FAMILY PLANNING

PRESENTED BY: MPONDA M.

 GENERAL OBJECTIVE

• By the end of the lecture/discussion the

student nurse should be able to acquire
knowledge and understanding of Family
Planning
 SPECIFIC OBJECTIVES
• At the end of the lecture/discussion
student nurses should be able to:
1. Define Family Planning
2. State client profiling
3. Outline the steps in counseling
4. State the types of family planning
methods
5. Outline the benefits of family planning
 INTRODUCTION
• Family planning allows individuals and
couples to anticipate and attain their
desired number of children and the
spacing and timing of their births.
 INTRODUCTION

 It is achieved through use of contraceptive

methods and the treatment of involuntary
infertility.

 This implies that men and women have

the right to be informed and have access
to safe, effective, affordable, and
acceptable methods of their choice.
 INTRODUCTION
• Family planning has many benefits for
men, women, children, families, and the
society at large.

• A woman’s ability to space and limit her

pregnancies has a direct impact on her
health and well-being as well as on the
outcome of each pregnancy
 DEFINITION
• Family planning is the voluntary
decision made by an individual or couple of
the number of children they wish to have,
when to have them, and the use of birth
control methods and other techniques to
implement such plans.
 SOCIAL HISTORY
• Name:
• Age:
• Residencial Address:
• Marital Status:
• Denomination:
• Level Of Education:
• Occupation Of Self:
• Social Harbit:
 SOCIAL HISTORY
• Hobbies:
• Name Of Husband:
• Occupation Of Husband:
• Habits Of Husband:

NB: This history is taken for investigation of

the client, follow-ups care and as a basis
for information, communication and
education.
 SOCIAL HISTORY
Ask How She Is Feeling
Accomodation:
Water Supply:
Waste Disposal:
Surroundings:
Toilet Facility:
 FAMILY PLANNING COUNSELING
• Counseling is a vital part of family
planning.

• It helps the client to arrive at an informed

decision of reproductive options and to
use the chosen method safely and
effectively.
 FAMILY PLANNING
COUNSELING
• Good counseling should focus on
individual client’s needs and situations
because every client is different and has
different needs.

• During counseling, the provider should

assess the needs of each client by asking
profiling questions.
 DEFINE PROFILILING
• Profiling is a way of grouping clients
according to their reproductive needs
during a counseling session, in order to
meet each individual client’s specific
needs.
 DEFINE PROFILILING
• Profiling also helps providers to integrate
information on other reproductive health
issues such as breastfeeding, STIs, and
HIV/AIDS, as the needs are identified.
 TYPES OF CLIENT PROFILING
 There are four (4) categories of clients or
profiles:
1. Spacers/Delayers
 These are clients who want to wait before
having a first or another baby.

 The family planning methods under in this

category include:
 TYPES OF CLIENT PROFILING
• Condoms (male/female)
• Spermicides
• Oral contraceptive pills
• Injectables
• Inplants
• Scientific natural family planning (SNFP)
• IUD or IUCD
 TYPES OF CLIENT PROFILING
2. Limiters
 These are clients who do not wish to have
any more children.

 The family planning methods under this

category include:
 TYPES OF CLIENT PROFILING

• Injectables
• Inplants
• IUCD
• Bilateral Tubal ligation (BTL)
• Vasectomy
 TYPES OF CLIENT PROFILING
3. Breastfeeders
 These are clients with a baby less than 6
months.

 The following are family planning methods

under this group:
 TYPES OF CLIENT PROFILING
• Condoms (male/female)
• Spermicides
• Minipill
• Injectables
• Inplants
• Lactational amenorrhea method (LAM)
• Scientific natural family planning (SNFP)
• IUCD
 TYPES OF CLIENT PROFILING
4. Multiple partners
 These are clients who have multiple sexual
partners or who suspect that their partners
have multiple sexual partners.

 The methods under this group include:

 Condoms (male/female)

 Abstinence
 COUSELING SKILLS
 A good counselor should have the
following skills:

 Understand and respect the client’s rights

 Earn the client’s trust

 COUSELING SKILLS
 Understand the benefits and limitations of
all contraceptive methods

 Understand the cultural and emotional

factors that affect a woman’s (or couple’s)
decision to use a particular contraceptive
method.
 COUSELING SKILLS
• Encourage the client to ask questions.

• Be non-judgmental, and show kindness

and respect towards the client.

• Present complete and accurate

information in an unbiased, client
sensitive manner
 COUSELING SKILLS
• Active listener

• Understand the effect of non-verbal

communication

• Acknowledge your limitations and refer

where necessary.
 RIGHTS OF THE CLIENT
• It is important to remember that clients
have the following rights.

• The right to decide whether or not to

practice family planning
 RIGHTS OF THE CLIENT
• The freedom to choose which method to
use

• The right to privacy and confidentiality

• The right to refuse any type of

examination
 STEPS IN COUNSELING
 The acronym GATHER is used to guide the
provider in their family planning counseling.
 The letters stand for:
 Greet,
 Ask,
 Tell,
 Help,
 Explain, and
 Return.
 STEPS IN COUNSELING
Greet
• Greet the client respectfully, introduce
yourself by name, ask the name of your
client, welcome her (or the couple), provide
privacy and promise confidentiality.

• Find out about their address.

