FAMILY PLANNING METHODS AND SERVICES AVAILABLE IN GHANA

1. FAMILY PLANNING METHODS AND SERVICES AVAILABLE IN GHANA Desiree M. Opoku FP Trainer /Service Provider

2. Family Planning • It is the ability of individuals and couples to enjoy their sexual life and decide freely and responsibly, whether they would: • have a family • how many children they want to have • how they want to space them - when they’ll start - when they’ll finish

3. Rationale for Contraceptive Use Designed to help individuals and couples in their reproductive age group to: • Space their children • Prevent unintended pregnancies • Manage infertility • Improve their reproductive health • Ensure that there is a balance between population and resources.

4. Factors to consider when choosing a contraceptive method • Ones lifestyle • Age • Number of Children • Health status • Relationships • Safer sex plan. • Effectiveness

5. FAMILY PLANNING METHODS Family Planning Methods Currently Available in Ghana Short Term Methods: • Condoms • Spermicides • Oral contraceptive pills • Injectables /Injections • Lactational Amenorrhoea Method (LAM) • Natural Family Planning Methods

6. Long Term Methods: Intrauterine Devices (IUDs) • -Copper T (CuT 380A) • -Levonorgestrel Intrauterine System (LNG- IUS)or hormonal IUD (MIRENA) Implants • -Jadelle • - Zarin • -Implanon

7. Permanent Methods • Bilateral Tubal ligation ( BTL /Mini Lap) • Vasectomy

8. Male Condom • It is a thin rubber covering that fits over a man’s erect penis. • There are varieties of male condoms • Condom prevents both pregnancy and STIs including HIV(Dual protection) • Condoms may be used in addition to another family planning method to prevent pregnancy and STIs including HIV(Dual method)

9. Male Condom Effectiveness • 98% effective when used correctly and consistently. How does it work? • Forms a barrier that keeps sperm out of the vagina, preventing pregnancy. • Also keep infections in the semen, on the penis or in the vagina from infecting the other partner.

10. Male condom cont’d Who can use it Clients who : • Are looking for a back up method (example: in case the woman forgets to take her contraceptives pills) • Have a medical condition that poses a health risk with the use of other contraceptive methods • Have sexual intercourse occasionally and do not want a regular contraception • Are at risk for exposure to transmission of STIs/ HIV.

11. Male Condom cont’d Who cannot use it? • Any one who is allergic to or reacts to latex Benefits • Are inexpensive and easy to get • Can help relieve premature ejaculation • Provides effective contraception immediately • Can be used with other methods (except female condoms) • Offer protection against STIs/HIV

13. Female Condom • It is a soft smooth covering made from polynitrile which is a synthetic material worn inside the vagina. • It has a ring at each end. The inner ring at the closed end of the condom is used to insert the condom. • The ring at the open end of the condom remains outside the vagina.

14. Female Condom cont’d Effectiveness • 95% effective if used correctly and consistently. How does it work? • Forms a barrier which blocks the passage of sperms to meet the ovum. • Also keep infections in the semen, on the penis or in the vagina from infecting the other partner.

15. Female Condom cont’d Who can use it? • Anyone looking for a back up method (example: in case the woman forgets to take her contraceptives Pills) • Has a medical condition that poses a health risk with the use of other contraceptive methods • Has sexual intercourse occasionally and does not want a regular contraception • Is at risk for exposure to transmission of STIs/ HIV.

16. FC2 Benefits • Offer protection against STIs/HIV infections • Generates heat and therefore increases sexual stimulation. • Does not interrupt foreplay and there is no risk of partner losing erection because it can be inserted ahead of time (6-8hrs).

17. How to use the female condom

18. Spermicides • These are chemicals that kill sperms. • Spermicides are available in a variety of preparations. Examples are: -creams, film, foaming tablets, vaginal suppositories, aerosol foams and jellies

19. Spermicides • 82% effective if used appropriately. Using spermicides with a condom increases effectiveness. • How does it work? • Spermicides kill the sperm thus preventing them from meeting the ovum.

