Facts about Pakistan• One birth every 7 seconds• 3 mothers die during childbirth every hour• 12 million children under 5 years are

malnourished• 50% of population are lacking safe drinking

water.• 60% lack safe sanitary facilities• One doctor per 2008 persons• One nurse per 6500 persons• One hospital bed per 1506 persons

Population Profile(2002)

• 3.2 million 1947

• 140 million 2002

• 160 million 2005

• 235 million By year 2015

• Population below poverty line 33.1%

• Growth rate 2.1%

• fertility rate 4 %

Contraceptive prevalence rate (CPR)

Iran 23%

Bangladesh 40%

Indonesia 48%

Malaysia 51%

Turkey 72%

Pakistan 21%

resulting in

Unemployment, law and order problems,and social unrest.

CONTRACEPTION

Contraception Saves Lives

Contraception means prevention of conception by any method with out abstinence from sexual intercourse.

MOTIVATION

Counselling

Is the process of helping clients to make informed and voluntary decisions about choice of contraception.

Counseling

FM counseling has 06 elements

GATHER

Greet Help

Ask Explain

Tell Return

Methods of Contraception• Physiological methods

– Rhythm method– Incomplete methods

• Chemical methods

• Barrier methods

• Intrauterine contraceptive devices

• Hormones

• Sterilization

Natural Family Planning

Abstaining from sexual intercourse during fertile phase of menstrual cycle.

Fertility Cycle

Phase I: Relatively infertile phase

(approx first 7 days)

Phase II: Fertile phase

(approx 8 to 16th day)

Phase III infertile phase

(approx 17th to 28th day)

Rhythm MethodAdvantage:-

• No expense involved.• No side effects.

Disadvantage:-• Planning of coitus.• Dependence on regularity of the cycle.• Suitable for educated,intelligent &

cooperative women.

Failure rate:- 3- 24 / HWY

Barrier methods of C.C

Male condom Advantages

– Simple– Responsibility on male– Protects against the transfer of venereal

diseases

Failure rate 6-18/100 women years

Male condomDisadvantages• Expensive• Less satisfying sex• Allergic reactionsFailure rate - 6-18 per HWY

Advantages• Safe,cheap,easy• Does not influence with the

orgasm of either partner.

DisadvantageLess effective in case of prolapse and retroversion

Failure Rate:- 6-12/HWY

Female condom

Diaphram

Functions1. Retainer of the spermicide2. To keep sperms away from alkaline

receptive cervical mucus3. Prevent the cervical mucus reaching the

vagina4. Prevents the aspiration of the sperms into

the cx & the uterus

Diaphram

Diaphram

Advantages– Safe,cheap,easy– Orgasm Does not influence the

orgasm of either partner.

DisadvantageLess effective in case of prolapse and retroversion

Failure Rate

2-15/100 women years

Intrauterine C.C Device

GROUPING OF DEVICESBY FAILURE (PREGNANCY) RATE

Device pregnancy rate per 100 women year of use

Group 1 Lippes loop, copper 7, Copper T 200

Significantly greater than 2.0

Group 2 Nova T, Multiload ML Cu 250, Copper T

220 C

Less than 2.0 but not less than 1.0

Group 3 Copper T 380 , Multiload ML Cu375,

Levonova

Significantly less than 1, most less than 0.5

Intrauterine C.C device

• Multiload• Hormone releasing IUCDs Progestasert Levonorgesrel (intrauterine system)

levonova Preloaded doesn't require to be loaded in

the inserter.

Mode of action

• Immobilize the sperms and prevent it from fertilizing the ovum.

• By producing inflammatory reaction in the endometrium prevents embedding of the fertilized ovum.

• Hormonal Effects.

Contraindications

• Bicornuate uterus

• Nullipara

• Women with irregular,heavy periods

s& fibroids.

• Present & past PID

• Suspected pregnancy

Multiload

Pass uterine sound to measure the length of uterine cavity

Introduce the multiload with the inserter until it touches the fundus

Then withdraw the inserter.

Conformation of proper insertion

• Easy insertion

• Excellent retention by the uterus

• Minimal uterine irritability

• Easy removal

• USG

Complications • Insertion is painful• Uterine bleeding• Infection• Uterine perforation• Expulsion• Complications relating to pregnancy:

congenital malformation, abortion, ectopic pregnancy & prematurity

EXPULSION

Rate is high in

• Nulliparous women

Pts with endometrial cavity < 40 mm

• Uterus with acute uterine flexion

• Smaller devices

PREVENTION

• Proper IUCD size

• Checking of thread

• Screening USG

HORMONAL CONTRACEPTION

Hormonal Contraception

• COC pills

• Progesterone only pill

• Injectables

• Long acting pill

• Vaginal rings

• Implants

• Dermal patches

Contraindications Oral Contraception

Absolute – Cholestatic jaundice of pregnancy– Porphyria– Pruritis of pregnancy– Herpes gestationalis – Cancer of breast.

Contraindications oral contraceptionRelative

– Thromboembolism– Blood dyscrasias– Diabetes– Obesity– Chorea– Migraine– Varicose veins– Asthma– Depressive psychosis– Elective surgery

SEQUENTIAL PILL

• Two types of pill

• First 14 containing only oestrogen

• And last seven a combination of oestrogen and progesterone

PROGESTRONE ONLY PILL

Mini pill

28 or 35 tablet packet

- femules - 500ug 28

- Noriday - 250ug 28

- Microval- 30ug 35

ADVANTAGES - POP

• Do not reduce breast milk

• Suitable for women with contraindication of estrogens

• Minimal side effects

• No risk of circulatory or malignant disease

LONG ACTING PILLS

• Once a month

• Quinestrel + Levonorgestrel

INJECTABLES

• DEPOPROVERA (DMPA)• 150mg every 12 wks

• NORIGEST (NET-EN)• 200 mg every 08 wks

• CYCLOPROVERA• Once a month

ADVANTAGES of INJECTABLES

• Highly effective

• Easy to deliver

• Use independent of sexual intercourse

• Do not reduce breast milk

• May reduce anaemia

• Less dysmenorrhoea & PMT

DISADVANTAGES of

INJECTABLES

• Requires regular visits to the clinical for injections

• Irregular uterine bleeding • Progesterone side effects eg

acne,malaise,fatigue,depression etc

VAGINAL RINGS

• Shell type

• Core type

• Contain Oestrogen + Progesterone or only Progesterone

• Rings changed every 03 months

CONTRACEPTIVE IMPLANTS

• NON – Biodegradable– Norplant – 1 - 5 yrs– Norplant – 2- 3 yrs– Implanon - 3yrs

• Biodegradable• Capronor - one year

POST COITAL CONTRACEPTION

• Immediate insertion of copper- T

• The YUZPE method– 2 tabs of COC at once and 02 tabs after 12

hours

• Ethinyl Oestradiol- 2.5 mg BD * 05 days

• Conjugated equine estrogens- 10 mg TDS * 05 days

MECHANISM OF ACTION POST COITAL CONTRACEPTION

• Block implantation

• Uterine fluid / genital tract mucus rendered hostile to sperm or blastocyst

RISK OF PREGNANCY POST COITAL CONTRACEPTION

• 20 %

• 30 % on the day of maximum risk

Surgical Contraception

Female Sterilization• Laparoscopic• Minilap• Vaginal tubectomy

Male sterilizationVasectomy

Non surgical Tubal Occlusion

• Quinacrine pellets

• Tetracycline methyl cyanoacrylate

• Oviduct plugs

Thank You