 STEPS IN COUNSELING
Ask
 Ask the client what s/he knows about
family planning and whether s/he has ever
used a method.
 Ask about her/his concerns about her/his
current situation.
 Find out about he/her reproductive goals,
e.g. the number of children they wish to
have.
 STEPS IN COUNSELING
Tell
 Tell the client about the various methods
are in her/his profile, relating them to the
clients particular situation and needs.

Help
 Help the client to make a choice of method
that will be appropriate and effective.
 STEPS IN COUNSELING
• If you have the family planning counseling
kit, use the front of the relevant cards
including the use of the screening
questions from the method card and
medical history on the family planning
card, to determine eligibility.
 STEPS IN COUNSELING
Explain
• Explain in detail how the client should use
the method of choice.

• Give her/him relevant single method

leaflet(s) if s/he has narrowed her/his
choices, or the all method leaflet if s/he is
still undecided about family planning.
 STEPS IN COUNSELING

Return
 A return visit should be scheduled before
the client leaves.

 If you have the family planning card, write

the date of the return visit on the card.
 STEPS IN COUNSELING
• Service providers at all sites should know
where to refer clients who choose a
contraceptive method not available at their
site so that they can receive this method.
 TYPES OF FAMILY PLANNING
METHODS
1. Combined Oral Contraceptives (COC)
 Combined oral Contraceptives (CoC) are
also called the ‘Pill’. e.g Oralcone F,
Safeplan, Microgynon.

 Pill contains low doses of two hormones -

progestin and estrogen like the natural
hormones progesterone and estrogen in a
woman’s body.
 TYPES OF FAMILY PLANNING
METHODS
 It is a small tablet that a woman takes
every day to prevent pregnancy.
Action/how it works
 It suppresses ovulation
 It thickens cervical mucus which makes it
difficult for the sperm to enter the uterus
to fertilize the ovum.
 It makes the endometrium unfavorable for
implantation.
 TYPES OF FAMILY PLANNING
METHODS
Effectiveness – 99%
 Effectiveness also depends on the user:
 Risk of pregnancy is greatest when a
woman starts a new pill pack 3 or more
days late, or misses 3 or more pills near
the beginning or end of a pill pack.
 TYPES OF FAMILY PLANNING
METHODS
How to use/when to start
 The client can begin taking the pill anytime
she is certain she is not pregnant.
 The ideal time to begin is during the first 7
days of her menstrual cycle.
 If a woman begins taking the pill after day
7 of her menstrual cycle, she should use a
back-up barrier method or abstain from
sexual intercourse for the next 7 days.
 TYPES OF FAMILY PLANNING
METHODS
• A woman can start taking the pill 3 weeks
after childbirth if she not breastfeeding.
• If breastfeeding, she should begin the Pill
6 months after delivery.
• Take one pill daily, when the packet is
empty, continue taking pills on daily basis
from the new packet.
• If a woman wants to get pregnant, she
should stop taking the pills.
 TYPES OF FAMILY PLANNING
METHODS
BENEFITS/ADVANTAGES
• Highly effective when taken daily and
immediate.
• Easy to use
• Does not interfere with sex
• Return to fertility after CoC are stopped,
no delay.
 TYPES OF FAMILY PLANNING
METHODS
 Decrease of menstrual flow, usually
become regular and lighter
 Decrease of menstrual cramps and
ovulation pain.
 Protects against ovarian and endometrial
cancer
 May improve anaemia, or may help to
reduce iron deficiency anaemia
 Acne can improve
 TYPES OF FAMILY PLANNING
METHODS
Side effects
• Mild headaches
• Dizziness
• Nausea
• Mild breast tenderness
• Slight weight gain
• Spotting between menstrual periods,
usually decreases after 2-3 cycles
• Some women can delay return to
fertility
 TYPES OF FAMILY PLANNING
METHODS
Disadvantages include:
• Must be taken daily
• Can reduce milk supply in breastfeeding
women
• Does not offer protection against STI,
including HIV/AIDS
 TYPES OF FAMILY PLANNING
METHODS
Managing Side Effects
• Explain to the woman that side effects are
not signs of illness, and that most side
effects usually become less or stop within
the first few months of using COCs.

• Explain that they keep taking COCs, as

skipping pills risks pregnancy and can
make some side effects worse.
 TYPES OF FAMILY PLANNING
METHODS
• Take each pill at the same time every day
to help reduce irregular bleeding and also
help with remembering.

• Take pills with food or at bedtime to help

avoid nausea.
 TYPES OF FAMILY PLANNING
METHODS
• The client can come back for help if side
effects bother her.

• Assess for pregnancy, if present stop the

pill.

• The client should have regular medical

checkups
 TYPES OF FAMILY PLANNING
METHODS
Women who should not use COC:
• History of arterial vascular disease
• Jaundice
• Blood clotting disorder
• Diabetes
• Breast cancer
• Liver tumors
• High blood pressure over 160/110
 TYPES OF FAMILY PLANNING
METHODS
• Women who are taking drugs for TB,
tetracycline, or anticonvulsants should use
a condoms as well because they reduce
the efficacy of the COC.
 TYPES OF FAMILY PLANNING
METHODS
Managing Missed Pills
• What to do when one misses a pill.
• If a client forget to take a pill at her
regular time, she should take the
forgotten pill as soon as she remembers
and then take the next pill at the regular
time.
• She should do this even if that means to
take two pills on the same time.
 TYPES OF FAMILY PLANNING
METHODS
 What if a client misses 2 pills?
 Explain to the client that its not safe to
forget more than one pill.
 If you forget two pills or more, take two
pills that day, two pills the next day, and
then one pill each day at the regular time.
 For the duration of that packet of pills use
a back-up barrier method (e.g a condom)
 TYPES OF FAMILY PLANNING
METHODS
2. PROGESTINE ONLY PILLS (POPs)
• POPs are also known as the ‘minipill’ e.g
microlut.
• It is a tablet that contains very low doses
of a progestin like the natural hormone
progesterone in a woman’s body.
• The minipill is a tablet which a woman
takes everyday to prevent pregnancy.
 TYPES OF FAMILY PLANNING
METHODS
Action/how it works
 It inhibits or suppresses ovulation

 It thickens the cervical mucus which

makes it difficult for sperm to reach or
meet an egg.

