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Lecture 1 family planning
BBiirrtthh CCoonnttrrooll && 
FFaammiillyy PPllaannnniinngg
RReemmeemmbbeerr 
TThhee ttoottaall rriisskkss ooff 
bbiirrtthh ccoonnttrrooll aarree 
mmuucchh lleessss tthhaann tthhee 
ttoottaall rriisskkss ooff aa 
pprreeggnnaannccyy!!!!
TTyyppeess ooff BBiirrtthh CCoonnttrrooll 
 HHoorrmmoonnaall 
 BBaarrrriieerr 
 IIUUDD 
 MMeetthhooddss bbaasseedd oonn 
iinnffoorrmmaattiioonn 
 PPeerrmmaanneenntt sstteerriilliizzaattiioonn
HHoorrmmoonnaall MMeetthhooddss 
 OOrraall CCoonnttrraacceeppttiivveess 
((BBiirrtthh CCoonnttrrooll PPiillll)) 
 IInnjjeeccttiioonnss ((DDeeppoo--PPrroovveerraa)) 
 IImmppllaannttss ((NNoorrppllaanntt II  IIII))
BBiirrtthh CCoonnttrrooll PPiillllss 
 PPiillllss ccaann bbee ttaakkeenn ttoo pprreevveenntt 
pprreeggnnaannccyy 
 PPiillllss aarree ssaaffee aanndd eeffffeeccttiivvee wwhheenn 
ttaakkeenn pprrooppeerrllyy 
 PPiillllss aarree oovveerr 9999%% eeffffeeccttiivvee 
 WWoommeenn mmuusstt hhaavvee aa ppaapp ssmmeeaarr ttoo 
ggeett aa pprreessccrriippttiioonn ffoorr bbiirrtthh ccoonnttrrooll 
ppiillllss
HHooww ddooeess tthhee ppiillll wwoorrkk?? 
 SSttooppss oovvuullaattiioonn 
 TThhiinnss uutteerriinnee lliinniinngg 
 TThhiicckkeennss cceerrvviiccaall mmuuccuuss
PPoossiittiivvee BBeenneeffiittss ooff BBiirrtthh CCoonnttrrooll PPiillllss 
PPrreevveennttss 
pprreeggnnaannccyy 
EEaasseess mmeennssttrruuaall 
ccrraammppss 
SShhoorrtteennss ppeerriioodd 
RReegguullaatteess ppeerriioodd 
DDeeccrreeaasseess 
iinncciiddeennccee ooff 
oovvaarriiaann ccyyssttss 
PPrreevveennttss 
oovvaarriiaann aanndd 
uutteerriinnee ccaanncceerr 
DDeeccrreeaasseess aaccnnee
SSiiddee--eeffffeeccttss 
 BBrreeaasstt 
tteennddeerrnneessss 
 NNaauusseeaa 
 IInnccrreeaassee iinn 
hheeaaddaacchheess 
 MMooooddiinneessss 
 WWeeiigghhtt cchhaannggee 
 SSppoottttiinngg
TTaakkiinngg tthhee PPiillll 
 OOnnccee aa ddaayy aatt tthhee ssaammee ttiimmee eevveerryyddaayy 
 UUssee ccoonnddoommss ffoorr ffiirrsstt mmoonntthh 
 UUssee ccoonnddoommss wwhheenn oonn aannttiibbiioottiiccss 
 UUssee ccoonnddoommss ffoorr 11 wweeeekk iiff yyoouu mmiissss aa 
ppiillll oorr ttaakkee oonnee llaattee 
 TThhee ppiillll ooffffeerrss nnoo pprrootteeccttiioonn ffrroomm 
SSTTDD’’ss
DDeeppoo--PPrroovveerraa 
 BBiirrtthh ccoonnttrrooll sshhoott ggiivveenn oonnccee eevveerryy 
tthhrreeee mmoonntthhss ttoo pprreevveenntt pprreeggnnaannccyy 
 9999..77%% eeffffeeccttiivvee pprreevveennttiinngg pprreeggnnaannccyy 
 NNoo ddaaiillyy ppiillllss ttoo rreemmeemmbbeerr
HHooww ddooeess tthhee sshhoott wwoorrkk?? 
 SSttooppss oovvuullaattiioonn 
 SSttooppss mmeennssttrruuaall ccyycclleess!! 
 TThhiicckkeennss cceerrvviiccaall mmuuccuuss
SSIIDDEE EEFFFFEECCTTSS 
 EExxttrreemmeellyy iirrrreegguullaarr mmeennssttrruuaall bblleeeeddiinngg 
aanndd ssppoottttiinngg ffoorr 33--66 mmoonntthhss!! 
 NNOO PPEERRIIOODD  aafftteerr 33--66 mmoonntthhss 
 WWeeiigghhtt cchhaannggee 
 BBrreeaasstt tteennddeerrnneessss 
 MMoooodd cchhaannggee 
**NNOOTT EEVVEERRYY WWOOMMAANN HHAASS SSIIDDEE--EEFFFFEECCTTSS!!
IIMMPPLLAANNTTSS 
 IImmppllaannttss aarree ppllaacceedd iinn tthhee bbooddyy ffiilllleedd 
wwiitthh hhoorrmmoonnee tthhaatt pprreevveennttss pprreeggnnaannccyy 
 PPhhyyssiiccaallllyy iinnsseerrtteedd iinn ssiimmppllee 1155 mmiinnuuttee 
oouuttppaattiieenntt pprroocceedduurree 
 PPllaassttiicc ccaappssuulleess tthhee ssiizzee ooff ppaappeerr 
mmaattcchhssttiicckkss iinnsseerrtteedd uunnddeerr tthhee sskkiinn iinn 
tthhee aarrmm 
 9999..9955%% eeffffeeccttiivveenneessss rraattee
NNoorrppllaanntt II vvss.. NNoorrppllaanntt IIII 
 SSiixx ccaappssuulleess 
 FFiivvee yyeeaarrss 
 TTwwoo ccaappssuulleess 
 TThhrreeee yyeeaarrss
NNoorrppllaanntt IImmppllaanntt
NNoorrppllaanntt CCoonnssiiddeerraattiioonnss 
 SShhoouulldd bbee ccoonnssiiddeerreedd lloonngg tteerrmm 
bbiirrtthh ccoonnttrrooll 
 RReeqquuiirreess nnoo uuppkkeeeepp  
 EExxttrreemmeellyy eeffffeeccttiivvee iinn pprreeggnnaannccyy 
pprreevveennttiioonn  9999%%
EEmmeerrggeennccyy CCoonnttrraacceeppttiioonn 
EEmmeerrggeennccyy ccoonnttrraacceeppttiioonn 
ppiillllss ccaann rreedduuccee tthhee 
cchhaannccee ooff aa pprreeggnnaannccyy bbyy 
7755%% iiff ttaakkeenn wwiitthhiinn 7722 
hhoouurrss ooff uunnpprrootteecctteedd sseexx!!
