This power point gives a brief overview of family planning methods

1. UNIT FOUR
FAMILY PLANNING
1

2. Session Objectives
2
At the end of this session, the students will be able to:
Define family planning
Discuss principles of Family Planning
Describe Rationale for family Planning
Discuss types of family planning methods

3. Contents
3
 Definition & concepts of family planning
 Principles of Family Planning
 Rationale for family Planning
 Types of family planning methods

4. Concepts of family planning
4
 Family is any combination of two or more persons who are
bound together over time by ties of mutual consent, birth
and/or adoption or placement and who, together, assume
responsibilities for variant combinations of some of the
following:
Physical maintenance and care of group members
Addition of new members through procreation or adoption
Socialization of children
Social control of members
Production, consumption, distribution of goods and
services, and

5. Concepts…
5
 Family planning refers to the use of various methods of fertility
control that will help individuals or couples to have the number
of children they want when they want them in order to assure the
well being of children and the parents.

6. Concepts…
6
Concepts in the definition:
 Prevent unwanted pregnancy & have when needed
 Deciding on number of children one wants to have
 Child spacing/deciding the interval b/n consecutive birth
 Analyzing the number of children they desire to have with
their economic capacity
 Plan to give birth

7. Concepts…
7
Family planning enables individuals and couples to determine the
number and spacing of their children
 a recognized basic human right.
 Practical benefits are gained at many levels:
 To individuals: improved maternal and infant health; expanded
opportunities for women’s education, employment and social
participation; reduced exposure to health risks; and reduced
recourse to abortion

8. Concepts…
8
 To families: reduced competition and dilution of resources;
reductions in household poverty; and more possibility for shared
decision-making.
 To the society: accelerated demographic transition; and the
opportunity to use the “demographic bonus” to speed economic
development.

9. Principles of family planning
9
In most of the countries, approach to family planning
activities are based on the following guiding
principles:
Individuals should decide freely the number and
spacing of their children
Individuals/couples have the right to information &
means to exercise this choice.
Women and men should have access to the widest
possible range of safe and effective family planning
methods and should participate fully in defining the
family planning services they need.
Family planning programs should cater for all people
who may be sexually active.

10. Principles…
10
Improving the quality of care in family planning
programs through:
►Involving communities in planning programs appropriate to
their needs
►Increasing the choice of family planning methods available
►Improving the skills and competence of family planning
service providers
►Providing accurate information and confidential counselling
for clients
►Providing follow-up advice and services to clients
►Ensuring affordable, acceptable and accessible services.

11. Rationale for family planning
11
 Demographic rationale
 Health rationale
 Human rights rationale

12. Demographic rationale
12
 The main intention of FP during (1960s-1970s)
 Reducing high fertility rates and slowing population
growth rate
 High fertility and rapid population growth has negative
effect on:
 Standards of living & human welfare
 Economic productivity
 Natural resources
 Environment

13. Health rationale
13
 Emphasized in 1980s
 Family planning reduces the consequences
of high fertility on mothers and children
 High number of pregnancy
 Births to young or old mothers
 Unintended pregnancy
 Closely spaced births causes high infant
and child morbidity & mortality

14. Health rationale…
14
 Maternal mortality rates decreases by effective FP services.
 Family planning could reduce maternal mortality by 20%
or more
 Family planning helps women to protect them selves from
unwanted pregnancies and its effects.
 Abortion
 FP serves children’s life by helping women space births.
 The occurrence of low birth weight, infant malnutrition
and mortality rates will be reduced.
 Birth intervals of at least 3 years reduce infant mortality
by up to 50%

15. Health rationale…
15
 Empower couples to determine their family size and
delay having a child.
 This improves family well being as couples with
fewer children are better able to provide them with
enough food, clothing, housing and schooling.

16. Health rationale…
16
 It can also be used because of various health conditions of
the mother related to pregnancy
 If the woman is at risk of endangering her health, she should
be advised to employ a method of family planning to prevent
any chance of pregnancy.
 The incidence and prevalence of STIs including HIV/AIDS
is reduced

17. Human rights rationale
17
 Emphasized in 1990s (ICPD)
 This rests on the belief that individuals and couples
have a right to control reproductive decisions
including family size and timing of birth.