 Makes the endometrium unfavorable for

implantation to take place.
 TYPES OF FAMILY PLANNING
METHODS
Effectiveness
 Is 99% though depends on the user e.g.
for women who have monthly bleeding,
risk of pregnancy is greatest if pills are
taken late or missed completely.
 TYPES OF FAMILY PLANNING
METHODS
How to use/when to start
 A woman can start taking POPs anytime
she wants if certain that she is not
pregnant, 1-5 days during menstruation.

 She can begin taking the pills starting 2

weeks after delivery for non-breast feeding
women and 6 weeks after delivery for
breastfeeding mothers.
 TYPES OF FAMILY PLANNING
METHODS
• If a woman begins taking POPs after day 7
of the menstrual cycle, she should use a
back-up method (e.g condoms, or
abstainance).
• Take the pill everyday, preferably at the
same time each day.
• When the packet is empty, start taking the
pills from the new packet immediately
• If she wants to get pregnant, she stop
taking the pills.
 TYPES OF FAMILY PLANNING
METHODS
Advantages/benefits
 Highly effective when taken everyday.
 Easy to use
 Can improve anaemia
 The quality and quantity of milk are not
altered (can used by breastfeeding
mothers)
 Does not interfere with sexual intercourse.
 TYPES OF FAMILY PLANNING
METHODS
• Reduces menstrual flow.
• POPs can be provided by CBDs
• Return of fertility after POPs are stopped,
no delay.
• Overtime decrease in flow protects against
endometrial or ovarian cancer
 TYPES OF FAMILY PLANNING
METHODS
Side effects
 irregular menstrual bleeding
 Prolonged bleeding
 Frequent bleeding
 No monthly bleeding
 Mild headaches
 TYPES OF FAMILY PLANNING
METHODS
• Dizziness
• Mood changes
• breast tenderness
• Abdominal pain
• Nausea
• Slight weight gain
• Does not offer protection against STIs
 TYPES OF FAMILY PLANNING
METHODS
Managing side effects
 Explain that side effects are not signs of
illness
 Try taking pills with food or at bed time to
help avoid nausea
 Explain that client should keep taking
POPs, as skipping pills risks pregnancy.
 Explain that client can come back if side
effects bother her.
 TYPES OF FAMILY PLANNING
METHODS
Precautions
Women who should not use POPs, those with:
 Arterial vascular disease
 Jaundice
 Liver infection or tumor
 Breast cancer
 Diabetes
 High blood pressure of more than 180/110
 Women on anticonvulsants or rifampicin
 TYPES OF FAMILY PLANNING
METHODS
Managing missed pills
 Take a missed pill as soon as you
remember and then take the next pill at
the regular time (she may take 2 pills at
the same time or on the same day).
 TYPES OF FAMILY PLANNING
METHODS
• It is not safe to forget 2 pills, but if you
forget 2 pills or more, take 2 pills that day,
2 pills the next day and then one pill each
day at the regular time. For the duration
of that packet use a back-up method.

• If she vomits within 2 hours after taking a

pill, she should take another pill from her
pack as soon as possible, and keep taking
pills as usual.
 TYPES OF FAMILY PLANNING
METHODS
3. PROGESTINE ONLY INJECTABLES
 It an injection that contain progestin like
the natural hormone progesterone in a
woman’s body.

 Most widely used progestin-only injectable

include Depo-provera and Noristerat.
 TYPES OF FAMILY PLANNING
METHODS
 Depo-provera is effective for 3 months
(given at 3 months interval).

 Noristerat is effective for 2 months (given

at 2 months interval).
 TYPES OF FAMILY PLANNING
METHODS
Action/ how it works
 It inhibits or suppresses ovulation.
 It thickens cervical mucus making sperm
penetration difficult.
 Makes endometrium unfavorable for
implatation to take place.
Effectiveness
 99%
 TYPES OF FAMILY PLANNING
METHODS
• Effectiveness also depends on:

• Getting the injections regularly

• Risk of pregnancy is high when a woman

misses an injection.
 TYPES OF FAMILY PLANNING
METHODS
How to use/ when to start
 May start anytime if sure that the client is
not pregnant, 1-5 days of menstrual
bleeding.
 If not breastfeeding, 3 weeks after
delivery.
 If it is 7 days after the start of her monthly
bleeding, and will need a back-up method
for the first 7 days after injection.
 TYPES OF FAMILY PLANNING
METHODS
Advantages/ benefits
 Highly effective when given on schedule
 Easy to use
 The quality and quantity of milk is not
altered (can be used by breastfeeding
mothers)
 Reduces menstrual flow
 TYPES OF FAMILY PLANNING
METHODS
• Good for women who may want to take
the pill but cannot remember to take it
everyday.
• Does not interfere with sexual intercourse
• May protect against certain cancers e.g
endometrial and ovarian cancer.
• May improve anaemia
 TYPES OF FAMILY PLANNING
METHODS
Side effects
 Irregular bleeding
 Prolonged bleeding
 Infrequent bleeding
 No monthly bleeding
 Weight gain
 TYPES OF FAMILY PLANNING
METHODS
 Mild headaches
 Dizziness
• Abdominal bloating and discomfort
• Mood changes
• Less sex drive
 TYPES OF FAMILY PLANNING
METHODS
Managing side effects
• Explain that side effects are not signs of
illness

