Appropriate Information on Family Planning

Low-Dose Combined Oral Contraceptives

• effective, reversible method
• should be taken everyday
• side effects: irregular vaginal bleeding, missed period, upset stomach
• protect against certain cancers, anemia and other conditions
• not recommended for breastfeeding women because it can reduce milk supply
• can be used fro emergency contraception after unprotected sex

DMPA (Depot-medroxyprogesterone acetate)

• effective and safe
• changes in vaginal bleeding are normal
• weight gain may occur
• do not prevent STD's
• do not contain estrogen

Norplant

• capsules are placed under the skin of a woman's upper arm
• can prevent pregnancy for at least 5 years
• can cause changes in menstrual bleeding, headache, breast tenderness, acne, weight gain, hair loss, more hair growth on the face
• effective within 24 hours after insertion

Tubal Ligation

• permanent , effective
• helps protect against ovarian cancer
• reversal surgery is difficult
• preparation of the patient for minilaparotomy or laparoscopy

Before: NPO for 8 hours, no medications
After: rest for 2-3 days, avoid heavy lifting for a week, take paracetamol, avoid sex for at least 1 week
Reportable sign and symptoms: high fever in the first 4 weeks, pain, pus, abdominal pain, diarrhea, fainting, dizziness


Vasectomy

• permanent
• no effect on sexual performance
• fully effective only after 20 ejaculations or 3 months. The man should use condom or his partner should use another method
• common complications: pain in the scrotum, swelling, bruising, brief feeling of faintness after the procedure

Condom

• prevents pregnancy and STD's including HIV/AIDS
• interrupts sex, reduces sensation
• comes in different sizes, shapes, colors and textures
• the only contraindication: LATEX allergy (severe redness, itching, swelling)

IUD

• small flexible plastic frame
• it is inserted into a woman's uterus through her vagina
• a provider can remove the IUD by pulling gently on the strings with forceps
• common side effects: menstrual changes (longer, heavier menstrual periods, bleeding and spotting, cramps or pain during periods)
• check IUD once a week during the first month after insertion, after each menstrual period, if possible after noticing any possible symptoms of serious problems
• to check the IUD, a woman should: wash her hands, sit in a squatting position, insert 1 or 2 fingers into her vagina as far as she can until she feels the strings. Do not pull on the strings
• instruct the patient to return for a visit 3-6 weeks after IUD insertion

Vaginal Methods (spermicide, diaphragm, cervical cap)

• methods that women control and can be used when needed
• help protect against some STD's
• insert spermicide up to 1 hour before sex. Place it high in the vagina. Insert foaming tablets, films, and suppositories at least 10 minutes before sex. Do not douche for at least 6 hours after sex
• insert a diaphragm or cervical cap ahead of time when you might have sex. After sex leave the diaphragm or cap in place and do not douche for at least 6 hours

Fertility awareness-based methods
: Remember the Rules:
Cervical secretions: avoid unprotected sex from the first day of any cervical secretions or feelings of vaginal wetness until the 4th day after the peak day of slippery secretions

Basal Body temperature (BBT): avoid unprotected sex from the first day of menstrual bleeding until body temperature has risen and stayed up for 3 full days

Calendar or rhythm: determine the fertile time through calendar calculations. Avoid unprotected sex between the first and last days of the estimated fertile time

Cervical Secretions + BBT: avoid unprotected sex from the first day of cervical secretions until both the 4th day after the peak of slippery secretions and the 3rd full day after the rise in body temperature


LAM (Lactation Amennorhea method)

• temporary
• based on breastfeeding
• can be used when (1) the woman breastfeeds often both day and night (2) menstruation have not returned (3) baby is less than 6 months
• effective for up to 6 months after childbirth
• an ideal pattern of breastfeeding for LAM is at least 8-10 times a day including at least once a night
  

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