Family Planning, Contraception, Sexual and Reproductive health

1. 3/6/2022
FAMILY PLANNING 1
FAMILY PLANNING
BY
DR ISAH ABIODUN
DEPT. OF FAMILY MEDICINE
FEDERAL MEDICAL CENTRE, KEFFI.

2. OUTLINE
 Introduction
 Demographics
 Effect
 Intervention
 Definition
 Advantages of Family planning
 Contraception
 Definition
 Prevalence
 Types
 Family Planning Services
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3. 3/6/2022
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4. World Population
1804= 1 Billion
1927= 2Billion
1974= 4billion
1999= 6 Billion
2011 (31th Oct) = 7 Billion
Total Fertility Rate = 2.59
Growth Rate =1.14%
Average Population Change = 75 Million
2050 = 8 Billion
DoublingTime: 62years
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5. NIGERIA
 Most populous Black nation representing the 20% of the total population
of sub-sahranAfrica and 2.4% of world’s population.
 1990 census = 100,000,000
 2006 census = 14o,000,000
 2012(July) = 166,629,000
 Total Fertility Rate : 5.6% (2010)
 Growth Rate :2.6% (2011 est.)
 DoublingTime:27 years
 2050 (UN projection)= 367,000,000
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6. EFFECTS
“Population, when unchecked, increases in a
geometrical ratio. Subsistence only increases
in an arithmetical ratio.” –Thomas Malthus
(1766 -1834)
 Economic Effects
 Environmental Effects
 Health Effects
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7. INTERVENTION
 1968- International conference on human rights in
Tehran recognized Family Planning(FP) as a basic human
right and a key control of human populaton.
 1974World Population Conference in Bucharest endorsed
the same view.
 1984 Population Conference in Mexico integrated FP
into PHC for effective output, also stressing the need to
be view as a component of reproductive health
 In 1994, the International Conference on Population and
Development (ICPD) set a broader agenda for
incorporating elements of quality in FP/RH services
 NumerousWorld bodies , Non governmental
organisation champion this cause today.
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8. DEFINITION
 “A way of thinking and living that is adopted
voluntarily upon the basis of knowledge ,
attitudes and responsible decisions by
individuals and couples in order to promote
health and welfare of the family group and
thus contribute effectively to the social
development of the country” –W.H.O
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9. DEFINITION – Cont’d
 Family Planning allows individuals and
couples to anticipate and attain their
desired number of children and the
spacing and timing of their births. It is
achieved through use of contraceptive
methods and the treatment of
involuntary infertility.
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10. AIMS OF FAMILY PLANNING
1.Preventing pregnancy-related health risks.
2.Reducing infant mortality rates.
3.Helps in preventing STIs including HIV/AIDS
4. Empowering people and enhancing education
5. Reducing adolescent pregnancies
6. Slowing Population growth.
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11. THE IDEAL CONTRACEPTIVE
 Highly effective
 Prolonged duration of action and still rapidly effective
 Without risk to health
 Aesthetically acceptable
 Inexpensive
 Easily accessible
 Provide privacy of use
 Offer protection against HIV & STI
 Independent of the act of coitus
No ideal method!!!
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12. Contraceptives-Facts and
Figures
 Number of women in reproductive age increased between 1990
and 2000 by about 200 Million
 75% live in less developed countries that are characterized by
high fertility rates, high maternal and infant mortality and low
life expectancy
 42.8% of our population are <15 years
 Average of 1st sexual intercourse is 16years of Females, a little
higher in Male
 Contraceptive prevalence =14.7%
1 in 5 pregnancies each year in Nigeria are unplanned , 60% of
these end up as abortion.
 Unmet needs = 20%
 These figures raise a number of questions concerning the
acceptability and efficacy of the methods available and the
quality of FP services.
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13. UNMET NEEDS
 220million women lack access to
contraception world wide despite, despite
their desired for use
 Most of them are in developing countries
 38% of all pregnancies annually are
unintended 6 out of 10 of these
pregnancies ends up as induced abortions
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14. REASONS FOR UNMET NEEDS
 Non affordability
 Unavailability
 Difficulty in limiting family size
 Hurdles created by laws
 Made a prescription drug in some countries
 Lack of information
 Poor acces to quality service
 Limited choice of methods
 Safety & side effects
 Husbands & family opposition against contraception

