Vital statistics are systematically collected facts related to vital events like births, deaths, and marriages. They are compiled from sources like censuses, registration records, and health surveys. Vital statistics are used for policymaking, administration, research, and public health programs. Some key vital statistics include birth rate, death rate, crude death rate, maternal mortality ratio, and infant mortality rate. Recent advancements in contraceptives allow individuals to plan their families and avoid unwanted births. Natural family planning methods like rhythm method and basal body temperature tracking require abstaining from sex during fertile periods, while barrier methods like condoms use physical barriers.

1. welcomewelcome

2. Vital statisticsVital statistics
&&
recent advancementrecent advancement
in contraceptivesin contraceptives

3. definitiondefinition
““Vital statistics have been defined asVital statistics have been defined as
the facts systematically collected andthe facts systematically collected and
compiled in numerical form related to orcompiled in numerical form related to or
derived from records of vital events”derived from records of vital events”

4. Sources of vitalSources of vital
statisticsstatistics
CensusCensus
Registration of births, deaths andRegistration of births, deaths and
marriagesmarriages
Notification of infectious diseasesNotification of infectious diseases
Records of hospitals and health centersRecords of hospitals and health centers
Health surveysHealth surveys

5. Uses of vital statisticsUses of vital statistics
For policy making, that is, to form theFor policy making, that is, to form the
basis for policy guidance, planning andbasis for policy guidance, planning and
projections;projections;
for administration, that is, to monitorfor administration, that is, to monitor
current demographic trends and actioncurrent demographic trends and action
programmesprogrammes
for research, that is, to support thefor research, that is, to support the
scientific study of the interrelationshipscientific study of the interrelationship
between fertility and mortality trendsbetween fertility and mortality trends
and socio-economic developmentand socio-economic development

6. Preparing population estimates and projections;Preparing population estimates and projections;
Cohort and period studies;Cohort and period studies;
Construction of life tables;Construction of life tables;
Preparing health indicators, such as infantPreparing health indicators, such as infant
mortality rates, neonatal mortality rates, post‐mortality rates, neonatal mortality rates, post‐
neonatal mortality rates, maternal mortalityneonatal mortality rates, maternal mortality
rates, etc.;rates, etc.;
Starting points in retrospective epidemiologicalStarting points in retrospective epidemiological
studies;studies;
Public health programmes in the absence ofPublic health programmes in the absence of
morbidity data, or for health educationmorbidity data, or for health education
Maternal and child health services for planningMaternal and child health services for planning
and evaluationand evaluation
Fertility data in family planningFertility data in family planning

7. Major vital statisticsMajor vital statistics
Birth rateBirth rate
The birth rate is defined as the numberThe birth rate is defined as the number
of the live births during a year per 1000of the live births during a year per 1000
estimated mid-year population. It is given byestimated mid-year population. It is given by
the formula.the formula.
Number of live births duringNumber of live births during
the yearthe year
Birth rateBirth rate ==
× 1000× 1000
Estimated mid-year populationEstimated mid-year population

8. Death rateDeath rate
Number of deaths in the population duringNumber of deaths in the population during
aa specified time periodspecified time period
Death RateDeath Rate == ×1000×1000
The number of persons in the populationThe number of persons in the population
during the specified time periodduring the specified time period

9. Crude death rateCrude death rate
It is defined as the number of deathsIt is defined as the number of deaths
per 1000 population per year in a givenper 1000 population per year in a given
community. It indicates the rate atcommunity. It indicates the rate at
which people are dying.which people are dying.

10. Maternal mortalityMaternal mortality
ratioratio
The number of women who die as aThe number of women who die as a
result of pregnancy and child birthresult of pregnancy and child birth
complications per 100,000 live births incomplications per 100,000 live births in
a given year.a given year.

11. Infant mortality rateInfant mortality rate
The number of deaths of infants underThe number of deaths of infants under
age 1 per 1000 live births in a givenage 1 per 1000 live births in a given
year.year.

12. Neonatal mortality rateNeonatal mortality rate
The number of deaths to infants underThe number of deaths to infants under
28 days of age in a given year per 100028 days of age in a given year per 1000
live births in that year.live births in that year.
Under 5 Mortality Rate (child
mortality rate) - The probability that a
newborn baby will die before reaching
age 5, expressed as a number per 1000
live births.
Diseases – specific mortality rate:
Mortality rates can be computed for
specific diseases.

14. INTRODUCTIONINTRODUCTION
India’s population is increasing veryIndia’s population is increasing very
explosive. It contributes one fifth ofexplosive. It contributes one fifth of
the world’s population by having morethe world’s population by having more
than one billion people. Populationthan one billion people. Population
explosion is found to be the main reasonexplosion is found to be the main reason
for shortages of resources andfor shortages of resources and
neutralization of the impact of progressneutralization of the impact of progress
made in various developmental sectors.made in various developmental sectors.

