Contraception.pptx by samirah abdu-aguye for pharmacy student

Contraception refers to the methods or devices used to prevent pregnancy. There are various types of contraception

1. CONTRACEPTION PHCP 304 Samirah Abdu-Aguye

2. INTRODUCTION Synonymous with ? Birth Control Contraception allows people who are sexually active either to prevent pregnancy or to attain their desired number of children and determine the timing of pregnancies. Promoting the use of contraception – and ensuring access to preferred contraceptive methods for women and couples – is essential to ensuring the well-being & independence of women, while supporting the health and development of communities. It is achieved through use of various methods

3. Worldwide Demographics An estimated 214 million women in developing countries would like to delay or stop childbearing but are not using any method of contraception. Most of these women live in 69 of the poorest countries on earth Contraceptive use has increased in many parts of the world, especially in Asia and Latin America, but continues to be low in sub-Saharan Africa. Globally, use of modern contraception has risen slightly, from 54% in 1990 to 57.4% in 2015.

4. Nigerian Demographics Nigeria has The 4 th highest maternal mortality rate in the world (out of 181 countries). The 8 th highest infant mortality rate (out of 188 countries) 7 th highest female fertility rate (approximately 5.4 kids/woman). A low current contraceptive prevalence rate of 10-15%, with almost 25% of married women reporting an unmet need for contraception

5. Benefits / Advantages 1. Preventing pregnancy-related health risks in women A woman’s ability to choose if and when to become pregnant has a direct impact on her health and physical well-being. Using contraception allows spacing of pregnancies and gives women the freedom to choose the number of children they want to have. It can also help to delay pregnancies in both very young & older women at increased risk of health problems and death from childbearing. It also prevents unintended pregnancies, thereby reducing deaths from unsafe abortions

6. 2. Reducing infant mortality Contraceptive use can prevent closely spaced and poorly timed pregnancies and births, which contribute to some of the world’s highest infant mortality rates. Infants of mothers who die as a result of giving birth also have a greater risk of death and poor health.

7. 3. Helping to prevent HIV/AIDS and some other STI’s Use of contraception reduces the risk of unintended pregnancies among women living with HIV, resulting in fewer infected babies and orphans. In addition, male and female condoms provide dual protection against unintended pregnancies and against STIs including HIV.

8. 4. Empowering people and enhancing education Using contraception enables people to make informed choices about their sexual and reproductive health. Family planning represents an opportunity for women to pursue additional education and participate in public life, including having paid employment outside the home. Additionally, having smaller families allows parents to invest more in each child.

9. 5. Reducing adolescent pregnancies Pregnant adolescents are more likely to have preterm or low birth-weight babies, Many adolescent girls who become pregnant have to leave school. This has long-term implications for them as individuals, their families and communities.

10. 6. Slowing population growth Contraceptive use is essential to slowing unsustainable population growth and the resulting negative impacts on the economy, environment, and national development efforts.

11. Barriers to Contraceptive Use Common reasons why women do not use contraceptives include Logistical problems, such as difficulty getting to health facilities or supplies running out at health clinics. Social barriers, such as opposition by partners, families or communities. Lack of knowledge also plays a role, with many women not understanding that they are able to become pregnant, not knowing what contraceptive methods are available, or having incorrect perceptions about the health risks of modern methods.

12. 4. Limited choice of methods; 5. Limited access to contraception, particularly among young people, poorer segments of populations, or unmarried people; 6. Fear or experience of side-effects 7. poor quality of available services;

13. Contraceptive Methods Contraceptive methods can be classified in different ways. For the purposes of this lecture, we will classify contraceptives into 2 groups: Hormonal and Non-Hormonal

14. Hormonal Methods

15. Hormonal Contraception Hormonal contraceptives contain either a synthetic progestin alone, or synthetic estrogen and progestin in combination. Progestins thicken cervical mucus, thereby stopping sperm from reaching the ovaries. While the estrogen/ progestin combination acts by the same mechanism and also inhibits ovulation and thickening of the endometrial lining Types of hormonal contraceptives include injectables , implants, rings, pills and IUD’s

16. Combined oral contraceptives (COCs) or “the pill” Contains two hormones (estrogen and progestogen) Prevents the release of eggs from the ovaries (ovulation) >99% efficacy with correct and consistent use Reduces risk of endometrial and ovarian cancer WHO recommends that they be used from 6 months after delivery Best started on the first day of a woman's cycle (1 st day of her period or before her period ends)

17. There are different types of combined hormonal contraceptive pills and they can be used for other purposes other than just contraception. Monophasic pills all contain the same balance of hormones. With bi or tri phasic pills, two or three different types of pills are taken each month, each with a different balance of hormones. Combined pills can come as "21-day pills." or “everyday/ 28- day pills”. Newer formulations can also come as 24 day pills, and 84 day pills

18. Progestogen-only pills (POPs) or "the minipill " Contains only progestogen hormones, not estrogen Thickens cervical mucous to block sperm and egg from meeting and prevents ovulation 99% efficacy with correct and consistent use Can be started at any time and used while breastfeeding; Must be taken at the same time each day

