FP

FAMILY PLANNING SERVICES

• Family planning is defined as the ability of individuals
and couples to anticipate and attain their desired
number of children and the spacing and timing of
their births
• It is achieved through use of contraceptive methods
• It is a means of promoting the health of women and
families and part of a strategy to reduce the high
maternal, infant and child mortality
 Eligibility for service
• Any reproductive age person, male or female
regardless of marital status is eligible
 Range of Services to be offered In
Family Planning Services
• Counseling
• Provision of contraceptives
• Screening for reproductive organ cancers
• Prevention, screening and Mgt for sexually
transmitted infections including HIV
• Prevention and Mgt of infertility
 Rationale for Family Planning
Services
• Health benefits: saves lives of women and
children and improves the quality of life for all
• Social and economic benefits
• Meeting individual/couples fertility benefits
 FP methods
• Natural Family Planning Methods vs. Modern
Family Planning Methods
• Temporary, Permanent vs. Emergency
contraception methods
• Hormonal vs. non-hormonal methods
 Natural FP Methods
• Abstinence
• Fertility awareness based methods: Standard
Days Method (SDM),Rhythm(Calendar)
Method, two-days method, Cervical mucus
(Billings ovulation) method, Sympto-thermal
method
• Lactation amenorrhea method (LAM)
• Withdrawal method
 Modern FP Methods
• Male and Female Condoms/Diaphragms and other barrier
methods
• Vaginal Contraceptive Foam Tablet and jellies
• Emergency Contraceptives
• Progestin-Only Pills
• Combined Oral Contraceptives
• Injectables contraceptives
• Implants
• Intra-Uterine Contraceptive Devices
• Bilateral tubal ligation
• Vasectomy
 Hormonal
• Steroidal contraception
• GnRH analogues
• Steroid hormone receptor antagonists
 Assignment
• What is the difference between FP and
contraception?
 Contraception
• Birth control
• Preventing pregnancy
 WHO Eligibility criteria for the use of
various contraceptive methods
• Category 1: A condition for which there is no
restriction for the use of the contraceptive method
• Category 2: A condition where the advantages of
using the method generally outweigh the theoretical
or proven risks
• Category 3: A condition where the theoretical or
proven risks usually outweigh the advantages of
using the method
• Category 4: A condition which represents an
unacceptable health risk if the contraceptive method
is used.
 Combined Oral
Contraceptives(COC)
• Pills that contain low doses of 2 hormones—a
progestin and an estrogen—like the natural
hormones progesterone and estrogen in a woman’s
body.
• Also called “the Pill,” low-dose combined pills, OCPs,
and Ocs
• Work primarily by preventing the release of eggs
from the ovaries (ovulation)
 How much effective?
• Effectiveness 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
• When no pill-taking mistakes are made, less than 1
pregnancy per 100 women using COCs over the first
year (3 per 1,000 women)
 Side effects, benefit vs.
contraindications
• Headaches, dizziness, nausea, breast tenderness, mood
changes
• Acne usually improves
• Blood usually increases
• Decrease milk production
• Risk of thrombosis increases
• Avoid in lactating mother( <6months) and immediate
postpartum if not lactating(<6wks)
• Decrease menstrual cramp, risk of endometrial cancer,
ovarian cyst and cancer
• Risk of cervical cancer slightly increases. What abt breast Ca?
 When to Start?
• A woman can start using COCs any time she wants if it is
reasonably certain she is not pregnant
• If she is starting within 5 days after the start of her monthly
bleeding, no need for a backup method
• If it is more than 5 days after the start of her monthly
bleeding, she can start COCs any time it is reasonably certain
she is not pregnant
• She will need a backup method for the first 7 days of taking
pills
• Can be started immediately after first trimester abortion
(with in 7days)
• 28-pill packs: When she finishes one pack, she should
take the first pill from the next pack on the very next
day
• 21-pill packs: After she takes the last pill from one
pack, she should wait 7 days—no more— and then
take the first pill from the next pack.
• It is very important to start the next pack on time.
Starting a pack late risks pregnancy.
