this are lecture notes on modern contraception

1. Modern contraception
Hellen Muringi
Department of medical microbiology and immunology
University of Nairobi
Visiting lecturer, Banadir University

2. Introduction
• Contraception=against conception
• The preventive methods to help women avoid
unwanted pregnancies are called
contraceptive methods.

3. Need for contraception
• To avoid unwanted pregnancies
• To regulate the timing of pregnancy
• To regulate the interval between pregnancy

4. Ideal contraceptive???
• Safe
• Effective
• Acceptable
• Reversible
• Inexpensive
• Long lasting
• Requires little or no medical supervision

5. Contraceptive methods
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6. Contraceptive methods
Spacing methods Terminal methods
1)Barrier 1)Male fertilisation
2)IUDs 2)Female fertilisation
3)Hormonal
4)Emergency contraception

7. Barrier methods
• Male condoms
• Female condoms
• Diaphragm
• Spermicides

8. 1. Male condom
3. Diaphragm
2. Female condoms

9. Spermicides
• Spermicides are surface active agents that
attach themselves to spermatozoa and kill
them.
• Available in various forms like
1. Foams
2. Creams
3. Suppositories
4. Soluble films

10. Intra uterine devices
• 1st generation:
-Inert/non-medicated devices
Eg:lippes loop(left as long as required)
• 2nd genration:
-Metallic IUDs
-Cu-T380 A(10 years)
-Nova T(5 years)
-Multiload devices
• 3rd generation:
-Hormonal IUDs
-progestasert(2 years)
-Mirena(LNG-20)(10 years)

11. IUCD continued
• Contraindication
• Timing:At the time of menstruation
post partum,post pueperal
Side effects:1)bleeding
2)pain
3)PID
4)perforation of uterus
5)Ectopic pregnancy

12. Hormonal contraceptives
• Combined pill:
-combination of estrogen and progestogen
-MALA-N,MALA-D(0.15mg levonorgestrel & 0.03mg
ethinyl estradiol)
Prgestogen only pill
-used in people above 40 years of age & CVS problem
Post coital contraception:
-Levonorgestrel
-Ullipristal
-Mifepristone

13. Adverse effects
• Cardiovascular effects
• Carcinogenesis
• Metabolic effects
• Liver adenomas
• Weight gain
• Breast tenderness

14. Depot formulations
• Injectables:
DMPA-150 mg IM inj every 3 monthly
Subdermal impants:
Norplant-6 silastic capsules, each containing
35 mg of levonorgestrol
-protection for 5 years

15. Natural/traditional methods
• Abstinence: only method that is 100%
effective
• Coitus interuptus
• Rhythm method
• Basal body temperature method
• Cervical mucus
• Symptothermal contraception or fertility
awareness

16. Terminal methods
• Permanent methods
• One time method
-Guidelines
• Husbands age:25-50 years
• Wife’s age:20-45
• 2 living children at the time of operation

17. Male Sterilisation
• Complications:
• Operative
• Sperm granules
• Spontaneous recanalisation
• Psychological
Post op advice:
Not sterile till 30 ejaculations
Avoid bathing till 24 hours of operation
Avoiding heavy weights and wearing a langot

18. Female sterilisation
• Laparoscopy
• Mini lap

19. Evaluation of contraceptive methods
Pearl index:
-failures per 100 women years of exposure
Pearl index= total accidental pregnancies X1200
total months of exposure
Life table analysis:
-The failure rate for each month of use, then the
cumulative rate is found out

20. Family planning in Somalia
• According to data from the United Nations
Population Fund (UNFPA), as of 2018, the
prevalence of modern contraception in
Somalia was low, with only about 6.3% of
married or in-union women aged 15 to 49
using a modern method of contraception.

