Emergency contraceptive pills can prevent pregnancy when taken up to 5 days after unprotected sex. They are safe and effective for all women. Emergency contraceptive pills have a failure rate of about 1-2% if used correctly. A woman can get pregnant immediately after taking emergency contraceptive pills, so it's important to begin using another contraceptive method right away for ongoing protection.

1. INTRODUCTION TO
FAMILY
PLANNING

2. FP METHODS/COMMODITIES & ITS EFFECTIVENESS
More effective
Less effective
Less than 1 pregnancy per
100 women in one year
About 30 pregnancies per 100
women in one year
Injections: Get repeat injections on time
LAM (for 6 months): Breastfeed often,
day and night
Pills: Take a pill each day
Condoms, diaphragm: Use correctly
every time you have sex
Fertility-awareness based methods:
Abstain or use condoms when fertile.
Newest methods (Standard Days Method
and TwoDay Method) may be easier to use.
How to make your
method most effective
After procedure, little or nothing
to do or remember
Vasectomy: Use another method
for first 3 months
Withdrawal, spermicide: Use
correctly every time you have sex
Injectables Pills
LAM
Male
Condoms
Female
Condoms
Diaphragm
Spermicide
IUD
Female
Sterilization
Vasectomy
Fertility-Awareness
Based Methods
Withdrawal
Implants
Appendix 4: Effectiveness chart 36
2

3. Introduction
• Ethiopia’s TFR of 4.6 places it in the middle of its
neighbors.
• This represents a large reduction over the past two
decades, from 6.4 in 1990.
• The most dramatic difference in fertility in Ethiopia is
between urban and rural women.
• Women from urban areas have a TFR of 2.3, while
women living in rural areas have a TFR of 5.2.
3

4. Fertility
• Fertility is one of the principal components of population
dynamics that determines the size & structure of the
population of a country, & has a powerful effect on its
health & economic success.
• Fertility continues to be relatively high in Ethiopia; in
part, because women continue to marry & give birth at a
young age, have polygamous unions, & have births close
together.
4

5. Trends in TFR, 2000-2016
5

6. Contraceptive Coverage
Current FP coverage - CPR is 36 % (35% for modern
and 1% for traditional methods) of which injectable is
the most popular (23%) followed by pills & condom.
6

7. Trends in the use of FP, 2000-2016
7

8. Unmet Need
• Unmet need for FP is defined as the percentage of
women who want to wait at least two years before their
next birth or stop childbearing entirely, but are not using
contraception.
• 22 % of currently married women in Ethiopia have an
unmet need for FP (9 % for limiting & 13% for spacing)
8

9. Trends in unmet need, and percentage of demand
satisfied with modern methods, 2000-2016
9

10. Family Planning
• FP is the use of any type of natural or modern
contraceptive methods by those who want to space or
limit their number of children to their desired number.
• The decision taken by an individual or couple based on a
voluntary & informed consent when to have children, the
number of children they want, and the interval between
pregnancies using a FP method of their choice.
10

11. Benefits of FP
 FP has intrinsic role in:
- Poverty reduction
- Health benefits
- Gender-equality, human rights, & education
- Environmental sustainability
• FP helps couples limit their family size.
• FP also saves lives; up to 1/3 of all maternal deaths &
illness could be prevented if women had access to
contraception. 11

12. Healthy Timing & Spacing of Pregnancy (HTSP)
• After a live birth:
– Using effective FP by couples continuously for at least two
years before trying to become pregnant again.
– Couples choosing to use an effective FP method continuously
to have their next pregnancy not more than five years afte the
last birth.
• When pregnancies are too far
• When pregnancies are too close
12

13. Benefits of HTSP
• Reduced risk of Pre-term births, low birth weight, small for
gestational age, and, in some populations, stunting or underweight
conditions
• Reduced risk of death for newborns, infants, and children < 5.
• HTSP allows young children to experience the substantial health
benefits of breastfeeding for a full two years.
• Is associated with reduced risk of pregnancy complications like
preeclampsia
• Benefits communities by helping to reduce poverty and to improve
the quality of life among community residents 13

