family planning methods

1. FAMILY PLANNING
BY
VARENCE

2. DEFINITION
 Is the process that allows individuals and the couples
to anticipate and attain their desired number of
children and the spacing between them and timing of
their birth. Or term given for pre-pregnancy planning
and action to delay, prevent or actualize the pregnancy
3 important elements of family planning
 Proper spacing
 Number of pregnancies
 Proper timing of children

3. OBJECTIVES
 Avoid unwanted pregnancy
 Bring about wanted birth
 Produce a change in the number of the chidren
born
 Regulate the interval between pregnancies
 Control time at which birth can occur

4. OBJECTIVES
 Avoid un wanted pregnant
 Bring about wanted birth
 Produce a change in the number of children
born
 Regulate the interval between pregnancies
 Control time at which the birth occur

5. ADVANTAGES
To the mother
 Reduces the risks paused by unwanted pregnancy
 Reduces the physical strain of child bearing
 Reduces risk of ovarian cysts
 Time to pursue education and employment
 Gives mother option until she waits to be financially
stable
 Reduces the number of maternal deaths
 Below 20years and above 35 years are at risk of
developing complications

6. TO THE CHILD/REN
 Prolonged breast feeding protects against
diseases
 Promotes physical growth and
development
 Promotes better childhood nutrition
 Better chances of survival
 Parental and child relationship

7. TO THE FATHER
 Allows father to keep a constant balance
between their physical mental and social
well being
 Increases the father sense of respect
because he is able to provide the type of
education and home environment

8. TO COMMUNITY
 Improves the quality of people’s lives
such as food and education
 It helps for better planning
 Its ensure proper utilisation of
resources

9. FAMILY PLANNING STRATEGIES
 Clinic bases services
 Community based distribution
 Commercial retail sales

10. TYPES OF FAMILY PLANNING
 Natural family method
 Artificial family methods
Hormonal and barrier
methods
 Permanent/surgical methods

11. ZZZ

14. NATURAL METHOD OF FAMILY PLANNING
 This is form of birth control method that doesn’t involve
introduction of chemical of foreign material into the body
artificial hormones or barriers
 Practice may be due to religious belief “ natural ” is the best
for them
 Effectiveness varies greatly, depends on the couple ability to
refrain from having intercourse on the fertile days
 Failure rates about 25%

15. MERITS
 Most of women can use them as long as they are
well trained
 Friendly user
 They don’t have chemical or physical products hence
no side effects
 They are acceptable by all faith and cultures
 They are immediate reversible

16. DEMERITS
 They are not suitable for a woman with irregular
menses
 Effectiveness greatly depends on couples to avoid sex
during unsafe days
 They demand high level of organisation
 No protection against STI
 Stress, infections and fatigue can mask the fertility
days
 Has high failure rate

17. NATURAL FAMILY PLANNING
METHODS
 Rhythm ( Calendar) Method
 Ovulation or cervical mucus method
 BBT
 Sympto-thermal method
 Coitus interruptus
 Lactational amennorhea

18. METHOD OF FERTILITY AWARENESS
RHYTHM (CALENDAR)
It is also called fertility awareness method
 Is the form of pregnancy prevention where
couples calculate a woman’s fertile time using
calendar
 The couple/individuals abstains from coitus on
the days of menstrual cycle when a woman is
most likely to conceive 3-6 day before and 3-4
after ovulation
 A woman keeps the diary of 6 menstrual cycles

19. HOW TO CALCULATE SAFE DAYS USING CALENDAR METHOD
This method suits women whose menstrual cycles are always
between 26 and 32 days in length for past 6 menstrual cycles
 Find the shortest cycle in your past record
 Subtract 18 from the total number of days in that cycle
 Count that number from day 1 of your current cycle and mark
that day with an X
 The day marked x is first fertile day
 The for the last fertile day you get the longest day subtract 11
from the total number in that cycle
 The day marked X is your last day

20. EXAMPLE
 If she has 6 menstrual cycles ranging from 26 -29 days
fertile period would be from 8th day (26-18) to the 18th
day ( 29-11) to avoid pregnancy
 Avoid coitus
 Use back up or contraceptive during those days
Demerits
Life span of sperm
Reliability
Failure of the method rate

