Family Planning 2024 PDF

FAMILY PLANNING. O IMPORTANCE FOR FAMILY PLANNING Decrease birth rate Decrease maternal mortality Reduce unwanted and high- risk pregnancies Reduce Infant mortality rate  TYPES 1. Natural contraception 2. Mechanical contraception 3. Hormonal contraception 4. Surgical contraceptio...

FAMILY PLANNING. O IMPORTANCE FOR FAMILY PLANNING Decrease birth rate Decrease maternal mortality Reduce unwanted and high- risk pregnancies Reduce Infant mortality rate  TYPES 1. Natural contraception 2. Mechanical contraception 3. Hormonal contraception 4. Surgical contraception Natural family planning methods(NFP)& Fertility Awareness based methods(FAM) Definition : use of signs ,symptoms and cycle data to determine when ovulation occurs. When couples are using NFP ,they should abstain from intercourse during the risk fertile days.  With FAM , couples use another method such as barriers or withdrawal during those days.  The same techniques used to teach fertility awareness can be used either to prevent pregnancy or to help a woman become pregnant. Natural Family planning methodsFertility Awareness based methods(FAM)  Calendar (Rhythm) method  Basal body temperature(temp elevate during ovulation 0,5 c)  Cervical mucous method  Symptothermal method :( Cervical mucous + body temperature )  Lactational amenorrhea method  Withdrawal ( Coitus interruption ) WHO CAN USE? Clients choice is influenced by religion or other personal reasons Other methods are contraindicated Medical care is inaccessible An inexpensive method is required Withdrawal or Coitus interruption  When having sex, ejaculation out side vagina.  This is intended to stop sperm from entering the uterine cavity.  This method frequently fails as drops of sperm can already escape from the penis into the vagina before the man ejaculates.  Effectiveness: Failure rate can be as high as 15% (15 pregnancies per 100 women).  More reliable methods are advised , require self control . The oldest methods  Calendar (Rhythm) method Record the first day of each menstrual cycle for 6-12 months Determine the beginning of the fertile period by subtracting 18 days from the shortest cycle Determine the end of the fertile period by subtracting 11days from the longest cycle If your longest period is 31 and the shortest 23days ,then your fertile period is from the 5th to the 20th day of her menstrual cycle i.e. 16 days  A woman can use the Stander Day Method if most of her menstrual periods are 26 to 32 days long.  Days 8 to 19 of each cycle are considered as fertile days. Lactation Amenorrhea Method(LAM)  A family planning method based on breastfeeding LAM is an effective method only under specific conditions: Woman breastfeeding exclusively , both day and night on demand (at least 90% of baby’s nutrition derived from breastfeeding) The woman has no menses The infant is less than 6 months old. Mechanical family planning methods or barrier methods  The barrier method is the method in which the vehicles prevent sperm from entering the cervical os.  Male condoms  Female condoms  Diaphragms  Spermicidals  Sponge  BARRIER METHODS  ACTION:  Create a barrier that keeps sperm from entering the vagina,  thus preventing pregnancy  ADVANTAGES :  Easy available , only when required.  Afford some protection against STD.  DISADVANTAGES:  Interruption to intercourse.  Allergy.  BARRIER METHODS  Male Condom:  It's a thin latex or plastic sheath placed over a man's erect penis during sex to trap sperm at the point of ejaculation.  Using Condom : Rolled on to the erect penis & must be applied before any genital contact & prior ejaculation.  Also form a barrier against STIs including HIV male condoms  Characteristics of Male Condoms Safe and easy to use , Widely available  condoms prevent STIs transmitted through body fluids such as gonorrhea and chlamydia  No hormonal side effects  Can help men with premature ejaculation  Can be used as temporary backup method  Require partner communication and cooperation  Can be damaged by oil based lubricants, heat, humidity or light  May reduce sensation  Can interrupt sex BARRIER METHODS  Diaphragm: is a thin rubber dome with the circumference of metal to help maintain its shape , available in sizes require assistance by doctor to be fitted, can stay for ayears  Should cover the cervix & spermicidal should apply before insertion.  