• If Missed 1 or 2 pills:
 take a hormonal pill as soon as possible
 little or no risk of pregnancy
• If Missed 3 pills or more days in a row in the
first or second week:
take a hormonal pill as soon as possible
 use a backup method for the next 7 days.
 also, if she had sex in the past 5 days, she can
consider ECPs
 Progestin-Only Pills
• Pills that contain very low doses of a progestin like
the natural hormone progesterone in a woman’s
body
• Also called “minipills”
• Work primarily by: thickening cervical mucus (this
blocks sperm from meeting an egg) and disrupting
the menstrual cycle, including preventing the release
of eggs from the ovaries (ovulation)
• Take one pill every day. No breaks between packs
• Safe for breastfeeding women and their babies
• Add to the contraceptive effect of breastfeeding
• Bleeding changes are common but not harmful
• When pills are taken every day, less than 1 pregnancy per 100
women using POPs over the first year (3 per 1,000 women).
• Safe and Suitable for Nearly All Women
• Women who are not breastfeeding should take a pill at the
same time each day.
 Emergency Contraceptive Pills
• Also known as “Morning after” pills or postcoital
contraceptives
1. Progestin-only pills
2. COC
3. IUCD
4. Mifepristone
 When to Take Them?
• As soon as possible after unprotected sex.
• The sooner ECPs are taken after unprotected
sex, the better they prevent pregnancy
• Can help to prevent pregnancy when taken
any time up to 5 days(72hr is the std) after
unprotected sex
• Levonorgesterol, two 0.75mg tablets to be taken 12 hours
apart within 72 hours unplanned sexual exposure
• COC with 50microgram of oestrogen, 2 tabs BID within 72hrs
of unplanned sexual exposure for 2doses
• COC with 35microgram of oestrogen, 4 tabs BID within 72
hours unplanned sexual exposure for two doses
• IUCD: would be effective if inserted within five days of
unplanned exposure, after ruling out the existence of
infection
 Progestin-Only Injectables
• Depot medroxyprogesterone acetate (DMPA) and
norethisterone enanthate (NET-EN)
• Each contain a progestin like the natural hormone
progesterone in a woman’s body
• Given by injection into the muscle
• DMPA, the most widely used progestin-only injectable, is also
known in its intramuscular form as “the shot,” “the jab,” the
injection, Depo, Depo-Provera, and Petogen
• Work primarily by preventing the release of eggs from the
ovaries (ovulation).
• As commonly used, about 4 pregnancies per 100 women
using progestin-only Injectables over the first year
• Return of fertility after injections are stopped------an average
of about 4 months longer for DMPA
• First 3 months: irregular and prolonged bleeding
• At one year no monthly bleeding, infrequent bleeding,
irregular bleeding
• Bleeding changes are normal and not harmful. If a woman
finds them bothersome, counseling and support can help.
• May help women to gain weight
• Woman can start using progestin-only
injectables as soon as 6 weeks after childbirth
• Do not provide progestin-only injectables for
DM mother over 20 years
 Implants
• Small plastic rods, each about the size of a
matchstick, that release a progestin like the natural
hormone progesterone in a woman’s body
• A specifically trained provider performs a minor
surgical procedure to place one or 2 rods under the
skin on the inside of a woman’s upper arm.
• Work primarily by: preventing the release of eggs
from the ovaries (ovulation) and thickening cervical
mucus
 Types of implants
• Jadelle: 2 rods containing levonorgestrel, highly
effective for 5 years
• Implanon NXT (Nexplanon): 1 rod containing
etonogestrel, labeled for up to 3 years of use
• Levoplant (Sino-Implant (II)), 2 rods containing
levonorgestrel. Labeled for up to 4 years of use
• Norplant, which consisted of 6 capsules and was
effective for 5−7 years,
• One of the most effective and long-lasting methods:
Far less than 1 pregnancy per 100 women using
implants over the first year (1 per 1,000 women)
• Do not require the user to do anything once they are
inserted
• Prevent pregnancy very effectively
• Are both long-lasting and reversible
• can be used postpartum immediately
• Bleeding changes are common but not harmful
• Typically, prolonged irregular bleeding over the first
year, and then lighter, more regular bleeding,
infrequent bleeding, or no bleeding
 Seminar topic
• IUCD:
 defn, types, indication, contraindications,
When can a women have an IUD insertion
 Classification of contraception
based on effectiveness
• Tier 1 Methods----“Very Effective”: IUCD, implant
• Tier 2 Methods---“Effective”: injectable (DMPA) Pill
Patch Ring
• Tier 3----- “Moderately Effective”: condoms (male
and female), Diaphragms, cervical cap, sponge
Fertility awareness-based methods
• Tier 4----- “Less Effective” : Withdrawal, Spermicides