15. DEFINITIONDEFINITION
According to expert committee of WHOAccording to expert committee of WHO
(1971, Report No. 483), Family Planning(1971, Report No. 483), Family Planning
has been defined as:has been defined as:
““A way of thinking and living that isA way of thinking and living that is
adopted voluntarily, upon the basis ofadopted voluntarily, upon the basis of
knowledge, attitudes and responsibleknowledge, attitudes and responsible
decision by individuals and couples, indecision by individuals and couples, in
order to promote the health and familyorder to promote the health and family
welfare of the family group and thuswelfare of the family group and thus
contribute effectively to the socialcontribute effectively to the social
development of a country.”development of a country.”

16. OBJECTIVESOBJECTIVES
To avoid unwanted births.To avoid unwanted births.
To bring about wanted births.To bring about wanted births.
To regulate the interval betweenTo regulate the interval between
pregnancies.pregnancies.
To control the times at which birthTo control the times at which birth
occur in relation to the ages of theoccur in relation to the ages of the
parents, and to determine the numberparents, and to determine the number
of children in the family.of children in the family.

17. HAZARDS OF UNPLANNEDHAZARDS OF UNPLANNED
LARGE FAMILYLARGE FAMILY
Hazards due to early marriage andHazards due to early marriage and
early pregnancyearly pregnancy

Heath hazards in pregnancy and child birthHeath hazards in pregnancy and child birth
leading to premature births, low birthleading to premature births, low birth
weight babies, prenatal mortality, abortionweight babies, prenatal mortality, abortion
and miscarriage, fetal and neonatal deaths,and miscarriage, fetal and neonatal deaths,

Incidence of cancer of cervixIncidence of cancer of cervix

Discontinuation of education affectingDiscontinuation of education affecting
proper job opportunities etc.proper job opportunities etc.

18. Contd..Contd..
Hazards due to frequent pregnanciesHazards due to frequent pregnancies
and too many pregnanciesand too many pregnancies

Increase risk from pregnancy andIncrease risk from pregnancy and
child birth.child birth.

Ill health of mother, low birth weightIll health of mother, low birth weight

Divided attention between childrenDivided attention between children

Increased risk of cancer of cervixIncreased risk of cancer of cervix

Economic hardshipsEconomic hardships

19. Contd..Contd..
Hazards due to pregnancy at late ageHazards due to pregnancy at late age
or till aor till a

Further increased risk ofFurther increased risk of
pregnancy and child birth,pregnancy and child birth,

Congenital abnormalities e.g.Congenital abnormalities e.g.
mongoloid child,mongoloid child,

Loss of social status.Loss of social status.

20. Overall Goal ofOverall Goal of
Family PlanningFamily Planning
Is to provide
Universal access
to family planning
information &
services wherever
& whenever these
are needed.

21. TUBECTOMY
VASECTOMY
ABSTINENCE
WITHDRAWAL
SDM BARRIER
IUCD (copper T)
HARMONAL
NOTE:- No birth control method, except Abstinence, is considered to be 100% effective.

22. I. Natural FamilyI. Natural Family
Planning methodsPlanning methods
No introduction of chemical of foreignNo introduction of chemical of foreign
material into the body.material into the body.
Practice maybe due to religious belief,Practice maybe due to religious belief,
“natural” way is best for them.“natural” way is best for them.
Effectiveness varies greatly, depends onEffectiveness varies greatly, depends on
couples ability to refrain from having sex oncouples ability to refrain from having sex on
fertile days.fertile days.
Failure Rates: about 25%Failure Rates: about 25%
Poses no risk to fetusPoses no risk to fetus

23. NATURAL FAMILYNATURAL FAMILY
PLANNINGPLANNING
Rhythm (Calendar) methodRhythm (Calendar) method
Basal Body Temperature (BBT)Basal Body Temperature (BBT)
Ovulation or Cervical Mucus (BillingsOvulation or Cervical Mucus (Billings
Method)Method)
Sympto thermal methodSympto thermal method
Ovulation AwarenessOvulation Awareness
Lactation Amenorrhea MethodLactation Amenorrhea Method
Coitus InterruptusCoitus Interruptus

24. A. RHYTHM (Calendar)A. RHYTHM (Calendar)
METHODMETHOD
- Abstaining from coitus on the daysAbstaining from coitus on the days
In relation with menstrual cycleIn relation with menstrual cycle
when a woman is most likely towhen a woman is most likely to
conceive (3 or 4 days before until 3conceive (3 or 4 days before until 3
or 4 days after ovulation).or 4 days after ovulation).
- Woman keeps a diary of 6Woman keeps a diary of 6
menstrual cyclesmenstrual cycles

