Family planning: is defined as "educational, comprehensive medical or social activities and services which enable individuals, including minors, to determine freely the number and spacing of their children and to select the means by which this may be achieved.
Birth control: Birth control is the use of any practices, methods, or devices to prevent pregnancy from occurring in a sexually active woman. Also referred to as family planning, pregnancy prevention, fertility control, or contraception; birth control methods are designed either to prevent fertilization of an egg or implantation of a fertilized egg in the uterus. Birth control methods may be reversible or irreversible.
Contraception: (birth control) prevents pregnancy by interfering with the normal process of ovulation, fertilization, and implantation. There are different kinds of birth control that act at different points in the process.
Benefits of Family planning
Women/family
• Better health
• Less physical/emotional strain
• Improved quality of life
• Increased educational opportunities
• Increased economic opportunities
• More energy for household activities
• More energy for personal development and community activities
For Children:
• Better health
• More food and other resources available
• Greater opportunity for emotional support from parents
• Better opportunity for education
Factors that affect on the decision of using contraception:
• husband involvement
• Effectiveness--statistics show two numbers:
- Failure rate: no. of women per 100 who become pregnant after 1 yr. when using a birth control consistently & correctly
- Typical use failure rate: takes into account improper or inconsistent use
• Cost
• Ease of use
• Side effects
Family planning methods
• Hormone-based contraceptives
6 types
1) Oral contraceptives (pills)
2) Vaginal ring
3) Transdermal patch
4) Injected hormones
5) Hormonal implants
6) Hormonal IUDs
Oral contraceptives pills
Types of Contraceptives Pills
Combined oral contraceptives (COCs)
Most widely used
Contain both estrogen & progestagen
Triphasic pill
Levels of hormones (estrogen & progestin) fluctuate during cycle
Progestin-only pills (POPs)
Contain only a progestagen, mostly Levonorgestrel (no estrogen).
Especially suitable for breastfeeding women.
How hormonal contraceptives work
FSH & LH trigger ovulation
How to use oral contraceptives
2. OBJECTIVES
Define family planning.
Discuss the health benefits of family planning.
Differentiate between different types of family
planning methods.
Identify specific mechanisms, indication,
contraindication, and side effects of those methods.
At the end of the lecture the student will be able to
3. Family planning: is defined as "educational, comprehensive
medical or social activities and services which enable individuals,
including minors, to determine freely the number and spacing of
their children and to select the means by which this may be
achieved.
Birth control: Birth control is the use of any practices, methods,
or devices to prevent pregnancy from occurring in a sexually active
woman. Also referred to as family planning, pregnancy prevention,
fertility control, or contraception; birth control methods are
designed either to prevent fertilization of an egg or implantation of
a fertilized egg in the uterus. Birth control methods may be
reversible or irreversible.
Contraception: (birth control) prevents pregnancy by interfering
with the normal process of ovulation, fertilization, and
implantation. There are different kinds of birth control that act at
different points in the process.
4.
5. Women/family
Better health
Less physical/emotional strain
Improved quality of life
Increased educational opportunities
Increased economic opportunities
More energy for household activities
More energy for personal
development and community
activities
6. For Children:
Better health
More food and other resources
available
Greater opportunity for
emotional support from parents
Better opportunity for education
7. husband involvement
Effectiveness--statistics show two numbers:
Failure rate: no. of women per 100 who become
pregnant after 1 yr. when using a birth control
consistently & correctly
Typical use failure rate: takes into account
improper or inconsistent use
Cost
Ease of use
Side effects
10. Types of Contraceptives Pills
Combined oral contraceptives (COCs)
Most widely used
Contain both estrogen & progestagen
Triphasic pill
Levels of hormones (estrogen & progestin) fluctuate
during cycle
Progestin-only pills (POPs)
Contain only a progestagen, mostly Levonorgestrel (no
estrogen).
Especially suitable for breastfeeding women.
11. FSH & LH trigger ovulation
Gonadotropin releasing
hormone (GnRH) triggers
release of gonadotropins FSH
& LH
Estrogen & progesterone in
hormonal contraceptives
inhibit LH, FSH, and GnRH
secretion, preventing ovulation
Progesterone also:
• thickens cervical mucus to prevent
Passage of sperm into the uterus
• changes uterine lining to inhibit implantation
12.
13. 1- COCs
Initiation:
- In the 1st day of menses
- Sure that the women not pregnant
- After child birth:
* Non-breastfed women: delay until 6 weeks
* Breastfed women: can delay until 6 months in complete, exclusive
breastfeeding.
Schedule:
- One pill per day until the pack is finished (21 pills).
