1. FAMILY PLANNING METHODS AND SERVICES AVAILABLE IN GHANA
Desiree M. Opoku
FP Trainer /Service Provider

2. Family Planning
It is the ability of individuals and couples to enjoy their sexual life and decide freely and responsibly, whether they would:
have a family
how many children they want to have
how they want to space them
- when they’ll start
- when they’ll finish

3. Rationale for Contraceptive Use
Designed to help individuals and couples in their reproductive age group to:
Space their children
Prevent unintended pregnancies
Manage infertility
Improve their reproductive health
Ensure that there is a balance between population and resources.

4. Factors to consider when choosing a contraceptive method
Ones lifestyle
Age
Number of Children
Health status
Relationships
Safer sex plan.
Effectiveness

5. FAMILY PLANNING METHODS
Family Planning Methods Currently Available in Ghana
Short Term Methods:
Condoms
Spermicides
Oral contraceptive pills
Injectables /Injections
Lactational Amenorrhoea Method (LAM)
Natural Family Planning Methods

6. Long Term Methods: Intrauterine Devices (IUDs) -Copper T (CuT 380A)
-Levonorgestrel Intrauterine System (LNG- IUS)or hormonal IUD (MIRENA)
Implants
-Jadelle
- Zarin
-Implanon

7. Permanent Methods
Bilateral Tubal ligation ( BTL /Mini Lap)
Vasectomy

8. Male Condom
It is a thin rubber covering that fits over a man’s erect penis.
There are varieties of male condoms
Condom prevents both pregnancy and STIs including HIV(Dual protection)
Condoms may be used in addition to another family planning method to prevent pregnancy and STIs including HIV(Dual method)

9. Male Condom Effectiveness
98% effective when used correctly and consistently.
How does it work?
Forms a barrier that keeps sperm out of the vagina, preventing pregnancy.
Also keep infections in the semen, on the penis or in the vagina from infecting the other partner.

10. Male condom cont’d Who can use it Clients who :
Are looking for a back up method (example: in case the woman forgets to take her contraceptives pills)
Have a medical condition that poses a health risk with the use of other contraceptive methods
Have sexual intercourse occasionally and do not want a regular contraception
Are at risk for exposure to transmission of STIs/ HIV.

11. Male Condom cont’d Who cannot use it?
Any one who is allergic to or reacts to latex
Benefits
Are inexpensive and easy to get
Can help relieve premature ejaculation
Provides effective contraception immediately
Can be used with other methods (except female condoms)
Offer protection against STIs/HIV

13. Female Condom
It is a soft smooth covering made from polynitrile which is a synthetic material worn inside the vagina.
It has a ring at each end. The inner ring at the closed end of the condom is used to insert the condom.
The ring at the open end of the condom remains outside the vagina.

14. Female Condom cont’d Effectiveness
95% effective if used correctly and consistently.
How does it work?
Forms a barrier which blocks the passage of sperms to meet the ovum.
Also keep infections in the semen, on the penis or in the vagina from infecting the other partner.

15. Female Condom cont’d Who can use it?
Anyone looking for a back up method (example: in case the woman forgets to take her contraceptives Pills)
Has a medical condition that poses a health risk with the use of other contraceptive methods
Has sexual intercourse occasionally and does not want a regular contraception
Is at risk for exposure to transmission of STIs/ HIV.

16. FC2 Benefits Offer protection against STIs/HIV infections
Generates heat and therefore increases sexual stimulation.
Does not interrupt foreplay and there is no risk of partner losing erection because it can be inserted ahead of time (6-8hrs).

17. How to use the female condom

18. Spermicides These are chemicals that kill sperms.
Spermicides are available in a variety of preparations.
Examples are:
-creams, film, foaming tablets,
vaginal suppositories, aerosol foams and jellies

19. Spermicides
82% effective if used appropriately. Using spermicides with a condom increases effectiveness.
How does it work?
Spermicides kill the sperm thus preventing them from meeting the ovum.

