Family Planning

1. Family Planning Dr. Amina Rashad Maternity and Gynecology Nursing Dep. Faculty of Nursing, Mansoura University

2. Specific objectives: • At the end of this chapter the student should be able to • Identify the concept of family planning. • List types of family planning. • Discuss mechanisms Of action of each method. • Enumerate advantages and disadvantages of each method . • Explain side effects and complications of each method. • Provide health education about of each method. FP, Dr. Amina Rashad

3. Definition of family planning • The WHO (1975) considered family planning as practice that help individuals or couples to attain certain objectives, which are: • 1- Avoidance of unwanted birth. • 2- Bringing about wanted birth. • 3- Regulation of interval between pregnancies. • 4- Avoid pregnancy for women with serious disease that would place pregnancy at risk. FP, Dr. Amina Rashad

4. TYPES OF FAMILY PLANNING METHODS • 1) Hormonal family planning methods: • Oral contraceptives • Injectable contraceptives • Subdermal implants FP, Dr. Amina Rashad

5. BARRIER METHODS • Barrier methods of contraception include the male condom, • female condom, • diaphragm, • cervical cap and spermicide. • All barrier methods are client-dependent. • To be effective, they need to be used correctly and consistently with every act of sexual intercourse. FP, Dr. Amina Rashad

6. Mechanism of action • These methods work by physically or chemically blocking the passage of sperm. In addition, some methods can prevent the transmission of STDs between partners. FP, Dr. Amina Rashad

7. Advantages of barrier methods • Effective at preventing pregnancy if used consistently and correctly; however, some are more effective than others • Condoms are effective in preventing STIS, including HIV, if used consistently and correctly • Safe FP, Dr. Amina Rashad

8. Have no systemic side effects • Easy to initiate and discontinue • Immediate return to fertility • Expect for the diaphragm and cervical cap, barrier methods do not require a clinic visit. FP, Dr. Amina Rashad

9. Disadvantages of Barrier methods • Not as effective as other modem methods • Some people find them difficult to use consistently and correctly • Some methods require partner’s participation FP, Dr. Amina Rashad

10. May interrupt sexual activity • Need proper storage in order to maintain the quality of the products • Need re-supply FP, Dr. Amina Rashad

11. LACTATIONAL AMENORRHEAMETHOD (LAM) • Def. The lactational amenorrhea method, or LAM, is a temporary contraceptive option for postpartum women. FP, Dr. Amina Rashad

12. Who will use LAM •    *Within 6 months postpartum •     *Amenorrheic •       Fully or nearly fully breastfeeding ( at least 85% of the time ) FP, Dr. Amina Rashad

13. Mechanism of action • The stimulation of the nipples by infant’s suckling sends nerve impulses to the mother’s hypothalamus, causing the release of prolactin and disruption in the release of gonadotrophin-releasing hormone (GnRH). The reduction in GnRH in turn suppresses the release of follicle stimulating hormone (FSH) and luteinizing hormone (LH) by pituitary gland • The reduction in FSH and LH affects follicular development and suppresses ovulation. FP, Dr. Amina Rashad

14. Advantages of LAM • Universally available to all breastfeeding women. • At least 98% effective • Protection begins immediately postpartum • There are proven health benefits of breastfeeding for mother and infant. • No commodities or supplies required • LAM can be used temporarily while a breastfeeding woman decides what other method of contraception to use. FP, Dr. Amina Rashad

15. Disadvantages of LAM • Full or nearly full breastfeeding may be difficult for some women to maintain due to social circumstances • No STI or HIV protection • Duration of method is limited • LAM is a temporary method that can only be used by breastfeeding women FP, Dr. Amina Rashad

16. Other Contraceptive Options for Breastfeeding Women • Use of contraceptive methods postpartum is based on what impact, if any, a method may have on lactation, breast milk and infant health. FP, Dr. Amina Rashad

17. Methods that can be started immediately postpartum: • Non-hormonal methods • IUDs • Barrier methods • Female sterilization (if there is a medical indication ) FP, Dr. Amina Rashad

18. Methods that can be stared 6 weeks postpartum: • Progestin-only pills (POPs) • Progestin-only Injectables (DMPA, NET-EN) • Subdermal implants ( Norplant ) • Hormonal IUS FP, Dr. Amina Rashad

19. Methods that can be started 6 months postpartum:Methods containing Estrogen • Combined oral contraceptives (COCs) • Combined monthly injectables FP, Dr. Amina Rashad

20. Other Non-Hormonal MethodsPeriodic Abstinence • Periodic abstinence involves abstaining from intercourse during a woman’s fertile phase of the menstrual cycle. A woman uses various signs to identify when she is fertile and during this time abstains from sexual intercourse: FP, Dr. Amina Rashad