22. CALCULATING SAFE DAYS USING MOON BEAD METHOD

23. BODY BASAL TEMPERATURE
 This identifies fertile and unfertile period of a woman ‘s cycle by
daily taking and recording of the rise in body temperature during
and after ovulation
 Before ovulation a woman’s BBT falls by 0.5°C at of ovulation and
her BBT rises to the full degrees due influence of progesterone .
 This high Temp is maintained throughout the ovulation
 Thought this is not reliable method of the birth irregular cycles
due outside factors such as lack of sleep and infections can cause
a woman’s temperature to vary

24. CERVICAL MUCUS /OVULATION/BILLING
 Cervical mucus is a fluid produced by small glands
 The fluid changes throughout her cycle from scanty or cloudy to
sticky or thick
 This happens in relation to changes in hormones during the
menstrual cycle as her body prepares for ovulation
 The consistency of ovulation mucus is like that of an egg and can
be stretched between the fingers this indicate the peak of her
fertility ( spinnburket sign)
 After ovulation the mucus tends to be dry up again
 Though it has short fall is that cervical mucus does not let her
know when you will be soon ovulating because sperms can live
longer in vagina

25. LACTATIONAL AMMENERRHOEA
 Is natural birth control technique based on exclusive
breast feeding which lead to amenorrhoea and
pregnancy protection
 LAM interferes with hormones that are responsible to
trigger the pregnancy
 Breastfeeding interferes with the release of the
hormones needed to trigger ovulation
Benefits
 B/feeding on demand improves health for mother and
baby
 Nothing to buy or use

26. ADVANTANGES
 Breast feeding on demand improves the
health of baby and the mother
 Nothing to buy
 Does not interfere with sex
disadvantages
 Its effective for first 6 months
 Doesn't provide protection against STIs

27. SYMPTO-THERMAL METHOD
 Combines the cervical and BBT methods
 temperature method of fertility control and
includes the self-observation of symptoms of
the ovulatory period, particularly the increased
cervical mucus discharge. A rise in temperature
must not be interpreted as ovulatory-related
before the end of the cervical mucus discharge

28. COITUS INTERRUPTUS/ WITHDRAW METHOD
 One of the oldest known method of contraceptive
 Coitus interruptus happens when a man takes off this dick out of the
vagina and ejaculate outside the vagina.
 The goal of the withdrawal method — also called "pulling out" — is to
keep sperm from entering the vagina. To prevent pregnancy
 Using the withdrawal method for birth control requires self-control. Even
then, the withdrawal method isn't an especially effective form of birth
control.
 Sperm may enter the vagina if withdrawal isn't properly timed or if pre-
ejaculation fluid contains sperm.
 The withdrawal method doesn't offer protection from sexually

29. PERMANT AND ARTIFIACIAL METHODS
 SPACING METHODS
 Barrier
 IUD
 Hormonal
 Post coital
 TERMINAL
 vasectomy
 BTL

30. MALE CONDOMS
 Its thin peace of rubbery
material that fits over a man’s
penis during sex.
ADV’S
 It most simple and effective
spacing method
 No side effects
 Easy to use
 No medical supervision
required
 Easily available ,safe and
inexpensive
 Has dual protection
DISADVANTAGES
 Chances of slipping off and tears
if not used correctly
 Possibility of allergic reaction to
lubber latex
 Some people may not enjoy sex
because of interference with
the sensation
 Not effective when not correctly
used

31. EFFECTIVENESS
 When used correctly every time you have sex,
male condoms are 98% effective. This means 2
out of 100 people will become pregnant in 1
year when male condoms are used as
contraception.
 Failure rate 16%

33. FEMALE CONDOM
IT’S A POUCH MADE OF POLYURETHANE WHICH LINES THE VAGINA
AND EXTERNAL GENITALIA
ITS 17 CM LONG WITH ONE FLEXIBLE POLYURETHANE RING AT EACH
END ONE END
 ADV’S
 Simple effective spacing
method
 No side effects
 Has dual protection
against pregnancy and
HIV
DISADVANTAGES
 Low motivation
 Expensive
 Failure rate 21%

36. DIAPHRAM
 synthetic of rubber plastic material used
 It’s a circular dome made of thin soft silicone
that is inserted into the vagina before the sex
 The device is introduced into vagina 3 hours
before intercourse and is kept into vagina for at
least more 6 hours after intercourse
 To work best it must be used with spermicide

