Family planning methods include all the contraceptive methods that a person may use to plan family.

2. Birth Control &
Family Planning

3. Remember
The total risks of birth
control are much less
than the total risks of a
pregnancy!!

4. Types of Birth Control
 Hormonal
 Barrier
 IUD
 Methods based on
information
 Permanent sterilization

5. Hormonal Methods
 Oral Contraceptives
(Birth Control Pill)
 Injections (Depo-Provera)
 Implants (Norplant I & II)

6. Birth Control Pills
 Pills can be taken to prevent pregnancy
 Pills are safe and effective when taken
properly
 Pills are over 99% effective
 Women must have a pap smear to get a
prescription for birth control pills

7. How does the pill work?
 Stops ovulation
 Thins uterine lining
 Thickens cervical mucus

8. Positive Benefits of Birth Control Pills
 Prevents
pregnancy
 Eases menstrual
cramps
 Shortens period
 Regulates period
Decreases
incidence of
ovarian cysts
Prevents ovarian
and uterine
cancer
Decreases acne

9. Side-effects
 Breast tenderness
 Nausea
 Increase in
headaches
 Moodiness
 Weight change
 Spotting

10. Taking the Pill
 Once a day at the same time everyday
 Use condoms for first month
 Use condoms when on antibiotics
 Use condoms for 1 week if you miss a pill
or take one late
 The pill offers no protection from STD’s

11. Depo-Provera
 Birth control shot given once every three
months to prevent pregnancy
 99.7% effective preventing pregnancy
 No daily pills to remember

12. How does the shot work?
 Stops ovulation
 Stops menstrual cycles!!
 Thickens cervical mucus

13. SIDE EFFECTS
 Extremely irregular menstrual bleeding
and spotting for 3-6 months!
 NO PERIOD  after 3-6 months
 Weight change
 Breast tenderness
 Mood change
*NOT EVERY WOMAN HAS SIDE-EFFECTS!

14. IMPLANTS
 Implants are placed in the body filled with
hormone that prevents pregnancy
 Physically inserted in simple 15 minute
outpatient procedure
 Plastic capsules the size of paper
matchsticks inserted under the skin in the
arm
 99.95% effectiveness rate

15. Norplant I vs. Norplant II
 Six capsules
 Five years
 Two capsules
 Three years

16. Norplant Implant

17. Norplant Considerations
 Should be considered long term
birth control
 Requires no upkeep 
 Extremely effective in pregnancy
prevention > 99%

18. Emergency contraception
pills can reduce the chance
of a pregnancy by 75% if
taken within 72 hours of
unprotected sex!
Emergency Contraception

19. Emergency Contraception (ECP)
 Must be taken within 72 hours of the act
of unprotected intercourse or failure of
contraception method
 Must receive ECP from a physician
 75 – 84% effective in reducing pregnancy
 California pharmacies can prescribe
without a doctor! (1/1/02)

20. ECP
 Floods the ovaries with high amount of
hormone and prevents ovulation
 Alters the environment of the uterus,
making it disruptive to the egg and sperm
 Two sets of pills taken exactly 12 hours
apart

21. BARRIER METHODS
 Spermicides
 Male Condom
 Female Condom
 Diaphragm
 Cervical Cap

22. BARRIER METHOD
 Prevents pregnancy blocks the egg
and sperm from meeting
 Barrier methods have higher failure
rates than hormonal methods due to
design and human error

23. SPERMICIDES
 Chemicals kill sperm in the vagina
 Different forms:
-Jelly -Film
-Foam -Suppository
 Some work instantly, others require pre-
insertion
 Only 76% effective (used alone), should be
used in combination with another method
i.e., condoms

24. MALE CONDOM
• Most common and effective barrier
method when used properly
• Latex and Polyurethane should only be
used in the prevention of pregnancy and
spread of STI’s (including HIV)

25. MALE CONDOM
 Perfect effectiveness rate = 97%
 Typical effectiveness rate = 88%
 Latex and polyurethane condoms are
available
 Combining condoms with
spermicides raises effectiveness
levels to 99%

26. FEMALE CONDOM
 Made as an alternative to male condoms
 Polyurethane
 Physically inserted in the vagina
 Perfect rate = 95%
 Typical rate = 79%
 Woman can use female condom if partner
refuses

