Presentation is loading. Please wait.

Presentation is loading. Please wait.

Family Planning and Contraception. Family Planning and Contraception MGIMS, Sewagram;; 04 Jul 2012 2 Demographic Transition.

Similar presentations


Presentation on theme: "Family Planning and Contraception. Family Planning and Contraception MGIMS, Sewagram;; 04 Jul 2012 2 Demographic Transition."— Presentation transcript:

1 Family Planning and Contraception

2 Family Planning and Contraception MGIMS, Sewagram;; 04 Jul Demographic Transition

3 Family Planning and Contraception MGIMS, Sewagram;; 04 Jul Distribution of contraceptive methods: India

4 Family Planning and Contraception MGIMS, Sewagram;; 04 Jul Distribution of contraceptive methods: Sri Lanka

5 Family Planning and Contraception MGIMS, Sewagram;; 04 Jul Analyzing the population growth Momentum of the population58% –Large size of population in the reproductive age-group Unmet need for contraception20% –Only 44 % of 168 million eligible couples are currently protected –Role of Health sector High wanted fertility20% –insurance against multiple infant and child deaths in a family Early age of marriage

6 Family Planning and Contraception MGIMS, Sewagram;; 04 Jul Unmet Need Unmet need for family planning is defined as the percentage of women of reproductive age, either married or in a union who are want to stop or delay childbearing but are not using any method of contraception.

7 Family Planning and Contraception MGIMS, Sewagram;; 04 Jul

8 8 Reasons for Unmet Need Perceived low risk of pregnancy –Infrequent sexual activity –Post-partum amenorrhoea –Sub-fecundity Opposition to use a contraceptive method Reasons related to knowledge, access or side effects –Lack of awareness –Cost and access to good quality Services –Side effects, health concerns

9 Family Planning and Contraception MGIMS, Sewagram;; 04 Jul Characteristics of ideal contraceptive Safe 100% effective Free of side effects Easily obtainable Affordable Acceptable to the user and sexual partner Free of effects on future pregnancies

10 Family Planning and Contraception MGIMS, Sewagram;; 04 Jul Quality in Family Planning

11 Family Planning and Contraception MGIMS, Sewagram;; 04 Jul Quality Quality is often defined as ‘meeting the needs of clients’. Programs that are customer focused consistently involve clients in defining their needs and in designing the services. Providing quality services is fundamental to sustainable services. Providing and subsequently maintaining quality services can only be accomplished through continuous problem solving and quality improvement.

12 Family Planning and Contraception MGIMS, Sewagram;; 04 Jul Elements of ‘Quality of Care’ in family planning Choice of method Interpersonal communication ( verbal & non verbal ) Technical Competence Information Follow-up Appropriate constellation of services

13 Family Planning and Contraception MGIMS, Sewagram;; 04 Jul Choice of method Cafeteria approach/ Contraceptive method mix Offering the right to the client to choose the method means giving confidence to the individual. He/she feels more comfortable in using the method for which he/she has been provided with clear, accurate and specific information and which is the best for his/her needs.

14 Family Planning and Contraception MGIMS, Sewagram;; 04 Jul Competence of the provider Technical competence Good interpersonal communication (verbal & non verbal)

15 Family Planning and Contraception MGIMS, Sewagram;; 04 Jul Right information Follow-up Appropriate organization of services Other tenets of quality of carre

16 Family Planning and Contraception MGIMS, Sewagram;; 04 Jul Indicators QUALITY OF CARE Number of contraceptive methods available at a specific outlet (basket of choice) Percentage of counseling sessions with new acceptors in which provider discusses all methods Percentage of client visits during which provider demonstrates skill at clinical procedures, including asepsis Percentage of clients reporting “sufficient time” with provider Percentage of clients informed of timing and sources for re- supply/revisit Percentage of clients who perceive that hours/days are convenient and the range of services provided is adequate.

17 Family Planning and Contraception MGIMS, Sewagram;; 04 Jul Counselling

18 Family Planning and Contraception MGIMS, Sewagram;; 04 Jul GATHER Approach to Counseling Greet the client in a friendly and respectful manner Ask the client about FP/RH needs Tell the client about different methods/services Help the client to make her own decision about which method/service to use Explain to the client how to use the method/service she has chosen Return visit and follow-ups of client scheduled

19 Family Planning and Contraception MGIMS, Sewagram;; 04 Jul Rights of Clients Information Knowledge of not only the benefits but also the risks / side effects Outlets providing FP/ RH services should carry a sign on a prominent place. Access to get the FP/RH services regardless of his/her sex, race, religion, color and socio-economic status. FP services should be available to people in their closest vicinity. Privacy Continuity

20 Family Planning and Contraception MGIMS, Sewagram;; 04 Jul Rights of Clients (cont.) Choice to practice FP or RH service should be absolutely voluntary and free. A competent provider will help the client to make a decision and will not pressurize the client to make certain choice for a certain method/service. Privacy for FP/ RH counseling where the client would feel open and frank with the provider. Continuity to obtain the FP/RH services without any break or discontinuation to avoid the after effects and the give-ups of the service. Opinion about the subject, method used and the service provided. This feedback is always helpful for the provider to improve one’s service delivery.