14. FP Methods
There are different types of FP methods.
The modern types can be classified as:
1. Natural FP methods
2. Short acting FP methods: condom, OCP
3. Intermediate acting FP method: injectable
4. LARC methods : Implants & IUCD
5. Permanent FP methods (these are irreversible methods):tubal
ligation & vasectomy (male & female sterilization)
14

15. Natural FP Methods
15

16. 1. Condoms
• Male Condom:
A thin sheath usually made of rubber (latex) that is placed
on an erect penis before sex.
• Female Condom:
A thin, soft, loose-fitting plastic (polyurethane) pouch that
lines the vagina. It has two flexible rings:
– An inner ring at the closed end, used to insert the
device inside the vagina and to hold the condom in
16

17. Condoms (2)
• Prevent both pregnancy and HIV/STIs
• Correct and consistent use may be difficult in
real-life situations
• Effectiveness:
21%
15%
Typical Use
5%
2%
Perfect Use
Male Female
Failure Rates:
Source: WHO, et al. Family Planning: A Global Handbook for Providers. 2007 17

18. Condoms (3)
How It Works:
• Prevents sperm from entering the female
reproductive tract.
• Prevents transmission of STIs/HIV from one
sexual partner to another.
Side Effects:
• Male Condom: Latex allergy (rare).
• Female Condom: none.
18

19. Male Condoms
• Have no side effects, other than in rare cases where a person has
an allergy to latex rubber
• Oil-based lubricants should not be used with male latex
condoms, because they will cause the condom to break. Clients
should not use any of the following as lubricants: oils (like
cooking or baby oil), petroleum jelly, lotions/creams,
butter/margarine, etc.
• It is safe to use water-, silicone-, or glycerin-based lubricants,
saliva, etc.
19

20. Female Condoms
inner ring
outer ring
• Female-controlled
• May be more comfortable to
men
• Provide protection for
external genitalia
• Does not interfere with
intercourse. (Can be
inserted up to 8 hours
before sex.)
20

21. 2. Combined Oral Contraceptives
• Most commonly used type of hormonal contraceptive
• Commonly called “the pill”
• Contain both estrogen and progestin
How it Works:
• Stops ovulation
21

22. Effectiveness
• Depends on how consistently & correctly the woman uses
COCs
• Risk of pregnancy greatest if a woman starts a new pill pack
3 or more days late, or misses 3 or more pills
• Failure Rate:
8% typical use (in 1 year)
Less than 1% perfect use (in 1 year)
• Return of fertility after COCs are stopped: No delay
• Protection against sexually transmitted infections (STIs):
22

23. Key points
• Take one pill every day: For greatest effectiveness a woman
must take pills daily and start each new pack of pills on time.
• Bleeding changes are more regular unlike progesterone only
contraceptive methods.
• Take any missed pill as soon as possible: Missing pills risks
pregnancy and may make some side effects worse.
• It can be given to women at any time to start later: If
pregnancy cannot be ruled out, a provider can give her pills to
take later, when her monthly bleeding begins.
23

24. Benefits/Risks of COCs
Known Health Benefits Known Health Risks
Help protect against:
•Risks of pregnancy
•Cancer: endometrial, ovarian..
•Symptomatic pelvic inflammatory disease
May help protect against:
•Ovarian cysts
•Iron-deficiency anemia
Reduce:
•Menstrual cramps, Menstrual bleeding
problems, ovulation pain, Excess hair on face
or body, Symptoms of polycystic ovarian
syndrome (irregular bleeding, acne, excess
hair on face or body), Symptoms of
Very rare:
•DVT or PTE
Extremely rare:
•Stroke
•Heart attack
24