27. Reality  : The Female
Condom

28. DIAPRAGHM
 Perfect Effectiveness Rate = 94%
 Typical Effectiveness Rate = 80%
 Latex barrier placed inside vagina during
intercourse
 Fitted by physician
 Spermicidal jelly before insertion
 Inserted up to 18 hours before intercourse
and can be left in for a total of 24 hours

29. DIAPHRAGM

30. CERVICAL CAP
 Latex barrier inserted in vagina before
intercourse
 “Caps” around cervix with suction
 Fill with spermicidal jelly prior to use
 Can be left in body for up to a total of 48
hours
 Must be left in place six hours after sexual
intercourse
 Perfect effectiveness rate = 91%
 Typical effectiveness rate = 80%

31. INTRAUTERINE DEVICES
(IUD)
 T-shaped object placed in the uterus to
prevent pregnancy
 Must be on period during insertion
 A Natural childbirth required to use
IUD
 Extremely effective without using
hormones > 97 %
 Must be in monogamous relationship

32. Copper T vs.. Progestasert
 10 years
 99.2 % effective
 Copper on IUD acts as
spermicide, IUD
blocks egg from
implanting
 Must check string
before sex and after
shedding of uterine
lining.
 1 year
 98% effective
 T shaped plastic that
releases hormones
over a one year time
frame
 Thickens mucus,
blocking egg
 Check string before
sex & after shedding
of uterine lining.

33. STERILIZATION
 Procedure performed on a man or a
woman permanently sterilizes
 Female = Tubal Ligation
 Male = Vasectomy

34. TUBAL LIGATION
 Surgical procedure performed on a
woman
 Fallopian tubes are cut, tied, cauterized,
prevents eggs from reaching sperm
 Failure rates vary by procedure, from
0.8%-3.7%
 May experience heavier periods

35. LAPAROSCOPY-’BAND-AID’
STERILIZATION

36. VASECTOMY
 Male sterilization procedure
 Ligation of Vas Deferens tube
 No-scalpel technique available
 Faster and easier recovery than a
tubal ligation
 Failure rate = 0.1%, more effective
than female sterilization

37. VASECTOMY

38. METHODS BASED ON
INFORMATION
 Withdrawal
 Natural Family Planning
 Fertility Awareness Method
 Abstinence

39. WITHDRAWAL
 Removal of penis from the vagina before
ejaculation occurs
 NOT a sufficient method of birth control by
itself
 Effectiveness rate is 80% (very unpredictable
in teens, wide variation)
 1 of 5 women practicing withdrawal become
pregnant
 Very difficult for a male to ‘control’

40. Natural Family Planning & Fertility
Awareness Method
 Women take a class on the menstrual cycle to
calculate more fertile times
 Requires special equipment and cannot be
self-taught
 NFP abstains from sex during the calculated
fertile time
 FAM uses barrier methods during fertile time
 Perfect effectiveness rate = 91%
 Typical effectiveness rate = 75%
 No 100% safe day-irregular periods

41. Abstinence
 Only 100% method of birth control
 Abstinence is when partners do not
engage in sexual intercourse
 Communication between partners is
important for those practicing
abstinence to be successful

42. Reasons for abstaining
 Moral or religious values
 Personal beliefs
 Medical reasons
 Not feeling ready for an
emotional, intimate
relationship
 Future plans

43. SOMETHING TO THINK ABOUT…
Couples who use no birth
control have a 85% chance
of a pregnancy within the
first year.

44. EXCELLENT REFERENCE SEE:
www.plannedparenthood.org/bc
Hatcher, Robert, MD
Contraceptive Technology ,17ed. (2001)

46. Quality in Family Planning

47. Quality
Quality is often defined as ‘meeting the needs
of clients’.
 Programs that are customer focused consistently involve
clients in defining their needs and in designing the services.
 Providing quality services is fundamental to sustainable
services.
 Providing and subsequently maintaining quality services can
only be accomplished through continuous problem solving
and quality improvement.