20. Spermicides Who can use it?
Anyone needing a backup method (for example in the case of a skipped /missed oral contraceptive pills)
Has sexual intercourse occasionally and does not need regular contraception
Who cannot use it?
Anyone that is allergic to or reacts to spermicides

21. Spermicides cont’d Benefits
Can be inserted by a partner as part of foreplay.
Easily available -can be purchased from pharmacies, chemical shops and supermarkets.
Increases vaginal lubrication.
Can be used ahead of time and does not interrupt sexual activity .

22. How to use spermicides
Usually requires 10 to 20 minutes after insertion before intercourse can begin
They are effective only for one hour after insertion
It is inserted deep into her vagina just before sexual intercourse while lying down, squatting or standing
After intercourse the vagina should not be washed until 6 to 8 hours
Spermicides should be used with each act of sexual intercourse
If more than 30 minutes elapses after insertion before intercourse ,insert another one.

23. Spermicides cont’d Side Effects
Spermicides may cause vaginal or penile irritation.
Limitations
Does not protect against STIs/ HIV.

24. Combined Oral Contraceptive Pill (COCs)
It is a pill that contains estrogen and progesterone which are similar to the natural hormones in a woman’s body.
COCs contain 28 pills in a pack. Some have 21 active pills and 7 nonactive pills which must all be taken as shown on the pack.
Some examples in Ghana are Microgynon, Secure, my Pearl, Yasmin

25. Combined Oral Contraceptive Pills

26. Combined Oral Contraceptive Pill
Who cannot use it?
Clients who:
Are breastfeeding because estrogen can decrease the quantity of breast milk.
Have undiagnosed vaginal bleeding
Are taking medication for seizures or convulsions, tuberculosis , and on ART (must use condoms in addition )
Benefits
The woman re-gains her fertility quickly
It may protects against certain cancers eg. Ovarian and endometrial cancer

27. Combined Oral Contraceptives
How to use COCs
Each 28-day pill pack has 21 active pills and 7 non active pills (the iron pills).
Swallow one active pill every day at the same time for 21 days as shown on the pack and then continue with the inactive (the iron pills)
Side effects
Most side effects go away after the first few months of use Side effects include:
Bleeding in between periods
Headache
Nausea and/or vomiting
Breast tenderness
Weight changes

28. Combined Oral Contraceptive Pill
Limitations
Does not provide protection against STIs/ HIV
What to do if a client skips/misses a pill
Missing 1 or 2 active pills in a row :
Take 1 active pill as soon as client remembers and then continue taking the pills 1 each day. Client can also take the 2 pills at the same time
Missing 3 or more active pills in a row:
A back up protection eg use condoms until the pill has been taken for 7 days in a row.
If client misses these pills in week 3 or row3, she should skip the remaining pills and start a new pack.

29. Progestin Only Pills (POPs) Mini-pill
It is a pill that contains only progestin
It does not affect the production of breast milk so it can be used by breastfeeding mothers
Effectiveness
Over 99% effective when taken correctly and consistently

30. Progestin Only Pills (POPs) Mini-pill
How does it work?
The pill prevents ovulation
It thickens the cervical mucus
It thins the endometrial lining
Who can use it?
Women who:
For medical reasons cannot use the combined contraceptive pills
Are breastfeeding below 6mths

31. Progestin Only Pill Who cannot use it? Women who:
Have abnormal vaginal bleeding
Are taking medication for seizures/convulsions, tuberculosis and on ART ( must use condoms in addition because these medications suppress the effect of the family planning hormones)
Benefits
Can be used whilst breastfeeding.
Safe and immediately effective.
Immediate return of fertility after stopping.

32. Progestin Only Pill
How to use the Pill
Take one pill at the same time every day.
When you finish a pack of pills, start a new pack the next day.
If breastfeeding, you can start 6 weeks after childbirth.
Side effects
Most side effects go away after the first few months of use.
Common side effects include:
Nausea, headaches , changes in monthly bleeding including irregular bleeding, spotting, heavier bleeding or no monthly bleeding are common but safe.
Limitations
Does not provide protection against STIs/HIV.

33. Progestin Only Pill What to do if a client misses a pill
If a woman is three or more hours late in taking a pill or misses a pill completely she should take a pill as soon as possible and keep taking pills as usual, one each day.
She may take 2 pills at the same time on the same day. She should use a back up method for the next 2 days.