• Reassure her that over time side effects

may regress

• For irregular bleeding, give brufen 800 mg

twice daily for 5 days.
 TYPES OF FAMILY PLANNING
METHODS
 For mild headaches, suggest an analgesia
such as Panadol. Brufen e.t.c

 For abdominal discomfort, suggest any

locally available remedies.
 TYPES OF FAMILY PLANNING
METHODS
Managing late injections
• If the client is less than 4 weeks for a
repeat injection of Depo-provera, or less
than 2 weeks of repaeat Noristerat, she
can receive the next injection, no need for
a back-up method.
 TYPES OF FAMILY PLANNING
METHODS
• A client who is more than 4 weeks late for
Depo-provera, or more than 2 weeks late
for Noristerat, can receive the next
injection if:
(i) She has not had sex since 2 weeks after
should have had her last injection
 TYPES OF FAMILY PLANNING
METHODS
(ii) She has a back-up method or has taken
emergency contraceptive pills (ECPs) after
any unprotected sex since 2 weeks after she
should have had her last injection

(iii) She fully or nearly fully breastfeeding and

gave birth less than 6 months ago.

• Discuss why the client was late, remind her

that should keep trying to come back on
time.
 TYPES OF FAMILY PLANNING
METHODS
4. EMERGENCY CONTRACEPTION
• Emergency contraception is a
contraception that can be used soon after
unprotected sexual intercourse.

 Emergency contraception pills (ECPs) are

sometimes called “morning after” pills or
postcoital contraceptives.
 TYPES OF FAMILY PLANNING
METHODS
Types of ECPs
 There are variety of the methods, including
hormonal methods.
1. PC-4 (hormonal)
2. Postinor (hormonal)
3. IUCD insertion
4. Both COCs and POPs can also be used
for emergency contraception.
 TYPES OF FAMILY PLANNING
METHODS
• ECPs works primarily by preventing or
delaying the release of the ovum from
the ovaries (ovulation).

• They do not work if a woman is already

pregnant.
 TYPES OF FAMILY PLANNING
METHODS
Action/ how it works
• Hormonal methods will either inhibit
ovulation, interfere with the menstrual
cycle or prevent the ovum from remaining
in the uterus.

• An IUCD work by preventing the ovum

from remaining in the uterus.
 TYPES OF FAMILY PLANNING
METHODS
Effectiveness
• 97-99%
• Very effective when taken within 72 hrs
following unprotected sexual intercourse.
• The sooner ECPs are taken after
unprotected sex, the better they prevent
pregnancy.
• Can prevent pregnancy when taken any
time up to 5 days after unprotected sex.
 TYPES OF FAMILY PLANNING
METHODS
Advantages/ benefits
• Effective in prevention of unwanted
pregnancy.

• In the case of IUCD, it also provides long

term contraception.
 TYPES OF FAMILY PLANNING
METHODS
When to use ECPs
 ECPs is appropriate in the following
situations:
1. Rape

2. Any unprotected sex

3. Contraceptives mistakes e.g Condom used

incorrectly, slipped or broken.
 TYPES OF FAMILY PLANNING
METHODS
• Couple incorrectly used a fertility
awareness method (e.g failed to abstain
or to use another method during fertile
days)

• Man fails to withdraw before ejaculation

• Woman has missed 3 or more COCs or has

started a new pack 3 or more days late.
 TYPES OF FAMILY PLANNING
METHODS
• IUCD has come out.

• Woman is more than 4 weeks late for her

repeat injection of Depo-provera or 2
weeks late for her Noristerat
 TYPES OF FAMILY PLANNING
METHODS
How to take or dosing of ECPs
 High dose COCs (e.g PC-4):

 Take 4 tablets of COCs within 72 hrs of

unprotected sex, or

 Take 2 tablets of COCs within 72 hrs of

unprotcted sex, take the second dose (2
tablets) 12 hrs after taking the first dose.
 TYPES OF FAMILY PLANNING
METHODS
• If client vomits within 2 hrs of taking the
dose, she should take another dose as
soon as possible.

