1. FAMILY PLANNING

3. • The goal of family planning is to improve pregnancy
planning and spacing, and prevent unintended
pregnancy.

4. Definition:
• The practice of controlling the number of children one has and the intervals
between their births, particularly by means of contraception or voluntary
sterilization.
• Planned pregnancies spaced two or more years apart result in healthier babies
and fewer medical problems for the woman.
• Family planning allows individuals and couples to anticipate and attain their
desired number of children and the spacing and timing of their births.
• It is achieved through use of contraceptive methods and the treatment of
involuntary infertility.(WHO)

5. • Family planning allows people to attain their desired number of
children and determine the spacing of their pregnancies.
• It is achieved through use of contraceptive methods and the
treatment of infertility.
• Contraceptive information and services are fundamental to the
health and human rights of all individuals.
• The prevention of unintended pregnancies helps to lower
maternal ill-health and the number of pregnancy-related deaths.

6. • Delaying pregnancies in young girls who are at increased risk of
health problems from early childbearing, and preventing
pregnancies among older women who also face increased risks,
are important health benefits of family planning.
• By reducing rates of unintended pregnancies, contraception also
reduces the need for unsafe abortion and reduces HIV
transmissions from mothers to newborns.
• This can also benefit the education of girls and create
opportunities for women to participate more fully in society,
including paid employment.

7. The availability of family planning services allows
individuals to achieve desired birth spacing and family
size, and contributes to improved health outcomes for
infants, children, women, and families
It is important that family planning is widely available
and easily accessible through trained health workers to
anyone who is sexually active, including adolescents.

8. Benefits/Advantages of Family Planning
•It prevents pregnancy related health risks to the women
•Reduces unwanted pregnancy
•Reduces infant and maternal mortality- which may result due
to high number of pregnancies for a woman
•Reduces adolescent/teenage pregnancies
•Slows down population growth

9. • According to 2017 estimates, 214 million women of reproductive age
in developing regions have an unmet need for contraception.
• Reasons for this include:
Limited access to contraception
A limited choice of methods
Fear or experience of side-effects
Cultural or religious opposition
Poor quality of available services
Gender-based barriers.

10. •For women, negative outcomes associated with unintended
pregnancy can include:
 Delays in initiating prenatal care
 Reduced likelihood of breastfeeding
 Increased risk of maternal depression
 Increased risk of physical violence during pregnancy

11. Barriers to people’s use of family planning services :
• Cost of services
• Limited access to publicly funded services
• Limited access to insurance coverage
• Family planning clinic locations and hours that are not
convenient for clients
• Lack of awareness of family planning services among
hard-to-reach populations
• No or limited transportation
• Inadequate services for men
• Lack of youth-friendly services

12. Family planning services include:
• Contraceptive services
• Pregnancy testing and counseling
• Pregnancy–achieving services including preconception
health services
• Basic infertility services
• Sexually transmitted disease services

13. • Patient education and counseling
• Breast and pelvic examinations
• Breast and cervical cancer screening
• Sexually transmitted infection (STI) and human
immunodeficiency virus (HIV) prevention
education, counseling, testing, and referral

14. Contraceptive Methods

15. • The choice of a birth control method depends on a number of
factors, including :
Health of the client,
How often one is having sex
Number of sexual partners
Need to prevent sexually transmitted infections
Whether or not one want children.

16. Questions to consider when selecting a birth control method:
• How well does the method prevent pregnancy?
• What are your feelings about getting pregnant? Would
an unplanned pregnancy create hardship or distress to
a woman or her partner? Or would a pregnancy be
welcomed if it occurred earlier than planned?
• How much does a method of birth control cost?
• What are the health risks?
• Is your partner willing to accept and use a given
method of birth control?

17. •Do you want a method that you only need to use when
you have sex? Or do you want something that is in place
and always working?
•Is preventing infections spread by sexual contact
important?. Condoms are the best choice for preventing
STIs. They work best when combined with spermicides.
•Availability: Can the method be used without a
prescription, a provider visit, or, in the case of minors,
parental consent?

18. • There are many different types of contraception, with varying rates of
effectiveness depending on correct usage.
• Health care providers play an important role in helping people find and
use a method that is both effective and acceptable.
• Methods include:
Hormonal contraceptive methods
• Usually oral pills or implants, patches or vaginal rings.
• They release small amounts of one or more hormones which prevent
ovulation.
Intra Uterine Devices (IUDs)
• Devices inserted into the uterus where they release either a copper
component or a small amount of a hormone (Levnorgesterol) to prevent
the sperm from reaching the egg.

