2. Birth Control & Family Planning

3. Remember The total risks of birth control are much less than the total risks of a pregnancy!!

4. Types of Birth Control Hormonal Barrier IUD
Methods based on information
Permanent sterilization

5. Hormonal Methods Oral Contraceptives (Birth Control Pill)
Injections (Depo-Provera)
Implants (Norplant I & II)

6. Birth Control Pills Pills can be taken to prevent pregnancy
Pills are safe and effective when taken properly
Pills are over 99% effective
Women must have a pap smear to get a prescription for birth control pills

7. How does the pill work? Stops ovulation Thins uterine lining
Thickens cervical mucus

8. Positive Benefits of Birth Control Pills
Prevents pregnancy
Eases menstrual cramps
Shortens period
Regulates period
Decreases incidence of ovarian cysts
Prevents ovarian and uterine cancer
Decreases acne

9. Side-effects Breast tenderness Nausea Increase in headaches Moodiness
Weight change
Spotting

10. Taking the Pill Once a day at the same time everyday
Use condoms for first month
Use condoms when on antibiotics
Use condoms for 1 week if you miss a pill or take one late
The pill offers no protection from STD’s

11. Depo-Provera
Birth control shot given once every three months to prevent pregnancy
99.7% effective preventing pregnancy
No daily pills to remember

12. How does the shot work? Stops ovulation Stops menstrual cycles!!
Thickens cervical mucus

13. SIDE EFFECTS NO PERIOD  after 3-6 months
Extremely irregular menstrual bleeding and spotting for 3-6 months!
NO PERIOD  after 3-6 months
Weight change
Breast tenderness
Mood change
*NOT EVERY WOMAN HAS SIDE-EFFECTS!

14. IMPLANTS
Implants are placed in the body filled with hormone that prevents pregnancy
Physically inserted in simple 15 minute outpatient procedure
Plastic capsules the size of paper matchsticks inserted under the skin in the arm
99.95% effectiveness rate

15. Norplant I vs. Norplant II
Six capsules
Five years
Two capsules
Three years

16. Norplant Implant

17. Norplant Considerations
Should be considered long term birth control
Requires no upkeep 
Extremely effective in pregnancy prevention > 99%

18. Emergency Contraception
Emergency contraception pills can reduce the chance of a pregnancy by 75% if taken within 72 hours of unprotected sex!

19. Emergency Contraception (ECP)
Must be taken within 72 hours of the act of unprotected intercourse or failure of contraception method
Must receive ECP from a physician
75 – 84% effective in reducing pregnancy
California pharmacies can prescribe without a doctor! (1/1/02)

20. ECP
Floods the ovaries with high amount of hormone and prevents ovulation
Alters the environment of the uterus, making it disruptive to the egg and sperm
Two sets of pills taken exactly 12 hours apart

21. BARRIER METHODS Spermicides Male Condom Female Condom Diaphragm
Cervical Cap

22. BARRIER METHOD
Prevents pregnancy blocks the egg and sperm from meeting
Barrier methods have higher failure rates than hormonal methods due to design and human error

23. SPERMICIDES Chemicals kill sperm in the vagina Different forms:
-Jelly -Film
-Foam -Suppository
Some work instantly, others require pre-insertion
Only 76% effective (used alone), should be used in combination with another method i.e., condoms

24. MALE CONDOM
Most common and effective barrier method when used properly
Latex and Polyurethane should only be used in the prevention of pregnancy and spread of STI’s (including HIV)

25. MALE CONDOM Perfect effectiveness rate = 97%
Typical effectiveness rate = 88%
Latex and polyurethane condoms are available
Combining condoms with spermicides raises effectiveness levels to 99%

26. FEMALE CONDOM Made as an alternative to male condoms Polyurethane
Physically inserted in the vagina
Perfect rate = 95%
Typical rate = 79%
Woman can use female condom if partner refuses

27. Reality  : The Female Condom

28. DIAPRAGHM Perfect Effectiveness Rate = 94%
Typical Effectiveness Rate = 80%
Latex barrier placed inside vagina during intercourse
Fitted by physician
Spermicidal jelly before insertion
Inserted up to 18 hours before intercourse and can be left in for a total of 24 hours

29. DIAPHRAGM

30. CERVICAL CAP Latex barrier inserted in vagina before intercourse
“Caps” around cervix with suction
Fill with spermicidal jelly prior to use
Can be left in body for up to a total of 48 hours
Must be left in place six hours after sexual intercourse
Perfect effectiveness rate = 91%
Typical effectiveness rate = 80%