POPs
• Take 1 pill within 72 hrs of unprotected
sex, another 1 pill 12 hrs later.
 TYPES OF FAMILY PLANNING
METHODS
Disadvantages/ side effects
• Nausea,
• Vomiting
• Breast tenderness
• ECPs do not protect against STIs,
including HIV/AIDS
 TYPES OF FAMILY PLANNING
METHODS
• Effective only if used with 72 hrs,
especially for hormonal.
• Headaches
• Dizziness
• Abdominal pain

NB: if no menses within 3 weeks, the client

should visit a service provider to check for
pregnancy.
 TYPES OF FAMILY PLANNING
METHODS
5. BARRIER METHODS
• Male and female condoms

• Cervical cap: a plastic rubber cup that

snugly covers the cervix.
 TYPES OF FAMILY PLANNING
METHODS
6. LONG TERM
1. IUCD (loop)
 It is a small T-shaped plastic device that
fits inside the uterus (womb) to prevent
pregnancy.
 TYPES OF FAMILY PLANNING
METHODS
• Copper-Bearing Intrauterine Device
• Type available: Tcu-380A
• The copper-bearing intrauterine device
(IUD) is a small, flexible T-shaped plastic
frame with copper sleeves or wire around
it.
• Almost all types of IUCD have one or two
strings or threads tied to them.
 TYPES OF FAMILY PLANNING
METHODS
 It works by causing a chemical change
that damages sperm and the ovum before
fusion.
 Effectiveness-98-99%
 Effective for 12 yrs.
 Return to fertility after removal: no delay.
 TYPES OF FAMILY PLANNING
METHODS
Side effects
 Prolonged bleeding
 Irregular bleeding
 Sporting between periods.
 Abdominal cramps and pain during
monthly bleeding.
 TYPES OF FAMILY PLANNING
METHODS
DISADVANTAGES
 Requires pelvic examination before
insertion
 Not suitable for women at risk of STI’ or
HIV/AIDS due to increased risk of PID.
 Does not offer protection against STI,
HIV/AIDS
TYPES OF FAMILY PLANNING
METHODS
THINGS TO REPORT IMMEDIATELY
 Pain after insertion lasting more than 8hrs.
 Extremely heavy vaginal bleeding (twice
as much or twice as long)
 Signs of infection: chills, fever, pain or
abnormal vaginal discharge
 IUD string missing
 Possible exposure to an STI.
 TYPES OF FAMILY PLANNING
METHODS
Who can use the copper-bearing IUCD
 Women who have or not had children
 Any age group
 Have just had an abortion (if no evidence
of infection)
 Breastfeeding
 TYPES OF FAMILY PLANNING
METHODS
When to start
 Anytime it is reasonably certain the woman
is not pregnant .e.g
 Having menstrual bleeding
 If she is starting within 12 days after the
start of her monthly bleeding
 TYPES OF FAMILY PLANNING
METHODS
• Anytime within 48 hrs after childbirth,
including after caesarean section (C/S).

• If it is more than 48 hrs after birth, delay

until 4 weeks or more.

• For emergency contraceptive: within 5

days after unprotected sex.
 TYPES OF FAMILY PLANNING
METHODS
PRECAUTIONS
 Puerperal sepsis or infection of the genital
tract.
 Unexplained vaginal bleeding
 Cervical, endometrial or ovarian cancer
 AIDS
 TYPES OF FAMILY PLANNING
METHODS
Managing side effects
(i) Heavy or prolonged bleeding
 Reassure that many women experience
heavy or prolonged bleeding.
 Explain that its not harmful, & usually
becomes less or stops after the first few
months of use.
 TYPES OF FAMILY PLANNING
METHODS
• Give non steroidal anti-inflammatory drugs
e.g. ibuprofen 800mg or indomethacin 25
mg twice daily for 5 days after meals.

• Provide iron tablets

 TYPES OF FAMILY PLANNING
METHODS
(ii) Irregular bleeding
 Reassurance
 Give ibuprofen or indomethacin

(iii) Cramping or pain

 Reassurance that it is common in the first
3 to 6 months of insertion
 TYPES OF FAMILY PLANNING
METHODS
• Explain that it is not harmful and usually
decreases overtime

• Suggest use of ASA 600mg, ibuprofen

200-400mg or panadol 1g
 TYPES OF FAMILY PLANNING
METHODS
7. IMPLANTS
• Implants are small flexible rods or
capsules that are placed just under the
skin of the upper arm.

• Each rod is about the size of a matchstick,

that releases a progestin like the natural
hormone.
 TYPES OF FAMILY PLANNING
METHODS
TYPES OF IMPLANTS
 Jadelle: 2 rods, effective for 5 years.

 Implanon: 1 rod, effective for 3 years.

 Norplant: 6 rods, effective 5 years.

 TYPES OF FAMILY PLANNING
METHODS
Action
 Thickens cervical mucus making it difficulty
for the sperm to meet the ovum.

 Inhibits ovulation.

 Causes endometrial atrophy

 TYPES OF FAMILY PLANNING
METHODS
How Effective
 One of the most effective and long-lasting
methods.

 99%

 Return to fertility after removal- no delay.

 TYPES OF FAMILY PLANNING
METHODS
Side Effects
 Irregular bleeding
 Infrequent bleeding
 Heavy or prolonged bleeding
 No monthly bleeding
 Headaches
 Abdominal pain
 TYPES OF FAMILY PLANNING
METHODS
• Acne
• Weight gain
• Breast tenderness
• Mood changes or changes in sex drive
• Dizziness
 TYPES OF FAMILY PLANNING
METHODS
Who Should Not Use Jadelle
 Active thrombophlebitis or thromboembolic
disorder