15. HORMONAL REGULATION OF THE MENSTRUAL CYCLE
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16. MECHANISMS OF ACTION OF CONTRACEPTIVES
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17. CONTRACEPTION
TYPES
A. Hormonal Methods
B. Barrier Methods
C. Sterilization
D Intrauterine Devices
E. Natural Methods
 Periodic abstinence
 Withdrawal
 Lactational Amenorrhea Method
F.The ideal contraception??
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18. MEDICAL ELIGIBILITY CRITERIA
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19. HORMONAL CONTRACEPTIVES
 Oral Contraceptives
 Injectables
 Implants
 Vaginal Ring
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20. Combined Oral Contraceptive(C.O.C)
 First introduced in 1956.
 Composed of synthetic oestrogen and progestogens
Oestrogens :Ethinyl estradiol (20,30,35 and 50mcg)
:Mestranol(50mcg)
Progestogens:
1.Estranes(Norethindrone,ethynodiol diacetate)
2.Gonanes(Levonorgesrel,desogestrel,Norgestimate)
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21. C.O.C-
Cont’d
 Inhibits the release of FSH/LH by the ant. Pituitary
 Highly effective. Perfect use failure rate = 0.1% in first
year. However,typical user failure rate range from
3-8%
 Advantages 1.Menstrual
2.Reduced risk of malignancy
3.Sexual benefit
4.Reduced risk ofAnaemia
5.Treatment of androgenic symptoms
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22. Contraindications
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23. Side Effects
 Breast tenderness
 Nausea
 Increase in headaches
 Depression
 Weight change
 Drug interactions
 Neoplasia
 VTE
 M.I and stroke 3/6/2022
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24. Progestogen Only Pills
 Suitable for clients who exhibit oestrogen intolerance.
 Taken every day with no breaks.
 Pearl index – 1-3 /100 woman years
 They contain lower dose of progestins than in combined
oral contraceptives.
 Common types include micronor, which contains 0.35
mg of norethisterone and Ovrette which contain 75mg of
norgestrel.
 It is best for lactating women.
 Suppresses ovulation in 50% of cases, thins the
endometrial lining and makes the cervical mucus
impervious to spermatozoa.
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25. Side Effects
 Extremely irregular menstrual bleeding and spotting for
3-6 months!
No bleeding after 3-6 months
 Weight change
 Breast tenderness
 Depression
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26. INJECTABLE CONTRACEPTIVES
 2 groups exist
 Depot medroxyprogesterone acetate (DMPA) supplied as
150mg/ml. Given every 3 months.
 Depot Norethisterone oenanthate supplied as 200mg/1ml, given
every 2months.
 Cycloprovera is given as monthly injection and contain 25mg of
DMPA and 5mg oestradiol cypionate
 Mesigyna 50mg norethindrone ethanthate & 5mg estradiol
valerate
 Pearl index= 0.0-1.3/100 women year has been reported
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27. Hormonal Implants
 Implants are placed in the body filled with hormone that
prevents pregnancy
 Physically inserted in simple 15 minute outpatient
procedure
 Plastic capsules the size of paper matchsticks inserted
under the skin in the arm
 99.95% effectiveness rate
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28. Norplant Considerations
 Should be considered long term birth control
 Requires no upkeep
 Extremely effective in pregnancy prevention
> 99%
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29. Types
Non Biodegradable Biodegradable
 Norplant I
 Norplant II
 Implanon (3-keto-desogestrol
acetate)
 Blood Levels :1st week - 85mcg
9 month -50mcg
18 month -35mcg
> 18 month -30mcg
 Capronor
 Anuelle
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30. Emergency Contraception-
Indications
 When no contraceptive has been used
 Condom breakage, slippage, incorrect use
 2 or more consecutive missed COC pills