34. Lactational Amenorrhoea Method (LAM)
This is a method that uses the temporary infertility that occurs during breast feeding
Feeding a new baby continuously only on breast milk can postpone ovulation (the release of an egg from an ovary) for up to six months if her period has not returned
When used as a family planning method, this pattern of exclusive breastfeeding is called the Lactational Amenorrhea Method (LAM)
It provides protection against pregnancy for up to six months.

35. LAM 98% effective How does it work?
A baby suckling suppresses the production of hormones that are necessary for ovulation
Who can use LAM?
A mother:
Who is exclusively breastfeeding day and night
Whose menstrual periods have not yet returned after delivery.
Whose baby is less than six months old.
It is effective when practiced correctly attaching and positioning to breast

36. LAM Who cannot use LAM A mother who:
Is not practicing exclusive breast feeding
Her menstrual period has returned after delivery.
Her baby is older than six months
Benefits for the Mother
It does not affect natural hormonal balance of the woman
It is immediately effective
It reduces bleeding after delivery
No supplies are needed
It has no side effects

37. LAM Benefits for the baby
It decreases the likelihood of infection from germs in water, milk or formula feeds
It increases bonding between mother and child.
It passes on some of the mother’s antibodies to protect the baby from certain bacteria and viruses
Provides the best natural nutrition for the baby
Limitation
It does not protect against STIs/HIV.

38. Emergency Contraception
They are used to help prevent a woman from unintended pregnancy after having unprotected sex. There are 2 types of emergency contraceptives:
1. Emergency Contraceptive Pills (ECPs)

39. Emergency Contraception – CUT IUD
Highly effective for preventing pregnancy
A Copper releasing IUD (Cu-IUD) can be used within 5 days of unprotected sexual intercourse as an emergency contraceptive

40. Emergency Contraception
How ECs work
The pills inhibit or delay the release of eggs from the ovaries. They do not work if the woman is already pregnant.
The copper IUD slows the movement of the sperms .
Who can use it?
Almost all women can use ECs
Women who have been assaulted (e.g. rape, incest)
When a woman misses two or more contraceptive pills in a cycle
When a condom breaks or slips off

41. Emergency Contraception
Benefits
It is safe, effective and easy to use
How to use it
The EC tablets must taken within 5 days after unprotected sex.
1 tablet start followed by 1 after 12 hrs or 2 start
Take 4 combined (active) oral contraceptive at once (e.g. Microgynon or Secure) followed by 4 more active pills after 12 hours or
Intrauterine device (IUD) inserted within 5 days of having unprotected sex
Limitation
ECPs do not protect against pregnancy for any future sex.
Cannot be used as regular contraceptive method
Offer no protection against STIs/HIV

42. Method failure
What options are available to clients incase a method fails ?
Emergency contraception (EC)
Comprehensive Abortion care (CAC)
Counsel for ANC

43. How to be reasonably sure your client is not pregnant;
Did you have a baby less than 6 months (LAM) ?
Have you abstained from sexual intercourse since your LMP ?
Have you had a baby in the last 4 weeks ?
Did your LMP start within the past 7 days (for IUD within 12 days) ?
Have you had a miscarriage or abortion in the past 7 days ?
Have you been using a reliable contraceptive method consistently and correctly ?

44. Thank you

45. CLINICAL METHODS OF CONTRACEPTION
Zenabu Addo
FP Trainer/Service Provider

46. INFORMATION ON CLINIC BASED METHODS
Injectables
They are methods that are given by injection in the arm and the buttocks. There are three kinds of injectables:
Depo Provera/Petogen - It is effective for 3 months
Noristerat It is effective for 2 months
Norigynon It is effective for 1 month

47. Depo Provera/Petogen/Noristerat
Inhibits /suppresses ovulation
It thickens cervical mucous
It thins the endometrial lining

48. Benefits Almost all women can use it It is very effective and safe
It is easy to use
It is reversible
It does not interfere with intercourse
It can be used by women who cannot take estrogen
It does not require daily attention

49. Limitations/Side Effects
Irregular bleeding, dizziness and nausea. These side effects disappear after few months of use
There may be delay return to fertility
Does not provide protection against STIs/HIV
It may cause amenorrhea

50. Norigynon
It works just like the COCs. Its benefits and limitations are also like the COCs.
It is given once a month intramuscularly (IM).

