The document covers the various methods of contraception and family planning, aiming to dispel misconceptions and provide accurate information. It discusses hormonal and barrier methods, their effectiveness, and the importance of personalized counseling for individuals, especially those who use drugs. The document also emphasizes the necessity of dual protection strategies to prevent STIs and unintended pregnancies, highlighting that no contraceptive method is completely effective.

1. Contraception and family planning

2. LEARNING OBJECTIVES
• To explore misbeliefs associated with contraception and the full range of
contraceptive methods
• To know the main components of family planning and contraceptive services
• To provide quality counseling on contraception and contraceptive choices to
women and gender non-conforming people who use drugs
• To identify the main barriers to accessing contraception and potential
approaches to overcome the barriers

3. BASIC INFORMATION AND CHOICES
• There are a lot of beliefs and misconceptions associated with contraceptives methods. For
example:
 Contraceptive methods can cause infertility
 Women lose libido with hormonal contraception
 Contraceptive methods can cause birth defects
• Health professional and harm reduction providers may also share these beliefs.
• The lack of accurate information will impact and limit people’s choices around pregnancy
prevention.
• Every person will have different needs and preferences for contraception.
Give them a choice!

4. Female Reproductive system

5. Female Reproductive system

6. Menstrual cycle

7. Physiology of menstruation

8. Ovarian cycle

9. Male Reproductive system

10. Male Reproductive system

11. Contraception
• There are many types of contraception widely used now days for
family planning purposes.
• Each method has its advantages and suits special cases and not
necessarily suits others and the choice of contraception depends
on different needs of the patients like the period of contraception
and also doctor should decide which method suits needs more.
• No method of contraception is completely effective.
• Types:-
1. Natural contraception
2. Mechanical contraception
3. Hormonal contraception
4. Surgical contraception

12. METHODS OF CONTRACEPTION
• The main effective methods of contraception are:
• Hormonal methods: implants, pills (progestogen and
combined),IUD, injectables
• Other methods: copper IUD, vasectomy and female
sterilisation
• Barrier methods: internal (female) and external (male)
condoms, diaphragm
• Other methods exist but are less effective and are not under the
control of women (for instance the natural method of withdrawal).

13. Types of Birth Control

14. HORMONAL METHODS
Implant • Small, flexible rods or capsules placed under the skin of the upper arm;
contains progestogen hormone only.
• A healthcare provider must insert and remove it.
• It can be used for 3–5 years, depending on implant.
• Irregular vaginal bleeding common but not harmful.
• Efavirenz-based ART may reduce the effectiveness of the implant.
Women living with HIV should receive appropriate counselling to choose
the contraceptive method most suited to their situation.
Progestogen-only pills • It thickens cervical mucous to block sperm and egg from meeting and
prevents ovulation.
• It is highly effective when taken correctly and consistently.
• Can be used while breastfeeding.
• Must be taken at the same time each day
Combined
contraceptive pills
• Contains two hormones (estrogen and progestogen).
• Prevents the release of eggs from the ovaries (ovulation).
• Reduces risk of endometrial and ovarian cancer but not other cancers.
• It is highly effective when taken correctly and consistently.
• For women who use drugs it may increase the risk of vein problems,
such as venous thrombosis or varicose veins. Check with a health
professional.

15. OTHER METHODS
The copper IUD
(Intrauterine device)
• Small flexible plastic device containing copper sleeves or wire that
is inserted into the uterus.
• Copper component damages sperm and prevents it from meeting
the egg.
• Longer and heavier periods during first months of use are common
but not harmful.
Vasectomy • Permanent contraception to block or cut the vas deferens tubes
that carry sperm from the testicles.
• It keeps sperm out of ejaculated semen.
• It is highly effective after three months.
• Does not affect male sexual performance.
• Voluntary and informed choice is essential.
Female Sterilisation • Permanent contraception to block or cut the fallopian tubes.
• Eggs are blocked from meeting sperm.
• It is highly effective and informed choice is essential.