25. An illustration of the Standard Days
Method. This method may be used by
women whose menstrual cycles are
always between 26 and 32 days in length

26. B. Basal BodyB. Basal Body
Temperature (BBT)Temperature (BBT)
Identifying fertile and infertile period of aIdentifying fertile and infertile period of a
woman’s cycle by daily taking and recordingwoman’s cycle by daily taking and recording
of the rise in body temperature during andof the rise in body temperature during and
after ovulation.after ovulation.
Just before ovulation, a woman’s BBT fallsJust before ovulation, a woman’s BBT falls
about 0.5about 0.5◦F.◦F. At time of ovulation, her BBTAt time of ovulation, her BBT
rises a full degree (influence ofrises a full degree (influence of
progesterone).progesterone).
This higher level is maintained the rest ofThis higher level is maintained the rest of
menstrual cycle.menstrual cycle.

27. How: Woman takes her temp eachHow: Woman takes her temp each
morning immediately after waking,morning immediately after waking,
before she undertake any activity.before she undertake any activity.
She has ovulated, slight drip in tempShe has ovulated, slight drip in temp
followed byfollowed by
Usually combined with calendarUsually combined with calendar
methodmethod
Ideal Failure rate: 9%Ideal Failure rate: 9%

28. an example of a chart completed by a woman using BBT, cervical
secretions, cervical position and feel, and other minor indicators.

29. C. CervicalC. Cervical
Mucus/Billings/OvulatMucus/Billings/Ovulat
ionion
Use changes inUse changes in
cervical mucus withcervical mucus with
ovulationovulation
Woman: must beWoman: must be
conscientious inconscientious in
assessing her vaginalassessing her vaginal
secretions.secretions.
Ideal Failure rate:Ideal Failure rate:
3%3%

30. Before ovulation:Before ovulation:
- thick and does- thick and does
not stretchnot stretch
With ovulation (peakWith ovulation (peak
day):day):
- copious, thin,- copious, thin,
watery, transparent .watery, transparent .
Feels slippery andFeels slippery and
stretches at least 1 inchstretches at least 1 inch
before the strandbefore the strand
breaks = propertybreaks = property
known asknown as
“spinnbarkeit”.“spinnbarkeit”. TheseThese
are Fertile daysare Fertile days

31. C. SymptothermalC. Symptothermal
MethodMethod
Combines the cervical mucus and BBT methodsCombines the cervical mucus and BBT methods
Watches temp daily and analyzes cervicalWatches temp daily and analyzes cervical
mucus daily.mucus daily.
Couple must abstain from intercourse until 3Couple must abstain from intercourse until 3
days after rise in temp or 4days after rise in temp or 4thth
day after peak ofday after peak of
mucus change.mucus change.
More effective than BBT or CM method aloneMore effective than BBT or CM method alone
Ideal Failure rate: 2%Ideal Failure rate: 2%

32. D. OvulationD. Ovulation
AwarenessAwareness
Use an OTC ovulation detection kit.Use an OTC ovulation detection kit.
These kits detect the midcycle surgeThese kits detect the midcycle surge
of Luteinizing Hormone (LH) that canof Luteinizing Hormone (LH) that can
be detected in urine 12 to 24 hoursbe detected in urine 12 to 24 hours
before ovulation.before ovulation.
98% to 100% accurate in predicting98% to 100% accurate in predicting
ovulationovulation
ExpensiveExpensive

33. E. LactationE. Lactation
Amenorrhea MethodAmenorrhea Method
Temporary introductory postpartumTemporary introductory postpartum
method of postponing pregnancy basedmethod of postponing pregnancy based
on physiological infertility experiencedon physiological infertility experienced
by Breast Feeding womenby Breast Feeding women
Universally available to all postpartumUniversally available to all postpartum
breastfeeding women.breastfeeding women.
No other FP commodities requiredNo other FP commodities required
Contributes to improve maternal andContributes to improve maternal and
child health and nutritionchild health and nutrition

34. F. COITUSF. COITUS
INTERRUPTUSINTERRUPTUS
One of oldest known methods ofOne of oldest known methods of
contraceptioncontraception
Couple proceeds with coitus until theCouple proceeds with coitus until the
moment of ejaculation.moment of ejaculation.
Then the man withdraws & spermatozoaThen the man withdraws & spermatozoa
are emitted outside the vaginaare emitted outside the vagina
Offers little protectionOffers little protection
Adolescent boys may lack the control orAdolescent boys may lack the control or
experience to use theexperience to use the method effectivelymethod effectively