19. Emergency contraception
• It is possible to prevent pregnancy after unprotected sex or if
contraception has failed, either with a pill or with an IUD. There is a
five-day window for this.
Sterilization
• Considered a permanent method that blocks sperm in men and eggs
in women.
• Voluntary and informed choice is essential.
Lactational Amenorrhea Method (LAM)
• A temporary method of contraception for new mothers whose monthly
bleeding has not returned.
• During this period, eggs are not released and so pregnancy cannot
occur.

20. LACTATIONAL AMMENORRHEA METHOD (LAM)

21. • The Lactational Amenorrhea Method (LAM), a sub-set of Natural
Family Planning (NFP), is a temporary, postpartum method of FP based
on the natural effect of breastfeeding on fertility.
• LAM works primarily by preventing ovulation—but for this to occur,
exclusive breastfeeding is mandatory.
• Therefore, effectiveness depends on the user.
• As commonly used, the pregnancy rate is about 2 per 100 women in
the first 6 months.
• With perfect use, the pregnancy rate is less than 1 per 100 women.

22. •For this method to be effective, all three of the following
criteria must be met:
The woman’s menstrual periods have not resumed.
The baby is exclusively breastfed.
 The baby is less than six months old.
•When any of these three criteria is no longer met, another FP
method must be introduced

23. •Prolactin released during continuous breastfeeding
suppress ovulation which makes pregnancy unlikely.
•LAM is up to 98% effective, if practiced during exclusive
breastfeeding period.
•Effectiveness is reduced in the absence of exclusive
breastfeeding.

24. Contraceptive benefits
•Effective protection against pregnancy as long as all the three
LAM criteria are met.
•Return to fertility is immediate once you stop exclusive
breastfeeding.

25. Non contraceptive benefits
•Breastfeeding provides passive immunity for the child.
•LAM does not interfere with sexual activity.
•It has no known health risks.
•LAM is affordable FP—it has no direct costs.
•Women living with HIV/AIDS can use LAM.

26. LIMITATIONS OF LAM
• The method is effective only as long as all three LAM criteria are met.
• Breastfeeding can transmit HIV from a mother to her baby.
• Exclusive breastfeeding may be inconvenient or difficult for some
women, especially working mothers.
• LAM does not protect a woman against STIs, including hepatitis B,
HIV/AIDS.
• Fertility may resume before resumption of menses.

27. BARRIER METHODS OF BIRTH CONTROL

28. CONDOMS:
• Male condoms sheath a penis. Female condoms fit loosely inside a
vagina.
• Both form a barrier that prevent sperm and egg from meeting.
• A condom must be worn at all times during intercourse to prevent
pregnancy.

29. •For contraception, male condoms are only moderately
effective in typical use (85%), but much more effective
when used consistently and correctly (98%).
•ADVANTAGES OF CONDOMS
Easily accessible and affordable
Offer contraception only if used appropriately
With consistent and proper use, they are highly
effective for prevention against STIs, including HIV/AIDS.

30. Reduce the risk of cervical cancer.
Almost every man is eligible to use a condom.
Condoms are easy to use with a little practice.
There is no health risk associated with this method.
Condoms do not interfere with the act of intercourse, as do
the foaming tablets

31. Limitation
• A new condom must be worn for each act of sexual intercourse.
• Have a higher failure rate if used inconsistently or incorrectly.
• May reduce sensitivity during sex.
• There may be itching for a few people who are allergic to latex.
• Condoms are user-dependent.
• Condoms are affected by heat, light, and humidity.

32. • The female condom is a sheath made of thin transparent,
polyurethane pre-lubricated with a silicone-based substance
(dimethicone).
• It has a flexible ring at the end; the ring at the closed end helps to
insert the condom and the ring at the open end holds the condom
outside the vagina.
• The effectiveness of the female condom is slightly less than the
male condom.
• The failure rate is about 5 % in perfect use, and 21% in typical use.

33. ADVANTAGES AND BENEFITS
•Almost every woman is eligible to use this method.
•They are effective if used consistently and correctly.
•They offer contraception only when needed.
•Condoms can be used without seeing a health care
provider.
•With consistent and proper use, condoms are highly
effective for prevention against STIs, including HIV/AIDS.

