This presentation outlines information on contraception. It begins with the origins and history of contraception dating back to ancient times. It then describes the physiology of the male and female reproductive systems and the menstrual cycle. Conception and pregnancy are explained. The various contraceptive methods are presented along with factors to consider when choosing a method. The pharmacology, mechanisms of action, effectiveness, side effects and drug interactions of different contraceptives are summarized. The roles and responsibilities of pharmacists regarding contraceptives are provided. Data from a family planning clinic is presented and barriers to dispensing oral contraceptives by community pharmacists in Nigeria are discussed. Recommendations and conclusions complete the presentation.

1. PRESENTATION
ON
CONTRACEPTION
BY
NJOKU CHIKOSOLU ROSEMARY
PRESENTED TO
THE DEPARTMENT OF PHARMACY
FEDERAL MEDICAL CENTRE, KEFFI
27th of May, 2022

2.  Preceptor: Pharm Rakiya Abubakar
Supervisors: Pharm Hindatu Sameel
Pharm Innocent Amoke
Members: Pharm Njoku Chikosolu Rosemary
Pharm Mohammed Mudashiru Okhai
Pharm Malji Modi Hamza
GROUP MEMBERS
GROUP MEMBERS

3. INTRODUCTION
ORIGIN OF CONTRACEPTION
PHYSIOLOGY OF THE FEMALE AND MALE REPRODUCTIVE SYSTEM
CONCEPTION AND PREGNANCY
CONTRACEPTIVE METHODS AND FACTORS DETERMINING CHOICE
OF SUITABLE METHOD
PHARMACOLOGY OF CONTRACEPTIVES
ROLE OF PHARMACISTS IN THE USE OF CONTRACEPTIVES
PHARMACEUTICAL RELEVANCE
DATA REPORT FROM FMC KEFFI FAMILY PLANNING CLINIC
KNOWLEDGE, WILLINGNESS AND BARRIERS TOWARDS
DISPENSING OF ORAL CONTRACEPTIVES BY COMMUNITY
PHARMACISTS IN NIGERIA
RECOMMENDATIONS
CONCLUSION
REFERENCES
OUTLINE
OUTLINE

4. 

Contraception is defined as the intentional
prevention of conception through the use of
various devices, sexual practices, chemicals,
drugs or surgical procedures.
Among 1.9 billion women of reproductive age
15-49 years worldwide, 1.1 billion have a need
for family planning (WHO, 2019).
Prevention of unintended pregnancies is a
significant public health concern.
INTRODUCTION
INTRODUCTION

5. As early as 1850 BC, papyrus scrolls in Ancient
Egypt and Mesopotamia contained directions on
using honey, acacia leaves and lint as a cervical cap.
In 3000 BC, King Minos of Crete used the bladder of
a goat as a condom. Through the ages, people also
used linen, sheep intestines and fish bladders as
condoms.
In 1885, the English pharmacist Walter Rendell
produced the first commercially available
spermicidal suppository from cocoa butter and
quinine sulfate.
ORIGIN OF CONTRACEPTION
ORIGIN OF CONTRACEPTION
ORIGIN OF CONTRACEPTION

6.  Margaret Sanger who founded the first American
birth control clinic in 1916, propelled the research
that led to the creation of the “pill”, one of the most
popular contraceptives.
Intrauterine devices (IUDs) came into widespread
use in 1960s when flexible plastic devices became
available.
Sterilization was first used for eugenic reasons in
early 1900s, but by the end of 20th century,
vasectomy and occlusion of fallopian tubes were
popular.
ORIGIN OF CONTRACEPTION
ORIGIN OF CONTRACEPTION
ORIGIN OF CONTRACEPTION

7. PHYSIOLOGY OF THE FEMALE
REPRODUCTIVE SYSTEM
PHYSIOLOGY OF THE FEMALE
REPRODUCTIVE SYSTEM
PHYSIOLOGY OF THE FEMALE
REPRODUCTIVE SYSTEM