35. II. BARRIER METHODSII. BARRIER METHODS
Placement of a chemical or otherPlacement of a chemical or other
barrier between the cervix andbarrier between the cervix and
advancing sperm so that sperm cannotadvancing sperm so that sperm cannot
enter the uterus or fallopian tubes &enter the uterus or fallopian tubes &
fertilize the ovum.fertilize the ovum.
Major advantage: lack hormonal sideMajor advantage: lack hormonal side
effects associated with COCseffects associated with COCs
Failure rates: higher & sexualFailure rates: higher & sexual
enjoyment may be lessened.enjoyment may be lessened.

36. ExamplesExamples
Condom – menCondom – men
Female CondomFemale Condom
Vagina pouch – womenVagina pouch – women
DiaphragmDiaphragm
Cervical capCervical cap
Vaginal sponge with spermicidal agentVaginal sponge with spermicidal agent

37. A. Male CondomA. Male Condom
Condom – a latex rubber or syntheticCondom – a latex rubber or synthetic
sheath, placed over the erect penis beforesheath, placed over the erect penis before
coitus begins.coitus begins.
Spermatozoa are deposited in the tip ofSpermatozoa are deposited in the tip of
condomcondom
Latex condoms: potential prevention againstLatex condoms: potential prevention against
spread of STIs, major part of fight tospread of STIs, major part of fight to
prevent infection with Humanprevent infection with Human
immunodeficiency virus (HIV).immunodeficiency virus (HIV).

38. MALE
CONDOM

39. B. FEMALE CONDOMSB. FEMALE CONDOMS
Latex sheaths made of polyurethane andLatex sheaths made of polyurethane and
prelubricated with a spermicide.prelubricated with a spermicide.
Inner ring (closed end)= covers cervix;Inner ring (closed end)= covers cervix;
Outer ring (open end)= rests againstOuter ring (open end)= rests against
vaginal openingvaginal opening
May be inserted any time before sexualMay be inserted any time before sexual
activity begins; then remove afteractivity begins; then remove after
ejaculation occurs.ejaculation occurs.

40. Like male condoms, one time use only.Like male condoms, one time use only.
Difficult to useDifficult to use
Offer protection against bothOffer protection against both
conception and STIconception and STI
More expensive than male condomsMore expensive than male condoms

41. The female condom, like the male condom, is a barrier contraceptive made of
latex or polyurethane. The condom has a ring on each end. The ring that is
placed inside the vagina fits over the cervix, while the other ring, which is
open, rests outside of the vagina and covers the vulva. The female condom is
sold over-the-counter.

42. C. DIAPHRAGMSC. DIAPHRAGMS
Circular rubber diskCircular rubber disk
placed over cervix beforeplaced over cervix before
intercourse. Usually withintercourse. Usually with
spermicidal gelspermicidal gel
Fitted initially byFitted initially by
physician, nurse orphysician, nurse or
midwifemidwife

43. Kept in place at least 6 hrs after coitus.Kept in place at least 6 hrs after coitus.
Should not stay for at least 24 hrs- mayShould not stay for at least 24 hrs- may
cause cervical inflammation (erosion) orcause cervical inflammation (erosion) or
urethral irritationurethral irritation
How to use:How to use:

Inserted into the vagina (rim coated withInserted into the vagina (rim coated with
spermicidal gel) by sliding it along thespermicidal gel) by sliding it along the
posterior wall & pressing it up against theposterior wall & pressing it up against the
cervix.cervix.

44. 
Check with a finger after insertion to beCheck with a finger after insertion to be
certain that its fitted well by palpating thecertain that its fitted well by palpating the
cervical os through diaphragm.cervical os through diaphragm.

Remove by inserting a finger through diaphragmRemove by inserting a finger through diaphragm
and loosening by pressing against the anteriorand loosening by pressing against the anterior
rim and then withdrawing it vaginally.rim and then withdrawing it vaginally.
After use, washes in mild soap & water,After use, washes in mild soap & water,
dries gently & stores in its protective case.dries gently & stores in its protective case.
May last for 2 to 3 years.May last for 2 to 3 years.

