Dr. Douglas Huber discusses the reasons safely timing and spacing pregnancies is vital to women's health and the hazards of unintended pregnancies in the developing world.

1. Family Planning Strategies and Tools
for Success
Douglas Huber MD, MSc, Co-Chair FP/RH Working
Group
Christian Connections for International Health
(www.ccih.org)
Pre-Conference Workshop: Addressing Family Planning
from Christian Viewpoints
Marymount University, Arlington, VA
9 June 2012
1

2. Objectives
• Identify new family planning strategies and
tools for to achieve success in Christian
Health programs
• Enable Christian facilities, providers,
communities and congregations to use state-
of-the-art FP materials to maximize health
impact

3. New vision for family planning
• Family planning is to women’s health what
immunizations are to children’s health
Dr. Khama Rogo, World Bank, November 2009
• (to 1300 participants at the Uganda family planning
conference)
3

4. Family Planning and the Millennium
Development Goals
Family planning (FP) essential to all the MDGs
1. Poverty and hunger
2. Universal primary education
3. Gender equality
4. Child mortality
5. Maternal health, including increased FP
6. HIV/AIDS & other diseases
7. Environmental sustainability
8. Global partnerships
4

5. “The fastest, easiest, cheapest way to prevent
maternal deaths is with family planning”
• Modern contraceptives (pill, injection,
IUD) over 100 times safer than
pregnancy in Kenya & Sub-Saharan Africa
• Access to FP reduces maternal
mortality—global estimates of 30+%
reduction in MM if address unmet need
for FP
5

6. 6

7. Healthy Timing and Spacing of Pregnancies
To achieve a 36mo birth interval (including breastfeeding),
contraception must be used for 18-22 months postpartum
before trying to become pregnant again.
Contraception
Exclusive Can become
needed to space
breastfeeding up to pregnant again
pregnancies
6 months
2-6 mo
postpartum (2-6)-24mo Use Contraception >24
Delivery 6mo 24mo
Months
postpartum

8. Unmet Family Planning Need 1st Year
Postpartum (blue) & All Women (purple)
80
70
60
50
1st Year PP
40 All Women
30
20
10
0
B-desh Haiti Kenya Nigeria
Source: Borda, M. and W. Winfrey. Family Planning Needs
during the First Year Postpartum. ACCESS-FP.

9. Post Partum Family Planning:
Key Message
• After a live birth, couples should use an
effective family planning method of their
choice, continuously for at least 2 years before
trying to become pregnant again.
9

10. A guide to family planning
for health workers and their clients
FIELDTESTING DRAFT
World Health Organization
Adapted from the WHO's Decision-Making
March 2010 Tool for Family Planning Clients and
Providers

11. Comparing family planning methods—simplified for
clients & providers
Very effective in
Most effective in Effective in preventing
preventing pregnancy,
preventing pregnancy pregnancy, but must be
but must be carefully
and easiest to use carefully used
used
Fewer side-effects, Fewer side-effects: Fewer side-effects:
permanent: Breastfeeding
method
Male and Fertility
female awareness-
condom based methods
Female Vasectomy
sterilization
More side-effects--most More side-effects—most IMPORTANT!
are normal: are normal: Only condoms
protect
against
IUD
both
Pills Injectables
pregnancy
Implants and
STIs/HIV/AIDS
11
WHO, Jan 2010. DRAFT

12. Breastfeeding method (LAM)
Safe with no side-effects
Effective IF:
 your monthly bleeding has not returned
 you are breastfeeding often, day and night, and
giving no other food or liquids
 your baby is less than 6 months old
12

13. Breastfeeding method (LAM)
What it is
– Using breastfeeding to delay next pregnancy
– Prevents the release of the egg
How to use
– You will need to breastfeed often, day and night, and give no other food or liquids
(breastfeed fully or nearly fully so that monthly bleeding does not return)
What to expect
– No monthly bleeding
Key points
– Very effective for 6 months if fully breastfeeding
– Have another method ready to start in combination with breastfeeding (for extra
effectiveness) before 6 months, especially if monthly bleeding returns or
breastfeeding decreases
– Does not protect against STIs or HIV/AIDS – discuss condoms
Breastfeeding
method 1
13 3

14. The Pill
Week 1
Week 2
Week 3
Reminder pills
• Safe
• Effective when a pill is taken every day
• Less monthly bleeding and cramps
14

15. The Pill
What it is
– A pill with hormones in it that is taken every day.
– Prevents release of egg, and blocks sperm from meeting egg.
How to use
– Take one pill every day.
– When you finish a pack of pills, start a new pack the next day.
If you miss a pill:
– Take missed pill as soon as possible.
– Okay to take 2 pills at the same time.
– If you miss more than 2 days of pills in a row, use condoms for 7 days and keep taking pills. If you
miss these pills in week 3, ALSO skip the reminder pills and start a new pack.
What to expect
– Sometimes irregular bleeding at first, then followed by lighter monthly bleeding with less cramping.
– Some women have stomach upset or mild headaches that go away after first few months.
Key points
– Take a pill every day.
– Be sure you have enough pills. Get more before you run out.
– Use condoms if you need protection from STIs or HIV/AIDS.
Pill
15
4

16. Contraceptive Misconceptions are Common in
Kenya (Adapted from MLE, Tupange, 3 June 2011)
Strongly agree+ agree with … Total
Use of injectable can make a woman 53
permanently infertile
People who use contraception end up with health 76
problems
Contraceptives can harm womb 64
Contraceptives reduces woman’s sexual urge 61

17. Contraceptive Misconceptions are Common! (Adapted
from MLE, Tupange, 3 June 2011)
Strongly agree+ agree with … Total
Contraceptives can cause cancer 58
Contraceptives can give you deformed babies 64
Contraceptives are dangerous to your health 73
Women who use contraception may become 36
promiscuous