51. Natural Family Planning (NFP) -Fertility Awareness
Natural family planning refers to a variety of methods used to plan/prevent pregnancy without the use chemicals.
Methods include:
Standard Days Method (SDM)
Calendar (rhythm) method
Basal body temperature (BBT) method
Cervical mucus method (CMM) Two Day Method
How does it work?
It is based on identifying the woman’s fertile days and avoiding intercourse during the fertile days to prevent pregnancy.

52. Standard Days Method (SDM)-Cycle beads

53. SDM with cycle beads
The Cycle Beads, are color-coded string of beads to help a woman to track her cycle days, know when she is fertile and monitor her cycle length.
It is appropriate for women with menstrual cycles between 26 and 32 days long. It identifies days 8-19 of the cycle as fertile period
How does it work?
It works by allowing the couple to identify “fertile period” (days intercourse can result in pregnancy) of the menstrual cycle

54. SDM
Who can use it?
Women with cycles 26 to 32 days long; women who have their monthly periods within this range
Couples who can abstain or use condom during the fertile period
Women who know when their last period started can use the SDM right away. Women who do not know can begin the SDM when their next period starts.

56. LONG-TERM METHODS Copper bearing Intrauterine Device (IUD)
The most commonly used IUD in family planning is copper bearing CuT380A, which is effective for 10 – 12 years of use.
There are also hormone-releasing IUDs -Levonorgestrel releasing intra uterine system (LNG-IUS). It is effective for 5 years.

57. IUD 99% effective How does it work?
How does it work?
The copper kills or weakens the sperms and so slows the movement of the sperm preventing it from meeting the egg. It may also damage the egg or change its speed of movement.
The LNG-IUS prevents fertilization
Thickens the cervical mucus.

58. IUD Benefits Highly effective. Long lasting solution
Immediately effective
One of the most private methods of birth controls
Quick return to fertility when IUD is removed
The LNG-IUS reduces menstrual bleeding and cramps
Limitations
It must be inserted and removed by a trained health care provider.
It does not provide protection against STIs/HIV.

59. WARNING SIGNS &SYMPTOMS
P -if period is late or abnormal bleeding or spotting
A - Abdominal pain , pain during intercourse
I -Infection exposure abnormal vaginal discharge
N - Not feeling well, fever chills
S - string missing has become shorter or longer or feel the hard part of IUD in the vagina or cervix

60. Implants
Implants are small flexible rods or capsules that contain synthetic progestin.
They are inserted under the skin of the inner aspect of a woman’s upper arm.

61. Implants Types Jadelle – 2 rods effective for 5 years
Sino Implants (Zarin) – 2 rods effective for 4 years
Implanon – 1 rod effective for 3 years

62. Implants Effectiveness Over 99% effective How do they work?
Implants partially prevent the eggs from being released or stops ovulation
Thickens cervical mucus.
Thins endometrial lining

63. Implants Benefits Almost all women can use it Completely reversible
Are safe for breastfeeding mothers and their babies.
Highly effective and easy to use
Limitations
Must be inserted and removed by a trained health care provider.
Does not provide protection against STIs/HIV.

64. PERMANENT METHODS Female Sterilization
Female sterilization is also called bilateral tubal ligation (BTL).
Simple operation in which the fallopian tubes are located , ligated /blocked and excised or cut and sealed.

65. Tubes blocked and cut here

66. Female Sterilization/Bilateral Tubal Ligation
Benefits
It is very effective
No more worry about pregnancy after mini lap
Woman still menstruates till menopause
Limitations
It is not reversible
Requires a trained physician or surgeon to perform the operation.
It does not protect against STIs /HIV

67. VASECTOMY
Vasectomy is a simple operation in which the vas deference that carry the sperms are located ligated and excised/cut.
After vasectomy a man will still have erections and ejaculations.
The only difference is that there will be no sperms in the fluid that is discharged.

69. Vasectomy Benefits Vasectomy is very effective It is permanent
Limitations
It is not reversible.
Requires a trained physician or surgeon to perform procedure
It does not protect against STIs/HIV

70. THANK YOU VERY MUCH FOR YOUR ATTENTION