Birth Control & Family Planning

Remember The total risks of birth control are much less than the total risks of a pregnancy!!

Types of Birth ControlHormonalBarrierIUDMethods based on informationPermanent sterilization

Hormonal MethodsOral Contraceptives (Birth Control Pill)Injections (Depo-Provera)Implants (Norplant I & II)

Birth Control PillsPills can be taken to prevent pregnancyPills are safe and effective when taken properlyPills are over 99% effectiveWomen must have a pap smear to get a prescription for birth control pills

How does the pill work?Stops ovulationThins uterine liningThickens cervical mucus

Positive Benefits of Birth Control PillsPrevents pregnancyEases menstrual crampsShortens periodRegulates period

Decreases incidence of ovarian cystsPrevents ovarian and uterine cancerDecreases acne

Side-effectsBreast tendernessNauseaIncrease in headachesMoodinessWeight changeSpotting

Taking the PillOnce a day at the same time everydayUse condoms for first monthUse condoms when on antibiotics Use condoms for 1 week if you miss a pill or take one lateThe pill offers no protection from STDs

Depo-ProveraBirth control shot given once every three months to prevent pregnancy99.7% effective preventing pregnancyNo daily pills to remember

How does the shot work?Stops ovulationStops menstrual cycles!! Thickens cervical mucus

SIDE EFFECTSExtremely irregular menstrual bleeding and spotting for 3-6 months!NO PERIOD after 3-6 months Weight change Breast tendernessMood change

*NOT EVERY WOMAN HAS SIDE-EFFECTS!

IMPLANTSImplants are placed in the body filled with hormone that prevents pregnancyPhysically inserted in simple 15 minute outpatient procedurePlastic capsules the size of paper matchsticks inserted under the skin in the arm99.95% effectiveness rate

Norplant I vs. Norplant IISix capsulesFive years

Two capsulesThree years

Norplant Implant

Norplant ConsiderationsShould be considered long term birth control Requires no upkeep Extremely effective in pregnancy prevention > 99%

Emergency contraception pills can reduce the chance of a pregnancy by 75% if taken within 72 hours of unprotected sex!

Emergency Contraception

Emergency Contraception (ECP)

Must be taken within 72 hours of the act of unprotected intercourse or failure of contraception methodMust receive ECP from a physician75 84% effective in reducing pregnancyCalifornia pharmacies can prescribe without a doctor! (1/1/02)

ECPFloods the ovaries with high amount of hormone and prevents ovulationAlters the environment of the uterus, making it disruptive to the egg and spermTwo sets of pills taken exactly 12 hours apart

BARRIER METHODSSpermicidesMale CondomFemale CondomDiaphragmCervical Cap

BARRIER METHODPrevents pregnancy blocks the egg and sperm from meeting Barrier methods have higher failure rates than hormonal methods due to design and human error

SPERMICIDESChemicals kill sperm in the vaginaDifferent forms:-Jelly-Film-Foam-SuppositorySome work instantly, others require pre-insertionOnly 76% effective (used alone), should be used in combination with another method i.e., condoms

MALE CONDOMMost common and effective barrier method when used properlyLatex and Polyurethane should only be used in the prevention of pregnancy and spread of STIs (including HIV)

MALE CONDOMPerfect effectiveness rate = 97%Typical effectiveness rate = 88%Latex and polyurethane condoms are availableCombining condoms with spermicides raises effectiveness levels to 99%

FEMALE CONDOMMade as an alternative to male condomsPolyurethanePhysically inserted in the vaginaPerfect rate = 95%Typical rate = 79%Woman can use female condom if partner refuses

Reality : The Female Condom

DIAPRAGHMPerfect Effectiveness Rate = 94%Typical Effectiveness Rate = 80%Latex barrier placed inside vagina during intercourseFitted by physicianSpermicidal jelly before insertionInserted up to 18 hours before intercourse and can be left in for a total of 24 hours

DIAPHRAGM

CERVICAL CAPLatex barrier inserted in vagina before intercourseCaps around cervix with suctionFill with spermicidal jelly prior to useCan be left in body for up to a total of 48 hours Must be left in place six hours after sexual intercoursePerfect effectiveness rate = 91%Typical effectiveness rate = 80%

INTRAUTERINE DEVICES (IUD)T-shaped object placed in the uterus to prevent pregnancyMust be on period during insertionA Natural childbirth required to use IUDExtremely effective without using hormones > 97 %Must be in monogamous relationship

Copper T vs.. Progestasert10 years99.2 % effectiveCopper on IUD acts as spermicide, IUD blocks egg from implantingMust check string before sex and after shedding of uterine lining.1 year98% effectiveT shaped plastic that releases hormones over a one year time frameThickens mucus, blocking eggCheck string before sex & after shedding of uterine lining.