8. PHYSIOLOGY OF THE FEMALE
REPRODUCTIVE SYSTEM
PHYSIOLOGY OF THE FEMALE
REPRODUCTIVE SYSTEM
PHYSIOLOGY OF THE FEMALE
REPRODUCTIVE SYSTEM

9. 
The menstrual cycle is a term used to describe
the sequence of events that occurs in a woman’s
body as it prepares for the possibility of
pregnancy each month.
The average cycle is 28 days long, however it can
range from 21-35 days.
The four phases of the menstrual cycle are the
menstrual phase, follicular phase, ovulation phase
and the luteal phase.
THE MENSTRUAL CYCLE
THE MENSTRUAL CYCLE

11. The male reproductive system includes internal and
external organs and structures that help with
reproduction.
The primary hormones involved in functioning of the
male reproductive system are follicle stimulating
home (FSH), luteinizing hormone (LH) and
testosterone.
FSH and LH are produced by the pituitary gland. FSH
is necessary for spermatogenesis while LH
stimulates production of testosterone which is
necessary to continue spermatogenesis.
PHYSIOLOGY OF THE MALE
REPRODUCTIVE SYSTEM
PHYSIOLOGY OF THE MALE
REPRODUCTIVE SYSTEM
PHYSIOLOGY OF THE MALE
REPRODUCTIVE SYSTEM

13. Conception occurs when a sperm cell fertilizes a
mature egg.
The fertilized egg begins to divide and after a
week it is attached to the lining of the uterus. This
is called implantation.
There is absence of menstruation, which may be
the first symptoms of pregnancy.
CONCEPTION AND PREGNANCY
CONCEPTION AND PREGNANCY

14. 






Methods of contraception include:
Oral contraceptive pills
Implants
Injections
Patches
Sponges
Vaginal rings
Intra uterine devices
CONTRACEPTIVE METHODS
CONTRACEPTIVE METHODS

15. 





Male and female condoms
Male and female sterilization
Lactational amenorrhea method
Calendar method
Withdrawal method (coitus interruptus)
These methods have different mechanisms of
action and effectiveness.
CONTRACEPTIVE METHODS
CONTRACEPTIVE METHODS

16. 







The most appropriate method of birth control
depends on;
Age
Individual’s overall health
Frequency of sexual activity
Number of sexual partners
Desire to have children in the future
Family history of certain diseases
Intended duration of use
Cost
FACTORS DETERMINING CHOICE OF
SUITABLE CONTRACEPTIVE METHOD
FACTORS DETERMINING CHOICE OF
SUITABLE CONTRACEPTIVE METHOD
FACTORS DETERMINING CHOICE OF
SUITABLE CONTRACEPTIVE METHOD

20. 



Effectiveness of contraceptive methods is
measured by the number of pregnancies per 100
women using the method per year (WHO, 2020).
Methods are classified by their effectiveness as
commonly used into;
Very effective (0-0.9 pregnancies per 100 women)
Effective (1-9 pregnancies per 100 women)
Moderately effective (10-19 pregnancies per 100
women)
Less effective (20 or more pregnancies per 100
women)
PHARMACOLOGY OF CONTRACEPTIVES
PHARMACOLOGY OF CONTRACEPTIVES

21. MECHANISMS OF ACTION AND
EFFECTIVENESS REPORT
MECHANISMS OF ACTION AND
EFFECTIVENESS REPORT
MECHANISMS OF ACTION AND
EFFECTIVENESS REPORT
METHOD MECHANISM OF
ACTION
EFFECTIVENESS
(pregnancies per
100 women /
year with
consistent and
correct use)
EFFECTIVENESS
(pregnancies per
100 women/
year as
commonly used)
Combined oral
contraceptives
(COCs) or “the pill”
Prevents the release
of eggs from the
ovaries (ovulation)
0.3 7
Progestogen-only
pills (POPs) or “the
minipill”
Thickens cervical
mucous to block
fertilization and
prevents ovulation
0.3 7
Progestogen only
injectables
Thickens cervical
mucous to block
fertilization and
prevents ovulation
0.2 0.4

