies, lack of women participation in health decision making process will affect greatly on overall concept of healthy family  Culture: Marginalization, stigmatization, loss or devaluation of language and culture and lack of access to culturally appropriate health care and services badly affect the family health Introduction to Reproductive Health(RH)  Learning Objectives At the end of this session the learners will be able to: Define RH Discuss the concept of RH Discuss the components of RH Discuss youth friendly health services  Definition of RH  RH is a “state of complete physical, mental & social wellbeing & not merely the absence of disease or infirmity, in all matters related to reproductive systems & to its functions & process (ICPD,1994)  RH encompasses three main points : 1. Sexual health 2. Reproductive freedom (access to information, methods and services in reproductive health matters) and 3. Safe motherhood.(safe pregnancy, safe childbirth and healthy children)  Sexual Health  A state of physical, emotional, mental, and social wellbeing in relation to sexuality; it is not merely the absence of disease, dysfunction, or infirmity  It includes a positive and respectful approach to sexuality and sexual relationships that are free of coercion, discrimination, and violence  Brain storm Sexuality? Sensuality ? Sexualization?  Sexuality It is a central aspects of humanity which includes:  Sex  Gender identities and roles  Sexual orientation  Sexual pleasure  Sexual intimacy and Reproduction  Sexuality is experienced and expressed in thoughts, fantasies, desires, beliefs, attitudes, values, behaviors, practices, roles and relationships Sensuality: Awareness and feeling with one’s own body and other people’s bodies, especially the body of a sexual partner: – Sensuality enables us to feel good about how our bodies look and feel and what they can do  Concept of RH Reproductive health implies A responsible, satisfying and safe sex life Successful maternal and infant survival Freedom to control reproduction Ability to minimize gynecological disease throughout life  Concept of RH Cont.. Women and men have the right:  To be informed and have access to safe, effective, affordable and acceptable Family Planning services  To have access to appropriate health care services that enable women to go safely through pregnancy and childbirth and provide couples with the best chance of having a healthy infant  Concept of RH Cont..  The concept of reproductive health is based on the equality between men and women  Human health, especially women’s right is central to reproductive health  The definition of RH is not merely about reproduction  It must be viewed as three interconnected domains:-  Universal rights,  Women’s empowerment, and  Health service provision  Components of RH care  Quality family planning counseling, information, education, communication (IEC) and services  Prenatal, safe delivery and post natal care, including breast feeding  Prevention and treatment of infertility  Prevention and management of complications of unsafe abortion  Safe abortion services, where not against the law  Components cont…  Treatment of reproductive tract infections, STI and other conditions of the reproductive system  Information and counseling on human sexuality, responsible parenthood and reproductive health  Active discouragement of harmful practices  Referral for additional services related to: family planning, pregnancy, devilry, abortion, infertility, RTI, cancer of reproductive organ  Youth Friendly Health Services: Defined by WHO as “Services that are: accessible, safe, effective, acceptable, and appropriate for adolescents in meeting their need, in the right place, at the right price (free where necessary)”. Are services that cater for the SRH needs of young people aged 10-24 years  YFHS… YFHS is an approach which brings together the qualities that youth people demand, with the high standards that have to be achieved in the best public services  Youth-friendly Health service characteristics Youth-Friendly Health Facility Characteristics Youth-Friendly Provider Characteristics Youth-Friendly Health Facility Programming Characteristics  Youth-Friendly Health Facility Characteristics  Convenient location  Adequate space  Counseling areas that provide visual and auditory privacy  Examination areas that provide visual and auditory privacy  Comfortable surroundings  High quality adolescent health materials available  Clear and visible information about youth clinic hours and location  Displays of information and health education materials on issues related to adolescent sexual and reproductive health  Teen-focused magazines and poster displayed on the walls 12/16/2024 28  Youth-Friendly Provider Characteristics  Familiarity with adolescent physiology and development  Counseling training  Skills to communicate fluently in the youth language  Effective interpersonal