FAMILY PLANNING

MR NKOLE J

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 Introduction
• Family planning is aimed at ensuring that all couples and
individuals have the basic right to decide freely and responsibly
the number and spacing of their children and to have the
information, education and the means to do so.
• Therefore In this presentation we are going to discuss the
general strategies of how Family planning services are being
provided and service delivery requirements as well as various
methods of family planning.

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 History and Trends of Family Planning in Zambia

• In Zambia, the Total Fertility Rate is at 4.7 births per woman

meaning that a Zambian woman will give Birth to 4.7 children
by the end of her Child bearing age (ZDHS,2018).
• Currently, the population growth rate is a 3%. Men and women
have the right to be informed and to have access to safe,
effective, affordable, and acceptable methods of their choice
for fertility regulation.

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 History and Trends of Family Planning in Zambia

• According to Zambia Demographic Health Survey 2018, half

of all married women of reproductive age in Zambia are using
a method of contraception (50%). Among married women, use
of modern methods was at 48%,which is far more common than
use of traditional methods (2%).
• The most widely used method is injectables (26%), followed by
the pill and implants (8% each).
• In general, women in Zambia do not begin to use contraception
until they have had at least one child.
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 History and Trends of Family Planning in Zambia

• Fifty four percent (54%) of married women residing in urban

areas use contraception compared with 46% of women in rural
areas. There is considerable variation in contraceptive use by
region.
• According to ZDHS(2018), Women from Western and Luapula
provinces are the least likely to use any method of
contraception (31% and 39%, respectively).
• Muchinga and Lusaka provinces have the highest rates of use of
any method (58% and 57%, respectively).
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 History and Trends of Family Planning in Zambia

• As expected, contraceptive use generally increases with

educational attainment and wealth.
• Injectables are the most popular contraceptive method across all
subgroups; irrespective of background characteristic, roughly a
quarter of current users rely on injectables to prevent
pregnancy.
• Use of any contraceptive method has not changed much in the
past 5 years; 49% of currently married women age 15-49
reported using a method in the 2013-14 ZDHS compared with
50% in the 2018 ZDHS. MR NKOLE J6
 History and Trends of Family Planning in Zambia
• However, the proportion of currently married women who use
modern contraceptive methods increased to 48% from 45% in
2013-14.
• The percentage of women using injectables has increased, from
19% in 2013-14 to 26% in 2018, whereas the use of the pill
fell from 12% to 8%.
• Among sexually active unmarried women, 44% are using a
contraceptive method. The most commonly used methods among
sexually active unmarried women are injectables (21%),
implants (9%), and male condoms (7%). MR NKOLE J 7
 General objective
• At the end of the lecture students should be able to acquire
knowledge on the methods of family planning.

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 Specific objectives
At the end of the lecture students should be able to
i. Define related terms.
ii. Outline the benefits of family planning.
iii. Describe the family planning counselling and profiling method.
iv. Outline the classification of family planning.
v. Outline the family planning methods, their advantages and
disadvantages.

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 Definitions
• Family Planning is a voluntary decision made by an individual
or a couple on the appropriate number of children they wish to
have, and when to have them (ITG, 2002).
• Family planning is a decision made by the couple on when
they want to have their next child and how they will protect
themselves from unplanned pregnancy (MoH, 2004).

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 Strategies for Family Planning
1.Integrating family planning services with other Reproductive
Health programmes such as STI/HIV Prevention and Control
programme, MCH/Safe Motherhood, Adolescent and
Reproductive Health, Male involvement, Prevention and
Management of Abortion and Breastfeeding.
2. Expanded access to Family planning through non –public
Delivery Systems - This is done by use of the private sector and
social marketing; community based programmes, and Information
Education and Communication.
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3. Targeting Family Planning services to priority groups -
Priority groups include HIV positive mothers, men adolescents
among others.

