Family Planning Strategies and Tools            for SuccessDouglas Huber MD, MSc, Co-Chair FP/RH Working                  ...
Objectives• Identify new family planning strategies and  tools for to achieve success in Christian  Health programs• Enabl...
New vision for family planning• Family planning is to women’s health what  immunizations are to children’s health     Dr. ...
Family Planning and the Millennium               Development GoalsFamily planning (FP) essential to all the MDGs1. Poverty...
“The fastest, easiest, cheapest way to prevent   maternal deaths is with family planning”• Modern contraceptives (pill, in...
6
Healthy Timing and Spacing of Pregnancies  To achieve a 36mo birth interval (including breastfeeding),  contraception must...
Unmet Family Planning Need 1st YearPostpartum (blue) & All Women (purple) 80 70 60 50                                     ...
Post Partum Family Planning:              Key Message• After a live birth, couples should use an  effective family plannin...
A guide to family planning      for health workers and their clients  FIELDTESTING DRAFTWorld Health Organization         ...
Comparing family planning methods—simplified for  clients & providers                                  Very effective in  ...
Breastfeeding method (LAM)Safe with no side-effectsEffective IF:   your monthly bleeding has not returned   you are brea...
Breastfeeding method (LAM)What it is     – Using breastfeeding to delay next pregnancy     – Prevents the release of the e...
The Pill                                    Week 1                                    Week 2                              ...
The PillWhat it is     – A pill with hormones in it that is taken every day.     – Prevents release of egg, and blocks spe...
Contraceptive Misconceptions are Common in       Kenya (Adapted from MLE, Tupange, 3 June 2011)Strongly agree+ agree with ...
Contraceptive Misconceptions are Common! (Adapted              from MLE, Tupange, 3 June 2011)Strongly agree+ agree with …...
Overcoming Obstacles to Contraceptive Use         (Adapted from MLE, Tupange, 3 June 2011)Strongly agree+ agree with …    ...
Injection        •Safe        •Hormone injection given every         2 months         (NET-EN) or 3 months (DMPA)        •...
InjectionWhat it is     – Hormone injection.     – Prevents release of egg.How to use     – Get an injection every 2 month...
Community DMPA pilot project – Zomba, Malawi    This Power point presentation is made possible by generous support of Amer...
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 ge...
IUDWhat it is     – Small, flexible, plastic "T" wrapped in copper wire that is placed in the womb.     – Prevents sperm f...
Copper T 380A and Levonorgestrel progestin-   releasing Intrauterine Devices (IUDs)                                       ...
Emergency contraceptive pills                   •Prevent pregnancy after                    unprotected sex               ...
Emergency contraceptive pillsWhat it is    – Pills taken after unprotected sex to prevent pregnancy.    – Prevents or dela...
Standard Days Method: Using CycleBeads®                         • Helps you know what                           days durin...
Standard Days Method with CycleBeadsWhat it is     – A natural (or fertility awareness-based) method that helps women trac...
Ideas for Progress• Postpartum and post-abortion family planning  becomes the standard of women’s care• Abundant commoditi...
Ideas for progress• Overcome misconceptions: give good  contraceptive method information to all—  using written and verbal...
Best practice: Health providers ensure universalaccess to acceptable, effective family planningREMEMBER:• The most common ...
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CCIH 2012 Conference, Family Planning Pre-Conference, Douglas Huber, Addressing Family Planning from Christian Viewpoints

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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.

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CCIH 2012 Conference, Family Planning Pre-Conference, Douglas Huber, Addressing Family Planning from Christian Viewpoints

  1. 1. Family Planning Strategies and Tools for SuccessDouglas 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. 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. 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. 4. Family Planning and the Millennium Development GoalsFamily planning (FP) essential to all the MDGs1. Poverty and hunger2. Universal primary education3. Gender equality4. Child mortality5. Maternal health, including increased FP6. HIV/AIDS & other diseases7. Environmental sustainability8. Global partnerships 4
  5. 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. 6
  7. 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 spacebreastfeeding up to pregnant again pregnancies 6 months 2-6 mo postpartum (2-6)-24mo Use Contraception >24 Delivery 6mo 24mo Months postpartum
  8. 8. Unmet Family Planning Need 1st YearPostpartum (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. 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. 10. A guide to family planning for health workers and their clients FIELDTESTING DRAFTWorld Health Organization Adapted from the WHOs Decision-Making March 2010 Tool for Family Planning Clients and Providers
  11. 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 11WHO, Jan 2010. DRAFT
  12. 12. Breastfeeding method (LAM)Safe with no side-effectsEffective 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. 13. Breastfeeding method (LAM)What it is – Using breastfeeding to delay next pregnancy – Prevents the release of the eggHow 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 bleedingKey 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. 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. 15. The PillWhat 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. 16. Contraceptive Misconceptions are Common in Kenya (Adapted from MLE, Tupange, 3 June 2011)Strongly agree+ agree with … TotalUse of injectable can make a woman 53permanently infertilePeople who use contraception end up with health 76problemsContraceptives can harm womb 64Contraceptives reduces woman’s sexual urge 61
  17. 17. Contraceptive Misconceptions are Common! (Adapted from MLE, Tupange, 3 June 2011)Strongly agree+ agree with … TotalContraceptives can cause cancer 58Contraceptives can give you deformed babies 64Contraceptives are dangerous to your health 73Women who use contraception may become 36promiscuous
  18. 18. Overcoming Obstacles to Contraceptive Use (Adapted from MLE, Tupange, 3 June 2011)Strongly agree+ agree with … TotalCan get a place FP is offered 87Can obtain FP if decide to use one 92You could use FP even if your partner 69doesn’t wantCould use FP even if none of her 89friends/neighbors usesCould use FP even if religious leader did not 88approveCould continue using FP even after 10experiencing side effects
  19. 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. 20. InjectionWhat 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. 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. 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. 23. IUDWhat 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. 24. Copper T 380A and Levonorgestrel progestin- releasing Intrauterine Devices (IUDs) 24
  25. 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. 26. Emergency contraceptive pillsWhat 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. 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. 28. Standard Days Method with CycleBeadsWhat 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 providerWhat to expect – No side effects – Woman and partner must agree on how to prevent pregnancy on 12 fertile daysKey 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. 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. 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. 31. Best practice: Health providers ensure universalaccess to acceptable, effective family planningREMEMBER:• 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

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