18. Family planning methods
 It Can be classified as:
 Traditional/natural Vs Modern methods
 Short acting, long-acting and permanent methods
 Behavioral, Barrier, Hormonal and Surgical methods
 Male method Vs Female methods
18

19. 19

20. FP methods…
 Many of the earliest methods of family planning
were based on sexual behaviour and are still used
by millions of women and men around the world.
 Abstinence
 many people (couples) may not find it
acceptable to go without sex
 Mutual pleasuring without intercourse
 outer-course/masturbation
20

21. Fertility awareness…
 "Fertility awareness" means that a woman knows how to
tell when the fertile time of her menstrual cycle starts and
ends. (The fertile time is when she can become pregnant.)
 These methods are:
1. Calendar-based methods;
 Standard Days Method and
 calendar rhythm method
21

22. Fertility awareness…
2. Symptoms-based methods;
 Two Day Method,
 BBT method,
 ovulation method (also known as Billings method or
cervical mucus method), and
 the symptothermal method(basal body temperature
+ cervical secretions + other fertility signs)
22

23. Effectiveness
23
Effectiveness depends on the
user: Risk of pregnancy is
greatest when couples have sex
on the fertile days without using
another method

24. Advantages of fertility awareness…
• Have no side effects
• Do not require procedures and usually do not require
supplies
• Help women learn about their bodies and fertility
• Allow some couples to adhere to their religious or cultural
norms about contraception
• Can be used to identify fertile days by both women who
want to become pregnant and women who want to avoid
pregnancy
24

25. Fertility awareness method at Glance
 Fertility awareness methods require partners'
cooperation
 Couple must be committed to abstaining or
using another method on fertile days.
 Must stay aware of body changes or keep track
of days, according to rules of the specific
method
 No side effects or health risks.
25

26. Standard Days method (SDM)
 Identifies days 8 - 19 of the cycle as fertile
 Is for women with menstrual cycles b/n 26
and 32 days
 Helps a couple to avoid unprotected
intercourse
 A client can use a color - coded string of
beads to help her keep track of where she
is in her cycle and know when she is fertile
26

27. 27

28. Calendar Rhythm Method
 First, a woman records the number of days in each
menstrual cycle for at least 6 months
 The first day of monthly bleeding is always counted as day 1
 Subtract 18 from her length of shortest recorded day and 11
from the longest cycle to get estimated first & last day of
fertile time.
 She updates these calculations each month, always using
the 6 most recent cycles
28

29. E.g. Of calendar…
 Shortest of her 6
cycles is 27 days
 Longest of her 6
cycle is 31 days
 When should she
avoid
unprotected sex?
29

30. Two Day Method
 Relies on a simple algorithm to help women identify when
they are fertile based upon the presence or absence of
cervical secretions.
30

31. The Two Day algorithm
31

32. Two Day Method
 Cervical secretions today or yesterday indicate fertile days
when unprotected sex should be avoided.
 The two Day Method is appropriate for women with cycles of
any length.
 Couples who can use the Two Day Method successfully are
those who can avoid unprotected sex for about 10-15 days per
cycle.
32

33. Basal Body Temperature (BBT) Method
 The woman takes her body temperature at the same
time each morning before she gets out of bed and
before she eats anything
 She records her temperature on a special graph.
 She watches for her temperature to rise slightly—0.2°
to 0.5° C (0.4° to 1.0° F)—just after ovulation (usually
about midway through the menstrual cycle)
33

34. BBT…
 Avoid sex or use another method from the first day of
monthly bleeding until 3 days after the woman's
temperature has risen above her regular temperature
 The couple can have unprotected sex on the 4th day
and until her next monthly bleeding begins
 NB: If a woman has a fever or other changes in body
temperature, the BBT method will be difficult to use
34

35. Ovulation Method
 The woman checks every day for any cervical secretions on
fingers, underwear,…
 As soon as she notices any secretions, she considers herself
fertile and avoids unprotected sex
 The couple can have unprotected sex on the 4th day after
her peak day and until her next monthly bleeding begins
 Important: If a woman has a vaginal infection or another
condition that changes cervical mucus, this method may
be difficult to use
35