Emergency CCoonnttrraacceeppttiioonn 
((EECCPP)) 
 MMuusstt bbee ttaakkeenn wwiitthhiinn 7722 hhoouurrss ooff tthhee 
aacctt ooff uunnpprrootteecctteedd iinntteerrccoouurrssee oorr 
ffaaiilluurree ooff ccoonnttrraacceeppttiioonn mmeetthhoodd 
 MMuusstt rreecceeiivvee EECCPP ffrroomm aa pphhyyssiicciiaann 
 7755 –– 8844%% eeffffeeccttiivvee iinn rreedduucciinngg 
pprreeggnnaannccyy 
 CCaalliiffoorrnniiaa pphhaarrmmaacciieess ccaann pprreessccrriibbee 
wwiitthhoouutt aa ddooccttoorr!! ((11//11//0022))
EECCPP 
 FFllooooddss tthhee oovvaarriieess wwiitthh hhiigghh aammoouunntt ooff 
hhoorrmmoonnee aanndd pprreevveennttss oovvuullaattiioonn 
 AAlltteerrss tthhee eennvviirroonnmmeenntt ooff tthhee uutteerruuss,, 
mmaakkiinngg iitt ddiissrruuppttiivvee ttoo tthhee eegggg aanndd ssppeerrmm 
 TTwwoo sseettss ooff ppiillllss ttaakkeenn eexxaaccttllyy 1122 
hhoouurrss aappaarrtt
BBAARRRRIIEERR MMEETTHHOODDSS 
 SSppeerrmmiicciiddeess 
 MMaallee CCoonnddoomm 
 FFeemmaallee CCoonnddoomm 
 DDiiaapphhrraaggmm 
 CCeerrvviiccaall CCaapp
BBAARRRRIIEERR MMEETTHHOODD 
PPrreevveennttss pprreeggnnaannccyy bblloocckkss tthhee 
eegggg aanndd ssppeerrmm ffrroomm mmeeeettiinngg 
BBaarrrriieerr mmeetthhooddss hhaavvee hhiigghheerr 
ffaaiilluurree rraatteess tthhaann hhoorrmmoonnaall 
mmeetthhooddss dduuee ttoo ddeessiiggnn aanndd 
hhuummaann eerrrroorr
SSPPEERRMMIICCIIDDEESS 
CChheemmiiccaallss kkiillll ssppeerrmm iinn tthhee vvaaggiinnaa 
DDiiffffeerreenntt ffoorrmmss:: 
--JJeellllyy --FFiillmm 
--FFooaamm --SSuuppppoossiittoorryy 
SSoommee wwoorrkk iinnssttaannttllyy,, ootthheerrss rreeqquuiirree 
pprree--iinnsseerrttiioonn 
OOnnllyy 7766%% eeffffeeccttiivvee ((uusseedd aalloonnee)),, sshhoouulldd 
bbee uusseedd iinn ccoommbbiinnaattiioonn wwiitthh aannootthheerr 
mmeetthhoodd ii..ee..,, ccoonnddoommss
MMAALLEE CCOONNDDOOMM 
• MMoosstt ccoommmmoonn aanndd eeffffeeccttiivvee bbaarrrriieerr 
mmeetthhoodd wwhheenn uusseedd pprrooppeerrllyy 
• LLaatteexx aanndd PPoollyyuurreetthhaannee sshhoouulldd oonnllyy 
bbee uusseedd iinn tthhee pprreevveennttiioonn ooff 
pprreeggnnaannccyy aanndd sspprreeaadd ooff SSTTII’’ss 
((iinncclluuddiinngg HHIIVV))
MMAALLEE CCOONNDDOOMM 
PPeerrffeecctt eeffffeeccttiivveenneessss rraattee == 9977%% 
TTyyppiiccaall eeffffeeccttiivveenneessss rraattee == 88%% 
LLaatteexx aanndd ppoollyyuurreetthhaannee ccoonnddoommss 
aarree aavvaaiillaabbllee 
CCoommbbiinniinngg ccoonnddoommss wwiitthh 
ssppeerrmmiicciiddeess rraaiisseess eeffffeeccttiivveenneessss 
lleevveellss ttoo 9999%%
FFEEMMAALLEE CCOONNDDOOMM 
MMaaddee aass aann aalltteerrnnaattiivvee ttoo mmaallee 
ccoonnddoommss 
PPoollyyuurreetthhaannee 
PPhhyyssiiccaallllyy iinnsseerrtteedd iinn tthhee vvaaggiinnaa 
PPeerrffeecctt rraattee == 9955%% 
TTyyppiiccaall rraattee == 7799%% 
WWoommaann ccaann uussee ffeemmaallee ccoonnddoomm iiff 
ppaarrttnneerr rreeffuusseess
RReeaalliittyy ä :: TThhee FFeemmaallee 
CCoonnddoomm
DDIIAAPPRRAAGGHHMM 
PPeerrffeecctt EEffffeeccttiivveenneessss RRaattee == 9944%% 
TTyyppiiccaall EEffffeeccttiivveenneessss RRaattee == 800%% 
LLaatteexx bbaarrrriieerr ppllaacceedd iinnssiiddee vvaaggiinnaa 
dduurriinngg iinntteerrccoouurrssee 
FFiitttteedd bbyy pphhyyssiicciiaann 
SSppeerrmmiicciiddaall jjeellllyy bbeeffoorree iinnsseerrttiioonn 
IInnsseerrtteedd uupp ttoo 118 hhoouurrss bbeeffoorree 
iinntteerrccoouurrssee aanndd ccaann bbee lleefftt iinn ffoorr aa 
ttoottaall ooff 2244 hhoouurrss
DDIIAAPPHHRRAAGGMM
CCEERRVVIICCAALL CCAAPP 
LLaatteexx bbaarrrriieerr iinnsseerrtteedd iinn vvaaggiinnaa bbeeffoorree 
iinntteerrccoouurrssee 
““CCaappss”” aarroouunndd cceerrvviixx wwiitthh ssuuccttiioonn 
FFiillll wwiitthh ssppeerrmmiicciiddaall jjeellllyy pprriioorr ttoo uussee 
CCaann bbee lleefftt iinn bbooddyy ffoorr uupp ttoo aa ttoottaall ooff 
448 hhoouurrss 
MMuusstt bbee lleefftt iinn ppllaaccee ssiixx hhoouurrss aafftteerr 
sseexxuuaall iinntteerrccoouurrssee 
PPeerrffeecctt eeffffeeccttiivveenneessss rraattee == 9911%% 
TTyyppiiccaall eeffffeeccttiivveenneessss rraattee == 800%%
IINNTTRRAAUUTTEERRIINNEE DDEEVVIICCEESS 
((IIUUDD)) 
TT--sshhaappeedd oobbjjeecctt ppllaacceedd iinn tthhee uutteerruuss ttoo 
pprreevveenntt pprreeggnnaannccyy 
MMuusstt bbee oonn ppeerriioodd dduurriinngg iinnsseerrttiioonn 
AA NNaattuurraall cchhiillddbbiirrtthh rreeqquuiirreedd ttoo uussee 
IIUUDD 
EExxttrreemmeellyy eeffffeeccttiivvee wwiitthhoouutt uussiinngg 
hhoorrmmoonneess  9977 %% 
MMuusstt bbee iinn mmoonnooggaammoouuss rreellaattiioonnsshhiipp
CCooppppeerr TT vvss.... PPrrooggeessttaasseerrtt 
1100 yyeeaarrss 
9999..22 %% eeffffeeccttiivvee 
CCooppppeerr oonn IIUUDD aaccttss 
aass ssppeerrmmiicciiddee,, IIUUDD 
bblloocckkss eegggg ffrroomm 
iimmppllaannttiinngg 
MMuusstt cchheecckk ssttrriinngg 
bbeeffoorree sseexx aanndd aafftteerr 
sshheeddddiinngg ooff uutteerriinnee 
lliinniinngg.. 
11 yyeeaarr 
998%% eeffffeeccttiivvee 
TT sshhaappeedd ppllaassttiicc 
tthhaatt rreelleeaasseess 
hhoorrmmoonneess oovveerr aa 
oonnee yyeeaarr ttiimmee ffrraammee 
TThhiicckkeennss mmuuccuuss,, 
bblloocckkiinngg eegggg 
CChheecckk ssttrriinngg bbeeffoorree 
sseexx  aafftteerr sshheeddddiinngg 
ooff uutteerriinnee lliinniinngg..
