1. Family Planning Dr. Amina Rashad Maternity and Gynecology Nursing Dep.
Faculty of Nursing, Mansoura University

2. Specific objectives:
At the end of this chapter the student should be able to
Identify the concept of family planning.
List types of family planning.
Discuss mechanisms Of action of each method.
Enumerate advantages and disadvantages of each method .
Explain side effects and complications of each method.
Provide health education about of each method.
9/18/2018
FP, Dr. Amina Rashad

3. Definition of family planning
The WHO (1975) considered family planning as practice that help individuals or couples to attain certain objectives, which are:
1- Avoidance of unwanted birth.
2- Bringing about wanted birth.
3- Regulation of interval between pregnancies.
4- Avoid pregnancy for women with serious disease that would place pregnancy at risk.
9/18/2018
FP, Dr. Amina Rashad

4. TYPES OF FAMILY PLANNING METHODS
1) Hormonal family planning methods:
Oral contraceptives
Injectable contraceptives
Subdermal implants
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FP, Dr. Amina Rashad

5. BARRIER METHODS
Barrier methods of contraception include the male condom,
female condom,
diaphragm,
cervical cap and spermicide.
All barrier methods are client-dependent.
To be effective, they need to be used correctly and consistently with every act of sexual intercourse.
9/18/2018
FP, Dr. Amina Rashad

6. Mechanism of action
These methods work by physically or chemically blocking the passage of sperm. In addition, some methods can prevent the transmission of STDs between partners.
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FP, Dr. Amina Rashad

7. Advantages of barrier methods
Effective at preventing pregnancy if used consistently and correctly; however, some are more effective than others
Condoms are effective in preventing STIS, including HIV, if used consistently and correctly
Safe
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FP, Dr. Amina Rashad

8. Have no systemic side effects Easy to initiate and discontinue
Immediate return to fertility
Expect for the diaphragm and cervical cap, barrier methods do not require a clinic visit.
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FP, Dr. Amina Rashad

9. Disadvantages of Barrier methods
Not as effective as other modem methods
Some people find them difficult to use consistently and correctly
Some methods require partner’s participation
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FP, Dr. Amina Rashad

10. May interrupt sexual activity
Need proper storage in order to maintain the quality of the products
Need re-supply
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FP, Dr. Amina Rashad

11. LACTATIONAL AMENORRHEA METHOD (LAM)
Def. The lactational amenorrhea method, or LAM, is a temporary contraceptive option for postpartum women.
9/18/2018
FP, Dr. Amina Rashad

12. Who will use LAM *Within 6 months postpartum *Amenorrheic
      Fully or nearly fully breastfeeding ( at least 85% of the time )
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FP, Dr. Amina Rashad

13. Mechanism of action
The stimulation of the nipples by infant’s suckling sends nerve impulses to the mother’s hypothalamus, causing the release of prolactin and disruption in the release of gonadotrophin-releasing hormone (GnRH). The reduction in GnRH in turn suppresses the release of follicle stimulating hormone (FSH) and luteinizing hormone (LH) by pituitary gland
The reduction in FSH and LH affects follicular development and suppresses ovulation.
9/18/2018
FP, Dr. Amina Rashad

14. Advantages of LAM Universally available to all breastfeeding women.
At least 98% effective
Protection begins immediately postpartum
There are proven health benefits of breastfeeding for mother and infant.
No commodities or supplies required
LAM can be used temporarily while a breastfeeding woman decides what other method of contraception to use.
9/18/2018
FP, Dr. Amina Rashad

15. Disadvantages of LAM
Full or nearly full breastfeeding may be difficult for some women to maintain due to social circumstances
No STI or HIV protection
Duration of method is limited
LAM is a temporary method that can only be used by breastfeeding women
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FP, Dr. Amina Rashad

16. Other Contraceptive Options for Breastfeeding Women
Use of contraceptive methods postpartum is based on what impact, if any, a method may have on lactation, breast milk and infant health.
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FP, Dr. Amina Rashad

17. Methods that can be started immediately postpartum:
Non-hormonal methods
IUDs
Barrier methods
Female sterilization (if there is a medical indication )
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FP, Dr. Amina Rashad

18. Methods that can be stared 6 weeks postpartum:
Progestin-only pills (POPs)
Progestin-only Injectables (DMPA, NET-EN)
Subdermal implants ( Norplant )
Hormonal IUS
9/18/2018
FP, Dr. Amina Rashad