- 7 days break between packs
- Start another pack in day 7
14. Missed 1
pill
Missed 2
pills or
more
•Taking missed pill as soon as remembered
•Taking remaining pills on schedule
•No backup method needed
•Taking most recently missed pill
•Discard other missed pills
•Resume daily pill-taking
•For next 7 days, abstain or using backup method
7 or more pills
left in the pack
Fewer than 7
pills left in the
pack
•Finishing pills
•Taking 7-days break before
starting a new pack
•Finishing pills
•Starting a new pack
without taking 7-days break
15. 2- POPs
Initiation:
- In the 1st day of menses
- Sure that the women not pregnant
- After child birth:
* Non-breastfed women: can start immediately.
* Breastfed women: can delay until 6 weeks
Schedule:
- One pill per day at the same time daily until the pack is finished (28
pills).
- no breaks between packs
16. Taking most recent missed pill as soon
as possible.
If not breastfed woman abstain or
backup method used for 48 hrs.
Taking nest pill at regular time.
17. Safe
Combined pills are highly effective: when used correctly
and consistently, pregnancy prevention rate is more than
99%
Reversible, rapid return to fertility
No action needed at the time of intercourse.
Serious complications are extremely rare.
Can have beneficial health effects other than
contraception.
Use is controlled by the patient.
18. Incorrect use and pill missing is common; not as
effective in typical use.
Require daily pill intake
Side effects are common
May pose health risks for small number of
women
Re-supply required
Offer no protection against STIs including HIV.
19. COCs POPs
Reduce risk of ovarian &
endometrial cancer
Reduce risk of benign breast
diseases
Reduce risk of ectopic pregnancy
Reduce menstrual irregularities
Reduce risk of anemia
Reduce symptoms of
dysmenorrhea, endometriosis,
premenstrual syndrome and PID.
The same as COCs.
20. COCs POPs
Nausea
Dizziness
Breast tenderness
Headaches
Mood changes
Wt gain (water and salt retention)
Menstrual irregularities:
- Spotting
- Breakthrough bleeding
- Amenorrhea
Menstrual irregularities:
- Spotting, breakthrough bleeding (if
not breastfeeding mother)
- Amenorrhea
Wt gain (↑ appetite)
Other side effects are similar to
those of COCs, but less common.
Acne
21. Absolute Contraindications Relative Contraindications
Thrombophlebitis or Thromboembolic
diseases
History of DVT
Coronary Heart Disease
Cerebrovascular accident of stroke
Liver diseases
Malignancy of female genital system
Abnormal bleeding from the genital tract
Benign or malignant liver tumors
Breast cancer or H/O benign neoplasms
Pregnancy
Heavy smokers
Sever HTN
Complicated DM
Epilepsy
Prolonged immobilization
Complicated valvular heart diseases
Superficial Thrombophlebitis
Mild and moderate HTN
Varicose veins
Migraine headache
Diabetes Mellitus
H/O liver disease
Gall bladder stones
Age > 35 years
H/O pre-eclampsia, diabetes, or cholestasis
with previous pregnancies.
Current treatment of antibiotic or
antiepileptic drugs
23. Injected Contraceptives
Depo-Provera (prog.); Lunelle (prog.+est.)
Injections: D-P every 12 weeks; Lunelle
monthly
Cost effective
Pros: no daily pill; spontaneity
Cons: no STD protection, weight gain,
bleeding, mood change, frequent clinic visits
D-P: takes up to 10 months for a woman
to get pregnant after stopping injections
25. Transdermal patch (Ortho-Evra)
Patch is placed on buttock, abdomen, outer
upper arm, or upper torso
Replaced weekly for 3 weeks, then a patch-
free week
Cost less than Nuvaring
Pros: no daily pill; spontaneity
Cons: no STD protection, skin irritation
26. Vaginal ring (Nuvaring)
Ring inserted into the vagina during period
Worn for 3 weeks, removed for 1 week, then
replaced with new ring
Highly Cost
Pros: no daily pill; spontaneity
Cons: no STD protection, not effective for
obese women.