STERILIZATIONProcedure performed on a man or a woman permanently sterilizesFemale = Tubal LigationMale = Vasectomy

TUBAL LIGATIONSurgical procedure performed on a womanFallopian tubes are cut, tied, cauterized, prevents eggs from reaching spermFailure rates vary by procedure, from 0.8%-3.7%May experience heavier periods

LAPAROSCOPY-BAND-AID STERILIZATION

VASECTOMYMale sterilization procedureLigation of Vas Deferens tubeNo-scalpel technique availableFaster and easier recovery than a tubal ligationFailure rate = 0.1%, more effective than female sterilization

VASECTOMY

METHODS BASED ON INFORMATIONWithdrawalNatural Family PlanningFertility Awareness MethodAbstinence

WITHDRAWALRemoval of penis from the vagina before ejaculation occursNOT a sufficient method of birth control by itselfEffectiveness rate is 80% (very unpredictable in teens, wide variation)1 of 5 women practicing withdrawal become pregnantVery difficult for a male to control

Natural Family Planning & Fertility Awareness MethodWomen take a class on the menstrual cycle to calculate more fertile timesRequires special equipment and cannot be self-taughtNFP abstains from sex during the calculated fertile timeFAM uses barrier methods during fertile timePerfect effectiveness rate = 91%Typical effectiveness rate = 75%No 100% safe day-irregular periods

AbstinenceOnly 100% method of birth control Abstinence is when partners do not engage in sexual intercourseCommunication between partners is important for those practicing abstinence to be successful

Reasons for abstainingMoral or religious valuesPersonal beliefsMedical reasonsNot feeling ready for an emotional, intimate relationshipFuture plans

SOMETHING TO THINK ABOUTCouples 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

QualityQuality 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 & 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; andto increase efficiency and savings.

Elements of Quality of Care in family planningChoice of methodInterpersonal communication (verbal & non verbal)Technical CompetenceInformationFollow-upAppropriate constellation of servicesBy Judith Bruce, 1990

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 clients 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 ones 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-upCorrect 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.

IndicatorsQUALITY OF CARENumber of contraceptive methods available at a specific outletPercentage of counseling sessions with new acceptors in which provider discusses all methodsPercentage of client visits during which provider demonstrates skill at clinical procedures, including asepsisPercentage of clients reporting sufficient time with providerPercentage of clients informed of timing and sources for re-supply/revisitPercentage 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 mannerAsk the client about FP/RH needsTell the client about different methods/servicesHelp the client to make her own decision about which method/service to useExplain to the client how to use the method/service she has chosenReturn visit and follow-ups of client scheduled

Rights of ClientsInformation 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 (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 ones service delivery.

Providers needsTraining will certainly help the provider to do a better counseling. It is needed to polish ones 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.

Providers needs (cont.)Supplies continuous & adequate - needed at the providers 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 & AttitudesUse of Family Planning

Exposure to Family Planning MessagesFamily Planning

Knowledge of contraceptive methodsPercent of women age 15-49

Which modern methods are mostfamiliar to married women?Percent of currently married women age 15-49

Does knowledge of any modern methodvary by residence, region and education? Women with no education (91%) know slightly less about modern methods than educated women (98%) No urban-rural difference

Do married women discuss family planning with their husbands?Percent of currently married women age 15-49 in the past year

What are couples attitudes toward family planning?Percent of women who report that they and their husband approve or not of family planning

Knowledge & AttitudesUse of Family Planning

Exposure to Family Planning MessagesFamily Planning

Use of contraception among married womenPercent of currently married women age 15-49

Does use of contraception vary by a womans level of education?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.

Source of supply forcontraceptive methodsPercent*First source, limited to women who started using IUD since 1995

Intention to use contraceptionin the futurePercent of currently married women who are not using a contraceptive method

Preferred method of Contraceptionfor future usePercent 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 contraceptionHealth concernsDifficult to get pregnantWants more childrenOpposed to family planningInfrequent sex/no sexFear side effects

26%24%10%9%8%6%Currently married women who are not using a contraceptive method

Knowledge & AttitudesUse of Family Planning

Exposure to Family Planning MessagesFamily Planning

From what source do women hear family planning messages?

From radio only

From television only

From both

NO MESSAGEFor all women who heard a message about family planning in the last few months preceding the interview10%5%64%

21%

ResidenceUrban86%Rural78%

EducationNone70%Primary80%Secondary+92%Does exposure to family planning messages vary by residence and education?

ResidenceUrban59%Rural36%

EducationNone28%Primary39%Secondary+62%Does exposure to family planning messages in the print media vary by residence and education?

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

***The early family planning initiatives in the 1950s and 1960s were motivatedby demographic concerns; the vanguard countries developed family planning programs in an effort to control rapid population growth. As such, the ultimate objective of these programs (and the majority that have followed) was to reduce fertility. This translated to a strong emphasis on the quantitative aspects of service delivery. How many acceptors entered the program each year? What volume of contraception was distributed? What percentage of the population at risk used a contraceptive method? **************In India, only 55 percent of children under four months of age are exclusively breastfed