Modern Contraception and family planning

this are lecture notes on modern contraception

1. Modern contraception Hellen Muringi Department of medical microbiology and immunology University of Nairobi Visiting lecturer, B anadir University

2. Introduction Contraception=against conception The preventive methods to help women avoid unwanted pregnancies are called contraceptive methods.

3. Need for contraception To avoid unwanted pregnancies To regulate the timing of pregnancy To regulate the interval between pregnancy

4. Ideal contraceptive??? Safe Effective Acceptable Reversible Inexpensive Long lasting Requires little or no medical supervision

5. Contraceptive methods cont

6. Contraceptive methods S pacing methods Terminal methods 1)Barrier 1)Male fertilisation 2)IUDs 2)Female fertilisation 3)Hormonal 4)Emergency contraception

7. Barrier methods Male condoms Female condoms Diaphragm Spermicides

8. Male condom 3. Diaphragm 2. Female condoms

9. S permicides Spermicides are surface active agents that attach themselves to spermatozoa and kill them. Available in various forms like Foams Creams Suppositories Soluble films

10. Intra uterine devices 1 st generation : -Inert/non-medicated devices Eg:lippes loop(left as long as required) 2 nd genration : -Metallic IUDs -Cu-T380 A(10 years) -Nova T(5 years) - Multiload devices 3 rd generation: -Hormonal IUDs - progestasert (2 years) - Mirena (LNG-20)(10 years)

11. IUCD continued Contraindication Timing:At the time of menstruation post partum,post pueperal Side effects:1)bleeding 2)pain 3)PID 4)perforation of uterus 5)Ectopic pregnancy

12. Hormonal contraceptives Combined pill: -combination of estrogen and progestogen -MALA-N,MALA-D(0.15mg levonorgestrel & 0.03mg ethinyl estradiol ) Prgestogen only pill -used in people above 40 years of age & CVS problem Post coital contraception: - Levonorgestrel - Ullipristal - Mifepristone

13. Adverse effects Cardiovascular effects Carcinogenesis Metabolic effects Liver adenomas Weight gain Breast tenderness

14. Depot formulations Injectables : DMPA-150 mg IM inj every 3 monthly Subdermal impants : Norplant-6 silastic capsules, each containing 35 mg of levonorgestrol -protection for 5 years

15. Natural/traditional methods Abstinence: only method that is 100% effective Coitus interuptus Rhythm method B asal  body temperature  method Cervical mucus Symptothermal contraception or fertility awareness

16. Terminal methods Permanent methods One time method -Guidelines Husbands age:25-50 years Wife’s age:20-45 2 living children at the time of operation

17. Male S terilisation Complications: Operative Sperm granules Spontaneous recanalisation Psychological Post op advice: Not sterile till 30 ejaculations Avoid bathing till 24 hours of operation Avoiding heavy weights and wearing a langot

18. Female sterilisation Laparoscopy Mini lap

19. Evaluation of contraceptive methods Pearl index: -failures per 100 women years of exposure Pearl index= total accidental pregnancies X1200 total months of exposure Life table analysis : -The failure rate for each month of use, then the cumulative rate is found out

20. Family planning in Somalia According to data from the United Nations Population Fund (UNFPA), as of 2018, the prevalence of modern contraception in Somalia was low, with only about 6.3% of married or in-union women aged 15 to 49 using a modern method of contraception.

21. Whom to target??? Eligible couple: -Currently married couple where in the wife is in the reproductive age (15-45 years) Unmet need of contraception: -Women with unmet need are those who are fecund and sexually active but are not using any method of contraception, and report not wanting any more children or wanting to delay the next child. -The concept of unmet need points to the gap between women's reproductive intentions and their contraceptive behaviour -Lack of awareness and accessibility

22. Hindrances to uptake of modern contraceptives Cultural and Religious Beliefs : Many African societies hold traditional beliefs that may oppose the use of contraceptives due to religious or cultural reasons. These beliefs often center around the idea that contraception is unnatural or goes against religious teachings. Misinformation and Myths : There are prevalent myths and misconceptions surrounding modern contraceptives in Africa. These myths can include fears about side effects, infertility, or health risks associated with contraceptive use. Stigma and Social Norms : In some communities, there is stigma attached to discussing or using contraceptives, particularly among unmarried individuals or younger women. Fear of judgment or ostracism can deter people from seeking out contraception. Limited Access to Services : Access to modern contraceptive methods can be limited in many African countries, particularly in rural areas where healthcare facilities may be scarce or poorly equipped. This lack of access can include both physical access to facilities and affordability of contraceptive methods. Gender Dynamics : In some societies, power imbalances between men and women can affect contraceptive decision-making. Women may face pressure from partners or family members to avoid contraceptive use, or they may lack the autonomy to make decisions about their reproductive health. Health Concerns and Side Effects : Concerns about potential side effects or health risks associated with modern contraceptives can also deter people from using them. Lack of accurate information about the safety and effectiveness of different methods can contribute to these fears. Desire for Large Families : In some African cultures, having many children is highly valued, and there may be resistance to contraceptive use due to a desire for large families or pressure to fulfill societal expectations regarding fertility .

23. Strategies to improve uptake Comprehensive Sexual Education : Implement comprehensive sexual education programs in schools and communities to provide accurate information about reproductive health, contraceptive options, and family planning. These programs should be culturally sensitive and tailored to the needs of different populations. Community Engagement and Mobilization : Work with community leaders, religious institutions, and local organizations to promote awareness and acceptance of modern contraceptives. Community health workers can play a crucial role in delivering information and services at the grassroots level. Improving Access to Services : Expand access to contraceptive services by increasing the availability of family planning clinics, mobile outreach services, and community-based distribution programs. Ensure that contraceptive methods are affordable and accessible, particularly in rural and underserved areas. Integration with Maternal and Child Health Services : Integrate family planning services with maternal and child health programs to reach women during antenatal and postnatal care visits. This approach can help normalize discussions about contraception and provide opportunities for counseling and provision of services. Empowering Women and Girls : Promote gender equality and empower women and girls to make informed decisions about their reproductive health. This may involve initiatives to improve education and economic opportunities for women, as well as efforts to address harmful gender norms and practices. Addressing Cultural and Religious Beliefs : Engage religious and traditional leaders in dialogues about family planning and contraception, emphasizing the compatibility of modern methods with religious and cultural values. Develop culturally appropriate messaging and materials to counter myths and misconceptions. Quality of Care and Client-Centered Services : Ensure that family planning services are of high quality and meet the needs of clients. This includes providing a range of contraceptive options, offering counseling and support for method choice and side effect management, and respecting clients' autonomy and confidentiality. Advocacy and Policy Change : Advocate for policies and programs that support access to modern contraceptives, including funding for family planning services, removal of legal and regulatory barriers, and integration of family planning into broader health and development initiatives. Male Engagement : Involve men and boys in discussions about family planning and contraception, emphasizing the benefits of shared decision-making and male involvement in reproductive health. Addressing men's concerns and misconceptions can help promote support for contraceptive use within families. Utilizing Technology : Explore the use of technology, such as mobile health applications and telemedicine, to increase access to contraceptive information and services, particularly in remote areas where healthcare facilities are limited.

24. Thank you