45. Contra indicationsContra indications

History of recurrent UTIsHistory of recurrent UTIs

If uterus is prolapsed, retroflexed, orIf uterus is prolapsed, retroflexed, or
anteflexedanteflexed

With acute cervicitisWith acute cervicitis

Allergy to rubber or spermicidesAllergy to rubber or spermicides

History of Toxic Shock SyndromeHistory of Toxic Shock Syndrome
a staphylococcal infection introduced througha staphylococcal infection introduced through
the vaginathe vagina

46. How to prevent ToxicHow to prevent Toxic
shock Syndromeshock Syndrome
Wash hands thoroughly with soap &Wash hands thoroughly with soap &
water before insertion or removal of awater before insertion or removal of a
diaphragm or cervical capdiaphragm or cervical cap
Do not use diaphragm or a cervical capDo not use diaphragm or a cervical cap
during your menstrual periodduring your menstrual period
Do not leave the diaphragm in placeDo not leave the diaphragm in place
longer than 24 hourslonger than 24 hours

47. Be aware of the symptoms of TSS, suchBe aware of the symptoms of TSS, such
as elevated temperature, diarrhea,as elevated temperature, diarrhea,
vomiting, muscle aches and a sunburn-vomiting, muscle aches and a sunburn-
like rash.like rash.
If symptoms of TSS should occur,If symptoms of TSS should occur,
immediately remove the diaphragm &immediately remove the diaphragm &
telephone your health care providertelephone your health care provider

48. D. CERVICAL CAPSD. CERVICAL CAPS
Made of soft rubber, shaped like aMade of soft rubber, shaped like a
thimble, and fit snugly over the uterinethimble, and fit snugly over the uterine
cervixcervix
Failure rate as high as 32%Failure rate as high as 32%
Readily dislodgedReadily dislodged
Contraindicated to:Contraindicated to:

An abnormally short or long cervixAn abnormally short or long cervix

A previous abnormal Pap smearA previous abnormal Pap smear

A history of TSSA history of TSS

49. An allergy to latex or spermicideAn allergy to latex or spermicide
A history of PID, cervicitis, or papillomaA history of PID, cervicitis, or papilloma
virus infectionvirus infection
A history of cervical cancerA history of cervical cancer
Undiagnosed vaginal bleedingUndiagnosed vaginal bleeding

50. Cervical capCervical cap
Oves brand cervical cap
Position of cervical cap

51. E. Vaginally Inserted
Spermicidal Products
Cause death to spermatozoa before theyCause death to spermatozoa before they
enter the cervixenter the cervix
Also change the vaginal pH to a strongAlso change the vaginal pH to a strong
acid level (not conducive to sperm survival)acid level (not conducive to sperm survival)
Purchased w/o prescriptionPurchased w/o prescription
Increase other methods effectivenessIncrease other methods effectiveness

52. Available in various preparations: gels,Available in various preparations: gels,
creams, sponges, films, foams &creams, sponges, films, foams &
suppositoriessuppositories
How to use:How to use:

Gels or creams are inserted into theGels or creams are inserted into the
vagina before coitus with anvagina before coitus with an
applicator.applicator.

53. 
To be effective: must be 1 hrTo be effective: must be 1 hr
before coitus, should not douchebefore coitus, should not douche
for 6 hrs after, to ensure that thefor 6 hrs after, to ensure that the
agent has completed itsagent has completed its
spermicidal action.spermicidal action.

Contraindicated: with acuteContraindicated: with acute
cervicitis, and inconveniencycervicitis, and inconveniency

Adolescent usually uses: noAdolescent usually uses: no
parental permission or extensiveparental permission or extensive
expenseexpense

54. ORALORAL
CONTRACEPTIONCONTRACEPTION
The Pill or COCs (combined oralThe Pill or COCs (combined oral
contraceptives)contraceptives)
With varying amounts of synthetic estrogenWith varying amounts of synthetic estrogen
combined with a small amount of syntheticcombined with a small amount of synthetic
progesterone (progestin)progesterone (progestin)
Estrogen – acts on FSH and LH thusEstrogen – acts on FSH and LH thus
suppresses ovulationsuppresses ovulation

55. Progesterone – cause a decrease in theProgesterone – cause a decrease in the
permeability of cervical mucus therebypermeability of cervical mucus thereby
limiting sperm motility and access tolimiting sperm motility and access to
ova.ova.

Also interferes with tubal transport andAlso interferes with tubal transport and
endometrial proliferationendometrial proliferation..

57. The pillThe pill

58. 3 types:3 types:

Monophasic:Monophasic:
fixed dosesfixed doses of both estrogen andof both estrogen and
progesterone throughout 21 day cycleprogesterone throughout 21 day cycle

Biphasic:Biphasic:
constant amount of estrogen throughoutconstant amount of estrogen throughout
cycle BUT increased amount of progestincycle BUT increased amount of progestin
during the last 11 daysduring the last 11 days..

