Learning Objectives

• Know the difference between family planning

and contraception
• Counselling
• Overview of different methods
 INTRODUCTION
• Family planning for birth control and child spacing
is an important tool for improving maternal and
family health.

• Family planning is the ability of individual and

couples to anticipate and attain their desired
number of children as well as the spacing and
timing of their birth.
 INTRODUCTION CONTD
• It is achieved via use of contraceptive
methods and treatment of involuntary
infertility.
• Contraception is the deliberate use of various
methods, devices, agents, drugs, sexual
practise or surgical intervention to prevent
pregnancy.
 FAILURE RATE
The effectiveness of a contraceptive method
depends :
• How it works
• How well it is used by the woman ( perfect use)
• As it should be used ( Typical use)
The failure of a contraceptive method:
• User Failure
• Method Failure
 FAILURE RATE CONTD
• Failure of a method is the number of pregnancy that
will occur should 100 women use the method over a
period of one year.
• Failure rate is due to 2 reasons
-Pregnancy rate with perfect
use.
-Pregnancy rate with typical use.
 PEARL INDEX
• The number of pregnancy during
the use of the method in a year
divided by the number of women
years of exposure to the risk of
pregnancy while using the
method.
 GENERAL COUNSELING
• Find out what she knows and if she has
previously used any method.
• Evaluate her risk for STIs including HIV/AIDS.
• Explore her reproductive wish.
• Exclude methods that are not appropriate for
her.
• Provide general information on each available
method using visual aid.
 GENERAL COUNSELING CONTD

• Encourage her asking question and

clarify any myths she may have.
• Ask her the method that appeals to
her.
• Help her make informed choice. Do
not influence or impose any method
on her.
 CHOICE – SPECIFIC COUNSELING
• Use plain language and terms she understands.
• Obtain gynaecological and medical history to
determine eligibity using WHO 2015 medical
eligibility criteria wheel.

• Physical examination that is appropriate for

method chosen to further confirm eligibility.
• Ensure no contraindication to her choice. Assist her
change to another suitable method if there is/are.
 CHOICE – SPECIFI C COUNSELING CONTD

• Provide more detailed information on the chosen

method , as well as benefits and side effects.
• Offer the method chosen.
• Educate her on prevention of STI in a non-
judgemental manner.
• Ask her to repeat given instruction to be sure she
understands.
• Provide emotional support and encourage her to
ask questions or express her concern.
 CHOICE – SPECIFIC COUNSELLING CONTD

• Schedule a follow up visit. Can still

return before visit if need be.
• Record relevant information
• Thank her.
 FOLLOW UP COUNSELLING
• Confirm the purpose of visit.
• Review her record.
• Is she satisfied with the method & still using it?
• Evaluate any change in her health status to know if
she needs to change the method.
• Give reassurance on any side effects, treat if
necessary.
• Does she have any question or concern? If yes,
respond accordingly.
 FOLLOW UP COUNSELLING CONTD
• Do necessary physical examination.
• Give contraceptive choice if due.
• Schedule return visit as necessary.
 OVERVIEW OF CONTRACEPTIVE METHODS
Combined Hormonal Contraceptive
• Combined oral contraceptive pill (COCP)
• Transdermal patch
• Vaginal ring
Progestogen – only contraceptive
• Progestogen - only pill ( Mini pill)
• Injectable progestogen
• Implants (LARC)
• Progestogen releasing IUS/ Mirena ( LARC).
IUCD ( The Loop or Coil ) also LARC

• 0
 OVERVIEW CONTRACEPTIVE METHODS
CONTD
Barrier method
• Male condom
• Female condom
• Diaphragm
• Cervical cap
Spermicides
Sterilization method
• Male ( Vasectomy)
• Female ( Tubal Ligation , Tubal Occlusion)
 OVER VIEW CONTRACEPTIVE METHODS
CONTD
Natural Method
• Calendar / Rhythm method
• Cervical Mucus / Billing method
• Basal Body Temperature ( BBT) method
• Lactational amenorrhoea method.
• Coitus interruptus
Emergency contraceptive
• Hormonal method
i. Levonorgestrel (1.5mg)
ii. Two dose levonorgestrel – 0.75mg ( Postinor)
iii. Ulipristal acetate
iv. Yuzpe regimen.
 OVERVIEW CONTRACEPTIVE METHODES
CONTD

Emergency Method CONTD

• IUCD
 COMBINED HORMONAL CONTRACEPTIVE

• Contain estrogens and progesterone.

• Mode of action, side effects and risks are similar
regardless of route of administration.
• Mechanism of action.
i. Inhibition of ovulation.
ii. Thickening of cervical mucus.
ADVANTAGES
• Effective
• Prompt return of fertility.
• Contraceptive effect is unrelated to coitus.
 NON CONTRACEPTIVE BENFITS
• Regular lighter menses
• Less dysmenorrhoea.
• Reduction or cessation of mid cycle pain.
• Treatment of endometriosis.
• Improve premenstratual syndrome.
• Used to rectify irregular menses.
• Decreases risk of benign breast lumps.
• Reduces risks of some Cancers ( ovary ,
endometrium).
 NON CENTRACEPTIVE BENEFITS CONTD

• Diminishes risk of anaemia.

• Decreases risks of PID.
• Some cases of Menorrhagia.
• Protects against loss of bone density.
• Decreases progression of Rheumatoid
arthritis.
 DISADVANTAGES
• Increases risk of Ca Cervix.
• Increases risk of breast Ca.
• May cause breakthrough bleeding.
 PROGESTOGEN ONLY CONTRACEPTIVE

• Contain only progesterone.

• Does not have the side effects and risks of
estrogens.
• Thus safer than combined hormonal
compounds.
• Have wide range of delivery system.
• Have short and long acting types.
 PROGESTOGEN ONLY CONTYRACEPTIVE
CONTD
• Mechanism of action:
-Thickens cervical mucus
-Thinning and atrophy of endometrium.
-May prevent ovulation.
• Very effective, however, mini pills has the
highest failure rate.
 ADVANTAGES
• Very safe
• Can be used where estrogens is contraindicated.
• Can be used by breastfeeding mothers, women with
hypertension, SCD, DM, Thromboembolic dz and
migraine.
• Decreases menses, dysmenorrhoea, and ovulation
pain.
• Protects against Ca endometrium.
• Not related to coitus.
• Quick return to fertility.
 DISADVANTAGES
• No protection against STI.
• May be stressful to take e.g. mini pill.
• May delay return to fertility e.g. Depo-
Provera.
 SIDE EFFECTS
• Depression
• Mood changes
• Weight gain / bloating
• Breast tenderness
• Acne
• Unpredictable bleeding / spotting.
• Amenorrhoea ( may be worrisome).
 CONTRA INDICATION
ABSOLUTE
• History of breast Ca.
• Post partum sepsis or septic abortion ( for IUS only)
RELATIVE
• CVA
• Liver tumour
• Cirrhosis
• Ischaemic heart disease
• APA syndrome
• Severe Thrombocytopenia