skills  Ability to relate to youth in a respectful manner  Skills to honor youth privacy and confidentiality  Knowledge of appropriate medical options for adolescents according to age and maturity  Skills to engage in conversation about body image and development, sex, relationships, and contraceptive method options 12/16/2024 29 Youth-Friendly Health Facility Programming Characteristics  Affordable fees  Boys and young men welcomed and served  Youth involvement in design and continuing feedback of programming  Wide range of services available including pregnancy and birth control counseling, STI/HIV testing and treatment  Flexible hours; offering lunch, evening and weekend appointments  Well-established mechanism to allow for slightly longer visits with adolescents  Clinic staff is called by first name to make the environment more informal and welcoming  Drop-in clients welcomed and appointments arranged rapidly  Well-established linkages and referrals to mental health, education, employment, and social services 12/16/2024 30 Why do you think that most adolescent not utilize YFS?  Factors Affecting Utilization of YFHS  Lack of knowledge on the part of the youth  Cultural barriers  Gender barriers  Poor quality of clinical services  Unwelcoming services  High cost  Peer pressure 12/16/2024 32  Maternal Health and Safe Motherhood Learningobjectives: By the end of this session students will be able to discuss:  Define Maternal Health  Describe causes of Maternal Mortality and Morbidity  Discuss key intervention strategies for maternal health  Discuss major components of maternal health services  Introduction Maternal health according to (WHO) refers to the health of women during pregnancy, childbirth and the postpartum period. It encompasses the health care dimensions of: family planning, preconception, In order to ensure a positive and prenatal, and fulfilling experience in most cases and reduce maternal morbidity and postnatal care mortality in other cases. 12/16/2024 34  Introduction Women’s health needs differ from those of men because of Biological differences Gender differentials in exposure to risk factors Unlike men, women need health services even when they are not ill to:- Prevent unwanted pregnancies, carry wanted pregnancies to term,  Deliver safely 12/16/2024 35 Introduction Every minute  380 women become pregnant  190 women face unplanned or unwanted pregnancy  110 women experience a pregnancy related complication  40 women have an unsafe abortion  1 woman dies from a pregnancy-related complication every two minute  800 women dies every day due to pregnancy or child birth related causes. 12/16/2024 36  Maternal Morbidity and Mortality Maternal Morbidity:  Any departure, subjective or objective, from a state of physiological or psychological well-being (during pregnancy, childbirth and the postpartum period up to 42 days or 1 year) 12/16/2024 37  Maternal Mortality  A maternal death : the death of a woman while pregnant or Within 42 days of termination of pregnancy, irrespective of the duration and the site of the pregnancy, from any cause related to or aggravated by the pregnancy (WHO 1993)  Pregnancy-related death: The death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the cause of the death  The difference is that pregnancy-related deaths include deaths from all, including accidental and incidental causes 12/16/2024 38  Maternal mortality… Late maternal death  The death of a woman from direct or indirect obstetric causes more than 42 days but less than one year after the termination of pregnancy Identifying late maternal deaths makes it possible to count deaths in which a woman had problems that began during pregnancy, even if she survived for more than 42 days after its termination 12/16/2024 39  Global situation in MM  Global: in 2020: MMR 223 deaths per 100,000 live births  Ethiopia: in 2022 MMR is 267 women die per 100,000 live births 12/16/2024 40  Trend of maternal mortality 12/16/2024 41  Causes of MM  DIRECT CAUSES (72%): Those resulting from Obstetric complications (pregnancy, labor, & puerperium) Interventions omissions Incorrect treatment A chain of events resulting from any of the above. – Including, Hemorrhage (APH, PPH), Sepsis, Unsafe abortion, Hypertensive disorders of pregnancy (Preeclampsia, eclampsia), Obstructed labour 12/16/2024 42 World wide causes of maternal mortality  Causes of MM… Indirect causes (28%): Those resulting from Previous existing diseases or Diseases that developed during pregnancy and which is not due to direct obstetric causes but aggravated by physiologic effects of pregnancy. Existing cardiovascular diseases, malaria, anemia, HIV/AIDS etc 12/16/2024 44  The Road To Maternal Mortality THE THREE DELAYS MODEL – Maternal death results as a result of the three delays. – Once the pregnancy occurred women experience the classic three delays 12/16/2024 45  THREE DELAYS… The first delay Is the