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 Principles of counselling in FP
i. Understand and respect client’s rights, earn their trust and
encourage them to ask questions.
ii. Understand cultural and emotional factors that may affect
service provision or utilization by the woman or couple.
iii. Do not be judgmental and listen to client concerns actively.
iv. Understand the effects of non-verbal communication.
v. Understand benefits and limitations of all available methods;
present complete and accurate information in an unbiased
client sensitive manner.
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Vi. Ensure that the information about methods covers the six (6)
topics that is;
 Effectiveness
 Advantages and disadvantages
 Side effects and complications
 How to use the method
 STI prevention and ABC (abstain, be faithful, condomise) - issues of behavioral change
 When to return
vii. Recognize your own insufficiency to effectively provide the
service and refer. MR NKOLE J 14
BENEFITS OF FAMILY PLANNING
On the woman
1. Gives more time for her family and own personal
advancement like education and managing business.
2. Family planning puts the woman at a lower risk of dying from
complications during pregnancy and childbirth
3. Enables her to regain her health after delivery
4. Gives enough time and opportunity to love and provide
attention to her husband and children
6. Family planning enables mother to breastfeed longer
7. Gets more time to take care of the baby
8. Gets more time to be physically, emotionally, and financially
prepared for her next pregnancy.
9.Hormonal methods can help with irregular bleeding and
pain during a woman’s monthly bleeding.
10.Family planning helps mothers avoid pregnancy when
they are vulnerable because of their youth or old age.
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
• 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
1. Fewer children means more food for each child.
2. Children will get all the attention, security, love, and care
they deserve.
3. Family planning makes education for the children more
affordable
4. 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.
Benefits to the couple/family
1. Families with fewer children are often able to send
those children to school so girls get a chance to attain
higher education,
2. Helps families spend less money and build up savings
over time
3. Helps couples to plan when and how many children to
have.
• 4. it allows parents to invest more in each child e.g. their
education
• 5. Family planning can also help you and your partner
enjoy sex more, because you are not afraid of
unwanted pregnancy.
Benefits to the nation
1. And some methods have other health benefits. For
example, condoms can help protect against the spread of
sexually transmitted infections (STIs), including HIV.
2. Help in the reduction of maternal and infant morbidity and
mortality because risk pregnancies are prevented.
3. Contraceptive use slows population growth, because
overpopulation puts pressure on the environment, the
economy and services such as education and health.
 Family planning counselling
• Counselling is a therapeutic and helping relationship through which
individuals are helped to define goals, make decisions, and resolve
problems related to personal, educational, health and psychosocial
concerns (MoH, 2001).
• Adequate counselling focuses on the individual client’s needs and
situation where the provider assesses the needs of each client by
asking profiling questions because every client is different and has
different needs.
• It helps the client to arrive at an informed decision of reproductive
options and to use the chosen method safely and effectively.
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 Family planning counselling
• Profiling is a way of grouping clients according to their
reproductive needs during a counselling session, in order to meet
each individual client’s specific needs.
• In order to provide individualized counselling, you need to
profile the client so that the information you provide is relevant
to that client.
• The selection of appropriate methods to discuss with client can
be done after profiling the client.

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 Counselling steps in family Planning

• The acronym GATHER is used as a guide in client counselling for

FP services(ITG, 2002). ; the letters stand for;
• Greet
• Ask
• Tell
• Help
• Explain
• Return
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 Counselling steps using GATHER

• Greet; greet client and introduce yourself, assure them of

confidentiality, give full attention and data about available
methods, collect full data from client
• Ask; ask client about themselves – particulars needs, obstetric
and medical history, Sexually Transmitted Infections (STIs), use of
FP before, assess client’s knowledge about FP. Discuss concerns
and dispel myths and misconceptions of client regarding FP
• Tell; tell client about modern FP methods available, and discuss
each in detail.
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• Help; help client choose a method and repeat information
regarding the chosen method if necessary.
Explain laboratory tests or procedures that may need to be
done.
Assess client suitability for the chosen method and help client
choose a different method if found not suitable for the chosen
method.

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• Explain; explain how to use the method – what, where, when and
how.
• Explain potential side effects, ask client to repeat instructions,
explain when to return for follow-up, resupply.
• Return; plan follow-up visit.
• During the follow-up visit find out if client is still using the method,
any side effects experienced, challenges, and help resolve them.
• If she stopped, find out why, and try to restart or chose another
method.
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• During the session, the counsellor can also use the acronym,
CLEAR that stands for Clear and simple language, Listen to
what the client is saying, Encourage and assure client of
effective use of the method, Ask for feedback from client and
have the client Repeat the key points.

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 Client profiling and their recommended f/p methods

• There are 4 categories (client profiles) of clients in family

planning;
1. Spacers or delayers
2. Limiters
3. Breast feeders
4. Multiple partners

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 Client profiling and their recommended f/p methods

1. Spacers or delayers; are clients who want to wait before

having a first or another child. Recommended FP methods
include condoms (female and male), spermicides, oral
contraceptives, injectables, Norplant, Scientific Natural Family
Planning (NSFP), and Intra Uterine Contraceptive Device
(IUCD).
2. Limiters; clients who do not wish to have any more children.
Recommended FP methods include injectables, Norplant,
vasectomy and tubal ligation.
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 Client profiling and their recommended f/p methods
• 3.Breast feeders; clients with a baby less than 6 months
postpartum. Recommended FP methods include condoms (female
and male), spermicides, mini pill, injectables, Norplant, Scientific
Natural Family Planning (NSFP), Lactational Amenorrhea
Method (LAM) internal/Intra Uterine Contraceptive Device
(IUCD).
• 4. Multiple partners; clients with several sexual partners or
who suspect that their partners have several partners.
Recommended FP methods include male and female condoms,
abstinence. Dual methods are highly recommended (double
protection)
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 Profiling questions

• Determine if the client is in a single faithful relationship with one

who is faithful.
• Is client currently breastfeeding a child who is less than six (6)
months.
• If yes then classify them in group 3 and they are known as
breast feeders.
• If no then classify them in group 1 and they are known as multi
partners.
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 Profiling questions

• Then also determine if the client and his/her partner wish to

have more children
• If yes then classify then in group 2 and they are known as
spacers or delayers.
• If no then classify them in group 4 and they are known as
limiters.