25. Side Effects
Possible Side Effects:
• Non-Menstrual:
headaches, dizziness, nausea, acne, breast
tenderness, mood changes, weight gain,
amenorrhea
• Menstrual:
amenorrhea, breakthrough bleeding or
spotting
25

26. Correcting Misunderstandings
• Combined oral contraceptives:
– Do not build up in a woman’s body. Women do not need a
“rest” from taking COCs.
– Must be taken every day, whether or not a woman has sex
that day.
– Do not make women infertile.
– Do not cause birth defects or multiple births.
– Do not change women’s sexual behavior.
– Do not collect in the stomach. Instead, the pill dissolves
each day.
– Do not disrupt an existing pregnancy.
26

27. Who can Use Combined Oral
Contraceptives
• Safe and Suitable for Nearly All Women
• Nearly all women can use COCs safely and effectively,
including women who:
– Have or have not had children, are not married, are of any
age, including adolescents and women over 40 years old, have
just had an abortion or miscarriage, smoke cigarettes—if
under 35 years old, have anemia now or had in the past, have
varicose veins, and are infected with HIV, whether or not on
ARV
• Women can begin using COCs:
– Without a pelvic examination, routine laboratory tests,
cervical ca screening, a breast examination, even when a
woman is not having monthly bleeding at the time, if it is
reasonably certain she is not pregnant 27

28. 3. Progestin-Only Pills
• Commonly called the “mini-pill”
• Contains only one hormone (progestin)
• Taken continuously (no hormone-free
interval)
How it Works:
• Thickening cervical mucus
• Disrupting the menstrual cycle, including
preventing the release of eggs from the
ovaries (ovulation) 28

29. Effectiveness
Effectiveness
• Failure rate (for women who are NOT breastfeeding):
3-10% typical use
less than 1% perfect use
• Failure rate (for women who are breastfeeding):
1% typical use
less than 1% perfect use
• Return of fertility after COCs are stopped: No delay
• Protection against sexually transmitted infections
(STIs): None
29

30. Key Points
• Take one pill every day: No breaks between
packs.
• Safe for breastfeeding women and their babies:
Progestin only pills do not affect milk production.
• Add to the contraceptive effect of breastfeeding:
Together, they provide effective pregnancy
protection.
• Bleeding changes are common but not harmful:
Typically, pills lengthen breastfeeding women's
non bleeding season. For women having monthly
bleeding, frequent or irregular bleeding is
common.
30

31. Benefits/Risks of POPs
Known Health Benefits Known
Health
Risks
Help protect against: risk of
pregnancy
None
31

32. Side Effects
• Non-Menstrual:
headaches, dizziness, nausea, Mood changes,
breast tenderness, abdominal pain, and other
possible physical changes: for women not
breastfeeding, enlarged ovarian follicles possible
acne, breast tenderness, mood changes, weight
gain, amenorrhea
• Menstrual:
Changes in bleeding patterns including:
– For breastfeeding women, longer delay in return of
monthly bleeding after childbirth (lengthened
postpartum amenorrhea)
– Frequent bleeding, Irregular bleeding, Infrequent bleeding,
Prolonged bleeding, No monthly bleeding
32

33. Correcting Misunderstandings
Progestin-only pills:
• Do not cause a breastfeeding woman’s milk to dry up.
• Must be taken every day, whether or not a woman has
sex that day.
• Do not make women infertile.
• Do not cause diarrhea in breastfeeding babies.
• Reduce the risk of ectopic (extra-uterine) pregnancy
33

34. Who can Use Combined Oral
Contraceptives
• Nearly all women can use POPs safely and effectively,
including women who: are breastfeeding, have or have not
had children, are not married, are of any age, including
adolescents and women over 40 years old, have just had an
abortion, miscarriage, or ectopic pregnancy, smoke
cigarettes, regardless of woman’s age or number of
cigarettes smoked, have anemia now or had in the past, have
varicose veins, are infected with HIV, whether or not on
antiretroviral therapy
• Women can begin using POPs: Without a pelvic
examination, any routine laboratory tests, cervical cancer
screening, a breast examination, even when a woman is not
having monthly bleeding at the time, if it is reasonably
certain she is not pregnant
34

