Post on 29-Jul-2015
Birth Control & Birth Control & Family PlanningFamily Planning
Remember Remember The The total riskstotal risks of of birth control are birth control are
much much less thanless than the the total risks of a total risks of a pregnancy!!pregnancy!!
Types of Birth ControlTypes of Birth Control
HormonalHormonal BarrierBarrier IUDIUD Methods based on Methods based on
informationinformation Permanent sterilizationPermanent sterilization
Hormonal MethodsHormonal Methods
Oral Contraceptives Oral Contraceptives
(Birth Control Pill)(Birth Control Pill) Injections (Depo-Injections (Depo-
Provera)Provera) Implants (Norplant I & II)Implants (Norplant I & II)
Birth Control PillsBirth Control Pills
Pills can be taken to prevent Pills can be taken to prevent pregnancypregnancy
Pills are safe and effective when Pills are safe and effective when taken properlytaken properly
Pills are over 99% effectivePills are over 99% effective Women must have a pap smear to Women must have a pap smear to
get a prescription for birth control get a prescription for birth control pillspills
How does the pill work?How does the pill work?
Stops ovulationStops ovulation Thins uterine liningThins uterine lining Thickens cervical mucusThickens cervical mucus
Positive Benefits of Birth Control Positive Benefits of Birth Control PillsPills
Prevents Prevents pregnancypregnancy
Eases menstrual Eases menstrual crampscramps
Shortens periodShortens periodRegulates Regulates
periodperiod
Decreases Decreases incidence of incidence of ovarian cystsovarian cysts
Prevents Prevents ovarian and ovarian and uterine uterine cancercancer
Decreases Decreases acneacne
Side-effectsSide-effects
Breast Breast tendernesstenderness
NauseaNausea Increase in Increase in
headachesheadaches
MoodinessMoodiness Weight changeWeight change SpottingSpotting
Taking the PillTaking the Pill
Once a day at the Once a day at the same timesame time everydayeveryday
Use condoms for first monthUse condoms for first month Use condoms when on antibiotics Use condoms when on antibiotics Use condoms for 1 week if you miss Use condoms for 1 week if you miss
a pill or take one latea pill or take one late The pill offers The pill offers no protection from no protection from
STD’sSTD’s
Depo-ProveraDepo-Provera
Birth control shot given once every Birth control shot given once every three months to prevent pregnancythree months to prevent pregnancy
99.7% effective preventing pregnancy99.7% effective preventing pregnancy No daily pills to remember No daily pills to remember
How does the shot How does the shot work?work?
Stops ovulationStops ovulation Stops menstrual cycles!! Stops menstrual cycles!! Thickens cervical mucusThickens cervical mucus
SIDE EFFECTSSIDE EFFECTS
Extremely irregular menstrual bleeding Extremely irregular menstrual bleeding and spotting for 3-6 months!and spotting for 3-6 months!
NO PERIOD NO PERIOD after 3-6 months after 3-6 months Weight change Weight change Breast tendernessBreast tenderness Mood changeMood change
*NOT EVERY WOMAN HAS SIDE-EFFECTS!*NOT EVERY WOMAN HAS SIDE-EFFECTS!
IMPLANTSIMPLANTS
Implants are placed in the body Implants are placed in the body filled with hormone that prevents filled with hormone that prevents pregnancypregnancy
Physically inserted in simple 15 Physically inserted in simple 15 minute outpatient procedureminute outpatient procedure
Plastic capsules the size of paper Plastic capsules the size of paper matchsticks inserted under the skin matchsticks inserted under the skin in the armin the arm
99.95% effectiveness rate99.95% effectiveness rate
Norplant I Norplant I vs. vs. Norplant II Norplant II
Six capsulesSix capsules Five yearsFive years
Two capsulesTwo capsules Three yearsThree years
Norplant ImplantNorplant Implant
Norplant Norplant ConsiderationsConsiderations
Should be considered long Should be considered long term birth control term birth control
Requires no upkeep Requires no upkeep Extremely effective in Extremely effective in
pregnancy prevention > 99%pregnancy prevention > 99%
Emergency Emergency contraception pills can contraception pills can reduce the chance of a reduce the chance of a pregnancy pregnancy by 75%by 75% if if
taken taken within 72within 72 hours hours of unprotected sex!of unprotected sex!