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• Following client profiling, a care provider should also
consider principles of counselling in FP as follows;
Understand and respect client’s rights.
Earn their trust and encourage them to ask questions.
Understand benefits and limitations of all available methods;
Present complete and accurate information in an unbiased client
sensitive manner.
Understand cultural and emotional factors that may affect
service provision or utilization by the woman or couple.
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Do not be judgmental and listen to client concerns actively.
Understand the effects of non-verbal communication.
Recognize your own insufficiency to effectively provide the
service and refer.
• Remember also that clients have the right;
To refuse to practice FP,
They have right to choose the method they find suitable,
They have right to privacy and confidentiality and right to
refuse any type of examination.
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 Quality of Care in Family Planning
• Quality of care is essential for maintaining the health and
satisfaction of clients. It is also important for increasing the
demand for FP and reducing fertility rates. High quality care
includes the following;
• 1. Providing and ensuring a wide range of methods,
including referral systems.- All women, men and young people
should be provided with the FP methods they request, as long as
they meet the eligibility criteria, without the interference of
personal opinions or preconceived biases of the service
providers. MR NKOLE J 37
• 2. Developing a client-provider relationship that is acceptable
to the client - Providers have to communicate with clients
effectively and in cultural appropriate and sensitive ways.
• All clients are treated with respect and dignity, in a way that
does not infringe upon the client’s rights. Personal biases are
also avoided.

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• 3. Effective counselling and provision of complete as well as
accurate information about all the methods - The care
provider develops an open, interactive communication with the
clients, listening attentively and addressing clients’ needs.
• Counselling on variety of methods available is done, and for
methods that are not available the client is referred to
appropriate centres where they can be accessed. Profiling has
to be considered during the counselling session, with the GATHER
approach being implemented.
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• 4.Providing ultimate privacy as well as confidentiality.
• The client has to be informed in advance if physical exam will
be performed, and the client has to be comfortable with it.
• If possible separate rooms are provided, or screens
alternatively.
• The client should only undress when necessary; the client should
not be left undressed for a long time. People without a role in
the room during FP counselling and examination should not be
present MR NKOLE J 40
• 5.Ensuring that care providers have the necessary technical
and counselling skills in order to provide the methods safely.
• Service providers and community players will be trained and
given capacity on FP updates. Training for each group will be
based on an assessment of current knowledge and functional job
description.
• Regular Technical Support and Supervision will be provided
from time to time. Updated protocols will also be provided.
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• 6. Providing convenient and accessible services that meet the
needs of the client.
• All FP services should have an accessible geographic location,
should be convenient to specific needs of male, female and
young adults, and should have good ventilation, with clean and
safe water with appropriate fire safety measures.

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• 7. Providing follow-up care to ensure continuity of services.
• All clients should be advised on appropriate follow-up visits,
encouraged to report any health concerns following the
established referral system.

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 History taking during family planning session
• Medical history
• Find out from the client if she has hypertension, diabetic , Blood
clotting disorder, Diabetes mellitus. These conditions are
worsened by some family planning methods e.g. some family
planning methods have side effect raising blood pressure while
others disturbs the uptake of glucose which contribute to increase
of sugar levels in the blood and worsen DM.
• Women with breast cancer may also not take some methods of
family planning especially those that contain estrogens.
Oestrogen predisposes to developing some types of cancers
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• Find also if the patient is on anti-TB drugs particularly the
regime that contains Rifampicin. Rifampicin suppresses effectives
of hormonal methods ( meaning effectiveness is reduced so
woman can conceive).
• Find out if the patient has history of repeated STIs because some
methods may not be appropriate like IUCD. Again this history
will also help you to guide the women on choosing appropriate
FP method which will help her to choose that will prevent her
from acquiring STI.
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• Surgical history
• Find out if the patient has had surgical operation involving the
uterus because some family planning methods may not be used
like intra uterine contraceptive device (IUCD) especially where
adhesions are suspected- may disturb incision site.

