• A way of thinking & living that is adapted voluntarily, upon the basis of the knowledge, attitudes & responsible decisions by individuals & couples, in order to promote the health & welfare of the family group & thus contribute effectively to the social devlopment of the country.

Spacing methods

• Barrier methodPhysical method

Chemical method

Combined method

• IUD

• Hormonal method

• Post-conceptional method

• miscellaneous

Male sterilization

Female sterilization

Terminal methods

Barrier methods

PHYSICAL METHODS

• Condom

• Nirodh

• + spermicidal jelly

• PR- 2to3/100

Advantages• Availability• Safe• Inexpensive• No supervision• No side effects• Compact &

disposable• Against STDs

Disadvantages• Slip off or tear• Interferes - sensation

• Polyurethane

• 2 rings

• Silicon

• High cost & acceptibility are the major problems

• 5/100

2.Diaphragm

• Of proper size should

be used.

• Held in position

• Atleast for 6hrs

• Always spermicidal jelly

• 6-12/100

• TSS

3.Vaginal sponge

• Vinegar/ olive oil

• TODAY

• Saturated with nonoxynol-9

• 20-40/100

Chemical methods

• Foams: foam tablets , foam aerosols

• Creams, jellies and pastes

• suppositories

• Soluble films

• The spermicides contain a base into which spermicide is incorporated

drawbacks

• High failure rates

• Repeated before each act

• Burning and irritation

IUD’s

• First generation

Lippes loop

Plastic material

Barium sulphate

Fine nylon tape

A,B,C & D

• Second generation

Earlier device• Copper 7• Copper T 200

Newer device• Variants of T device

1. T Cu-220 C

2. T Cu 380 A or Ag

3rd generation

Progestasert• 65mcg dialy

LNG-20[mirena]• 20mcg levonorgestrel• 0.2/100• MOA

Advantages

• Simplicity

• Time taken

• Stays long

• Inexpensive

• Reversible

• Motivation

contraindications

Absolute• Pregnancy• PID• U D vaginal bleeding• Carcinoma• Ectopic pregnancy

Relative• Anaemia• Uterine distortions• Mennorhagia• Unmotivated• h/o PID

Timing of insertion

Side effects & complications

• Bleeding• Pain• PID• Uterine perforation• Pregnancy• Ectopic pregnancy• Expulsion 12-20%• Fertility after removal [70%]• Cancer & teratogenesis• Mortality 1/100000

HORMONAL CONTRACEPTIVES

ORAL PILLS• Combined pills• POP• Post-coital pill• Once a month male pill• Male pillDEPOT FORMULATIONS• Injectables• SC implants• Vaginal rings

Combined pill

• 5-21st day• Withdrawl bleeding not• MALA-N&-D• POP• Norethisterone &

levonorgestrel• Poor cycle control• Increased preg rate• In older women

Post-coital contraception

• IUD

• LNG 0.75mg

• 2 OC pills

• Mifepristone

Once a month pill

• Quinsterol

• A long acting estrogen is given in combination with a short acting progesterone..

• MALE PILL

MOAAdverse effects• CV effects• Carcinogenesis• Metabolic effects• Others- liver disorders

lactationsubsequent fertilityectopic pregnancy

foetal devlopment

Unwanted effects• Breast tenderness• Weight gain• Head ache & migrane• Bleeding disturbances

Depot formulations

Injectables

Progesterone only injectables

• DMPA• NET-EN [norethisterone

enantate]• DMPA-sc104mg

Combined injectable• Subdermal implants• Vaginal rings

Post conceptional methods Miscellaneous

• Menstrual regulation• Menstrual induction• Abortion

• Abstinence• Coitus interruptus• Rhythm method• Natural family planning

methods

1. BBT

2. Cervical mucus method

3. Symptothermic method• Breast feeding• Birth control vaccine

Terminal methods

• Guidelines

1. Husband Age 25-50

2. Wife 20-45

3. Min 2

4. >/= 3, the lower limit of age can be relaxed

5. Spouse concent

Male sterilization

• In PHC• Atleast 1cm• Until 30• Complications• Operative• Sperm granules• Spontaneous recanalisation• Auto immune response• psychological

Female sterilization

• Laproscopy

• Minilap [mass campaigns]

• HW-F 7-10 days

12-18 months

Evaluation

• Pearl index- failures per100 women years of exposure

• Total accidenal pregnancies

=-------------------------------------X 1200

total months of exposure

• Life-table analysis: calculate failure rate for each month of use

Contraception & adolescence

• Barriers

• IUD

• Hormonal