Family Planning Method

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					FAMILY PLANNING
            FAMILY PLANNING
Family Planning is often use as a
 synonym for birth control. It is most
  y    y
 usually applied by a couple who
 wish to limit their number of
 c de ,       co t o t e t     go
 children, to control the timing of
 pregnancy (also known as spacing
 children) or both.
 The             f F il l
 Th essence of Family planning,  i
 therefore, is to make intercourse
 purely a means of expressing love,
 building stability in the relationship
 and sharing physical pleasure and
 not a means of reproducing.
Is Family Planning important to family
          happiness? Why?

             Family Planning – allows you to manage
               the many difficulties and frustrations
                          children
               of raising children. With family
               planning, you can help to limit
               frustrations of stress, moving,
               changing jobs, etc. to help promote
               health and well being of your child.
Do you have a method
      in mind?
             do, l t’ t lk b t h         it
      If you d let’s talk about how it suits you
      • What do you like about it?
        What h        h   d b t
      • Wh t have you heard about it?

      If not, we can find a method that is
       i ht f
      right for you
                  Comparing methods
     Most effective           Very effective but must      Effective but must be carefully
               remember
and nothing to remember.        be carefully used
                                              used.                     used
                                                                        used.

    Fewer side-effects,          Fewer side-effects:              Fewer side-effects:
       permanent:
                                           LAM


                                                            Male and                Fertility
                                                                       Vaginal
                                                             female                awareness-
                                                                       methods
                                                            condom
                                                                d                based methods
  Female        Vasectomy
sterilization

    More side-effects:            More side-effects:             IMPORTANT!
                                                                 Only condoms
                                                                 protect
        IUD                                                      against
                                                                 both
                                 Pills       Injectables         pregnancy
                   Implants
                                                                 and STIs/HIV/AIDS
   Ways to Avoid Pregnancy                                     You can
                                                               decide


Options using family planning:

        Condoms                Condoms              Any family
                                  AND            planning method
                             Another family
                                                   WITH
                            planning method
                                 For example:   Uninfected
     Male      Female
   condoms
           OR
              condoms               AND           partner


Some other options:

               Other              Delay
             safe forms          or avoid
            of intimacy           having
                                   sex
What method are you using?
 • IUD                      • Vasectomy or
                              Female Sterilization

 • The Pill                 • Condoms
                              (Male or Female)

 • Long-Acting Injectable
                            • Vaginal Methods

 • Implants                 • LAM


                            • Fertility Awareness-Based
                              Methods
  Emergency Contraceptive Pills
• Need to be taken as soon as possible
  after unprotected sex

• Do not cause abortion

• Might cause nausea, vomiting,
  spotting or bleeding

• Do not prevent pregnancy the next time
  you have sex

• Not for regular use
                           Copper IUD
• Small device that fits inside the womb
 Very effective
•V     ff i
• Keeps working up to 10 years
• Can remove
  whenever you want
• Very safe
• Might increase menstrual
         g
  bleeding or cramps


                   Do you want to know more
                  about the IUD, or talk about a
                       different method?
Who can and cannot use the IUD
Most women can safely
 se
use the IUD




But usually cannot use IUD if :




                                     • Unusual
      May be
     •M b              Gave birth
                      •G     bi th     vaginal
     pregnant           recently                  • Infection or
                                      bleeding     problem in
                     (more than 2     recently
                       days ago)                 female organs
               Possible side-effects
 If you choose this method, you may have some side-effects.
 They are not usually signs of illness.


After insertion:                    Other common side-effects:

• Some cramps                        Longer and
                                    •L         d
  for several days                   heavier periods

                                    • Bleeding or spotting
                                             g     p     g
• Some spotting                       between periods
  for a few weeks
                                    • More cramps or
                                      pain during periods

                                    May get less after a few months
          How would you feel
        about these side-effects?
           What will happen when
             you get your IUD
Steps:
     Pelvic    i ti
     P l i examination
     Cleaning the vagina and cervix
     Placing IUD in the womb
     through the cervix
 •      y
     May hurt at insertion
 •   Tell the doctor if it hurts
 •   Rest as long as you like afterwards
 •      y            p
     May have cramps for several
     days after insertion
                                           Afterwards:
                  Are you ready to         you can check
                choose this method?
                 h     thi    th d?        your IUD from
                 What questions do         time to time
                     you have?
         You may be able to get
             your IUD now