37. ADVANTAGES
 Cheap
 No side effects
 Very effective if used along with spermicidal
 Its potable
DISADVANTAGES
 Requires doctor to measure the size required
 Allergic reaction to rubber
 Erosion
 Some difficult in insertion
 Require privacy and time for insertion

38. 56
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39. DIAPHRAGM CONTAINER

40. ZZ

41. CHEMICAL BARRIER METHODS
 These methods usually kill the sperms and the way
chemical contraceptives help in preventing the
pregnancy they include
 Form of tablets Arosols
Cream jelly
Suppositories

42. MERITS
 Easy to administer
 Not very expansive
 Available free in health centers
DEMERITS
 May cause irritation and burning
 Must be applied each time before sex

43. INTRA-UTERINE DEVICE (IUD)
 Its medicated devices inserted into the uterus intended to release a
small quantity of the drug into the uterus in sustained manner over
prolonged period of time ie its small device that is inserted via the
cervix into the uterus to prevent pregnancy
 A small string hangs down from the IUD into the upper part of the
vagina and its to noticeable during sexual intercourse but can be felt
MOA
 It acts by changing the lining of the uterus and fallopian tubes
affecting the movement of the ovum and sperm

44. TYPES OF IUD
 Non medicated IUDs
 This exert their action by producing sterile inflammatory
response in the endometrium by mechanical interaction
 They don’t contain therapeutically active agents
 Rings of stainless have mechanical effects on the uterus
leading to contraception not take place they include T-coil,
lippes loop

45. WHY NON MEDICATED IUDS NOLONGER IN
USE
 Newer devices that are safer and effective
 Irregularities in menstrual bleeding
 Severe pelvic pain
 Cases of PID
 High rates of failure

46. MEDICATED IUDS
 The device uses copper wire
 Made of T-shaped polyethylene
 They are in various forms as per
surface of the wire cu-T-30, cu-t-
200 and cu-T-380 2nd generation
 They work by changing
endometrial lining
 They interfere with passage of
sperms in the uterine cavity
 They diminish sperm transport via
the cervix to the oviducts by
increasing the thickness of the
cervical mucous
 Steroidal releasing hormones causes
the endometrial gland atrophy and
inhibit ova development
 Causes endometrial hyper
maturation hence becoming
unfavourable environment for
implantation
COPPER BEARING IUDS
PROGESTRONE RELEASING IUDS (
progestasert and Merina) 3rd generation

47.  Safe and private
 Inexpensive
 Long term birth control
 Reversible
 Convenient
 Can be inserted immediate
after delivery
 Some studies say it protects
against uterine cancer
 Acts as an emergency
 Heavy bleeding
 Spotting after insertion
 Ectopic pregnancy
 May come out accidently
 No protection against STIs
 Insertion needs skilled
personal
ADVANTANGES DISADVANTAGES

48. SIDE EFFETS
 Amenorrhoea
 Intermenstrual bleeding
 Pelvic pain
 Ovarian cyst
 Acne
 Perforation
 Explusion

49. CONTRAINDICATIONS
 History of PID
 Abnormal shaped uterus
 Ectopic pregnancy
 Menorrhagia
 GIT carcinoma
 In pregnancy

50. ORAL CONTRACEPTIVE METHODS
 They are prescribed pills that prevent
pregnancy
 They contain two hormones oestrogen and
progesterone
 They prescribed also for menstrual cramps or to
prevent anaemia
They include
 combined pills
 Pop
 Emergency pills
 Phased pills

51. COMBINED ORAL PILLS (COCS)
 Pills that have low doses of two hormones progestin and
oestrogen like natural hormones in woman’s body
 They contain two hormones progesterone and oestrogen
 Oestrogen work by preventing the egg from being released
from ovaries by inhibiting of secretion of LH and FSH from
pituitary gland
 Progesterone work by causing the thickening of the
endometrium which prevents implantation of the fertilised
ovum
 Endometrium becomes atrophic and unreceptive for
implantation

52. EFFECTIVENESS
 Effectiveness depends on the user
 Risk of pregnancy is greatest when a woman starts a new
pill pack, 3 or more days late or misses 3 or more pills near
the beginning or end of the park
 7 in 100 will get pregnancy thus safeguarding 93 women
who are using COCs to get pregnant in first year
 When there no mistake made in taking pills < 1 pregnancy
per 100 women using COCs over the first year

