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Facts about Pakistan• One birth every 7 seconds• 3 mothers die during childbirth every hour• 12 million children under 5 years are
malnourished• 50% of population are lacking safe drinking
water.• 60% lack safe sanitary facilities• One doctor per 2008 persons• One nurse per 6500 persons• One hospital bed per 1506 persons
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Population Profile(2002)
• 3.2 million 1947
• 140 million 2002
• 160 million 2005
• 235 million By year 2015
• Population below poverty line 33.1%
• Growth rate 2.1%
• fertility rate 4 %
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Contraceptive prevalence rate (CPR)
Iran 23%
Bangladesh 40%
Indonesia 48%
Malaysia 51%
Turkey 72%
Pakistan 21%
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resulting in
Unemployment, law and order problems,and social unrest.
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CONTRACEPTION
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Contraception Saves Lives
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Contraception means prevention of conception by any method with out abstinence from sexual intercourse.
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MOTIVATION
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Counselling
Is the process of helping clients to make informed and voluntary decisions about choice of contraception.
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Counseling
FM counseling has 06 elements
GATHER
Greet Help
Ask Explain
Tell Return
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Methods of Contraception• Physiological methods
– Rhythm method– Incomplete methods
• Chemical methods
• Barrier methods
• Intrauterine contraceptive devices
• Hormones
• Sterilization
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Natural Family Planning
Abstaining from sexual intercourse during fertile phase of menstrual cycle.
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Fertility Cycle
Phase I: Relatively infertile phase
(approx first 7 days)
Phase II: Fertile phase
(approx 8 to 16th day)
Phase III infertile phase
(approx 17th to 28th day)
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Rhythm MethodAdvantage:-
• No expense involved.• No side effects.
Disadvantage:-• Planning of coitus.• Dependence on regularity of the cycle.• Suitable for educated,intelligent &
cooperative women.
Failure rate:- 3- 24 / HWY
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Barrier methods of C.C
Male condom Advantages
– Simple– Responsibility on male– Protects against the transfer of venereal
diseases
Failure rate 6-18/100 women years
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Male condomDisadvantages• Expensive• Less satisfying sex• Allergic reactionsFailure rate - 6-18 per HWY
Advantages• Safe,cheap,easy• Does not influence with the
orgasm of either partner.
DisadvantageLess effective in case of prolapse and retroversion
Failure Rate:- 6-12/HWY
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Female condom
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Diaphram
Functions1. Retainer of the spermicide2. To keep sperms away from alkaline
receptive cervical mucus3. Prevent the cervical mucus reaching the
vagina4. Prevents the aspiration of the sperms into
the cx & the uterus
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Diaphram
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Diaphram
Advantages– Safe,cheap,easy– Orgasm Does not influence the
orgasm of either partner.
DisadvantageLess effective in case of prolapse and retroversion
Failure Rate
2-15/100 women years
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Intrauterine C.C Device
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GROUPING OF DEVICESBY FAILURE (PREGNANCY) RATE
Device pregnancy rate per 100 women year of use
Group 1 Lippes loop, copper 7, Copper T 200
Significantly greater than 2.0
Group 2 Nova T, Multiload ML Cu 250, Copper T
220 C
Less than 2.0 but not less than 1.0
Group 3 Copper T 380 , Multiload ML Cu375,
Levonova
Significantly less than 1, most less than 0.5
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Intrauterine C.C device
• Multiload• Hormone releasing IUCDs Progestasert Levonorgesrel (intrauterine system)
levonova Preloaded doesn't require to be loaded in
the inserter.
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Mode of action
• Immobilize the sperms and prevent it from fertilizing the ovum.
• By producing inflammatory reaction in the endometrium prevents embedding of the fertilized ovum.
• Hormonal Effects.
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Contraindications
• Bicornuate uterus
• Nullipara
• Women with irregular,heavy periods
s& fibroids.
• Present & past PID
• Suspected pregnancy
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Multiload
Pass uterine sound to measure the length of uterine cavity
Introduce the multiload with the inserter until it touches the fundus
Then withdraw the inserter.
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Conformation of proper insertion
• Easy insertion
• Excellent retention by the uterus
• Minimal uterine irritability
• Easy removal
• USG
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Complications • Insertion is painful• Uterine bleeding• Infection• Uterine perforation• Expulsion• Complications relating to pregnancy:
congenital malformation, abortion, ectopic pregnancy & prematurity
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EXPULSION
Rate is high in
• Nulliparous women
Pts with endometrial cavity < 40 mm
• Uterus with acute uterine flexion
• Smaller devices
PREVENTION
• Proper IUCD size
• Checking of thread
• Screening USG
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HORMONAL CONTRACEPTION
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Hormonal Contraception
• COC pills
• Progesterone only pill
• Injectables
• Long acting pill
• Vaginal rings
• Implants
• Dermal patches
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Contraindications Oral Contraception
Absolute – Cholestatic jaundice of pregnancy– Porphyria– Pruritis of pregnancy– Herpes gestationalis – Cancer of breast.
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Contraindications oral contraceptionRelative
– Thromboembolism– Blood dyscrasias– Diabetes– Obesity– Chorea– Migraine– Varicose veins– Asthma– Depressive psychosis– Elective surgery
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SEQUENTIAL PILL
• Two types of pill
• First 14 containing only oestrogen
• And last seven a combination of oestrogen and progesterone
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PROGESTRONE ONLY PILL
Mini pill
28 or 35 tablet packet
- femules - 500ug 28
- Noriday - 250ug 28
- Microval- 30ug 35
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ADVANTAGES - POP
• Do not reduce breast milk
• Suitable for women with contraindication of estrogens
• Minimal side effects
• No risk of circulatory or malignant disease
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LONG ACTING PILLS
• Once a month
• Quinestrel + Levonorgestrel
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INJECTABLES
• DEPOPROVERA (DMPA)• 150mg every 12 wks
• NORIGEST (NET-EN)• 200 mg every 08 wks
• CYCLOPROVERA• Once a month
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ADVANTAGES of INJECTABLES
• Highly effective
• Easy to deliver
• Use independent of sexual intercourse
• Do not reduce breast milk
• May reduce anaemia
• Less dysmenorrhoea & PMT
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DISADVANTAGES of
INJECTABLES
• Requires regular visits to the clinical for injections
• Irregular uterine bleeding • Progesterone side effects eg
acne,malaise,fatigue,depression etc
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VAGINAL RINGS
• Shell type
• Core type
• Contain Oestrogen + Progesterone or only Progesterone
• Rings changed every 03 months
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CONTRACEPTIVE IMPLANTS
• NON – Biodegradable– Norplant – 1 - 5 yrs– Norplant – 2- 3 yrs– Implanon - 3yrs
• Biodegradable• Capronor - one year
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POST COITAL CONTRACEPTION
• Immediate insertion of copper- T
• The YUZPE method– 2 tabs of COC at once and 02 tabs after 12
hours
• Ethinyl Oestradiol- 2.5 mg BD * 05 days
• Conjugated equine estrogens- 10 mg TDS * 05 days
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MECHANISM OF ACTION POST COITAL CONTRACEPTION
• Block implantation
• Uterine fluid / genital tract mucus rendered hostile to sperm or blastocyst
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RISK OF PREGNANCY POST COITAL CONTRACEPTION
• 20 %
• 30 % on the day of maximum risk
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Surgical Contraception
Female Sterilization• Laparoscopic• Minilap• Vaginal tubectomy
Male sterilizationVasectomy
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Non surgical Tubal Occlusion
• Quinacrine pellets
• Tetracycline methyl cyanoacrylate
• Oviduct plugs
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Thank You