Should left 6 hr post intercourse , if intercourse not happen within 3 hr , another spermicide. should apply.  On removal , must be washed & inspected for any damage Diaphragm  BARRIER METHODS_ mechanical  Spermicidal creams, vaginal tablets , jellies & pessaries : These preparation kill spermatozoa  Work by causing the membrane of sperm cells to break, killing them or slowing movement.  Must be apply immediately before, in case of pessaries 10 minutes before intercourse.  Spermicide are not as effective when used alone. BARRIER METHODs…….  Cervical cap & vault cap :  Cervical caps is also placed deep in the vagina before sex, covering the cervix as a barrier  These only cover the cervix , adhering to it by suction,  Similar to the diaphragm but uncommon,  Latex female condoms:  transparent sheath that fits loosely inside a woman’s vagina  Severe allergic reaction to latex is the only condition that prevents use (UNCOMMON) cervical cap female condoms  INTRAUTERINE CONTRACEPTIVE DEVICE  is a birth control device placed in the uterus. It is also known as an IUCD.  Small plastic device with copper sleeves or wire around it, inserted through the vagina and cervix into the uterus  – Safe , reversabile  – Highly effective (94-99%),  – Long acting (up to 10 years)  – Require trained provider to insert and remove  It is the world's most widely used method of reversible birth control, IUCD device Mechanism of action  Prevents fertilization by:  Impairing the viability of the sperm.  IUCD create an inflammatory response , with increased number of leukocytes destroying the fertilized ovum  Interfering with movement of the sperm  The Copper IUCD change the endometrial enzymes which make the endometrium inappropriate for implantation Timing of IUD Insertion  Insertion time  5th day of menstruation  Postpartum insertion  Immediately after vaginal or cesarean delivery if there is  no infection or bleeding complications  or delay at least 6 weeks postpartum  Postabortion insertion  Immediately or within 12 days if no infection Common side effects:  – Heavier and/or prolonged menstrual bleeding  – Menstrual cramping  – Spotting between periods  Side effects are most common during the first 3−6 Months then relieved. Other uncommon complications:  Perforations—Very rare, 1 in 1,000 insertions  PID— due to STIs  Expulsion  Hormonal family planning methods  Hormonal contraception refers to birth control methods that act on the hormonal system  Types  Skin patch  Vaginal ring  Pills ( Combined & Minipill )  Injection  Implants HORMONAL METHOD OF CONTRACEPTION  Hormonal contraceptives can be given  orally,(pills)  vaginally,  trans dermally, injections  Oral type- Progestin only pills Known as mini pills contains progesterone only MECHANISM OF ACTION: thickens cervical mucus to prevent sperm entry into the upper reproductive part (main mechanism). Other mechanism include ovulation suppression(in about 50% of cycles ), It must be taken every day also during menstrual cycle at the same time, Benefits  Safe for breastfeeding women—No effect on breastfeeding, milk production or infant growth and development after infant is six weeks old  Adds to the contraceptive effect of breastfeeding— Together, if taken correctly, failure rate less than 1% during first year of use  Does not interfere with sex  Progestin-Only Pills: Limitations  Less effective for non-breastfeeding mother—If taken correctly, 3–10 women/100 will become pregnant first year  Pill must be taken every day  Bleeding changes (more frequent, irregular) are common but not harmful  A few women may have headaches, dizziness or breast tenderness  Provide back-up method (e.g., condoms) to use if/when pill is missed 32  COCs: Combined oral contraceptive pills  Pills that contain low doses of two hormones— a progestin and an estrogen  Also called “the pill”  Work primarily by:  Preventing the release of eggs from the ovary  Thickening cervical mucus so that sperm cannot penetrate 33  COCs: Mechanisms