CONTRACEPTION AND FAMILY

PLANNING
Dr. ALICE KAARIA
NAKURU CBD CME
Introduction
Family planning allows people to attain their desired number of children and
determine the spacing of pregnancies, and is achieved through use of
contraceptive methods and the treatment of infertility
 214 million WRA in who want to avoid pregnancy are not using a modern
contraceptive method (unmet need)
 Some family planning methods, such as condoms, help prevent the
transmission of HIV and other sexually transmitted infections.
 Family planning / contraception reduces the need for abortion
 Family planning empowers people’s rights to determine the number and
spacing of their children.
 Family planning /contraception prevents deaths of mothers and children by
preventing unintended pregnancy
Reasons for Unmet Need for
Contraception

 Limited choice of methods

 Limited access to contraception, particularly among young

people, poorer segments of populations, or unmarried people
 Fear or experience of side-effects

 Cultural or religious opposition

 Poor quality of available services

 User and providers bias

 Gender-based barriers: male partner influence

 Methods
Effectiveness to
Method Description How it works
prevent pregnancy
>99% with correct
Combined oral Contains two hormones Prevents the release of and consistent use
contraceptives (estrogen and eggs from the ovaries
(COCs) or “the pill” progestogen) (ovulation) 92% as commonly
used

99% with correct and

Thickens cervical consistent use
Progestogen-only pills Contains only
mucous to block sperm
(POPs) or "the progestogen hormone,
and egg from meeting
minipill" not estrogen 90–97% as
and prevents ovulation
commonly used

Small, flexible rods Thickens cervical

placed under the skin of mucous to block sperm
Implants >99%
the upper arm; contains and egg from meeting
progestogen only and prevents ovulation
 Methods
Effectiveness to
Method Description How it works
prevent pregnancy

Injected into the Thickens cervical >99% with correct

muscle or under the mucous to block and consistent use
Progestogen only
skin every 2 or 3 sperm and egg from
injectables
months, depending meeting and
on product prevents ovulation 97% as commonly
used

>99% with correct

and consistent use
Monthly injectables Injected monthly into
Prevents the release
or combined the muscle, contains
of eggs from the 97% as commonly
injectable estrogen and
ovaries (ovulation) used
contraceptives (CIC) progestogen
 Methods
Effectiveness
Method Description How it works to prevent
pregnancy
Small flexible plastic
Copper component
Intrauterine device device containing
damages sperm and
(IUD): copper copper sleeves or wire >99%
prevents it from
containing that is inserted into the
meeting the egg
uterus

A T-shaped plastic
device inserted into
Thickens cervical
Intrauterine device the uterus that steadily
mucous to block sperm >99%
(IUD) levonorgestrel releases small
and egg from meeting
amounts of
levonorgestrel daily
 Methods

How it Effectiveness to prevent

Method Description
works pregnancy

The patch and the CVR are

Continuously
Combined new and research on
releases 2 hormones
contraceptive patch effectiveness is limited.
– a progestin and an
Prevents Effectiveness studies report
estrogen- directly
Combined ovulation that it may be more effective
through the skin
contraceptive vaginal than the COCs, both as
(patch) or from the
ring (CVR) commonly and consistent or
ring.
correct use.
 Methods
Effectiveness to
Method Description How it works prevent pregnancy

98% with correct and

Sheaths or coverings Forms a barrier to consistent use
Male condoms that fit over the erect prevent sperm and egg
penis from meeting
85% as commonly
used

90% with correct and

Sheaths that fit loosely consistent use
inside a woman's Forms a barrier to
Female condoms vagina, made of thin, prevent sperm and egg
transparent, soft plastic from meeting
film 79% as commonly
used
 Methods
Effectiveness to
Method Description How it works prevent pregnancy

Permanent
contraception to block >99% after 3 months
Male sterilization Keeps sperm out of semen evaluation
or cut the vas deferens
(vasectomy) ejaculated semen
tubes that carry sperm
from the testicles

Permanent
Female
contraception to block Eggs are blocked
sterilization (tubal >99%
or cut the fallopian from meeting sperm
ligation)
tubes
 Methods
Effectiveness to
Method Description How it works prevent pregnancy
Temporary
contraception for new
mothers whose
Lactational menstrual period has Prevents the release
amenorrhea not returned; requires of eggs from the
method (LAM) exclusive or full ovaries (ovulation)
breastfeeding day and 98% as commonly
night of an infant less used
than 6 months old

Emergency If 100 women used

contraception pills Pills taken to prevent progestin-only
(ulipristal acetate pregnancy up to 5 emergency
Delays ovulation
30 mg or days after unprotected contraception, one
levonorgestrel 1.5 sex would likely become
mg) pregnant.
 Methods: Fertility Awareness
Effectiveness to
Method Description How it works prevent pregnancy
Women track their fertile 95% with consistent
Prevents pregnancy by and correct use.
days(usually days 8 to 19
Standard Days avoiding unprotected
of each 26 to 32 day cycle)
Method or SDM vaginal sex during most 88% with common use
using cycle beads or other
fertile days. (Arevalo et al 2002)
aids