36. Withdrawal (coitus interruptus & "pulling out")
 Applied when the man withdraws his penis from his partner's
vagina and ejaculates outside the vagina, keeping his semen away
from her external genitalia
 Always available in every situation
 Can be used as a primary method or as a backup method
 Requires no supplies and no clinic or pharmacy visit.
 One of the least effective contraceptive methods
 Some men use this method effectively, however. Offers better pregnancy
protection than no method at all
 Promotes male involvement and couple communication
 If used correctly, about 4 pregnancies per 100 women 36

37. Lactational Amenorrhea Method (LAM)
 LAM requires 3 conditions and All 3 must be met:
 The mother's monthly bleeding has not returned
 The baby is fully or nearly fully breastfed and is fed
often, day and night
 The baby is less than 6 months old
 More than 98% effective
37

38. Advantage of LAM
 Universally available
 At least 98% effective
 Begins immediately postpartum
 Health benefits for mother and infant
 Bridge to other contraceptives
 Builds on established cultural and religious
practices
 Improves breastfeeding and weaning patterns
38

39. Disadvantages of LAM
 Breastfeeding pattern may be
difficult to maintain
 No STI or HIV protection
 Duration of method limited
 Only useful for fully or nearly
fully breastfeeding women
39

40. Oral Contraceptives: Types of the Pills
40
Oral
Contraceptives
(Ocs)
Combined Oral
Contraceptive Pills
(COCs)
contain estrogen and
progestin
• most widely used pills
• low-dose most
common
Progestin -Only Pills
(POPs)
• contain no estrogen
• especially useful during
breastfeeding

41. A. Combined Oral Contraceptives
 COCs are also called “the Pill,” low-dose combined
pills, OCPs, and OCs
 Experiments on OCP were tried around 1950s
 In 1956, the journal Science announced the success of
Rock’s clinical trials pills
 Pills that contain low doses of 2 hormones—a
progestin and an estrogen—like the natural hormones
progesterone and estrogen in a woman's body
41

42. COCs…
 OCPs have three other main effects:
1) they change the consistency of fallopian tube thereby
either slowing or speeding up the travel of the egg and/or
sperm up or down its path;
2) they thin the lining of the uterus-depleting it in glycogen
and decreasing its thickness making it extremely difficult
for the unborn child to implant if a woman did conceive
while taking the pill and;
3) they serve to thicken the cervical mucus, thereby making
it more difficult for the sperm to travel up through the Cx.
42

43. Effectiveness
 depends on the user: Risk of pregnancy is greatest
when a woman starts a new pill pack 3 or more days
late, or misses 3 or more pills near the beginning or
end of a pill pack
 8 pregnancies per 100 women using COCs
 When no pill-taking mistakes are made, less than 1
pregnancy per 100 women
43

44. Reason why some Users prefer
 Are controlled by the woman
 Can be stopped at any time without a provider's help
 Do not interfere with sex
44

45. Known Health Benefits
Help protect against:
 Risks of pregnancy
 Cancer of the lining of the uterus (endometrial cancer)
, Cancer of the ovary
 Symptomatic pelvic inflammatory disease
May help protect against:
 Ovarian cysts
 Iron-deficiency anemia
45

46. Health benefits…
Reduce:
 Menstrual cramps
 Menstrual bleeding problems
 Ovulation pain
 Excess hair on face or body
 Symptoms of polycystic ovarian syndrome (irregular
bleeding, acne, excess hair on face or body)
 Symptoms of endometriosis (pelvic pain, irregular
bleeding)
46

47. Commonly reported Side effects
 Changes in bleeding patterns including:
 Lighter bleeding and fewer days of bleeding
 Irregular bleeding
 Infrequent bleeding
 No monthly bleeding
 Headaches , Dizziness, Nausea
 Breast tenderness
 Weight & Mood change
 Acne (can improve or worsen, but usually improves) 47

48. Existing kind of pack—21 pills or 28 pills
21 pills 28 pills (7 non hormonal)
48

49. COCs…
 A woman can start using COCs any time she wants if it is
reasonably certain she is not pregnant
 Two kind of pack—21 pills or 28 pills
 Give as many packs as possible—even as much as a year’s
supply (13 packs)
 Return to pregnancy after stopping use is immediate
49

