Here are the key points I would discuss with the couple: 1. Since the husband has hepatitis B, permanent sterilization methods like vasectomy may not be advisable as it involves surgical procedures. 2. For the wife, IUCD insertion carries a small risk of introducing infection into the uterus. So IUCD may not be the best option. 3. Barrier methods like condoms would help prevent disease transmission but they have higher failure rates compared to other long-acting reversible methods. 4. The safest option would be for the wife to use an injectable contraceptive like DMPA injections which is long-acting and very effective. It does not involve any surgical procedure or devices inside the body.

1. Contraceptive
Methods

2. Contraceptive Methods
What’s available?
What are women choosing?
Why?

3. GATHER APPROACH
G- Greet
A- Ask
T- Talk
H- Help
E- Explain
R- Reassure, revisit 3

4. GATHER APPROACH
G- Greet
A- Ask--- History
T- Talk about the side effects, indication &
contraindication
H- Help in selecting
E- Explain- How to use, side effects, warning
signals, follow up
R- Reassure, revisit 4

5. Types
Temporary- Spacing Method
Permanent- Terminal Methods
5

8. Barrier methods
 Aim – to prevent
live sperm from
meeting the ovum.
 This methods
require high degree
of motivation on
the part of the user.
 Only effective if
they are used
consistently and
carefully.

9.  most widely known n
widely used barrier device
by the male around the
world.
 In India– trade name–
NIRODH.
 The female condom resembles
a male condom. The only
difference is, it is larger and
has a ring on the inside. The
women puts the condom into
her vagina until it hits the
cervix.

10.  It is a vaginal barrier known
as Dutch-Cap, a shallow cup
made up of synthetic
rubber/ plastic material..
 Spermicidal jelly is must
used along with it.
 Cervical caps are smaller
versions of diaphragms. It is
made of rubber and fits
over the cervix.
Diaphragm

11.  The contraceptive sponge, or
birth control sponge, is a soft,
round piece of plastic foam with
a loop for removal and is
inserted deep into vagina
 The sponge is filled with a
spermicide known as
nonoxynol-9.

12. • This are contraceptive
devices which contain
chemicals that can
destroy sperms and can
be used alone or with
other devices like
diaphragms or cervical
caps.
• Most common chemical
used is Nonoxynol-9(N-9)
• Effectiveness:72%
Spermicides

13. Intrauterine Contraceptive
Devices(IUDs)
First generation-
Lippe Loops Second Generation-
CuT-380 A
Third generation-
Mirena(Levonorgestrel)
*All IUDs made up of polyethylene/ other polymers
& have tail made up of fine nylon threads

14. First
generation
• Inert & non-
medicated acts
mechanically
• Now only of
historical
importance
Second
generation
• Metallic copper has
anti fertility effect
• Are smaller & easier
to fit
• Currently ‘T Cu-380
A’ is used under
NFWP (10yrs)
• Multiload devices
like CuT 250 are
effective for 5 yrs.
Third
generation
• Release hormone -
Progesterone or
Estrogen
• Progestasert:
Releases progesterone
65µg daily Effective
life of 1 year
• LNG-20 (Mirena) –
Releases
levonorgestrel 20µg
daily & effective life
of 5 years

15. MECHANISM
OF ACTION

17. Insertion of IUD
17

18. Ideal candidate for IUD insertion
1. Has at least one living child
2. No history of pelvic disease
3. Normal menstrual periods
4. Willing to check IUD tail
5. Access to follow-up & treatment of potential
complication
6. Monogamous relationship 18

21. The vaginal ring (NuvaRing)
• is a small soft, plastic ring that is
inserted into the vagina.
• It releases a continuous dose of
the hormones estrogen and
progestogen into the bloodstream
to prevent pregnancy.
• It also thickens the cervical
mucus, which makes it more
difficult for sperm to move
through the cervix, and thins the
lining of the womb so a fertilised
egg is less likely to implant itself.

22. Oral
Contraceptive
Pills(OCPs)
Combined Pills
a)Progestog
en only pill
(POP)
a)Post
coital pill
a)Non
hormonal
pills
a)Male pill

24. How to take pills
The standard way to take the pill
is to take 1 every day for 21
days, then have a break for 7
days, and during this week you
have a bleed like a period. You
start taking the pill again after 7
days.

