1. Family Planning Women’s Health Training Day 2014

2. Outline Contraceptive options – Barrier – Short-term hormonal options – Long-term options – Permanent – Other Pregnancy options – Continuing the pregnancy – Terminating pregnancy

3. Learning Objectives Become comfortable discussing family planning options with patients Advise patients according to their needs, including: – Lifestyle – Discretion – Adherence – Economic status – Personal values

4. Barrier methods Male condom Female condom Diaphragm Cervical Cap Sponge

5. Short-term options Oral contraceptives – progestin only – combined estrogen + progestin – combined triphasic Patch Nuva-ring Depo-provera Spermicide (non-hormonal)

6. Risks of hormonal therapy (pill, patch) General complaints: weight gain, breakthrough bleeding Estrogenic effects: nausea, breast tenderness, fluid retention, 3x risk of DVT Progestin effects: hair growth, male-pattern baldness, and nausea

7. Contraindications (estrogen + progestin methods)

8. Long-term options LARC = long-acting reversible contraceptive Implanon, Nexplanon (hormonal implant) Mirena, Skyla (hormonal IUD) ParaGuard (copper IUD)

9. Permanent options Vasectomy Tubal ligation (blocks fallopian tubes distally) Essure (blocks fallopian tubes proximally)

10. Methods that are free Fertility awareness (“rhythm method”) – Clue App for smartphone Withdrawal

11. Typical vs. Perfect use

12. Emergency contraception Plan B (Levonorgestrel-based pills) Ella ParaGuard Yuzpe Regimen (dependent on birth control pill)

13. How to distill the contraception options? bedsider.org

14. The user-experience

15. Pregnancy Options

16. Pregnancy Options Continuing pregnancy Parenting – Resources at http://www.usa.gov/Topics/Parents.shtml http://www.usa.gov/Topics/Parents.shtml Adoption – Resources at https://www.childwelfare.gov/adoption/ https://www.childwelfare.gov/adoption/

17. Pregnancy Options Terminating pregnancy Medical abortion (<8.4 weeks) – Two consecutive pills – Done at home – Pros include privacy, support, feeling “more natural” Procedural abortion – Options depend on how far along the pregnancy is – Done in the office – can be outpatient clinic – Pros include privacy, feeling “more taken care of”, over with faster

18. USA Abortion Facts 50% of pregnancies are unintended 21% of pregnancies end in abortion In 2011, 1.06 million abortions were performed, – This is down 13% from 1.21 million in 2008. – From 1973 through 2011, nearly 53 million legal abortions occurred.

20. By age 45… At least half of American women will experience an unintended pregnancy by age 45 At 2008 abortion rates: – one in 10 women will have an abortion by age 20 – one in four by age 30 – three in 10 by age 45

21. Abortion laws in GA Abortion must be provided by a licensed physician Prohibited after “viability” except in case of life or health endangerment “Partial birth abortion” (intact dilation & extraction) banned post-viability Public funds can only be used towards abortions in cases of life endangerment, rape, or incest

22. Providers and institutions may refuse to participate Mandatory counseling must include information on fetal pain, but not breast cancer risk or psychological distress risk Mandatory 24-hour waiting period (initial consult may be done via phone) Mandatory parental notice (not consent) Abortion laws in GA

23. References Guttmacher Institute Association of Reproductive Health Professionals (ARHP) www.bedsider.org Centers for Disease Control