Facts about Pakistan• One birth every 7 seconds• 3 mothers die in 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• Unemployment, law and order problems and social

unrest increasing.

Population Profile

• 3.2 million 1947

• 128 million 1995

• 235 million By year 2015

• Population below poverty line 33.1%

Surgical Contraception

Female Sterilization• Laparoscopic• Minilap• Vaginal tubectomy

Male sterilization• vasectomy

Non surgical Tubal Occlusion

• Quinacrine pellets

• Tetracycline methyl cyanoacrylate

• Oviduct plugs

Barrier methods of C.C

Male condom• Advantages

• Simple

• Responsibility on male

• Protects against the transfer of venereal diseases

Male condom

Disadvantages

• Expensive

• Less satisfying sex

• Allergic reactions

Failure rate - 6-18 per HWY

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

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 Devices

• Multiload Cu 250 and 375. These come preloaded and doesn't require to be loaded in the inserter.

Contraceptive prevalence rate (CPR)

Iran 23%

Bangladesh 40%

Indonesia 48%

Malaysia 51%

Turkey 72%

Pakistan 12%

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.

Methods of Contraception • Physiological methods

– Rhythm method– Incomplete method

• Chemical methods

• Barrier methods

• Intrauterine contraceptive devices

• Hormones

• Sterilization

• Early abortion

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: Absolutely infertile phase

(approx 17th to 28th day)

Rhythm Method

• Advantage

• No expensive involved

• No side effects

• Disadvantage

• Planning of coitus

• Dependence on regularity of the cycle

• Suitable for educated,intelligent & cooperative women

Advantage Safe,easy,cheap

Orgasm doest not interfer with the orgasm of either partner.

Disadvantage

Less effective in case of prolaspe and retroversion

Failure Rate 2 – 15 /100 women years.

Intrauterine C.C device• Copper 250 and 375• Multiload

• Hormone releasing IUCDs

Progestasert

Levonorgesrel (Mirena)

levonova

Preloaded doesn't require to be loaded in the inserter.

Method

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.

Mode of action

• Immobilize the sperm and prevent it from fertlizing the ovum.

• Inflammatory reaction in the Endometrium prevents embedding of fertilzed ovum.

• Hormonal Effects.

Contradictions

Complications

Hormonal Contracption

• COC pills

• Progesterone only pill

• Long acting pill

• Intectables

• Vaginal rings

• implants

Contraindications oral contraception

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

Contraindications oral contraception

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

SEQUENTIAL PILL

• Two types of pill

• First 14 containj only oestrogen

• And last seven a combination of oestrogen and progestrogen

PROGESTRONE ONLY PILL

• Mini pell

• 28 or 35 packet

- femules - 500ug 28

- Moridey - 250ug 28

- Microval- 30ug 35

ADVANTAGES - POP

• Do not treduce breast milk

• Suitable for women with contraindication of oestrogens

• 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 ever 08 wks

• CYCLOPROVERA• Once a month

ADVANTAGES INJECTABLES

• Highly effective

• Easy to deliver

• Use independent of sexual intercourse

• Do not reduce breast milk

• May reduce anaemia

• Less dysmenorrhoea & PMT

DISADVANTAGES INJECTABLES

• Requires regulkar visits to the clinica for injections

• Not retrievable• Return to fertility is delayed for months• Menstrual irregularities• Galactorrhoea• Mild androgenic affects• Enuresis

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– Implnon - 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 oestrogens- 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