22. METHOD MECHANISM OF
ACTION
EFFECTIVENESS
(pregnancies per
100 women/year
with consistent
and correct use)
EFFECTIVENESS
(pregnancies per
100 women/
year as
commonly used)
Monthly combined
injectable
contraceptives (CIC)
Prevents release
of eggs from
ovaries (ovulation)
0.05 3
Combined
contraceptive patch
and combined
contraceptive
vaginal ring (CVR)
Prevents release
of eggs from
ovaries (ovulation)
0.3 (for patch)
0.3 ( for CVR)
7
7
Intrauterine device
(IUD) levonorgestrel
Thickens cervical
mucous to block
fertilization
0.5 0.7
MECHANISMS OF ACTION AND
EFFECTIVENESS REPORT
MECHANISMS OF ACTION AND
EFFECTIVENESS REPORT
MECHANISMS OF ACTION AND
EFFECTIVENESS REPORT

23. METHOD MECHANISM OF
ACTION
EFFECTIVENESS
(pregnancies per
100 women/
year with
consistent and
correct use)
EFFECTIVENESS
(pregnancies per
100 women/
year as
commonly used)
Male condoms Forms a barrier to
fertilization
2 13
Female condoms Forms a barrier to
fertilization
5 21
Male sterilization
(Vasectomy)
Keeps sperm out of
ejaculated semen
0.1 0.15
Female
sterilization
(tubal ligation)
Egg is blocked from
meeting sperm
0.5 0.5
ECPs (UA 30mg
or levonorgestrel
1.5mg)
Prevents ovulation <1 for UA ECPs
1 for progestin-
only ECPs
_
MECHANISMS OF ACTION AND
EFFECTIVENESS REPORT
MECHANISMS OF ACTION AND
EFFECTIVENESS REPORT
MECHANISMS OF ACTION AND
EFFECTIVENESS REPORT

24. METHOD MECHANISM OF
ACTION
EFFECTIVENESS
(pregnancies per
100 women/year
with consistent
and correct use)
EFFECTIVENESS
(pregnancies per
100 women/year
as commonly
used )
Lactational
amenorrhea
method
Prevents
ovulation
0.9 (in six months) 2 (in six months)
Calendar method
or rhythm method
Avoiding
unprotected
vaginal sex during
most fertile days
or using a condom
Reliable
effectiveness
rates are not
available
15
Basal Body
Temperature (BBT)
Method
Avoiding
unprotected
vaginal sex during
most fertile days
Reliable
effectiveness
rates are not
available
_
MECHANISMS OF ACTION AND
EFFECTIVENESS REPORT
MECHANISMS OF ACTION AND
EFFECTIVENESS REPORT
MECHANISMS OF ACTION AND
EFFECTIVENESS REPORT

25. METHOD MECHANISM OF
ACTION
EFFECTIVENESS(
pregnancies per
100 women/year
with consistent
and correct use)
EFFECTIVENESS
(pregnancies per
100 women/year
as commonly
used)
Implants Thickens cervical
mucous to block
fertilization and
prevents ovulation
0.1 0.1
IUD containing
copper
Copper damages
sperm and
prevents
fertilization
0.6 0.8
Withdrawal
(coitus interruptus)
Tries to keep
sperm out of the
woman’s body.
4 20
MECHANISM OF ACTION AND
EFFECTIVENESS REPORT
MECHANISM OF ACTION AND
EFFECTIVENESS REPORT
MECHANISM OF ACTION AND
EFFECTIVENESS REPORT
MECHANISM OF ACTION AND
EFFECTIVENESS REPORT

