Contraceptvies basics gujarati Government

Contraceptive basic government in gujarat

1. Contraceptive Methods : Basics and
effectiveness
14.2.2025

3. IMPLANTs (0.05 Consistent & correct use)
A contraceptive implant is a small plastic rod that is inserted
under the skin of the upper arm to prevent pregnancy.
Effectiveness: Highly effective, progestogen-only hormonal method
•Thickens cervical mucus
•Prevents ovulation
• Long-acting (3-7 years) with high continuation rates (84%)
•Popular Brands: Norplant, Jadelle, Implanon, Nexplanon, Femplant
Technology
•MicroCHIPS: Remote-controlled contraceptive implant
•Wirelessly operated
•Lasts up to 16 years
Side Effects:
•Common (e.g., bleeding changes)
•No major health risks

4. INTRA-UTERINE CONTRACEPTIVE DEVICE (IUCD) (0.2)
A method of contraception, made of plastic and copper, inserted in the uterus.
There are two types of IUCD
IUCD 375- protection for 5 yearsIUCD 380 A- protection for 10 years
1.IntervalIUCD:Anytimeduringmenstrualcycle/after6weeksofdelivery/after12daysof
completion of abortion.
2.Postpartum IUCD (PPIUCD): Within 48 hours of vaginal delivery/ concurrent with C Section
3.Post-AbortionIUCD:Within12daysofcompletionofabortion(surgicalabortion).Incaseof
medicalabortion,thecompletionofabortionisascertainedon12thdayaftertheintakeof
second pill or 15th day after intake of first pill

5. Benefits of IUCD
1.Highly effective long-acting reversible contraceptive method
2.No hassle of remembering to use contraceptives before each sexual contact
3.Immediately effective on insertion/ immediate return of fertility on removal
4.Free from side effects of hormonal methods
5.Can be used as emergency contraception if inserted within 5 days of unprotected
sex
Effects of IUCD insertion (non-harmful and reversible):
Slight bleeding/ spotting after insertion.
Increase in duration/ amount of menstrual bleeding/ spotting/ light bleeding
during first few months after insertion
Discomfort or cramps during insertion and for the next few days
Can be used as emergency contraception if inserted within 5 days of unprotected
sex

6. FEMALE STERILIZATION (0.5)
✔It is a permanent method of contraception which can be adopted
once the couple’s family is complete.
✔Procedure involves ligation of both the fallopian tubes which can
be done either through minilap procedure or laproscopic
procedure.

Should have at least one child who is above one year
of age (unless medically indicated)

Client and their spouse/partner
should not have undergone
successful sterilization in the
past


Medical eligibility (to be
ascertained by provider)

Client should be
ever- married

Age should be between
22-49 years (for
females) and 22-60
years (males)
WHO CAN ADOPT STERILIZATION

7. MALE STERILIZATION (0.1)
It is a permanent method of contraception that can be adopted
once the couple’s family is complete. The procedure involves
ligation of the vas deferens to prevent the entry of sperms in
the penis
Benefits of Male Sterilization:
1.A safe, simple, and highly effective method No cut, no
stitches required
2.The acceptor can walk back after 30 minutes of the
procedure
3.Minimal/ no post-operative complications or discomfort
4.No long-term side effects
Follow Up:
✔The client should report to the health facility for semen
examination three months after the surgery.
✔It is important to use a reliable contraceptive method
till the success of the procedure can be ascertained.
✔The success of the procedure can be ascertained after
semen examination only.
✔The sterilization certificate can be collected after three
months of the procedure from the health facility if the
procedure is successful.

8. Benefits of Female Sterilization:
•A safe, simple, and highly effective method.
•Permanent and effective immediately
•No further contraception is required
•No long-term side effects
•Can be adopted concurrently with Delivery/Abortion or within 7
days (No effect on quality/ quantity of milk)
Key points to note for female and male sterilization:
✔It is a surgical procedure that has a possibility of complications/
failure, requiring further management.
✔In the unlikely event of complication/ failure/ death, there is a
redressal mechanism in form of an indemnity cover.
✔The client must provide written informed consent for the procedure.
✔Reversal of procedure involves major surgery and success cannot be
guaranteed.

9. Hormonal Methods
Synthetic Oestrogen / Progesterone
(e.g. COCP, POP, Implant, Injectable, IUS)
Inhibit ovulation :
•steady levels of
oestrogen and progesterone trick
pituitary gland into thinking already
pregnant
• suppress LH/FSH production
(combined methods or high-dose
progesterone)
Mechanisms of Action:
Suppress Endometrial Growth
•Makes the uterine lining less
receptive, reducing the
likelihood of a fertilized egg
attaching to the uterus
(Implantation).
•Key Hormone: Progesterone.
Thicken Cervical Mucus
•Creates a barrier, making
it difficult for sperm to
reach the uterus and
fertilize the egg.
•Key Hormone:
Progesterone.