21 Family Planning and Contraception MGIMS, Sewagram;; 04 Jul Using backup methods to increase contraceptive effectiveness Backup methods: contraceptive methods used simultaneously w/another method to support it Condoms, foam, diaphragm, can all be combined w/other methods for extra protection When a backup method might be a good idea: –If on the pill: During first cycle of the pill After forgetting 2 or more pills, or after several days of diarrhea or vomiting when on the pill First month after switching pill type When taking medications that can reduce effectiveness of the pill –During first 1-3 months after IUD insertion –When first learning how to use a new method –To increase overall effectiveness of contraception

22 Family Planning and Contraception MGIMS, Sewagram;; 04 Jul Methods of Contraception Natural methods Barrier methods Hormonal methods IUD Sterilization

23 Family Planning and Contraception MGIMS, Sewagram;; 04 Jul Effectiveness of birth control methods FDA, 1997 w/o spermicide

24 Family Planning and Contraception MGIMS, Sewagram;; 04 Jul Natural Family planning methods They include: –Calendar (Rhythm) method –Standard Day Method –Basal body temperature –Cervical mucous method –Symptothermal method –Ovulation awareness method –Lactational amenorrhea method –Withdrawal ( Coitus interruption )

25 Family Planning and Contraception MGIMS, Sewagram;; 04 Jul Fertility Awareness Methods Standard days method –For women w/cycles b/w 26 & 32 days –Couples avoid unprotected intercourse b/w days 8-19 of each menstrual cycle –Highest rate of effectiveness of natural family planning methods Calendar method: self- knowledge of fertility –After charting cycles for some time (preferably 1 year), a woman estimates the time she is ovulating based on the calendar Mucus method: based on cyclical changes –Vaginal secretions change throughout cycle; woman learns to “read” these changes and keeps a daily chart Basal body-temperature –Based on changes in body temperature around ovulation Combination of these methods

26 Family Planning and Contraception MGIMS, Sewagram;; 04 Jul Standard Days Method (w/Cyclebeads) Arevalo M et al., Contraception, 2002;65: On WHITE bead days you can get pregnant. Avoid unprotected intercourse to prevent a pregnancy. On the day you start your your period, move the ring to the RED bead. Every morning move the ring to the next bead. Always move the ring from the narrow to the wide end. 1 2 Also, mark this date on your calendar When you start your next period, move the ring directly to red bead and begin again. On BROWN bead days you can have intercourse with very low probability of pregnancy. If you have not started your period by the day after you put the ring on the last brown bread, contact your provider. If you start your period before you put the ring on the darker brown bead, contact your provider. (may not be a good method for you)

27 Family Planning and Contraception MGIMS, Sewagram;; 04 Jul Cervical Mucus Method Slight amount Thick White Sticky Holds its shape Increasing amounts Thinner Cloudy Slightly stretchy Profuse Thin Transparent Stretchy Early Mucus Transitional Mucus Highly Fertile Mucus

28 Family Planning and Contraception MGIMS, Sewagram;; 04 Jul Calendar or Rhythm Method Low-risk Days Egg may still be present Ovulation These days may be unsafe if 28-day cycle varies as much as 8-9 days between shortest and longest cycles Intercourse on these days may leave live sperm to fertilize egg

29 Family Planning and Contraception MGIMS, Sewagram;; 04 Jul Basal Body Temperature Method BBT=body temp in resting state on waking Slight drop immediately before ovulation After ovulation, release of progesterone causes slight increase in temperature

30 Family Planning and Contraception MGIMS, Sewagram;; 04 Jul Fertility Awareness Methods pros & cons Pros: –Essentially free –No medical side effects –Does not interrupt sexual activity –Woman gains awareness about her body and natural cycles, which can increase comfort w/sexuality –Acceptable to Catholic Church Cons: –No STI protection –Requires some degree of discipline in order to keep track of calendar/charts, etc. –Need to abstain from intercourse or use a backup method during fertile days

31 Family Planning and Contraception MGIMS, Sewagram;; 04 Jul Barrier & spermicide methods Include: –Condoms (male & female) –Spermicides (foam, sponge) –Cervical barriers (diaphragm & cervical cap) Work by preventing sperm from reaching an egg Condoms provide protection against STIs