59. 
Triphasic:Triphasic:
Varies level of estrogen and progesterone.Varies level of estrogen and progesterone.
Closely mimic natural cycle, reducingClosely mimic natural cycle, reducing
breakthrough bleeding (bleeding outsidebreakthrough bleeding (bleeding outside
the normal menstrual flow)the normal menstrual flow)

60. COCs must be prescribed by physicianCOCs must be prescribed by physician
after pelvic examination and aafter pelvic examination and a
Papanicolaou (Pap) smear.Papanicolaou (Pap) smear.
Packed 21 or 28 pills to a containerPacked 21 or 28 pills to a container

28 pills ( 21 active pills/7 placebo pills)28 pills ( 21 active pills/7 placebo pills)
Used correctly: 99.7% effectiveUsed correctly: 99.7% effective
Typical failure rate: 8%Typical failure rate: 8%

61. Contraindications to OralContraindications to Oral
Contraceptive UseContraceptive Use
Breast-feeding & less than 6 weeksBreast-feeding & less than 6 weeks
postpartumpostpartum
Age 35 years or older & smoking 15 orAge 35 years or older & smoking 15 or
more cigarettes per daymore cigarettes per day
Multiple risk factors for arterialMultiple risk factors for arterial
cardiovascular disease, such as oldercardiovascular disease, such as older
age, smoking, diabetes, hypertensionage, smoking, diabetes, hypertension

62. StrokeStroke
Complicated valvular heart diseaseComplicated valvular heart disease
Migraine with focal neurologic symptomsMigraine with focal neurologic symptoms
Migraine w/o focal neurologic symptomsMigraine w/o focal neurologic symptoms
and age 35 years or olderand age 35 years or older
Breast cancerBreast cancer
NeuropathyNeuropathy
Liver cirrhosisLiver cirrhosis

63. Vaginal RingsVaginal Rings
A silicone ring that surrounds the cervixA silicone ring that surrounds the cervix
& continuously release a combination of& continuously release a combination of
estrogen & progesteroneestrogen & progesterone
Hormones are absorbed directly by theHormones are absorbed directly by the
mucous membrane of vagina, avoiding amucous membrane of vagina, avoiding a
“first-pass” through liver (as happens“first-pass” through liver (as happens
with COCs)with COCs)
Also approved in 2001 by USA FDAAlso approved in 2001 by USA FDA

64. Ring is inserted by the woman and leftRing is inserted by the woman and left
in place for 3 weeks, then remove for 1in place for 3 weeks, then remove for 1
week. Menstrual bleeding occurs duringweek. Menstrual bleeding occurs during
ring-free week.ring-free week.
Efficiency is 99.7%Efficiency is 99.7%

65. Emergency PostCoitalEmergency PostCoital
ContraceptionContraception
““morning-after pills”morning-after pills”
With high level of estrogen interferingWith high level of estrogen interfering
with progesterone production,with progesterone production,
prohibiting good implantationprohibiting good implantation
Eg. Yuzpe Regimen (Preven) – speciallyEg. Yuzpe Regimen (Preven) – specially
designed particularly after a sexualdesigned particularly after a sexual
assault has occurredassault has occurred
Effectiveness: between 75% & 85%Effectiveness: between 75% & 85%

66. SubcutaneousSubcutaneous
ImplantsImplants
Norplant is a contraceptive method 6 non-Norplant is a contraceptive method 6 non-
biodegradable Silastic Implantsbiodegradable Silastic Implants
Plastic, flexible rods are implanted underPlastic, flexible rods are implanted under
the skin of a woman's upper arm. Rodsthe skin of a woman's upper arm. Rods
contain a synthetic progesterone hormone,contain a synthetic progesterone hormone,
released in small doses continuously over areleased in small doses continuously over a
5 year period.5 year period.

67. Prevents pregnancy by: inhibitingPrevents pregnancy by: inhibiting
ovulation, cervical mucus becomesovulation, cervical mucus becomes
thicker & harder to be penetrated bythicker & harder to be penetrated by
sperm, & making the lining of the uterussperm, & making the lining of the uterus
unreceptive to a fertilized egg.unreceptive to a fertilized egg.
Disadvantage: Expensive (ave. $500-Disadvantage: Expensive (ave. $500-
$750)$750)

68. Advantage: long-term, reversible,Advantage: long-term, reversible,
effective & reliable alternative to COCs &effective & reliable alternative to COCs &
their estrogen-related side effectstheir estrogen-related side effects

Sexual enjoyment not inhibited as withSexual enjoyment not inhibited as with
condoms, spermicides, diaphragms & naturalcondoms, spermicides, diaphragms & natural
family planning methodsfamily planning methods

Can be used during breast-feedingCan be used during breast-feeding

Can be safely used in adolescentsCan be safely used in adolescents
Rare complication: infection at insertionRare complication: infection at insertion
sitesite