SSTTEERRIILLIIZZAATTIIOONN 
PPrroocceedduurree ppeerrffoorrmmeedd oonn aa mmaann oorr 
aa wwoommaann ppeerrmmaanneennttllyy sstteerriilliizzeess 
FFeemmaallee == TTuubbaall LLiiggaattiioonn 
MMaallee == VVaasseeccttoommyy
TTUUBBAALL LLIIGGAATTIIOONN 
SSuurrggiiccaall pprroocceedduurree ppeerrffoorrmmeedd oonn aa 
wwoommaann 
FFaallllooppiiaann ttuubbeess aarree ccuutt,, ttiieedd,, 
ccaauutteerriizzeedd,, pprreevveennttss eeggggss ffrroomm 
rreeaacchhiinngg ssppeerrmm 
FFaaiilluurree rraatteess vvaarryy bbyy pprroocceedduurree,, ffrroomm 
00..8%%--33..77%% 
MMaayy eexxppeerriieennccee hheeaavviieerr ppeerriiooddss
LLAAPPAARROOSSCCOOPPYY--’’BBAANNDD--AAIIDD’’ 
SSTTEERRIILLIIZZAATTIIOONN
VVAASSEECCTTOOMMYY 
MMaallee sstteerriilliizzaattiioonn pprroocceedduurree 
LLiiggaattiioonn ooff VVaass DDeeffeerreennss ttuubbee 
NNoo--ssccaallppeell tteecchhnniiqquuee aavvaaiillaabbllee 
FFaasstteerr aanndd eeaassiieerr rreeccoovveerryy tthhaann aa 
ttuubbaall lliiggaattiioonn 
FFaaiilluurree rraattee == 00..11%%,, mmoorree eeffffeeccttiivvee 
tthhaann ffeemmaallee sstteerriilliizzaattiioonn
VVAASSEECCTTOOMMYY
MMEETTHHOODDSS BBAASSEEDD OONN 
IINNFFOORRMMAATTIIOONN 
WWiitthhddrraawwaall 
NNaattuurraall FFaammiillyy PPllaannnniinngg 
FFeerrttiilliittyy AAwwaarreenneessss MMeetthhoodd 
AAbbssttiinneennccee
WWIITTHHDDRRAAWWAALL 
RReemmoovvaall ooff ppeenniiss ffrroomm tthhee vvaaggiinnaa bbeeffoorree 
eejjaaccuullaattiioonn ooccccuurrss 
NNOOTT aa ssuuffffiicciieenntt mmeetthhoodd ooff bbiirrtthh ccoonnttrrooll bbyy 
iittsseellff 
EEffffeeccttiivveenneessss rraattee iiss 800%% ((vveerryy 
uunnpprreeddiiccttaabbllee iinn tteeeennss,, wwiiddee vvaarriiaattiioonn)) 
11 ooff 55 wwoommeenn pprraaccttiicciinngg wwiitthhddrraawwaall 
bbeeccoommee pprreeggnnaanntt 
VVeerryy ddiiffffiiccuulltt ffoorr aa mmaallee ttoo ‘‘ccoonnttrrooll’’
Natural FFaammiillyy PPllaannnniinngg  
FFeerrttiilliittyy AAwwaarreenneessss MMeetthhoodd 
WWoommeenn ttaakkee aa ccllaassss oonn tthhee mmeennssttrruuaall ccyyccllee 
ttoo ccaallccuullaattee mmoorree ffeerrttiillee ttiimmeess 
RReeqquuiirreess ssppeecciiaall eeqquuiippmmeenntt aanndd ccaannnnoott bbee 
sseellff--ttaauugghhtt 
NNFFPP aabbssttaaiinnss ffrroomm sseexx dduurriinngg tthhee 
ccaallccuullaatteedd ffeerrttiillee ttiimmee 
FFAAMM uusseess bbaarrrriieerr mmeetthhooddss dduurriinngg ffeerrttiillee 
ttiimmee 
PPeerrffeecctt eeffffeeccttiivveenneessss rraattee == 9911%% 
TTyyppiiccaall eeffffeeccttiivveenneessss rraattee == 7755%% 
NNoo 110000%% ssaaffee ddaayy--iirrrreegguullaarr ppeerriiooddss
AAbbssttiinneennccee 
OOnnllyy 110000%% mmeetthhoodd ooff bbiirrtthh 
ccoonnttrrooll 
AAbbssttiinneennccee iiss wwhheenn ppaarrttnneerrss ddoo 
nnoott eennggaaggee iinn sseexxuuaall iinntteerrccoouurrssee 
CCoommmmuunniiccaattiioonn bbeettwweeeenn ppaarrttnneerrss 
iiss iimmppoorrttaanntt ffoorr tthhoossee pprraaccttiicciinngg 
aabbssttiinneennccee ttoo bbee ssuucccceessssffuull
RReeaassoonnss ffoorr aabbssttaaiinniinngg 
MMoorraall oorr rreelliiggiioouuss vvaalluueess 
PPeerrssoonnaall bbeelliieeffss 
MMeeddiiccaall rreeaassoonnss 
NNoott ffeeeelliinngg rreeaaddyy ffoorr aann 
eemmoottiioonnaall,, iinnttiimmaattee 
rreellaattiioonnsshhiipp 
FFuuttuurree ppllaannss
SSOOMMEETTHHIINNGG TTOO TTHHIINNKK AABBOOUUTT…… 
CCoouupplleess wwhhoo uussee nnoo bbiirrtthh 
ccoonnttrrooll hhaavvee aa 8855%% cchhaannccee 
ooff aa pprreeggnnaannccyy wwiitthhiinn tthhee 
ffiirrsstt yyeeaarr..
EXCELLENT RREEFFEERREENNCCEE SSEEEE:: 
wwwwww..ppllaannnneeddppaarreenntthhoooodd..oorrgg//bbcc 
HHaattcchheerr,, RRoobbeerrtt,, MMDD 
CCoonnttrraacceeppttiivvee TTeecchhnnoollooggyy ,,1177eedd.. ((22000011))
Lecture 1 family planning
Quality iinn FFaammiillyy PPllaannnniinngg
QQuuaalliittyy 
Quality 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.
AAiimmss  OObbjjeeccttiivveess 
In 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.
Elements of ‘‘QQuuaalliittyy ooff CCaarree’’ 
iinn 
ffaammiillyy ppllaannnniinngg 
By Judith Bruce, 1990 
Choice of method 
Interpersonal communication (verbal  non 
verbal) 
Technical Competence 
Information 
Follow-up 
Appropriate constellation of services
CChhooiiccee ooff mmeetthhoodd 
Offering the right to the client to choose 
the method means giving confidence to 
the individual. 
He/she feels more comfortable in 
using the method for which he/she has 
been provided with clear, accurate and 
specific information and which is the best 
for his/her needs.
Good interpersonal ccoommmmuunniiccaattiioonn 
((vveerrbbaall  nnoonn vveerrbbaall)) 
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.
TTeecchhnniiccaall CCoommppeetteennccee 
 Quality needs command on the 
subject. 
It is inevitable to acquire all the 
essential knowledge and to polish 
one’s technical competence regarding 
family planning services.
IInnffoorrmmaattiioonn 
Providing all the necessary 
information to the client helps 
him/her in using the selected method 
correctly, without any fear. 
Right information will certainly clear 
the myths and rumors about the 
subject and will improve the adopting 
rate among the potential clients.
FFoollllooww--uupp 
Correct and continuous follow up of 
the users is indispensable to monitor 
the possible complications with the 
use of contraceptives. 
 It ensures eventually an improved 
continuation rate among the users.
Appropriate ccoonnsstteellllaattiioonn ooff 
sseerrvviicceess 
Adding family planning services along with 
the routine ones under the same roof may 
attract more clientele. 
The clients do not have to go to some other 
service specialized in family planning only. 
 Clients discuss their problems with more 
openness with their own physician in a 
friendly ambiance.
IInnddiiccaattoorrss 
QQUUAALLIITTYY OOFF CCAARREE 
Number of contraceptive methods available at 
a specific outlet 
Percentage of counseling sessions with new 
acceptors in which provider discusses all 
methods 
Percentage of client visits during which 
provider demonstrates skill at clinical 
procedures, including asepsis 
Percentage of clients reporting “sufficient 
time” with provider 
Percentage of clients informed of timing and 
sources for re-supply/revisit 
Percentage of clients who perceive that 
hours/days are convenient and the range of 
services provided is adequate.
Return visit and follow-ups of client 
method/service she has chosen 
Explain to the client how to use the 
decision about which method/service 
to use 
Help the client to make her own 
methods/services 
Tell the client about different 
Ask the client about FP/RH needs 
respectful manner 
Greet the client in a friendly and 
AApppprrooaacchh ttoo CCoouunnsseelliinngg 
GGAATTHHEERR 
scheduled
RRiigghhttss ooff CClliieennttss 
Information about all the methods / services 
available. 
Knowledge of not only the benefits but also the 
risks / side effects of all the contraceptive 
methods / RH services to make an independent 
decision. 