 Undiagnosed abnormal genital bleeding

 Acute liver disease

 TYPES OF FAMILY PLANNING
METHODS
 Benign or malignant liver tumour

 Known or suspected breast cancer or other

hormone dependent cancer

 If pregnant while using the implants ,they

should be removed immediately
 TYPES OF FAMILY PLANNING
METHODS
When should Jadelle be Inserted
Make sure she is not pregnant
Inserted within 7 days after onset of
menstrual bleeding
Or immediately or within 7 days after
abortion
If inserted any other time ,advise to
use additional non-hormonal (barrier)
method for the following 7 days
 TYPES OF FAMILY PLANNING
METHODS
Drug Interactions
 Certain drugs interfere with the hormone
delivered by jadelle making it less effective
in preventing pregnancy
 Avoid use if client is taking antiepileptics
mainly barbiturates,phenytoin and
carbamazepine but not valproate
 Antibiotics ,avoid only griseofulvin and
rifampicin
 TYPES OF FAMILY PLANNING
METHODS
Managing Side Effects
(i) Irregular bleeding
 reassurance that its not harmful, and
usually becomes less or stops after first
year of use.
 Give Ibuprofen 800 mg or Mefenamic acid
500 mg tds after meals for 5 days.
 Give CoC 1 pill daily for 21 days.
 TYPES OF FAMILY PLANNING
METHODS
(ii) No monthly bleeding
 Reassurance that some experience this,
and that its not harmful.
(iii) Heavy or prolonged bleeding
 Reassurance that its generally not harmful,
and usually becomes less or stops after a
few months.
 Other treatment as in irregular bleeding.
 TYPES OF FAMILY PLANNING
METHODS
• Give iron tablets to help prevent anaemia

•For ordinary headaches give ASA 600 mg or

Ibuprofen 200-400 mg, Panadol 1g

(iv) Abdominal pain

• As for headaches and other locally
available remedies.
 TYPES OF FAMILY PLANNING
METHODS
(v) Acne
 Reassurance
 If not comfortable, suggesting switching to
CoC. Many women’s acne improves with
CoC use.

(vi)Weight changes
 Review diet and counsel as needed.
 TYPES OF FAMILY PLANNING
METHODS
(vii) Breast tenderness

 Advise the use of a well fitting bra.

 Try hot or cold compresses

 ASA 600 mg, Ibuprofen 200-400 mg, Panadol

1g, or other locally available remedies.
 TYPES OF FAMILY PLANNING
METHODS
(viii) Mood changes or sex drive
 Ask changes in life style that could affect
her mood or sex drive.
 Consider locally available remedies.

(ix) Dizziness
 Consider locally available remedies
 TYPES OF FAMILY PLANNING
METHODS
(x) Pain on insertion site

 Check if bandage not too tight.

 Advise to avoid pressure on the site

 Give pain relief.

 TYPES OF FAMILY PLANNING
METHODS
8. PERMANENT FAMILY PLANNING
METHODS
• Permanent family planning, intends to
provide life-long and permanent protection
against pregnancy.
• Reversal is usually impossible.
• Mainly two types female and male
sterilization.
 TYPES OF FAMILY PLANNING
METHODS
A. FEMALE STERILIZATION/ TUBAL
LIGATION
 Tubal ligation or female sterilization is a
permanent method for family planning for
women who do not want nay more
children.
 TYPES OF FAMILY PLANNING
METHODS
How It Works
 A trained provider makes a surgical in the
lower abdomen, the tubes are blocked so
that sperm and ovum can not meet for
fertilization.
 TYPES OF FAMILY PLANNING
METHODS
 Two surgical approaches may be used.
1. Minilaparotomy:
 Involves making a small incision in the
abdomen.

 The fallopian tubes are brought to the

incision, then they are blocked or cut.
 TYPES OF FAMILY PLANNING
METHODS
2. Laparoscopy:
 Involves inserting a long thin tube with a
lens in it into the abdomen through an
incision.

 This laparoscope enables the Dr to see and

block or cut the tubes.

NB: need to obtain informed consent.

 TYPES OF FAMILY PLANNING
METHODS
Effectiveness: 99.5%

Side effects: none

Known health benefits

 Protect risk of pregnancy
 Protect against risk of PID
 Protect against ovarian cancer.
TYPES OF FAMILY PLANNING
METHODS
Who should use it
 All women

Advantage/benefits
 Highly effective
 Permanent
 Does not interfere with sexual intercourse
 TYPES OF FAMILY PLANNING
METHODS
 May help protect against ovarian cancer

 Important method for clients for whom

pregnancy would be a health risk.
TYPES OF FAMILY PLANNING
METHODS
Disadvantages
 Risk of minor complications from surgery
e.g bleeding or infection.
 Pain for a few days after surgery
 Only specialized people can perform the
surgery and requires special equipment.
 Does not offer protection against STI,
including HIV/AIDS.
 TYPES OF FAMILY PLANNING
METHODS
B. MALE STERILIZATION/VASECTOMY
 It is a permanent method of family
planning for men who do not want any
more children.

 It is also called male surgical

contraception.
 TYPES OF FAMILY PLANNING
METHODS
How it Works
 Works by closing off each vas deferens,
keeping sperm out of semen, thus making
the sperm not to reach and fertilize the
ovum.
 TYPES OF FAMILY PLANNING
METHODS
Surgical procedure:
 A small incision is made in the scrotum,
locates the vas deferens, blocks it by
cutting and tying it closed or by
cauterization.
 TYPES OF FAMILY PLANNING
METHODS
Effectiveness:
 3 months in taking effect.

 The man or couple must use condoms or

another contraceptive for 3 months after
vasectomy.

 99%
 TYPES OF FAMILY PLANNING
METHODS
Advantages/ benefits
 Extremely effective
 Permanent
 Does not interfere with erection, release of
semen or sexual pleasure.
 Protection for the male only (females are
at risk for pregnancy).
 TYPES OF FAMILY PLANNING
METHODS
• Usually irreversible.

