A guide to family planning

for community health workers and their clients

OBJECTIVES:
After the discussion and demonstration, the BSN II students will be able to
develop positive attitude, acquire basic knowledge and skills in Family Planning
and Counseling.
SPECIFIC OBJECTIVES:
1. Recognize the importance of responsible parenthood to get parents
actively involve in the promotion of their children’s well- being.
2. Explain to clients different component of responsible parenthood.
3. Present all family planning methods to clients.
4. Allow the clients to choose appropriate methods according to their
beliefs or situation.
5. Practice teaching at home the different family planning methods
comprehensively.
Responsible Parenthood
Responsible parenthood is the primary right and responsibility of
parents to get actively involved in the promotion of their children’s
well-being through the provision of adequate care, attention, and
affection.

One of the main concerns of responsible parents is determining

the number and spacing of their children taking into account such
factors as psychological preparedness, health status, sociocultural,
and economic concerns.
 The 3 components of responsible parenthood
1. The value of children
The most common value of children is economic, that is, children are viewed
invariably as investments, security for old age, help in the farm or in the house ,to
take care of their younger siblings and/ or help parents earn a living.
Another common value is that of the sociocultural type, that is, those who
want to have children so that they can continue the family tree or to keep their
“names” alive.

2. Duties and responsibilities of parents

The physical, emotional and mental healthy of the child depends on the
quality of parental care he gets as he/she grows. This duty and responsibility
starts during the prenatal stage.
Keeping them warm and healthy, hugging and cuddling them, playing and
helping them learn are all important for growing children.
3. Rights of Children
All children are entitled to rights without distinction as to legitimacy, sex, social status, religion, political
background of parents and other factors. These rights includes;
a. The child has the right to be born well once he is conceive
b. The child has the right to a wholesome family life.
c. The child has the right to develop into a happy, useful, and active member of the
society.
d. The child has the right to a healthy and vigorous life.
e. The child has the right to enrich and strengthen his character through a moral and
upright life,
f. The child has the right to education and skills development.
g. The child has the right to safe and wholesome recreation and activities.
h. The child has the right to be protected from anything that will affect negatively his
development and growth.
i. The child has the right to live in an environment that will affect positively his growth
and development.
j. The child has the right to the care, assistance and protection of the State when his
parents or guardian fail or cannot provide him.
k. The child has the right to an efficient and honest government.
l. The child has the right to grow up as a free and responsible individual.
Why use family planning?

You have the right to choose how many children to have and when

How can family planning help you?

• Healthier mothers and children
• Fewer children means more time and money for
each one
• Delaying pregnancy lets young people stay in
school

--------- Family planning can save your life ----------

Why use family planning?

Benefits
– Mothers and babies are healthier when risky pregnancies are avoided.
– Smaller families mean more money and food for each child.
– Parents have more time to work and to be with family.
– Delaying first or second pregnancy lets young people stay in school.

Things to Consider
– Many young people need contraceptives to delay pregnancy. Ideally, young women and men
should wait until at least 18 years or have finished studies, and are ready before having
children.
– After having a child, it is healthier to wait at least 2 years to try to become pregnant again.
– Having more than 4 children makes childbirth riskier.

Why use
family
planning
1
There are many methods available…
-----you can choose one that is right for you-----
There are many methods available
• Do you have children? Do you want (more) children in the future?
• Do you want to prevent pregnancy now?
• Are you using a family planning method now?
• Have you used a family planning method before?
• Is there a method you would like to use? What is it about that method that you like?
• Are you or your partner breastfeeding an infant less than 6 months old?
• Do you want to keep your method private from partner or parents?
• Have you talked to your partner about using family planning? Will he or she be helpful and
supportive?
• Are you concerned about STIs or HIV/AIDS?
• Do you have any health problems? If yes, go to page 17

Choosing
a
method
2
Comparing family planning methods

Most effective Very effective but must be Effective but must be carefully
and easiest to use carefully used used

Fertility
awareness-based
methods
Breastfeeding
m ethod

Female Vasectomy Male and

sterilization female
condom

IMPORTANT!
IUD
Only condoms
Injectables protect
against
Implants both
Pills
pregnancy
and STIs
or
HIV/AIDS
Comparing family planning methods
There are many methods to choose from.
• Some are more effective than others.
• Some are easier to use and some are harder to use.
• Methods that are harder to use may be less effective if you don't use them correctly.