20. Spermicides Who can use it? • Anyone needing a backup method (for example in the case of a skipped /missed oral contraceptive pills) • Has sexual intercourse occasionally and does not need regular contraception Who cannot use it? • Anyone that is allergic to or reacts to spermicides

21. Spermicides cont’d Benefits • Can be inserted by a partner as part of foreplay. • Easily available -can be purchased from pharmacies, chemical shops and supermarkets. • Increases vaginal lubrication. • Can be used ahead of time and does not interrupt sexual activity .

22. How to use spermicides • Usually requires 10 to 20 minutes after insertion before intercourse can begin • They are effective only for one hour after insertion • It is inserted deep into her vagina just before sexual intercourse while lying down, squatting or standing • After intercourse the vagina should not be washed until 6 to 8 hours • Spermicides should be used with each act of sexual intercourse • If more than 30 minutes elapses after insertion before intercourse ,insert another one.

23. Spermicides cont’d Side Effects • Spermicides may cause vaginal or penile irritation. Limitations • Does not protect against STIs/ HIV.

24. Combined Oral Contraceptive Pill (COCs) • It is a pill that contains estrogen and progesterone which are similar to the natural hormones in a woman’s body. • COCs contain 28 pills in a pack. Some have 21 active pills and 7 nonactive pills which must all be taken as shown on the pack. • Some examples in Ghana are Microgynon, Secure, my Pearl, Yasmin

25. Combined Oral Contraceptive Pills

26. Combined Oral Contraceptive Pill Who cannot use it? Clients who: • Are breastfeeding because estrogen can decrease the quantity of breast milk. • Have undiagnosed vaginal bleeding • Are taking medication for seizures or convulsions, tuberculosis , and on ART (must use condoms in addition ) Benefits • The woman re-gains her fertility quickly • It may protects against certain cancers eg. Ovarian and endometrial cancer

27. Combined Oral Contraceptives How to use COCs • Each 28-day pill pack has 21 active pills and 7 non active pills (the iron pills). • Swallow one active pill every day at the same time for 21 days as shown on the pack and then continue with the inactive (the iron pills) Side effects • Most side effects go away after the first few months of use Side effects include: • Bleeding in between periods • Headache • Nausea and/or vomiting • Breast tenderness • Weight changes

28. Combined Oral Contraceptive Pill Limitations • Does not provide protection against STIs/ HIV What to do if a client skips/misses a pill • Missing 1 or 2 active pills in a row : Take 1 active pill as soon as client remembers and then continue taking the pills 1 each day. Client can also take the 2 pills at the same time • Missing 3 or more active pills in a row: A back up protection eg use condoms until the pill has been taken for 7 days in a row. • If client misses these pills in week 3 or row3, she should skip the remaining pills and start a new pack.

29. Progestin Only Pills (POPs) Mini-pill • It is a pill that contains only progestin It does not affect the production of breast milk so it can be used by breastfeeding mothers Effectiveness • Over 99% effective when taken correctly and consistently

30. Progestin Only Pills (POPs) Mini-pill How does it work? • The pill prevents ovulation • It thickens the cervical mucus • It thins the endometrial lining Who can use it? Women who: • For medical reasons cannot use the combined contraceptive pills • Are breastfeeding below 6mths

31. Progestin Only Pill Who cannot use it? Women who: • Have abnormal vaginal bleeding • Are taking medication for seizures/convulsions, tuberculosis and on ART ( must use condoms in addition because these medications suppress the effect of the family planning hormones) Benefits • Can be used whilst breastfeeding. • Safe and immediately effective. • Immediate return of fertility after stopping.

32. Progestin Only Pill How to use the Pill • Take one pill at the same time every day. • When you finish a pack of pills, start a new pack the next day. • If breastfeeding, you can start 6 weeks after childbirth. Side effects • Most side effects go away after the first few months of use. • Common side effects include: Nausea, headaches , changes in monthly bleeding including irregular bleeding, spotting, heavier bleeding or no monthly bleeding are common but safe. Limitations • Does not provide protection against STIs/HIV.

33. Progestin Only Pill What to do if a client misses a pill • If a woman is three or more hours late in taking a pill or misses a pill completely she should take a pill as soon as possible and keep taking pills as usual, one each day. • She may take 2 pills at the same time on the same day. She should use a back up method for the next 2 days.