19. Methods that can be started 6 months postpartum: Methods containing Estrogen
Combined oral contraceptives (COCs)
Combined monthly injectables
9/18/2018
FP, Dr. Amina Rashad

20. Other Non-Hormonal Methods Periodic Abstinence
Periodic abstinence involves abstaining from intercourse during a woman’s fertile phase of the menstrual cycle. A woman uses various signs to identify when she is fertile and during this time abstains from sexual intercourse:
9/18/2018
FP, Dr. Amina Rashad

21. Advantages of periodic Abstinence
User-controlled
Readily available
Safe and free from side effects
Requires skills and motivation
Signs of fertility may not be reliable
Requires partner’s cooperation to abstain
No STI/HIV protection
Relatively high failure rates
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FP, Dr. Amina Rashad

22. Withdrawal
Also known as coitus interrupts, it requires removing the penis from the vagina before ejaculation so as to prevent contact between sperm and the egg.
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FP, Dr. Amina Rashad

23. Characteristics of Withdrawal
Contraceptive efficacy is similar to that of barrier methods, with pregnancy rates of about 4% for perfect use and at least 19% for typical use during the first year
Correct and consistent use requires self-control
Probably provides no protection from STIs/HIV
9/18/2018
FP, Dr. Amina Rashad

24. Combined Oral Contraceptives (COCs) Progestin-only pills (POPs)
Types of oral contraceptives (Ocs)
Combined Oral Contraceptives (COCs)
Progestin-only pills (POPs)
Most widely used
Contain both estrogen and progestin.
Estrogen content is 0.03 mg or less
(Note: COCs with higher estrogen content of mg can be used for emergency contraception-see pages )
Contain no estrogen
The amount of progestin is less than in COCs
Especially suitable for breastfeeding women
9/18/2018
FP, Dr. Amina Rashad

25. Mechanisms Of Action Of Oral Contraceptives
Suppression of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) responsible for follicle development and ovulation (primary mechanism for COCs, secondary for POPs)
Thickening of cervical mucus, making it difficult for sperm to enter the uterine cavity (primary mechanism for POPs, secondary for POPs)
9/18/2018
FP, Dr. Amina Rashad

26. Advantages of oral contraceptives
Safe and effective: when used correctly and consistently, pregnancy prevention rate is greater than 99% (with COCs)
Reversible, rapid return to fertility
No action needed at the time of sexual intercourse
Serious complications are extremely rare
Beneficial health effects other than contraception
Use is controlled by the woman
9/18/2018
FP, Dr. Amina Rashad

27. Disadvantages of Oral Contraceptives
Incorrect use is common not as effective in typed
Require daily use
Side effects are common
May pose health risks for a small number of women
Re-supply required
Offer no protection against sexually transmitted infections (STIs), including HIV
9/18/2018
FP, Dr. Amina Rashad

28. Side Effects of Oral Contraceptives
Combined Oral Contraceptives
Progestin-only Pills
Nausea
Dizziness
Breast tenderness
Headaches
Mood changes
Weight gain
Breakthrough bleeding
Irregular bleeding (when not breastfeeding)
Amenorrhea
Other side effects are similar to those of COCs, but less common
9/18/2018
FP, Dr. Amina Rashad

29. Non-contraceptive Health Benefits of Oral Contraceptives
Combined Oral Contraceptives
Progestin-only pills
Reduced risk of ovarian and endometrial cancer
Reduced risk of benign breast disease
Reduced risk of ectopic pregnancy
Reduced menstrual irregularities
Reduced risk of anemia
Reduced symptoms of painful menses, dysmenorrhea, endometriosis, premenstrual syndrome and pelvic inflammatory disease
Thought to have some of the non-contraceptive health benefits as in COCs
9/18/2018
FP, Dr. Amina Rashad

30. Adverse Effects of Oral Contraceptives
Combined Oral Contraceptives
Progestin-only Pills
Increased risk in certain subgroups of women for cardiovascular complications, such as thrombosis and stroke
No overall increase in the risk of breast cancer among women who have ever used COCs however, a slightly increased risk of breast cancer in current users, possibly due to a detection bias
Small increase in the risk of cervical cancer, possibly due to other factors, such as smoking or multiple sexual partners, or detection bias
No known adverse effects
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FP, Dr. Amina Rashad