Outlets providing FP/ RH services should carry a 
logo / indicative sign on a prominent place. They 
should also provide a comfortable clean 
environment to the clients where they will be 
treated with respect, attention and courtesy. 
Access to get the FP/RH services regardless of 
his/her sex, race, religion, color and socio-economic 
status. FP services should be available 
to people in their closest vicinity.
RRiigghhttss ooff CClliieennttss ((ccoonntt..)) 
Choice to practice FP or RH service should be 
absolutely voluntary and free. A competent 
provider will help the client to make a decision and 
will not pressurize the client to make certain 
choice for a certain method/service. 
Privacy for FP/ RH counseling where the client 
would feel open and frank with the provider. 
Continuity to obtain the FP/RH services without any 
break or discontinuation to avoid the after effects 
and the give-ups of the service. 
Opinion about the subject, method used and the 
service provided. This feedback is always helpful 
for the provider to improve one’s service delivery.
PPrroovviiddeerr’’ss nneeeeddss 
Training will certainly help the provider to do a 
better counseling. It is needed to polish one’s skills 
to pass the right information, to help the client in 
decision making, to explain the use of a specific 
method, to screen the client etc. 
Information about all the FP methods/RH 
services.Moreover, other information about the 
local community like social, cultural and religious 
beliefs is always helpful in dealing with the FP 
clients. 
Update about the FP methods and about the new 
developments in the reproductive health. 
Outlet adequately equipped for a trained provider is 
an essential requirement for the FP/RH services. 
There should be a logo / sign to show the 
availability of FP services in that particular outlet.
PPrroovviiddeerr’’ss nneeeeddss ((ccoonntt..)) 
Supplies continuous  adequate - needed at the 
provider’s outlet to ensure an all time good 
service for the users and other potential clients. 
Backup  referral for the complicated cases 
should be there, where and when needed. 
Feedback about the services provided in a certain 
outlet helps the provider to amend and 
ameliorate his/her services. 
Acknowledgement in the shape of certification or 
some incentives to be encouraged to continue 
with the same motivation and involvement.
Lecture 1 family planning
Family Planning 
KKnnoowwlleeddggee  AAttttiittuuddeess 
UUssee ooff FFaammiillyy PPllaannnniinngg 
EExxppoossuurree ttoo FFaammiillyy PPllaannnniinngg 
MMeessssaaggeess
o Knowledge off ccoonnttrraacceeppttiivvee mmeetthhooddss 
Currently married women All women 
96 95 
33 
92 92 
24 
Any method Any modern method Any traditional 
Percent of women age 15-49
Which mmooddeerrnn mmeetthhooddss aarree 
mmoosstt 
ffaammiilliiaarr ttoo mmaarrrriieedd wwoommeenn?? 
90 
90 
79 
83 
77 
64 
54 
47 
Male sterilization 
Implants 
Female sterilization 
Monthly pill 
Condom 
IUD 
Daily pill 
Injectables 
Percent of currently married women age 15-49
Does knowledge ooff aannyy mmooddeerrnn mmeetthhoodd 
vvaarryy bbyy rreessiiddeennccee,, rreeggiioonn aanndd eedduuccaattiioonn?? 
• No urban-rural difference 
• Women with no education (91%) know 
slightly less about modern methods than 
educated women (98%)
Do mmaarrrriieedd wwoommeenn ddiissccuussss 
ffaammiillyy ppllaannnniinngg wwiitthh tthheeiirr hhuussbbaannddss?? 
34 
53 
12 
Never Once or twice Three or + 
Percent of currently married women age 15-49 in the past year
a What arree ccoouupplleess’’ aattttiittuuddeess ttoowwaarrdd 
ffaammiillyy ppllaannnniinngg?? 
11 
9 
6 
6 
68 
Both approve 
Both disapprove 
One approves, other dissaproves 
Husband's attitude unknown 
Respondent unsure 
Percent of women who report that they and their husband 
approve or not of family planning
Family Planning 
KKnnoowwlleeddggee  AAttttiittuuddeess 
UUssee ooff FFaammiillyy PPllaannnniinngg 
EExxppoossuurree ttoo FFaammiillyy PPllaannnniinngg 
MMeessssaaggeess
UUssee ooff ccoonnttrraacceeppttiioonn aammoonngg 
mmaarrrriieedd wwoommeenn 
24 
19 
5 
Traditional 
methods 
Modern 
methods 
Any method 
Percent of currently married women age 15-49
DDooeess uussee ooff ccoonnttrraacceeppttiioonn vvaarryy 
bbyy aa wwoommaann’’ss lleevveell ooff 
eedduuccaattiioonn?? 
No education Primary Secondary and + 
Percent of currently married women age 15-49 
19 
16 
23 
19 
35 
23 
Any method Any modern method
Contraceptive uussee aallssoo vvaarriieess 
bbyy rreessiiddeennccee 
3333%% ooff uurrbbaann wwoommeenn uussee aannyy 
mmeetthhoodd ooff ffaammiillyy ppllaannnniinngg 
ccoommppaarreedd ttoo…… 
2222%% ffoorr tthheeiirr rruurraall ccoouunntteerrppaarrttss..
Women’s current use of modern 
contraceptive methods 
Other 
modern 
methods 
1% 
Male condom 
5% 
Female 
sterilisation 
8% 
Injectables 
40% 
IUD 
7% 
Monthly pill 
15% 
Daily pill 
24%
SSoouurrccee ooff ssuuppppllyy ffoorr 
ccoonnttrraacceeppttiivvee mmeetthhooddss 
38 
Public sector Private medical Other private 
Percent 
44 47 
13 
57 
27 
44 
18 17 
37 
5 
70 
5 
65 
9 
Daily pill Monthly pill Injectables Condom IUD* 
*First source, limited to women who started using IUD since 1995
IInntteennttiioonn ttoo uussee 
ccoonnttrraacceeppttiioonn 
iinn tthhee ffuuttuurree 
42 45 
13 
Intends to use Does not intend Unsure 
Percent of currently married women who are not 
using a contraceptive method
Preferred method ooff CCoonnttrraacceeppttiioonn 
ffoorr ffuuttuurree uussee 
34 
26 
15 
4 2 2 
Injectables 
Daily pill 
Monthly pill 
IUD 
Condom 
Implants 
Percent of currently married women who are not using a 
contraceptive method, but who intend to use
SSoommee rreeaassoonnss cciitteedd bbyy 
wwoommeenn ffoorr nnoott iinntteennddiinngg 
ttoo uussee ccoonnttrraacceeppttiioonn 
HHeeaalltthh ccoonncceerrnnss 
DDiiffffiiccuulltt ttoo ggeett pprreeggnnaanntt 
WWaannttss mmoorree cchhiillddrreenn 
OOppppoosseedd ttoo ffaammiillyy 
ppllaannnniinngg 
IInnffrreeqquueenntt sseexx//nnoo sseexx 
FFeeaarr ssiiddee eeffffeeccttss 
26% 
24% 
10% 
9% 
8% 
6% 
Currently married women who are not using a contraceptive method
Family Planning 
KKnnoowwlleeddggee  AAttttiittuuddeess 
UUssee ooff FFaammiillyy PPllaannnniinngg 
EExxppoossuurree ttoo FFaammiillyy PPllaannnniinngg 
MMeessssaaggeess
FFrroomm wwhhaatt ssoouurrccee ddoo 
wwoommeenn hheeaarr ffaammiillyy 
ppllaannnniinngg mmeessssaaggeess?? 
FFrroomm rraaddiioo oonnllyy 
FFrroomm tteelleevviissiioonn 
oonnllyy 
FFrroomm bbootthh 
NNOO MMEESSSSAAGGEE 
10% 
5% 
64% 
21% 
For all women who heard a message about family planning 
in the last few months preceding the interview
DDooeess eexxppoossuurree ttoo ffaammiillyy 
ppllaannnniinngg mmeessssaaggeess vvaarryy bbyy 
rreessiiddeennccee aanndd 
eedduuccaattiioonn?? 
Residence 
UUrrbbaann 8866%% 
RRuurraall 7788%% 
Education 
NNoonnee 7700%% 
PPrriimmaarryy 8800%% 
SSeeccoonnddaarryy++ 9922%%
Does exposure to family planning 
messages in the print media 
vary by residence and education? 