50. COCs…
 Missed pills
 The key message is “Take a missed hormonal pill
as soon as possible”
 Using backup methods
 Risk of pregnancy varies on the number of days
without pills, period of missed pills and sex
during that time
50

51. Key Points for Providers and Clients (COCs)
 Take one pill every day. For greatest effectiveness a woman
must take pills daily and start each new pack of pills on time.
 Bleeding changes are common but not harmful. Typically,
irregular bleeding for the first few months and then lighter and
more regular bleeding.
 Take any missed pill as soon as possible. Missing pills
risks pregnancy and may make some side effects worse.
 Can be given to women at any time to start later. If
pregnancy cannot be ruled out, a provider can give her pills
to take later, when her monthly bleeding begins.
51

52. B. Progestin-Only Pills
 Commonly known as POPs, “minipills” and progestin-
only oral contraceptives
 contain very low doses of a progestin/do not contain
estrogen
 Safe for breastfeeding women and who cannot use
methods with estrogen
 Act by;
 thickening cervical mucus
 Disrupting the menstrual cycle
52

53. Effectiveness
For breastfeeding women
 1 pregnancy in 100 women
for women not breastfeeding;
 Less effective (3 to 10 pregnancy per 100 POP)
 If taken on daily basis, less than 1 in 100 women
Concern: Can be used while breastfeeding
Can be used as ECPs (not more than 5 days after
unprotected sex).
53

54. How to take
 Packs: 28 pills or 35 pills
 Take one pill each day—until
the pack is empty
 backup method
 Cues for taking PILLS
54

55. Emergency Contraceptive Pills
 Additional names "morning after" pills or
postcoital contraceptives
 Can prevent pregnancy when taken any time
up to 5 days after unprotected sex
• ECPs cannot interrupt an established
pregnancy
55

56. What Pills Can Be Used as ECPs?
 A special ECP product with estrogen and
levonorgestrel
 POP with levonorgestrel or norgestrel
 COC with estrogen and a progestin—levonorgestrel,
norgestrel, or norethindrone (also called
norethisterone)
56

57. The Effectiveness
 Progestin-only OC’s – levonorgestrel - only, in
preferred regimen one dose of 1.5 mg or 2 doses of
0.75mg, 12 hrs apart
→88% reduction in risk (1/100 will get pregnant)
 Combined OCs: 2 doses of pills containing ethinyl
estradiol (100 mcg) and levonorgestrel (0.5 mg)
taken 12 hrs apart
→75% reduction in risk (2/100 will get pregnant)
57

58. 58

59. Who is medically eligible?
 All women can use ECPs safely and effectively,
including women who cannot use ongoing hormonal
contraceptive methods.
 Because of the short-term nature of their use, there are
no medical conditions that make ECPs unsafe for any
woman.
59

60. Recommend ECPs if:
 Sex was forced (rape) or coerced
 Any unprotected sex
 Contraceptive mistakes;
 Condom was used incorrectly, slipped, or broke
 Couple incorrectly used a fertility awareness method
 Man failed to withdraw, as intended, before he ejaculated
 Woman has missed 3 or more combined oral contraceptive pills or
has started a new pack 3 or more days late
 IUD has come out of place
 Woman is more than 2 weeks late for her repeat progestin-only
injection or more than 7 days late for her repeat monthly injection
60

61. Have to Know
 Emergency contraceptive pills help to prevent
pregnancy when taken up to 5 days after unprotected
sex. The sooner they are taken, the better.
 Do not disrupt an existing pregnancy.
 Safe for all women—even women who cannot use ongoing
hormonal contraceptive methods.
 Provide an opportunity for women to start using an
ongoing family planning method.
 Many options can be used as emergency contraceptive
pills. Dedicated products, progestin-only pills, and combined
oral contraceptives all can act as emergency contraceptives.
61