32 Family Planning and Contraception MGIMS, Sewagram;; 04 Jul Condoms (male) Sheath that fits over the erect penis The only temporary method of birth control for men Only form of contraception that effectively reduces STI transmission Made of thin latex, polyurethane, or natural membrane Many varieties –Different features, shapes, textures, colors, flavors –Lubricated or nonlubricated Note: average shelf life of condoms is 5 years; don’t store latex condoms in hot places (glove compartment, back pocket) b/c heat can deteriorate the latex

33 Family Planning and Contraception MGIMS, Sewagram;; 04 Jul How to use the (male) condom Pinch reservoir tip or twist tip of nonreservoir tip condom before unrolling condom over the penis to leave room for ejaculate--reduces chance of condom breaking Unroll condom over erect penis before any contact between the penis and vulva occurs Use a water-based lubricant to reduce risk of condom breaking (oil-based lubricants deteriorate condom) Hold condom at the base of the penis before withdrawing from the vagina to avoid spilling semen inside vagina

34 Family Planning and Contraception MGIMS, Sewagram;; 04 Jul Female condom Consists of two flexible polyurethane rings and a soft, loose-fitting polyurethane sheath –One ring at closed end fits loosely against cervix; other ring at open end encircles the labial area Can be inserted before sexual activity; don’t need to remove it immediately following ejaculation

35 Family Planning and Contraception MGIMS, Sewagram;; 04 Jul Costs, pros, & cons of condoms Costs –Male condoms, about $0.75-$1 each –Female condoms, about $3 each Advantages –STI protection! –Available w/o prescription or medical intervention Disadvantages –Can reduce sensation Polyurethane transmits heat well, so some say that the female condom has less reduction in sensation –Interruption of sexual experience (though some couples find sensual ways of incorporating condoms into foreplay) –Note: female condom can be inserted several hours before intercourse

36 Family Planning and Contraception MGIMS, Sewagram;; 04 Jul Vaginal spermicides Include: foam, sponge, suppositories, creams, film Spermicide: chemical that kills sperm (nonoxynol-9) Cost: $0.85 per application Advantage: no prescription necessary Disadvantages: –Interruption of sexual experience (except for the sponge) –Skin irritation (which can increase susceptibility to STI infection) –No protection from STIs –Not effective enough to be used w/o a condom or other method

37 Family Planning and Contraception MGIMS, Sewagram;; 04 Jul Cervical barrier devices Cervical cap: covers cervix only Diaphragm: covers upper vaginal wall behind cervix underneath pubic bone FemCap & Lea’s shield have removal straps Lea’s Shield allows a one-way flow of fluid from cervix to vagina Method is usually combined w/spermicide diaphragm Cerv cap Lea’s shield FemCap

38 Family Planning and Contraception MGIMS, Sewagram;; 04 Jul How to use cervical barrier devices Diaphragm & cervical cap: need to be fitted (may need to be refitted w/weight gain or loss >10 lbs.) FemCap & Lea’s Shield do not have to be fitted, but still require a prescription in the U.S. Use diaphragm & cervical cap only with water-based lubricants b/c they are latex (FemCap & L.S. are silicone) Can insert up to 6-8 hr. before intercourse; should leave in at least 8 hr after

39 Family Planning and Contraception MGIMS, Sewagram;; 04 Jul Placement of cervical barrier devices (& FemCap)

40 Family Planning and Contraception MGIMS, Sewagram;; 04 Jul Intrauterine Devices (IUDs) Small plastic objects inserted into uterus 3 generations –Inert –Copper-releasing –Hormone-releasing (progesterone) Have fine plastic threads attached that hang slightly out of cervix into vagina for removal Very high continuation rate (how many women are still using it one year after starting) compared w/other methods progesterone

41 Family Planning and Contraception MGIMS, Sewagram;; 04 Jul IUD Mechanisms of Action Levonorgestrel-Releasing IUD (LNG-IUS, Mirena ® ) –Inhibits fertilization –Thickens cervical mucous –Inhibits sperm function –Thins and suppresses the endometrium Copper-Releasing IUD (ParaGard ® T380A) –Inhibits fertilization –Releases copper ions (Cu 2+ ) that reduce sperm motility –May disrupt the normal division of oocytes and the formation of fertilizable ova

42 Family Planning and Contraception MGIMS, Sewagram;; 04 Jul Costs, pros, & cons of IUDs Advantages –Very effective (essentially no “user error”) –Long-term protection –No interruption of sexual activity –Don’t have to remember to use –Can be used during breast-feeding Disadvantages –No STI protection –Risk of PID (usually within first 1-2 months following insertion) –Rare incidence of perforating uterine wall

43 Family Planning and Contraception MGIMS, Sewagram;; 04 Jul Hormone-based contraceptives 1) Oral contraceptives (pills) 2) Vaginal ring 3) Transdermal patch 4) Injected hormones 5) Hormonal IUDs