Emergency ContraceptionEmergency Contraception
Emergency Contraception Emergency Contraception (ECP)(ECP)
Must be taken within 72 hours of Must be taken within 72 hours of the act of unprotected intercourse the act of unprotected intercourse or failure of contraception methodor failure of contraception method
Must receive ECP from a physicianMust receive ECP from a physician 75 – 84% effective in reducing 75 – 84% effective in reducing
pregnancypregnancy California pharmacies can prescribe California pharmacies can prescribe
without a doctor! (1/1/02)without a doctor! (1/1/02)
ECPECP
Floods the ovaries with high amount of Floods the ovaries with high amount of hormone and prevents ovulationhormone and prevents ovulation
Alters the environment of the uterus, Alters the environment of the uterus, making it disruptive to the egg and spermmaking it disruptive to the egg and sperm
Two sets of pills taken exactly 12 Two sets of pills taken exactly 12 hours aparthours apart
BARRIER METHODSBARRIER METHODS
SpermicidesSpermicides Male CondomMale Condom Female CondomFemale Condom DiaphragmDiaphragm Cervical CapCervical Cap
BARRIER METHODBARRIER METHOD
Prevents pregnancy blocks the Prevents pregnancy blocks the egg and sperm from meeting egg and sperm from meeting
Barrier methods have higher Barrier methods have higher failure rates than hormonal failure rates than hormonal methods due to design and methods due to design and human errorhuman error
SPERMICIDESSPERMICIDES Chemicals kill sperm in the vaginaChemicals kill sperm in the vagina Different forms:Different forms:
--JellyJelly -Film-Film
-Foam-Foam --SuppositorySuppository Some work instantly, others Some work instantly, others
require pre-insertionrequire pre-insertion Only 76% effective (used alone), Only 76% effective (used alone),
should be used in combination with should be used in combination with another method i.e., condomsanother method i.e., condoms
MALE CONDOMMALE CONDOM
• Most common and effective barrier Most common and effective barrier method when used properlymethod when used properly
• Latex and Polyurethane should Latex and Polyurethane should only be used in the prevention of only be used in the prevention of pregnancy and spread of STI’s pregnancy and spread of STI’s (including HIV)(including HIV)
MALE CONDOMMALE CONDOM
Perfect effectiveness rate = Perfect effectiveness rate = 97%97%
Typical effectiveness rate = Typical effectiveness rate = 88%88%
Latex and polyurethane Latex and polyurethane condoms are availablecondoms are available
Combining condoms with Combining condoms with spermicides raises effectiveness spermicides raises effectiveness levels to 99%levels to 99%
FEMALE CONDOMFEMALE CONDOM
Made as an alternative to male Made as an alternative to male condomscondoms
PolyurethanePolyurethane Physically inserted in the vaginaPhysically inserted in the vagina Perfect rate = 95%Perfect rate = 95% Typical rate = 79%Typical rate = 79% Woman can use female condom if Woman can use female condom if
partner refusespartner refuses
Reality Reality : The Female : The Female CondomCondom
DIAPRAGHMDIAPRAGHM
Perfect Effectiveness Rate = 94%Perfect Effectiveness Rate = 94% Typical Effectiveness Rate = 80%Typical Effectiveness Rate = 80% Latex barrier placed inside vagina Latex barrier placed inside vagina
during intercourseduring intercourse Fitted by physicianFitted by physician Spermicidal jelly before insertionSpermicidal jelly before insertion Inserted up to 18 hours before Inserted up to 18 hours before
intercourse and can be left in for a intercourse and can be left in for a total of 24 hourstotal of 24 hours
DIAPHRAGM DIAPHRAGM
CERVICAL CAPCERVICAL CAP
Latex barrier inserted in vagina before Latex barrier inserted in vagina before intercourseintercourse
““Caps” around cervix with suctionCaps” around cervix with suction Fill with spermicidal jelly prior to useFill with spermicidal jelly prior to use Can be left in body for up to a total of Can be left in body for up to a total of
48 hours 48 hours Must be left in place six hours after Must be left in place six hours after
sexual intercoursesexual intercourse Perfect effectiveness rate = 91%Perfect effectiveness rate = 91% Typical effectiveness rate = 80%Typical effectiveness rate = 80%
INTRAUTERINE DEVICES INTRAUTERINE DEVICES (IUD)(IUD)
T-shaped object placed in the T-shaped object placed in the uterus to prevent pregnancyuterus to prevent pregnancy
Must be on period during insertionMust be on period during insertion A Natural childbirth required to useA Natural childbirth required to use
IUD IUD Extremely effective without using Extremely effective without using
hormones > 97 %hormones > 97 % Must be in monogamous Must be in monogamous
relationshiprelationship
Copper T Copper T vs.. vs..
ProgestasertProgestasert 10 years10 years 99.2 % effective99.2 % effective Copper on IUD acts Copper on IUD acts
as spermicide, IUD as spermicide, IUD blocks egg from blocks egg from implantingimplanting
Must check string Must check string before sex and before sex and after shedding of after shedding of uterine lining.uterine lining.
