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Session Objectives. At the end of this session, the participants will be able to:Identify how contraceptive methods physiologically work on the male and female reproductive systemCompare and contrast, using reference materials, mechanism of action, advantages, disadvantages, special issues and instructions for each contraceptive method presentedIdentify contraceptive methods for birth spacing versus birth limitingBecome familiar with the
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1. Contraceptive Technology Overview
2. Session Objectives At the end of this session, the participants will be able to:
Identify how contraceptive methods physiologically work on the male and female reproductive system
Compare and contrast, using reference materials, mechanism of action, advantages, disadvantages, special issues and instructions for each contraceptive method presented
Identify contraceptive methods for birth spacing versus birth limiting
Become familiar with the “Decision Making Tool for FP Clients and Providers”
3. Session Objectives (2) Define “medical eligibility,” name the source of international standards for eligibility
Use the pregnancy checklist.
Name at least two new methods of FP
Identify the contraceptive methods that are particularly appropriate for sexually active youth
4. Name traditional methods women use in your region
5. What are the main categories of contraception? Birth Spacing - Temporary Methods of contraception
Natural methods
Artificial methods
Short term
Long term
Birth Limiting - Permanent Methods of Contraception
Emergency Contraception
Please cite methods that women traditionally use to prevent pregnancy in your setting? Please cite methods that women traditionally use to prevent pregnancy in your setting?
6. Birth Spacing - Temporary Methods of Contraception Lactational Amenorrhea Method (LAM or Exclusive Breast Feeding)
Natural methods.
Fertility awareness/Periodic abstinence
Cervical Mucus (BOM – Billing ovulatory method)
Calendar method/Rhythm (Safe days)/Ogino-Knaus
Standard Day Method (SDM)
TwoDay Method
Basal Body Temperature
Symptothermal
7. Birth Spacing - Temporary Methods of Contraception (2) Artificial
Short term:
Barriers
Male condoms (Latex, synthetic non-latex e.g. Durex Avanti, eZ-on, Tectylon )
Female Condom (Reality/FC female condom, VA female condom, PATH Woman’s condom)
Diaphragm (SILCS, Lea’s Shield)
Cervical caps (FemCap, Oves)
Vaginal rings e.g. NuvaRing
Sponge (Today sponge, Protectaid sponge)
Spermicides, jellies, creams,
8. Birth Spacing - Temporary Methods of Contraception (3) Artificial
Short term met:
Transdermal e.g. contraceptive patch (Ortho Evra), Spray (Nesterone Metered Dose Transdermal System)
The pill
COCs e.g. Microgynon,Nordette, Trinordial, Marvelon, Seasonale, Yasmin (contains dropirenone)
POPs e.g. Microlut, Exluton, microval, Cerazette (contains desogestrel)
9. Birth Spacing- Temporary Methods of Contraception (4) Artificial
Short term met:
Injectables
Progestogen only
DMPA,
Uniject – depo – subQ Provera 104 (DMPA – SC)
Net en/Noristerat)
Combined
Mesigyna (Norigynon)
Cylofem (Nunelle, Lunella, Cyclo-Provera, Novafem, Feminera)
10. Birth Spacing - Temporary Methods of Contraception (5)
Long term:
IUCDs,
Copper e.g. CuT380A (12 yrs), Multiload 375 (7 yrs),
Progestin - releasing e.g. Minera (5 yrs), Femilis, Femilis Slim (for nulliparous), FibroPlant (3 yrs)
Frameless e.g. GyneFix, FibroPlant – LNG (3 yrs)
Implants e.g.
Norplant (5 yrs),
Jadelle (5yrs),
Implanon (3yrs),
Nesterone (2 yrs )
11. Birth Limiting - Permanent Methods of Contraception Sterilization
Transcervical (through hysteroscopy)
Chemicals e.g. Quinacrine
Plugs e.g. Adiana procedure
Microcoils e.g. Essure
Tuballigation
Laparotomy
Minilaparotomy
Vasectomy
Classical,
No-scalpel
Other male methods: Longer- acting formulations of testosterone alone or in combination with a progestin
12. What are the main categories of emergency contraception? Emergency Contraception
Yuzpe method
Progestin only
IUD
13. What do family planning clients desire in a family planning method?
14. Clients Desire for FP Methods More choices – helps ensure that users are satisfied with their FP method
Highly effective protection
Costs less
Easier to use
15. Pregnancies per 100 Women in 1st 12 Months of FP Use
Method Typical Use Perfect Use
No method 85 85
Spermicides 26 6
Female condoms 21 5
Male condoms 14 3
Fertility awareness 20 9
* BTT 20 2
* Cervical mucus 20 3
* Calendar 13 9
* SDM 12 5
* LAM – 6 months 2 0.5
Diaphragm with Spermicide 20 6
COCs 8 0.1
POPs + breastfeeding 1 0.5
TCu-380A 0.8 0.6
Female sterilization 0.5 0.5
DMPA & NET EN 0.3 0.3
Vasectomy 0.15 0.1
Norplant implant 0.1 0.1
16. For services to be of quality All FP clients should have services that include:
Providers trained in counseling
Informed choice
Informed consent
Rights of the client
Adequate and appropriate equipment and supplies
Service providers should be provided with guidelines for screening clients
Methods requiring surgical approaches need trained staff, equipped facilities and infection prevention procedures must be in place
17. Informed Choice and Informed consent Informed choice: An individual’s well-considered, voluntary
decision based on:
Options
Information
Understanding
Informed consent: A medical, legal, and rights-based
construct whereby the client agrees to receive medical
treatment, to use a family planning method, or to take
part in a study, (ideally) as a result of the client’s informed
choice
Individual: informed choice is something that is experienced by the client rather than something that is done by the provider. The client can reach an informed choice anywhere, at any time, and does not necessarily require the input of a healthcare worker.