53. ADVANTAGES
 Easy to obtain from drug shops or
pharmacy
 Controlled by woman
 Do not interfere with sex
 Prevents functional ovarian cyst
 Prevents Ca of endometrium and ovary
 Prevents ion deficiency aneamia

54. DISADVANTAGES
 Daily intake
 No protection from STI
 Having Side Effects
 Menstrual irregularities: spotting,
amenorrhea
 Might cause dark patches on your
face

55. SIDE EFFECTS OF COC
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Minor side effects
(Oestrogen)
 Nausea
 Headache
 Vomiting
 Breast Tenderness
 PMS
 Vaginal discharge
 Migraine
Minor side effects
(Prostrogen)
 Weight Gain
 skin changes ( acne)
 Loss of libido
 Vaginal dryness
 Scanty menses
 Depression
 Mastalgia

56. MAJOR SIDE EFFECTS
 Major sides effects /risk factor
 Venous Thromboembolism
 MI
 Stroke
 Hypertension
 Migraine
 Increase incidence of breast ca, ca
cervix and liver cancer

57. HOW TO USE COC PILLS?
 1 pill a day until the pack is done with food or immediately after meal
to prevent stomach upset
 Same time every day
 After dinner
 Before going to bed at night
 Link up taking with certain activity will act as reminder
 Missed 1 or 2 take pills as soon as possible
 Missed 3 or more pills particularly in first week or second week take
pills as soon as possible and use of back up for next 7 days if she had
sex in last 5 days
 ECP is considered
 If one has missed > 7 consecutive days then consider as stopped COCs
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58. DO NOT PROVIDE COCS IN FOLLOWING CASES
 Breast feeding mother less 6moths
 Liver cirrhosis
 Smoking and > 35 years
 Persistent blood pressure above 140/90
 Gall bladder disease
 Has ever had blood clot in limbs or stroke
 Has breast cancer or has ever had
 Has CAD
 Is on tegretol, rifampicin, barbiturates they
make COCs less effective

59. FOLLOW UP
 3 monthly to ensure compliance and acceptability
with further follow up to 12 monthly interval and
encourage patient to seek advise if any worries
 B/P and weight annually
 Check if pills are being taken correctly
 If client is 35 years there should be thorough re-
assessment

60. CONTRACEPTIVE CASES
 A 16 year old wants pills but refuses a pelvic exam, do you give
them to her?
 19 year old says her menses comes on Sunday, so she wants to
know does she start this Sunday or next?
 To take a break from pills a 21 year old stops the pills for a month
while her partner is off home . How long a break does she
need?
 A 16 year old presents with her mother requesting pills for acne,
the mother insists you give her the ones that are the cheapest,
the patient wants the ones she sees on TV that are good for your
skin, which do you choose?

61. CONT’D-CONTRACEPTIVE CASES
• A 23 year old is getting monthly PMDD, what do you
advise?
• A 55 year old comes in on birth control pills from her
previous physician, is this dangerous?
• A 26 year old with three previous Myalgic
encephalomyelitis presents for contraceptive advice,
she has a sister and a mom with breast cancer and
she refuses to take the pills, can she use them?

62. POPS(MINIPILLS)
 Pills that contain low doses of progestin like
natural hormone progestogen in a woman’s body
 They don’t contain oestrogen and so can be used
throughout breastfeeding and by women who
cannot use methods with estrogen.
They primarily work by;
 Mainly thickening cervical mucous
 Atrophy of endometrium, hinders implantation
 Interferes ova release and tubal transportation

63. EFFECTIVESS
 Effectiveness depends compliance and user
 For breastfeeding woman if pills are taken every day 1
pregnancy in 100 women on POPs over first year
 POPs is nearly 100% in lactating mothers and does not
alter the quality milk
 For non breastfeeding woman about 7 pregnancies
per 100 women using POPs over the first year

64. ADVANTAGES
 Can be used by any age
 Doesn’t supress the milk
 Have fewer s/e due lack of oestrogen
 Suitable for pts who have HTN, SCD
 Decreases menstrual cramps
 Decreases menstrual flow
 Protection against PID
 Easy to use