34. •The woman can control this method.
• It can be inserted eight hours before an anticipated sexual
act.
• There is no need to see a health care provider before use.
•Condoms are easy to use with a little practice.
• No health risk is associated with the method.
•Unlike latex rubber, there is no known allergy to polyure

35. LIMITATIONS OF FEMALE CONDOMS
• Condom must be inserted before sexual intercourse
(although they can be inserted in advance—as much
as eight hours).
• Female condoms are expensive.
• Can be used only once - it cannot be reused.

37. DIAPHRAGM AND CERVICAL CAP
•A diaphragm is a flexible rubber cup that is filled with
spermicidal cream or jelly.
•It is placed into the vagina over the cervix before
intercourse, to prevent sperm from reaching the uterus.
•It should be left in place for 6 to 8 hours after
intercourse.

38. •Diaphragms must be prescribed by a health provider. The
provider will determine the correct type and size of
diaphragm for the woman.
•About 5 to 20 pregnancies occur over 1 year in 100 women
using this method, depending on proper use.
•A similar, smaller device is called a cervical cap.

39. Risks include:
•Irritation and allergic reactions to the diaphragm or
spermicide,
•Increased frequency of urinary tract infection and vaginal
yeast infection.
•In rare cases, toxic shock syndrome may develop in
women who leave the diaphragm in too long.
•A cervical cap may cause an abnormal Pap test.

40. DIAPHRAGM AND CERVICAL CAP:

41. VAGINAL SPONGE:
• Vaginal contraceptive sponges are soft, and contain a
chemical that kills or "disables" sperm.
• The sponge is moistened and inserted into the vagina,
to cover over the cervix before intercourse.
• The vaginal sponge can be bought without a
prescription.

42. HORMONAL METHODS OF BIRTH CONTROL

43. • They are either both an estrogen and a progestin, or a progestin
alone.
• A prescription is needed for most hormonal birth control methods.
• Both hormones prevent ovary from releasing an egg during cycle.
• They do this by affecting the levels of other hormones in the body.
• Progestin help prevent sperm from making their way to the egg by
making mucus around cervix thick and sticky.

44. Types of hormonal birth control methods include:
• Birth control pills - These may contain both estrogen and progestin,
or only progestin.
• Implants-These are small rods implanted beneath the skin. They
release a continuous dose of hormone to prevent ovulation.
• Progestin injections - Such as Depo-Provera, that are given
Intramuscularly once every 3 months.
• The vaginal ring - Such as NuvaRing, is a flexible ring about 2 inches
wide. It is placed into the vagina. It releases the hormones progestin
and estrogen.
• Emergency ("morning after pill") pill or contraception – It can be
bought without a prescription.

45. The Combined Oral Contraception (COC) pill
•The Pill comes in packets of 21 or 28 tablets.
• In the 28-pill packet, only the first 21 pills are active pills (I.e.
contain hormones).
•The remaining seven pills are inactive and usually contain iron.
• Works primarily by preventing the release of eggs from the
ovaries (suppress ovulation)
•Thickens the cervical mucus thus interfering with sperm
transport

49. EFFECTIVENESS
Effectiveness depends on the user:
• It is 99.7% effective in preventing pregnancy if used correctly and
consistently.
• Risk of pregnancy is greatest when a woman starts a new pill pack 3 or
more days late, or misses 3 or more pills near the beginning or the end
of a pill pack.
Contraceptive Benefits
• Highly effective if used correctly and consistently
• Are effective immediately if given within the first 5 days of the
menstrual cycle

50. Non-contraceptive Health Benefits
• Reduction of menstrual flow (lighter, shorter periods)
• Decrease in dysmenorrhea (painful periods)
• Reduction of symptoms of endometriosis and polycycstic ovarian
syndrome (PCOS)
• Improvement and prevention of iron - deficiency anemia
• Protection against ovarian and endometrial cancer

51. • Side Effects of COCs
Minor side effects include:
• Nausea (more common in the first three months)
• Spotting or bleeding in between menstrual periods, especially if one
forgets to take the pills or takes them late (more common in the first
three months)
• Mild headaches
• Breast tenderness
• Weight change gain /loss
• Mood change
• Amenorrhea (some women see amenorrhea as an advantage)

52. Major side effects or complications are rare, but possible and
include:
•Myocardial infarction
•Stroke
•Venous thrombosis or embolism, or both

53. PROGESTIN-ONLY PILLS (POPS)
•The Progestin Only Pills (POPs), also called the “Mini Pill” are
oral hormonal contraceptives that contain progesterone only
in a smaller dose (typically 10 – 50%) less than that used in
the combined pill.
•They do not contain Estrogen hence clients do not experience
the side effects associated with estrogen.
•Common brands available in the public sector and the local
market contain Levonorgestrel 30mcg.

