FAMILY PLANNING

PRESENTER:ALINITWE MATIA.
SUPERVISOR:Dr.PETRUS
FAMILY PLANNING SERVICES
• Def: are educational, comprehensive medical or social activities
which enable individuals, including minors, to determine freely the
number and spacing of their children and select the means by which
this may be achieved.
Family planning
• Def: is the practice of controlling number of children in the family
and the intervals between their births, particularly by artificial
contraception or voluntary sterilization.
Contraception
• The term contraception includes all measures temporary or permanent, designed to prevent
pregnancy due to the coital act.
• Ideal contraceptive methods should be:
• highly (100%) effective,
• acceptive,
• safe,
• reversible,
• cheap,
• having non-contraceptive benefits,
• simple to use and
• requiring minimal motivation, maintenance and supervision.
Benefits of family planning
1.Preventing pregnancy related health risks in women
• Allow spacing & delay pregnancy in young women at risk of health problems
and death from early child bearing
• Prevent unintended pregnancies
• Help limit family size ( women with >4parity have increased risk of maternal
mortality.
• Reduce the need for the unsafe abortions.
Benefits of family planning
cont….
2. Reducing infant mortality and morbidity
• FP prevents closely spaced & ill timed pregnancies and birth –
contributing to highest infant mortality rates.
• Infants with mothers who died at birth also have increased risk of
death & poor health.
3. Help prevent HIV/AIDS
• FP reduce risk of unintended pregnancies in HIV positive women
→fewer infected babies and orphans.
• Men and women condoms prevent unwanted pregnancies and STIs.
Benefits of family planning
cont….
4. Empowering people and enhancing education
• FP help people to make choices about their sexual and reproductive
health
• Helps women attain additional health education and participate in
public life and employment
• Having smaller families allow parents to invest more in each child
Benefits of family planning
cont….
5. Reducing adolescent pregnancies
• Adolescent age pregnancies are likely to end with preterm or LBW
babies → higher mortality and morbidity rates
• Many adolescent girls who become pregnant leave school →
implications on them, families and the community.
6. Slow population growth
• FP is a key to slowing unsustainable population growth resulting into
negative impacts on economy, environment, and national or regional
development efforts.
Components of family planning
services
 Client education about FP methods;

 Counselling for informed choice and continuity;

 Initiating FP methods (screening, providing method and giving

instructions on how to use);
 Routine follow up;

 Management of contraceptives related side effects and complications

Classification of family planning
methods
TERMINAL OR PERMANENT METHODS TEMPORARY SPACING METHODS

Male-vasectomy  Barrier methods

Female -Tubal occlusion  Natural contraception
• Used by couples who have  intrauterine contraceptive devices-
finished their family. IUCDs
• There is a permanent stopping  Steroidal contraception
of conception. • Used for spacing or giving a gap
between children
• Used to postpone children’s arrival
while the couple gets adjusted
1.METHODS OF FAMILY
PLANNING
STEROIDAL(HORMONAL) CONTRACEPTIVES
 HORMONAL CONTRACEPTIVE PILLS: Combined oral contraceptives, Progestin only pills
 Injectables: progestin-only injectables , Combined injectable contraceptives.
 Implants
 Steroidal Contraceptives devices: LNG-IUD, Vagina ring( LNG-ring, Combined ring), Combined
trans-dermal patch).
INTRA-UTERINE DEVICES: Copper-IUD, LNG-IUD
BARRIER METHODS: Condoms, diaphragm, spermicides, cervical cap
NATURAL CONTRACEPTION: Fertility Awareness Methods, Withdrawal, Lactational Amenorrhea
Method
COMBINED ORAL
CONTRACEPTION
(COCs)
Pills that contain estrogen and progesterone

The commonly used estrogen are: Ethinyl-estradiol, Menstranol.

The commonly used progestins are: Levonorgestrel, Norethisterone,

Desogestrel.
Mechanism of action of
combined oral contraception
(COCs)
 Preventing ovulation by suppressing FSH and LH: By both estrogen
and progestin components
Thickens cervical mucus: By progestin component