31. How To Take COCs Initiating
During the first 7 days of menstrual cycle, preferable on the first day
Anytime the provider is reasonably sure woman is not pregnant
For non-breastfeeding women postpartum-delay until 3 weeks after childbirth
For breastfeeding women postpartum-delay until 6 months after childbirth or until breastfeeding is discontinued
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FP, Dr. Amina Rashad

32. Schedule
Take I pill every day until all pills in the pack are finished
7- day break between packs (for standard 21-pill packs)
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FP, Dr. Amina Rashad

33. How to Take POPs Initiating
Postpartum breastfeeding women – delay 6 weeks
Postpartum non-breastfeeding women – can start immediately
Other women
Preferably first 5 days of menstrual cycle
Anytime provider is reasonably sure that woman is not pregnant
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FP, Dr. Amina Rashad

34. Schedule Take I pill each day
Take within 3 hours of the same time each day (preferably the same time)
No break between packs
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FP, Dr. Amina Rashad

35. Missed Pill Regimen Take most recently missed pill as soon as possible
If not breastfeeding, abstain from sex or use backup method for 48 hours
Take next pll at regular time
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FP, Dr. Amina Rashad

36. Key counseling Topics for Oral Contraceptive Users
Safety and efficacy
How oral contraceptives work
Advantages and disadvantages
Possible side effects and warning symptoms
How to take pills and what to do when pills are missed
How to obtain and use backup methods and emergency contraception
No protection from STIs, including HIV
9/18/2018
FP, Dr. Amina Rashad

37. INJECTABLE CONTRACEPTIVES Types of Injectable contraceptives
Product
Duration of protection from pregnancy
Progestin-only Injectables
DMPA
(Depot-medroxyprogesterone acetate)
3 months
NET-EN
(Norethisterone enanthate)
2 months
Combined Injectables
Mesygyna
50mg DMPA+ 5mg estradiol valerate
Cyclofem
25mg DMPA+ 5mg estradiol cypionate
1 month
9/18/2018
FP, Dr. Amina Rashad

38. Mechanisms of action of Injectables
Suppression of follicle-stimulating hormone (FSH) and luteinizing hormone(LH) responsible for follicle development and ovulation.
Thickening of cervical mucus, making it difficult for sperm to enter the uterine cavity.
9/18/2018
FP, Dr. Amina Rashad

39. Advantages of Injectable Contraceptives
Progestin-only Injectables
Cmbined Injectables
Safe and highly effective (more than 99%)
Long-acting, but reversible can be discontinued without provider’s help
Require no effect on action at the time of intercourse
Have no effect on lactation and can be used by breastfeeding women
Offer non-contraceptive health benefits
Reversible, can be discontinued without provider’s help
Cause less menstural disturbances than progestin-only injectables
Require no action at the time of intercourse
9/18/2018
FP, Dr. Amina Rashad

40. Disadvantages of Injectable Contraceptives
Progestin-only Injectables
Combined Injectables
Side effects are common, specially menstrual changes in the form of amenorrhea or irregular bleeding
Contraceptive effect and side effects cannot be stopped immediately
Return to fertility after discontinuation is usually delayed. It takes an average of 9 months for a woman to achieve pregnancy after last injection
No ST/HIV protection
Side effects occur:
Bleeding changes are common, although less than with progestin-only injectables
Estrogen-related side effects include
headaches, dizziness and breast tenderness
Contraceptive effects and side effects cannot be stopped immediately
9/18/2018
FP, Dr. Amina Rashad

41. Side Effects Of Injectables
Menstrual changes ( more common for progestin-only injectables than for combined injectables):
Irregular bleeding or spotting
Prolonged or heavy bleeding
Amenorrhea
Weight gain (more common for progestin-only injectbles)
Less common side effects include headaches, dizziness, breast tenderness and mood changes
9/18/2018
FP, Dr. Amina Rashad

42. Non-contraceptive Health Benefits of Progestin-only Injectables
Reduced risk of:
endometrial cancer and possibly ovarian cancer
ectopic pregnancy
vaginal yeast infection
acute PID
fibroids
Reduced frequency and severity of sickle-cell disease crises
Reduced symptoms of endometriosis
9/18/2018
FP, Dr. Amina Rashad