27. SIDE EFFECTS OF CONTRACEPTIVES
SIDE EFFECTS OF CONTRACEPTIVES
METHOD COMMON SIDE EFFECTS
Oral contraceptive
pills
Weight gain, nausea, bleeding, breast
tenderness, mood swings, irregular periods,
Implants Headaches, mood changes, acne, growth of
facial hair
Patches Skin irritation, weight gain, mood swings
Vaginal rings Irritation, vaginal bleeding, vaginal discharge,
bloating, headaches
Injections Mood changes, irregular periods, weight gain,
acne, excessive growth of facial hair
Intra uterine devices Bleeding, menstrual cramps, heavy and
irregular periods
Condoms Allergy, skin irritation, Discomfort
Spermicides Irritation and allergic reactions
Sterilization Discomfort, bleeding

28. Antibiotics: Patient is advised to use additional
method of birth control.
Anti-retroviral drugs: Patient should use a
contraceptive method not affected by anti-
retrovirals.
Anti-fungal drugs: Patient is advised to use
additional method of birth control
Anti-seizure drugs: Patient can be placed on barrier
methods, IUDS, diaphragms, injections.
Herbal remedies: Patient can avoid the herbals or
use a contraceptive method not affected.
DRUGS DECREASING THE EFFICACY
OF ORAL CONTRACEPTIVES
DRUGS DECREASING THE EFFICACY
OF ORAL CONTRACEPTIVES
DRUGS DECREASING THE EFFICACY
OF ORAL CONTRACEPTIVES

29. 




The pharmaceutical care roles of pharmacists
includes;
Providing information on emergency contraceptives,
their effectiveness and how to use them properly.
Pharmacists can play a role in overcoming barriers for
access to contraceptive services.
Documenting and reporting of any adverse reactions
encountered with the use of any contraceptive method.
Following-up of patients using contraceptives.
Counsel, refer and encourage patients who are in need
of family planning services to family planning clinics.
ROLE OF PHARMACISTS IN THE USE
OF CONTRACEPTIVE METHODS
ROLE OF PHARMACISTS IN THE USE
OF CONTRACEPTIVE METHODS
ROLE OF PHARMACISTS IN THE USE
OF CONTRACEPTIVE METHODS

30.  Contraception reduces the need for unsafe abortion
by reducing the number of unintended pregnancies.
Contraception reduces pregnancy related morbidity
and mortality.
Contraception also reduces teenage pregnancies,
thereby reducing pregnancy related mortality rates
for teenage women and negative impacts on their
development and education.
PHARMACEUTICAL RELEVANCE
PHARMACEUTICAL RELEVANCE

31. 


Services to prevent, screen for and treat diseases
such as chlamydia, gonorrhea, HIV, HPV and
cervical cancer are available to clients at family
planning clinics.
Barrier methods such as condoms serve as a very
safe method of birth control and also prevent the
transmission of sexually transmitted diseases.
Contraceptive use helps to slow down population
explosion, thereby reducing pressure on health
services, economy and education.
PHARMACEUTICAL RELEVANCE
PHARMACEUTICAL RELEVANCE

32. DATA JANUARY FEBRUARY MARCH APRIL
TOTAL
NUMBER OF
PATIENTS
173 142 160 140
TOTAL MALES 4 6 5 14
TOTAL
FEMALES
169 136 155 126
DATA REPORT FROM FMC KEFFI
FAMILY PLANNING CLINIC
DATA REPORT FROM FMC KEFFI
FAMILY PLANNING CLINIC
DATA REPORT FROM FMC KEFFI
FAMILY PLANNING CLINIC
AGE (YEARS) JANUARY FEBRUARY MARCH APRIL
15-19 1 1 1 1
20-24 20 17 11 17
25 and above 152 124 148 122

33. CONTRACEPTIVE METHOD JANUAR
Y
FEBRUARY MARCH APRIL
Levonorgestrel 150mg
(levoplant)
4 3 5 2
Levonogestrel 150mg
(jadelle)
22 16 18 23
Etonogestrel 68mg
(NXT Implanon)
31 25 4 17
Norethistherone 200mg
(Noristerat)
24 19 22 20
MP 150mg (Depo-provera) 23 16 15 18
MP 104mg (Sayana press) 1 0 1 _
Pills 7 18 27 _
Female Condom 3 0 0 _
Male Condom 4 80 117 _
IUD (copper) 6 4 7 _
Sterilization 0 0 0 _
DATA REPORT FROM FMC KEFFI
FAMILY PLANNING CLINIC
DATA REPORT FROM FMC KEFFI
FAMILY PLANNING CLINIC
DATA REPORT FROM FMC KEFFI
FAMILY PLANNING CLINIC