 Late taken of minipills
 More than 2wks late for progestin-only injectable contraceptive
 More than 7days late for a combined estrogen + progestin monthly
injection
 IUCD expulsion
 Sexual assault
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31. Vaginal Rings
 Steroids absorbed though vaginal epithelium
directly into circulation
 Contain ethniyl estradiol and etonogestreland
 Place in vagina for 21 days and remove 7 days
to allow withdrawal bleedings
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32. Emergency contraception
 Levonorgestrel
 Mifepristone
 Yuzpe Regimen (EE 50mcg +NG 0.50mg)
 IUD Emergency Contraception
 Effectiveness:
 Levonorgestrel regimen: 60-93%
 Combined regimen: 56-89%
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33. Barrier Methods
 Spermicides
 Male Condom
 Female Condom
 Diaphragm
 Cervical Cap
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34. Condom
 Easily available, reversible, and have fewer
side effects than hormonal methods.
 Effective and acceptable if used consistently
and correctly.
 Protect against STD
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35. FEMALE CONDOM
 It contains 2 flexible rings. The ring at the
closed end of the sheath serves as an insertion
mechanism and internal anchor that is placed
inside the vaginal canal. The other ring forms
the external patent edge of the device and
remains outside of the canal after insertion.
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36. FEMALE CONDOM
MECHANISM OF ACTION
 Prevents passage of sperm
and infections into the vagina
( protection against STDs )
 Can be inserted up to 8 hours
prior to intercourse; can remain in
place up to 8 hours
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37. FEMALE CONDOM
EFFICACY
 Pregnancy rates for the female condom range between 5
and 21 per 100 women per year. (higher than male
condoms)
 To increase efficacy Simultaneous use of both the female
and male condom is not recommended
 Re-use is not recommended .
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38. DIAPHRAGM
 The diaphragm is a shallow latex cup
with a spring mechanism in its rim to hold it
in place in the vagina
 It is inserted before intercourse so that the
posterior rim fits into the posterior fornix and
the anterior rim is placed behind the pubic bone.
 Spermicidal cream is applied to the inside of the
dome, which fits against the vaginal wall.
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39. DIAPHRAGM
 It prevents pregnancy by acting as a barrier to the
passage of semen into the cervix
 provides effective contraception for 6 hours.
 After intercourse, the diaphragm must be left in place
for at least 6 hours.
 Effectiveness depends on the age of the user,
continuity of use, and the use of spermicide along
with the diaphragm. Failure rate is estimated to be
20% .
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40. DIAPHRAGM
 Relative Contraindications :
- Latex allergy
- Uterine prolapse
- Repeated UTIs
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41. DIAPHRAGM
 Disadvantages :
- Prolonged use increase the risk of UTI
- More than 24 hours use is not recommended
due to the possible risk of TSS.
- Might cause vaginal erosions if not placed properly .
- Requires a professional fitting (trained provider is
needed) .
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42. Cervical cap
 a cup-shaped latex device that fits over the
base of the cervix.
 The cap must be filled one third full with
spermicide prior to insertion
 Inserted 8 hours before coitus and can be left
in place for as long as 48 hours.
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44. Spermicides
 consist of a base combined with either
nonoxynol-9 or octoxynol
 Surfactant that destroys the sperm cell membrane
 Forms available : vaginal foams, suppositories,
jellies, films, foaming tablets, and creams.