62. Progestin-Only Injectables
 The injectable contraceptives depot medroxyprogesterone acetate
(DMPA) and norethisterone enanthate (NET-EN) each contain a
progestin like the natural hormone progesterone in a woman's
body
 so can be used throughout breastfeeding and by women who
cannot use methods with estrogen
 DMPA, the most widely used progestin-only injectable, ("the
shot," "the jab," the injection, Depo, Depo-Provera, Megestron, and
Petogen)
 NET-EN is also known as norethindrone enanthate, Noristerat,
and Syngestal 62

63. How do they act?
 Work primarily by preventing the release of eggs from the
ovaries (ovulation)
 Given by injection into the muscle (intramuscular
injection), the hormone is then released slowly into the
bloodstream
 A different formulation of DMPA (the New DMPA)can be
injected just under the skin (subcutaneous injection)
63

64. How Effective?
 Depends on getting injections regularly
 ,less than 1 pregnancy per 100 women
 As commonly used, about 3 pregnancies per 100
women using progestin-only injectables over the
first year
 Return of fertility after injections are stopped:
 An average of about 4 months longer for DMPA and
 1 month longer for NET-EN than with most other
methods
64

65. From Users Report
With the use of DMPA
 First 3 months:
 Irregular bleeding
 Prolonged bleeding
 At one year:
 No monthly bleeding
 Infrequent bleeding
 Irregular bleeding
 NET-EN affects bleeding patterns less than DMPA
 Abdominal bloating and discomfort , Wt gain, loss of bone density,
dizziness, headache, low sex drive, mood change
65

66. Why Some Women Say They Like Progestin-Only
Injectables
 Do not require daily action
 Do not interfere with sex
 Are private: No one else can tell that a woman is using
contraception
 Cause no monthly bleeding (for many women)
 May help women to gain weight
66

67. Key Points for Providers and Clients
 Bleeding changes are common but not harmful. Typically,
irregular bleeding for the first several months and then no
monthly bleeding.
 Return for injections regularly. Coming back every 3
months (13 weeks) for DMPA or every 2 months for NET-EN is
important for greatest effectiveness.
 Injection can be as much as 4 weeks late for DMPA or 2
weeks late for NET-EN. Client should come back even if
later.
 Gradual weight gain is common.
 Return of fertility is often delayed. It takes several months
longer on average to become pregnant after stopping
progestin-only injectables than after other methods.
67

68. Monthly Injectables
 contain 2 hormones—a progestin and an estrogen
 Also called CICs, the injection
 Return of fertility after injections are stopped: An
average of about one month longer than with most
other methods
 Are good for spacing births
 Planning the Next Injection (+/- 7 days)
68

69. Combined Patch
 A small, thin, square of
flexible plastic worn on the
body
 Continuously releases 2
hormones—a progestin and an
estrogen directly through the
skin into the bloodstream
 Also called Ortho Evra and
Evra.
69

70. Combined Patch…
 A new patch is worn every week for 3 weeks, then no patch for
the fourth week. During this fourth week the woman will have
monthly bleeding.
 Selecting "patch-change day."
 Works primarily by preventing the release of eggs from the
ovaries (ovulation). 70

71. Combined Vaginal Ring
 Continuously releases progestin and an
estrogen through the wall of the vagina
directly into the bloodstream
 Requires keeping a flexible ring in the
vagina. It is kept in place all the time,
every day and night for 3 weeks, followed
by a week with no ring in place.
 Start each new ring on time for greatest
effectiveness
71

72. Vaginal Ring…
 Researches on vaginal ring is minimal to
confidently talk about the effectiveness and Health
benefits, side effects and the likes
 Tell the woman how to use it
72

73. Implants
 Implants are small plastic rods or capsules, each about
the size of a matchstick, that release a progestin like
the natural hormone progesterone in a woman's body
 Do not contain estrogen
 Therefore, preferred during BF
73

74. Implants
 Many types of implants:
 Jadelle: 2 rods, effective for 5 years
 Implanon: 1 rod, effective for 3 years (studies are
underway to see if it lasts 4 years)
 Norplant: 6 capsules, labeled for 5 years of use
(large studies have found it is effective for 7 yrs)
 Sinoplant: 2 rods, effective for 5 years
 One of the most effective and long-lasting methods and
the effectiveness increases through out the year of stay 74