delay in deciding to seek care for an obstetric complication. – Failure to recognize signs of complications – Failure to perceive severity of illness – Fear of the costs – Previous negative experience with the health system Usually caused by socio economic factors – Women’s status, literacy, Income, employment, workload, Culture, Values, Beliefs 12/16/2024 46  THREE DELAYS… The second delay Delay to go to health facility after the decision has been made to seek care. This is a delay in physically reaching the care facility Usually caused by inaccessibility of service – Difficulty in finding or paying for transportation. – Lack of available transportation – Conditions of roads 12/16/2024 47  THREE DELAYS… The third delay – Is the delay in obtaining care once present at the facility. – Women wait for many hours at the referral centre because of  Poor skills of health providers  Shortages of supplies and basic equipment  Difficulties in obtaining blood supplies, equipment or an operating theatre  Non-availability of health personnel 12/16/2024 48 THREE DELAYS… 12/16/2024 49  Maternal Health services(safe motherhood)  It is a comprehensive care given before, during and after pregnancy and delivery.  Making motherhood safe requires action on three fronts:  Reducing the numbers of high-risk and unwanted pregnancies  Reducing the numbers of obstetric complications  Reducing the case fatality rate in women with complications 12/16/2024 50  Key strategies to Safe Motherhood Achieving safe motherhood and reducing maternal mortality requires a three-pronged strategy: Prevention of Prevention complications Prevention of of pregnancy death (Maternity care) (FP) (EOC) 12/16/2024 51  Pillars of safe Motherhood 12/16/2024 52  Essential services of safemotherhood 1. Preconception care 2. Antenatal care 3. Delivery services 4. Postpartum care 5. Post-abortion care 6. Family planning 7. RHeducation and services for adolescents 8. Community education on safe motherhood 12/16/2024 53  ANTENATAL CARE(ANC)  ANC is a care given to pregnant women with the aim of improving the maternal and perinatal out come  All pregnant women should have a minimum of 8 antenatal contacts (at least 20 minutes duration each)for: - Prevention, - Early detection and - Management of complications.  Benefits of Antenatal Care  Used as an opportunity to provide information to women and their families about:  Danger signs and symptoms during pregnancy and delivery  Developing an appropriate delivery/birth plan  Unique opportunity for early diagnosis and treatment of problems like:  Maternal problems: anemia, vaginal bleeding, preeclampsia/eclampsia, infection  Fetal problems: Abnormal fetal growth or movement, abnormal fetal position  HIV, syphilis, malaria, malnutrition  What is Focused Antenatal Care(FANC)? - Focused Antenatal Care is a care routinely provided to all pregnant women from screening to intensive life support provided to any woman while pregnant and up to delivery - “Having one or more visits with a trained person during pregnancy” can detect early signs of disease or risk factors and timely intervention (WHO). 12/16/2024 56  Approach ofFANC An approach of ANCthat emphasizes: Individualized care Client- centered Fewer but comprehensive visits Disease detection, not risk Care by a skilled provider 12/16/2024 57  Goals ofFANC - Early detection and treatment of problems and complications - Prevention of complications and disease - Birth preparedness & complication readiness - Health promotion 12/16/2024 58 WHO’s 2016 ANC Model WHO recommends a minimum of eight contacts: five contacts in the third trimester, one contact in the first trimester, and two contacts in the second trimester 12/16/2024 59 12/16/2024 60  Evidence-based ANC interventions - Prevention, detection, investigation of anemia and treatment of iron-deficiency anemia reduces maternal anemia. - Detection, investigation and treatment of Hypertensive disease in pregnancy/pre-eclampsia, controls disease (reduces case Fatality among women and newborns) 12/16/2024 61  Evidence-based ANC interventions - Treatment of Eclampsiareduces:  Case fatality among women and newborns,  Recurrent convulsions (mgso4) - Prevention of obstructed labor  Reduces C-section and death 12/16/2024 62  Evidence-based ANC interventions - Breastfeeding counseling  Increases rates of exclusive breastfeeding - Follate supplementation  Reduces risk for neural tube defects 12/16/2024 63  Evidence-based ANC interventions - Immunization against tetanus and promotion of  clean delivery  Prevents maternal and newborn tetanus - Screening for infection: syphillis, gonorrhea  Reduces fetal loss, LBW, maternal/infant morbidity - Screening for infection: bacteriuria  Prevents preterm delivery and LBW 12/16/2024 64 Trends of ANC use in Ethiopia EDHS, ANC use – In 2000 around 27% – In 2005 around 28% – In 2011 around 34% – In 2016 around 62% – in 2019 around 70% 