27. Contraceptive Implants
1.5" rod is inserted under skin of upper arm
Progestin-only
Effective for up to 3 years
Cost not yet known
Pros: no daily pill; spontaneity
Cons: no STD protection, weight gain,
bleeding, mood change, surgical procedure
28. Small plastic objects inserted into
uterus
2 types
Hormone-releasing (progesterone)
Copper-releasing
Have fine plastic threads attached
that hang slightly out of cervix into
vagina for removal
Very high continuation rate (how
many women are still using it one
year after starting) compared
w/other methods
progesterone
30. Levonorgestrel-Releasing IUD
(LNG-IUS, Mirena®)
Inhibits fertilization
Thickens cervical mucous
Inhibits sperm function
Thins and suppresses the
endometrium
Copper-Releasing IUD
(ParaGard® T380A)
• Inhibits fertilization
• Releases copper ions (Cu2+)
that reduce sperm motility
• May disrupt the normal
division of oocytes and the
formation of fertilizable ova
31. Advantages Disadvantages
Very safe and highly effective
(essentially no “user error”)
Long-term protection
No interruption of sexual
activity
Don’t have to remember to use
Can be used during breast-
feeding
No systemic side effects
Complications are rare
Can cause side effects
Insertion & removal needs
trained health care provider
No protection against STIs
32. Absolute:
Women who are pregnant.
Women who have unprotected sex with more than
one partner.
Women whose partners have other sex partners.
Women with unexplained vaginal bleeding.
Women with infections such as gonorrhea,
chlamydia, or cervicitis.
Women who have an active, recent, or frequent
pelvic infections.
33. Women who have uterine problems such as
fibroids that can change the uterus.
Women who have an impaired immune response,
such as a disease that lowers the body’s method to
fight infection.
Women with a recent abnormal pap-smar test.
Women with cancer of the uterus or cervix.
Relative:
Anemia
Diabetic woman.
34. Bleeding (Menorrhagia)
Pelvic inflammatory disease (PID)
Perforation
Ectopic pregnancy or pregnancy on IUD
Expulsion
35. Interval insertion
during menstruation (at the end of it usually at the 5th
day)
Postpartum insertion:
4-6 weeks after delivery (some specialists prefer to
insert it 10 minutes after delivery)
Post-abortive insertion:
2-3 weeks after abortion (some prefer to insert
immediately after abortion if there is no infection)
36. 4 to 6 weeks after the IUD
insertion, to make sure it is in
place.
The women have to check the
string of the IUD after every
period.
checkup must be done once a year
for:
The copper IUD is approved for
use for up to 10 years.
The LNg IUD is approved for
use for up to 5 years.
37. P – Period late, abnormal spotting or bleeding
A – Abdominal pain, pain with intercourse
I – Infection exposure (any STD), abnormal discharge
N – Not feeling well, unexplained fever or chills
S – String missing, shorter, or longer
38. Include:
Condoms (male & female)
Spermicides (foam, sponge)
Cervical barriers (diaphragm & cervical
cap)
Work by preventing sperm from reaching an
egg
Only condoms provide protection against
STIs
39. Sheath that fits over the erect penis
The only temporary method of birth control for men
Only form of contraception that effectively reduces STI
transmission
Made of thin latex, polyurethane, or natural membrane
Natural membrane (from sheep intestines) condoms can permit passage
of viruses (AIDS, herpes, hepatitis, HPV)
Many varieties
Different features, shapes, textures, colors, flavors
Some “extended pleasure” types have a desensitizing agent on the
inside to delay ejaculation
Lubricated or nonlubricated
Note: average shelf life of condoms is 5 years; not to be
stored in hot places (heat can deteriorate the latex)
40. Consists of two flexible polyurethane rings
and a soft, loose-fitting polyurethane sheath
One ring at closed end fits loosely against
cervix; other ring at open end encircles the
labial area
Can be inserted before sexual activity; don’t
need to remove it immediately following
ejaculation
41. Costs
Advantages
STI protection!
Available without prescription or medical
intervention
Disadvantages
Can reduce sensation
Polyurethane transmits heat well, so some say that the
female condom has less reduction in sensation
Interruption of sexual experience
42. Include: foam, sponge, suppositories, creams, film
Spermicide: chemical that kills sperm
(nonoxynol-9)
Cost
Advantage: no prescription necessary
Disadvantages:
Interruption of sexual experience (except for the
sponge)
Skin irritation (which can increase susceptibility
to STI infection)
No protection from STIs
Not effective enough to be used without a
condom or other method
43. Covering the cervix is one of the oldest
methods in contraceptive history
Casanova (18th century Europe) promoted using
squeezed-out lemon half; European women
shaped beeswax to cover cervix
Cervical cap: covers cervix only
Diaphragm: covers upper vaginal wall
behind cervix underneath pubic bone
FemCap & Lea’s shield have removal straps
Lea’s Shield allows a one-way flow of fluid
from cervix to vagina
Method is usually combined with spermicide
44. Diaphragm & cervical cap: need to be fitted
(may need to be refitted with weight gain or
loss >10 lbs.)
