FAMILY PLANNING/

CONTRACEPTIONBY

DR OLUTAYO A A.

OUTLINE INTRODUCTION EPIDEMIOLOGY METHODS OF CONTRACEPTION CONCLUSION

Family planning The planning of when to have children Choosing the number children to have in a

family Determine the length of time between their

birth. Involves use of techniques like

Sexual education Use of contraception Preconception counseling and management Infertility management

INTRODUCTION

Family planning services Educational, comprehensive medical and

social activities To determine freely the number and

spacing of children To select the means of achieving these Has direct impact on health and wellbeing.

Benefits of family planning Prevents pregnancy related health risks in

women. Allows to determine number and spacing More than 4 children - sharp increase in

maternal mortality. Reduces unintended pregnancies and the

need for unsafe abortion. Prevents HIV/AIDS and other STIs

Helps to reduce infant mortality Reduces adolescent pregnancies Empowering people and enhancing

education Reduces population explosion.

Use of various methods and devices to prevent conception/impregnation

May be inform of sexual practices, drugs or surgical procedures.

CONTRACEPTION

Current contraceptive prevalent rate in Nigeria

2008 14.6% 2009 11.0% 2010 13.0% 2012 10.0% Fertility rate in Nigeria is 5.6 UNFPA(2012)

Life expectancy in Nigeria is 47.2years at birth

Maternal mortality ratio (600 ->800) in the last decade.

Globally 13% of maternal death are due to unsafe abortion (WHO 2011)

Infant mortality rate – 88 in every 1000 births. (UNICEF, WB Indices 2012)

For every death 20 others suffer morbidities such as obstetric fistulas , infections and other disabilities.

Two-third of unintended pregnancies occur in women not using contraception.

75% of unintended pregnancies can be prevented by meeting family planning needs(Singh, S. 2009)

Contraception can reduce maternal death by 44%(Cleland J, Peterson H. 2012)

Natural family planning methods Barrier methods Hormonal methods Intrauterine devices Permanent methods (female and male) Emergency contraception

Methods of contraception

Natural family planning Rhythm method (calendar method) Basal body temperature Cervical mucus(Billings method) Symptothermal method(combined method)

10-20% failure rate Lactational amenorrhea(0.9-1.2% first

6months 7.4% at 12months) Withdrawal method(5-25% FR) not in

premature ejaculation Post coital douche

Barrier methods Male condom (10-30% FR first year) Female condom(15% FR) Vaginal diaphragm(7%) Cervical cap Spermicides(Vaginal jellies, creams, sponge,

gels, suppositories and foam nonoxynol-9, active for about 2hours).

10-30%FR

Male Condoms

Female condom

Cervical cap

Vaginal diaphragm

Hormonal methods Oral contraceptive pills

Combined pills Sequential Mini pills(progesterone only) Reduces incidence of ovarian and endometrial cancer, benign breast diseases, Also protects against development of colorectal cancer and progression of rheumatoid arthritis.

Combined oral contraceptive pills

Contraindications; Thromboembolic phenomenon Breast cancer Myocardial infarction Hypertension Active liver disease Smoking Pregnancy

Failure rate between 1-2% if taken appropriately.

Non contraceptive uses of OCPS Menorrhagia DUB PCOS Dysmenorrhea Hirsutism Acne

Injectables Progesterone only( DMPA, NET-EN) Combined contraceptive

injections(cyclofem, mesigna) Given monthly.Progestogens Suitable for sickle cell disease patients Protects against the risk of endometrial and

cancers, endometriosis and PID.

Irregular vaginal bleeding Weight gain Amenorrhea Return to fertility may take few months Failure rate 1%

Implants Norplants Jardelle Implanon Nexplanon

Failure rate < 1%

Implant -Implanon

Vaginal ring Transdermal patch

Vaginal ring (Nuva ring)

Intrauterine contraceptive devices Cu T 380A, 380S multiload Cu-250, 375.

Heavy menstrual flow and abdominal cramps Hormone releasing e.g progestasert(1year)

mirena IUS LNG20(5-7years) More suitable in a patient with menorhagia Less abdominal cramps Effectiveness 95-98%

CU-T IUCD

Mirena

Sterilisation Permanent Male - Vasectomy Female – Bilateral tubal ligation

Minilaparotomy, per vagina or laparoscopy Essure (Sterilisation implant). > 99% effective Regret 5% >35years 20% <35years

Emergency contraception After unprotected sexual intercourse Failure of contraceptive method In cases of rape or incest Following a single act of sexual exposure in

young girls.

Standard regimen (Yuzpe regime) IUCD insertion Failure rate 10%

Family planning is a right of every individual

and there is need to improve on the shortage of its services and also on the high unmet need for contraception. Contribute to improvement in our health indices and the path to MDG.

CONCLUSION

THANKS FOR LISTENING