65. DISADVANTAGES
 Pill burden
 Amenorrhoea
 Irregular menses
 Spotting btn periods
 Prolonged heavy bleeding
 No protection against STIs
 No protection against ovarian cyst

66.  6 wks -6months postpartum
 Has no children/Not married
 Aged > 35 and adolescents
 BMI > 35
 Controlled HTN
 Has had abortion or ectopic
pregnancy
 Has varicose vein
 DM/ CHD / Valvular disease
 Smokers < 15 cigarettes
 Hiv not on ritovir
 Active Liver cirrhosis,
 Gall bladder disease
 Has ever had blood clot in limbs or
stroke
 Has breast cancer or has ever had
 Severe Coronary Artery Diseases
 Is on tegretol, rifampicin,
barbiturates they make POPs less
effective
 Unexplained uterine bleeding
WHO TO USE POPs WHO NOT USE POPs

67. CAUTION
 Missed pills need to be taken at the same
time of day
 Take another pill if vomiting occurs within 2
hours after taking pill
 Drug interaction POPs not affected by broad
spectrum abx apart from enzyme inducing
drugs reduces efficacy

68. EMERGENCY CONTRACEPTIVE METHODS/
MORNING-AFTER PILLS
 ECPs help to prevent pregnant when taken within five 5
days after un protected sex, contraceptive accidents
like condom rupture or missed pills
 The sooner ECPs are taken after unprotected sex, the
better they prevent pregnancy
 Do not interrupt an existing pregnancy
 Safe for all women
 Many option can be used POPs COCs and postinor
(levonogestrel), IUD
 They work by preventing or delaying ovulation

69. HOW EFFECTIVE?
 If all 100 women used ulipristal acetate ECPs, fewer than
one woman would likely become pregnant.
 If all 100 women used progestin-only ECPs, one woman
would likely become pregnant.
 If all 100 women used combined estrogen and progestin
ECPs, 2 women would likely become pregnant.
 Copper-bearing IUD is more than 99% effective in
preventing pregnancy when inserted within 120 hrs

70. HOW TO USE ECPS
 They should be started with in 5 days or 120 hours of unprotected sex
 For POPs take 20 pills bid for one day
 For COCs take 4 pills bid for one day
 After taking ECPs start FP next day
 For Postinor 1pill bid for 24 hours
 Don’t use ECPs for routine FP method
 They cause Nausea taking them after meals is better
 When you vomit 2 hours after taking pills re-vist your General
Practioner

71. CAUTION
 Explain that ECPs can avert pregnancy resulting from unprotected or accidental
sex after It cannot protect her from future pregnancy, if unprotected sex occurs
again . Therefore, it should not be used as a regular contraceptive method
 Counsel the client to choose a family planning method to start using after the
emergency contraception and if she is already on FP she should continues as
usual
 If she does not want to start a contraceptive method now, give her condoms or
COCs and ask her to use them if she changes her mind. Give instructions on use.
Invite her to come back any time, if she wants another method or has any
questions or problems.
 Tell her that ECP does not protect from STIs/HIV.
 Explain that ECP will not harm an existing pregnancy or cause abortion .

72. WHO CAN USE THIS METHOD
 A woman has been raped( sexual assault)
 A woman who has had unplanned sexual intercourse
 Women who can’t use hormonal contraceptives
 Mistakes using contraception such as
 Condom breakage and spillage
 Had unprotected sex after she has missed 3 or more COCs
or started new pack 3or more days late
 For POP it depends on type and hours
 Expulsion of IUD or Implant
 4 Weeks late of her Depo Provera (DMPA)injection repeat
and has had unprotected sex

73. S/E
• Changes in your menses- monthly bleeding
that starts earlier or later than expected
• Headache
• Fatigue
• Tummy pain
• Nausea
• Breast tenderness

74. RETURN TO CLINIC IF;
 Fever
 Excessive swelling
 More than 7 days late of your menses
 Sudden pain in your lower tummy
 You think you are pregnant

75. DEPO PROVERA (DEPOT-MEDROXY PROGESTERONE
ACETATE)
 Its only a progesterone injectable contraceptive
method that is given by I.M in 150mg every 12 weeks
 Its is prepared in a micro-acqueous cystalline
suspension which results in slow absorption
 Starts working within 24 hours of injection

76. MOA
Stops ovulation
 Thickens cervical mucous making
difficult for sperms to ascend up
Makes endometrium lining thin and
unsuitable for implantation-prevents
implantation

77. EFFECTIVENESS
 Its 99.9 % when effectively used
 It also depends if the injection was given
properly deep in the muscles
 Effectives increases as one stays on the method
 About 4 pregnancies per 100 women using
progestin-only injectables over the first year.