Residence 
UUrrbbaann 5599%% 
RRuurraall 3366%% 
Education 
NNoonnee 2288%% 
PPrriimmaarryy 3399%% 
SSeeccoonnddaarryy++ 6622%%
MMaaiinn ffiinnddiinnggss 
• Knowledge of family planning is very high, 
except in two areas (56%) 
• 19% of women use a modern method of 
contraception (24% use any method) 
• Use of any contraceptive method has been 
increasing since 1995 (13%) to 24% in 2000 
• Use varies greatly by residence, region and level 
of education
MMaaiinn ffiinnddiinnggss 
• Injectables and the daily and monthly 
pills are the 3 methods most used by 
women 
• Slightly more than 2 women in 5 intend 
to use family planning in the future 
• 4 women in 5 have heard of a family 
planning message in the media
Lecture 1 family planning

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Lecture 1 family planning

  • 2. BBiirrtthh CCoonnttrrooll && FFaammiillyy PPllaannnniinngg
  • 3. RReemmeemmbbeerr TThhee ttoottaall rriisskkss ooff bbiirrtthh ccoonnttrrooll aarree mmuucchh lleessss tthhaann tthhee ttoottaall rriisskkss ooff aa pprreeggnnaannccyy!!!!
  • 4. TTyyppeess ooff BBiirrtthh CCoonnttrrooll HHoorrmmoonnaall BBaarrrriieerr IIUUDD MMeetthhooddss bbaasseedd oonn iinnffoorrmmaattiioonn PPeerrmmaanneenntt sstteerriilliizzaattiioonn
  • 5. HHoorrmmoonnaall MMeetthhooddss OOrraall CCoonnttrraacceeppttiivveess ((BBiirrtthh CCoonnttrrooll PPiillll)) IInnjjeeccttiioonnss ((DDeeppoo--PPrroovveerraa)) IImmppllaannttss ((NNoorrppllaanntt II IIII))
  • 6. BBiirrtthh CCoonnttrrooll PPiillllss PPiillllss ccaann bbee ttaakkeenn ttoo pprreevveenntt pprreeggnnaannccyy PPiillllss aarree ssaaffee aanndd eeffffeeccttiivvee wwhheenn ttaakkeenn pprrooppeerrllyy PPiillllss aarree oovveerr 9999%% eeffffeeccttiivvee WWoommeenn mmuusstt hhaavvee aa ppaapp ssmmeeaarr ttoo ggeett aa pprreessccrriippttiioonn ffoorr bbiirrtthh ccoonnttrrooll ppiillllss
  • 7. HHooww ddooeess tthhee ppiillll wwoorrkk?? SSttooppss oovvuullaattiioonn TThhiinnss uutteerriinnee lliinniinngg TThhiicckkeennss cceerrvviiccaall mmuuccuuss
  • 8. PPoossiittiivvee BBeenneeffiittss ooff BBiirrtthh CCoonnttrrooll PPiillllss PPrreevveennttss pprreeggnnaannccyy EEaasseess mmeennssttrruuaall ccrraammppss SShhoorrtteennss ppeerriioodd RReegguullaatteess ppeerriioodd DDeeccrreeaasseess iinncciiddeennccee ooff oovvaarriiaann ccyyssttss PPrreevveennttss oovvaarriiaann aanndd uutteerriinnee ccaanncceerr DDeeccrreeaasseess aaccnnee
  • 9. SSiiddee--eeffffeeccttss BBrreeaasstt tteennddeerrnneessss NNaauusseeaa IInnccrreeaassee iinn hheeaaddaacchheess MMooooddiinneessss WWeeiigghhtt cchhaannggee SSppoottttiinngg
  • 10. TTaakkiinngg tthhee PPiillll OOnnccee aa ddaayy aatt tthhee ssaammee ttiimmee eevveerryyddaayy UUssee ccoonnddoommss ffoorr ffiirrsstt mmoonntthh UUssee ccoonnddoommss wwhheenn oonn aannttiibbiioottiiccss UUssee ccoonnddoommss ffoorr 11 wweeeekk iiff yyoouu mmiissss aa ppiillll oorr ttaakkee oonnee llaattee TThhee ppiillll ooffffeerrss nnoo pprrootteeccttiioonn ffrroomm SSTTDD’’ss
  • 11. DDeeppoo--PPrroovveerraa BBiirrtthh ccoonnttrrooll sshhoott ggiivveenn oonnccee eevveerryy tthhrreeee mmoonntthhss ttoo pprreevveenntt pprreeggnnaannccyy 9999..77%% eeffffeeccttiivvee pprreevveennttiinngg pprreeggnnaannccyy NNoo ddaaiillyy ppiillllss ttoo rreemmeemmbbeerr
  • 12. HHooww ddooeess tthhee sshhoott wwoorrkk?? SSttooppss oovvuullaattiioonn SSttooppss mmeennssttrruuaall ccyycclleess!! TThhiicckkeennss cceerrvviiccaall mmuuccuuss
  • 13. SSIIDDEE EEFFFFEECCTTSS EExxttrreemmeellyy iirrrreegguullaarr mmeennssttrruuaall bblleeeeddiinngg aanndd ssppoottttiinngg ffoorr 33--66 mmoonntthhss!! NNOO PPEERRIIOODD  aafftteerr 33--66 mmoonntthhss WWeeiigghhtt cchhaannggee BBrreeaasstt tteennddeerrnneessss MMoooodd cchhaannggee **NNOOTT EEVVEERRYY WWOOMMAANN HHAASS SSIIDDEE--EEFFFFEECCTTSS!!
  • 14. IIMMPPLLAANNTTSS IImmppllaannttss aarree ppllaacceedd iinn tthhee bbooddyy ffiilllleedd wwiitthh hhoorrmmoonnee tthhaatt pprreevveennttss pprreeggnnaannccyy PPhhyyssiiccaallllyy iinnsseerrtteedd iinn ssiimmppllee 1155 mmiinnuuttee oouuttppaattiieenntt pprroocceedduurree PPllaassttiicc ccaappssuulleess tthhee ssiizzee ooff ppaappeerr mmaattcchhssttiicckkss iinnsseerrtteedd uunnddeerr tthhee sskkiinn iinn tthhee aarrmm 9999..9955%% eeffffeeccttiivveenneessss rraattee
  • 15. NNoorrppllaanntt II vvss.. NNoorrppllaanntt IIII SSiixx ccaappssuulleess FFiivvee yyeeaarrss TTwwoo ccaappssuulleess TThhrreeee yyeeaarrss
  • 17. NNoorrppllaanntt CCoonnssiiddeerraattiioonnss SShhoouulldd bbee ccoonnssiiddeerreedd lloonngg tteerrmm bbiirrtthh ccoonnttrrooll RReeqquuiirreess nnoo uuppkkeeeepp  EExxttrreemmeellyy eeffffeeccttiivvee iinn pprreeggnnaannccyy pprreevveennttiioonn 9999%%
  • 18. EEmmeerrggeennccyy CCoonnttrraacceeppttiioonn EEmmeerrggeennccyy ccoonnttrraacceeppttiioonn ppiillllss ccaann rreedduuccee tthhee cchhaannccee ooff aa pprreeggnnaannccyy bbyy 7755%% iiff ttaakkeenn wwiitthhiinn 7722 hhoouurrss ooff uunnpprrootteecctteedd sseexx!!
