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  1. 1. Birth Control &Family Planning
  2. 2. RememberThe total risks of birth control aremuch less than the total risks of a pregnancy!!
  3. 3. Types of Birth ControlHormonalBarrierIUDMethods based oninformationPermanent sterilization
  4. 4. Hormonal MethodsOral Contraceptives(Birth Control Pill)Injections (Depo-Provera)Implants (Norplant I & II)
  5. 5. Birth Control PillsPills can be taken to preventpregnancyPills are safe and effective whentaken properlyPills are over 99% effectiveWomen must have a pap smear toget a prescription for birth controlpills
  6. 6. How does the pill work?Stops ovulationThins uterine liningThickens cervical mucus
  7. 7. Positive Benefits of Birth Control Pills  Prevents Decreases pregnancy incidence of  Eases menstrual ovarian cysts cramps Prevents  Shortens period ovarian and  Regulates period uterine cancer Decreases acne
  8. 8. Side-effectsBreast Moodinesstenderness Weight changeNausea SpottingIncrease inheadaches
  9. 9. Taking the PillOnce a day at the same time everydayUse condoms for first monthUse condoms when on antibioticsUse condoms for 1 week if you miss apill or take one lateThe pill offers no protection fromSTD’s
  10. 10. Depo-ProveraBirth control shot given once everythree months to prevent pregnancy99.7% effective preventing pregnancyNo daily pills to remember
  11. 11. How does the shot work? Stops ovulation Stops menstrual cycles!! Thickens cervical mucus
  12. 12. 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!
  13. 13. IMPLANTSImplants are placed in the body filledwith hormone that prevents pregnancyPhysically inserted in simple 15 minuteoutpatient procedurePlastic capsules the size of papermatchsticks inserted under the skin inthe arm99.95% effectiveness rate
  14. 14. Norplant I vs. Norplant IISix capsules Two capsulesFive years Three years
  15. 15. Norplant Implant
  16. 16. Norplant ConsiderationsShould be considered long termbirth controlRequires no upkeep Extremely effective in pregnancyprevention > 99%
  17. 17. Emergency Contraception Emergency contraception pills can reduce the chance of a pregnancy by 75% if taken within 72 hours of unprotected sex!
  18. 18. Emergency Contraception (ECP)Must be taken within 72 hours of theact of unprotected intercourse orfailure of contraception methodMust receive ECP from a physician75 – 84% effective in reducingpregnancyCalifornia pharmacies can prescribewithout a doctor! (1/1/02)
  19. 19. ECPFloods the ovaries with high amount ofhormone and prevents ovulationAlters the environment of the uterus,making it disruptive to the egg and spermTwo sets of pills taken exactly 12hours apart
  20. 20. BARRIER METHODSSpermicidesMale CondomFemale CondomDiaphragmCervical Cap
  21. 21. BARRIER METHODPrevents pregnancy blocks theegg and sperm from meetingBarrier methods have higherfailure rates than hormonalmethods due to design andhuman error
  22. 22. SPERMICIDESChemicals kill sperm in the vaginaDifferent forms:-Jelly -Film-Foam -SuppositorySome work instantly, others requirepre-insertionOnly 76% effective (used alone), shouldbe used in combination with anothermethod i.e., condoms
  23. 23. 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)
  24. 24. MALE CONDOMPerfect effectiveness rate = 97%Typical effectiveness rate = 88%Latex and polyurethane condomsare availableCombining condoms withspermicides raises effectivenesslevels to 99%
  25. 25. FEMALE CONDOMMade as an alternative to malecondomsPolyurethanePhysically inserted in the vaginaPerfect rate = 95%Typical rate = 79%Woman can use female condom ifpartner refuses
  26. 26. Reality ™ : The Female Condom
  27. 27. DIAPRAGHMPerfect Effectiveness Rate = 94%Typical Effectiveness Rate = 80%Latex barrier placed inside vaginaduring intercourseFitted by physicianSpermicidal jelly before insertionInserted up to 18 hours beforeintercourse and can be left in for atotal of 24 hours
  28. 28. DIAPHRAGM
  29. 29. CERVICAL CAPLatex barrier inserted in vagina beforeintercourse“Caps” around cervix with suctionFill with spermicidal jelly prior to useCan be left in body for up to a total of48 hoursMust be left in place six hours aftersexual intercoursePerfect effectiveness rate = 91%Typical effectiveness rate = 80%
  30. 30. INTRAUTERINE DEVICES (IUD)T-shaped object placed in the uterus toprevent pregnancyMust be on period during insertionA Natural childbirth required to use IUDExtremely effective without usinghormones > 97 %Must be in monogamous relationship
  31. 31. Copper T vs.. Progestasert10 years 1 year99.2 % effective 98% effectiveCopper on IUD acts T shaped plasticas spermicide, IUD that releases hormones over ablocks egg from one year time frameimplanting Thickens mucus,Must check string blocking eggbefore sex and after Check string beforeshedding of uterine sex & after sheddinglining. of uterine lining.
