Family Planning And Contraception.pdf

Family Planning and Contraception

What is family planning? • The use of contraception to control the frequency and timing of pregnancies Family planning originated to provide help and advice with planning and birth control

What is contraception? The prevention of conception or pregnancy development

Classification of contraception Reversible

Permanent









male sterilization
female sterilization

Natural methods Hormonal contraception Barriers methods Intrauterine devices IUDs Emergency contraception

BEHAVIORAL METHODS (natural method) 1. natural family planning 2. lactation

Natural family planning


Abstaining from intercourse during fertile period of the month. Fertile period is calculated by various techniques: --Changes in basal body temp, -- changes in cervical mucus; --changes in the cervix; -- multiple indices Failure rates are quite high. 20% per year




Lactational amenorrhea method (LAM) is used by fully breastfeeding mothers


During the first 6 months of infant life, full breastfeeding gives more than 98% contraceptive protection.

Lactation • Its based on the physiological effect of suckling to suppress ovulation • To be a successful Contraception there should be: – exclusive breastfeeding for the first 6 months without any Addition – no menstrual period

Hormonal contraception Available in 3 forms: • Oral contraception • Injectable • Implant

Oral contraception • Pills is tablet contain female hormones • 100 millions women use this method world wide • Available in 2 forms: – Combined oral contraception – Mini pills

Combined Oral Contraceptives (COP)
The most extensively used method
Contains synthetic estrogen + synthetic progesterone derivatives
Pills package contains 21 active pills + 7 placebo OR pill free interval
Each pill contains 20-30 ug of ethinyl estradiol + 1 mg 19 – nor testosterone
The women started to take her first pill on the first day of her menses to 21 day then take 7 placebo
The menses occur during placebo period

Mini pills • Ideal women who like pill taking but cant take COC • Failure rate of POP is greater than that of COC • If POP fails , there is a slightly higher risk of ectopic pregnancy • Taken every day without a break ( for 28 days) • Particular indication include: breastfeeding, older age, • cardiovascular risk factors and diabetes • must be taken on same time of day  • • •

Mode of action Works mainly peripherally . Decreases sperm permeability by altering the cervical mucus. Reduces endometrial receptivity to implantation.

Injectable progestogens • 2 types :
Depot Medroxyprogesterone acetate (DepoProvera)
Morethisterone Enanthate

 Each injection of Depo-Provera lasts around 12-13 weeks (3m)  Norethisterone enanthate lasts for 8 weeks so it is not widely used

benefits of Depo-Provera:





slow release failure rate < 1% (0.5%) v. effective avoid 1st pass hepatic effect, patient will not have GI upset

Side effect of Depo-Provera :
Weight gain
Delay in return of fertility
Persistent menstrual irregularity (amenorrhea, oligomenorrhea )
Increase the risk of osteoporosis
functional ovarian cyst

Contraindications of Injectable Hormonal Agents:






Known/suspected pregnancy Undiagnosed vaginal bleeding Breast cancer Liver disease Note : prolonged use – increase in the side effects

Barrier methods of contraception :  Male Condoms  Female Barrier Female Condom

Male Condoms • Made of latex rubber • Cheap and available • Various sizes and shapes • Hypo allergic latex condom and plastic condoms are available • Used to prevent STDs • Emergency contraception if condom burst or slip off Benefits : • easy to use, to apply, cheap & available, doesn’t affect hormones of patient, male participant, and only contraception effective in protecting against STDs

Fail due to :  not applied in a right way  applied after a pre ejaculatory discharge  Rupture Drawbacks:  Interruption of coitus  Decreased sensation  may cause a latex sensitivity to a patient. Efficacy:
88 to 98%, depending on if used properly

Female Barrier :    

Diaphragm or Dutch cap is most commonly used Others include cervical caps & vault caps All used in conjunction spermicidal cream or gel Diaphragm should inserted immediately prior to intercourse and removed no earlier than 6 hrs later  Increase risk of UTI and vaginal irritation

Female Barrier Benefits :
can be used multiple intercourse.
female participant.

disadvantages :
expensive and not available
difficult to use
patient has to go to the Dr to insert them for Her (needs professional)
Time Limitation

doesn’t save from STD's because the patient Needs to use with them spermicidal ( injury to The vaginal mucosa, so it becomes more prone To STD's).

Intrauterine contraception:
Intrauterine device (IUD): small device which is placed into uterine cavity.
Two highly effective intrauterine contraceptives:
copper bearing IUD
Levonorgestrel-releasing IUD.