FemCap & Lea’s Shield do not have to be
fitted, but still require a prescription
Use diaphragm & cervical cap only with water-
based lubricants b/c they are latex (FemCap &
L.S. are silicone)
Can insert up to 6-8 hr. before intercourse;
should leave in at least 8 hr after
46. Works mainly by preventing ovulation or fertilization
In theory, can also interfere with implantation
Evidence suggests this is not primary mechanism of action
If it was, efficacy should not decrease with short-term delay, as long
as EC was administered some time before implantation
However, EC is increasingly less effective with delay
Oral contraceptive pills
95% effective within 24 hrs; 75% effective within 72 hrs
Prevention: 2 doses of combined estrogen & progesterone
Plan B: 2 doses of progesterone
Other combinations of oral contraceptives can substitute for these
Copper-T IUD
99% effective if inserted within 5 days
47. Standard days method
For women with cycles between 26 & 32 days (28 days)
Couples avoid unprotected intercourse between days 8-19 of each
menstrual cycle
Highest rate of effectiveness of natural family planning methods
Mucus method: based on cyclical changes
Vaginal secretions change throughout cycle; woman learns to
“read” these changes and keeps a daily chart
Calendar method: self- knowledge of fertility
After charting cycles for some time (preferably 1 year), a woman
estimates the time she is ovulating based on the calendar
Basal body-temperature
Based on changes in body temperature around ovulation
Often, some combination of these methods will be used
48. On WHITE bead days
you can get pregnant.
Avoid unprotected
intercourse to prevent
a pregnancy.
On the day you start your
your period, move the
ring to the RED bead.
Every morning
move the ring
to the next
bead.
Always move
the ring from
the narrow to
the wide end.
1
2
Also, mark this date
on your calendar
When you start your
next period, move the
ring directly to red
bead and begin again.
On BROWN bead
days you can
have intercourse
with very low
probability of
pregnancy.
If you have not started
your period by the day
after you put the ring on
the last brown bread,
contact your provider.
If you start
your period
before you put
the ring on the
darker brown
bead, contact
your provider.
(may not be a good
method for you)
50. Low-risk Days
Egg may still
be present Ovulation
These days may be
unsafe if 28-day cycle
varies as much as 8-9
days between shortest
and longest cycles.
Intercourse on these days
may leave live sperm to
fertilize egg.
8
51. BBT=body temp in resting state on waking
Slight drop immediately before ovulation
After ovulation, release of progesterone causes slight
increase in temperature
52. Pros:
Essentially free
No medical side effects
Does not interrupt sexual activity
Woman gains awareness about her body and natural cycles,
which can increase comfort w/sexuality
Acceptable to Catholic Church
Cons:
No STI protection
Requires some degree of discipline in order to keep track of
calendar/charts, etc.
Need to abstain from intercourse or use a backup method during
fertile days
53. Essentially permanent, although vasectomies are
sometimes reversible
Does not affect hormones, desire, sexual functioning
Female sterilization
Tubal sterilization: fallopian tubes are severed to block
passage of sperm & eggs
Transcervical sterilization: tiny coil inserted through cervix
into fallopian tubes
Coil promotes tissue growth that, after 3 months, blocks fallopian
tubes
Male sterilization (vasectomy)
Safer, less expensive, fewer complications than female
sterilization
Cutting and closing vas deferens (ducts that carry sperm)
54. Laparoscope: narrow, lighted viewing instrument that is
inserted into abdomen to locate the fallopian tubes
55. Vas deferens
on each side is
cut; small
section is
removed, and
the ends are
tied off or
cauterized
56. Nursing
amenorrhea is common for a brief period after birth
while breastfeeding
80% of women ovulate before first period (and so do not
know that they are fertile)
Withdrawal before ejaculation
difficult to judge when to withdraw
anxiety may lower pleasure for both partners
Cowper's gland fluid may carry sperm
any sperm on vulva may travel into vagina/uterus
Douching
sperm reach uterus in 1-2 minutes
douching may speed sperm along
irritates vaginal tissue
57. Backup methods: contraceptive methods used
simultaneously with another method to support it
When a backup method might be a good idea:
If on the pill:
During first cycle of the pill
After forgetting 2 or more pills, or after several days of
diarrhea or vomiting when on the pill
First month after switching pill type
When taking medications that can reduce effectiveness of
the pill
During first 1-3 months after IUD insertion
When first learning how to use a new method
To increase overall effectiveness of contraception
58. The “male pill”: Testosterone & progestin
may lower sperm count
New forms of reversible vasectomy
Injection of a blocking gel into vas
deferens; gel is dissolved to reverse the
procedure
Insertion of two plugs into each vas
deferens--can be removed later
59. Most new developments are improvements on
existing contraception for females
Variations on methods of delivery,
formulation of hormones
New designs of IUDs, female condoms
spermicides with microbicides (to kill
microbes that cause STIs)