  • 19. Emergency CCoonnttrraacceeppttiioonn ((EECCPP)) MMuusstt bbee ttaakkeenn wwiitthhiinn 7722 hhoouurrss ooff tthhee aacctt ooff uunnpprrootteecctteedd iinntteerrccoouurrssee oorr ffaaiilluurree ooff ccoonnttrraacceeppttiioonn mmeetthhoodd MMuusstt rreecceeiivvee EECCPP ffrroomm aa pphhyyssiicciiaann 7755 –– 8844%% eeffffeeccttiivvee iinn rreedduucciinngg pprreeggnnaannccyy CCaalliiffoorrnniiaa pphhaarrmmaacciieess ccaann pprreessccrriibbee wwiitthhoouutt aa ddooccttoorr!! ((11//11//0022))
  • 20. EECCPP FFllooooddss tthhee oovvaarriieess wwiitthh hhiigghh aammoouunntt ooff hhoorrmmoonnee aanndd pprreevveennttss oovvuullaattiioonn AAlltteerrss tthhee eennvviirroonnmmeenntt ooff tthhee uutteerruuss,, mmaakkiinngg iitt ddiissrruuppttiivvee ttoo tthhee eegggg aanndd ssppeerrmm TTwwoo sseettss ooff ppiillllss ttaakkeenn eexxaaccttllyy 1122 hhoouurrss aappaarrtt
  • 21. BBAARRRRIIEERR MMEETTHHOODDSS SSppeerrmmiicciiddeess MMaallee CCoonnddoomm FFeemmaallee CCoonnddoomm DDiiaapphhrraaggmm CCeerrvviiccaall CCaapp
  • 22. BBAARRRRIIEERR MMEETTHHOODD PPrreevveennttss pprreeggnnaannccyy bblloocckkss tthhee eegggg aanndd ssppeerrmm ffrroomm mmeeeettiinngg BBaarrrriieerr mmeetthhooddss hhaavvee hhiigghheerr ffaaiilluurree rraatteess tthhaann hhoorrmmoonnaall mmeetthhooddss dduuee ttoo ddeessiiggnn aanndd hhuummaann eerrrroorr
  • 23. SSPPEERRMMIICCIIDDEESS CChheemmiiccaallss kkiillll ssppeerrmm iinn tthhee vvaaggiinnaa DDiiffffeerreenntt ffoorrmmss:: --JJeellllyy --FFiillmm --FFooaamm --SSuuppppoossiittoorryy SSoommee wwoorrkk iinnssttaannttllyy,, ootthheerrss rreeqquuiirree pprree--iinnsseerrttiioonn OOnnllyy 7766%% eeffffeeccttiivvee ((uusseedd aalloonnee)),, sshhoouulldd bbee uusseedd iinn ccoommbbiinnaattiioonn wwiitthh aannootthheerr mmeetthhoodd ii..ee..,, ccoonnddoommss
  • 24. MMAALLEE CCOONNDDOOMM • MMoosstt ccoommmmoonn aanndd eeffffeeccttiivvee bbaarrrriieerr mmeetthhoodd wwhheenn uusseedd pprrooppeerrllyy • LLaatteexx aanndd PPoollyyuurreetthhaannee sshhoouulldd oonnllyy bbee uusseedd iinn tthhee pprreevveennttiioonn ooff pprreeggnnaannccyy aanndd sspprreeaadd ooff SSTTII’’ss ((iinncclluuddiinngg HHIIVV))
  • 25. MMAALLEE CCOONNDDOOMM PPeerrffeecctt eeffffeeccttiivveenneessss rraattee == 9977%% TTyyppiiccaall eeffffeeccttiivveenneessss rraattee == 88%% LLaatteexx aanndd ppoollyyuurreetthhaannee ccoonnddoommss aarree aavvaaiillaabbllee CCoommbbiinniinngg ccoonnddoommss wwiitthh ssppeerrmmiicciiddeess rraaiisseess eeffffeeccttiivveenneessss lleevveellss ttoo 9999%%
  • 26. FFEEMMAALLEE CCOONNDDOOMM MMaaddee aass aann aalltteerrnnaattiivvee ttoo mmaallee ccoonnddoommss PPoollyyuurreetthhaannee PPhhyyssiiccaallllyy iinnsseerrtteedd iinn tthhee vvaaggiinnaa PPeerrffeecctt rraattee == 9955%% TTyyppiiccaall rraattee == 7799%% WWoommaann ccaann uussee ffeemmaallee ccoonnddoomm iiff ppaarrttnneerr rreeffuusseess
  • 27. RReeaalliittyy ä :: TThhee FFeemmaallee CCoonnddoomm
  • 28. DDIIAAPPRRAAGGHHMM PPeerrffeecctt EEffffeeccttiivveenneessss RRaattee == 9944%% TTyyppiiccaall EEffffeeccttiivveenneessss RRaattee == 800%% LLaatteexx bbaarrrriieerr ppllaacceedd iinnssiiddee vvaaggiinnaa dduurriinngg iinntteerrccoouurrssee FFiitttteedd bbyy pphhyyssiicciiaann SSppeerrmmiicciiddaall jjeellllyy bbeeffoorree iinnsseerrttiioonn IInnsseerrtteedd uupp ttoo 118 hhoouurrss bbeeffoorree iinntteerrccoouurrssee aanndd ccaann bbee lleefftt iinn ffoorr aa ttoottaall ooff 2244 hhoouurrss
  • 30. CCEERRVVIICCAALL CCAAPP LLaatteexx bbaarrrriieerr iinnsseerrtteedd iinn vvaaggiinnaa bbeeffoorree iinntteerrccoouurrssee ““CCaappss”” aarroouunndd cceerrvviixx wwiitthh ssuuccttiioonn FFiillll wwiitthh ssppeerrmmiicciiddaall jjeellllyy pprriioorr ttoo uussee CCaann bbee lleefftt iinn bbooddyy ffoorr uupp ttoo aa ttoottaall ooff 448 hhoouurrss MMuusstt bbee lleefftt iinn ppllaaccee ssiixx hhoouurrss aafftteerr sseexxuuaall iinntteerrccoouurrssee PPeerrffeecctt eeffffeeccttiivveenneessss rraattee == 9911%% TTyyppiiccaall eeffffeeccttiivveenneessss rraattee == 800%%
  • 31. IINNTTRRAAUUTTEERRIINNEE DDEEVVIICCEESS ((IIUUDD)) TT--sshhaappeedd oobbjjeecctt ppllaacceedd iinn tthhee uutteerruuss ttoo pprreevveenntt pprreeggnnaannccyy MMuusstt bbee oonn ppeerriioodd dduurriinngg iinnsseerrttiioonn AA NNaattuurraall cchhiillddbbiirrtthh rreeqquuiirreedd ttoo uussee IIUUDD EExxttrreemmeellyy eeffffeeccttiivvee wwiitthhoouutt uussiinngg hhoorrmmoonneess 9977 %% MMuusstt bbee iinn mmoonnooggaammoouuss rreellaattiioonnsshhiipp
  • 32. CCooppppeerr TT vvss.... PPrrooggeessttaasseerrtt 1100 yyeeaarrss 9999..22 %% eeffffeeccttiivvee CCooppppeerr oonn IIUUDD aaccttss aass ssppeerrmmiicciiddee,, IIUUDD bblloocckkss eegggg ffrroomm iimmppllaannttiinngg MMuusstt cchheecckk ssttrriinngg bbeeffoorree sseexx aanndd aafftteerr sshheeddddiinngg ooff uutteerriinnee lliinniinngg.. 11 yyeeaarr 998%% eeffffeeccttiivvee TT sshhaappeedd ppllaassttiicc tthhaatt rreelleeaasseess hhoorrmmoonneess oovveerr aa oonnee yyeeaarr ttiimmee ffrraammee TThhiicckkeennss mmuuccuuss,, bblloocckkiinngg eegggg CChheecckk ssttrriinngg bbeeffoorree sseexx aafftteerr sshheeddddiinngg ooff uutteerriinnee lliinniinngg..