Methods I can provide now:

• condoms
• pills
• injections
• breastfeeding method counselling
• standard days method counselling
• withdrawal counselling
• emergency contraceptive pills

Methods provided at the clinic:

• implants
• IUD
• female sterilization
• vasectomy

Choosing
a
method
3
The pill

Week 1

Week 2

Week 3

Reminder pills

• Safe
• Effective when a pill is taken every day
• Less monthly bleeding and cramps
The pill
What it is
– A pill with hormones in it that is taken every day.
– Prevents release of egg, and blocks sperm from meeting egg.

How to use
– Take one pill every day.
– When you finish a pack of pills, start a new pack the next day.
If you miss a pill:
– Take missed pill as soon as possible.
– Okay to take 2 pills at the same time.
– If you miss more than 2 days of pills in a row, use condoms for 7 days and keep taking pills. If you
miss these pills in week 3, ALSO skip the reminder pills and start a new pack.

What to expect
– Sometimes irregular bleeding at first, then followed by lighter monthly bleeding with less
cramping.
– Some women have stomach upset or mild headaches that go away after first few months.

Key points
– Take a pill every day.
– Be sure you have enough pills. Get more before you run out.
– Use condoms if you need protection from STIs or HIV/AIDS.

Pill
4
Minipill

Week 1

Week 2

Week 3

Week 4

• Safe
• Good method while breastfeeding
Minipill
What it is
A pill with a hormone in it that you take every day.
Blocks sperm from reaching the egg.

How to use
If breastfeeding, can start 6 weeks after
childbirth. Take one pill at the same time every
day.
When you finish a pack of pills, start a new pack
the next day.
Late taking pill, for women who are breastfeeding:
Take a pill as soon as you remember, and
continue taking pills.
Late taking pill, for women who are not
breastfeeding:
If you take a pill more than three hours late, use
condoms for the next 2 days and keep taking
pills.

What to expect, if not breastfeeding

Changes in monthly bleeding including irregular bleeding, spotting, heavier bleeding or no
monthly bleeding, are common and safe.

Key points Minipill

Take a pill at the same time every day, if not breastfeeding.
Be sure you have enough pills. Get more before you run out.
5
Consider what method to use when you stop breastfeeding.
Injection

• Safe
• Hormone injection given every 2 months
(NET-EN) or 3 months (DMPA)
• Very effective when injections are on
time
• Use can be kept private
Injection
What it is
– Hormone injection.
– Prevents release of egg.

How to use
– Get an injection every 2 months (NET-EN) or 3 months (DMPA).
– If breastfeeding, can start 6 weeks after childbirth.
– Works best if you get your injections on time.
If late for an injection:
– DMPA: Can still get an injection up to 4 weeks late.
– NET-EN: Can still get an injection up to 2 weeks late.
If later, use condoms and return for an injection as soon as possible.

What to expect
– Irregular bleeding at first, then spotting or no monthly bleeding. This is common
and safe.
– Possible slight weight change.
– After stopping injections, it can take several months to become pregnant.

Key points
– Does not cause infertility.
– Be sure to get next injection on time.
– Use condoms if you need protection from STIs or HIV/AIDS.

Injection
6
Male condom

• Prevents both pregnancy and sexually

transmitted infections including HIV/AIDS

• Effective when used correctly every time you

have sex

• Easy to get and use

Male condom
What it is
– A thin rubber covering that fits over the erect penis.
– Is a barrier that keeps sperm out of the vagina.

How to use
– Put a new condom onto erect penis before each sex act.
– Dispose of properly, in rubbish or latrine.

What to expect
– No side-effects.

Key points
– Can be used with other family planning methods to prevent sexually transmitted infections
including HIV.
– Important to use correctly every time you have sex.
– Be careful not to tear condom when opening package or putting on.
– Partners must agree to use.
– Emergency contraceptive pills can be used if condom breaks or is not used.

Male
om
7
cond
Female condom

• Prevents both pregnancy and sexually

transmitted infections including HIV/AIDS

• Effective when used correctly every time you

have sex
Female condom

What it is
– Plastic covering inserted into the vagina before sex.
– Is a barrier that keeps sperm out of the vagina.

How to use
– Insert new female condom into vagina before every sex act.
– Dispose of properly, in rubbish or latrine.

What to expect
– No side-effects.

Key points
– Can be used with other family planning methods to prevent sexually transmitted infections
including HIV.
– Important to use correctly every time you have sex.
– Make sure penis enters inside the condom ring and stays in during sex.
– Partners must agree to use.
– Emergency contraceptive pills can be used if condom slips or is not used correctly.