75. 75

76. Implants
 Implanon users are more likely to have infrequent or
no monthly bleeding than irregular bleeding lasting
more than 8 days
 Complications
 Infection at insertion site
 Difficult removal
 Expulsion of implant (Rare)
 Therefore, need for training
76

77. Implants at a Glance
 Implants are small flexible rods or capsules that are
placed just under the skin of the upper arm.
 Provide long-term pregnancy protection. Very effective for
3 to 7 years, depending on the type of implant, immediately
reversible.
 Require specifically trained provider to insert and
remove. A woman cannot start or stop implants on her own.
 Little required of the client once implants are in place.
 Bleeding changes are common but not harmful. Typically,
prolonged irregular bleeding over the first year, and then
lighter, more regular bleeding or infrequent bleeding.
77

78. Copper-Bearing Intrauterine Device
 Almost all types of IUDs have one or two strings, or
threads, tied to them
 The strings hang through the cervix into the vagina
• Studies have found that the TCu-380A is effective for
12 years though labeled for up to 10 years of use
• Effectiveness: Over 10 years of IUD use: About 2
pregnancies per 100 women
78

79. 79

80. IUD-Cu…
Side Effects
 Changes in bleeding patterns (especially in the first 3 to 6
months) including:
 Prolonged and heavy monthly bleeding
 Irregular bleeding
 More cramps and pain during monthly bleeding
Complications (Rare)
 Puncturing (perforation).
 Miscarriage, preterm birth, or infection in the rare case that
the woman becomes pregnant with the IUD in place 80

81. IUD-Cu…
Known Health Risks
 Pelvic inflammatory
disease (PID)=rare
 Anemia: because of
heavy monthly bleeding
81

82. Key Points for Providers and Clients
 Long-term pregnancy protection. Shown to be very
effective for 12 years, immediately reversible.
 Inserted into the uterus by a specifically trained
provider.
 Little required of the client once the IUD is in place.
 Bleeding changes are common. Typically, longer and
heavier bleeding and more cramps or pain during monthly
bleeding, especially in the first 3 to 6 months.
82

83. Levonorgestrel Intrauterine Device (hormonal IUD)
 (LNG-IUD) is a T-shaped plastic device that steadily
releases small amounts of levonorgestrel each day.
(Levonorgestrel is a progestin widely used in implants and
oral contraceptive pills.)
 brand name Mirena
 Works primarily by suppressing the growth of the lining
of uterus (endometrium)
 No delay in returning of fertility after its removal
83

84. Misconceptions _corrected
IUDs:
 are not abortifacients
 do not cause infertility
 do not cause discomfort for the male partner
 do not travel to distant parts of the body
84

85. Points to Remember
 Long-term pregnancy protection. Very effective for 5
years, immediately reversible.
 Inserted into the uterus by a specifically trained
provider.
 Little required of the client once the LNG-IUD is in
place.
 Bleeding changes are common but not harmful.
Typically, lighter and fewer days of bleeding, or infrequent or
irregular bleeding.
85

86. Male Condoms
 a barrier method that keeps sperm out of the vagina
 Other names: rubbers, "raincoats," "umbrellas,"
 Effectiveness;
 commonly used, about 15 pregnancies per 100
women
 used correctly with every act of sex, about 2
pregnancies per 100 women
 Require both male and female partner's
cooperation. The only dual protection method 86

87. Why some Users prefer
 Have no hormonal side effects
 Can be used as a temporary or backup
method
 Can be used without seeing a health care
provider
 Are sold in many places and generally easy
to obtain
 Help protect against both pregnancy and
STIs, including HIV
87

88. Summary of Male Condoms
 Male condoms help protect against sexually transmitted
infections, including HIV
 Require correct use with every act of sex for greatest
effectiveness.
 Talking about condom use before sex can improve the chances
one will be used.
 May dull the sensation of sex for some men. Discussion
between partners sometimes can help overcome the objection
88

89. Female Condoms
 Sheaths, or linings, that fit loosely inside a woman's vagina,
made of thin, transparent, soft plastic film.
 Have flexible rings at both ends
 One ring at the closed end helps to insert the condom
 The ring at the open end holds part of the condom
outside the vagina
 May require some practice. Inserting and removing the
female condom from the vagina becomes easier with
experience
89