of Action Suppress ovulation Reduce sperm transport in upper genital tract (fallopian tubes) Thicken cervical mucus (preventing sperm penetration) 34  COCs: Key Benefits  Highly effective when taken daily (failure rate 0.1–0.5 % during first year of use)  Controlled, and can be stopped, by the woman  Does not interfere with sex  Helps protect against cancer of the uterine lining, cancer of the ovary, symptomatic pelvic inflammatory disease (PID) and anemia 36  COCs: Who Should Not Use (WHO) COCs should not be used if a woman:  Has breast cancer  Is 35 years old or older and smokes 15 cigarettes/day  Has diabetes (>20 years duration)  Has breast cancer  Has liver tumors  Has to undergo major surgery with prolonged bed rest Source: WHO 2004. 37  COCs: Counseling Considerations  Discuss limitations (side effects)  Can start three weeks after delivery if not breastfeeding; six months after delivery if breastfeeding  Can start even if menses has not started, as long as you are reasonably sure she is not pregnant, but will need to use condoms or abstain for the first week of use 38  COCs: Counseling on What to Do for Missed Pills (cont.)  Take a missed hormonal/active pill as soon as possible  Keep taking pills as usual, even if this means she will take 2 pills on same day  If missed 1 or 2 pills:  Take pill as soon as possible  If missed 3 or more pills in Week 1 or 2:  Take pill as soon as possible and use back-up method for seven days 39  Emergency Contraception (EC):  Methods that prevent pregnancy after unprotected sexual intercourse has occurred  Regular contraceptive pills (COCs or POPs) used in a special way.  Used in higher dosages  Used as soon as possible after unprotected sex(within 120 hours or five days) NOTE: Emergency contraception does not stop a pregnancy that has started! 40  Vaginal Ring  A soft, flexible vaginal ring, which delivers low doses of estrogen and progestin into the body.  This helps prevent pregnancy by suppressing ovulation and thickening the cervical mucus, which helps block sperm from entering the uterus.  The ring is inserted into the vagina and left for 3 weeks. It is then removed for 1 week, during which a woman menstruates, and a new ring is inserted after the 1-week "break.".  IMPLANTS  Implants are progestin only contraceptives inserted under the skin of women’s upper arm by a minor surgical procedure  Advantages: implants are a good method for women who want a long-term contraceptive, as each implant lasts for three- five years.  Disadvantages:  Irregular menses , amenorrhea could happen.  Insertion and removal may be associated with minor discomfort and skin discolouration  Effectiveness: 99%. implants  4.Injectables.  (a) Depo Provera: an injection of progesterone administered every three months.  (b) Noristerat – a 2 monthly injectable.  (c) Norigynon: a monthly injection of progesterone and eostradiol combination, recalled in 2002. Side effect for hormonal methods  Nausea  Weight change  Dizziness  Mild headaches  Breast tenderness  Mood changes  Breast tenderness  Amenorrhea Absolute Contraindications of Hormonal family planning methods  Family history of CVA  History of thromboembolic disease  History of liver disease  Undiagnosed vaginal bleeding  Vasectomy (Male Sterilization):  Permanent contraception for men who want no more children  A safe, convenient, highly effective and simple contraceptive procedure for men that is provided under local anesthesia in an out- patient setting  Surgery through a small incision in the scrotum that closes off the vas deferens, keeping sperm out of semen  After first 3 months, highly effective in preventing pregnancy (99.6 to 99.8% effective) 48 vasectomy  Postpartum (PP) Female Sterilization  Tubal ligation  Permanent contraception for women who want no more children  Performed by mini laparotomy, which involves small incision in abdomen  Works because fallopian tubes are blocked or cut so egg cannot move down tube and reach sperm  highly effective (99.5%); comparable to vasectomy, implants, IUDs  Ideally done within 48 hours after delivery  May be performed immediately following delivery or during cesarean section 50 tubal ligation