69. Potential side effects:Potential side effects:

Weight gainWeight gain

Irregular menstrual cycle (e.g., spotting,Irregular menstrual cycle (e.g., spotting,
breakthrough bleeding, amenorrhea,breakthrough bleeding, amenorrhea,
prolonged periods)prolonged periods)

Hair lossHair loss

DepressionDepression

Scarring at insertion siteScarring at insertion site

Need for removalNeed for removal

70. NorplantNorplant

71. IntramuscularIntramuscular
InjectionsInjections
Single injection ofSingle injection of
medroxyprogesterone acetate (Depo-medroxyprogesterone acetate (Depo-
Provera) – every 12 weeksProvera) – every 12 weeks
Lunelle (a synthetic estrogen &Lunelle (a synthetic estrogen &
progesterone) – every 30 daysprogesterone) – every 30 days
They inhibit ovulation, alter theThey inhibit ovulation, alter the
endometrium, & change cervical mucusendometrium, & change cervical mucus
100% effective, can be used during100% effective, can be used during
breast feedingbreast feeding

72. Long-term reliability w/o many sideLong-term reliability w/o many side
effects, no visible sign that birth controleffects, no visible sign that birth control
measure is being usedmeasure is being used
Possible side effects: irregular menstrualPossible side effects: irregular menstrual
cycle, headache, weight gain, depressioncycle, headache, weight gain, depression
Risk for osteoporosis: so, includeRisk for osteoporosis: so, include
adequate amount of Ca in diet (up to 1200adequate amount of Ca in diet (up to 1200
mg/day), engage in weight bearingmg/day), engage in weight bearing
exercise dailyexercise daily

73. INTRAUTERINE
DEVICES
A small plastic object inserted into theA small plastic object inserted into the
uterus through the vaginauterus through the vagina
1980’s very popular in US but decrease1980’s very popular in US but decrease
due to lawsuits with increase incidencedue to lawsuits with increase incidence
of PID (infection of the pelvic organ)of PID (infection of the pelvic organ)
IUD prevent fertilization by creating aIUD prevent fertilization by creating a
local sterile inflammatory condition thatlocal sterile inflammatory condition that
prevents implantationprevents implantation

74. Fitted by a physician, nurse, midwifeFitted by a physician, nurse, midwife
(ambulatory setting)(ambulatory setting)
Inserted after menstrual flow or afterInserted after menstrual flow or after
childbirthchildbirth
3 common types of IUD (US)3 common types of IUD (US)

Copper T380(ParaGard)Copper T380(ParaGard)

T-shaped plastic device wound with copperT-shaped plastic device wound with copper

Progestasert & MirenaProgestasert & Mirena

75. Advantages: only one insertion, does notAdvantages: only one insertion, does not
require daily attention, does notrequire daily attention, does not
interfere with sexual enjoymentinterfere with sexual enjoyment
Check: IUD string is in place & yearlyCheck: IUD string is in place & yearly
pelvic exampelvic exam
Contraindications:Contraindications:

Has or history of PIDHas or history of PID

Risk for Toxic Shock Syndrome (TSS; aRisk for Toxic Shock Syndrome (TSS; a
staphylococcal infection from the use ofstaphylococcal infection from the use of
tampons)tampons)

76. 
Multiple sexual partners: risk for STIsMultiple sexual partners: risk for STIs

Never been pregnantNever been pregnant

Uterus distorted in shapeUterus distorted in shape

Severe dysmenorrhea, menorrhagia, historySevere dysmenorrhea, menorrhagia, history
of ectopic pregnancyof ectopic pregnancy

Valvular heart diseaseValvular heart disease

AnemiaAnemia

77. SURGICAL METHODS
Includes sterilization:Includes sterilization:

Tubal sterilization – womenTubal sterilization – women

Vasectomy – menVasectomy – men
Preferred method: most effective, noPreferred method: most effective, no
effect on sexualityeffect on sexuality
Chosen with great thought and care andChosen with great thought and care and
should be considered permanentshould be considered permanent

78. MALE & FEMALEMALE & FEMALE

79. VASECTOMY
Small incision made on each side of theSmall incision made on each side of the
scrotum. Vas deferens is then cut &scrotum. Vas deferens is then cut &
tied, cauterized, or plugged, blockingtied, cauterized, or plugged, blocking
the passage of spermatozoathe passage of spermatozoa
Ambulatory, under local anesthesiaAmbulatory, under local anesthesia
99.5% effective99.5% effective

