1. Family Planning 101: Key Concepts in Adolescent Health Care April 2010 Meera Beharry, MD Division of Adolescent Medicine University of Rochester Medical Center ACT for Youth Center of Excellence Cornell University Family Life Development Center Cornell University Cooperative Extension of New York City New York State Center for School Safety University of Rochester Medical Center Div. of Adolescent Medicine

2. Objectives Define family planning Describe methods of contraception Identify resources for adolescents

3. Family Planning The use of education and birth control to limit the number of offspring and the population of a country. American Heritage® New Dictionary of Cultural Literacy, 3rdEd, 2005 by Houghton Mifflin Company

4. Legal Issues Distributing information and counseling patients about contraception was illegal under federal and state laws. AP Margaret Sanger, 1914

5. US fertility rates: 1917-1997 and Key Family Planning Events MMWR, Dec 03, 1999 48(47);1073-1080 Birth Control Pills, IUD approved by FDA Timing of ovulation established Title X established

6. Myriad of Methods Ring Implant Diaphragm Injection (“shot”) Patch IUD Pills Condoms Abstinence Cap Spermicides

7. How do you choose?

8. Decision 1 Hormonal, Non-hormonal or both?

9. Non-Hormonal/Barrier Condoms

10. Non-Hormonal/Barrier Condoms Diaphragm Cervical Cap Diaphragm Cervical Cap Spermicide Spermicides

11. Non-Hormonal/Barrier Condoms Diaphragm Cervical Cap Copper IUD

12. Non-Hormonal/Barrier Condoms Diaphragm Cervical Cap Spermicide Copper IUD Abstinence 1 Period abstinence/fertility awareness 1 “Withdrawal”, coitus interruptus 1 Society for Adolescent Med., J Adolesc Health 2006;38:83–87

13. Hormonal Pill –Daily –Emergency (not recommended as a regular form of birth control)

14. Hormonal Pill Patch

15. Hormonal Pill Patch Injection

16. Hormonal Pill Patch Injection Ring

17. Hormonal Pill Patch Injection Ring Progesterone IUD IUD

18. Hormonal Pill Patch Injection Ring Progesterone IUD Implantable device

19. Advantages/Disadvantages

20. Non-Hormonal/Barrier Advantages No hormones Fewer or no medical contraindications* Can prevent STD Disadvantages Event based use Some need a doctor’s visit

21. Hormonal Advantages Not event dependent Additional health benefits –Menstrual symptoms –Acne –Lower cancer risk –Less blood loss Disadvantages Require use as prescribed Some medical contraindications

22. Quick Quiz Does a young woman need to have a pelvic exam before starting birth control?

23. NO!

24. Decision 2: if hormonal method Any contraindications?

25. W.H.O. Absolute Contraindications to Estrogen Containing Products Blood clotting problems Stroke Very high blood pressure Some cancers Some liver diseases Major surgery with prolonger immobilization Migraine headaches with aura http://whqlibdoc.who.int/hq/2008/WHO_RHR_08.19_eng.pdf

26. Decision 3: if hormonal method, How often do you take it?

27. How Often Do You Take It? MethodFrequency PillsEvery day

28. How Often Do You Take It? MethodFrequency PillsEvery day PatchOnce a week

29. How Often Do You Take It? MethodFrequency PillsEvery day PatchOnce a week RingOnce a month

30. How Often Do You Take It? MethodFrequency PillsEvery day PatchOnce a week RingOnce a month InjectionEvery 3 months*

31. How Often Do You Take It? MethodFrequency PillsEvery day PatchOnce a week RingOnce a month InjectionEvery 3 months* Implant (Implanon®)Every 3 years*

32. How Often Do You Take It? MethodFrequency PillsEvery day PatchOnce a week RingOnce a month InjectionEvery 3 months* ImplantEvery 3 years* IUDEvery 5 years*

33. Quick Quiz: Match the method

34. Match the Frequency & the Method FrequencyMatch ColumnsMethod a) Once a month 1-Implant b) Once a week 2-Injection c) Daily 3-IUD d) Every 3 months 4-Patch e) Every 5 years 5-Pills f) Every 3 years 6-Ring

35. Match the Frequency & the Method FrequencyCorrect AnswerMethod a) Once a month a-61-Implant b) Once a week b-42-Injection c) Daily c-53-IUD d) Every 3 months d-24-Patch e) Every 5 years e-35-Pills f) Every 3 years f-16-Ring

36. Emergency Contraception

37. What if…. …the condom broke or slipped off... …you forgot your regular birth control... …you were forced to have sex... Association of Reproductive Health Professionals

38. Emergency Contraception What is it? –A method for preventing implantation –A method for preventing fertilization There are three types available in the U.S.

39. Association of Reproductive Health Professionals

40. Emergency Contraception Pills What they are not: –They are not the “abortion pill” –They are not a form of family planning

41. Resources Internet: –http://youngwomenshealth.org/http://youngwomenshealth.org/ –www.plannedparenthood.orgwww.plannedparenthood.org –http://ec.princeton.edu/http://ec.princeton.edu/ Current health care provider –www.adolescenthealth.org Family Planning Benefit Program –www.nyhealth.gov/community/pregnancy/family _planning/program_sites.htm

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