Female
condom 8
Implants
• Safe to use

• One of the most effective methods

• Lasts for 3 to 5 years

• Can be removed any time if you want to get pregnant

Implants
What it is
– Small tubes placed under the skin of inner, upper arm.
– Hormones from the tubes blocks sperm from reaching egg and prevents release of egg.

How to use
– Specially trained provider inserts and removes implants.
– Nothing to remember to do after insertion.

What to expect
– Changes in monthly bleeding including irregular bleeding, spotting, heavier bleeding or no monthly
bleeding, are common and safe.

Key points
– Use another method if waiting for appointment.
– Use condoms if you need protection from STIs or HIV/AIDS.

Where to go:

Implants
9
IUD

• Safe to use

• One of the most effective methods

• Can be used for up to 12 years

• Can be removed any time if you already want to get pregnant

IUD
What it is
– Small, flexible, plastic "T" wrapped in copper wire that is placed in the womb.
– Prevents sperm from meeting the egg.

How to use
– Specially trained provider inserts and removes IUD.
– Can be put in right after you have a baby as well as at other times.
– Nothing to remember to do after insertion.

What to expect
– Some cramping and heavier bleeding during monthly bleeding in the first few months
of use.

Key points
– Use another method if waiting for appointment.
– Use condoms if you need protection from STIs or HIV/AIDS.

Where to go:

IUD
10
Female sterilization

• Safe and permanent method – for women or

couples who will not want more children

• One of the most effective methods

• Simple operation
Female sterilization
What it is
– Specially trained provider makes one or two small cuts to reach the tubes that carry eggs
to the womb.
– Cuts or blocks the tubes. The womb is not removed.
– Can be done right after you have a baby as well as other times.

What to expect
– After procedure, nothing to remember and no side-effects.
– Do not need to be put to sleep during procedure.
– Usually you can go home a few hours after procedure.
– May have soreness for a few days after procedure.
– Monthly bleeding will continue as usual for you.

Key points
– Permanent method.
– Use condoms if you need protection from STIs or HIV/AIDS.

Where to go:

Female
Sterilization
11
Vasectomy

• Safe and permanent method – for men or

couples who will not want more children
Tubes cut here

• One of the most effective

methods

• Simple operation

• Must use back-up method

for first 3 months
Vasectomy
What it is
– Specially trained provider makes two small cuts to reach the tubes that carry
sperm.
– Cuts tubes. Testicles are not removed.
– Works by keeping sperm out of semen.

How to use
– 3-month delay in taking effect. Couple must use another method until then.
– After 3 months, nothing to remember.
What to expect
– Do not need to be put to sleep during procedure.
– Usually you can go home a few hours after procedure.
– May have bruising and soreness for a few days after procedure.

Key points
– Does not decrease sex drive, erection or ejaculation.
– Permanent method.
– Use condoms if you need protection from STIs or HIV/AIDS.
Where to go:

Vasectomy
12
 Breastfeeding method
Lactational Amenorrhea Method (LAM)

• Safe with no side-effects

• Effective if:
- you are breastfeeding often, day and
night, and giving no other food or liquids
- your baby is less than 6 months old, and
- your monthly bleeding has not returned.
Breastfeeding method
(Lactational Amenorrhea Method)
What it is
– Breastfeeding in a way that prevents pregnancy.
– Prevents release of egg.

How to use:
– Breastfeed often, day and night (breastfeed fully or nearly fully) and give no other food or
liquids.
– If you breastfeed less, your monthly bleeding starts, or it is 6 months after you have had your baby,
the method will not work.

What to expect
– No monthly bleeding.

Key points
– Very effective for 6 months if fully or nearly fully breastfeeding.
– Have another method ready to start at 6 months or before, if monthly bleeding returns or
breastfeeding decreases.
– Use condoms if you need protection from STIs or HIV/AIDS.
Breastfeeding
method
13
Standard Days Method:
Using calendar or Cycle Beads

• Helps you know what days during the month

you could get pregnant

• To prevent pregnancy, either avoid sex OR use

condoms on those days

• Best used by women with regular monthly

bleeding
Standard Days Method:
Using calendar or Cycle Beads

What it is
– Learning which days each month you could get pregnant (fertile days).
– Avoiding sex or use a condom during fertile days.

How to use
– Use cycle beads or calendar to count days of the cycle. Start with first day of monthly
bleeding.
– Days 8 through 19 of every cycle are 'fertile days'.
– Avoid unprotected sex during fertile days.

What to expect
– Partners must avoid sex or use condoms for 12 days in a row, every month.
– No side-effects.

Key points
– Both partners must agree to avoid sex or use condoms on fertile days.
– If monthly bleeding becomes less regular, you may need to choose another method.
– Use condoms if you need protection from STIs or HIV/AIDS.