31. INTRAUTERINE DEVICES (IUD)
T-shaped object placed in the uterus to prevent pregnancy
Must be on period during insertion
A Natural childbirth required to use IUD
Extremely effective without using hormones > 97 %
Must be in monogamous relationship

32. Copper T vs.. Progestasert
10 years
99.2 % effective
Copper on IUD acts as spermicide, IUD blocks egg from implanting
Must check string before sex and after shedding of uterine lining.
1 year
98% effective
T shaped plastic that releases hormones over a one year time frame
Thickens mucus, blocking egg
Check string before sex & after shedding of uterine lining.

33. STERILIZATION
Procedure performed on a man or a woman permanently sterilizes
Female = Tubal Ligation
Male = Vasectomy

34. TUBAL LIGATION Surgical procedure performed on a woman
Fallopian tubes are cut, tied, cauterized, prevents eggs from reaching sperm
Failure rates vary by procedure, from 0.8%-3.7%
May experience heavier periods

35. LAPAROSCOPY-’BAND-AID’ STERILIZATION

36. VASECTOMY Male sterilization procedure Ligation of Vas Deferens tube
No-scalpel technique available
Faster and easier recovery than a tubal ligation
Failure rate = 0.1%, more effective than female sterilization

37. VASECTOMY

38. METHODS BASED ON INFORMATION
Withdrawal
Natural Family Planning
Fertility Awareness Method
Abstinence

39. WITHDRAWAL Removal of penis from the vagina before ejaculation occurs
NOT a sufficient method of birth control by itself
Effectiveness rate is 80% (very unpredictable in teens, wide variation)
1 of 5 women practicing withdrawal become pregnant
Very difficult for a male to ‘control’

40. Natural Family Planning & Fertility Awareness Method
Women take a class on the menstrual cycle to calculate more fertile times
Requires special equipment and cannot be self-taught
NFP abstains from sex during the calculated fertile time
FAM uses barrier methods during fertile time
Perfect effectiveness rate = 91%
Typical effectiveness rate = 75%
No 100% safe day-irregular periods

41. Abstinence Only 100% method of birth control
Abstinence is when partners do not engage in sexual intercourse
Communication between partners is important for those practicing abstinence to be successful

42. Reasons for abstaining
Moral or religious values
Personal beliefs
Medical reasons
Not feeling ready for an emotional, intimate relationship
Future plans

43. SOMETHING TO THINK ABOUT…
Couples who use no birth control have a 85% chance of a pregnancy within the first year.

44. EXCELLENT REFERENCE SEE:
Hatcher, Robert, MD
Contraceptive Technology ,17ed. (2001)

46. Quality in Family Planning

47. 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.

48. Aims & Objectives
In 1994, the International Conference on Population and Development (ICPD) set a broader agenda for incorporating elements of quality in FP/RH services.
to provide more and improved services to new groups of clients and to larger numbers of clients than ever before;
to increase client satisfaction and client use of services;
to have a positive impact on reproductive & overall health; and
to increase efficiency and savings.
The early family planning initiatives in the 1950s and 1960s were motivated
by demographic concerns; the vanguard countries developed family planning programs in an effort to control rapid population growth. As such, the ultimate objective of these programs (and the majority that have followed) was to reduce fertility. This translated to a strong emphasis on the quantitative aspects of service delivery. How many acceptors entered the program each year? What volume of contraception was distributed? What percentage of the population at risk used a contraceptive method?

49. Elements of ‘Quality of Care’ in family planning
By Judith Bruce, 1990
Choice of method
Interpersonal communication (verbal & non verbal)
Technical Competence
Information
Follow-up
Appropriate constellation of services

50. Choice of method
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.

51. Good interpersonal communication (verbal & non verbal)
It helps in conveying the right message and to build a rapport with the client.
The language should be simple enough, without any technical terms so to put him/her at ease.
It is a tool to get acquainted to the client’s knowledge, attitude, perceptions and feelings about the subject.

52. Technical Competence Quality needs command on the subject.
It is inevitable to acquire all the essential knowledge and to polish one’s technical competence regarding family planning services.

53. Information
Providing all the necessary information to the client helps him/her in using the selected method correctly, without any fear.
Right information will certainly clear the myths and rumors about the subject and will improve the adopting rate among the potential clients.