54. •They thicken cervical mucus thus interfering with sperm
movement and Suppressing ovulation.
•EFFECTIVENESS- POPs are 99.5 % effective if used correctly
and consistently during exclusive breastfeeding.
•They are most effective when taken at the same time every
day.
• For women who have monthly bleeding, risk of pregnancy is
greatest if pills are taken late or missed completely.

55. Contraceptive benefits
•Effective and safe
•Does not affect breast milk production and can be used
during breastfeeding starting 6 weeks after childbirth
•Suitable for women with risk factors such as heart attack,
stroke and thrombosis.
•Return to fertility is immediate upon discontinuation

56. Non-contraceptive benefits
• Less side effects such as weight gain
• Taking POPs does not increase risk of blood clotting.
• May prevent endometrial cancer

57. Limitations
•They provide a slightly lower level of contraceptive
protection than COCs.
•They require strict daily pill-taking, preferably at the
same time each day.
•They do not protect against STIs, including hepatitis B
and HIV/ AIDS.
•Less effective in women who are not breastfeeding

58. Side effects
•Irregular spotting or bleeding, frequent or infrequent
bleeding, prolonged bleeding, amenorrhea (less common).
•Bleeding changes are common, but not harmful.
•Headaches, dizziness, nausea.
•Mood changes.
•Breast tenderness (although less common than with COCs).

60. INJECTABLE CONTRACEPTIVES

61. •Injectable contraceptives contain one or two contraceptive
hormones and provide protection from pregnancy for one,
two, or three months (depending on the type) following an
injection.
•About 50% of all women in Kenya who use modern
contraceptive methods choose injectable contraceptives.

62. •The most widely used injectable methods contain only
progestin (Progestin-only Injectable Contraceptives or POICs).
•Less common injectable are those that contain both progestin
and estrogen (Combined Injectable Contraceptives or CIC).

63. •Act by Preventing the release of eggs from the ovaries
(suppressing ovulation)
EFFECTIVENESS:
• Effectiveness depends on receiving injections on time, Risk of
pregnancy is greatest when a woman is late for an injection or
misses an injection.
• POIC is 99% effective if used correctly and consistently(as per
recommendations) and 96% effective as commonly used.

64. Contraceptive Benefits
•They are highly effective and safe.
•They contain no estrogen; thus do not have the cardiac and
blood-clotting side-effects associated with estrogen
containing pills and injectable.
•Convenient as it doesn’t require daily action.
•Do not affect breast milk production hence can be used
during breastfeeding

65. Non-contraceptive Health Benefits
• Amenorrhea, which might be beneficial for women with (or
at risk of) iron-deficiency anemia
• Reduction of symptoms of endometriosis
• Protection against endometrial cancer
• Protection against uterine fibroids
• Possible prevention of ectopic pregnancy
• Possible protection from pelvic inflammatory disease

66. Limitations include:
•Return of fertility may be delayed for four months or
longer after discontinuation.
•They offer no protection against STIs, including hepatitis
B and HIV; individuals at risk for these should use
condoms in addition to injectable contraceptives.
•This method is provider-based, so a client must go to a
health care facility regularly.

67. Side effects include:
• Changes in menstrual bleeding patterns such as:
Irregular bleeding
 Heavy and prolonged bleeding
Light spotting or bleeding
Amenorrhea, especially after one year of use

68. •Weight changes
•Headache
•Dizziness
•Mood swings
•Abdominal bloating
•Breast tenderness

69. CONTRACEPTIVE IMPLANTS
• Contraceptive implants (also called sub-dermal implants) are small
hormone (progesterone) bearing capsules or rods which when
inserted under the skin release the hormone slowly over a period of
time to prevent pregnancy.
• Implants do not contain estrogen; therefore, they are free from the
side effects associated with that hormone.
• Prevent pregnancy primarily by making cervical mucus too thick for
sperm to penetrate and they also suppress ovulation in menstrual
cycle