Standard
Days
Method 14
Withdrawal

• No supplies

• No side-effects

• Can be used at any time

• Not as effective as other methods

Withdrawal

What it is
– The man withdraws his penis from his partner's vagina and ejaculates outside the
vagina.
– Works by keeping sperm out of the woman's body.

How to use
– When the man feels he is close to ejaculation he withdraws his penis from the woman's
vagina.

What to expect
– Learning to do this correctly can take time.
– May not be good for men who ejaculate quickly.

Key points
– Other methods provide greater protection from pregnancy for most people.
– Emergency contraceptive pills can be used if ejaculation occurs before withdrawal.
– Use condoms if you need protection from STIs or HIV/AIDS.
Withdrawal
15
Emergency contraceptive pills

• Prevent pregnancy after unprotected sex

• Work best when taken as soon as possible, up
to 5 days after unprotected sex
• Do not cause abortion
Emergency contraceptive pills
What it is
– Pills taken after unprotected sex to prevent pregnancy.
– Prevents or delays release of egg.
– Does not cause abortion.

How to use
– Can take up to 5 days after unprotected sex.
– Works best when taken as soon as possible after unprotected sex.

What to expect
– Sometimes cause nausea, vomiting, vaginal spotting or bleeding for a few days.

Key points
– Does not prevent pregnancy the next time you have sex. Does not protect against future acts of sexual
intercourse.
– Regular methods are more effective, consider if there is a method you would like to use.
– Seek treatment if you may have been exposed to STIs or HIV/AIDS.

Where to get emergency contraceptive pills:

Emergency
Contraception
16
Special situations
After childbirth
– Breastfeeding method prevents pregnancy effectively for up to 6 months if used correctly, and provides
baby with best food.

When to start other methods:

– IUD: just after childbirth or wait 4 weeks after childbirth.
– Female sterilization: just after childbirth or wait 6 weeks after childbirth.
– Vasectomy: ideally 3 months before due date, as it takes 3 months to be effective.
– Minipills, injections, implants: 6 weeks after childbirth if breastfeeding. Immediately after childbirth if not
breastfeeding.
– Pills: 6 months after childbirth if breastfeeding. 6 weeks if not breastfeeding.

HIV/AIDS
– HIV+ (not AIDS): Can use any method except spermicides.
– On ART or sick: Can usually use most methods, refer for advice.
– On TB drugs: Can usually use most methods, refer for advice.
– Condoms recommended to prevent transmission of HIV, even if using another method.
– If a women with HIV chooses to breastfeed, she should be counselled to:
• Breastfeed exclusively until her infant is 6 months old.
• After 6 months, add foods and continue to breastfeed for 12 months.
• Then stop breastfeeding when safe and adequate food is available.

Special
situations 17
Men or women who do not want more children
– Discuss permanent methods (female sterilization and vasectomy) and long term methods (IUD, implant).

Age
– Younger: Can use all methods. Emphasize STI/HIV/AIDS protection.
– Older: Can use all methods. Discuss permanent and long term methods.

After abortion
– Can use any method immediately post abortion.
– If infection is present, wait to insert IUD until treated.

People living with disabilities

– Can use all methods.
– Important to discuss family planning needs and STI/HIV/AIDS prevention.

After rape
– Use emergency contraception if not on regular method.
– Refer for STI/HIV counselling.

Conflict/Disaster/Displaced persons/Street families

– Can use all methods.
– Think carefully about availability of resupply and offer back up methods (condoms, barriers, emergency
contraceptive pills).
– Preventing both pregnancy and STI/HIV/AIDS is especially important.

Special
situations 18
Using pills, injections or the minipill if she has health conditions
Ask her if she has any serious health conditions.
• If she reports having a problem, check to see if it is listed below.
• If it is listed, check to see what methods she can use.

If she has high blood pressure If she ever had serious heart condition or stroke
She cannot use the pill She cannot use the pill or injections
She can use injections or the minipill She can use the minipill

If she smokes and is age 35 or older If she has diabetes (high sugar level in her blood) for more
than 20 years
She cannot use the pill
She can use injections or the minipill She cannot use the pill or injections
She can use the minipill
If she has repeated severe headaches, often on one side, and/or
pulsating, causing nausea, and which are made worse by If she has ever had a blood clot in her legs or lungs
light, noise, or movement (migraine)? She cannot use the pill, injections or the minipill
She can use condoms or other method without hormones
She cannot use the pill
(refer if needed)
She can use injections or the minipill
If she has ever had breast cancer
If she regularly takes pills for tuberculosis (TB), seizures (fits), She cannot use the pill, injections or the minipill
or ritonavir for ARV therapy? She can use condoms or other method without hormones
She cannot use the pill (refer if needed)
She can use injections or the minipill
If she has serious liver condition or jaundice (yellow skin
If she has bleeding between menstrual periods, which is or eyes)?
unusual for her, or bleeding after intercourse (sex) She cannot use the pill, injections or the minipill
She cannot use injections She can use condoms or other method without hormones
She can use the pill or the minipill (refer if needed)