18. Overcoming Obstacles to Contraceptive Use
(Adapted from MLE, Tupange, 3 June 2011)
Strongly agree+ agree with … Total
Can get a place FP is offered 87
Can obtain FP if decide to use one 92
You could use FP even if your partner 69
doesn’t want
Could use FP even if none of her 89
friends/neighbors uses
Could use FP even if religious leader did not 88
approve
Could continue using FP even after 10
experiencing side effects

19. Injection
•Safe
•Hormone injection given every
2 months
(NET-EN) or 3 months (DMPA)
•Very effective when injections
are on time
•Use can be kept private
19

20. Injection
What it is
– Hormone injection.
– Prevents release of egg.
How to use
– Get an injection every 2 months (NET-EN) or 3 months (DMPA).
– If breastfeeding, can start 6 weeks after childbirth.
– Works best if you get your injections on time.
If late for an injection:
– DMPA: Can still get an injection up to 4 weeks late.
– NET-EN: Can still get an injection up to 2 weeks late.
If later, use condoms and return for an injection as soon as possible.
What to expect
– Irregular bleeding at first, then spotting or no monthly bleeding. This is common
and safe.
– Possible slight weight change.
– After stopping injections, it can take several months to become pregnant.
Key points
– Does not cause infertility.
– Be sure to get next injection on time.
– Use condoms if you need protection from STIs or HIV/AIDS.
Injection
20
6

21. Community DMPA pilot project – Zomba, Malawi
This Power point presentation is made possible by generous support of American people though United
States Agency for International Development (USAID). The contents are the responsibility of AHS and do
not reflect the views of USAID or United States Government.

22. IUD
•Safe to use
•One of the most effective methods
•Can be used for up to 12 years
•Can be removed any time if you want to get
pregnant
22

23. IUD
What it is
– Small, flexible, plastic "T" wrapped in copper wire that is placed in the womb.
– Prevents sperm from meeting the egg.
How to use
– Specially trained provider inserts and removes IUD.
– Can be put in right after you have a baby as well as at other times.
– Nothing to remember to do after insertion.
What to expect
– Some cramping and heavier bleeding during monthly bleeding in the first few
months of use.
Key points
– Use another method if waiting for appointment.
– Use condoms if you need protection from STIs or HIV/AIDS.
Where to go: ________________
IUD 1
23 0

24. Copper T 380A and Levonorgestrel progestin-
releasing Intrauterine Devices (IUDs)
24

25. Emergency contraceptive pills
•Prevent pregnancy after
unprotected sex
•Work best when taken as
soon as possible, up to 5
days after unprotected sex
•Do not cause abortion

26. Emergency contraceptive pills
What it is
– Pills taken after unprotected sex to prevent pregnancy.
– Prevents or delays release of egg.
– Does not cause abortion.
How to use __________________________
– Can take up to 5 days after unprotected sex.
– Works best when taken as soon as possible after unprotected sex.
What to expect
– Sometimes cause nausea, vomiting, vaginal spotting or bleeding for a few
days.
Key points
– Does not prevent pregnancy the next time you have sex. do not protect
against future acts of sexual intercourse.
– Regular methods are more effective, consider if there is a method you
would like to use.
– Seek treatment if you may have been exposed to STIs or HIV/AIDS.
Where to get emergency contraceptive pills: _____________________
Emergency
Contraception 1
6

27. Standard Days Method: Using CycleBeads®
• Helps you know what
days during the month
you could get pregnant
(days 9 to 19 of cycle)
• To prevent pregnancy,
either avoid sex OR use
condoms on those days
• Best used by women
with regular monthly
bleeding
27

28. Standard Days Method with CycleBeads
What it is
– A natural (or fertility awareness-based) method that helps women track their cycle to know when
they are most fertile
– Prevents sperm from meeting egg by avoiding unprotected sex on fertile days.
How to use
– Using CycleBeads, move a ring daily to know if on fertile or infertile day
– Use condoms or not have sex on 12 fertile days marked by white beads
– Monitor period comes monthly between darker brown bead and last brown bead
Check cycles are always within 26 to 32-day range required for this method
– If period starts before placing ring on darker brown bead, it came too soon
– If period does not start the day after placing ring on last brown bead, it is too late
– If a short or long cycle more than once in a year, use another method. Contact provider
What to expect
– No side effects
– Woman and partner must agree on how to prevent pregnancy on 12 fertile days
Key points
– Move the ring daily even on days you are having your monthly bleeding
– If you forget whether you moved the ring, check your calendar for date your period started , count
how many days have passed and place ring on the bead for today.
– Agree with partner in advance about using condoms or abstinence on fertile days.
– Use condoms if you need protection from STIs or HIV/AIDS.

29. Ideas for Progress
• Postpartum and post-abortion family planning
becomes the standard of women’s care
• Abundant commodities for all providers—
especially CHWs—no stock-outs
• CHWs manage vast majority of client concerns in
the community for common non-harmful
expected changes—especially for injectables,
pills, implants and IUDs, based on WHO guide

30. Ideas for progress
• Overcome misconceptions: give good
contraceptive method information to all—
using written and verbal—e.g., WHO FP guide
for specific method accepted or currently
using (1/2 or 1/4 page from flip chart--cost-
effective)
• Give women their method of choice--
injectables popular in Africa

31. Best practice: Health providers ensure universal
access to acceptable, effective family planning
REMEMBER:
• The most common harm for women using
contraception is an unintended pregnancy
• Healthy timing and spacing of pregnancy (HTSP)
means waiting 2+ years before trying to become
pregnant again
• Family planning is to women’s health what
immunizations are to children’s health
31