12/16/2024 65  Intra-partum care – Aims  Clean and safe delivery  Recognition, early detection and management of complications at health center or hospital (for example, hemorrhage, eclampsia, prolonged/obstructed labour) – Strategy  All women and birth attendants should be aware of the requirements for a clean delivery: clean hands, clean delivery surface, clean cord cutting and care  Intra-partum care – All health care providers should be trained in and practice clean and safe delivery techniques and avoid unnecessary vaginal examinations and episiotomies. – All women and their birth attendants should be aware of the need to refer cases of prolonged or obstructed labour to a higher level of care. – All institutional deliveries should be monitored using an appropriately adapted version of a partograph in order to prevent prolonged labour. 12/16/2024 67  The five cleans in deliverycare – Clean hands – Clean delivery surface – Clean perineum – Clean cord cutting – Clean environment 12/16/2024 68  Intra-partum care – Intra-partum care strategies are critical to reduce maternal mortality – The single most critical intervention for safe motherhood is to ensure: o Askilled health professional is present in everybirth, o Access to an emergency obstetric care in case of complications 12/16/2024 69  Institutional delivery  The proportion of births occurring in health facilities in the area  A key strategy to ensure skilled care during childbirth is to that all births take place in health facilities in which obstetric complications can be treated when they arise  The situation in Ethiopia EDHS 2005- 5 EDHS 2011- 10 EDHS 2016- 26 EDHS 2019- 48  Skilled birthattendance o The skilled attendance is defined as a process through which a woman is provided with adequate care during labor, delivery, and the postpartum period o Skilled attendance depends on; – The presence of a skilled attendant – The enabling environment 12/16/2024 71  Enabling environment 1.Availability of drugs and suppliesto Availability of provide skilled care at different levels. skilled providers 2.Availability of functioningreferral system at different levels 3.Awareness and readiness of the community for utilizing skilledcare 4.Supporting policy and political commitment Skilled attendance 12/16/2024 72  Skilled attendant at birth –Most maternal deaths are due to a failure to get skilled help in time for deliverycomplications. – Skilled attendant refers exclusively to people with midwifery skills (for example midwives, doctors and nurses) who have been trained to proficiency in the skills necessary to manage normal deliveries and diagnose, manage or refer obstetric complications. 12/16/2024 73  Minimum set of skills forthe skilled attendant – Take a detailed history, ask relevant questions, demonstrate cultural sensitivity, and use good interpersonal skills. – Perform a general examination, identify deviations from normal, and screen for conditions that are prevalent or endemic in the area. – Take vital signs (temperature, pulse, respiration, blood pressure) 12/16/2024 74  Minimum set of skillsfor the skilled attendant – Auscultate the foetal heartrate. – Calculate the estimated date of delivery. – Provide appropriate intervention (including referral) for intrauterine foetal death, mal-presentations and abnormal lies at term, multiple pregnancy, poor nutrition and anaemia, pre-eclampsia, rupture of membranes prior to term, severe vaginalbleeding 12/16/2024 75  Minimum set ofskills for the skilled attendant – Perform an abdominal examination, identifying abnormalities and factors that place the us atrisk – Assess the effectiveness of uterine contractions – Perform a vaginal examination – Use the partograph 12/16/2024 76 Birth attended by a skilled provider 2005-2019  Postpartum care Postpartum care is the medical care a woman receives after childbirth. It focuses on the physical and emotional recovery of the mother and the well-being of the newborn baby. This period typically lasts for 6-8 weeks, during which the mother's body undergoes significant changes as it returns to its pre-pregnancy state  PPC cont… The main life threatening complications of postnatal period include haemorrhag, anemia genital trauma, hypertension, sepsis, urinary tract infections and mastitis. All women should receive a postpartum visit within the first week of delivery in order to ensure early detection and management of hypertension, haemorrhage and sepsis. –However, all women should be assessed within 24 hours after delivery.  