78. ADVANTAGES
 Doesn’t suppress lactation
 Reduces uterine fibroids and endometrial Ca
 Appropriate for women above 35 years
 Long acting method
 Privacy and convenient
 Does not interfere with sex activity
 Its prevents PID, ectopic pregnancy
 Used in early post partum period
 Prevent iron deficiency anaemia

79. DISADVS
 Heavy prolonged bleeding esp in first
months
 Weight gain
 Delayed return to fertility
 Requires injection every 3 months
 Does not protect against HIV/STIs
 Amenorrhoea esp after 3 months

80. SIDE EFFECTS
 changes in bleeding
 Weight gain
 Headaches
 Dizziness
 Abdominal bloating and discomfort
 Mood changes
 Less sex drive
 Other possible physical changes include loss of bone
density

81. WHEN TO START INJECTABLES?
 Start 1st Injection within 5 days of menstruation
 6th-28th days + no pregnancy – Starts Injection +
additional method
 Post-natal:
 Breast-feeding the baby- start after 6 weeks to 6 months
 No breast-feeding – immediately after birth
 Miscarriage – Starts within first 7 days
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82. ELIGIBILITY CRITERIA FOR METHOD
 Healthy women of all ages (Nulliparous or multiparous)
 Obese
 Who should not use estrogen
 Have or have not had children
 Are married or are not married
 Are of any age, 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
 Breastfeeding, starting as soon as 6 weeks after childbirth
 Are living with HIV, whether or not on antiretroviral therapy
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83. SAYANA PRESS DEPOT-MEDROXYPROGESTERONE
ACETATE ( DMPA-SC)
 Sayana Press is a new formula of DMPA.
 Sayana Press is lower-dose than depo-IM. It
contains 104 mg of DMPA rather than the 150 mg
in depo-IM. The dose is smaller, but it is equally
effective to depo-IM because it is injected in a
different way
 Sayana Press is given into the fatty tissue below the
skin. This is called a subcutaneous (SC) injection

84. HOW ARE DEPO-IM AND SAYANA PRESS INJECTION
SITES DIFFERENT?
 Sayana Press is delivered under the skin at the back of the upper
arm, the abdomen, or the anterior thigh, whereas depo-IM is
delivered into the muscle of the arm, the hip, or the buttocks.
 Sayana Press is a subcutaneous injection, whereas depo-IM is
intramuscular.
 Sayana Press is DMPA prefilled in Uniject, whereas depo-IM is
DMPA in a vial filled by the provider and is given from a standard
syringe.
 Sayana Press is lower dose than depo-IM.

85. WHO CAN USE DMPA-SC
 Breastfeeding a baby who is at least six weeks
old.
 Has or has not had children
 Can not or does not want to use other methods
 Has a sexually transmitted infection including
HIV
 Is taking medicines, including ARVs to treat AIDS

86. ADVS AND DISADVS
 Refer to depo-provera

87. SIDE EFFECTS
 Prolonged or heavy vaginal bleeding,
irregular bleeding, or spotting.
 Headaches and dizziness.
 Changes in mood and sex drive
 Weight gain.
 Abdominal bloating and discomfort.
 Amenorrhea (no bleeding).

88. WOMEN WHO NOT ELIGIBLE FOR DMPA
 Migraine headaches (that began or got
worse after getting the injection)
 had a heart attack or stroke
 Serious liver condition
 High blood pressure
 Breast cancer
 Lupus (SLE)

89. PROGESTERONE-ONLY
HORMONAL CONTRACEPTIVES
IMPLANTS
 Small plastic rods, each about the size of a
matchstick, that release aprogestin like the natural
hormone progesterone in a woman’s body.
 A trained provider performs a minor surgical
procedure to place one or 2 rods under the skin
inside of a woman’s upper arm.
 Do not contain estrogen, and so can be used
throughout breastfeeding and by women who
cannot use methods with estrogen