Renders the endometrium unfavorable for implantation( by causing

atrophy): By progestin component
Effectiveness of COCs
Failure rate for perfect use: 0.3 %
Failure rate for typical use: 9 %
Adverse effects of Combined
oral contraceptive pills( COCs)
Nausea, vomiting, headache ( Attributable to estrogen) and leg cramps (attributable to
progestin).These are transient and often subside following continuous use for 2–3 cycles
Mastalgia ( Estrogen and progestin) .Heaviness or even tenderness in the breast is often
transient
 Weight gain ( By progestins) — Though progestins have got an anabolic effect due to its
chemical relation to testosterone, use of low dose COCs does not cause any increase in
weight.
Chloasma and acne: Results from estrogen and progestin respectively. They are
annoying for cosmetic reasons. Low dose ora contraceptives improves acne as
levonorgestrel preparations are less androgenic.
Menstrual abnormalities—(a) Breakthrough bleeding (BTB) is commonly due to
subthreshold blood level of hormones.
Metabolic Changes associated
with COCs
Estrogen lowers LDL cholesterol concentrations and raise serum levels of
triglycerides and of total cholesterol, HDL, and very-low density
lipoprotein (VLDL) cholesterol.
 Estrogens increase hepatic production of fibrinogen and many of the
clotting factor.
Estrogen also augment Angiotensinogen production and its conversion
by renin to angiotensin I may be associated with “pill-induced
hypertension,”
 COCs elevate sex hormone-binding globulin (SHBG) levels, which in turn
lower concentrations of bioavailable testosterone and thus, lessen
androgenic side effects.
Cardiovascular Effects
associated COCs.
 Hypertension: Rarely induce hypertension , because low dose of COCs is used. COCS are
contraindicated in severe form of hypertension
 Deep-vein thrombosis and pulmonary embolism: This is due to production of fibrinogen and other
clotting factors induced by estrogen.
 Ischemic Stroke , Myocardial infarction

Other effects associated with COCs:

 Cholelithiasis
 Cholecystitis
 Benign liver adenomas (rare)
 Cervical adenocarcinoma (rare)
 Retinal thrombosis (rare)
Non-contraceptive Health
Benefits of COCs
Protect against: endometrial cancer, Cancer of the ovary,
Symptomatic pelvic inflammatory disease, Ovarian cysts, Iron-
deficiency anemia
Reduce: Menstrual cramps, ovulation pain
Treatment of : Dysmenorrhea, menstrual abnormalities, symptoms of
endometriosis , Hirsutism , symptoms of PCOS.
Contraindications of COCs
Fully or nearly fully breastfeeding less than 6 months.
Partially breastfeeding less than 6 weeks.
With 3 weeks post partum for a mother who is not breastfeeding
35 years of age or older and smokes.
serious liver disease
History jaundice while using COCs
If blood pressure is 160/100 mm Hg or higher on First occasion
Persistant blood pressure is 140–159/90–99 mm Hg
Contraindications of COCs
Diabetes for more than 20 years or diabetes retinopathy, nephropathy or
neuropathy
Gallbladder disease
History of stroke, DVT, heart attack
Current or History of breast cancer
Migraine headaches with aura at any age
Migraine headaches without aura and is age 35 or older.
Taking barbiturates, carbamazepine, lamotrigine, oxcarbazepine, phenytoin,
primidone, topiramate, rifampicin, or rifabutin.
Multiple risk factors for arterial cardiovascular disease (such as older age,
smoking, diabetes, and hypertension)
Different formulations of COCs.
Monophasic pills: have a constant dose of both estrogen and
progestin in each of the hormonally active pills throughout the entire
cycle
Biphasic pills: Contain 2 different progesterone doses but same
estrogen dose throughout the cycle.
Triphasic: In these preparations, the hormonal doses of both
estrogen and progestin vary over the course of the cycle.
Prescription of combined oral
contraception
A simple regime of “3 weeks on and 1 week off” :Packet of 21 tablets.
One tablet is to be taken daily at bed time for consecutive 21 days, then have a 7
days break.Next pack should be started on the eighth day.
Packing of 28 tablets
One tablet is to be taken daily. No break between packs. The first 21 pills are
active and contains estrogen and progestin. The last 7 pills are placebo and
contain only either iron or vitamin preparations.
This is the preferred regimen since the last 7 pills contains Iron / vitamins
protect the women from anemia.
Continuous or extended use of COCs: Taken at the interval of 60–80 days.
Suitable for women who prefer to bleed 2-3 times/year.
 Transdermal combined Patch
(Ortho Evra) and Transvaginal
combined Ring (NuvaRing)
Transdermal Patch (Ortho Evra)
Contains ethinyl estradiol and the progestin called norelgestromin.
The patch may be applied to buttocks, upper outer arm, lower abdomen, or upper
torso.
The patch releases 150 mg per day of the progestin, norelgestromin, and 20 mg per
day of ethinyl estradiol.
A patch is applied weekly for 3 weeks, followed by a patch-free week to allow
withdrawal bleeding.
Side effects:Skin irritation or rash where the patch is applied
Health benefits , health risks, contraindications, Mechanism of action : Are like
those of combined oral contraceptives
However, Transdermal patch is associated with higher risk of DVT/PE compared to
COCs.
 Transvaginal combined Ring
(NuvaRing)
Contains ethinyl estradiol and etonogestrel, which are absorbed
across the vaginal epithelium.
NuvaRing releases a daily dose of 15 mcg of ethinyl estradiol and 120
mcg of etonogestrel.
The ring is placed in the vagina for 3 weeks and is removed for 1
week to allow for a withdrawal bleed.
Side effects: Leucorrhea, Vaginitis.
Health benefits , health risks, contraindications, Mechanism of
action : Are like those of combined oral contraceptives
Ortho Evra and Nuva ring
respectively
PROGESTIN ONLY
PILLS( POP).
They only contain progestin