54. Follow-up
Correct and continuous follow up of the users is indispensable to monitor the possible complications with the use of contraceptives.
It ensures eventually an improved continuation rate among the users.

55. Appropriate constellation of services
Adding family planning services along with the routine ones under the same roof may attract more clientele.
The clients do not have to go to some other service specialized in family planning only.
Clients discuss their problems with more openness with their own physician in a friendly ambiance.

56. Indicators QUALITY OF CARE
Number of contraceptive methods available at a specific outlet
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.

57. 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

58. Rights of Clients
Information about all the methods / services available.
Knowledge of not only the benefits but also the risks / side effects of all the contraceptive methods / RH services to make an independent decision.
Outlets providing FP/ RH services should carry a logo / indicative sign on a prominent place. They should also provide a comfortable clean environment to the clients where they will be treated with respect, attention and courtesy.
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.

59. 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.

60. Provider’s needs
Training will certainly help the provider to do a better counseling. It is needed to polish one’s skills to pass the right information, to help the client in decision making, to explain the use of a specific method, to screen the client etc.
Information about all the FP methods/RH services.Moreover, other information about the local community like social, cultural and religious beliefs is always helpful in dealing with the FP clients.
Update about the FP methods and about the new developments in the reproductive health.
Outlet adequately equipped for a trained provider is an essential requirement for the FP/RH services. There should be a logo / sign to show the availability of FP services in that particular outlet.

61. Provider’s needs (cont.)
Supplies continuous & adequate - needed at the provider’s outlet to ensure an all time good service for the users and other potential clients.
Backup & referral for the complicated cases should be there, where and when needed.
Feedback about the services provided in a certain outlet helps the provider to amend and ameliorate his/her services.
Acknowledgement in the shape of certification or some incentives to be encouraged to continue with the same motivation and involvement.

63. Family Planning Knowledge & Attitudes Use of Family Planning
Exposure to Family Planning Messages

64. Knowledge of contraceptive methods
Percent of women age 15-49

65. Which modern methods are most familiar to married women?
Percent of currently married women age 15-49

66. Does knowledge of any modern method vary by residence, region and education?
No urban-rural difference
Women with no education (91%) know slightly less about modern methods than educated women (98%)

67. Do married women discuss family planning with their husbands?
Percent of currently married women age in the past year

68. What are couples’ attitudes toward family planning?
Percent of women who report that they and their husband approve or not of family planning

69. Family Planning Knowledge & Attitudes Use of Family Planning
Exposure to Family Planning Messages

70. Use of contraception among married women
Percent of currently married women age 15-49

71. Does use of contraception vary by a woman’s level of education?
Percent of currently married women age 15-49

72. Contraceptive use also varies by residence
33% of urban women use any method of family planning compared to…
22% for their rural counterparts.

73. Women’s current use of modern contraceptive methods
In India, only 55 percent of children under four months of age are exclusively breastfed

74. Source of supply for contraceptive methods
Percent
*First source, limited to women who started using IUD since 1995

75. Intention to use contraception in the future
Percent of currently married women who are not using a contraceptive method

76. Preferred method of Contraception for future use
Percent of currently married women who are not using a contraceptive method, but who intend to use

77. Some reasons cited by women for not intending to use contraception
Health concerns
Difficult to get pregnant
Wants more children
Opposed to family planning
Infrequent sex/no sex
Fear side effects
26%
24%
10% 9% 8% 6%
Currently married women who are not using a contraceptive method

78. Family Planning Knowledge & Attitudes Use of Family Planning
Exposure to Family Planning Messages

79. From what source do women hear family planning messages?
From radio only
From television only
From both
NO MESSAGE
10% 5%
64%
21%
For all women who heard a message about family planning in the last few months preceding the interview

80. Does exposure to family planning messages vary by residence and education?
Urban 86%
Rural 78%
Education
None 70%
Primary 80%
Secondary+ 92%

81. Does exposure to family planning messages in the print media vary by residence and education?
Urban 59%
Rural 36%
Education
None 28%
Primary 39%
Secondary+ 62%

82. Main findings
Knowledge of family planning is very high, except in two areas (56%)
19% of women use a modern method of contraception (24% use any method)
Use of any contraceptive method has been increasing since 1995 (13%) to 24% in 2000
Use varies greatly by residence, region and level of education

83. Main findings
Injectables and the daily and monthly pills are the 3 methods most used by women
Slightly more than 2 women in 5 intend to use family planning in the future
4 women in 5 have heard of a family planning message in the media