48. Aims & Objectives
In 1994, the International Conference on Population and
Development (ICPD) set a broader agenda for
incorporating elements of quality in FP/RH services.
 to provide more and improved services to new groups of
clients and to larger numbers of clients than ever before;
 to increase client satisfaction and client use of services;
 to have a positive impact on reproductive & overall
health; and
 to increase efficiency and savings.

49. Elements of ‘Quality of Care’ in
family planning
 Choice of method
 Interpersonal communication (verbal & non
verbal)
 Technical Competence
 Information
 Follow-up
 Appropriate constellation of services
By Judith Bruce, 1990

50. Choice of method
 Offering the right to the client to choose the
method means giving confidence to the
individual.
 He/she feels more comfortable in
using the method for which he/she has been
provided with clear, accurate and specific
information and which is the best for his/her
needs.

51. Good interpersonal communication
(verbal & non verbal)
 It helps in conveying the right message and to
build a rapport with the client.
 The language should be simple enough, without
any technical terms so to put him/her at ease.
 It is a tool to get acquainted to the client’s
knowledge, attitude, perceptions and feelings
about the subject.

52. Technical Competence
 Quality needs command on the subject.
 It is inevitable to acquire all the essential
knowledge and to polish one’s technical
competence regarding family planning
services.

53. Information
 Providing all the necessary information to
the client helps him/her in using the
selected method correctly, without any
fear.
 Right information will certainly clear the
myths and rumors about the subject and
will improve the adopting rate among the
potential clients.

54. Follow-up
 Correct and continuous follow up of the
users is indispensable to monitor the
possible complications with the use of
contraceptives.
 It ensures eventually an improved
continuation rate among the users.

55. Appropriate constellation of
services
 Adding family planning services along with the
routine ones under the same roof may attract
more clientele.
 The clients do not have to go to some other
service specialized in family planning only.
 Clients discuss their problems with more
openness with their own physician in a friendly
ambiance.

56. Indicators
QUALITY OF CARE
 Number of contraceptive methods available at a
specific outlet
 Percentage of counseling sessions with new
acceptors in which provider discusses all methods
 Percentage of client visits during which provider
demonstrates skill at clinical procedures, including
asepsis
 Percentage of clients reporting “sufficient time” with
provider
 Percentage of clients informed of timing and
sources for re-supply/revisit
 Percentage of clients who perceive that hours/days
are convenient and the range of services provided
is adequate.

57. GATHER
Approach to Counseling
 Greet the client in a friendly and respectful
manner
 Ask the client about FP/RH needs
 Tell the client about different
methods/services
 Help the client to make her own decision
about which method/service to use
 Explain to the client how to use the
method/service she has chosen
 Return visit and follow-ups of client
scheduled

58. Rights of Clients
 Information about all the methods / services available.
 Knowledge of not only the benefits but also the risks /
side effects of all the contraceptive methods / RH
services to make an independent decision.
 Outlets providing FP/ RH services should carry a
logo / indicative sign on a prominent place. They
should also provide a comfortable clean
environment to the clients where they will be treated
with respect, attention and courtesy.
 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.

59. Rights of Clients (cont.)
 Choice to practice FP or RH service should be
absolutely voluntary and free. A competent provider
will help the client to make a decision and will not
pressurize the client to make certain choice for a
certain method/service.
 Privacy for FP/ RH counseling where the client would
feel open and frank with the provider.
 Continuity to obtain the FP/RH services without any
break or discontinuation to avoid the after effects and
the give-ups of the service.
 Opinion about the subject, method used and the service
provided. This feedback is always helpful for the
provider to improve one’s service delivery.

60. Provider’s needs
 Training will certainly help the provider to do a better
counseling. It is needed to polish one’s skills to pass
the right information, to help the client in decision
making, to explain the use of a specific method, to
screen the client etc.
 Information about all the FP methods/RH
services.Moreover, other information about the local
community like social, cultural and religious beliefs is
always helpful in dealing with the FP clients.
 Update about the FP methods and about the new
developments in the reproductive health.
 Outlet adequately equipped for a trained provider is an
essential requirement for the FP/RH services. There
should be a logo / sign to show the availability of FP
services in that particular outlet.