35. 4. Emergency Contraception
• Contraceptive methods that can be used by
women to prevent an unintended pregnancy in
the first few days after unprotected intercourse,
or after a contraceptive accident (i.e., after a
condom breaks, slips, or leaks).
• Commonly known as “morning after pills” or
“post-coital pills.”
• Pills that contain a progestin alone, or a
progestin and an estrogen together
35

36. Pills that Can Be Used as Emergency
Contraceptive Pills
• A special ECP product with the progestin
levonorgestrel
• A special ECP product with estrogen and
levonorgestrel
• Progestin-only pills (POPs)
• Combined oral contraceptives (COCs)
• Other Types of EC:
– Intrauterine Contraceptive Devices
– Mifepristone (RU-486)
36

37. Key Points
• Emergency contraceptive pills help to prevent pregnancy
when taken up to 5 days after unprotected
• Do not disrupt an existing pregnancy.
• Safe for all women Provide an opportunity for women to
start using an ongoing family planning method.
• Many options can be used as emergency contraceptive
pills
37

38. Key messages
When to take?
Start as soon as possible.
First
dose must be started within
120 hours (5 days) of an
unprotected intercourse
How many doses?
Hours between two
doses?
2 doses
12 hours
Each dose
must contain
at least 0.75
mg of
levonorgestrel
38

39. Effectiveness
• 8% of women who had sex once during the 2nd or 3rd week
of the menstrual cycle would likely become pregnant
without any contraception
• 1% of women using progestin-only ECPs, would likely
become pregnant
• 2% of women using estrogen and progestin ECPs, would
likely become pregnant
• A woman can become pregnant immediately after taking
ECPs. To stay protected from pregnancy, women must
begin to use another contraceptive method at once.
• Return of fertility after taking ECPs: No delay.
• Protection against STIs (STIs): None 39

40. Benefits/Risks of POPs
Known Health Benefits Known
Health
Risks
Help protect against: risk of
pregnancy
None
40

41. Correcting Misunderstandings
• Emergency contraceptive pills:
– Do not cause abortion.
– Do not cause birth defects if pregnancy occurs.
– Are not dangerous to a woman’s health.
– Do not promote sexual risk-taking.
– Do not make women infertile
41

42. Who Can Use Emergency
Contraceptive Pills
• All women with unprotected sex & did not
want to be pregnant. Tests and
examinations are not necessary for using
ECPs. They may be appropriate for other
reasons especially if sex was forced.
42

43. Side Effects
• Changes in bleeding patterns including:
– Slight irregular bleeding for 1–2 days after ECPs
– Monthly bleeding starts earlier or later than expected
• In the week after taking ECPs:
– Nausea
– Abdominal pain
– Fatigue
– Headaches
– Breast tenderness
– Dizziness
– Vomiting
43

44. 5. Progestin-Only Injectables
(Depot Medroxyprogesterone Acetate-
DMPA)
• The injectable contraceptives depot medroxyprogesterone
acetate (DMPA) contain a progestin like the natural
hormone progesterone in a woman’s body.
• The hormone is then released slowly into the
bloodstream. A different formulation of DMPA can be
injected just under the skin (subcutaneous injection).
Work primarily by preventing the release of eggs from
the ovaries (ovulation).
44

45. Key Points
• Bleeding changes are common but not harmful: Typically,
irregular bleeding for the first several months and then no
monthly bleeding.
• Return for injections regularly: Coming back every 3
months (13 weeks) for DMPA
• Injection can be as much as 2 weeks early or late: Client
should come back even if later.
• Gradual weight gain is common.
• Return of fertility is often delayed: It takes several months
longer on average to become pregnant after stopping progestin
only injectables than after other methods
45