16. BARRIER METHODS
Diaphragm, cervical
cap, sponge
• The diaphragm and cervical cap are dome-shaped and made of silicone. The
cap covers only the cervix.
• The diaphragm is larger. It lodges behind your pubic bone. You need to use
spermicide with the diaphragm or cap to help prevent pregnancy.
• The diaphragm, cervical cap and sponge are among the least effective forms of
birth control.
External condom (male
condom)
• Made of very thin latex or polyurethane, it fits over an erect penis.
• Forms a barrier to prevent sperm and egg from meeting.
• It is effective when used correctly and consistently, with lubricant.
• Can prevent unintended pregnancy and also protects against sexually
transmitted infections, including HIV.
Internal condom
(female condom)
• Made of very thin, transparent, soft polyurethane – most are latex-free.
• It fits loosely inside the vagina.
• Unlike external condoms, internal condoms can be used even when the penis isn’t
erect.
• Can be used for vaginal and anal sex.
• It is best to insert the internal condom ahead of time, and always before and until
vaginal or anal sex is finished.
• It is effective when used correctly and consistently (with lubricant). It can prevent
unintended pregnancy and HIV, and it offers increased protection against SITs by
partially covering external genitalia.

17. STIs and Pregnancy Prevention
• Abstinence
• Hormonal Methods
• Non-hormonal Methods

18. What is the most effective method
of preventing pregnancy and STIs?
Abstinence

19. •avoiding vaginal intercourse (penis to vagina sex),
•avoiding oral (mouth to penis or vagina sex) and anal
intercourse (penis to anus sex), or
•avoiding genital contact (any type of direct touching
of the partner's penis or vagina)
Abstaining is not necessarily forever, and it is not only
for virgins.
What is abstinence?

20. • Abstinence is the only 100% effective method
against STIs and pregnancy if you do not have
vaginal, anal, oral sex or skin to skin contact.
• What are alternative ways that a person who is
abstinent can be intimate with a partner?
Abstinence

21. Hormonal methods of
birth control

22. The pill
• A hormonal method that contains:
a. estrogen and progesterone or
b. progesterone only
• Prevents the release of a mature egg
• Thickens cervical mucous
• Changes the lining of the uterus
• Typical effectiveness rate is 91%

23. 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

24. Side-effects
• Breast tenderness
• Nausea
• Increase in headaches
• Moodiness
• Weight change

26. 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

27. Transdermal patch
• A patch that releases hormones through the skin
• Thin, smooth and beige patch
• Prevents the release of a mature egg
• Thickens cervical mucous
• Changes the lining of the uterus
• Typical effectiveness rate is 91%

29. Nuva Ring (vaginal ring)
• Soft and flexible ring, inserted into the vagina
• The ring slowly releases hormones while in the
vagina for 3 weeks
• Prevents the release of a mature egg
• Thickens cervical mucous
• Changes the lining of the uterus
• Typical effectiveness rate is 91%

31. Depo Provera – Injectable contraceptive
• An injection of progestin administered every 12
to 13 weeks
• Prevents the release of a mature egg
• Thickens cervical mucous
• Changes the lining of the uterus
• Typical effectiveness rate is 94%

32. 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!

34. Intrauterine Contraception-IUC
• T-Shaped device that is inserted in the uterus by
a Doctor
• Two types of IUC:
• the Copper intrauterine device (no hormone)
• the levonorgestrel-releasing intrauterine system
(contains a progestin)
• Typical effectiveness rate is 99.8%

35. Copper T vs.. Progestasert
• 10 years
• 99.2 % effective
• Copper on IUD acts as
spermicide, IUD blocks egg
from implanting
• 1 year
• 98% effective
• T shaped plastic that
releases hormones over a
one year time frame
• Thickens mucus, blocking
egg

37. Hormonal methods of birth control
• Side effects that may occur during the first few
months on hormonal contraception include :
 irregular bleeding, spotting
 nausea
 mood swings
 bloating
 breast tenderness
 headaches

38. Emergency contraception
• Can be taken up to 5 days after intercourse
• The sooner it is taken, the better it works
• Delays or prevents the release of an egg
• May prevent implementation of a fertilized egg
• 95 % effective if taken within 24 hours after
intercourse
• 85% effective if taken 25-48 hours after intercourse
• 58% effective if taken 49-72 hours after intercourse