• You can start any day of the
  menstrual cycle if we can be
           aren’t
  sure you aren t pregnant




          Would you like to get
            your IUD now?
                 What to remember
• Your kind of IUD:



• When to have IUD taken out:            See a nurse or doctor if:
                                         • Missed a
                                           menstrual
                                           period, or
                                           think you
• Bleeding changes and cramps              may be
                                              y
  are common. Come back if                 pregnant
                                                              • Could have an
  they bother you.                                              STI or HIV/AIDS

• Come back for a c ec up in 3 to 6
  Co e bac o check-up
  weeks or after next menstrual period
                                         • IUD strings
                                                                     • Bad
                                           seem to have
                                                                       pain in
                                           changed
                                                                       lower
                                           length or are
                                                                       abdomen
                                           missing
                              The Pill
• Take a pill every day

• Can be very effective

• Very safe

• Helps reduce menstrual
  bleeding and cramps
         g         p
• Some women have side-effects
  at first—not harmful


                           Do you want to know more
                          about the pill, or talk about a
                               different method?
 Who can and cannot use the pill
Most women can safely
use the pill




But usually cannot use the pill if:




  • Smoke     • High blood   • Gave birth • Breastfeeding   • May be   • Some other
   g
 cigarettes     pressure     in the last 3   6 months       pregnant      serious
    AND                         weeks          or less                     health
 age 35 or                                                               conditions
    older
              Possible side-effects
If you choose this method, you may have some side-effects.
They are not usually signs of illness.
  • But many women do not have any
  • Often go away after a few months
 Most
 M t common:




   • Nausea           Spotting
                    • S               • Mild       • Tender    • Dizziness
(upset stomach)     or bleeding      headaches       breasts
                  between periods                                             • Slight
                                      Do you want to try                     weight gain
                                    using this method and                      or loss
                                     see how you like it?
               How to take the pill

  Take     ill    hd     b     th
• T k one pill each day, by mouth



If you use the 28-pill pack:
• Once you have finished all the pills in
   the pack, start new pack on the
                                        28-pill
   next day                              pack


           the 21 ill     k
If you use th 21-pill pack:
• Once you have finished all the pills in
   the pack, wait 7 days before starting
                                                  21 pill
                                                  21-pill
   new pack                                        pack
                          If you miss pills
                                                                             Forgetting pills
If you miss pills:                                                               can lead to
                                                                                pregnancy!
• ALWAYS take a pill as soon as
  you remember, and continue
  taking pills, one each day

But if you miss 3 or more pills or start a pack 3 or more days late:
 • You must also use condoms or          • AND if you miss 3 or
   avoid sex for the next 7 days           more pills in week 3:
                                          Also skip the reminder
                                          pills (or the pill-free
                                          week) and go straight to the next pack



   If you miss a reminder pill (28-day packs only):
                     • Throw away the missed pill(s) and
  Reminder
  pills                continue taking pills, one each day
  You may be able to start today

• You can start any day of the
  menstrual cycle if we can be
  sure you aren’t p g
       y          pregnant




        Would you like to start now?
                   What to remember
• Take one pill each day

• If you miss pills, you can        See a nurse or doctor if:
  get pregnant                      • Severe, constant pain in            y
                                                                     • Very bad
                                      belly, chest, or legs            headaches

• Side-effects are common but
  rarely harmful. See a doctor if
   h b h
  they bother you.

• Come back for more pills
                  out,
  before you run out
                                    • A bright
  or if you have problems             spot in
                                      your
                                      vision
                                      before bad                 • Yellow skin or
                                      headaches                    eyes
          Long-Acting Injectable
• An injection every 2 or 3 months,
  depending on type
  d     di       t
• Very effective
  Often takes longer t get pregnant
• Oft t k l          to t         t
  after stopping
• Very safe
     y
• Changes monthly bleeding




                 Do you want to know more
                b t thi      th d    t lk b t
               about this method, or talk about
                     a different method?
        Who can and cannot use
         a long-acting injectable
Most women can safely
use this injectable




But usually cannot use this injectable if:




 • Very high blood                                      • Some other
     pressure        • Breastfeeding         • May be   serious health
                         6 weeks             pregnant     conditions
                          or less
             Possible side-effects
If you choose this method, you may have some side-effects.
They are not usually signs of illness.