61. Provider’s needs (cont.)
 Supplies continuous & adequate - needed at the
provider’s outlet to ensure an all time good service
for the users and other potential clients.
 Backup & referral for the complicated cases should
be there, where and when needed.
 Feedback about the services provided in a certain
outlet helps the provider to amend and ameliorate
his/her services.
 Acknowledgement in the shape of certification or
some incentives to be encouraged to continue with
the same motivation and involvement.

63. Knowledge & Attitudes
Use of Family Planning
Exposure to Family Planning
Messages
Family Planning

64. Knowledge of contraceptive methods
96 95
33
92 92
24
Any method Any modern method Any traditional
Currently married women All women
Percent of women age 15-49

65. Which modern methods are most
familiar to married women?
90
90
83
79
77
64
54
47
Injectables
Daily pill
IUD
Condom
Monthly pill
Female sterilization
Implants
Male sterilization
Percent of currently married women age 15-49

66. Does knowledge of any modern method
vary by residence, region and education?
• Women with no education (91%) know
slightly less about modern methods than
educated women (98%)
• No urban-rural difference

67. Do married women discuss
family planning with their husbands?
34
53
12
Never Once or twice Three or +
Percent of currently married women age 15-49 in the past year

68. What are couples’ attitudes toward
family planning?
9
11
6
6
68
Respondent unsure
Husband's attitude unknown
One approves, other dissaproves
Both disapprove
Both approve
Percent of women who report that they and their husband
approve or not of family planning

69. Knowledge & Attitudes
Use of Family Planning
Exposure to Family Planning
Messages
Family Planning

70. Use of contraception among
married women
24
19
5
Any method
Modern
methods
Traditional
methods
Percent of currently married women age 15-49

71. Does use of contraception vary
by a woman’s level of education?
Percent of currently married women age 15-49
19
16
23
19
35
23
Any method Any modern method
No education Primary Secondary and +

72. Contraceptive use also varies
by residence
33% of urban women use any
method of family planning
compared to…
22% for their rural counterparts.

73. Other
modern
methods
1%
Female
sterilisation
8%
Male condom
5%
Injectables
40%
IUD
7%
Monthly pill
15%
Daily pill
24%
Women’s current use of modern
contraceptive methods

74. Source of supply for
contraceptive methods
38
13
57
27
44
18 17
37
5
47
44
70
5
65
9
Daily pill Monthly pill Injectables Condom IUD*
Public sector Private medical Other private
Percent
*First source, limited to women who started using IUD since 1995

75. Intention to use contraception
in the future
42
45
13
Intends to use Does not intend Unsure
Percent of currently married women who are not
using a contraceptive method

76. Preferred method of Contraception
for future use
34
26
15
4 2 2
Injectables
D
aily
pill
M
onthly
pill
IU
D
C
ondom
Im
plants
Percent of currently married women who are not using a
contraceptive method, but who intend to use

77. Some reasons cited by
women for not intending to
use contraception
Health concerns
Difficult to get pregnant
Wants more children
Opposed to family planning
Infrequent sex/no sex
Fear side effects
26%
24%
10%
9%
8%
6%
Currently married women who are not using a contraceptive method

78. Knowledge & Attitudes
Use of Family Planning
Exposure to Family Planning
Messages
Family Planning

79. From what source do
women hear family planning
messages?
From radio only
From television only
From both
NO MESSAGE
For all women who heard a message about family planning
in the last few months preceding the interview
10%
5%
64%
21%

80. Residence
Urban 86%
Rural 78%
Education
None 70%
Primary 80%
Secondary+ 92%
Does exposure to family planning
messages vary by residence
and education?

81. Residence
Urban 59%
Rural 36%
Education
None 28%
Primary 39%
Secondary+ 62%
Does exposure to family planning
messages in the print media
vary by residence and education?

82. Main findings
• Knowledge of family planning is very high,
except in two areas (56%)
• 19% of women use a modern method of
contraception (24% use any method)
• Use of any contraceptive method has been
increasing since 1995 (13%) to 24% in 2000
• Use varies greatly by residence, region and level
of education

83. Main findings
• Injectables and the daily and monthly
pills are the 3 methods most used by
women
• Slightly more than 2 women in 5 intend
to use family planning in the future
• 4 women in 5 have heard of a family
planning message in the media