Family Planning

Contraceptive
Technology
HR Siswosudarmo
Departrment of Obstetrics and
Gynecology, Faculty of Medicine,
Gajah Mada University
Yogyakarta

History
China (2700 BC) :

abortifacient

Egypt (1850 BC) :

vaginal paste

India (date ?)
:
abstinence,
tampon
Taurat
: withdrawl
Hadist of prophet Muhammad: Al Azl

Technological
Innovation
1564: Fallopius designed a linen
sheath to
cover the glans penis
as a protection
against
siphylis
1838: Cervical cap
1843: Condom of rubber
1885: Spermicide
1909: IUD of metal ring
1956: Steroid contraceptives

Principles of
contraception
Impacting on the ovum or the sperm
Steroid and Male vaccine
Blocking the meeting of ovum and
sperm
Condom, cervical cap or diaphragm, coitus
interruptus, spermicide, periodic
abstinence, and sterilization (male and
female)
Interfering with implantation
IUD
Combination: exp OC, injectables, implant.

Contraceptive

Effectiveness
No. of pregnancies per 100
women-years

Theoretical effectiveness

Reliabilty of the method when it is

used correctly.

Practical or use effectiveness

Observed reliability among a large
users

Cost effectiveness
expense Vs outcome in a program

Program effectiveness
Success of a particular method

Contraceptive
Safety

Refers to the number of

complications or side effects after
certain period of use
It influences to continuation of use
and acceptability
It affects effectiveness, mainly
program effectiveness
It is a concern to policy maker,
clinicians and particularly to users

Contraceptive
Terminology (1)
Safety : number of users who do
not have any complaint
Complication : events related to
method of delivery
Side effect : events related to
the method it self
Side effects, complications and
concerns, are often used together

Contraceptive
Terminology (2)

Continuation Rate

Number of user who are still using the

method after certain period of time

Discontinuation rate
Number of user who has stopped using
the method for any reason (medical,
desire to get pregnant, loss to follow up,
etc)

Contraceptive
Terminology (3)

Drop out

Discontinue using the method,

usually for medical reason (side
effect etc)

Loss to follow up
Disappear from study follow up for
uncertain reason
Home visits minimize these cases

Contraceptive
Terminology (4)

Failure rate or pregnancy rate

(cf.effectiveness)
Number of user who get pregnant
after a certain period of time
Pearl index (cumulative pregnancy
rate): No. of pregnancies per 100
women-years
Life table or survival curve: a
curve which shows how much and
when the events take place

Contraceptive
Terminology (5)

Acceptability

It refers to prevalence of a specific

method in population
Initial acceptability: No. of
clients that could be recruited. It
depends on original motivation,
age, education, persuasiveness of
the FP workers, and characteristics
of the available methods.

Contraceptive
Terminology (6)

Acceptability

Continued acceptability :
Prevalence of use after a long
period of time. It is more related to
the characteristics of the method
itself, cultural setting, and the
availability, stocks and delivery
system of a specific method

Contraceptive
requirements
Ideal method should meet:
Safe and effective
Simple and easy to use
Require no repetitive action
Inexpensive
Independent with coitus
Highly reversible
Accepted in a certain cultural setting

Future Contraceptive
Technology

LHRF agonist inhibit ovulation

LHRF antagonist may induce luteolysis
(abortifacient)
LHRF analog may inhibit
spermatogenesis, but it is inconsistent
GnRH analog to suppress
spermatogenesis is under study
Birth control vaccine based on hCG
are now in human clinical trial

Type of Cc Method (1)

(Based on its effectiveness)
Simple method
Reliable method
Secure or permanent method

Simple method
Periodic abstinence
Coitus interruptus (withdrawl, al azl)
Barrier method:
Condom, male and female
Vaginal cap or diaphragm

Vaginal spermicides: tissue, jelly, tablets

Natural method of Billing
Lactation amenorrhea method

Reliable (effective) method

Hormonal: injectables, oral pills
(COCs, POPs, Minipills ) , and
implant
IUDs: metal ring, inert plastic ,
copper loaded and progestogen
loaded IUDs

Permanent or Secure
method
Often called: Sterilization or Voluntary
surgical contraception (VSC)
Male
Vasectomy, conventional method
Non scalpel vasectomy

Female
Tubectomy (minilaparotomy or others)

Laparoscopic insertion of tubal ring etc

Healthy Reproductive
Age
Young Rep
Age

High Risk
Rep Age

Healthy Rep
Age

20
postponing
pregnancy

phase of spacing

Simple method
Pills, injectables

Hormonal
IUD
VSC *
Simple method

3
5

terminating
fertilty
VSC
IUD
Hormonal

List of Contraceptive (1)

Comparison between method
Method

Safety

Simple

+++
Pills
++
Injectables +
+
Implant
++
IUD
VSC

++
+++

Effectiveness
Simplicity

++

+++
+++

++

++

++

++

+++

_ _

List of Contraceptive (2)

Comparison between method
Method Con.Rate Cost
Simple

__

Pills

__

Injectab

Revers Acceptance
+++

++

++

++

++

++

++

++

Implants
IUD

++

++

++

++

+++

++

VSC

+++

_ _ _

__

SUMMARY (1)

SUMMARY (2)

SUMMARY(3)