21. Whom to target???
• Eligible couple:
-Currently married couple where in the wife is in the
reproductive age (15-45 years)
• Unmet need of contraception:
-Women with unmet need are those who are fecund
and sexually active but are not using any method of
contraception, and report not wanting any more
children or wanting to delay the next child.
-The concept of unmet need points to the gap between
women's reproductive intentions and their
contraceptive behaviour
-Lack of awareness and accessibility

22. Hindrances to uptake of modern contraceptives
• Cultural and Religious Beliefs: Many African societies hold traditional beliefs that may
oppose the use of contraceptives due to religious or cultural reasons. These beliefs often
center around the idea that contraception is unnatural or goes against religious teachings.
• Misinformation and Myths: There are prevalent myths and misconceptions surrounding
modern contraceptives in Africa. These myths can include fears about side effects, infertility,
or health risks associated with contraceptive use.
• Stigma and Social Norms: In some communities, there is stigma attached to discussing or
using contraceptives, particularly among unmarried individuals or younger women. Fear of
judgment or ostracism can deter people from seeking out contraception.
• Limited Access to Services: Access to modern contraceptive methods can be limited in many
African countries, particularly in rural areas where healthcare facilities may be scarce or
poorly equipped. This lack of access can include both physical access to facilities and
affordability of contraceptive methods.
• Gender Dynamics: In some societies, power imbalances between men and women can affect
contraceptive decision-making. Women may face pressure from partners or family members
to avoid contraceptive use, or they may lack the autonomy to make decisions about their
reproductive health.
• Health Concerns and Side Effects: Concerns about potential side effects or health risks
associated with modern contraceptives can also deter people from using them. Lack of
accurate information about the safety and effectiveness of different methods can contribute
to these fears.
• Desire for Large Families: In some African cultures, having many children is highly valued, and
there may be resistance to contraceptive use due to a desire for large families or pressure to
fulfill societal expectations regarding fertility.

23. Strategies to improve uptake
• Comprehensive Sexual Education: Implement comprehensive sexual education programs in schools and communities to provide
accurate information about reproductive health, contraceptive options, and family planning. These programs should be culturally
sensitive and tailored to the needs of different populations.
• Community Engagement and Mobilization: Work with community leaders, religious institutions, and local organizations to promote
awareness and acceptance of modern contraceptives. Community health workers can play a crucial role in delivering information and
services at the grassroots level.
• Improving Access to Services: Expand access to contraceptive services by increasing the availability of family planning clinics, mobile
outreach services, and community-based distribution programs. Ensure that contraceptive methods are affordable and accessible,
particularly in rural and underserved areas.
• Integration with Maternal and Child Health Services: Integrate family planning services with maternal and child health programs to
reach women during antenatal and postnatal care visits. This approach can help normalize discussions about contraception and provide
opportunities for counseling and provision of services.
• Empowering Women and Girls: Promote gender equality and empower women and girls to make informed decisions about their
reproductive health. This may involve initiatives to improve education and economic opportunities for women, as well as efforts to
address harmful gender norms and practices.
• Addressing Cultural and Religious Beliefs: Engage religious and traditional leaders in dialogues about family planning and
contraception, emphasizing the compatibility of modern methods with religious and cultural values. Develop culturally appropriate
messaging and materials to counter myths and misconceptions.
• Quality of Care and Client-Centered Services: Ensure that family planning services are of high quality and meet the needs of clients.
This includes providing a range of contraceptive options, offering counseling and support for method choice and side effect
management, and respecting clients' autonomy and confidentiality.
• Advocacy and Policy Change: Advocate for policies and programs that support access to modern contraceptives, including funding for
family planning services, removal of legal and regulatory barriers, and integration of family planning into broader health and
development initiatives.
• Male Engagement: Involve men and boys in discussions about family planning and contraception, emphasizing the benefits of shared
decision-making and male involvement in reproductive health. Addressing men's concerns and misconceptions can help promote
support for contraceptive use within families.
• Utilizing Technology: Explore the use of technology, such as mobile health applications and telemedicine, to increase access to
contraceptive information and services, particularly in remote areas where healthcare facilities are limited.

24. •Thank you