1 year1 year 98% effective98% effective T shaped plastic T shaped plastic
that releases that releases hormones over a hormones over a one year time frameone year time frame
Thickens mucus, Thickens mucus, blocking eggblocking egg
Check string before Check string before sex & after sex & after shedding of uterine shedding of uterine lining.lining.
STERILIZATIONSTERILIZATION
Procedure performed on a man Procedure performed on a man or a woman or a woman permanentlypermanently sterilizessterilizes
Female = Tubal LigationFemale = Tubal Ligation Male = VasectomyMale = Vasectomy
TUBAL LIGATIONTUBAL LIGATION
Surgical procedure performed on a Surgical procedure performed on a womanwoman
Fallopian tubes are cut, tied, Fallopian tubes are cut, tied, cauterized, prevents eggs from cauterized, prevents eggs from reaching spermreaching sperm
Failure rates vary by procedure, Failure rates vary by procedure, from 0.8%-3.7%from 0.8%-3.7%
May experience heavier periodsMay experience heavier periods
LAPAROSCOPY-’BAND-AID’ LAPAROSCOPY-’BAND-AID’ STERILIZATIONSTERILIZATION
VASECTOMYVASECTOMY
Male sterilization procedureMale sterilization procedure Ligation of Vas Deferens tubeLigation of Vas Deferens tube No-scalpel technique availableNo-scalpel technique available Faster and easier recovery Faster and easier recovery
than a tubal ligationthan a tubal ligation Failure rate = 0.1%, more Failure rate = 0.1%, more
effectiveeffective than female than female sterilizationsterilization
VASECTOMYVASECTOMY
METHODS BASED ON METHODS BASED ON INFORMATIONINFORMATION
WithdrawalWithdrawal Natural Family PlanningNatural Family Planning Fertility Awareness MethodFertility Awareness Method AbstinenceAbstinence
WITHDRAWALWITHDRAWAL
Removal of penis from the vagina Removal of penis from the vagina beforebefore ejaculation occurs ejaculation occurs
NOTNOT a sufficient method of birth a sufficient method of birth control by itselfcontrol by itself
Effectiveness rate is 80% (very Effectiveness rate is 80% (very unpredictable in teens, wide variation)unpredictable in teens, wide variation)
1 of 51 of 5 women practicing withdrawal women practicing withdrawal become pregnantbecome pregnant
Very difficult for a male to ‘control’ Very difficult for a male to ‘control’
Natural Family Planning & Natural Family Planning & Fertility Awareness MethodFertility Awareness Method Women take a class on the menstrual cycle Women take a class on the menstrual cycle
to calculate to calculate moremore fertilefertile times times Requires special equipment and cannot be Requires special equipment and cannot be
self-taughtself-taught NFP abstains from sex during the NFP abstains from sex during the
calculated fertile timecalculated fertile time FAM uses barrier methods during fertile FAM uses barrier methods during fertile
timetime Perfect effectiveness rate = 91%Perfect effectiveness rate = 91% Typical effectiveness rate = 75%Typical effectiveness rate = 75% No 100% safe dayNo 100% safe day-irregular periods -irregular periods
AbstinenceAbstinence
Only 100% method of birth Only 100% method of birth control control
Abstinence is when partners do Abstinence is when partners do not engage in sexual intercoursenot engage in sexual intercourse
Communication between Communication between partners is important for those partners is important for those practicing abstinence to be practicing abstinence to be successfulsuccessful
Reasons for abstainingReasons for abstaining
Moral or religious valuesMoral or religious values Personal beliefsPersonal beliefs Medical reasonsMedical reasons Not feeling ready for an Not feeling ready for an
emotional, intimate emotional, intimate relationshiprelationship
Future plansFuture plans
SOMETHING TO THINK ABOUT…SOMETHING TO THINK ABOUT…
Couples who use no birth Couples who use no birth control have a 85% control have a 85% chance of a pregnancy chance of a pregnancy within the first year.within the first year.
EXCELLENT REFERENCE EXCELLENT REFERENCE SEE:SEE:
www.plannedparenthood.org/www.plannedparenthood.org/bc bc Hatcher, Robert, MD Hatcher, Robert, MD
Contraceptive TechnologyContraceptive Technology ,17ed. (2001) ,17ed. (2001)
Quality in Family PlanningQuality in Family Planning
QualityQualityQuality 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 & ObjectivesAims & ObjectivesIn 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’ Elements of ‘Quality of Care’ in in
family planningfamily planning
Choice of method Interpersonal communication (verbal &
non verbal) Technical Competence Information Follow-up Appropriate constellation of services
By Judith Bruce, 1990
Choice of methodChoice 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 Good interpersonal communication (verbal & non verbal)(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 CompetenceTechnical 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.
InformationInformation
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-upFollow-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 Appropriate constellation of servicesservices
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.