46. Effectiveness
• Effectiveness depends on getting injections regularly: Risk
of pregnancy is greatest when a woman misses an injection.
As commonly used, about 3 pregnancies per 100 women
using progestin-only injectables over the first year will get
pregnant. This means that 97% effectiveness.
• When women have injections on time, less than 1
pregnancy per 100 women using progestin-only injectables
over the first year
• Return of fertility after injections are stopped: An average
of about 4 months longer for DMPA and 1 month longer
for NET-EN than with most other methods
• Protection against STIs: None
46

47. Side Effects
• Changes in bleeding patterns including, with DMPA:
• First 3 months:
– Irregular bleeding
– Prolonged bleeding
– At one year:
– No monthly bleeding
– Infrequent bleeding
– Irregular bleeding
• Weight gain, Headaches, Dizziness, Abdominal
bloating and discomfort, Mood changes, Less sex drive,
Other possible physical changes: Loss of bone density
47

48. Benefits/Risks of POPs
Known Health Benefits Known
Health
Risks
Helps protect against: Risks of pregnancy,
endometrial cancer, Uterine fibroids
May help protect against: Symptomatic
pelvic inflammatory disease, Iron-deficiency
anemia
Reduces:
Sickle cell crises among women with sickle
cell anemia, Symptoms of endometriosis
(pelvic pain, irregular bleeding)
None
48

49. Correcting Misunderstandings
• Progestin-only injectables:
– Can stop monthly bleeding, but this is not harmful.
It is similar to not having monthly bleeding during
pregnancy. Blood is not building up inside the
woman.
– Do not disrupt an existing pregnancy.
– Do not make women infertile.
49

50. Who Can Use Progestin-Only
Injectables
• Nearly all women can use progestin-only injectables
safely and effectively, including women who: Have or
have not had children, are not married, are of any age,
including adolescents and women over 40 years old, have
just had an abortion or miscarriage, smoke cigarettes,
regardless of woman’s age or number of cigarettes
smoked, are breastfeeding (starting as soon as 6 weeks
after childbirth), are infected with HIV, whether or not
on ARVs
• Women can begin using progestin-only injectables:
Without a pelvic examination, any routine laboratory
tests, cervical cancer screening, a breast examination,
even when a woman is not having monthly bleeding at
the time, if it is reasonably certain she is not pregnant 50

51. Overview of LARC methods
51

52. 7. Permanent FP Methods
Voluntary Surgical Contraception:
• Offers life-long protection against unintended
pregnancy in a single procedure that can be provided at
any healthcare facility with basic surgical capacity.
• Can be done for both males and females.
• The client should understand that this is a permanent
method for pregnancy prevention, but it does not
protect from HIV and STIs. It is an ideal method for
men and women who are sure that they do not want
more children.
52

53. Voluntary Surgical Contraception:
1. Tubal-ligation( Female Sterilization)
2. Vasectomy (Male Sterilization )
53

54. Female Sterilization
Tubal Ligation
• A surgical procedure
Effectiveness:
• Failure Rate:
less than 1% per year
54

55. Male Sterilization
Vasectomy:
• A surgical procedure
• Closes vas deferens tubes (which
carry sperm from the testicles)
Effectiveness:
• Failure Rate:
– 2-3% without medical examination of the semen 3 months
post-surgery
– less than 1% with medical examination of the semen 3
months post-surgery 55

56. Voluntary Surgical Contraception (1)
Characteristics:
– Highly effective
– Permanent
– Has no chemical or hormonal side effects
– Does not interfere with intercourse
– Easy to use
– Chance of regret
– Surgical procedure (with associated discomfort)
– No protection from STIs, including HIV
56

57. Voluntary Surgical Contraception (2)
Possible Side Effects:
• Some pain and discomfort during and immediately
after surgical procedure
• Rare complications associated with the procedure
itself
57