• Requires skilled medical personnel.

• Lack of protection from sexually

transmitted diseases and infections,
including HIV
 NATURAL FAMILY PLANNING
METHODS
9. ABSTINENCE
 Abstinence is avoiding having sexual
intercourse, that is, no sexual penetration.
 NATURAL FAMILY PLANNING
METHODS
Advantages and benefits
• 100% effective

• Cheap

• Prevention from STIs, including HIV/AIDS

• No side effects
 NATURAL FAMILY PLANNING
METHODS
• Increases individual self-esteem as one
takes control of one’s sexuality and
chooses to have sexual intercourse only
when one finds the right partner for a safe
and monogamous relationship.
 NATURAL FAMILY PLANNING
METHODS

How to use
• Try to avoid situations where you may be
tempted to have sex.

• Talk to/reason with your partner and

emphasize the advantages of waiting until
you are both sure of yourselves and trust
each other.
 NATURAL FAMILY PLANNING
METHODS
• Think about the dangers of STIs and
HIV/AIDS

• Practice other affectionate and love

stimulating methods.

• Avoid being influenced by pornographic

movies.
 NATURAL FAMILY PLANNING
METHODS

Disadvantages
• Peer pressure.

• May be hard to exercise such self control.

• May be difficult to negotiate with partner.

 NATURAL FAMILY PLANNING
METHODS

10. LACTATION AMENORRHEA

METHOD (LAM)
 Its a temporary family planning method
based on the natural effect of
breastfeeding on fertility.
 NATURAL FAMILY PLANNING
METHODS
How it works
 When the baby suckles frequently at the
breast, it stimulates the anterior pituitary
gland to release prolactin which then
inhibits ovulation.

 For it to be effective the woman must

breastfeed the baby frequently ( 2-3
hourly) and must be the only food or drink
the baby receives.
 NATURAL FAMILY PLANNING
METHODS
 LAM requires 3 conditions, which must be
met.
1. The mother’s monthly bleeding has not
returned.
2. The baby is breastfeeding frequently (
2-3 hourly)
3. The baby should be less than 6 months
old.
 NATURAL FAMILY PLANNING
METHODS
How effective
 98 – 99% effective if used correctly.

How to use/when to start

 The woman may start LAM at any time if she
meets all 3 criteria required for using the method.

 Start breastfeeding immediately (within 1 hour) or

as soon as possible after the baby is born.
 NATURAL FAMILY PLANNING
METHODS
• Any time if she has been fully or nearly
breastfeeding her baby since birth and her
monthly bleeding has not returned.

• The woman should breastfeed the baby

fully (at least 2-3 hourly during the day, 4-
6 hourly during the night
 NATURAL FAMILY PLANNING
METHODS
Benefits/ advantages
 Highly effective when LAM criteria are met.
 Universally available
 No cost or supplies, no medical supervision
 No health risks or side effects
 Improves mother and child bonding
 No interference with intercourse
 NATURAL FAMILY PLANNING
METHODS
• Helps to pass passive immunity ( transfer
of protective antibodies) to the baby.

• Breast milk is the best source of nutrition

to the baby.

• Decrease exposure to contamination from

other food supplements, utensils and
water.
 NATURAL FAMILY PLANNING
METHODS
Side effects/disadvantages
 Does not offer protection against STIs,
including HIV/AIDS

 Protection only lasts for six months after

childbirth.
 SCIENTIFIC NATURAL FAMILY
PLANNING OR FERTILITY AWARENESS
METHODS

• Scientific Natural Family Planning is a

method based on recognizing signs and
symptoms naturally occurring in a
woman’s menstrual cycle to identify times
of fertility and infertility.
 SCIENTIFIC NATURAL FAMILY
PLANNING OR FERTILITY AWARENESS
METHODS
• These methods require partners
cooperation.

• Couple must be committed to abstain and

avoid genital to genital contact or using
another method on fertile days.

• These methods are sometimes called

periodic abstinence
 SCIENTIFIC NATURAL FAMILY
PLANNING OR FERTILITY AWARENESS
METHODS
 The woman can use several ways that can
be used individually or in combination to
tell when her fertile time begins and ends.

1. Calendar based method

 SCIENTIFIC NATURAL FAMILY
PLANNING OR FERTILITY AWARENESS
METHODS
2. Symptom based methods: depend on
observing signs of fertility.
a) Cervical mucus method: observing
mucus only.
b) Basal Body Temperature (BBT)
method: observing changes in body
temperature only
 SCIENTIFIC NATURAL FAMILY
PLANNING OR FERTILITY AWARENESS
METHODS
1. CALENDAR BASED METHOD
 A woman keeps tracking of days of the
menstrual cycle to identify the start and
end of the fertile time.

 Used by women whose menstrual cycle is

between 26-32 days long.
 SCIENTIFIC NATURAL FAMILY
PLANNING OR FERTILITY AWARENESS
METHODS
 A woman keeps track of the days of her
menstrual cycle, counting the first day of
monthly bleeding as day 1.

 Days 8 to 19 of every cycle are considered

fertile days.
 SCIENTIFIC NATURAL FAMILY
PLANNING OR FERTILITY AWARENESS
METHODS
• The couple avoids vaginal sex or uses other
barrier methods during this period.

• They can have unprotected sex on days 1 to

7 at the beginning of the cycle, and from day
20 until her next monthly bleeding begins.