IndicatorsIndicatorsQUALITY OF CAREQUALITY 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 GATHER Approach to CounselingApproach 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 scheduled
Rights of ClientsRights 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 socio-economic status. FP services should be available to people in their closest vicinity.
Rights of Clients Rights of Clients (cont.)(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 needsProvider’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 Provider’s needs (cont.)(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.
Knowledge & AttitudesKnowledge & Attitudes
Use of Family PlanningUse of Family Planning
Exposure to Family Planning Exposure to Family Planning MessagesMessages
Family Planning
Knowledge of contraceptive Knowledge of contraceptive methodsmethods
96 95
33
92 92
24
Any method Any modern method Any traditional
Currently married women All women
Percent of women age 15-49
Which modern methods are Which modern methods are mostmost
familiar to married women?familiar to married women?
90
90
83
79
77
64
54
47
Injectables
Daily pill
IUD
Condom
Monthly pill
Female sterilization
Implants
Male sterilization
Percent of currently married women age 15-49
Does knowledge of any modern Does knowledge of any modern methodmethod
vary by residence, region and vary by residence, region and education?education?
• Women with no education (91%) know slightly less about modern methods than educated women (98%)
• No urban-rural difference
Do married women discuss Do married women discuss family planning with their husbands?family planning with their husbands?
34
53
12
Never Once or twice Three or +Percent of currently married women age 15-49 in the past year
What are couples’ attitudes What are couples’ attitudes toward toward
family planningfamily planning??
9
11
6
6
68
Respondent unsure
Husband's attitude unknown
One approves, other dissaproves
Both disapprove
Both approve
Percent of women who report that they and their husband approve or not of family planning
Knowledge & AttitudesKnowledge & Attitudes
Use of Family PlanningUse of Family Planning
Exposure to Family Planning Exposure to Family Planning MessagesMessages
Family Planning
Use of contraception Use of contraception amongamong
married women married women
24
19
5
Any method
Modernmethods
Traditionalmethods
Percent of currently married women age 15-49
Does use of contraception Does use of contraception vary vary
by a woman’s level of by a woman’s level of education?education?
Percent of currently married women age 15-49
1916
2319
35
23
Any method Any modern method
No education Primary Secondary and +
Contraceptive use also Contraceptive use also varies by residencevaries by residence
33% of urban women use any 33% of urban women use any method of family planning method of family planning
compared to…compared to…
22% for their rural 22% for their rural counterpartscounterparts..
Other modern methods
1%
Female sterilisation
8%
Male condom5%
Injectables40%
IUD7%
Monthly pill15%
Daily pill24%
Women’s current use of modern contraceptive methods
Source of supply forSource of supply forcontraceptive methodscontraceptive methods
38
13
57
27
44
18 17
37
5
4744
70
5
65
9
Daily pill Monthly pill Injectables Condom IUD*
Public sector Private medical Other private
Percent
*First source, limited to women who started using IUD since 1995
Intention to use Intention to use contraceptioncontraceptionin the futurein the future
4245
13
Intends to use Does not intend Unsure
Percent of currently married women who are not using a contraceptive method
Preferred method of ContraceptionPreferred method of Contraceptionfor future usefor future use
34
26
15
4 2 2
Percent of currently married women who are not using a contraceptive method, but who intend to use
Some reasons cited by Some reasons cited by women for not women for not
intending to use intending to use contraceptioncontraception
Health concernsHealth concerns
Difficult to get pregnantDifficult to get pregnant
Wants more childrenWants more children
Opposed to family Opposed to family
planningplanning
Infrequent sex/no sexInfrequent sex/no sex
Fear side effectsFear side effects
26%
24%
10%
9%
8%
6%
Currently married women who are not using a contraceptive method
Knowledge & AttitudesKnowledge & Attitudes
Use of Family PlanningUse of Family Planning
Exposure to Family Planning Exposure to Family Planning MessagesMessages
Family Planning
From what source do From what source do women hear family women hear family planning messages?planning messages?
From radio onlyFrom radio only
From television From television onlyonly
From bothFrom both
NO MESSAGENO MESSAGEFor all women who heard a message about family planning
in the last few months preceding the interview
10%
5%
64%
21%
ResidenceUrbanUrban 86%86%RuralRural 78%78%
EducationNoneNone 70%70%PrimaryPrimary 80%80%Secondary+Secondary+ 92%92%
Does exposure to family Does exposure to family planning messages vary by planning messages vary by residence and residence and
education?education?
ResidenceUrbanUrban 59%59%RuralRural 36%36%
EducationNoneNone 28%28%PrimaryPrimary 39%39%Secondary+Secondary+ 62%62%
Does exposure to family planning messages in the print media
vary by residence and education?
Main findingsMain 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 findingsMain 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