34. Lactational Amenorrhoea Method (LAM) • This is a method that uses the temporary infertility that occurs during breast feeding • Feeding a new baby continuously only on breast milk can postpone ovulation (the release of an egg from an ovary) for up to six months if her period has not returned • When used as a family planning method, this pattern of exclusive breastfeeding is called the Lactational Amenorrhea Method (LAM) • It provides protection against pregnancy for up to six months.

35. LAM 98% effective How does it work? • A baby suckling suppresses the production of hormones that are necessary for ovulation Who can use LAM? A mother: Who is exclusively breastfeeding day and night • Whose menstrual periods have not yet returned after delivery. • Whose baby is less than six months old. • It is effective when practiced correctly attaching and positioning to breast

36. LAM Who cannot use LAM A mother who: • Is not practicing exclusive breast feeding • Her menstrual period has returned after delivery. • Her baby is older than six months Benefits for the Mother • It does not affect natural hormonal balance of the woman • It is immediately effective • It reduces bleeding after delivery • No supplies are needed • It has no side effects

37. LAM Benefits for the baby • It decreases the likelihood of infection from germs in water, milk or formula feeds • It increases bonding between mother and child. • It passes on some of the mother’s antibodies to protect the baby from certain bacteria and viruses • Provides the best natural nutrition for the baby Limitation • It does not protect against STIs/HIV.

38. Emergency Contraception • They are used to help prevent a woman from unintended pregnancy after having unprotected sex. There are 2 types of emergency contraceptives: 1. Emergency Contraceptive Pills (ECPs)

39. Emergency Contraception – CUT IUD 2. IUD: • Highly effective for preventing pregnancy • A Copper releasing IUD (Cu-IUD) can be used within 5 days of unprotected sexual intercourse as an emergency contraceptive

40. Emergency Contraception How ECs work • The pills inhibit or delay the release of eggs from the ovaries. They do not work if the woman is already pregnant. • The copper IUD slows the movement of the sperms . Who can use it? • Almost all women can use ECs • Women who have been assaulted (e.g. rape, incest) • When a woman misses two or more contraceptive pills in a cycle • When a condom breaks or slips off

41. Emergency Contraception Benefits • It is safe, effective and easy to use How to use it • The EC tablets must taken within 5 daysafter unprotected sex. • 1 tablet start followed by 1 after 12 hrs or2 start • Take 4 combined (active) oral contraceptive at once (e.g. Microgynon or Secure) followed by 4 more active pills after 12 hours or • Intrauterine device (IUD) inserted within 5 days of having unprotected sex Limitation • ECPs do not protect against pregnancy for any future sex. • Cannot be used as regular contraceptive method • Offer no protection against STIs/HIV

42. Method failure What options are available to clients incase a method fails ? • Emergency contraception (EC) • Comprehensive Abortion care (CAC) • Counsel for ANC

43. How to be reasonably sure your client is not pregnant; • Did you have a baby less than 6 months (LAM) ? • Have you abstained from sexual intercourse since your LMP ? • Have you had a baby in the last 4 weeks ? • Did your LMP start within the past 7 days (for IUD within 12 days) ? • Have you had a miscarriage or abortion in the past 7 days ? • Have you been using a reliable contraceptive method consistently and correctly ?

44. Thank you

45. CLINICAL METHODS OF CONTRACEPTION ZenabuAddo FP Trainer/Service Provider

46. INFORMATION ON CLINIC BASED METHODS Injectables • They are methods that are given by injection in the arm and the buttocks. There are three kinds of injectables: • DepoProvera/Petogen- It is effective for 3 months • Noristerat-It is effective for 2 months • Norigynon - It is effective for 1 month

47. DepoProvera/Petogen/Noristerat • Inhibits /suppresses ovulation • It thickens cervical mucous • It thins the endometrial lining

48. Benefits • Almost all women can use it • It is very effective and safe • It is easy to use • It is reversible • It does not interfere with intercourse • It can be used by women who cannot take estrogen • It does not require daily attention

49. Limitations/Side Effects • Irregular bleeding, dizziness and nausea. These side effects disappear after few months of use • There may be delay return to fertility • Does not provide protection against STIs/HIV • It may cause amenorrhea

50. Norigynon • It works just like the COCs. Its benefits and limitations are also like the COCs. • It is given once a month intramuscularly (IM).