Postpartumcare cont… –Management of complications at health centre or hospital (for example, haemorrhage, sepsis and eclampsia) –Promotion and support to breastfeeding and management of breast complications) –Information and services for family planning –STD/HIV prevention and management –Tetanus toxoid immunization 12/16/2024 80  Postpartum care: Newborn care –Resuscitation –Prevention and management of hypothermia –Early and exclusive breastfeeding –Prevention and management of infections including ophthalmia neonatorum and cord infections –Recording of birth weight and referral of newborn for immunizations and growth monitoring 12/16/2024 81  Post-abortion care Mortality due to unsafe abortion –Worldwide, 20 million unsafe abortions occur each year –70,000 women die each year as a result of complications following abortion. –1 in 8 pregnancy related deaths are due to unsafe abortion. 12/16/2024 82  Comprehensive post-abortion care –Emergency treatment of incomplete abortion and potentially life threatening complications –Post-abortion family planning counseling and services –Links between post-abortion emergency services and the reproductive health care system. 12/16/2024 83  Emergency treatment for post-abortion complications – Initial assessment to confirm the presence of abortion complications. – Medical evaluation (brief history, limited physical and pelvic examinations. – Prompt referral and transfer if the woman requires treatment beyond the capability ofthe facility. – Stabilization of emergency conditions and treatment ofany complications. – Uterine evacuation to remove retained products of conception. 12/16/2024 84  Links to other reproductive healthservices –Identify the reproductive health servicesthat each woman may need –Offer as wide a range of services as possible  Eg Treatment of STIs, Cervical Cancer screening 12/16/2024 85  Gender and Reproductive health Sex is biological or reproductive differences based on genitalia, chromosomes, hormones (Male or Female) Gender refers to the economic, social and cultural attributes and opportunities associated with being male or female in a particular social setting at a particular point in time Sex Gender Biological Social Born Not born Natural learned Universal Local Unchangeable Changeable Characteristics of gender Relational Socially constructed Hierarchical Power relations (unequal power relationships due to the greater importance and value to the characteristics and activities associated with what is masculine) Changes: Changes over time (potential for modification through development interventions Context specific Varies with ethnicity, class culture etc. Institutional Systemic (a social system that is supported by values, legislation, religion, etc.)  Gender equality: Is equal treatment of women and men in laws and policies and equal access to resources and services within families, communities and society at large  Gender equity Is fairness and justice in the distribution of benefits and responsibilities between women and men. It often requires women‐specific programs and policies to end existing inequalities  Gender discrimination - any distinction, exclusion or restriction made on the basis of socially constructed gender roles and norms which prevents a person from enjoying full human rights  Gender stereotypes: believing or thinking that gender roles are natural and we don't question them.  Gender mainstreaming: the incorporation of gender issues into programs  Gender analysis: a research tool that helps policy makers and program managers appreciate the importance of gender issues FIREHIWOT HAILE (MPH/RH) 2024G.C  Session objective By the end of this session students will be: – Define FP – List types of FP methods – Explain objectives of FP – Discuss rationale/advantage of FP – Explain the advantages, disadvantages, indications and contraindications of contraceptives  Introduction Contraception?  Contraception is the intentional prevention of pregnancy during sexual intercourse  It is the device and/or practice to decrease the risk of conceiving, or bearing offspring 93  Family planning:  The decision-making process by couples, together or individually: on the number of children that they would like to have in their lifetime, and the age interval between children.  This means that both halves of a couple have equal rights to decide on their future fertility. 94 Objectives of family planning  Limit family size  Adequately space children  Reduce maternal and child morbidity and mortality related to complications of unwanted and high risk pregnancies  Help infertile couples to bear children  Advantages of FP  For women – Avoid unwanted and high risk pregnancies – Reduce morbidity and mortality  Children – Avoid morbidity and mortality – Better feeding, Care, Clothing, Schooling  Family – Improves family well-being – Better food, clothing, housing, and living  Nations – Better Economic development – People's economic situation move faster in countries where women have fewer children. – Less unproductive force – FP reduces youth dependency ratio – Conservation of Natural resources – reduces the exploitation of natural resource by reducing population growth  World/Earth – Low demands on natural resources – Better opportunity for better life  Family planning methods Refers to methods or ways by which unwanted pregnancy is prevented Not all these methods are equally effective, safe or equally acceptable Therefore, individualization of contraceptive choice is important for successful prevention of pregnancy Classifications Hormonal Cotraceptive Methods A. Oral contraceptives  Oral contraceptives are pills that a woman takes by mouth to prevent pregnancy.  