80. procedureprocedure

81. Does not interfere with production of sperm,Does not interfere with production of sperm,
does not pass beyond severed vas deferens anddoes not pass beyond severed vas deferens and
absorbed at that point. (seminal fluid continuesabsorbed at that point. (seminal fluid continues
but w/o sperm)but w/o sperm)
Advantages:Advantages:

Very effective 3 months after the procedureVery effective 3 months after the procedure

Permanent, safe, simple & easy to performPermanent, safe, simple & easy to perform

Can be performed in a clinic, office or at aCan be performed in a clinic, office or at a
primary care centerprimary care center

82. 
No re supplies or repeated clinic visitsNo re supplies or repeated clinic visits

No apparent long term risksNo apparent long term risks

An option for couples whose femaleAn option for couples whose female
partner could not undergo permanentpartner could not undergo permanent
contraceptioncontraception

A man who had vasectomy will not loseA man who had vasectomy will not lose
his sexual ability and ejaculationhis sexual ability and ejaculation

Does not affect male hormonal functionDoes not affect male hormonal function

83. Disadvantages:Disadvantages:

Slightly uncomfortable due to slight pain &Slightly uncomfortable due to slight pain &
swelling 2-3 days after procedureswelling 2-3 days after procedure

Reversibility is difficult and expensiveReversibility is difficult and expensive

Bleeding may result in hematoma in theBleeding may result in hematoma in the
scrotumscrotum

May be associated with urolithiasisMay be associated with urolithiasis
developmentdevelopment

A few men develop chronic pain afterA few men develop chronic pain after
vasectomy (postvasectomy pain syndrome)vasectomy (postvasectomy pain syndrome)

84. TUBAL LIGATION
Fallopian tubes are occluded by cautery,Fallopian tubes are occluded by cautery,
crushing, clamping, or blocking &crushing, clamping, or blocking &
thereby preventing passage of boththereby preventing passage of both
sperm and ovasperm and ova
99.5% effective99.5% effective
Operation performed:Operation performed:

Laparoscopy – using a lighted laparoscopeLaparoscopy – using a lighted laparoscope

Culdoscopy - a tube inserted through theCuldoscopy - a tube inserted through the
posterior fornix of the vaginaposterior fornix of the vagina

Colpotomy – incision through the vaginaColpotomy – incision through the vagina

85. TUBAL LIGATIONTUBAL LIGATION

86. LaparoscopyLaparoscopy

A small as 1 cm is made just under theA small as 1 cm is made just under the
woman’s umbilicus (under general or localwoman’s umbilicus (under general or local
anesthesia)anesthesia)

A lighted laparoscope in inserted throughA lighted laparoscope in inserted through
the incision.the incision.

Carbon dioxide is then pumped into theCarbon dioxide is then pumped into the
incision to lift the abdominal wall upwardincision to lift the abdominal wall upward
and out of the line of vision.and out of the line of vision.

87. 
The fallopian tube is located throughThe fallopian tube is located through
laparoscope & an electrical current tolaparoscope & an electrical current to
coagulate tissue is then passed throughcoagulate tissue is then passed through
the instrument for 3 to 5 seconds.the instrument for 3 to 5 seconds.

Or the tubes are clamped & cut, or filledOr the tubes are clamped & cut, or filled
with a silicone gel to seal themwith a silicone gel to seal them

Can be done as soon as 4 to 6 hours after theCan be done as soon as 4 to 6 hours after the
birth of a baby or after an abortionbirth of a baby or after an abortion

88. * Woman may return to having coitus 2 to* Woman may return to having coitus 2 to
3 days after procedure3 days after procedure
Does not affect menstrual flow (unlikeDoes not affect menstrual flow (unlike
hysterectomy: removal of the uterus orhysterectomy: removal of the uterus or
ovaries)ovaries)
Complications: bowel perforation,Complications: bowel perforation,
hemorrhage, & the risk of generalhemorrhage, & the risk of general
anesthesia after the procedureanesthesia after the procedure

89. FUTURE TRENDS
IN CONTRACEPTION
Lower-dose of estrogen pillsLower-dose of estrogen pills
Male pillMale pill
Progesterone-implanted diaphragm andProgesterone-implanted diaphragm and
biodegradable implants that do not havebiodegradable implants that do not have
to be removedto be removed

90. Permanently implanted progesterone-Permanently implanted progesterone-
filled vaginal ringfilled vaginal ring
Birth Control VaccineBirth Control Vaccine

consist of antibodies against Humanconsist of antibodies against Human
Chorionic Gonadotropin Hormone &Chorionic Gonadotropin Hormone &
injections of testosterone for males (haltsinjections of testosterone for males (halts
sperm production, just as estrogen haltssperm production, just as estrogen halts
ova production in female)Birth Controlova production in female)Birth Control
VaccineVaccine