10. INJECTABLE MEDROXY PROGESTRONE ACETATE (Antara IM & SC)(0.05
consistence and correct use)

An intramuscular hormonal method for women that provides protection for 3 months with a single dose.
Dose and site:
The injection is given intramuscularly in the upper arm,
buttocks, or thigh, as per the client's preference


Benefits of Injectable MPA:
•No interference with sexual intercourse Private and confidential method.
•Can be adopted as postpartum (Breastfeeding- At 6 weeks of delivery and Non-
Breastfeeding at 4 weeks after delivery) or post-abortion contraception (within 7 days of
completion of abortion).
•No effect on quantity and quality of milk.
•Decrease menstrual cramps, menorrhagia.
•Prevents/ improves anaemia.
•Protects against endometrial & ovarian cancer.
•Protects against ectopic pregnancy

11. Clarifying Misconceptions
•Does NOT cause Infertility
•Does NOT cause weakening of bones
•Does NOT lead to Abortions or birth defects
•Can be safely used by adolescents
•Does NOT cause cancers (breast/ cervix/ endometrium)
Effects of Injectable MPA (non-harmful and reversible):
•Menstrual Irregularities: Light/ Heavy/ No bleeding
•Delay in return of fertility (7-10 months from the last dose of injection)
•Slight weight gain
•Mood swings
•Headache

12. 4. COMBINED ORAL CONTRACEPTIVE PILLS (MALA N)
Key Features:
•‘The Pill’: Prevents ovulation.
•Contains Oestrogen (Ethinylestradiol) + Progesterone (e.g.,
Levonorgestrel) or Anti-androgen (Cyproterone Acetate).
•Taken 21 days, followed by a 7-day break.
•Available in:
•1st, 2nd, and 3rd generations.
•Monophasic or multiphasic formulations
Progesterone-Only Pill (PoP)
Key Features:
•Also known as the ‘Mini-pill.’
•Main effect: Thickens cervical mucus, preventing sperm penetration.
•Contains Progesterone (e.g., Norethisterone) – continuous use.
Advantages:
•Few contraindications.
•Safe during breastfeeding.
Common Side Effects:
•Changes in bleeding patterns.
•Hormonal side effects (e.g., acne).

13. Contraindications:
Benefits of COC:
❖Decrease in menstrual flow and cramps Regulates menstrual cycle
❖Decreases ovarian cysts
❖Decrease benign breast lumps
❖Protect against ovarian and endometrial cancer
❖Prevents ectopic pregnancy
❖Immediate return of fertility on discontinuation
1.Age: >35 years and a smoker.
2.Past Medical History (PMH):
1.Risk factors for CVD, liver disease, or VTE.
3.Family History (FH): Significant history of clotting disorders.
4.Blood Pressure: Hypertension.
5.Body Mass Index (BMI): High BMI.
6.Migraine With aura.

14. Effects of COC (non-harmful and reversible):
oBleeding changes (irregular/ scanty/ no bleeding/ spotting)
oNausea/ vomiting/ headache
oWeight changes/ Breast tenderness/ Acne.
Specific Risks
1.Venous Thrombo-Embolism (VTE):
1.Absolute risk is low (lower than in pregnancy).
2.Risk depends on the type of progestogen used.
2.Cardiovascular Disease (CVD) & Stroke:
1.Very rare.
2.Associated with co-morbidities like:
1.Migraine with aura.
2.Smoking.
3.Hypertension.
3.Breast Cancer:
1.Possible increased risk.
2.Risk returns to normal 10 years after stopping.
4.Cervical Cancer:
1.Small increased risk after 5 years of use.
2.Risk increases further after 10 years of use.
3.Returns to normal 10 years after stopping.

15. Contraceptive Methods: Emergency Contraception Pills
•Also Known As:
"The Morning After Pill," "Plan B“
•How It Works:
- Inhibits ovulation
-Can be taken up to 5 days after unprotected sex
•Types & Efficacy:
•Levonorgestrel (Levonelle):
Proven efficacy up to 3 days, reduced efficacy from 3-5 days
•Ulipristal Acetate (EllaOne):
Selective progesterone receptor modulator, effective up to 5 days
•Challenges:
- Misbeliefs and myths hinder use:
•EC is abortion
•Promotes promiscuity
•Causes sterility
•Lack of provider knowledge about its mechanism
•Repeat use often frowned upon