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 Classification of family planning

• There are two main classifications of FP which include Artificial

family planning and Natural FP.
1.ARTIFICIAL
• Artificial methods can be further classified as
i. hormonal
ii. mechanical
iii. surgical

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 1.Hormonal
i) Oral Contraceptives (The Pill)- POPs, COCs
Combined Oral Contraceptives (COC’s)
Progesterogen-only Pills (POP’s)
Emergency Contraceptives - Emergency Contraceptive Pill
ii) Progestagen Injectables
Depo-Contraceptives
Progestagen-Releasing Rings
Implants
Ortho Evra (The Patch) MR NKOLE J 48
 2. Mechanical methods/Barrier
Condoms (male, female)
Cervical cap
Diaphragm
Intrauterine Devices (IUDs
3. Surgical methods
Bilateral Tubal Ligation
Vasectomy

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 1. HORMONAL
• i) Combined oral Contraceptives (CoC)
• Combined oral Contraceptives (CoC) are also called the ‘Pill’.
e.g. microgynon, Safeplan.
• Pill contains low doses of two hormones hormones—a progestin
and estrogen like the natural hormones progesterone and
estrogen in a woman’s body.
• Mode of action - Pregnancy is prevented because the pill stops
ovulation by inhibiting the production of follicle stimulating (FSH)
and luteinizing hormones (LH) which are responsible for
development and maturation of the ovum. MR NKOLE J
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• MOA continued
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.
Effectiveness – 99%
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.
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• How to use and when to start
• The woman swallows a pill each day to prevent pregnancy
• 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.
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• 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.
• Advantages of the Pill
Does not interfere with sex.
Quick return of fertility

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Regulates the menstrual cycle as both oestrogen and
progesterone that regulate the menstrual cycle are present in
circulation.
Reduces menstrual flow and cramping as it balances the
hormones for normal menstruation to occur
Reduces the risk of ovarian cysts, endometriosis, ovarian and
endometrial cancer as Oestrogens usually promote development
of cancer.
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They also change the uterine lining (endometrium) and thicken
the cervical mucus thereby inhibiting the sperm from penetrating.
It is a reversible method of birth control which should be given
only by prescription

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• Disadvantages of the Pill
Must be taken every day at the same time each day as to
maintain of serum hormonal levels
Lactation is suppressed as the combined effect of oestrogen and
progesterone inhibit effectiveness of prolactin, a milk producing
hormone.
May have lowered effectiveness if used with other drugs like
rifampicin and Griseofulvin or some epileptic drugs such as
phenytoin and carbamazepine hence need additional methods
of birth control. MR NKOLE J
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Increased risk of heart attack, stroke, or blood clots (in lungs,
legs, or arms), especially if you smoke more than 10 cigarettes
a day, or are over 35 and smoke as these hormones interfere
with normal functioning of the clotting factors hence increase the
risk of clot formation.
Possible mood swings or depression.
May decrease sexual desire as the natural mechanisms that
bring about Libido are disturbed with the artificial hormones
circulating.
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Does not prevent sexually transmitted infections, HIV/AIDS or
Hepatitis B.

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 Side effects and their management
• Side effects • Management
• Mild headaches • Explain to the woman that side
• Dizziness effects are not signs of illness, and
• Nausea that most side effects usually
• Mild breast tenderness become less or stop within the first
• Slight weight gain few months of using COCs.
• Spotting between menstrual periods, • Take pills with food or at bedtime
usually decreases after 2-3 cycles to help avoid nausea.
• Some women can delay return to
fertility • If symptoms persist then you stop
the pill.
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 PRECAUTION
• Women who should not use • Liver tumors
COC: • High blood pressure over 160/110
• History of arterial vascular
disease
• Jaundice
• Blood clotting disorder
• Diabetes
• Breast cancer

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 Managing missed pills

• What to do when one misses a • What if a client misses 2 pills?

pill. • Explain to the client that it not
• If a client forgets to take a pill at safe to forget more than one pill.
her regular time, she should take • If you forget two pills or more,
the forgotten pill as soon as she take two pills that day, two pills
remembers and then take the next the next day, and then one pill
pill at the regular time. each day at the regular time.
• She should do this even if that • For the duration of that packet of
means to take two pills on the pills use a back-up barrier
same time. method (e.g. a condom)
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• 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.
• MOA: Pregnancy is prevented because the pill stops ovulation
by inhibiting the production of follicle stimulating (FSH) and
luteinizing hormones (LH) which are responsible for development
and maturation of the ovum.
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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.
Effectiveness - 99%
Management of missed pills just like discussed under COC