They contain two female hormones, estrogen and progestin (combined oral contraceptives (COCs» or progestin only.(progestin-only pills (POPs). 101 102 Combined Oral Contraceptives (COCs)  Combined oral contraceptives are preparations of synthetic estrogen and progesterone which are highly effective in preventing pregnancy.  Pills that contain low doses of two hormones-a progestin and an estrogen.  Instructions: Begin with:  The onset of menses  6 weeks after delivery if breast feeding  After 3 weeks if not breast feeding  Immediately or with in 7 days after abortion  Packing of 28 tablets containing 21 hormonal tabs and 7 placebo or iron 103 The two forms of low-dose COCs:  Monophasic– each active pill contains the same amount of estrogen and progestin  Biphasic– the active pills in the packet contain two different dose-combinations of estrogen and progestin. 12/16/2024 104  For example in a cycle of 21 active pills, 10 may contain one combination while 11 contain another  Triphasic– the active pills contain three different dose combinations of estrogen and progestin  Out of a cycle of 21 active pills, 6 may contain one combination, 5 another combination, while 10 pills contain other combinations of the same two hormones  COCs: Mechanisms of Action Suppress ovulation Reduce sperm transport in upper genital tract (fallopian tubes) Change endometrium making implantation less likely Thicken cervical mucus (preventing sperm penetration) 3 106 106 Advantages  Contraceptive Highly effective when taken correctly and consistently Effective immediately (after 24 hours) Do not interfere with intercourse Convenient and easy to use Client can stop use any time they want to get pregnant can be provided by trained person 107  Non-contraceptive  Decreased menstrual flow (lighter, shorter periods) and may improve iron deficiency anemia  Decreased menstrual cramps  May lead to more regular menstrual cycles  Protects against ovarian and endometrial cancer  Decreases benign breast disease and ovarian cysts.  Prevents ectopic pregnancy  Protects against some causes of PID 108  Disadvantages  User-dependent (require continued motivation and daily use)  Some nausea, dizziness, mild breast tenderness or headaches as well as spotting or light bleeding (usually disappear within 2 or 3 cycles)  Effectiveness may be lowered when certain drugs like rifampin, phenytoin, and barbiturates are also taken 109  Cont…  Forgetfulness increases failure  Serious side effects (e.g., heart attack, stroke, blood clots in lung or brain, liver tumors)  Resupply must be available  Does not protect against GTls or other STDs (e.g., HBV, HIV/AIDS) 110  Contra-indications Pregnancy (known or suspected) Breast-feeding and fewer than 6-8 weeks postpartum Unexplained vaginal bleeding (until evaluated) Active liver disease (viral hepatitis) Age 35 and smoker History of heart disease, stroke or high blood pressure (> 180/110) 111 How to Take COCs: Schedule and Missed Pills Schedule: Quick start in COC Take one pill every day 21-day packs  7-day break 28-day packs  no break between packs Missed pill: Take missed pill as soon as remembered Missed 1 or 2 Keep taking other pills on schedule active pills No backup method needed Source: WHO, 2004. 113 How to Take COCs: Missed Pills Miss 3 or more Take first missed pill as soon as you remember active pills or Continue daily pill taking as usual and use start pack 3 or backup method or abstain for next 7 days more days late Count number of active pills remaining in pack 7 or more active Fewer than 7 active pills left in the pack pills left in the pack Finish active pills Finish active pills Discard inactive pills Take hormone-free break Start new pack immediately Source: WHO, 2004. 114 Progestin Only Pills (POPs)  As the name indicates the pill only contains progestin, no estrogen.  These pills may be used during breast-feeding period, as they do not reduce milk flow.  The tablets must be taken at the same time each day without interruption or contraceptive safety will be reduced.  As there is no estrogen in the pills there is an increased chance of spotting when used by menstruating115women. Mechanism of action  Thickens cervical mucus,  preventing sperm penetration.  Suppresses ovulation  Makes the endometrium less favorable for implantation  Reduces sperm transport in upper genital tract (fallopian tube) 116 Advantages  Contraceptive  Effective when taken at the same time every day (0.5- 10 pregnancies per 100 women during the first year of use)  Immediately effective (