16. CENTCHROMAN PILLS (CHHAYA PILLS)
This is a Non-hormonal, non-steroidal, weekly pill that is suitable for nearly all women
including those who are unmarried and have no children.
Benefits of Centchroman:
•No hormonal effects
•No interference with sexual intercourse/ pleasure
•Can be adopted as postpartum (earlier than 4 weeks of
delivery) or post-abortion contraception (within 7 days of
completion of abortion).
•No effect on quantity and quality of milk Immediatereturn
of fertility on discontinuation
•Prevents/ improves anaemia
Effects of Centchroman (non-harmful and
reversible):
1. Delayed / Prolonged Periods
2. Scanty Periods over time

17. Contraceptive methods: Male condoms (Nirodh)
Key Features:
•Made of latex or plastic.
•Cheap and widely available.
•One of the few male contraceptive methods.
•Effectiveness: Medium-low (2–15% 12-month pregnancy rate,
depends on user action).
Common Myths (Debunked):
1."They have holes where viruses can pass through": No.
2."Unreliable and leak": No.
3."Break or slip off easily": Happens in only 2% of cases on average.
4."Condoms don’t fit": Latex condoms are elastic, stretchable, and come
in different sizes.
5."Condoms reduce sexual pleasure": A matter of opinion – ultra-thin
condoms are available.

18. Benefits:
•Protection against most STIs/HIV.
•Can be used with other contraceptives for dual protection.
•Few side effects or eligibility issues.
•Quality assurance in manufacturing and proper storage is essential.
Success Story:
Thailand’s 100% Condom Programme (for Sex Workers):
•Increased condom use from 14% to 94% in 5 years.
•Significant decline in STI cases and HIV prevalence.
Contraceptive methods: Male condoms (Nirodh)….Contd.

19. Effectiveness of Fertility Awareness Methods
1. Rhythm (Calendar) Method
•Also known as the calendar method.
•Traditional vs. modern approaches; effectiveness is debated.
•Most fertile period: Days 9–16 (sperm can live up to 7 days).
2. Cervical Mucus Method
•Monitor cervical secretions.
•Avoid intercourse on wet days and until you have 2 dry days
(Two-Day Method).
3. Standard Days Method
•For women with cycles between 26–32 days.
•Examples: CycleBeads, CycleTel™.
4.Calendar Method
•Chart menstrual cycles on a calendar (regular cycles required).
•Abstinence/condoms recommended for 12 days/month.

20. Contraceptive methods: Others
Lactation amenorrhea
• Breastfeeding naturally suppresses ovulation
Conditions for Effectiveness:
1.Within 6 months of birth.
2.Fully or “nearly fully” breastfeeding on a regular schedule.
3.Baby receives only breast milk (no other foods, only occasional
sips of water).
4.No return of menstruation.
Withdrawal method (Coitus Interruptus)
Man withdraws and ejaculates outside the woman’s body.
One of the least effective methods (78% typical use)

21. PREGNANCY TESTING KIT (NISHCHAY KIT)
Under the National Family Planning Program Schemes ASHA
would regularly collect Nishchay kits from the sub-center and
provide them to women for detection of pregnancy.
✔ASHA should inform the women about the availability of the
Nishchay Kit with them.
✔ASHA should counsel women regarding the advantages of early
detection of pregnancy
✔ASHA should provide the Nishchay kit to the client for early
detection of pregnancy and tell her how to use the Kit.
✔She should also tell the client how to read the pregnancy test
results. ASHA may help and conduct the test for clients who are
not able to understand how to read the results on their own.
✔ASHA should refer the client, as per client’s need and pregnancy
test results.

22. Basics of Stock Position for FP Commodities
Indenting Of FP Commodities At State Level
Timeline:
• Indenting is done annually, typically January-March
• Initiated after receiving a mail from MOHFW
Quantity Determination based on analysis of the following data:
1.Average consumption from HMIS data
2.District’s demand (Google Sheet)
3.Average of last 3 years’ indent

23. Indent For F.Y. 2024-25 From State To MoH
Name of the Commodity Total Approved Quantity
Antara IM 3,00,000
Chhaya 9,00,000
Condom 5,00,00,000
EC Pill 4,00,000
IUCD 375 3,00,000
IUCD 380 5,00,000
OC Pill 30,00,000
PTK 35,00,000
Tubal Ring 2,00,000

24. Sr. No. Item
Required Quantity per User/
Year*
1 Condom 72 Pieces
2
Combined Oral Contraceptive
Pills
13 Cycles
3
Intra-uterine Contraceptive
Device
1 Piece
4 Tubal Rings 1 Pair
5 Injectable Contraceptive 4 Doses
6 Weekly Pill 9 Strips
*Does not include the wastage per user
FP commodities; Quantity per per user/Year