25. • They are Progestin only pills(POPs)
• It thickens the mucus inside the cervix
• It also thins the lining of the uterus. This helps keep the fertilized egg from
implanting itself.
• Highly effective for breast feeding mothers.

26. 21 OCP + 7 iron tablets(60mg
ferrous fumarate)
Available free of cost at
PHC,UHTC.
21 OCP + 7 iron tablets(60mg
ferrous fumarate)
Available at subsidized cost at
health centres @Rs 3
Under Governmental RCH
programmes

27. Chhaya or Centchroman is a
non-hormonal pill that needs
to be taken twice a week for
first 3 months and once a week
thereafter. It is a safe and
effective method and can be
given to breastfeeding
mothers.

28. Post-coital contraception
Within 72 hrs of unprotected intercourse
Levonorgestrel (i-pill): 1.5mg stat (0.75mg
– 2 tab)
OC pills: 4 pills stat & 4 pills after 12 hrs
interval
IUD
Failure rate: 1-2 / HWY

30. Injectables
contraceptives
Progestogen
only injectable
DMPA (Depot
medroxyprogest
erone acetate)-
IM
NET-EN
(Norethisteron
e enantate)
DMPA-SC
Combined
injectable
•Cyclofem/cycl
o-provera and
Mesigyna

31. Injectable contraceptive is an effective method of contraception that can be
injected subcutaneously or in the muscles (usually buttock or upper arm).
It prevents pregnancy from taking place by releasing progestogen in the body.
Each dose of injectable contraceptive prevents pregnancy for three months.
Currently intramuscular variety of Injectable contraceptive(ANTARA) is
available at government facilities, free of cost.

33. Subdermal Implants
Norplant
 6 sialistic capsules,
 Each 35 mg of levonorgestrel
Norplant (R) – 2
 2 rods
Effective contraception is provided for
5 years
Failure rate: 0.05 / HWY
33

34. • The contraceptive
patch is a small sticky
patch that releases
hormones into your body
through your skin to
prevent pregnancy. In the
UK, the patch's brand
name is Evra.
• Each patch lasts for 1
week. You change the
patch every week for 3
weeks, then have a week
off without a patch.

35. PERMANENT
METHODS

37. During a NSV-no-scalpel
vasectomy (also referred to
as a keyhole vasectomy), no
incisions are made.
Instead, the surgeon uses a
hemostat (locking forceps
with a sharp tip) to
puncture through the skin
of the scrotal sac.

38. TUBECTOMY

44. 1.A 35 years old woman comes to Basic Health
Care Facility for her postnatal Checkup. She
complains of severe fatigue and weakness. She has
2 sons and 1 daughter. She wants to know about
different methods of child spacing:
1.How will you give health education to this
woman regarding family planning methods?
2.What is the preferred contraceptive method in
this case?
3.Is there any specific investigation you will do
regarding her present complaint?
CASE STUDIES ON FAMILY PLANNING

45. Case scenario 1: Answer
a) First a detailed history will be taken including her medical and gynecological
history.
-Then we will ask her about the duration of spacing being desired and whether
she wants to have more children.
- According to her need and requirement we will explain about different
methods available along with their advantages and disadvantages and which
method is best.
b) If contraception is needed for a short period then barrier methods may be
used (physical methods e.g. condom, chemical methods e.g. spermicides or
combined methods or OCPs).
c) If contraception is required for longer period, then formulations injections,
IUDs, or sub dermal implants may be used.
d) A complete blood picture is done to check for anemia.

46. Case scenario 2:
A 30 years old woman has 1 and half year
old son. She has no history of pelvic disease
and has normal menstrual period. She
wants to have child spacing for about 3
years:
1.What is the ideal contraceptive method
for this woman?
2.What advise will you give her?

