Presentation on theme: "Desiree M. Opoku FP Trainer /Service Provider. Family Planning It is the ability of individuals and couples to enjoy their sexual life and decide freely."— Presentation transcript:
Desiree M. Opoku FP Trainer /Service Provider
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
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.
Factors to consider when choosing a contraceptive method Ones lifestyle Age Number of Children Health status Relationships Safer sex plan. Effectiveness
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
Long Term Methods: Intrauterine Devices (IUDs) -Copper T (CuT 380A) -Levonorgestrel Intrauterine System (LNG- IUS)or hormonal IUD (MIRENA) Implants -Jadelle - Zarin -Implanon
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)
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.
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.
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
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.
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.
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.
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).
How to use the female condom
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
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.
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
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.
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.
Spermicides cont’d Side Effects Spermicides may cause vaginal or penile irritation. Limitations Does not protect against STIs/ HIV.
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
Combined Oral Contraceptive Pills
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
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
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.
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
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
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.
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.
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.
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.
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
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
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.
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)
Emergency Contraception – CUT IUD 2. 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
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
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
Method failure What options are available to clients incase a method fails ? Emergency contraception (EC) Comprehensive Abortion care (CAC) Counsel for ANC
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 ?
Zenabu Addo FP Trainer/Service Provider
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
Depo Provera/Petogen/Noristerat Inhibits /suppresses ovulation It thickens cervical mucous It thins the endometrial lining
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
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
Norigynon It works just like the COCs. Its benefits and limitations are also like the COCs. It is given once a month intramuscularly (IM).
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.
Standard Days Method (SDM)-Cycle beads
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
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.
LONG-TERM METHODS Copper bearing Intrauterine Device (IUD) The most commonly used IUD in family planning is copper bearing CuT380 A, 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.
IUD 99% effective 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.
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.
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
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.
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
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
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.
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.
Tubes blocked and cut here
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
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.
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