Health
conditions 19
Questions to be reasonably sure a woman is not pregnant
Women who are not currently having their monthly bleeding may still be able to start hormonal methods (pills, injectables, or
the minipill) NOW. Ask these questions to be reasonably sure she is not pregnant.

If the client answers NO to ALL of the questions, pregnancy cannot If the client answers YES to AT LEAST ONE of the questions
be ruled out. She should wait until next menstrual period (and avoid and has no signs or symptoms of pregnancy,* provide her with
sex or use condoms until then) or else take pregnancy test. the method.

NO YES
1. Did you have a baby less than 6 months ago, are you fully or nearly-fully breastfeeding, and have you had no
menstrual period since then?

2. Have you abstained from sexual intercourse since your last menstrual period or delivery?

3. Have you had a baby in the last 4 weeks?

4. Did your last menstrual period start within the past 7 days?

5. Have you had a miscarriage or abortion in the past 7 days?

6. Have you been using a reliable contraceptive method consistently and correctly?

Signs of pregnancy
If a woman has a late menstrual period Early signs Later signs
or several other signs, she may be
pregnant. Try to confirm by pregnancy Late menstrual period Urinating more Larger breast
test or physical examination. often Breast tenderness Weight change Darker nipples
Nausea Always tired More vaginal discharge than usual
Vomiting Mood changes Enlarged abdomen
Changed eating habits Movements of a baby

Pregnancy
checklist 20
Frequently Asked Questions

Do family planning methods make people sterile?

 NO – Only female sterilization and vasectomy are permanent

 With all other methods, couples can have a child soon after stopping

 Couples who have never had a child can safely use family planning and have a baby soon
after stopping

Do family planning methods cause cancer?

 NO – In fact, some family planning methods can help prevent certain cancers

Does family planning cause birth defects?

 NO – No method of family planning causes birth defects, even if used during
pregnancy

Frequently
asked
questions
21
How is vasectomy different from castration?
 Castration is the removal of testes. In vasectomy, however, the testes are not touched at all. The tube
that carries sperm is cut. This keeps sperm out of semen, but it does not decrease sexual function or
affect ejaculation.

Do family planning methods cause weight gain?

 Some women have some change in weight when using hormonal methods. The weight changes are
usually small

Can young people use family planning safely?

 YES – Young people can use non-permanent methods and go on to have children after
stopping

All people at risk of STIs/HIV or AIDS should use condoms even if they also use
another method

Add any questions that are often asked in your community.

Frequently
asked
questions
22
 Male and female anatomy

Ovary Fallopian tube

Penis Seminal

vesicles Womb lining

(endometrium)
Urethra Prostate

Vas Womb
Foreskin deferens (uterus)

Testicles
Cervix
Scrotum
Vagina

Male and
female anatomy 23
 How to use a male condom
    

Use a new condom Before any contact, Unroll condom all After ejaculation, Use only once
for each sex act place condom on tip the way hold rim of condom Throw away used
of erect penis to base of penis in place, and condom safely
with rolled withdraw penis while
side out it is still hard

How to use
male condom 24
 How to use a female condom
    Inner
ring

Outer
ring

Open
end

Inner
ring Gently insert the inner ring into
the vagina
Use a new condom Choose a comfortable Squeeze the inner ring, Place the index finger inside
each time position at the closed end condom, and push the inner ring
Open package up as far as it will go
carefully Make sure the outer ring is
Make sure the outside the vagina and
condom is well- the condom is not twisted
lubricated inside Be sure that the penis enters
To remove, twist
outer ring and pull inside the condom and
gently stays inside it during
intercourse
Throw away
condom safely

How to use
female condom 25
How to use Cycle Beads
 Move ring to RED bead when period starts

 Move ring to next bead every day. Move ring even on

bleeding days

Use condoms or abstain when ring is on WHITE

 beads

BROWN beads are safe days of no pregnancy


When period starts again move ring to red bead to
 begin again.

Always check your period comes between dark brown

bead and last brown bead.

How to use
Cycle beads 26