90. PROGESTERONE-ONLY IMPLANTS
 Norplant (Levonorgestrel)-
 6 capsules
 Subcutaneously
 5 years
 Jadelle (Levonorgestrel)
 2 rod
 5 years
 Implanon (Etonorgestrel)
 1 rod
 Subcutaneously
 3 years (recently studies shows it may be highly effective for
5 years
 Levoplant (Sino-Implant )
 2 rods containing levonorgetrel labelled for 3 years
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91. Norplant Implanon®
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92. HOW EFFECTIVE
 Far less than 1 pregnancy per 100 women using implants over the
first year (1 per 1,000 women). This means that 999 of every
1,000 women using implants will not become pregnant
 A small risk of pregnancy remains beyond the first year of use and
continues as long as the woman is using implants.
 For heavier women, the effectiveness of Jadelle and Levoplant
may decrease near the end of the duration of use stated on the
label. These users may want to replace their implants sooner
 Interacts with enzyme-inducing medication, and reduces its
effectiveness

93. MERITS
 High effectiveness of up to 99%
 Safe for use during lactation
 Very inexpensive method of long-term
 Do not require the user to do anything once they are
inserted
 Are both long-lasting and reversible
 Do not interfere with sex
 Suitable in conditions which preclude the use of
combined hormonal contraception

94. DEMERITS
 No protection against HIV
 Removal needs trained personnel
 Interaction with anticonvulsants
 Changes in bleeding patterns esp in first year

95. DISADVANTAGES
 Surgical implication
 Pain, redness, sensitivity in the area of application
 Menstrual problem
 Amenorrhoea
 Irregular
 Heavy
 Severe headache
 Weight gain 3-12%
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96. WHEN TO START IMPLANON?
 Start 1st Implant within 5 days of menstruation
 6th-28th days + no pregnancy – Starts Injection +
additional method
 Post-natal:
 Breast-feeding the baby- start after 6 wks to 6
months
 No breast-feeding – immediately after birth
 Miscarriage – Starts within first 7 days
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97.  Very high level of protection against
pregnancy
 Need no regular attention
 No side effects connected to estrogen
 Fertility return within 3 months of removal
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98. ELIGIBILITY
 Used safely between for Adolescent and woman above 40
years
 Breast feeding women
 Cigarette smokers
 Breastfeeding
 Have anemia now or in the past
 Have varicose veins
 Are living with HIV, whether or not on antiretroviral therapy
apart from Efavirenz
 Have just had an abortion, miscarriage, or ectopic pregnancy

99. INELIGIBILITY
 Unexplained vaginal bleeding
 Migraine headaches with aura
 IHD or stroke
 Suspected pregnancy
 serious liver disease
 Breast cancer
 Suspected blood clots

100. COMPLICATIONS
 Infection at insertion site esp in first 2 months
 Difficult removal
 Expulsion of implant
 There are a few reports of implants found in another
place in the body due to improper insertion, for
example, in a blood vessel

101. RULES OF USING IMPLANON
 One every 3 Years
 Health concerns:
VTE no increased risk
Bone marrow density- no evidence of any effect
Endocarditis- no need of prophylactic antibiotics for
insertion or removal
 Complication: only 1%
 Discontinuation: 43% within 3 years (because of bleeding)
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102. Sterilization
permanent
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103. GUIDELINES OF STERILIZATION
 Husband aged between 25-50 years
 Wife age in between 20- 45 years
 Must have two living children
 Need consent from the spouse

104.  Surgical procedure that removes all or part of the vas
deferens (usually as a means of sterilization)
sometimes reversible
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105. METHODS OF MALE STERILIZATION
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106. EFFECTIVENESS:
 Failure rate is 1 in 2000
 ADVANTAGES
 permanent; safe and inexpensive
 Single procedure
 Effective & lasting protection
 Low failure rate
 Independent of sexual intercourse
 No side effects in future
 Sperm production or hormone out not affected
 Recanalization is possible
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107. DISADVANTAGES
 Difficult to reverse
 Does not protect from STD
 Contraceptive effect begins after 20 discharges. It
requires additional method in this period.
 Scrotum pain, bleeding, hematoma may occur.
 Local infection
 Spontaneous recanalization in some cases
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108. INDICATION:
 Those couples not wanting any more children.
 Whose wife shouldn’t strictly become pregnant for
health reasons.
 CONTRA INDICATIONS
 Single man
 Men without any children
 Men with psychological issues
 Men undergoing marriage related problems
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109. •No Need for Pre Medication.
•Local Anesthesia.
SIDE EFFECTS
•Fever
•Bleeding
•Pain
•Hematoma
HOW IS PROCEDURE PERFORMED?