47. 1. The woman is candidate for IUCD. A medicated (2nd generation e.g.
copper containing or 3rd generation e.g. hormone releasing) devise may be
used.
2. Advice to be given is:
-Tell them that they might expect cramping and spotting for a few days.
- Tell them to check IUD tail ( maintaining hand hygiene and check after
menses)
- Schedule follow-up visits for 3 to 6 weeks.
- Counsel to return immediately if there are signs of any potential
complication
Case scenario 2: Answer

48. A married couple having 2 children comes to you
for advice on contraception. They want long term
contraception for 1-5 years. The man is reluctant
to use male’s contraceptive method. Wife (35
years) is a known hypertensive for 10 years.
1.What type of contraception would you advise?
2.How will you counsel the couple regarding
that contraception?
3.What is the mode of action of that
contraception?
Case scenario 3:

49. a)Since she is hypertensive patient, OCPs are contraindicating.
IUCD is preferred for long term protection.
b) Copper or hormonal IUCD can be used. They are inserted during
menstruation or within 10 days of beginning of period. Advantages
are that it is simple, effective, inexpensive, reversible, easy
insertion and free of systemic metabolic effects. Disadvantages
include bleeding, pain, pelvic infection and expulsions. Follow up is
needed.
c) MOA: Copper enhances cellular response in the endometrium
and effects enzymes and composition of cervical mucus. Hormonal
IUCD increases cervical mucus viscosity and prevent sperm entry.
They cause a foreign body reaction.
Case scenario 3: Answer

50. Case scenario 4:
A young woman works in NGO. Recently she got married
but want child spacing for about 1 year till her NGO
project ends. Her husband is reluctant to use any male
contraception method. She is herself afraid of having any
contraceptive method that will affect her fertility.
1.What is the preferred method of contraception in this
case?
2.How will you counsel her regarding that specific
contraceptive method?

51. 1) Oral contraceptives are preferred as they don’t
affect long term fertility.
2) One pill daily is taken per 21 days followed by a
pill free interval of 7 days. Each pack is started on
the fifth day of the period. If a pill is missed take 2
pills as soon as possible.
- Advise her of danger signs and adverse effects of
pills (cardiovascular effects like MI and DVT,
cervical cancer risk, breast tenderness, headache,
bleeding disturbances and weight gain).
Case scenario 4: Answer

52. A married couple comes to RHTC family OPD. They have
2 daughters (one 5 years old and second 4 years old). 2
months back husband was diagnosed with sexually
transmitted disease (hepatitis B). Now they want to
plan for a male child. Their concern are regarding
disease transmission.
1.How are you going to counsel them regarding
another pregnancy?
2.What contraceptive method will you suggest them?
3.What will you advise the husband regarding the
disease?
Case scenario 5:

53. Case scenario 5: Answer
1) Since there is risk of transmission of STD to the
child, the couple is advised to refrain from having a
child now.
b) They should practice abstinence or use barrier
method. Barrier methods may be physical (condom,
diaphragm, vaginal sponge) or chemical. They
provide protection against STDs but are less
effective and require motivator.
c) Husband is advised to visit a doctor and get
treatment for this disease and use barrier methods.

54. A 26 years old married woman is on Oral
contraceptive pill since last 2 months. One day
show forgot to rake OCPs. Next day she comes
to OPD and wanted to know what is she suppose
to do now?
1.What advise will you give her regarding her
missed OCP dose?
Case scenario 6: Answer

55. 1) If one pill is missed, she should take it as soon
as she remembers and should take the next pill
at the usual time.
-If two pills are missed, take them together and
take the next pill at usual time.
-If more than 3 pills are missed, then chock the
pack. If less than 7 tablets are left then take
recent one and continue.
Case scenario 6: Answer

56. Q.1 Rakhi comes to talk to you about an
IUD. She is a 20 year old primi in a long term
relationship. She likes the idea of having a
contraceptive method that doesn’t contain
hormones but her periods are already quite
heavy and painful.
Case scenario 7:

57. You advise:
• that copper IUDs have no hormones but may
worsen heavy, painful periods especially initially
• Hormone releasing IUDs don’t usually cause
hormonal side effects and will help her heavy,
painful periods
• Third generation IUDs like Mirena has less
hormone
Case scenario 7: Answer

58. Case scenario 8:
A married woman was living alone. Her
husband came by as a surprise from
England. Next morning she comes to OPD
for suggestion regarding emergency
contraception.
1. How will you counsel her regarding
emergency?

59. Case scenario 8: Answer
1) A post coital contraception (ECPs) is needed
within 72 hours of unprotected intercourse or
an IUCD may be inserted within 5 days.
- ECPs is preferred e.g. Levonorgestrel 0.75mg
tab and next tab after 12 hours of 1st dose or
Mifepristone 10mg once within 72 hours or
Ethyl estradiol 2 pills within 72 hours and
same done after 12 hours.
- Brand names OTC are ‘I pill’ or gov brand ‘Ezy
pill’