Woman takes her body 99% effective with

temperature at the same Prevents pregnancy by correct and consistent
Basal Body
time each morning before avoiding unprotected use.
Temperature (BBT)
getting out of bed vaginal sex during
Method 75% with typical use of
observing for an increase fertile days
of 0.2 to 0.5 degrees C. FABM (Trussell, 2009)

Women track their fertile

periods by observing Prevents pregnancy by 96% with correct and
presence of cervical avoiding unprotected consistent use.
TwoDay Method 86% with typical or
mucus (if any type color or vaginal sex during most common use. (Arevalo,
consistency) fertile days, 2004)
(Today or yesterday)
 Methods: Combined Fertility
Awareness

Effectiveness to
Method Description How it works prevent pregnancy

98% with correct and

consistent use.
Women track their fertile
periods by observing Prevents pregnancy
Sympto- changes in the cervical by avoiding
thermal mucus (clear texture), body unprotected vaginal
Method temperature (slight sex during most Reported 98% with
increase) and consistency fertile typical use (Manhart
of the cervix (softening). et al, 2013)
 Traditional Methods

Effectiveness to
Method Description How it works prevent pregnancy

Women monitor their

pattern of menstrual cycle 91% with correct and
Avoiding unprotected consistent use.
over 6 months, subtracts
vaginal sex during
Calendar 18 from shortest cycle
the 1st and last
method or length (estimated 1st
estimated fertile
rhythm method fertile day) and subtracts
days, by abstaining
11 from longest cycle 75% with common
or using a condom.
length (estimated last use
fertile day)

Man withdraws and 96% with correct and

Tries to keep sperm consistent use
Withdrawal ejaculates outside the
out of the woman's
(coitus vagina, keeping semen
body, preventing 73% as commonly
interruptus) away from her external
fertilization used (Trussell, 2009)
genitalia
Effectiveness
 Risks and Benefits:
Combined Oral Contraceptives, Patch, Vaginal Rings
Pros Cons
Reduced bleeding and cramping with  Does not protect against STI or HIV
periods, which lowers the risk of anaemia  May not be as effective when taken
Fewer or no periods (with certain with certain drugs

types of pill)  May delay return of normal cycles
 Reduced pain during ovulation  Pills must be taken every day.
 Reduced risk of PID  Patch: Reduced protection if
 Reduced fibrocystic breast changes exposed to direct sun or high heat.
Reduced risk of ectopic pregnancy Can release a high dose of hormone

from the patch, which leaves less for
 May reduce acne
the patch to release later in the week.
 May reduce ovarian cysts
 May reduce symptoms  Patches deliver more estrogen than
of endometriosis low-dose birth control pills. Women
 Protection against ovarian and using the patch may be more likely to
endometrial cancer get VTE. The risk may be higher with
smoking
 Can be used after an abortion
 Progestin Only Pills, Injection, Implants
Pros Cons
 Fewer or no periods  Causes more irregular periods or spotting
 Reduced cramps and pain during between periods
ovulation  May not be as effective when taken with
 Reduced bleeding and cramping with certain drugs
periods, which lowers the risk of  Makes diabetes more likely if the woman
anaemia has had gestational diabetes
 Reduced risk of PID  Progestin-only pills are less effective than
 Can be used by women who cannot combination pills
take estrogen  Pills must be taken at the same time each
 May be used by women over 35 who day.
are smokers  Implant must be inserted and removed by
 May be used while breastfeeding a trained health professional.
 Protection against endometrial and  Implant may cause headaches.
ovarian cancer  Injection may delay return of normal
 Implant gives rapid return to fertility cycles for 6 to 8 months stopping
 Injection and implants: very effective  Injection may cause slight weight gain.
 Injection reduces symptoms  Injection may decrease levels of HDL
of endometriosis  Prolonged injection can cause bone loss,
 Injection reduces frequency which may not be fully reversible after
of seizures and number of sickle cell stopping.
crises (of concern during the teenage, when young
women should be building bone mass.
 Intrauterine Devices
Pros Cons
 Does not require cooperation of partner  Does not provide protection against
 More than 99% effective in preventing STIs or HIV
pregnancy  Only a health professional can remove the
 Most cost-effective method of birth control IUD.
over time  When inserted, an IUD can spread n
 Safe to use while breastfeeding active genital infection into the uterus,
leading to endometritis in the first months
 Can be removed whenever there are
after insertion.
problems or want to stop using it. Fertility
returns with the first ovulation cycle
following IUD removal.
 Can be inserted after a normal vaginal
delivery, a cesarean section, or a first
trimester abortion
 Hormonal IUD can relieve heavy
menstrual bleeding and cramping in most
women.
Medical Eligibility Criteria
World Health Organization (WHO) Medical Eligibility Criteria is
guidance on the safety of various contraceptive methods for use
in the context of specific health conditions and characteristics

Categories

A condition for which there is no restriction for the use of the

1 contraceptive method

A condition where the advantages of using the method generally outweigh

2 the theoretical or proven risks

3 A condition where the theoretical or proven risks usually outweigh the

advantages of using the method

A condition which represents an unacceptable health risk if the

4 contraceptive method is used.
Example of MEC Use
MEC
HIV and ARVs
 Dual method of protection: Condom plus another method

 ARVs may affect the efficacy of some hormonal

contraceptives
 TB drugs may affect the efficacy of some hormonal methods

 IUD is contraindicated in Stage IV disease

THANK YOU