It contains very low dose of a progestin in any one of the following
form: Levonorgestrel 75 μg, norethisterone 350 μg, desogestrel 75
μg, lynestrenol 500 μg,norgestrel 30 μg
The progestin dose is substantially lower than the dose in any
combination oral contraceptive.
Mechanism of action of POP.

Works mainly by making cervical mucus thick and viscous, thereby

prevents sperm penetration.
Prevent implantation by causing atrophic endometrium.

Rarely prevent ovulation ( in 2 percent of cases).

Side effects of POP
Unscheduled bleeding and menstrual changes.
Follicular cysts
Weight gain: Although available data are limited, POPs do not appear
to be associated with significant weight gain. It contain low dose of
progestin and hence, does not signicantly increase LDL.
Amenorrhea in about 20–30 percent
Acne
Mastalgia
Nausea, headache
Benefits of POP
Side effects attributed to estrogen in the combined pill are totally
eliminated
No adverse effect on lactation
It may be prescribed in patient having (medical disorders)
hypertension, fibroid, diabetes, epilepsy, smoking and history of
thromboembolism
Reduces the risk of endometrial cancer.
Contraindications of POPs
Severe liver cirrhosis or severe liver tumor, such as liver cancer.
Current DVT/PE and not on anticoagulants
Taking barbiturates, carbamazepine, oxcarbazepine, phenytoin,
primidone, topiramate, rifampicin, or rifabutin. Those drugs can make
POPs less effective
Current or history of breast cancer.
Thrombogenic mutations or lupus with positive (or unknown)
antiphospholipid antibodies.
Prescription of POP

The first pill has to be taken on the first day of the cycle and then
continuously.
It has to be taken regularly and at the same time of the day.

There must be no break between the packs.

If a progestin-only pill is taken even 3 hours late, a supplemental form

of contraception must be used for the next 48 hours.
 Emergency
Contraceptive
Pills( Morning after
Pills)
Emergency contraceptive pills (ECPs) help a woman avoid pregnancy
after she has sex without contraception.
ECPs help to prevent pregnancy when taken up to 5 days after
unprotected sex. The sooner they are taken, the better.
Do not disrupt an existing pregnancy.
Safe for all women—even women who cannot use ongoing hormonal
contraceptive methods.
Can be used more than once in a woman’s cycle.
Mechanism of action

Work by preventing or delaying

the release of eggs from the
ovaries (ovulation).
Available ECPs
Ulipristal acetate
Progestin only ECPs ( Levonorgestrel )
Combined estrogen progestin ECPs
Eectiveness of Emergency
Contraceptive Pills (ECPs)
Pill Formulations and Dosing for
Emergency Contraception
Progestin-only
injectables
The commonly used Progestin-only injectables are DMPA and NET-EN:

Depot medroxyprogesterone acetate(DMPA): Depo Provera

Dose: IM 150 mg every 3 months.
Alternatively, a subcutaneous version of DMPA called depo-subQ
provera is also available: Dose is 104mg every 3 months

Norethisterone enanthate(NET-EN): Dose: 200 mg every 2 months

Mechanism of action of
Progestin-only injectables.
(1) Inhibition of ovulation by suppressing the mid cycle LH peak

(2) Works mainly by making cervical mucus thick and viscous, thereby
prevents sperm penetration.

(3) Prevent implantation by causing atrophic endometrium.

Side effects of progestin only
injectables
 Irregular menstrual bleeding : ¼ of women stop using DMPA the first year because of this.