19. Implants/ Implanon Small, flexible rods or capsules placed under the skin of the upper arm contains progestogen hormones only Thickens cervical mucous to block sperm and egg from meeting and prevents ovulation >99% effectiveness A Health-care provider must insert and remove; can be used for 3–5 years depending on implant; irregular vaginal bleeding common but not harmful

20. Progestogen only injectables / E.g. DMPA Injected into the muscle every 2 or 3 months, depending on product >99% effectiveness with correct and consistent use Delayed return to fertility (about 1–4 months on the average) after use; Weight gain & irregular vaginal bleeding are common side effects

21. Monthly injectables or combined injectable contraceptives (CIC) Injected monthly into the muscle, contains estrogens and progestogens >99% efficacy with correct and consistent use

22. Combined Vaginal ring (CVR) The vaginal ring is a small, flexible ring a woman inserts into her vagina once a month to prevent pregnancy. It is left in place for three weeks and taken out for the remaining week each month. Two types of vaginal rings are currently available, NuvaRing and Annovera .

23. Combined contraceptive patch Transdermal patch applied to the skin that continuously releases the 2 hormones Comes in Packs of 3, one patch per week The patch and the CVR are relatively new and research on their effectiveness is limited. However, a few studies report that the patch may be more effective than the COCs

24. Intrauterine device (IUD) levonorgestrel A T-shaped plastic device inserted into the uterus that steadily releases small amounts of levonorgestrel (a Progestin) each day Can last for 5-7 Years Also suppresses the growth of the lining of uterus (endometrium) >99% effectiveness if properly used Decreases amount of blood lost with menstruation over time; Reduces menstrual cramps and symptoms of endometriosis; and can cause amenorrhea (no menstrual bleeding) in a group of users

25. Common Side Effects of Hormonal Contraception Intermenstrual spotting Nausea Breast tenderness Headaches and migraine Weight gain Mood changes (Increased risk of developing depression) Missed periods Decreased libido Changes to vaginal discharge Changes to eyesight for those using contact lenses Acne

26. Contraindications Combined Oral Pregnancy, Obesity Smokers over the age of 35 years, or anyone who stopped smoking within the last year and is over 35 years old Taking certain medications (Anti TB, HIV or antiepileptics ) Previous personal/ family history of thrombosis, stroke, heart problems or diabetes with complications Women who have severe migraines, especially with aura Previous history of breast cancer or disease of the liver or gallbladder Progestin only Previous/current breast cancer and/ liver disease Unexplained uterine bleeding Taking medications for tuberculosis, HIV/AIDS or some antiepileptics

27. Long term Risks Cardiovascular Problems : Combination pills can slightly increase the risk of cardiovascular (CV) side effects, such as heart attack, stroke, and blood clots. These can all be fatal. Patients with uncontrolled High blood pressure and personal or family histories of CV disease should avoid them. Cancers : Decreased rates of ovarian and endometrial cancers, but slightly increased rates of breast, cervical and benign liver tumors Depo-Provera (Injectable progestin) has also been linked to a loss of bone mineral density , increasing the risk for osteoporosis and bone fracture in later life.

28. Non Hormonal Methods

29. Copper Containing Intrauterine Device(IUD) Small flexible plastic device containing copper sleeves or wire that is inserted into the uterus Copper component damages sperm and prevents it from meeting the egg Can last for 3-12 years depending on the type >99% effective if used properly Longer and heavier periods during first months of use are common but not harmful. The device can also be used as emergency contraception

30. Male condoms Sheaths or coverings that fit over a man's erect penis Forms a barrier to prevent sperm and egg from meeting 98% effectiveness with correct and consistent use Also protects against sexually transmitted infections, including HIV

31. Female condoms Sheaths, or linings, that fit loosely inside a woman's vagina, made of thin, transparent, soft plastic film Forms a barrier to prevent sperm and egg from meeting 90% effective with correct and consistent use Also protects against sexually transmitted infections, including HIV Often used together with a spermicide, should not be used at the same time as a condom

32. Two-day / Billings Method Women track their fertile periods by observing presence of cervical mucus (of any type, color or consistency) Prevents pregnancy by avoiding unprotected vaginal sex during most fertile days, 96% effective with correct and consistent use. Difficult to use if a woman has a vaginal infection or another condition that changes cervical mucus. Unprotected coitus may be resumed after 2 consecutive dry days (or without secretions)

33. Basal Body Temperature (BBT) Method The Woman takes her body temperature at the same time each morning before getting out of bed observing for an increase of 0.2 to 0.5 degrees C. Prevents pregnancy by avoiding unprotected vaginal sex during fertile days 99% effective with correct and consistent use. If the BBT has risen and has stayed higher for 3 full days, ovulation has occurred and the fertile period has passed. Sex can resume on the 4th day until her next monthly bleeding.

34. Sympto-thermal Method Women track their fertile periods by observing changes in the cervical mucus (clear texture) , body temperature (slight increase) and consistency of the cervix (softening). Prevents pregnancy by avoiding unprotected vaginal sex during most fertile 98% effective with correct and consistent use. May have to be used with caution after an abortion, around menarche or menopause, and in conditions which may increase body temperature.