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• How to use/when to start
• A woman can start taking POPs anytime she wants if is certain
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.
• If a woman begins taking POPs after day 7 of the menstrual
cycle, she should use a back-up method (e.g. condoms, or
abstinence). Take the pill everyday, preferably at the same time
each day. MR NKOLE J 64
Advantages/benefits • Side effects
• Highly effective when taken • irregular menstrual bleeding
everyday. • Prolonged bleeding
• Easy to use • Frequent bleeding
• Can improve anaemia • No monthly bleeding
• The quality and quantity of milk • Mild headaches
are not altered (can used by • Dizziness
breastfeeding mothers)
• Mood changes
• Does not interfere with sexual
intercourse. • NB;- Management same as CoC
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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 ECPs
• There are variety of the methods, including hormonal
methods.
1. PC-4 (hormonal)
2. Postinor 1& 2 (hormonal)
3. IUD insertion
4. Both COCs and POPs can also be used for
emergency contraception.
• Progesterone Only/Emergency Contraceptive Pill (ECP)
• Comprises of two Pills each containing 750micrograms of
Progestagen levanorgesterel. The first pills are taken within 72
hours of unprotected sex and the second taken 12 hours after
the first dose.
• Another type comprises 1 pill in a pack. The pill has to be taken
within 72hrs after unprotected sexual intercourse.
• Preferably the pill should be taken within 24hrs following
unprotected sexual intercourse.
• ECP only works if a woman is not already pregnant.
• Effectiveness: 98%.
• Action/ how it works
i. Interferes with egg development.
ii. Prevents or delays ovulation.
iii. Prevents implantation if pregnancy occurred

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• Combined emergency contraceptives ECP (e.g. PC4):
• Take 4 tablets of COCs within 72 hrs. of unprotected
sex, or
• Take 2 tablets of COCs within 72 hrs. of unprotected
sex, take the second dose (2 tablets) 12 hrs. after taking
the first dose.
• If client vomits within 2 hrs. of taking the dose, she should
take another dose as soon as possible.
 Advantages and disadvantages ECP
• Advantages • Disadvantages
• Effective prevention of • Nausea,
unwanted pregnancy. • Vomiting
• In the case of IUCD, it also • Breast tenderness
provides long term • ECPs do not protect against
contraception. STIs, including HIV/AIDS
• Effective only if used with 72
hrs. especially for hormonal.
 When to use Emergency Contraceptive Pills

i. Rape
ii. Any unprotected sex
iii. Contraceptives mistakes e.g. Condom used incorrectly, slipped
or broken.
iv. Couple incorrectly used a fertility awareness method (e.g.
failed to abstain or to use another method during fertile days)
v. Man fails to withdraw before ejaculation
vi. Woman has missed 3 or more COCs or has started a new pack
3 or more days late. MR NKOLE J 72
• 3.Progesterone Injectables
• These are Injectables hormonal methods containing synthetic
progesterone.
• Examples of these methods of contraceptives include Depo-
Provera (DMPA) given every three months and Noristarat (NET-
EN) given at two months interval.
• Mode of action: progesterone inhibits ovulation, and/or thickens
the cervical mucus to prevent sperm from passing through.

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Changes the rate of ovum transport by reducing the cilia or
peristaltic movement of the smooth muscles of the fallopian tubes
and makes the endometrium unsuitable for implantation.
It is a reversible method of birth control given only by
prescription
Effectiveness: > 99%

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• When to start and how to use
• 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.

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• Advantages of Progestagen Injectables
Does not interfere with sex.
Can be used during Lactation after six weeks post-partum as it
does not inhibit effectiveness of prolactin hormone.
Ensures periodic contact of client with the health provider.
May stop menses or make them very light due to hormonal
imbalances.
Excellent alternative for women 35 years and older.
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Reduces the risk of ovarian and endometrial cancer, and may
cause recession of benign breast lamps and ovarian cysts as
Oestrogens usually promote development of cancer.
Disadvantages of Progestagen Injectables
Irregular or unpredictable bleeding or spotting due to hormonal
imbalances.
Possible weight gain or loss due to variations in appetite.
It may delay chances of getting pregnant after the doses are
stopped. It can take between six and eighteen months for
menstruation and ovulation to return to normal.MR NKOLE J 77
Does not protect against sexually transmitted diseases or
HIV/AIDS.
Client must go to the family planning clinic every time for the
injection