110. •Avoid heavy and compelling efforts and moves for
48 hours.
•2-3 days home rest.
•Incision should be kept dry and clean for first 48
hours.
•For 2-3 days sexual intercourse is not
recommended.
•Wear T-bandage or scrotal support for 2 weeks
•
POST-VASECTOMY RECOMMENDATIONS

111. •Within 7 days after procedure.
•Man should be advised on effective
contraception until two consecutive semen
sample 4 weeks apart confirm azoospermia
(the first sample should be taken 8 weeks
after surgery)
FOLLOW UP

112. TUBAL LIGATION
 Irreversible, permanently effective surgical
procedure for sterilization in which a woman's
fallopian tubes are clamped and blocked and sealed
for women who will not want more children
 Interruption of the continuity of the oviducts by
cutting, cautery, or by a plastic or metal device to
prevent future conception.

113. METHODS OF FEMALE STERILIZATION
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114. EFFECTIVENESS
• Failure rate is 1 in 200
 ADVANTAGES
• Immediate Effect.
• Single procedure.
• Failure rate is very low.
• No health problem
• Cost effective/ free of charge
• Does not require teaching or training
• It one time method
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115. DISADVANTAGES OF TUBAL LIGATION
• Difficult to revoke and expensive.
• Does not protect from Sexually Transmitted
diseases.
• Pregnancy may be experienced even at low levels.
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116. TUBAL LIGATION ELIGIBILITY
CRITERIA:
Explain to the client that an abdominal (minilap,
postpartum or laparoscopic) or vaginal approach can
be used for TL.
It can be performed within 48 hours of childbirth.
An interval procedure after 6 weeks postpartum
At any time if the woman is not pregnant.

117. •Single Woman
•Women without any children
•Women who are not positively sure whether she or
her husband want more children.
•Women with psychological issues.
•Women undergoing marriage related problem.
TUBAL LIGATION NOT ADVISABLE FOR

118. •In the most suitable and shortest time.
•Allow time between counseling and procedure for
couple to consider their decision.
•Women who are surely known not being pregnant.
•May be performed after delivery.
•May be performed after abortion in 1st trimester.
APPLICATION TIME FOR TUBAL LIGATION

119. •Can be performed during C-section operation.
•Prenatal period is the most suitable period to
provide counseling services for those who will have
tubal ligation or vasectomy immediately after
delivery.
•Early post partum period may not be a suitable time
for the applicant to decide about terminating her
fertility.
APPLICATION TIME FOR TUBAL LIGATION

120. •General, regional or local anesthesia
based on the decision of physician.
•3-4cm of incision in mini-laprotomy.
•1cm of incision is made under the umbilicus
in laparoscopy.
HOW IS TUBAL LIGATION PERFORMED?

121. SIDE EFFECTS OF TUBAL LIGATION
•Not Harmful for problem occurs rarely.
• Bleeding,
• Injuries in Organs
• Infection
• Embolism

122. •Within 7 days.
•If non absorbable suture is used, it shall be
remove.
If any complaints.. Postoperative fever,
dizziness with fainting, persistent or
increasing abdominal pain, and bleeding or
fluid discharge from the incision
REFERRAL
FOLLOW UP IN TUBAL LIGATION

123. REVERSAL OF STERILIZATION
 For the female laparotomy does not always
work (microsurgical techniques are associated
with 70% success) and carries 5% ectopic
pregnancy
 For the male, technically feasible up to 90%, but
pregnancy is <60%
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124. FOLLOW-UP
 After 1 week
 After 3 months
 Every year
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125. 0
1
2
3
4
5
6
7
8
9
10
FP METHODS: FAILURE RATE AMONG TYPICAL USERS
Combined Oral
Contraceptive
Patch Ring Implant Female
Sterilization
Injectable
Contraceptive
IUD
Percentage
of
Women
Experiencing
an
Unintended
Pregnancy
8% 8% 8%
3%
0.1% 0.05%
0.5%

126. THE END
REFFERENCE
Family planning; a global
handbook for provider 2018 3rd
edition