 Amenorrhea: in up to 50 percent after 1 year and in 80 percent after 5 years.

 Weight gain: about 1–2 kg per year

 Unique to DMPA, prolonged anovulation can follow discontinuation. 1/4 of patients do

not resume regular menses for up to 1 year
 Loss of bone mineral density ( In long term DMPA users)

 Higher risk of stroke in patients with severe hypertension

 Headaches, Dizziness
Contraindication of Progestin-
Only Injectables
Breastfeeding less than 6 weeks.
Severe cirrhosis of the liver or severe liver tumor such as liver cancer.
BP equal or more than 160/100mmHg
Diabetes for more than 20 years or damage to arteries, vision,
kidneys, or nervous system caused by diabetes.
History of stroke, DVT/PE and heart attack.
unexplained vaginal bleeding
Current or history of breast cancer.
several conditions that could increase the chances of heart disease
Monthly Injectables(Combined
injectable contraceptives)
Monthly injectables contain 2 hormones—a progestin and an estrogen.
The commonly used are:
Medroxyprogesterone acetate (MPA)/estradiol cypionate: 25 mg
Norethisterone enanthate (NET-EN)/ estradiol valerate: 25 mg
Mechanism of action: The same as COCs
Contraindications of monthly injectables

35 years of age or older and smokes more than 15 cigarettes a day.
Taking lamotrigine: Monthly injectables can make lamotrigine less
effective.

Other contraindications are the same as of COCs

Implants
Implants are small flexible rods that are placed just under the skin of the
upper arm.
Contains only progestins.
Contraindications are similar to POPs
Types of implants:
Jadelle: 2 rods containing levonorgestrel, highly effective for 5 years.
Implanon NXT (Nexplanon): 1 rod containing etonogestrel, labeled for up to
3 years of use. It can be seen on X-ray and has an improved insertion device.
Levoplant (Sino-Implant (II)): 2 rods containing levonorgestrel. Labeled for
up to 4 years of use.
Mechanism of action of implants

(1) Inhibition of ovulation by suppressing the mid cycle LH peak

(2) making cervical mucus thick and viscous, thereby prevents sperm
penetration.

(3) Prevent implantation by causing atrophic endometrium.

Nexplanon
A single-rod implant with 68 mg of etonogestrel.
It is radiopaque
Used for 3 years
This device replaced Implanon, which is not radiopaque.
Jadelle
Originally named Norplant-2.
Has 2 rods
Contains levonorgestrel (LNG)
Each rod contains 75mg of LNG
Contraception for 5 years
It releases 50 mcg of levonorgestrel per day.
Sino-implant II

Two-rod system with the same amount (150 mg) of LNG and same
mechanism of action as Jadelle.

But provides 4 years of contraception.

Progesterone-Releasing Vaginal
Ring
Continuously releases natural progesterone hormone
Does not contain Estrogen.
Suitable for postpartum women who are actively breastfeeding, at
least 4 times per day.
Put in place for every 3 months up to 1 year post partum
INTRAUTERINE
DEVICES( IUDs)
2 widely available IUDs are:

 Copper-Bearing Intrauterine Device (E.g: TCu-380A or ParaGard).

Has been approved for use for 10 years

Levonorgestrel intrauterine system (LNG-20 or Mirena).

Copper-Bearing Intrauterine Device(Cu
T 380A)

Has been approved for use for 10 years

ParaGard is also approved for emergency contraception when placed
within 72 hours of unprotected intercourse or contraceptive failure.
Mechanism of action

Induce intense local endometrial inflammatory response that is toxic

to sperm.
The same inflammatory response prevent implantation (Toxic to
blastocyst).
Copper levels rise in the cervical mucus and act to decrease sperm
motility and viability.
Adverse Effects of IUD
Ectopic Pregnancy: IUDs provide effective contraception and lower
the absolute number of ectopic pregnancies. However, if an IUD fails,
a higher proportion of pregnancies are likely to be ectopic.
Lost Device: Common during the first month
Perforation
Dysmenorrhea and bleeding irregularities: Common in first 6 months
Contraindication of Copper
bearing IUD
Puerperium more than 48 hours ago but less than 4 weeks ago.
Infection following childbirth or abortion
Unexplained vaginal bleeding
Known current cervical, endometrial, or ovarian cancer; gestational trophoblast
disease; pelvic tuberculosis.
HIV infection with severe or advanced clinical disease
Women who have a very high individual likelihood of STI infection should not
have an IUD inserted unless gonorrhea and chlamydia are ruled out by lab tests
Known or suspected pregnancy
Copper allergy or Wilson disease
Levonorgesterol Intrauterine
Device