34. DATA RESULTS
GENDER Total responses 67
Males 40.9%
Females 59.1%
YEARS OF PRACTICE AS A
COMMUNITY PHARMACIST
Less than 1 year 37.3%
1-5 years 59.7%
5-10 years 1.5%
Above 10 years 1.5%
ANY PRIOR EDUCATION ON
ORAL CONTRACEPTIVES
Yes 94%
No 6%
NUMBER OF ORAL
CONTRACEPTIVES DISPENSED
WEEKLY
1-3 32.3%
3-6 27.7%
More than 6 40%
KNOWLEDGE, WILLINGNESS AND BARRIERS TOWARDS
DISPENSING OF ORAL CONTRACEPTIVES BY COMMUNITY
PHARMACISTS IN NIGERIA
KNOWLEDGE, WILLINGNESS AND BARRIERS TOWARDS
DISPENSING OF ORAL CONTRACEPTIVES BY COMMUNITY
PHARMACISTS IN NIGERIA
KNOWLEDGE, WILLINGNESS AND BARRIERS TOWARDS
DISPENSING OF ORAL CONTRACEPTIVES BY COMMUNITY
PHARMACISTS IN NIGERIA
KNOWLEDGE, WILLINGNESS AND BARRIERS TOWARDS
DISPENSING OF ORAL CONTRACEPTIVES BY COMMUNITY
PHARMACISTS IN NIGERIA

35. KNOWLEDGE OF ORAL
CONTRACEPTIVES
KNOWLEDGE OF ORAL
CONTRACEPTIVES
KNOWLEDGE OF ORAL
CONTRACEPTIVES
DATA RESULTS
INDICATIONS FOR ORAL
CONTRACEPTIVES
Pregnancy prevention 98.5%
Acne 11.9%
Hirsutism 10.4%
Menstrual cramps 17.9%
PUD 7.5%
Anemia 3%
COMMON SIDE EFFECTS
OBSERVED IN PATIENTS ON
ORAL CONTRACEPTIVES
Irregular bleeding 89.6%
Nausea 40.3%
Weight gain 62.7%
Mood swings 37.3%
Breast tenderness 43.3%
Headache 34.3%
DRUGS THAT INTERACT
WITH ORAL
CONTRACEPTIVES
Anti seizure 43.3%
Antibiotics 35.8%
Antifungals 26.9%
CONTRAINDICATIONS FOR
ORAL CONTRACEPTIVES
Migraine 21.7%
Pregnancy 4.1 %
Breast cancer 81.7%

36. REASONS RESPONSE
IMPROVED ACCESS AND ADVICE
WILL BENEFIT PATIENTS
Agree 92.5%
Disagree 4.5%
Neutral 3%
PHARMACISTS ARE WELL QUALIFIED
AND EDUCATED TO DISPENSE AND
COUNSEL ON ORAL
CONTRACEPTIVES
Agree 97%
Disagree 0%
Neutral 3%
CONTRACEPTION IS A SIGNIFICANT
PUBLIC HEALTH CONCERN
Agree 95.5%
Disagree 1.5%
Neutral 3%
INCREASES BUSINESS/REVENUE
BENEFIT
Agree 61.2%
Disagree 13.4%
Neutral 25.4%
REASONS FOR THE COMMUNITY
PHARMACISTS’ WILLINGNESS TO
DISPENSE ORAL CONTRACEPTIVES
REASONS FOR THE COMMUNITY
PHARMACISTS’ WILLINGNESS TO
DISPENSE ORAL CONTRACEPTIVES
REASONS FOR THE COMMUNITY
PHARMACISTS’ WILLINGNESS TO
DISPENSE ORAL CONTRACEPTIVES
REASONS FOR THE COMMUNITY
PHARMACISTS’ WILLINGNESS TO
DISPENSE ORAL CONTRACEPTIVES