  32. 32. STERILIZATIONProcedure performed on a man ora woman permanently sterilizesFemale = Tubal LigationMale = Vasectomy
  33. 33. TUBAL LIGATIONSurgical procedure performed on awomanFallopian tubes are cut, tied,cauterized, prevents eggs fromreaching spermFailure rates vary by procedure, from0.8%-3.7%May experience heavier periods
  35. 35. VASECTOMYMale sterilization procedureLigation of Vas Deferens tubeNo-scalpel technique availableFaster and easier recovery than atubal ligationFailure rate = 0.1%, more effectivethan female sterilization
  36. 36. VASECTOMY
  37. 37. METHODS BASED ON INFORMATIONWithdrawalNatural Family PlanningFertility Awareness MethodAbstinence
  38. 38. WITHDRAWALRemoval of penis from the vagina beforeejaculation occursNOT a sufficient method of birth control byitselfEffectiveness rate is 80% (veryunpredictable in teens, wide variation)1 of 5 women practicing withdrawalbecome pregnantVery difficult for a male to ‘control’
  39. 39. Natural Family Planning &Fertility Awareness MethodWomen take a class on the menstrual cycleto calculate more fertile timesRequires special equipment and cannot beself-taughtNFP abstains from sex during thecalculated fertile timeFAM uses barrier methods during fertiletimePerfect effectiveness rate = 91%Typical effectiveness rate = 75%No 100% safe day-irregular periods
  40. 40. AbstinenceOnly 100% method of birthcontrolAbstinence is when partners donot engage in sexual intercourseCommunication between partnersis important for those practicingabstinence to be successful
  41. 41. Reasons for abstainingMoral or religious valuesPersonal beliefsMedical reasonsNot feeling ready for anemotional, intimaterelationshipFuture plans
  42. 42. SOMETHING TO THINK ABOUT…Couples who use no birth control have a 85% chance of a pregnancy within the first year.
  43. 43. EXCELLENT REFERENCE Hatcher, Robert, MD Contraceptive Technology ,17ed. (2001)
  44. 44. Quality in Family Planning
  45. 45. QualityQuality 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.
  46. 46. Aims & ObjectivesIn 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.
  47. 47. Elements of ‘Quality of Care’ in family planning By Judith Bruce, 1990Choice of methodInterpersonal communication (verbal & nonverbal)Technical CompetenceInformationFollow-upAppropriate constellation of services
  48. 48. Choice of methodOffering the right to the client to choosethe method means giving confidence tothe individual.He/she feels more comfortable inusing the method for which he/she hasbeen provided with clear, accurate andspecific information and which is the bestfor his/her needs.
  49. 49. 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.
  50. 50. Technical Competence Quality needs command on thesubject.It is inevitable to acquire all theessential knowledge and to polishone’s technical competence regardingfamily planning services.
  51. 51. InformationProviding all the necessaryinformation to the client helpshim/her in using the selected methodcorrectly, without any fear.Right information will certainly clearthe myths and rumors about thesubject and will improve the adoptingrate among the potential clients.
  52. 52. Follow-upCorrect and continuous follow up ofthe users is indispensable to monitorthe possible complications with theuse of contraceptives. It ensures eventually an improvedcontinuation rate among the users.
  53. 53. Appropriate constellation of servicesAdding family planning services along withthe routine ones under the same roof mayattract more clientele.The clients do not have to go to some otherservice specialized in family planning only. Clients discuss their problems with moreopenness with their own physician in afriendly ambiance.
  54. 54. Indicators QUALITY OF CARENumber of contraceptive methods available ata specific outletPercentage of counseling sessions with newacceptors in which provider discusses allmethodsPercentage of client visits during whichprovider demonstrates skill at clinicalprocedures, including asepsisPercentage of clients reporting “sufficienttime” with providerPercentage of clients informed of timing andsources for re-supply/revisitPercentage of clients who perceive thathours/days are convenient and the range ofservices provided is adequate.
  55. 55. GATHER Approach to CounselingGreet the client in a friendly andrespectful mannerAsk the client about FP/RH needsTell the client about differentmethods/servicesHelp the client to make her owndecision about which method/serviceto useExplain to the client how to use themethod/service she has chosenReturn visit and follow-ups of client
  56. 56. Rights of ClientsInformation about all the methods / servicesavailable.Knowledge of not only the benefits but also therisks / side effects of all the contraceptivemethods / RH services to make an independentdecision.Outlets providing FP/ RH services should carry alogo / indicative sign on a prominent place. Theyshould also provide a comfortable cleanenvironment to the clients where they will betreated with respect, attention and courtesy.Access to get the FP/RH services regardless ofhis/her sex, race, religion, color and socio-economic status. FP services should be availableto people in their closest vicinity.
  57. 57. Rights of Clients (cont.)Choice to practice FP or RH service should beabsolutely voluntary and free. A competentprovider will help the client to make a decision andwill not pressurize the client to make certainchoice for a certain method/service.Privacy for FP/ RH counseling where the clientwould feel open and frank with the provider.Continuity to obtain the FP/RH services without anybreak or discontinuation to avoid the after effectsand the give-ups of the service.Opinion about the subject, method used and theservice provided. This feedback is always helpfulfor the provider to improve one’s service delivery.
