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 STDs

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 vs. Norplant II
Six capsules
Five years

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
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 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 STIs (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.. Progestasert
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.
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
Choice of method
Interpersonal communication (verbal & non
verbal)
Technical Competence
Information
Follow-up
Appropriate constellation of services
By 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-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
scheduled
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 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 needs
Training 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 & Attitudes
Use of Family Planning

Exposure to Family Planning
Messages
Family Planning
Knowledge of contraceptive methods
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 most
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 method
vary 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?
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 toward
family 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 & Attitudes
Use of Family Planning

Exposure to Family Planning
Messages
Family Planning
Use of contraception among
married women
24
19
5
Any method
Modern
methods
Traditional
methods
Percent 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
19
16
23
19
35
23
Any method Any modern method
No education Primary Secondary and +
Contraceptive use also varies
by residence

33% of urban women use any
method of family planning
compared to
22% for their rural counterparts.
Other
modern
methods
1%
Female
sterilisation
8%
Male condom
5%
Injectables
40%
IUD
7%
Monthly pill
15%
Daily pill
24%
Womens current use of modern
contraceptive methods
Source of supply for
contraceptive methods
38
13
57
27
44
18
17
37
5
47
44
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 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
4
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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
Difficult to get pregnant
Wants more children
Opposed to family planning
Infrequent sex/no sex
Fear side effects

26%
24%
10%
9%
8%
6%
Currently married women who are not using a contraceptive method
Knowledge & Attitudes
Use of Family Planning

Exposure to Family Planning
Messages
Family Planning
From what source do
women hear family planning
messages?

From radio only

From television only

From both


NO MESSAGE
For all women who heard a message about family planning
in the last few months preceding the interview
10%
5%
64%

21%
Residence
Urban 86%
Rural 78%

Education
None 70%
Primary 80%
Secondary+ 92%
Does exposure to family planning
messages vary by residence
and education?
Residence
Urban 59%
Rural 36%

Education
None 28%
Primary 39%
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