Well-considered: taking into consideration the client’s health status, relationship status, risk of STIs, preferences, beliefs and lifestyle; and confirmation that the client doesn’t have any unrealistic expectations about the method (e.g., wants sterilization to space births but wants more children in future).
Voluntary: no pressure, coercion, stress or access barriers
Options: awareness of, and access to, a choice of methods
Information: about options, advantages and disadvantages, effectiveness, side effects, risks. Sources of information for the client vary widely; a health care provider may be only a minor source. Thus, the challenge for providers is to determine what information each client needs and how to provide enough information, without overwhelming the client with too much detail.
Understanding: information from providers must be in language and terms client can understand; client need to understand consequences of different choices
Individual: informed choice is something that is experienced by the client rather than something that is done by the provider. The client can reach an informed choice anywhere, at any time, and does not necessarily require the input of a healthcare worker.
Well-considered: taking into consideration the client’s health status, relationship status, risk of STIs, preferences, beliefs and lifestyle; and confirmation that the client doesn’t have any unrealistic expectations about the method (e.g., wants sterilization to space births but wants more children in future).
Voluntary: no pressure, coercion, stress or access barriers
Options: awareness of, and access to, a choice of methods
Information: about options, advantages and disadvantages, effectiveness, side effects, risks. Sources of information for the client vary widely; a health care provider may be only a minor source. Thus, the challenge for providers is to determine what information each client needs and how to provide enough information, without overwhelming the client with too much detail.
Understanding: information from providers must be in language and terms client can understand; client need to understand consequences of different choices
18. Benefits of Informed Choice in Family Planning Increases the chances of correct method use, reducing unwanted pregnancy
Reduces fear and dissatisfaction related to side effects, making continuation more likely
Increases client’s ability to recognize serious warning signs, reducing health risks
Increases client satisfaction and promotion of the program by positive word-of-mouth
Increases a person’s sense of empowerment and self-esteem
Promotes positive relationships between providers and clients
19. Clients Who Receive Their Method of Choice Are More Likely to Continue Using the Method The 1991 Pariani study shows that clients who receive their method of choice are much more likely to continue using the method.
Approximately 90% of the women in the study who received their method of choice were continuing one year later.
Whereas only 20% of the women who had not received their method of choice were still using a method after a year.
The 1991 Pariani study shows that clients who receive their method of choice are much more likely to continue using the method.
Approximately 90% of the women in the study who received their method of choice were continuing one year later.
Whereas only 20% of the women who had not received their method of choice were still using a method after a year.
20. Medical Eligibility Criteria for Contraceptive Use (MEC) WHO’s - Evidence-Based
Guidance For Contraceptive
Use
The Medical Eligibility Criteria address who can use contraceptive methods, for example, can women with hypertension use the pill or can women with diabetes use Depo-Provera?
The Medical Eligibility Criteria address who can use contraceptive methods, for example, can women with hypertension use the pill or can women with diabetes use Depo-Provera?
21. Utilization of evidence-based information
22. Purpose of the Medical Eligibility Criteria (MEC) To base guidelines for family planning practices on the best available evidence
To address and change misconceptions about who can and cannot safely use contraception
To reduce medical policy and practice barriers (i.e., unjustified by the evidence)
To improve quality, access and use of family planning services
MEC meant to inform national policies and guidelines, and ultimately, by addressing misconceptions and other medical barriers, to improve service quality, access, and use
Service guidelines necessary but not sufficient—research shows that adherence to recommended practices does not automatically occur or improve without active intervention, but that such adherence does in fact improve with active intervention such as training/seminars
MEC meant to inform national policies and guidelines, and ultimately, by addressing misconceptions and other medical barriers, to improve service quality, access, and use
Service guidelines necessary but not sufficient—research shows that adherence to recommended practices does not automatically occur or improve without active intervention, but that such adherence does in fact improve with active intervention such as training/seminars
23. MEC Categories The classification takes into account whether the client is initiating (I) a method or is a continuing user.
The classification takes into account whether the client is initiating (I) a method or is a continuing user.
24. WHO Eligibility CriteriaBased on low dose formulations
25. Other Useful Resources Decision-making tool
Checklists
Pregnancy checklist
CBD – DMPA checklist
COC checklist
Essentials of contraceptive technology
26. How a service provider can be reasonably sure that a woman is not pregnant No signs or symptoms of pregnancy, and
No intercourse since last normal menses, or
Correctly and consistently using another reliable method, or
Within 7 days after onset of normal menses, or
27. How a service provider can be reasonably sure that a woman is not pregnant (2) Within 7 days post-abortion or miscarriage or
Within 4 weeks postpartum (non-lactating), or
Fully or nearly fully breastfeeding, amenorrheic, and less than 6 months postpartum.
28. Thanks for participating