  58. 58. Provider’s needsTraining will certainly help the provider to do abetter counseling. It is needed to polish one’s skillsto pass the right information, to help the client indecision making, to explain the use of a specificmethod, to screen the client etc.Information about all the FP methods/RHservices.Moreover, other information about thelocal community like social, cultural and religiousbeliefs is always helpful in dealing with the FPclients.Update about the FP methods and about the newdevelopments in the reproductive health.Outlet adequately equipped for a trained provider isan essential requirement for the FP/RH services.There should be a logo / sign to show theavailability of FP services in that particular outlet.
  59. 59. Provider’s needs (cont.)Supplies continuous & adequate - needed at theprovider’s outlet to ensure an all time goodservice for the users and other potential clients.Backup & referral for the complicated casesshould be there, where and when needed.Feedback about the services provided in a certainoutlet helps the provider to amend andameliorate his/her services.Acknowledgement in the shape of certification orsome incentives to be encouraged to continuewith the same motivation and involvement.
  60. 60. Family PlanningKnowledge & AttitudesUse of Family PlanningExposure to Family Planning Messages
  61. 61. Knowledge of contraceptive methods Currently married women All women 96 92 95 92 33 24 Any method Any modern method Any traditional Percent of women age 15-49
  62. 62. Which modern methods are most familiar to married women? Male sterilization 47 Implants 54Female sterilization 64 Monthly pill 77 Condom 79 IUD 83 Daily pill 90 Injectables 90 Percent of currently married women age 15-49
  63. 63. Does knowledge of any modern methodvary by residence, region and education? • No urban-rural difference • Women with no education (91%) know slightly less about modern methods than educated women (98%)
  64. 64. Do married women discussfamily planning with their husbands? 53 34 12 Never Once or twice Three or + Percent of currently married women age 15-49 in the past year
  65. 65. What are couples’ attitudes toward family planning? Both approve 68 Both disapprove 6 One approves, other dissaproves 6 Husbands attitude unknown 11 Respondent unsure 9 Percent of women who report that they and their husband approve or not of family planning
  66. 66. Family PlanningKnowledge & AttitudesUse of Family PlanningExposure to Family Planning Messages
  67. 67. Use of contraception among married womenTraditional 5 methods Modern 19 methodsAny method 24 Percent of currently married women age 15-49
  68. 68. Does use of contraception vary by a woman’s level of education? No education Primary Secondary and + 35 23 23 19 19 16 Any method Any modern method Percent of currently married women age 15-49
  69. 69. Contraceptive use also varies by residence 33% of urban women use any method of family planning compared to…22% for their rural counterparts.
  70. 70. Women’s current use of modern contraceptive methods IUD 7% Injectables 40% Male condom 5% Monthly pill 15% Female Daily pill sterilisation 24% 8% Other modern methods 1%
  71. 71. Source of supply for contraceptive methods Public sector Private medical Other private Percent 70 65 57 44 44 4738 37 27 18 17 13 9 5 5Daily pill Monthly pill Injectables Condom IUD**First source, limited to women who started using IUD since 1995
  72. 72. Intention to use contraception in the future 45 42 13Intends to use Does not intend Unsure Percent of currently married women who are not using a contraceptive method
  73. 73. Preferred method of Contraception for future use 34 26 15 ll 4 2 2 m s ll D s le nt pi pi IU do ab a y ly on pl l ct th ai Im C je D onIn M Percent of currently married women who are not using a contraceptive method, but who intend to use
  74. 74. Some reasons cited by women for not intending to use contraception Health concerns 26% Difficult to get pregnant 24% Wants more children 10% Opposed to family 9% planning 8% Infrequent sex/no sex 6% Fear side effectsCurrently married women who are not using a contraceptive method
  75. 75. Family PlanningKnowledge & AttitudesUse of Family PlanningExposure to Family Planning Messages
  76. 76. From what source do women hear family planning messages? From radio only 10% From television only 5% From both 64% NO MESSAGE 21%For all women who heard a message about family planning in the last few months preceding the interview
  77. 77. Does exposure to familyplanning messages vary by residence and education? Residence Urban 86% Rural 78% Education None 70% Primary 80% Secondary+ 92%
  78. 78. Does exposure to family planningmessages in the print media vary by residence and education? Residence Urban 59% Rural 36% Education None 28% Primary 39% Secondary+ 62%
  79. 79. Main findings• Knowledge of family planning is very high,except in two areas (56%)• 19% of women use a modern method ofcontraception (24% use any method)• Use of any contraceptive method has beenincreasing since 1995 (13%) to 24% in 2000• Use varies greatly by residence, region and levelof education
  80. 80. Main findings• Injectables and the daily and monthlypills are the 3 methods most used bywomen• Slightly more than 2 women in 5 intendto use family planning in the future• 4 women in 5 have heard of a familyplanning message in the media