39. Barrier methods
(non-hormonal)

40. BARRIER METHODS
• Spermicides
• Male Condom
• Female Condom
• Diaphragm
• Cervical Cap

43. SPERMICIDES
• Chemicals kill sperm in the vagina
• Different forms:
-Jelly -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

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

45. MALE CONDOM
• Typical effectiveness rate = 88%
• available
• Combining condoms with spermicides raises effectiveness levels to 99%

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

47. The Female Condom
The female condom is a lubricated polyurethane sheath, similar in appearance to a male condom. It is
inserted into the vagina. The closed end covers the cervix. Like the male condom, it is intended for one-time
use and then discarded.
The sponge is inserted by the woman into the vagina and covers the cervix blocking sperm from entering the
cervix. The sponge also contains a spermicide that kills sperm. It is available without a prescription.

48. Vaginal Ring (NuvaRing)
• 95-99% Effective A new ring is inserted into the
vagina each month
• Does not require a "fitting" by a health care
provider, does not require spermicide, can make
periods more regular and less painful, no pill to
take daily, ability to become pregnant returns
quickly when use is stopped.
Nuva Ring is a flexible
plastic (ethylene-vinyl
acetate copolymer) ring that
releases a low dose of a
progestin and an estrogen
over 3 weeks.

49. DIAPHRAGM
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

50. DIAPHRAGM

51. 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%

52. Cervical Cap
The cervical cap is a flexible rubber cup-like device that is
filled with spermicide and self-inserted over the cervix
prior to intercourse. The device is left in place several
hours after intercourse. The cap is a prescribed device
fitted by a health care professional and can be more
expensive than other barrier methods, such as condoms.

53. Sponge
The sponge is inserted by the woman into the vagina and covers the
cervix blocking sperm from entering the cervix. The sponge also
contains a spermicide that kills sperm. It is available without a
prescription

54. Sponge and Spermicides
• The sponge is a soft, disposable, device with a
spermicide
• Typical effectiveness is 76%-88%
• Fits over the cervix
• Traps and absorbs sperm to increase effect of
spermicide
• Spermicide in the sponge disables the sperm
• Effective for up to 12 hours
• Spermicides disable sperm
• Typical effectiveness is 88%onge

56. Surgical
Methods

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

58. Sterilization
• Tubal ligation - a surgical procedure to close or
block the fallopian tubes ensuring sperm and egg
do not meet

59. Sterilization
• Vasectomy - A surgical procedure to close or block
the vas deferens

60. VASECTOMY
• Male sterilization procedure
• Ligation of Vas Deferens tube
• Faster and easier recovery than a tubal ligation
• Failure rate = 0.1%, more effective than female sterilization

61. During a vasectomy (“cutting the vas”) a urologist cuts and ligates (ties off) the
ductus deferens. Sperm are still produced but cannot exit the body. Sperm
eventually deteriorate and are phagocytized. A man is sterile, but because
testosterone is still produced he retains his sex drive and secondary sex
characteristics.

62. Important to take note

63. DUAL PROTECTION
People who use drugs and their sexual partners must be counselled on dual protection
strategies to prevent the transmission of HIV and STIs, as well as to avoid unintended
pregnancy. These include:
• Condoms, plus another contraceptive method
• Condoms, plus emergency contraception if condom fails
• Selectively using condoms and another method (for example, using the pill
with the main partner, but the pill plus condoms with others).

64. METHADONE AND CONTRACEPTION
• Offering contraception services in conjunction with substance use treatment like
methdaone could help the women and gender non-conforming people who use drugs
meet their needs for contraception.
• It can reduce unintended pregnancy. There is no evidence that methadone is
incompatible with contraceptive methods.
HIV treatment and hormonal contraception
• There is no evidence of incompatibility between ARVs and hormonal contraceptives.

65. COUNSELLING SKILLS
• Importance of providing accurate information
• Non-judgmental attitudes
• Active listening
• Clear communication without technical words – use simple language
• Respect people’s right to confidentiality, privacy and informed choice
• Non-discrimination (regardless of their age, family or social status, sexual behaviour,
kind and frequency of drug use, etc.)