MR NKOLE J 78
 Managing side effects
• Side effects • Management
• Irregular bleeding
• Explain that side effects are not
• Prolonged bleeding
signs of illness
• Infrequent bleeding
• Reassure her that over time side
• No monthly bleeding
effects may regress
• Weight gain
• Mild headaches • For irregular bleeding, give
• Dizziness Brufen 800 mg twice daily for 5
• Abdominal bloating and discomfort
days. For mild headaches, suggest
• Mood changes
an analgesia such as Panadol.
Brufen e.t.c
• Less sex drive
MR NKOLE J 79
 Managing late injections
• If the client is less than 4 weeks • She has not had sex since 2 weeks
for a repeat injection of Depo- after should have had her last
Provera, or less than 2 weeks of injection
repaeat Noristarat, she can • She has a back-up method or has
receive the next injection, no need taken emergency contraceptive
for a back-up method. pills (ECPs) after any unprotected
• A client who is more than 4 weeks sex since 2 weeks after she should
late for Depo-Provera, or more have had her last injection
than 2 weeks late for Noristerat, • She fully or nearly fully
can receive the next injection if: breastfeeding and gave birth less
MR NKOLE J than 6 months ago 80
 LONG ACTIVE REVERSIBLE CONTRACETIVES (LARC)

Description of implants
 They are small plastic rods or capsule, each about the size of a
match stick, that release progesterone like the natural hormone
progesterone in a woman’s body
 The procedure of insertion is performed by a specifically
trained provider
 Do not contain estrogen, as such they can be used throughout
breastfeeding and by women who cannot use methods with
estrogen.
 Types of Implants
1. Norplant 2. Sino-implants
 6 capsule  Also known as Femplant, trust
 Effective for 5 years implant or zarin
 No longer in use in Zambia  2 rods
 Effective for 4 years
 Types of Implants
• 3. Implanon 4. Jadelle
• 1 rod pre loaded in a  2 rods
disposable applicator  Effective for 5 years
• Effective for 3 years

MR NKOLE J 83
 Implants Cont’
Mechanism of action
Primary
 Production of thick cervical mucus which prevents sperm
penetration
 Inhibition of ovulation (50 % of menstrual cycles)
Secondary
 Decreased natural progesterone production by the ovary during
the postovulatory(luteal) phase even in those cycles in which
ovulation occurs
 Suppression of endometrial growth (hypoplasia)
 Advantages of implant
 Highly effective in preventing  Long term protection up to 5 years.
pregnancy  Are highly effective in preventing
 Have almost immediate return to pregnancy even in obese women.
fertility after removal  Are effective immediately after
 Are effective 24 hours after insertion insertion.
 Does not affect the quality or quantity  Protects against Anaemia by
of breast milk, as such it may safely be decreasing the amount of menstrual
used by lactating mothers flow.
 Can be removed anytime, and the
woman can become pregnant right
away.
 Implants Cont’
 Provide long term protection up to 5 years
 Decreases the amount of menstrual flow which helps to protect
against anaemia
 Requires one visit for insertion and follow up after seven days
 Protects against endometrial and ovarian cancers
 Decreases ectopic pregnancy
 The client does not have to use anything at the time of sexual
intercourse, this allows her privacy and control over her fertility
 Disadvantages of Implants
 Causes menstrual Changes and  Trained provider dependent
irregularities.  Some pain, minor bleeding on
 Do not offer protection against insertion site
STI/HIV  Heavier/ longer menstrual
 Insertion or removal requires a periods and bleeding/ spotting,
trained health provider in a amenorrhea
health facility.  Requires minor incision for
 It is expensive removal
WHO SHOULD NOT USE JADELLE
• Active thrombophlebitis or thromboembolic disorder
• Undiagnosed abnormal genital bleeding
• Acute liver disease
• 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
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
SIDE EFFECTS • Breast tenderness
• Irregular bleeding • Mood changes or changes in sex
• Infrequent bleeding drive
• Heavy or prolonged bleeding • Dizziness
• No monthly bleeding
• Headaches
• Abdominal pain
• Acne
• Weight gain
MR NKOLE J 90
DRUG INTERACTIONS
• Certain drugs interfere with the hormone delivered by
Jadelle making it less effective in preventing pregnancy
• Avoid use if client is taking antiepileptic mainly
barbiturates; phenytoin and carbamazepine but not
valproate
• Antibiotics ,avoid only Griseofulvin and rifampicin
 PROGESTAGEN- RELEASING RINGS
• These are comfortable, flexible contraceptive ring that is
about two inches in diameter and contains synthetic low
dose hormone (levanorgesterel), hormone is similar to
those produced by a women’s body.
• The ring is inserted directly into the upper vagina by the
client and remains in situ for three months during which
time hormone is released slowly from the ring and are
directly absorbed through the walls of the vagina then
distributed into the bloodstream.
• Pregnancy is prevented because the ring prevents the ovulation.
• The ring is a reversible method of birth control available only by
prescription.
Effectiveness: 99%. Less than 1 per 100 women may become
pregnant with proper use.
• Advantages of Progestagen- releasing rings
• Does not interfere with sex. Ability to remove the ring at leisure.
• No need to remember to put it on daily/weekly.
• Muscles within the vagina allow the ring to stay in place during
sex and/or exercise.
• Reduces menstrual flow and cramping.
• Decreases acne outbreaks.
• Reduces the risk of ovarian and endometrial cancer.
• Fertility returns immediately after discontinued use.
• Disadvantages of Progestagen- releasing rings
• Not a good choice if patient is uncomfortable with touching
herself.
• Increased risk of heart attack, stroke, or blood clots (in lungs,
legs, or arms), especially if client smokes more than 15
cigarettes a day, or are over 35 and smoke.
• Patient may experience vagina discomfort and discharge.
• If the ring is kept out of the vagina longer than 3 hours on any
day during the 21 day period (3weeks) pregnancy can occur;
therefore a back-up method (condoms) is recommended for 7
days.
• Does not prevent sexually transmitted infections, HIV/AIDS and
Hepatitis B.
 ORTHO EVRA (The Patch)
• It's a sticky patch you put on the
skin, and it releases two hormones
that prevent pregnancy.
• One of them is ethinylestradiol,
which is a standard ingredient of
most contraceptive Pills, and the
other is a Progestagen called
norelgestromin.
• Stick it on a clean, dry, non-hairy
area of skin (not on breasts).
 ORTHO EVRA (The Patch)
• Each patch lasts a week, and there is need to change it every
seven days.
• After using Evra for three weeks, the client breaks for a week
during which time, menstruation occurs.
• So it is three weeks on, and one week off'– just like the Pill.
• It stops ovulation and/or thickens the cervical mucus and stops
sperm from passing through.
• The patch is a reversible method of birth control available
only by prescription.
• It is less effective in very heavy (obese) women
Effectiveness; 95% - 99%.
• Advantages of the Patch
• Does not interfere with sex.
• No GIT upset or nausea/vomiting as it is just applied and
absorbed from the skin.
• No need to remember to put it on daily.
• Reduces menstrual flow and cramping.
• Decreases acne outbreaks.
• Reduces the risk of ovarian and endometrial cancer.
• Fertility returns immediately
• Disadvantages of the Patch
• May cause slight skin irritation at the patch site.
• Possible mood swings or depression.
• Women are encouraged not to use creams, lotions, or oils near
the patch site as these agents may cause the patch to detach.
• Does not prevent sexually transmitted infections or HIV/AIDS.
• The patch may come off, possibly without you noticing it. This
happens in about 4 per cent of women.
 Surgical Methods - Permanent family planning