44 Family Planning and Contraception MGIMS, Sewagram;; 04 Jul How hormonal contraceptives work FSH & LH trigger ovulation Gonadotropin releasing hormone (GnRH) triggers release of gonadotropins FSH & LH Estrogen & progesterone in hormonal contraceptives inhibit LH, FSH, and GnRH secretion, preventing ovulation  Progesterone also: thickens cervical mucus to prevent Passage of sperm into the uterus changes uterine lining to inhibit implantation 

45 Family Planning and Contraception MGIMS, Sewagram;; 04 Jul Types of oral contraceptives Constant-dose combination pill –Contains both estrogen and progestin –Dose of each is constant throughout cycle –Amount of estrogen in pills has decreased from approx. 175 micrograms in 1960 to avg. of 25 micrograms today Triphasic pill –Levels of hormones (estrogen & progestin) fluctuate during cycle Seasonale –Reduces the # of menstrual periods to 4 instead of 13 per year –Has lower dose of estrogen and progestin Progestin-only pill –Low dose of progestin and no estrogen –For women who should not take estrogen (breastfeeding, high b.p., at risk for blood clots, smoke)

46 Family Planning and Contraception MGIMS, Sewagram;; 04 Jul How to use oral contraceptives Different types of OCs will differ in how to begin, and other instructions--read instructions carefully & talk w/health care practitioner Don’t skip pills, regardless of whether or not you are having sex Take pill at the same time each day –If you miss 1 pill: take missed pill as soon as you remember, and then take next pill at the regular time –If you miss >1 pill: consult health care practitioner for advice; use a backup method for remainder of your cycle

47 Family Planning and Contraception MGIMS, Sewagram;; 04 Jul Oral contraceptives possible side effects & health issues Women who should not take OCs: – history of blood clots, strokes, heart/circulation problems, jaundice, breast or uterine cancer, liver disease Women considered risky for taking OCs: –Women who smoke, have migraines, depression, high b.p., epilepsy, diabetes/prediabetes, asthma, varicose veins Side effects of OCs can include: –Weight gain, decreased sexual interest, headaches, mood changes, nausea, bleeding between periods –May clear up after 2-3 cycles on the pill

48 Family Planning and Contraception MGIMS, Sewagram;; 04 Jul Oral contraceptives possible side effects & health issues Rare but serious side effects of OCs--must be reported to a health care practioner ASAP 10.3

49 Family Planning and Contraception MGIMS, Sewagram;; 04 Jul Other hormonal methods (contain both estrogen and progestin) Vaginal ring (Nuvaring) –2” ring inserted into the vagina during period –Worn for 3 weeks, removed for 1 week, then replaced with new ring –Pros: no daily pill; spontaneity –Cons: no STD protection, not effective for obese women. Transdermal patch (Ortho Evra) –Patch is placed on buttock, abdomen, outer upper arm, or upper torso –Replaced weekly for 3 weeks, then a patch-free week –Pros: no daily pill; spontaneity –Cons: no STD protection, skin irritation

50 Family Planning and Contraception MGIMS, Sewagram;; 04 Jul Other hormonal methods (cont.) Injected Contraceptives –Depo-Provera (prog.); Lunelle (prog.+est.) –Injections: D-P every 12 weeks; Lunelle monthly –Pros: no daily pill; spontaneity –Cons: no STD protection, weight gain, bleeding, mood change, frequent clinic visits –D-P: takes up to 10 months for a woman to get pregnant after stopping injections Contraceptive Implants –1.5” rod is inserted under skin of upper arm –Progestin-only –Effective for up to 3 years –Cost not yet known –Pros: no daily pill; spontaneity –Cons: no STD protection, weight gain, bleeding, mood change, surgical procedure

51 Family Planning and Contraception MGIMS, Sewagram;; 04 Jul Sterilization Essentially permanent, although vasectomies are sometimes reversible Does not affect hormones, desire, sexual functioning Female sterilization –Tubal sterilization: fallopian tubes are severed to block passage of sperm & eggs –Transcervical sterilization: tiny coil inserted through cervix into fallopian tubes Coil promotes tissue growth that, after 3 months, blocks fallopian tubes Male sterilization (vasectomy) –Safer, less expensive, fewer complications than female sterilization –Cutting and closing vas deferens (ducts that carry sperm)

52 Family Planning and Contraception MGIMS, Sewagram;; 04 Jul Ex. of female sterilization procedure Laparoscope: narrow, lighted viewing instrument that is inserted into abdomen to locate the fallopian tubes

53 Family Planning and Contraception MGIMS, Sewagram;; 04 Jul Ex. of male sterilization procedure Vas deferens on each side is cut; small section is removed, and the ends are tied off or cauterized


Download ppt "Family Planning and Contraception. Family Planning and Contraception MGIMS, Sewagram;; 04 Jul 2012 2 Demographic Transition."

Similar presentations


Ads by Google