35. Male sterilization (vasectomy) Blocks or cuts the vas deferens tubes that carry sperm from the testicles Keeps sperm out of ejaculated semen Used to be permanent, but can now be reversed >99% effective after 3 months 3 months delay in taking effect while stored sperm is still present; does not affect male sexual performance.

36. Female sterilization (tubal ligation) Involves blocking or cutting the fallopian tubes Eggs are blocked from meeting sperm >99% effective Can be permanent or reversible, depending on the method used Voluntary and informed choice is essential

37. Lactational amenorrhea method (LAM) A temporary family planning method based on the natural effect of breastfeeding on fertility requires exclusive or full breastfeeding day and night of an infant less than 6 months old Prevents the release of eggs from the ovaries (ovulation) 99% effective with correct and consistent use

38. Emergency contraception Also known as post coital contraception Popular types include Levonorgestrel ( postinor ) and Ullipristal acetate ( ella -one) These Progestin-only pills are taken to prevent pregnancy up to 5 days after unprotected sex Prevents ovulation If 100 women used progestin-only emergency contraception, one would likely become pregnant. Does not disrupt an already existing pregnancy Copper IUDs can also be used

39. Standard Days Method or SDM Women track their fertile periods (usually days 8 to 19 of each 26 to 32 day cycle) using cycle beads or other aids Prevents pregnancy by avoiding unprotected vaginal sex during most fertile days. 95% effective with consistent and correct use. Can be used to identify fertile days by both women who want to become pregnant and women who want to avoid pregnancy. Correct, consistent use requires partner cooperation.

40. Calendar method or rhythm method Women monitor their pattern of menstrual cycle over 6 months, Subtract 18 from shortest cycle length (estimated 1st fertile day) and subtracts 11 from longest cycle length (estimated last fertile day) The couple prevents pregnancy by avoiding unprotected vaginal sex during the 1st and last estimated fertile days, or using a condom. 91% effective with correct and consistent use. May need to delay or use with caution when using drugs (such as anxiolytics, antidepressants, NSAIDS, or certain antibiotics) which may affect timing of ovulation.

41. Withdrawal (coitus interruptus ) Man withdraws his penis from his partner's vagina, and ejaculates outside the vagina, keeping semen away from her external genitalia Tries to keep sperm out of the woman's body, preventing fertilization 96% effective with correct and consistent use One of the least effective methods, because proper timing of withdrawal is often difficult to determine, leading to the risk of ejaculating while inside the vagina. Pre-ejaculate is also a problem

42. Essure ® (Permanent Contraception) Approved by the FDA in 2002 Permanent method of contraception During the insertion procedure, a soft, flexible insert is placed in each fallopian tube. Over the next three months, a barrier (scar tissue) will form around the inserts, totally blocking the tubes. Needs another form of contraception to prevent pregnancy before the process is complete . Does not require surgery or anesthesia Long term risks include pain and ectopic pregnancies

43. Male Contraception Use of contraception by men makes up a relatively small subset of the above prevalence rates. The modern contraceptive methods for men are limited to male condoms, coitus interruptus and sterilization (vasectomy). However, research is currently been carried out on three promising methods for men. These include A daily gel that stops sperm production (Contains testosterone and a progestin) A male birth control pill — dimethandrolone undecanoate A nonsurgical vasectomy called RISUG, which stands for reversible inhibition of sperm under guidance. (Soon to be launched in India, has data for preventing pregnancies for up to 13 years)

44. REFERENCES/ USEFUL RESOURCES 1. Austin A. Unmet contraceptive need among married Nigerian women: an examination of trends and drivers. Contraception. 2015;91(1):31-38. 2. Who.int. WHO | Family planning / contraception [Internet]. 2018 [cited 2 August 2018]. Available from: http://www.who.int/mediacentre/factsheets/fs351/en/ Who.int. WHO | Emergency contraception [Internet]. 2018 [cited 2 August 2018]. Available from: http://www.who.int/mediacentre/factsheets/fs244/en1. Belluz J. The 3 most promising new methods of male birth control, explained [Internet]. Vox . 2018 [cited 2 August 2018]. Available from: https://www.vox.com/2018/4/4/17170262/male-birth-control-explained

45. 5. Essure ® |What is Essure [Internet]. Essure.com. 2018 [cited 2 August 2018]. Available from: http://www.essure.com/what-is-essure 6. Minipill (progestin-only birth control pill) - Mayo Clinic [Internet]. Mayoclinic.org. 2018 [cited 2 August 2018]. Available from: https://www.mayoclinic.org/tests-procedures/minipill/about/pac-20388306 7. Smith L. Birth control pill: Side effects, risks, alternatives, and the shot [Internet]. Medical News Today. 2018 [cited 2 August 2018]. Available from: https://www.medicalnewstoday.com/articles/290196.php 8. Nigeria - Country Profile - 2018 [Internet]. Indexmundi.com. 2018 [cited 2 August 2018]. Available from: https://www.indexmundi.com/nigeria/