70. •Implants provide 99.9% effective protection against
pregnancy.
•They are effective 24 hours post insertion.
Example:
•Jadelle: 2 rods Levonorgestrel 75 mg/rod - 5 years
effectiveness
•Implanon & Implanon NXT : 1 rod Etonogestrel 68 mg/rod -3
years
•Sino-implant[Zarin] : 2 rods Levonorgestrel 75mg/rod - 4 years
•Indoplant - 2 rods Levonorgestrel 75mg/rod - 4 years

71. Contraceptive Benefits
•Highly effective and offers long term protection against
pregnancy
•Does not interfere with act of sexual intercourse
•Effective within 24 hours after insertion
•No frequent clinic visits required
•Fertility returns almost immediately after implants are
removed

72. Non-contraceptive Health Benefits
•Implants do not affect breastfeeding and can be used by
breastfeeding mothers starting immediately post-partum
•May reduce menstrual flow (thinning of the endometrium)
•They help prevent ectopic pregnancy (but do not eliminate the
risk altogether)
•They protect against iron-deficiency anemia
•They help protect from symptomatic PID
•May protect against endometrial cancer

73. Some of the limitations include:
• The client cannot initiate or discontinue the method on her own as it
requires a trained provider to insert and remove the implant.
• Insertion and removal requires minor surgical procedures and may be
uncomfortable.
• Do not protect against STIs, including hepatitis B and HIV. Individuals
at risk should use condoms in addition to the implants.
• There may be slight delay in resumption of fertility (about 1 year)

74. After Insertion:
• Counsel women to expect some soreness or bruising (or
both),after the anesthetic wears off. This is common and does
not require treatment.

75. Instruct her to:
•Keep insertion area dry for five days.
•Remove the gauze bandage after one day, but leave the
adhesive plaster in place for an additional five days (come back
to the health facility for removal)
•Return to the clinic if the rod(s) come out or if soreness
develops after the removal of the adhesive plaster.
•Return to the clinic if she experiences pain, heat, pus, or
redness at the insertion site, or if she sees a rod come out.

76. 2-rods implants

77. 1-Rod implant

80. Intra Uterine Contraceptive Device (IUCD)

81. •Intra uterine device is a small flexible plastic device that is
inserted into the uterine cavity to prevent pregnancy.
•It provides long term protection against pregnancy.
•TYPES OF IUCD
Copper based devices
Hormone releasing devices

82. Copper-Based Devices
• Copper-based devices release copper and work mainly by preventing
fertilization.
• Several studies have shown that copper IUCDs reduce the number of
viable sperms that reach the fallopian tubes, where fertilization
normally takes place.
• This is an indication that prevention of fertilization is highly effective
in women using copper IUCDs than other possible mechanisms, such
as prevention of implantation.
• In Kenya, the most widely used copper-bearing IUCD is Copper T380A.

83. Hormone-Releasing IUCDs
•The hormone releasing IUCDs are less widely available in
Kenya.
•They are devices made of plastic and work by releasing a
progestin, Levonorgestrel (LNG), during a period of five years.
•Mirena®, the LNG-20 IUS, is the most widely used
hormonereleasing intrauterine system in use in Kenya.

84. •Prevent fertilization by interfering with sperms mobility
•Copper IUCD – Copper ions decrease sperm motility and
function by altering the uterine and tubal fluid environment
•Hormonal IUCD – The progesterone released thickens cervical
mucus, suppress ovulation in cycles and thins the endometrial
lining

85. •IUCD is 99% effective if used correctly and consistently.
•Copper IUCD: Less than 1 pregnancy per 100 women
using an IUD over the first year (6 to 8 per 1,000
women).
•Hormone releasing IUCD: Less than 1 pregnancy per
100 women using an LNG-IUD over the first year (2 per
1,000 women).

86. Contraceptive Benefits
•High effectiveness and safety
•Provides immediate protection after insertion
•Long-acting protection (copper based - 12 years, hormone
releasing - 5 years)
•Can be used immediately after delivery (copper based)

87. • Client has no further cost following insertion
• Immediate return to fertility upon removal of device
• Copper IUCD is effective as an emergency contraceptive if
inserted within 5 days of unprotected sexual intercourse.
• Do not interfere with breastfeeding hence can be used by
women who are breastfeeding

88. Non-contraceptive benefits
• IUCDs do not interfere with intercourse.
• IUCDs help prevent ectopic pregnancies.
• IUCDs, including the Cu-IUCDS, might help protect from endometrial
cancer.
• LNG-IUS (Hormonal) minimizes bleeding and is suitable for women
with menorrhagia, it has been found to be beneficial in women who
experience cramps
• LNG-IUS provides benefits in the reduction of symptoms of
endometriosis

90. VOLUNTARY SURGICAL CONTRACEPTION

91. Voluntary Surgical Contraception (VSC) includes surgical
procedures that are intended to provide permanent
contraception.
• These methods are best for men, women, and couples who
feel certain they do not want to have children in the future.
• These procedures can sometimes be reversed if a pregnancy is
desired at a later time.
• However, the success rate for reversal is low.