  • 33. SSTTEERRIILLIIZZAATTIIOONN PPrroocceedduurree ppeerrffoorrmmeedd oonn aa mmaann oorr aa wwoommaann ppeerrmmaanneennttllyy sstteerriilliizzeess FFeemmaallee == TTuubbaall LLiiggaattiioonn MMaallee == VVaasseeccttoommyy
  • 34. TTUUBBAALL LLIIGGAATTIIOONN SSuurrggiiccaall pprroocceedduurree ppeerrffoorrmmeedd oonn aa wwoommaann FFaallllooppiiaann ttuubbeess aarree ccuutt,, ttiieedd,, ccaauutteerriizzeedd,, pprreevveennttss eeggggss ffrroomm rreeaacchhiinngg ssppeerrmm FFaaiilluurree rraatteess vvaarryy bbyy pprroocceedduurree,, ffrroomm 00..8%%--33..77%% MMaayy eexxppeerriieennccee hheeaavviieerr ppeerriiooddss
  • 36. VVAASSEECCTTOOMMYY MMaallee sstteerriilliizzaattiioonn pprroocceedduurree LLiiggaattiioonn ooff VVaass DDeeffeerreennss ttuubbee NNoo--ssccaallppeell tteecchhnniiqquuee aavvaaiillaabbllee FFaasstteerr aanndd eeaassiieerr rreeccoovveerryy tthhaann aa ttuubbaall lliiggaattiioonn FFaaiilluurree rraattee == 00..11%%,, mmoorree eeffffeeccttiivvee tthhaann ffeemmaallee sstteerriilliizzaattiioonn
  • 38. MMEETTHHOODDSS BBAASSEEDD OONN IINNFFOORRMMAATTIIOONN WWiitthhddrraawwaall NNaattuurraall FFaammiillyy PPllaannnniinngg FFeerrttiilliittyy AAwwaarreenneessss MMeetthhoodd AAbbssttiinneennccee
  • 39. WWIITTHHDDRRAAWWAALL RReemmoovvaall ooff ppeenniiss ffrroomm tthhee vvaaggiinnaa bbeeffoorree eejjaaccuullaattiioonn ooccccuurrss NNOOTT aa ssuuffffiicciieenntt mmeetthhoodd ooff bbiirrtthh ccoonnttrrooll bbyy iittsseellff EEffffeeccttiivveenneessss rraattee iiss 800%% ((vveerryy uunnpprreeddiiccttaabbllee iinn tteeeennss,, wwiiddee vvaarriiaattiioonn)) 11 ooff 55 wwoommeenn pprraaccttiicciinngg wwiitthhddrraawwaall bbeeccoommee pprreeggnnaanntt VVeerryy ddiiffffiiccuulltt ffoorr aa mmaallee ttoo ‘‘ccoonnttrrooll’’
  • 40. Natural FFaammiillyy PPllaannnniinngg FFeerrttiilliittyy AAwwaarreenneessss MMeetthhoodd WWoommeenn ttaakkee aa ccllaassss oonn tthhee mmeennssttrruuaall ccyyccllee ttoo ccaallccuullaattee mmoorree ffeerrttiillee ttiimmeess RReeqquuiirreess ssppeecciiaall eeqquuiippmmeenntt aanndd ccaannnnoott bbee sseellff--ttaauugghhtt NNFFPP aabbssttaaiinnss ffrroomm sseexx dduurriinngg tthhee ccaallccuullaatteedd ffeerrttiillee ttiimmee FFAAMM uusseess bbaarrrriieerr mmeetthhooddss dduurriinngg ffeerrttiillee ttiimmee PPeerrffeecctt eeffffeeccttiivveenneessss rraattee == 9911%% TTyyppiiccaall eeffffeeccttiivveenneessss rraattee == 7755%% NNoo 110000%% ssaaffee ddaayy--iirrrreegguullaarr ppeerriiooddss
  • 41. AAbbssttiinneennccee OOnnllyy 110000%% mmeetthhoodd ooff bbiirrtthh ccoonnttrrooll AAbbssttiinneennccee iiss wwhheenn ppaarrttnneerrss ddoo nnoott eennggaaggee iinn sseexxuuaall iinntteerrccoouurrssee CCoommmmuunniiccaattiioonn bbeettwweeeenn ppaarrttnneerrss iiss iimmppoorrttaanntt ffoorr tthhoossee pprraaccttiicciinngg aabbssttiinneennccee ttoo bbee ssuucccceessssffuull
  • 42. RReeaassoonnss ffoorr aabbssttaaiinniinngg MMoorraall oorr rreelliiggiioouuss vvaalluueess PPeerrssoonnaall bbeelliieeffss MMeeddiiccaall rreeaassoonnss NNoott ffeeeelliinngg rreeaaddyy ffoorr aann eemmoottiioonnaall,, iinnttiimmaattee rreellaattiioonnsshhiipp FFuuttuurree ppllaannss
  • 43. SSOOMMEETTHHIINNGG TTOO TTHHIINNKK AABBOOUUTT…… CCoouupplleess wwhhoo uussee nnoo bbiirrtthh ccoonnttrrooll hhaavvee aa 8855%% cchhaannccee ooff aa pprreeggnnaannccyy wwiitthhiinn tthhee ffiirrsstt yyeeaarr..
  • 44. EXCELLENT RREEFFEERREENNCCEE SSEEEE:: wwwwww..ppllaannnneeddppaarreenntthhoooodd..oorrgg//bbcc HHaattcchheerr,, RRoobbeerrtt,, MMDD CCoonnttrraacceeppttiivvee TTeecchhnnoollooggyy ,,1177eedd.. ((22000011))
  • 46. Quality iinn FFaammiillyy PPllaannnniinngg
  • 47. QQuuaalliittyy Quality 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.
  • 48. AAiimmss OObbjjeeccttiivveess In 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.
  • 49. Elements of ‘‘QQuuaalliittyy ooff CCaarree’’ iinn ffaammiillyy ppllaannnniinngg By Judith Bruce, 1990 Choice of method Interpersonal communication (verbal non verbal) Technical Competence Information Follow-up Appropriate constellation of services
  • 50. CChhooiiccee ooff mmeetthhoodd Offering the right to the client to choose the method means giving confidence to the individual. He/she feels more comfortable in using the method for which he/she has been provided with clear, accurate and specific information and which is the best for his/her needs.
  • 51. Good interpersonal ccoommmmuunniiccaattiioonn ((vveerrbbaall nnoonn vveerrbbaall)) 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.
  • 52. TTeecchhnniiccaall CCoommppeetteennccee Quality needs command on the subject. It is inevitable to acquire all the essential knowledge and to polish one’s technical competence regarding family planning services.
  • 53. IInnffoorrmmaattiioonn Providing all the necessary information to the client helps him/her in using the selected method correctly, without any fear. Right information will certainly clear the myths and rumors about the subject and will improve the adopting rate among the potential clients.
  • 54. FFoollllooww--uupp Correct and continuous follow up of the users is indispensable to monitor the possible complications with the use of contraceptives. It ensures eventually an improved continuation rate among the users.
  • 55. Appropriate ccoonnsstteellllaattiioonn ooff sseerrvviicceess Adding family planning services along with the routine ones under the same roof may attract more clientele. The clients do not have to go to some other service specialized in family planning only. Clients discuss their problems with more openness with their own physician in a friendly ambiance.
  • 56. IInnddiiccaattoorrss QQUUAALLIITTYY OOFF CCAARREE Number of contraceptive methods available at a specific outlet Percentage of counseling sessions with new acceptors in which provider discusses all methods Percentage of client visits during which provider demonstrates skill at clinical procedures, including asepsis Percentage of clients reporting “sufficient time” with provider Percentage of clients informed of timing and sources for re-supply/revisit Percentage of clients who perceive that hours/days are convenient and the range of services provided is adequate.
  • 57. Return visit and follow-ups of client method/service she has chosen Explain to the client how to use the decision about which method/service to use Help the client to make her own methods/services Tell the client about different Ask the client about FP/RH needs respectful manner Greet the client in a friendly and AApppprrooaacchh ttoo CCoouunnsseelliinngg GGAATTHHEERR scheduled
  • 58. RRiigghhttss ooff CClliieennttss Information about all the methods / services available. Knowledge of not only the benefits but also the risks / side effects of all the contraceptive methods / RH services to make an independent decision. Outlets providing FP/ RH services should carry a logo / indicative sign on a prominent place. They should also provide a comfortable clean environment to the clients where they will be treated with respect, attention and courtesy. Access to get the FP/RH services regardless of his/her sex, race, religion, color and socio-economic status. FP services should be available to people in their closest vicinity.
  • 59. RRiigghhttss ooff CClliieennttss ((ccoonntt..)) Choice to practice FP or RH service should be absolutely voluntary and free. A competent provider will help the client to make a decision and will not pressurize the client to make certain choice for a certain method/service. Privacy for FP/ RH counseling where the client would feel open and frank with the provider. Continuity to obtain the FP/RH services without any break or discontinuation to avoid the after effects and the give-ups of the service. Opinion about the subject, method used and the service provided. This feedback is always helpful for the provider to improve one’s service delivery.