• Permanent family planning, intends to provide life-long

and permanent protection against pregnancy.
• Reversal is usually impossible.
• Mainly two types female and male sterilization.
1.Female sterilization/ tubal ligation
 Tubal ligation or female sterilization is a permanent
method for family planning for women who do not want
any more children
How it works
• A trained provider makes a surgical incision in the lower
abdomen, the tubes are blocked so that sperm and ovum can
not meet for fertilization.
• Two surgical approaches may be used;
i)Mini laparotomy:
• Involves making a small incision in the abdomen.
• The fallopian tubes are brought to the incision, then they are
blocked or cut.
 Bilateral tubal ligation
• Two surgical approaches may be
used;
i)Mini laparotomy:
• Involves making a small incision in
the abdomen.
• The fallopian tubes are brought
to the incision, then they are
blocked or cut.

MR NKOLE J 105
 ii) Laparoscopy: a surgical procedure
in which a fibre-optic instrument is
inserted through the abdominal wall to
view the organs in the abdomen or
permit small-scale surgery.
• 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.
Laparoscopy

MR NKOLE J 107
Effectiveness: 99.5% Who should use it
• All women
 Side effects: none
Advantage/benefits
Known health benefits • Highly effective
• Protect risk of pregnancy • Permanent
• Protect against risk of PID • Does not interfere with sexual
intercourse
• Protect against ovarian • Important method for clients with
cancer. satisfied parity.
Disadvantages of tubal ligation
• 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.
• Male sterilization/vasectomy
• A small incision is made in the scrotum, locates the vas
deferens, blocks them by cutting and tying them closed or by
cauterization. It is a permanent method of family planning
for men who do not want any more children.
• It is also called male surgical contraception.
• 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.
Vasectomy

MR NKOLE J 111
Effectiveness: 3 months in Advantages/ benefits
taking effect. The man or • Extremely effective
couple must use condoms • Permanent
• Does not interfere with erection,
or another contraceptive release of semen or sexual
for 3 months after pleasure.
vasectomy.
• 99%
• Disadvantages
• Protection for the male only (females are at risk for
pregnancy).
• Usually irreversible.
• Requires skilled medical personnel.
• Lack of protection from sexually transmitted diseases
and infections, including HIV.
 MECHANICAL/BARRIER METHODS

Intrauterine Contraceptive Device (IUCD)