92. These include:
•Bilateral Tubal Ligation (BTL) for female
•Vasectomy (male).

93. • BTL is 99.9% effective in preventing pregnancy
• Contraceptive Benefits
Highly effective and safe
Efficacy does not depend on the client’s action.
It is permanent.
Has no effect on breast-feeding
BTL does not affect a woman’s sexual desire, ability and performance
It is cost effective after the initial procedure
No significant long term side effects

94. Limitations
• Does not protect against STIs and HIV.
• Generally irreversible
• Procedure needs specially equipped facilities and trained personnel.
• Failure of procedure pre-disposes to ectopic pregnancy.
• Subjects client to pain and leaves permanent scar.
• The client needs to sign a consent
• Only adequately trained service providers can offer the method

95. VASECTOMY
•Vasectomy is the surgical process of cutting and tying the vas
deferens in order to prevent spermatozoa from mixing with
seminal fluid. Consequently, when ejaculation occurs, the
seminal fluid will not have any sperm.
•The operation is performed under local anesthesia.
•It prevents sperm movement from the testes to the seminal
vesicle and urethra thus preventing fertilization.
•It is 99.8% effective.

96. ADVANTAGES
•Highly effective and safe
•It is considered permanent providing a lifelong protection.
•Does not interfere with the act of sexual intercourse.
•It is not associated with long-term health risks.
•Less expensive; easy to perform
•Has fewer side effects and complications than many methods
for women
•The man takes responsibility for contraception

97. LIMITATIONS AND RISKS
•The procedure is virtually irreversible .
•Only a trained and skilled health provider can offer vasectomy.
•There is a delay in effectiveness after the procedure has been
performed (3 months) hence the need for a backup method
•Does not protect against STIs and HIV.
•There are minimal risks and side effects of local anesthesia and
surgical procedure.

99. Fertility Awareness Based Methods

100. Fertility awareness-based methods (FAMs), also referred
to as natural family planning (NFP) methods, require
abstaining from intercourse during the fertile time the
menstrual cycle

101. EFFECTIVENESS
• Pregnancy rates range from 1-14 % with correct and typical use in
the first year.
• Effectiveness is enhanced by use of multiple techniques to identify
the fertile time and to achieve this one must be able to recognize her
fertile time.
This is managed through several approaches, either singly or in
combination, which include calendar-based methods and symptoms-
based methods.

102. STANDARD DAYS METHOD (SDM)
• The SDM is based on the fact that there is a fertile window during the
menstrual cycle when one can be pregnant.
• This occurs several days before ovulation and a few hours after.
• To prevent pregnancy, couples avoid unprotected sex or abstain
between days 8-19 of the menstrual cycle..
• SDM is more than 95-% effective with correct use, and more than 88-
% effective with typical use among women with regular cycles of 26-32
days.

103. The Standard Days Method
• Identifies days 8-19 of the cycle as fertile.
• Is for women with menstrual cycles between
26 and 32 days long.
• Helps a couple avoid unplanned pregnancy
by knowing which days they should not have
unprotected intercourse.
• A client can use a color-coded string of beads
to help her keep track of where she is in her
cycle and know when she is fertile.
103

104. Standard Day Method

105. SYMPTOMS-BASED METHODS
• Symptoms-based methods depend on observation of signs of
fertility, such as the presence or absence of cervical mucus.
•It is also based on changes in the amounts and characteristics
of the cervical mucus and body temperature, or a
combination of the two, or use of specific ovulation detection
kits.

106. •Recognize evidence of ovulation (peak day),when the
mucus is very clear, stretchy (Spinnberkeit’s sign), and
slippery.
•Continue to avoid sex for three more days after peak day,
even if secretions completely disappear before three days
have expired.
•The couple can resume sex on the fourth day after the
peak day and until her next monthly bleeding.