  • 60. PPrroovviiddeerr’’ss nneeeeddss Training will certainly help the provider to do a better counseling. It is needed to polish one’s skills to pass the right information, to help the client in decision making, to explain the use of a specific method, to screen the client etc. Information about all the FP methods/RH services.Moreover, other information about the local community like social, cultural and religious beliefs is always helpful in dealing with the FP clients. Update about the FP methods and about the new developments in the reproductive health. Outlet adequately equipped for a trained provider is an essential requirement for the FP/RH services. There should be a logo / sign to show the availability of FP services in that particular outlet.
  • 61. PPrroovviiddeerr’’ss nneeeeddss ((ccoonntt..)) Supplies continuous adequate - needed at the provider’s outlet to ensure an all time good service for the users and other potential clients. Backup referral for the complicated cases should be there, where and when needed. Feedback about the services provided in a certain outlet helps the provider to amend and ameliorate his/her services. Acknowledgement in the shape of certification or some incentives to be encouraged to continue with the same motivation and involvement.
  • 63. Family Planning KKnnoowwlleeddggee AAttttiittuuddeess UUssee ooff FFaammiillyy PPllaannnniinngg EExxppoossuurree ttoo FFaammiillyy PPllaannnniinngg MMeessssaaggeess
  • 64. o Knowledge off ccoonnttrraacceeppttiivvee mmeetthhooddss Currently married women All women 96 95 33 92 92 24 Any method Any modern method Any traditional Percent of women age 15-49
  • 65. Which mmooddeerrnn mmeetthhooddss aarree mmoosstt ffaammiilliiaarr ttoo mmaarrrriieedd wwoommeenn?? 90 90 79 83 77 64 54 47 Male sterilization Implants Female sterilization Monthly pill Condom IUD Daily pill Injectables Percent of currently married women age 15-49
  • 66. Does knowledge ooff aannyy mmooddeerrnn mmeetthhoodd vvaarryy bbyy rreessiiddeennccee,, rreeggiioonn aanndd eedduuccaattiioonn?? • No urban-rural difference • Women with no education (91%) know slightly less about modern methods than educated women (98%)
  • 67. Do mmaarrrriieedd wwoommeenn ddiissccuussss ffaammiillyy ppllaannnniinngg wwiitthh tthheeiirr hhuussbbaannddss?? 34 53 12 Never Once or twice Three or + Percent of currently married women age 15-49 in the past year
  • 68. a What arree ccoouupplleess’’ aattttiittuuddeess ttoowwaarrdd ffaammiillyy ppllaannnniinngg?? 11 9 6 6 68 Both approve Both disapprove One approves, other dissaproves Husband's attitude unknown Respondent unsure Percent of women who report that they and their husband approve or not of family planning
  • 69. Family Planning KKnnoowwlleeddggee AAttttiittuuddeess UUssee ooff FFaammiillyy PPllaannnniinngg EExxppoossuurree ttoo FFaammiillyy PPllaannnniinngg MMeessssaaggeess
  • 70. UUssee ooff ccoonnttrraacceeppttiioonn aammoonngg mmaarrrriieedd wwoommeenn 24 19 5 Traditional methods Modern methods Any method Percent of currently married women age 15-49
  • 71. DDooeess uussee ooff ccoonnttrraacceeppttiioonn vvaarryy bbyy aa wwoommaann’’ss lleevveell ooff eedduuccaattiioonn?? No education Primary Secondary and + Percent of currently married women age 15-49 19 16 23 19 35 23 Any method Any modern method
  • 72. Contraceptive uussee aallssoo vvaarriieess bbyy rreessiiddeennccee 3333%% ooff uurrbbaann wwoommeenn uussee aannyy mmeetthhoodd ooff ffaammiillyy ppllaannnniinngg ccoommppaarreedd ttoo…… 2222%% ffoorr tthheeiirr rruurraall ccoouunntteerrppaarrttss..
  • 73. Women’s current use of modern contraceptive methods Other modern methods 1% Male condom 5% Female sterilisation 8% Injectables 40% IUD 7% Monthly pill 15% Daily pill 24%
  • 74. SSoouurrccee ooff ssuuppppllyy ffoorr ccoonnttrraacceeppttiivvee mmeetthhooddss 38 Public sector Private medical Other private Percent 44 47 13 57 27 44 18 17 37 5 70 5 65 9 Daily pill Monthly pill Injectables Condom IUD* *First source, limited to women who started using IUD since 1995
  • 75. IInntteennttiioonn ttoo uussee ccoonnttrraacceeppttiioonn iinn tthhee ffuuttuurree 42 45 13 Intends to use Does not intend Unsure Percent of currently married women who are not using a contraceptive method
  • 76. Preferred method ooff CCoonnttrraacceeppttiioonn ffoorr ffuuttuurree uussee 34 26 15 4 2 2 Injectables Daily pill Monthly pill IUD Condom Implants Percent of currently married women who are not using a contraceptive method, but who intend to use
  • 77. SSoommee rreeaassoonnss cciitteedd bbyy wwoommeenn ffoorr nnoott iinntteennddiinngg ttoo uussee ccoonnttrraacceeppttiioonn HHeeaalltthh ccoonncceerrnnss DDiiffffiiccuulltt ttoo ggeett pprreeggnnaanntt WWaannttss mmoorree cchhiillddrreenn OOppppoosseedd ttoo ffaammiillyy ppllaannnniinngg IInnffrreeqquueenntt sseexx//nnoo sseexx FFeeaarr ssiiddee eeffffeeccttss 26% 24% 10% 9% 8% 6% Currently married women who are not using a contraceptive method
  • 78. Family Planning KKnnoowwlleeddggee AAttttiittuuddeess UUssee ooff FFaammiillyy PPllaannnniinngg EExxppoossuurree ttoo FFaammiillyy PPllaannnniinngg MMeessssaaggeess
  • 79. FFrroomm wwhhaatt ssoouurrccee ddoo wwoommeenn hheeaarr ffaammiillyy ppllaannnniinngg mmeessssaaggeess?? FFrroomm rraaddiioo oonnllyy FFrroomm tteelleevviissiioonn oonnllyy FFrroomm bbootthh NNOO MMEESSSSAAGGEE 10% 5% 64% 21% For all women who heard a message about family planning in the last few months preceding the interview
  • 80. DDooeess eexxppoossuurree ttoo ffaammiillyy ppllaannnniinngg mmeessssaaggeess vvaarryy bbyy rreessiiddeennccee aanndd eedduuccaattiioonn?? Residence UUrrbbaann 8866%% RRuurraall 7788%% Education NNoonnee 7700%% PPrriimmaarryy 8800%% SSeeccoonnddaarryy++ 9922%%
  • 81. Does exposure to family planning messages in the print media vary by residence and education? Residence UUrrbbaann 5599%% RRuurraall 3366%% Education NNoonnee 2288%% PPrriimmaarryy 3399%% SSeeccoonnddaarryy++ 6622%%
  • 82. MMaaiinn ffiinnddiinnggss • Knowledge of family planning is very high, except in two areas (56%) • 19% of women use a modern method of contraception (24% use any method) • Use of any contraceptive method has been increasing since 1995 (13%) to 24% in 2000 • Use varies greatly by residence, region and level of education
  • 83. MMaaiinn ffiinnddiinnggss • Injectables and the daily and monthly pills are the 3 methods most used by women • Slightly more than 2 women in 5 intend to use family planning in the future • 4 women in 5 have heard of a family planning message in the media

Editor's Notes

  1. The early family planning initiatives in the 1950s and 1960s were motivated by demographic concerns; the vanguard countries developed family planning programs in an effort to control rapid population growth. As such, the ultimate objective of these programs (and the majority that have followed) was to reduce fertility. This translated to a strong emphasis on the quantitative aspects of service delivery. How many acceptors entered the program each year? What volume of contraception was distributed? What percentage of the population at risk used a contraceptive method?
  2. In India, only 55 percent of children under four months of age are exclusively breastfed