• The couple can use memory aids such as

cyclebeads or they can mark a calendar.
 SCIENTIFIC NATURAL FAMILY
PLANNING OR FERTILITY AWARENESS
METHODS
2. SYMPTOM-BASED METHODS:
a) Cervical secretions method: When a
woman sees or feels cervical secretions, she
may be fertile.
 SCIENTIFIC NATURAL FAMILY
PLANNING OR FERTILITY AWARENESS
METHODS
How to Use It
 The woman checks for cervical secretions
every afternoon and/or evening, on
fingers, underwear, or tissue paper or by
sensation in or around the vagina.
 SCIENTIFIC NATURAL FAMILY
PLANNING OR FERTILITY AWARENESS
METHODS
• If she notices any secretions of any type,
color or consistency, she considers herself
fertile that day and the following days.

• The couple can have unprotected sex

again after the woman has had 2 dry days
in a row.
 SCIENTIFIC NATURAL FAMILY
PLANNING OR FERTILITY AWARENESS
METHODS
b) Basal Body Temperature (BBT)
method: observing changes in body
temperature only
How it Works
 The woman takes her body temperature at
the time each morning before getting out
of bed and before eats anything.
 She records her temperature on a graph.
 SCIENTIFIC NATURAL FAMILY
PLANNING OR FERTILITY AWARENESS
METHODS
 She watches her temperature to rise
slightly 0.2 to 0.5⁰ just after ovulation.

 The couple avoids vaginal sex from the

first day of monthly bleeding until 3 days
after the woman’s temperature has risen
above her regular temperature.
 SCIENTIFIC NATURAL FAMILY
PLANNING OR FERTILITY AWARENESS
METHODS
• When the woman’s temperature has risen
above her regular temperature and stayed
higher for 3 full days, ovulation has
occurred and fertile period has passed.

• The couple can have unprotected sex on

the 4th day and until her next monthly
bleeding.
 SCIENTIFIC NATURAL FAMILY
PLANNING OR FERTILITY AWARENESS
METHODS
11. Withdrawal/Coitus Interruptus/ or
Pulling Out.
 The man withdraws his penis from the
vagina and ejaculates outside the vagina,
keeping his semen away from her external
genitals.
 SCIENTIFIC NATURAL FAMILY
PLANNING OR FERTILITY AWARENESS
METHODS
 Effectiveness 73%

How to Use
 Before sex a man should urinate and wipe
the tip of his penis to remove any sperm
remaining.
 BENEFITS OF FAMILY
PLANNING ON THE WOMAN
 Mothers will be healthier, because risky
pregnancies are avoided.

 Is at a lower risk of dying from

complications during pregnancy and
childbirth
 BENEFITS OF FAMILY
PLANNING ON THE WOMAN
 Enables her to regain her health after
delivery

 Gives enough time and opportunity to love

and provide attention to her husband and
children
 BENEFITS OF FAMILY
PLANNING ON THE WOMAN
 Gives more time for her family and own
personal advancement

 When suffering from an illness, gives

enough time for treatment and recovery
 BENEFITS OF FAMILY
PLANNING ON THE WOMAN
• Is able to breastfeed longer (this reduces
the risk of breast and ovarian cancer)

• Gets more time to take care of the baby

• Gets more time to be physically,

emotionally, and financially prepared for
her next pregnancy
 BENEFITS OF FAMILY
PLANNING ON THE WOMAN
 Family planning reduces health risks to
women and gives them more control over
their reproductive lives.

 Family planning helps mothers avoid

pregnancy when they are vulnerable
because of their youth or old age.
 BENEFITS OF FAMILY
PLANNING ON THE WOMAN
• Hormonal methods can help with irregular
bleeding and pain during a woman’s
monthly bleeding.
 BENEFITS TO THE FATHER
 May feel an increased sense of satisfaction
from safeguarding the health and well-
being of his wife and children ·

 Has more time between births, allowing

him time to plan finances before the next
child

 Has more time for his wife which will

contribute to a better relationship
 BENEFITS TO THE FATHER
• Lightens the burden and responsibility in
supporting his family

• Enables him to give his children their basic

needs (food, shelter, education, and better
future)

• Gives him time for his family and own

personal advancement
 BENEFITS TO CHILDREN
 Fewer children means more food for each
child.

 Healthy mothers produce healthy children

 Will get all the attention, security, love,

and care they deserve.
 BENEFITS TO CHILDREN
• May be breastfed for a longer period of
time, which allows them to reap the
benefits of breastfeeding, including:
better nutrition, protection from childhood
diseases ,attention from the mother .

• Makes education for the children more

affordable.
 BENEFITS TO THE COUPLE
/FAMILY
 Families with fewer children are often able
to send those children to school so girls
get a chance to attain higher education,

 Helps families spend less money and build

up savings over time
 BENEFITS TO THE COUPLE
/FAMILY
• Helps couples to plan when and how
many children to have.

• It allows parents to invest more in each

child e.g their education

• Family planning can also help you and

your partner enjoy sex more, because you
are not afraid of unwanted pregnancy.
 BENEFITS TO THE NATION
 And some methods have other health
benefits. For example, condoms can help
protect against the spread of sexually
transmitted infections (STIs), including
HIV.
 BENEFITS TO THE NATION

• Help in the reduction of maternal and

infant morbidity and mortality because risk
pregnancies are prevented.

• Contraceptive use slows population

growth, because overpopulation puts
pressure on the environment, the
economy and services such as education
and health.
THE END