Device that contains levonorgesterol

Effective for 5 years

Mechanism of action
It induces strong and uniform suppression of endometrium.
Cervical mucus becomes very scantly.
Contraindication of
Levonorgestrel IUD
Recently diagnosed DVT/PE and she is not on anticoagulant therapy
severe cirrhosis or severe liver tumor such as liver cancer
Recent or history of breast cancer
Other contraindication are the same for Copper bearing IUD.
 Surgical
sterilization
Female Sterilization( Bilateral
tubal ligation)
Intended to provide life-long, permanent, and very effective
protection against pregnancy. Reversal is usually not possible.

Method of Action : Tubal sterilization prevents pregnancy by

surgically occluding both fallopian tubes to prevent the ovum and
sperm from uniting.

Before performing any sterilization procedure, careful counseling

should be provided and informed consent obtained.
Pomeroy and Parkland
techniques for BTL respectively
When to Perform BTL
Immediately or within 7 days post partum ( Post partum BTL)

 At 6 weeks or more post partum if it is reasonably certain she is not

pregnant( Interval BTL). For those with monthly menstrual cycles , it
should be given within 7 days after the start of her monthly bleeding

Within 48 hours after uncomplicated abortion

MALE SURGICAL STERILIZATION:
VASECTOMY
It is a permanent sterilization operation done in the male involving
ligation of the vas deferens.
It is safe and simple surgical procedure.
Vasectomy is safer than tubal sterilization because it is less invasive
and is performed with local analgesia.
Unlike female tubal ligations, vasectomy is not immediately effective.
Because sperm can remain viable in the proximal collecting system
after vasectomy. It takes approximately 3 months or 20 ejaculations.
So,patients should use another form of contraception until
azoospermia is confirmed by semen analysis, usually in 6 to 8 weeks.
PROCEDURE FOR VASECTOMY
BARRIER
METHODS
These methods prevent sperm deposition in the vagina or prevent
sperm penetration through the cervical canal.
The objective is achieved by mechanical devices or by chemical
means which produce sperm immobilization, or by combined means.
Mechanical: Male condom , female condom, diaphragm, cervical cap.
Chemical: Spermicides
Male Condom
Condoms are made of polyurethane or latex.
Polyurethane condoms are thinner and nonallergenic. So, they are suitable to
those who are allergic to latex rubber. They have a higher
breakage and slippage rate compared with latex condoms.
Most male condom are made of latex rubber.
Lubricants for Latex Condoms:
 Lubrication helps encourage condom use and avoid condom breakage
 Lubricants that can be used includes: Those made of silicone, Those made with
water or glycol.
!!!!!Do not use products made with oil as lubricants for latex condoms (any oils,
petroleum jelly, lotions, etc,,) .
Female condom
Female condoms are made of various materials, such as latex,
polyurethane, and nitrile.
Can be inserted up to 8 hours before sex.
DIAPHRAGM
A soft latex cup that covers the cervix. Plastic and silicone diaphragms
may also be available.
Used with spermicidal cream, jelly, or foam to improve effectiveness.
Works by blocking sperm from entering the cervix; spermicide kills or
disables sperm.
The device is introduced up to 3 hours before intercourse and is to
be kept for at least 6 hours after the last coital act.
CERVICAL CAP
is a small, soft, silicone cap that fits directly over the cervix.
Used together with spermicide to improve effectiveness.
One of the least effective methods, as commonly used.
Insert the cervical cap any time up to 42 hours before having sex.
Can be left in place at least 6 hours after her partner’s last
ejaculation, but not more than 48 hours from the time it was put in.
Spermicides
Sperm-killing substances inserted deep in the vagina, near the cervix
before sex.
Usually, they contain surfactants like nonoxynol–9, octoxynol or
benzalkonium chloride.
nonoxynol–9 is the commonly used substance.
Work by causing the membrane of sperm cells to break, killing them
or slowing their movement.
Can be used alone, with diaphragm , condoms or with cervical cap.
Should be inserted any time less than one hour before sex.
 NATURAL FAMILY
PLANNING METHODS
It includes:

Fertility Awareness Methods

Coitus Interruptus.
Lactational amenorrhea
Fertility Awareness Methods

Also called Periodic abstinence.