45. Spermicides
 Failure rate is about 26% within the 1st year of use.
 Advantages : ease of application , available over the
counter , inexpensive and it augments the
contraceptive efficacy of the cervical cap and
diaphragm .
 Disadvantages : minimal protection against STDs ,
risk of vaginal irritation and allergic reaction.

46. IUD
-IUD is the world's most widely used method of reversible birth
control.
2 TYPES:
1- Copper Releasing (paragard).
 Frameless copper releasing IUCD(Flexigard)
2-Progesterone Releasing (IUS):
A-Progestasert (progesterone T) 1976 - 2001.
B-Mirena (levonorgestrel).


47. Clinical uses
 Long-term contraception
 Women with contraindications to COC
 Emergency contraceptive (1:1000 )
 menorrhagia , endometriosis, chronic
pelvic pain, dysmenorrhea , anemia.

48. Mechanism ofAction
These mechanisms have not been defined precisely and are the
subject of ongoing controversy . It has several effects on the
reproductive system :
- The Mirena is intended to initially release a daily dose of 20
micrograms levonorgestral (a progestin).
- Inhibition of ovulation.
-Cervical mucus is changed to obstruct passage of sperm
through the cervix.
- endometrial thinning which inhibits implantation of embryos

49. Absolute Contraindications
-Pregnancy.
-Post partum puerperal sepsis
-Immediately post-septic abortion
-Undiagnosed abnormal vaginal bleeding.
-Suspected gynecological malignancy.
(Cervical cancer, Endometrial cancer)
-Current STDs.
-Current PID.
-anatomical abnormalities

50. Sterilization
 Sterilization :female sterilization and male vasectomy are
permenant method of contaception and highly effective
 They are generally chosen by relatively older couple who are sure
that they completed their family.
 Also individuals who carry a genetic disorder may choose to be
strlized.
 28% of reproductive age women undergo tubal ligation and 10% of
men undergo vasectomy.
 Sterilization methods include:
1- Vasectomy in males.
2- Tubal Ligation in females .

51. Tubal Ligation
 This involve mechanically blockage of
both fallopian tube to prevent the sperm
reaching and fertilizing the oocyte
 sterilization performed by
laparoscopically(under GA) or through a
suprapubic “mini-laparotomy”
 Failure rate: 0.5%

53. Tubal Ligation
Advantages:
• intended to be permanent
• highly effective
• safe
• quick recovery
• lack of significant long-term side effects
• cost effective

54. Tubal Ligation
Disadvantage:
• possibility of patient regret
• difficult to reverse
• future pregnancy could require assisted reproductive
technology (such as IVF)
• more expensive than vasectomy

55. Cont.
Complication:
A women may experienced anasthetic problem or may be
damage to intra-abdominal during the procedure.
NOTE:
ectopic pregnancy can be a late complication
and any sterilized women who misses her period and has
symptom of pregnancy should seek
medical advice.

56. Vasectomy
Mechanism of action:
Vasectomy involve division of the vas deferens on each
side to prevent the release of sperm during
ejaculation.
Easier than tubal ligation.
Usually done under local anesthesia.
 Failure rate: 0.1%.

58. Vasectomy
Advantages:
• permanent
• highly effective
• safe
• quick recovery
• lack of significant long-term side effects
• cost effective; less expensive than tubal ligation

59. Family Planning Services.
 Defined as “Educational comprehensive
medical or social activities which enables
individuals, including Minors, to determine
freely the number and spacing of their
children and to select the means by which
this may be achieved”
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60. Range Of Family Planning
Services
 Proper spacing & limitation of births
 Advice on sterility
 Education for parenthood
 Screening for pathological conditions related to
reproductive system e.g. Ca cervix
 Genetic counselling
 Pre-marital counselling & examination
 Carrying out pregnancy tests
 Marriage counselling
 Preparation of couples for the arrival of the first
child
 Providing services for unmarried mothers
 Teaching home economics & nutrition
 Providing adoption services.
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61. FAMILY PLANNING SERVICE
DELIVERY POINTS
 Called family planning clinics
 Most worldwide run by nurse practitioners
 Occasionally provision in Health centres as part of
PHC services
 Special training needed.
 Counseling skills important
 Those seeking contraception are clients not
patients
 Requires a separate building
 Issues of fees. Free services or services at minimal
cost.
 Data collection. Research and cooperation with
regional health authorities and NGOs important.
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62. COUNSELLING FOR
CONTRACEPTION
This provides information for a client in the most simplest way for her to
understand and apply to him or herself.
 TYPES OF COUNSELLING
1. INITIAL COUNSELLING
All methods are described to client
The client selects an appropriate method
It may be individual or group counselling
2.METHOD SPECIFIC COUNSELLING
 This is one on one basis prior to, during or immediately following
service provision
All questions or doubts about any method are clarified.
Information about a particular method, mode of action, side effects, etc
are explained.
 FOLLOW UP COUNSELLING
 This is done during the return visit for re-supply or checkup.
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