• An IUCD is a small plastic device which is placed
in the uterus by a trained family planning
clinician.
• It is a small T-shaped plastic device that fits inside
the uterus (womb) to prevent pregnancy.
• 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 IUD have one or two strings or
threads tied to them.
 IUCD CONT...
• Prevents fertilisation by;
 impeding sperm transport,
interference with implantation.
It works by causing a chemical change that damages sperm and
the ovum before fusion.
Effectiveness: 98% - 99%
• Other forms of IUCD contain synthetic progesterone hence
making it both a mechanical as well as a hormonal method
depending on the type.
• It is a reversible method of birth control
• Advantages • Disadvantages
• Effective immediately • Must be inserted and removed in
• Easily inserted and removed in a a clinic.
clinic.
• Has no systemic side effects • May be some cramping or pain
• Depending on the type they can be at the time of insertion.
left in place up to 10 years. • May experience increased
• Does not interfere with breast- bleeding or cramping during
feeding. periods.
• Return to fertility is immediate if no • May experience spotting between
infection has occurred
periods.
 Things to report immediately when using IUCD
• Pain after insertion lasting more than 8 hrs.
• 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.
 CONDOMS (Male)
• The male condom is a thin usually latex sheath that a man wears
over his penis during sexual intercourse. It is an over the counter
barrier method of birth control.
• Effectiveness: 86 - 97%.
• They create a barrier between the penis and the vagina
preventing sperm and/or any disease from entering the
woman's cavity or from vagina to the penis.
Condoms cont…
 Advantages of the male condoms

• Easy to get and relatively • Responsibility of both partners.

inexpensive.
• Can be purchased without a
• Can be discontinued at any time.
prescription.
• Provides some protection from
STI/HIV, Cervical cancer. • Does not interfere with breast-
• Reliable method for people who feeding.
cannot use hormonal birth control • Does not interfere with fertility.
methods.
• May be used immediately after
• It provides dual protection for on a
client against STI/HIV and birth or after abortion, the period
prevention of unwanted pregnancy. when infection occurs easily.
 Disadvantages of the male condoms

• Requires a man’s cooperation for • Some men say it reduces sexual

a woman to protect herself from feelings.
pregnancy and disease. • Must be rolled onto an erect penis
• Some irritation or sensitivity to before sexual intercourse, can
latex. interrupt foreplay.
• Difficulty using condoms correctly. • Spillage or leaking of sperm is
• Must use a new condom with possible if condom is put on or
every sex act. removed incorrectly.
 FEMALE CONDOMS

• A female condom is a strong odourless, transparent sheath that

transmits heat and lines the vagina to create barrier against
sperm and STIs.
• It is polyurethane (plastic) sheath with an inner ring that fits
inside the vagina, around the cervix (like the diaphragm) and an
outer ring that covers the external genitalia.
• After the man ejaculates, client must twist the end closed and
gently pull from the vagina.
• Effectiveness: 79% - 95%
Female condom

MR NKOLE J 123
 Advantages of the female condoms

• Can be inserted into the vagina • Can be used by people allergic

up to eight hours before sexual to latex or spermicides or by
intercourse.
• Can be used with Spermicides to those who can't take hormones.
increase STIs protection. • Made from polyurethane plastic,
• Over the counter barrier method which conducts body heat.
of birth control and can be • Erection unnecessary to keep
purchased without a prescription.
• Provides protection against some female condom in place.
STIs. • Does not interfere with breast-
• Some women and men have an feeding.
increased sensitivity or "natural"
feel compared to male condoms.
 Disadvantages of the female condoms

• Difficult to insert or keeping in • May irritate vagina or penis.

place. • More expensive than male latex
• Cannot be combined with male condoms.
condoms as they pull each other • Must be used every time one has
off. sex.
• May be noisy if not correctly put • After the man ejaculates, the
on. open end must be twisted and
gently pull from the vagina.
 DIAPHRAGM
• A Diaphragm is a barrier method
of birth control that uses a dome
shaped rubber cup with flexible
rim that covers the cervix and is
inserted into the vagina before
intercourse. It is used in
combination with spermicidal jelly
or cream.
MR NKOLE J 127
 CERVICAL CAP

• Cervical cap is a barrier

contraceptive method. It is a soft
rubber cup like device that fits
snugly around the base of the
cervix. It can be used with
Spermicides for prolonged and
additional pregnancy prevention.
 VAGINAL SPERMICIDES

• Vaginal spermicides are a chemical birth control method that kill

sperm on contact to prevent pregnancy.
• These come in the form of gel, foam, cream, film, suppository, or
tablet
• NB; SCIENTIFIC NATURAL FAMILY PLANNING WILL PRESENTED
SEPARATELY IN THE NEXT PRESENTATION.

• THANKS FOR LISTENING.

MR NKOLE J 130