107. BASAL BODY TEMPERATURE (BBT)
• Body temperature is taken either orally, rectally, or vaginally at
the same time each morning before getting out of bed and
before eating anything.
•The routine for taking the temperature must be the same for
the entire cycle.
•The temperature readings are recorded on a special graph
paper, which makes it easy to identify small changes in
temperature readings.

108. • The temperature rises by 0.20C - 0.50C, around the time of
ovulation (about midway through the menstrual cycle for
many women).
• The couple avoids sex from the first day of monthly bleeding
until three days after the temperature has risen above her
regular temperature.
• The couple should be taught to apply method rules
appropriately.

109. SYMPTO-THERMAL METHOD (CERVICAL MUCUS + BBT)
•The pre-ovulatory and post-ovulatory infertile phases of the
menstrual cycle are identified by a combination of the above
two techniques (the cervical mucus and BBT shift), as well as
other signs and symptoms around ovulation.

110. •The signs and symptoms used in the sympto-thermal method
include:
Thermal shift (BBT)
 Cervical mucus changes (BILLINGS)
 Cervical changes (consistency, position, openness, or closure)

111. •Other appropriate signs and symptoms, such as sharp lower
abdominal pain (mittelschmerz), breast tenderness, increased
libido
•Couples are taught to apply the combined rules of the above
methods to identify the fertile time.

112. Contraceptive benefits
• They do not require contraceptive commodities and supplies.
• Less expensive.
• There are no side effects or health risks.
• Return to fertility is immediate.

113. Non-contraceptive benefits
• Improve knowledge of the reproductive system and understanding of
menstrual cycle.
• Shared responsibility by couples.
• Limited need for professional consultation.
• Enhances Male engagement and spousal communication /Cooperation
• They can be used by both literate and illiterate women.
• They allow adherence to religious and cultural norms.
• Women who want to become pregnant can use them to identify fertile
days.
• They can be used where other methods are contra-indicated.

114. LIMITATIONS OF Fertility Awarenes Methods (FAMs)
• Clients require intensive education and instruction before being
confident to use method.
• Does not protect against sexually transmitted infections including HIV
• These are user-dependent methods hence need cooperation and
commitment by both partners.

115. •May not be easy to use if menstrual cycle is irregular.
•Require accurate daily record keeping.
•Unreliable if client is breastfeeding and has amenorrhea.
•Has a high failure rate if client is not well trained
•These methods require varying periods of sexual abstinence
during fertile phase.

116. WITHDRAWAL METHOD (COITUS INTERRUPTUS)
• It is a method in which the man completely removes the penis from
the vagina, and away from the external genitalia before he ejaculates
in order to prevent sperm from entering the female’s reproductive
tract.
• This method might be appropriate for couples who need a temporary
method while they await the start of another method, or for those
who have entered into a sexual act without any other method and
need contraception immediately.

117. EFFECTIVENESS
• Effectiveness of this method depends on the user:
• Risk of pregnancy is greatest when the man does not withdraw before
he ejaculates with every act of sex.
• Its important to note that:
 Its one of the least effective methods, as commonly used.
 As commonly used, about 20 pregnancies per 100 women whose
partners use withdrawal over the first year will occur.
When used correctly with every act of sex, about 4 pregnancies per
100 women whose partners use withdrawal over the first year will
occur.
There is no delay in return of fertility

118. ADVANTAGES OF COITUS INTERUPTUS
•Promotes male engagement and couple communication
•Does not affect breastfeeding.
•Has no economic cost
•Does not involve use of devices or chemicals.
•Has no health risks associated directly with it
•Always available as a back-up method and no need for
professional supervision.

119. LIMITATIONS
• It demands consistent self-control by couples .
•It is possible for pre-ejaculatory fluid containing sperm to
flow out during the excitement phase, before withdrawal.
• It does not protect from STIs, including HIV/AIDS and HBV—
couples at high risk of infection should use a condom with
each act of intercourse

120. • Couples who have intercourse infrequently should not solely rely on
the withdrawal method because it requires a lot of practice.
• Service providers should counsel couples who want to rely on the
withdrawal method to use another method while the man is learning
to withdraw on time.
WHO SHOULD NOT USE
• Lack of ejaculatory control (or premature ejaculation) is a
contraindication to the use of the withdrawal method of birth
control.

121. FP Methods

123. Watch the Vedios
• https://youtu.be/7KBvwbEFQ8A

124. END