IUDs are safe, relatively inexpensive. Highly effective, failar rate for copper IUD (1-2) and for LNG-IUS(0.5). Should be performed by trained healthcare personnel A fine thread is left protruding from cervix into vagina so it can be removed by traction on this thread
Protect against intrauterine and ectopic pregnancy but if pregnancy occurs there is increase risk of ectopic

copper-bearing IUDs
Available in various shapes and sizes.
Licensed for between 3-5 years of use, possibly up to 10 years.
The more copper wire a device has, the more effective it is.
Some IUDs have silver cored copper for add efficacy. Mode of action of:
Copper-bearing IUDs work primarily by a toxic effect on sperm which prevent fertilization.
As all IUDs induce an inflammatory response on the endometrium which prevent implantation.

copper-bearing IUDs

Side effect of copper-bearing IUDs :
Increased menstrual bleeding.
Increased dysmenorrhoea.
Increased risk of pelvic infection in first few weeks.

Hormone-releasing IUDS -- levonorgestrel-releasing -- progesterone-releasing Mode of action of:
levonorgestrel-releasing IUS work locally on cervical mucus and endometrium hormonal effect: -- It thickens mucus in cervix, so it helps to stop sperm reaching the egg. --It make lining of uterus thin, making periods lighter and shorter.


As all IUDs induce an inflammatory response on the endometrium which prevent implantation.

Levonorgestrel-releasing intrauterine system Aadvantages
Highly effective (0.5).
Dramatic reduction in menstrual blood loss.
Protection aqainst pelvic inflammatory disease.

Disadvantages
Persistent spotting and irregular bleeding in first few months of use.
Progestogenic side effects, e.g. acne, breast tenderness.

Contraindication of IUDs :    

Previous PID Previous ectopic pregnancy Known malformation of uterus Copper allergy

Implants(implanon)
A single elastic rod inserted subdermally under local anesthesia into upper arm
Release progestogen etonogestrel
Lasts for 3 years
No genuine failure reported
A rapid return of fertility when it is removed.
Particularly useful for women who have difficulty remembering to take a pill and who want highly effective long-term contraception.
success rate good as sterilization (failure rate 1%)
the same mechanism, side effects and
Complications of progestogen but in low rate,

implanon

Emergency contraception : Contraception method that is used after intercourse has taken place and before implantation has occurred .  should be considered if : Unprotected intercourse has occurred Failure of barrier method COC has been forgotten

There are 2 types : 1- Hormonal emergency contraception
Levonorgestrel in a single dose of 1.5 mg
Has to be taken within 72 hrs of unprotected intercourse(2 doses should be taken 12h apart) and is more effective the earlier it is taken
No real contraindication
Not 100% effective
The precise mechanism of action is not known but probably involves disruptionof ovulation or corpus luteal function.

An IUD for emergency contraception
A copper bearing IUD
Effective up to 5 days following the anticipated day of ovulation
Can cover multiple episode of intercourse in the same menstrual cycle
IUD prevent implantation and copper ions exert an embryo toxic effect
Contraindication as any IUD
Hormonal releasing IUD has not shown to be effective for EC and should not be used

Characterized Family planning in Indonesia: • women in Indonesia first sexual intercourse occurs at time of marriage • average woman in Indonesia has become a mother or is pregnant by age 21. • More than one-fifth reproductive age women have had 4 children or more. • average family size in Indonesia is roughly 3 children. • Abortion is illegal in Indonesia and often performed under unsafe conditions. • Half of births occur 54 months afterprevious birth, up from a birth interval of 45 months in 1997.

Modern Contraceptive use in Indonesia

Source: Macro International Inc, 2009. MEASURE DHS STAT compiler. http://www.measuredhs.com, September 9 2009

Modern Contraceptive use by age in Indonesia

Source: Macro International Inc, 2009

Family planning has a direct influence on improving lives worldwide in two other ways • Enhanced national security – Family planning stabilizes society. • Optimize financial resources – Family planning saves dollars

Current Family Planning Efforts • The Indonesian National Family Planning Programme is implemented by government with involvement and participation community and private sectors. • The government aims to decrease TFR and make family planning an integral part of government policy. • Decentralized family planning programme, four years after other sectors, including health, but still centrally secures the budget for family planning. • new decentralization laws, 249 regencies and 65 municipalities will absorb responsibility for planning, financing and managing health and family planning programmes.

Challenges and Opportunities • Capacity to provide appropriate and high quality services • Decentralization and programming at different levels • Diversification in contraceptive methods used.