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 (DepoProvera)
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 SIDEEFFECTS!

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

Six capsules
Five years

Norplant II

vs.

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

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/b
c 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

By Judith Bruce, 1990

Choice of method
Interpersonal communication (verbal &
non verbal)
Technical Competence
Information
Follow-up
Appropriate constellation of services

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 socioeconomic 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.

Family Planning
Knowledge & Attitudes
Use of Family Planning
Exposure to Family Planning
Messages

Knowledge of contraceptive
methods

Percent of women age 15-49

Which modern methods are

most
familiar to married women?

Percent of currently married women age 15-49

Does knowledge of any modern

method
vary by residence, region and
education?
No

urban-rural difference

Women

with no education (91%) know

slightly less about modern methods than
educated women (98%)

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

Family Planning
Knowledge & Attitudes
Use of Family Planning
Exposure to Family Planning
Messages

Use of contraception
among
married women

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

Contraceptive use also

varies by residence
33% of urban women use any
method of family planning
compared to
22% for their rural
counterparts.

Womens current use of modern

contraceptive methods

Source of supply for

contraceptive methods

Percent

*First source, limited to women who started using IUD since 1995

Intention to use
contraception
in the future

Percent of currently married women who are not

using a contraceptive method

Preferred method of Contraception

for future use

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
26%
Difficult to get pregnant

24%

Wants more children

10%

Opposed to family

9%

planning
Infrequent sex/no sex

8%
6%

Fear side effects

Currently married women who are not using a contraceptive method

Family Planning
Knowledge & Attitudes
Use of Family Planning
Exposure to Family Planning
Messages

From what source do

women hear family
planning messages?
From radio only

10%

From television only

5%

From both

64%

NO MESSAGE

21%

For all women who heard a message about family planning

in the last few months preceding the interview

Does exposure to family

planning messages vary by
residence
and
education?
Residence
Urban
Rural

86%
78%

Education
None
Primary
Secondary+

70%
80%
92%

Does exposure to family planning

messages in the print media
vary by residence and education?
Residence
Urban
Rural

59%
36%

Education
None
Primary
Secondary+

28%
39%
62%

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