Professional Documents
Culture Documents
Planning and
Contraception
Demographic Transition
Safe
100% effective
Easily obtainable
Affordable
Choice of method
Technical Competence
Information
Follow-up
Follow-up
Information
Knowledge of not only the benefits but also the risks / side
effects
Outlets providing FP/ RH services should carry a sign on
a prominent place.
Access to get the FP/RH services regardless of his/her
sex, race, religion, color and socio-economic status. FP
services should be available to people in their closest
vicinity.
Privacy
Continuity
Family Planning and Contraception
19 MGIMS, Sewagram;; 04 Jul 2012
Rights of Clients (cont.)
Natural methods
Barrier methods
Hormonal methods
IUD
Sterilization
w/o spermicide
Basal body-temperature
– Based on changes in body temperature around ovulation
2 Every morning
If you start
your period move the ring
before you put to the next
the ring on the bead.
darker brown Always move
bead, contact the ring from
your provider. On WHITE bead days the narrow to
(may not be a good you can get pregnant. the wide end.
method for you)
Avoid unprotected
intercourse to prevent
On BROWN bead a pregnancy.
days you can
have intercourse
with very low When you start your
probability of next period, move the
pregnancy. ring directly to red
bead and begin again.
Family Planning and Contraception
26 MGIMS, Sewagram;; 04 Jul 2012
Arevalo M et al., Contraception, 2002;65:333-338.
Cervical Mucus Method
Low-risk Days
8
unsafe if 28-day cycle
varies as much as 8-9
days between shortest
and longest cycles.
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
Include:
– Condoms (male & female)
– Spermicides (foam, sponge)
– Cervical barriers (diaphragm & cervical cap)
Many varieties
– Different features, shapes, textures, colors, flavors
– Lubricated or nonlubricated
Note: average shelf life of condoms is 5 years; don’t store latex condoms in
hot places (glove compartment, back pocket) b/c heat can deteriorate the latex
Pinch reservoir tip or twist tip of nonreservoir tip condom before unrolling
condom over the penis to leave room for ejaculate--reduces chance of
condom breaking
Unroll condom over erect penis before any contact between the penis and
vulva occurs
Hold condom at the base of the penis before withdrawing from the vagina to
avoid spilling semen inside vagina
Advantages
– STI protection!
– Available w/o 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 (though some couples find sensual
ways of incorporating condoms into foreplay)
– Note: female condom can be inserted several hours before intercourse
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 w/o a condom or
other method
Family Planning and Contraception
36 MGIMS, Sewagram;; 04 Jul 2012
Cervical barrier devices
diaphragm Cerv cap
Cervical cap: covers cervix only
Diaphragm & cervical cap: need to be fitted (may need to be refitted w/weight
gain or loss >10 lbs.)
FemCap & Lea’s Shield do not have to be fitted, but still require a prescription
in the U.S.
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
(& FemCap)
3 generations
– Inert progesterone
– Copper-releasing
– Hormone-releasing (progesterone)
Very high continuation rate (how many women are still using
it one year after starting) compared w/other methods
Family Planning and Contraception
40 MGIMS, Sewagram;; 04 Jul 2012
IUD Mechanisms of Action
Advantages
– Very 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
Disadvantages
– No STI protection
– Risk of PID (usually within first 1-2 months following insertion)
– Rare incidence of perforating uterine wall
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
Family Planning and Contraception
44 MGIMS, Sewagram;; 04 Jul 2012
Types of oral contraceptives
Triphasic pill
– Levels of hormones (estrogen & progestin) fluctuate during cycle
Seasonale
– Reduces the # of menstrual periods to 4 instead of 13 per year
– Has lower dose of estrogen and progestin
Progestin-only pill
– Low dose of progestin and no estrogen
– For women who should not take estrogen (breastfeeding, high b.p., at risk for
blood clots, smoke)
Family Planning and Contraception
45 MGIMS, Sewagram;; 04 Jul 2012
How to use oral contraceptives
10.3
Injected Contraceptives
– Depo-Provera (prog.); Lunelle (prog.+est.)
– Injections: D-P every 12 weeks; Lunelle monthly
– 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
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
Family Planning and Contraception
50 MGIMS, Sewagram;; 04 Jul 2012
Sterilization
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