90. Effectiveness:
 21 pregnancies per 100 women
 Correct use=about 5 pregnancy Per 100 women
Some women prefer it for:
 Women can initiate their use
 Have a soft, moist texture that feels more natural than male latex
condoms during sex
 Help protect against both pregnancy and STIs, including HIV
 Outer ring provides added sexual stimulation for some women
 Can be used without seeing a health care provider
90

91. Why Some Men Say They Like Female Condoms
 Can be inserted ahead of time so do not interrupt sex
 Are not tight or constricting like male condoms
 Do not dull the sensation of sex like male condoms
 Do not have to be removed immediately after
ejaculation
91

92. 92

93. Spermicidal
 Are Sperm-killing substances placed deep in the vagina, near
the cervix, shortly before sex
 Require correct use with every act of sex for greatest
effectiveness.
 One of the least effective contraceptive methods.
 Can be used as a primary method or as a backup method
 Work by causing the membrane of sperm cells to break, killing
them or slowing their movement
 This keeps sperm from meeting an egg
 Can be pessaries, spray, Foam, Creams, tabs 93

94. Diaphragms
 A soft latex cup that covers the cervix
(plastics may be available in some
places)
 The rim contains a firm, flexible spring
that keeps the diaphragm in place.
 Used with spermicidal cream, jelly, or
foam to improve effectiveness
 Works by blocking sperm from
entering the cervix; spermicide kills or
disables sperm
94

95. Diaphragms…
 It is placed deep in the vagina before sex
 It covers the cervix.
 Spermicide provides additional
 contraceptive protection.
 A pelvic examination is needed before starting use
 The provider must select a diaphragm that fits
properly.
 Require correct use with every act of sex for greatest
effectiveness.
95

96. Cervical Caps
 A soft, deep, latex or plastic rubber cup that snugly
covers the cervix
 Comes in different sizes; requires fitting by a
specifically trained provider
 keep sperm from meeting an egg
 One of the least effective methods, as commonly used
(32/100 pregnancies)
 When used correctly with every act of sex, about 20
pregnancies per 100
 Insert the cervical cap any time up to 42 hours before
having sex. 96

97. Female Sterilization
 Permanent
 The 2 surgical approaches most often used:
 Minilaparotomy
 Laparoscopy
 No return of fertility
97

98.  Alternative names: tubal sterilization, tubal ligation, voluntary
surgical contraception, tubectomy, bi-tubal ligation, tying the
tubes, minilap, and "the operation."
 Works because the fallopian tubes are blocked or cut. Eggs
released from the ovaries cannot move down the tubes, and so
they do not meet sperm
 Effectiveness varies slightly depending on how the tubes are
blocked, but pregnancy rates are low with all techniques
 One of the most effective techniques is cutting and tying the
cut ends of the fallopian tubes after childbirth (postpartum
tubal ligation)
98

99. Key Points for Female
Sterilization
 Permanent. Intended to provide
life-long, permanent, and very
effective protection against
pregnancy. Reversal is usually not
possible.
 Involves a physical examination
and surgery. The procedure is done
by a specifically trained provider.
 No long-term side effects.
99

100. Vasectomy
 Through a puncture or small incision in
the scrotum, the provider locates each
of the 2 tubes that carries sperm to the
penis (vas deferens) and cuts or blocks
it by cutting and tying it closed or by
applying heat or electricity (cautery)
 Works by closing off each vas deferens,
keeping sperm out of semen. Semen is
ejaculated!!
100

101. Vasectomy…
 Effectiveness: 2 to 3 per 100 women
 Vasectomy is not fully effective for 3 months after the
procedure
 Fertility does not return because vasectomy generally
cannot be stopped or reversed
 Can not prevent STIs
 The man takes responsibility for contraception—takes
burden off the woman
 Increases enjoyment and frequency of sex
101

102. Vasectomy…
Complications: uncommon to rare
 Severe scrotal or testicular pain that lasts for
months or years
 Infection at the incision site or inside the incision
 Bleeding under the skin that may cause swelling or
bruising (hematoma)
102

103. Which one is preferable?
103

104. 104

105. THANK YOU!!!
105