Transcript Document

Birth Control &
Family Planning
Remember
The total risks of
birth control are
much less than the
total risks of a
pregnancy!!
Types of Birth Control
 Hormonal
 Barrier
 IUD
 Methods
based on
information
 Permanent sterilization
Hormonal Methods
 Oral
Contraceptives
(Birth Control Pill)
 Injections (Depo-Provera)
 Implants (Norplant I & II)
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

How does the pill work?



Stops ovulation
Thins uterine lining
Thickens cervical mucus
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
Side-effects



Breast
tenderness
Nausea
Increase in
headaches



Moodiness
Weight change
Spotting
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
Depo-Provera
Birth control shot given once every
three months to prevent pregnancy
 99.7% effective preventing pregnancy
 No daily pills to remember

How does the shot work?
Stops ovulation
 Stops menstrual cycles!!
 Thickens cervical mucus

SIDE EFFECTS

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!
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
Norplant I


Six capsules
Five years
Norplant II
vs.


Two capsules
Three years
Norplant Implant
Norplant Considerations
Should be considered long term
birth control
 Requires no upkeep 
 Extremely effective in pregnancy
prevention > 99%

Emergency Contraception
Emergency contraception
pills can reduce the
chance of a pregnancy by
75% if taken within 72
hours of unprotected sex!
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)
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
BARRIER METHODS
Spermicides
 Male Condom
 Female Condom
 Diaphragm
 Cervical Cap

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

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
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)
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%

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
Reality  : The Female
Condom
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
DIAPHRAGM
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%
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
Copper T




vs..
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.
Progestasert





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.
STERILIZATION
Procedure performed on a man or
a woman permanently sterilizes
 Female = Tubal Ligation
 Male = Vasectomy

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
LAPAROSCOPY-’BAND-AID’
STERILIZATION
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

VASECTOMY
METHODS BASED ON
INFORMATION
Withdrawal
 Natural Family Planning
 Fertility Awareness Method
 Abstinence

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’
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
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

Reasons for abstaining
 Moral
or religious values
 Personal beliefs
 Medical reasons
 Not feeling ready for an
emotional, intimate
relationship
 Future plans
SOMETHING TO THINK ABOUT…
Couples who use no birth
control have a 85% chance
of a pregnancy within the
first year.
EXCELLENT REFERENCE SEE:
www.plannedparenthood.org/bc
Hatcher, Robert, MD
Contraceptive Technology ,17ed. (2001)
Quality in Family Planning
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.
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.
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
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.
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.
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.
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.
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.
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.
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.
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

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 socioeconomic status. FP services should be available
to people in their closest vicinity.
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.
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.
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.
Family Planning
Knowledge & Attitudes
Use of Family Planning
Exposure to Family Planning
Messages
Knowledge of contraceptive methods
Currently married women
96
92
95
All women
92
33
24
Any method
Any modern method
Percent of women age 15-49
Any traditional
Which modern methods are most
familiar to married women?
Male sterilization
Implants
Female sterilization
Monthly pill
Condom
IUD
47
54
64
77
79
83
Daily pill
90
Injectables
90
Percent of currently married women age 15-49
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%)
Do married women discuss
family planning with their husbands?
53
34
12
Never
Once or twice
Three or +
Percent of currently married women age 15-49 in the past year
What are couples’ attitudes toward
family planning?
Both approve
68
Both disapprove
6
One approves, other dissaproves
6
Husband's attitude unknown
Respondent unsure
11
9
Percent of women who report that they and their husband
approve or not of family planning
Family Planning
Knowledge & Attitudes
Use of Family Planning
Exposure to Family Planning
Messages
Use of contraception among
married women
Traditional
methods
Modern
methods
Any method
5
19
24
Percent of currently married women age 15-49
Does use of contraception vary
by a woman’s level of education?
No education
Primary
Secondary and +
35
23
23
19
19
16
Any method
Any modern method
Percent of currently married women age 15-49
Contraceptive use also varies
by residence
33% of urban women use any
method of family planning
compared to…
22% for their rural counterparts.
Women’s current use of modern
contraceptive methods
IUD
7%
Injectables
40%
Male condom
5%
Monthly pill
15%
Daily pill
24%
Other
modern
methods
1%
Female
sterilisation
8%
Source of supply for
contraceptive methods
Public sector
Private medical
Other private
Percent
70
65
57
44 47
44
38
37
27
18
13 17
5
Daily pill
Monthly pill Injectables
5
Condom
9
IUD*
*First source, limited to women who started using IUD since 1995
Intention to use
contraception
in the future
42
45
13
Intends to use
Does not intend
Unsure
Percent of currently married women who are not
using a contraceptive method
Preferred method of Contraception
for future use
34
26
15
nt
s
pl
a
Im
D
2
m
C
on
do
y
on
th
l
2
M
IU
ll
pi
ll
pi
ly
ai
D
In
je
ct
ab
le
s
4
Percent of currently married women who are not using a
contraceptive method, but who intend to use
Some reasons cited by
women for not intending
to use contraception
Health concerns
26%
Difficult to get pregnant
24%
Wants more children
10%
Opposed to family
9%
planning
Infrequent sex/no sex
8%
6%
Fear side effects
Currently married women who are not using a contraceptive method
Family Planning
Knowledge & Attitudes
Use of Family Planning
Exposure to Family Planning
Messages
From what source do
women hear family
planning messages?
From radio only
10%
From television
only
5%
From both
64%
NO MESSAGE
21%
For all women who heard a message about family planning
in the last few months preceding the interview
Does exposure to family
planning messages vary by
residence
and
education?
Residence
Urban
Rural
86%
78%
Education
None
Primary
Secondary+
70%
80%
92%
Does exposure to family planning
messages in the print media
vary by residence and education?
Residence
Urban
Rural
59%
36%
Education
None
Primary
Secondary+
28%
39%
62%
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
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