21. Advantages of periodic Abstinence • User-controlled • Readily available • Safe and free from side effects • Requires skills and motivation • Signs of fertility may not be reliable • Requires partner’s cooperation to abstain • No STI/HIV protection • Relatively high failure rates FP, Dr. Amina Rashad

22. Withdrawal • Also known as coitus interrupts, it requires removing the penis from the vagina before ejaculation so as to prevent contact between sperm and the egg. FP, Dr. Amina Rashad

23. Characteristics of Withdrawal • Contraceptive efficacy is similar to that of barrier methods, with pregnancy rates of about 4% for perfect use and at least 19% for typical use during the first year • Correct and consistent use requires self-control • Probably provides no protection from STIs/HIV FP, Dr. Amina Rashad

24. ORAL CONTRACEPTIVES Types of oral contraceptives (Ocs) FP, Dr. Amina Rashad

25. Mechanisms Of Action Of Oral Contraceptives • Suppression of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) responsible for follicle development and ovulation (primary mechanism for COCs, secondary for POPs) • Thickening of cervical mucus, making it difficult for sperm to enter the uterine cavity (primary mechanism for POPs, secondary for POPs) FP, Dr. Amina Rashad

26. Advantages of oral contraceptives • Safe and effective: when used correctly and consistently, pregnancy prevention rate is greater than 99% (with COCs) • Reversible, rapid return to fertility • No action needed at the time of sexual intercourse • Serious complications are extremely rare • Beneficial health effects other than contraception • Use is controlled by the woman FP, Dr. Amina Rashad

27. Disadvantages of Oral Contraceptives • Incorrect use is common not as effective in typed • Require daily use • Side effects are common • May pose health risks for a small number of women • Re-supply required • Offer no protection against sexually transmitted infections (STIs), including HIV FP, Dr. Amina Rashad

28. Side Effects of Oral Contraceptives FP, Dr. Amina Rashad

29. Non-contraceptive Health Benefits of Oral Contraceptives FP, Dr. Amina Rashad

30. Adverse Effects of Oral Contraceptives FP, Dr. Amina Rashad

31. How To Take COCsInitiating • During the first 7 days of menstrual cycle, preferable on the first day • Anytime the provider is reasonably sure woman is not pregnant • For non-breastfeeding women postpartum-delay until 3 weeks after childbirth • For breastfeeding women postpartum-delay until 6 months after childbirth or until breastfeeding is discontinued FP, Dr. Amina Rashad

32. Schedule • Take I pill every day until all pills in the pack are finished • 7- day break between packs (for standard 21-pill packs) FP, Dr. Amina Rashad

33. How to Take POPsInitiating • Postpartum breastfeeding women – delay 6 weeks • Postpartum non-breastfeeding women – can start immediately • Other women • Preferably first 5 days of menstrual cycle • Anytime provider is reasonably sure that woman is not pregnant FP, Dr. Amina Rashad

34. Schedule • Take I pill each day • Take within 3 hours of the same time each day (preferably the same time) • No break between packs FP, Dr. Amina Rashad

35. Missed Pill Regimen • Take most recently missed pill as soon as possible • If not breastfeeding, abstain from sex or use backup method for 48 hours • Take next pll at regular time FP, Dr. Amina Rashad

36. Key counseling Topics for Oral Contraceptive Users • Safety and efficacy • How oral contraceptives work • Advantages and disadvantages • Possible side effects and warning symptoms • How to take pills and what to do when pills are missed • How to obtain and use backup methods and emergency contraception • No protection from STIs, including HIV FP, Dr. Amina Rashad

37. INJECTABLE CONTRACEPTIVESTypes of Injectable contraceptives FP, Dr. Amina Rashad

38. Mechanisms of action of Injectables • Suppression of follicle-stimulating hormone (FSH) and luteinizing hormone(LH) responsible for follicle development and ovulation. • Thickening of cervical mucus, making it difficult for sperm to enter the uterine cavity. FP, Dr. Amina Rashad

39. Advantages of Injectable Contraceptives FP, Dr. Amina Rashad

40. Disadvantages of Injectable Contraceptives FP, Dr. Amina Rashad

41. Side Effects Of Injectables • Menstrual changes ( more common for progestin-only injectables than for combined injectables): • Irregular bleeding or spotting • Prolonged or heavy bleeding • Amenorrhea • Weight gain (more common for progestin-only injectbles) • Less common side effects include headaches, dizziness, breast tenderness and mood changes FP, Dr. Amina Rashad

42. Non-contraceptive Health Benefits of Progestin-only Injectables • Reduced risk of: • endometrial cancer and possibly ovarian cancer • ectopic pregnancy • vaginal yeast infection • acute PID • fibroids • Reduced frequency and severity of sickle-cell disease crises • Reduced symptoms of endometriosis FP, Dr. Amina Rashad