37. BARRIERS RESPONSE
INSUFFICIENT TRAINING/
KNOWLEDGE OF PHARMACISTS
ABOUT OCs
Agree 31.3%
Disagree 55.2%
Neutral 13.4%
PHYSICIANS’ RESISTANCE TO
PHARMACISTS HANDLING ORAL
CONTRACEPTIVES
Agree 27.3%
Disagree 48.5%
Neutral 24.2%
OBJECTIONS TO USE OF ORAL
CONTRACEPTIVES BASED ON
RELIGIOUS/CULTURAL BELIEFS
Agree 65.7%
Disagree 20.9%
Neutral 13.4%
LACK OF TRUST IN PHARMACISTS’
COMPETENCY TO DISPENSE OC
Agree 12.1%
Disagree 77.3%
Neutral 10.6%
MAJOR CONCERNS FOR PATIENTS’
SAFETY
Agree 65.7%
Disagree 20.9%
Neutral 13.4%
BARRIERS PREVENTING COMMUNITY
PHARMACISTS FROM DISPENSING
ORAL CONTRACEPTIVES
BARRIERS PREVENTING COMMUNITY
PHARMACISTS FROM DISPENSING
ORAL CONTRACEPTIVES
BARRIERS PREVENTING COMMUNITY
PHARMACISTS FROM DISPENSING
ORAL CONTRACEPTIVES
BARRIERS PREVENTING COMMUNITY
PHARMACISTS FROM DISPENSING
ORAL CONTRACEPTIVES

38. Pharmacists should undergo comprehensive
trainings on contraception, sexual and
reproductive health services.
Pharmacists should be more involved in the
activities of the family planning clinics.
Pharmacists’ role in family planning is expanding,
therefore pharmacists should be knowledgeable
and well updated to take on these roles.
RECOMMENDATIONS
RECOMMENDATIONS

39. Effective contraception benefits both mother and
children by decreasing morbidity and mortality.
Contraceptive information and services is the right
of every individual and there is need to improve on
the shortage of services and meet the high need for
contraception.
Appropriate contraceptive methods should be
chosen only after interacting, counseling the patient
involved and putting the individual specific factors
into consideration.
Pharmacists play a crucial role in access to
reproductive health services, therefore they should
have sufficient knowledge and stay current on new
contraceptive options that may be available.
CONCLUSION
CONCLUSION

40. Konje JC, Oladini F, Otolorin EO, Ladipo OO (1988).
Factors determining the choice of contraceptive
methods at the Family Planning Clinic, University
College Hospital, Ibadan, Nigeria. Br J Fam Plan
1998 Oct;24(3):107-10.PMID:9855717.
Kavanaugh LM, Anderson R (2013).Contraception
and Beyond: The Health Benefits of Services
Provided at Family Planning Centres. https://ww.
guttmacher.org/report/contraception-and-beyond-
health-benefits-services -provided-family-planning-
centres
World Health Organization (2020).Family planning/
contraception methods. https://www.who.int/news-
room/fact-sheets/detail/family-planning-
contraception
REFERENCES
REFERENCES

41. National Research Council (US) Committee on
Population. Contraception and Reproduction: Health
Consequences for Women and Children in the
Developing world. Washington (DC): National Academies
Press (US); 1989.4, Contraceptive Benefits and Risks.
American Pregnancy Association. Menstruation: A
Journey Through Your Cycle. https://americanpregnancy.
org/womens-health/menstruation/ (Accessed 1/5/2022)
https://www.healthline.com/health/womens-health/
stages-of-menstrual-cycle (Accessed 1/05/2022)
https://www.webmd.com/sex/birth-control/medicines-
interfere-birth-control-pills (Accessed 1/05/2022)
REFERENCES
REFERENCES