“Fertility awareness” means that a woman knows how to tell when the
fertile time of her menstrual cycle starts and ends.
This method requires instruction on the physiology of menstruation and
conception and on methods of determining ovulation.
It includes
Calendar-based methods : Standard Days Method and calendar rhythm
method.
Symptoms-based methods: TwoDay Method, Basal Body Temperature
(BBT) Method, Ovulation Method, Symptothermal Method
Standard Days Method
A woman can use the Standard Days Method if most of her menstrual
cycles are 26 to 32 days long.
Less effective if more than 2 cycles/year are below 26 or above 32
days.
For this method, Days 8 through 19 of every cycle are considered
fertile days. So, unprotected sexual intercourse is avoided within this
period.
Calendar Rhythm Method
Before relying on this method, a woman records the number of days in
each menstrual cycle for at least 6 months.
To estimate the fertile time: The woman subtracts 18 from the length
of her shortest recorded cycle. This tells her the estimated first day of
her fertile time. Then she subtracts 11 days from the length of her
longest recorded cycle. This tells her the estimated last day of her fertile
time. She updates these calculations each month, always using the 6
most recent cycles.
• Examples: If the shortest of her last 6 cycles was 27 days and the
longest was 31 days. She starts avoiding unprotected sex on day 9(27-
18) up to day 20(31-11).
TwoDay Method
The woman checks for cervical secretions every afternoon and/or
evening, on fingers, underwear, or tissue paper or by sensation in or
around the vagina.
As soon as she notices any secretions of any type, color, or consistency,
she considers herself fertile that day and the following day.
So, the couple avoid unprotected intercourse on days when the
secretions are present and for an additional day following a day with
secretions.
If a woman has a vaginal infection or another condition that changes
cervical mucus, this method may be difficult to use.
Ovulation Method( Billing
method)
The woman checks every day for any cervical secretions on fingers,
underwear, or tissue paper or by sensation in or around the vagina.
For this method ,avoid unprotected sexual intercourse in the
following conditions:
During menses : Possibility of ovulation during menses.So, the blood
obscure the secrections!
2 days before ovulation: Because of possibility of confusing semen
with secretions
All days with secretions until 4 days past the last day of secretions
Basal Body Temperature (BBT)
Method
The woman takes her body temperature at the same time each
morning before she gets out of bed and record it on special graph.
Usually the temperature rises (0.4°F) and sustained throughout luteal
phase.
Therefore , unprotected intercourse is avoided from the first day of
menses until 3 days after the woman’s temperature.
The couple can have unprotected sex on the 4th day after the rise of
temperature until her next monthly bleeding begins.
Symptothermal Method (basal body temperature
+
cervical secretions + other fertility signs)
Users identify fertile and nonfertile days by combining BBT and
ovulation method instructions.
The couple avoids unprotected sex between the first day of monthly
bleeding and either the fourth day after peak cervical secretions or
the third full day after the rise in temperature (BBT), whichever
happens later.
coitus interruptus(Withdrawal)

Withdrawal of penis shortly before ejaculation.

It requires sufficient self-control by the man so that withdrawal of penis

precedes ejaculation and deposit the semen outside the genital organs.
The failure rate for coitus interruptus is quite high (27%).

Failure can be attributed to the deposition of semen (pre-ejaculate) into

the vagina before orgasm, or the deposition of semen near the introitus.
Lactational Amenorrhea Method
After delivery, the restoration of ovulation is delayed because
breastfeeding increases prolactin that inhibit pulsatile gonadotrophin-
releasing hormone (GnRH) from the hypothalamus resulting in
suppression of ovulation.
The lactational amenorrhea method (LAM) requires 3 conditions:
1. The mother’s monthly bleeding has not returned.
2. The baby is fully or nearly fully breastfed and is fed often, day and
night.
3. The baby is less than 6 months old.
Failure Rates for
Contraceptive
Failure Rates for Various Contraceptive
Methods During the First Year of Use.
Medical eligibility
criteria (MEC)
Medical eligibility criteria (MEC)
categories for contraceptive use
Interpretation and application
of MEC categories in practice
REFERRENCES
1. FAMILY PLANNING , A GLOBAL HANDBOOK FOR PROVIDERS,
WHO,2018 EDITION.
2. (Blueprints Series) - Blueprints Obstetrics and Gynecology, 6E 2013
[PDF][Dr.Carson] VRG(1)
3. DC Dutta'ss T Gynecology Textbook - Including Contraception, 6E
(2014) [PDF] [UnitedVRG]
4. William Obstetrics, 25th edition
THANK YOU