      • Very common:          • Common:      • Less common:
     Changes to monthly        Weight gain      Some others
           bleeding


                  Do you want to try
                using this method and
                 see how you like it?
  You may be able to start today

• You can start any day of the
             y
  menstrual cycle if we can be
  sure you aren’t pregnant




       Would you like to start now?
            Getting your injection
Your injection:
• Either in your arm or your buttock
• Don’t rub the injection site afterwards

When to come back:
• For DMPA, every 3 months
• For NET-EN, every 2 months
• Come back even if you are late

                    Can you
               mark a calendar?
             What l     ill h l
             Wh t else will help you
                  remember?
               What to remember
• Name of your injectable:



  When t     f      t i j ti
• Wh to come for next injection:

                                       See a nurse or doctor if:
• Bleeding changes and weight
                                       • A bright
  gain are common. Come back if they     spot in
                                                                      • Unusually
  bother you.                            your
                                                                        heavy or
                                         vision
                                         before bad                     long
                                         headaches                      bleeding




                                                      • Yellow skin
                                                        or eyes
                   Norplant Implants
• 6 small plastic tubes placed under skin of
  upper arm
• Very effective
               years
• Last up to 7 years, depending on your
  weight
• Very safe
• Usually change monthly bleeding




               y
            Do you want to know more
          about this method, or talk about
                a different method?
Who can and cannot use implants
Most women can safely
use implants




But usually cannot use implants if:




  • Breastfeeding         • May be    • Some other serious
      6 weeks             pregnant       health conditions
       or less
            Possible side-effects
If you choose this method, you may have some side-effects.
They are not usually signs of illness.

• Very common:
  Light spotting or bleeding

• Common:
  Irregular bleeding, no monthly bleeding

• Less common: Some others


                                                  How would you
                                                  feel about these
                                                    side effects?
                                                    side-effects?
  Implant insertion and removal
• Insertion and removal should be
  quick and easy
• Injection prevents pain
  Provider puts 6 capsules just under
• P    id      t        l j t     d
  the skin of inside upper arm
• Provider bandages opening in skin
  and wraps the arm — no stitches
• Need to be removed
  after 4 to 7 years,                     Are you ready to
  depending on your weight              choose this method?
                                         What questions do
                                             you have?
 You may be able to start today

• You can start any day of the
             y
  menstrual cycle if we can be
  sure you aren’t pregnant




       Would you like to start now?
              What to remember

  Co e back     e t s time
• Come bac when it is t e to
  have the implants removed      See a nurse or doctor if:

  Side effects
• Side-effects are common but    • A bright                    • May be
                                   spot in                       pregnant,
  rarely harmful. Come back if     your                          especially if
                                   vision                        pain or
  they bother you.                 before bad                    soreness in
                                   headaches                     belly

• Come back any time if you
                                                            • Infection or
  have problems or want                                       continued pain in
                                                              the insertion site
  implants removed

                                          • Unusually
                                            heavy or long
                                            bleeding
                                            bl di
                                                            • Yellow skin
                                                              or eyes
               Vasectomy for Men

• Simple surgical procedure

• Permanent. For men who will
  not want more children.
   ot a t o e c d e

• Very effective

  Very safe
• V      f

• No effect on sexual ability


            Do you want to know more
                                              Tubes
                     method
          about this method, or talk about
                a different method?          cut here
 When you can have vasectomy

Most men can have
vasectomy at any time




But may need to wait if:
• Any problems with genitals such
     infection, swelling, injuries,
  as infection s elling inj ries
  lumps in penis or scrotum
• Some other serious conditions or
  infections
                 Before you decide
Let’s discuss:
• Temporary methods are also
  available
• Vasectomy is a surgical procedure
• Has risks and benefits
• Prevents having any more children
• Permanent—decision should be
      f ll      id   d
  carefully considered
• You can decide against              Are you ready to choose
                                            this method?
  procedure any time before surgery
                                      W       k           b
                                      Want to know more about
                                          the procedure?
                    The procedure
1. You will stay awake and get medication
   to stop pain
2. Small opening made in scrotum
  — not   painful
3. Tubes that carry sperm are cut and tied
4. The opening is closed
5.
5 Rest 15 to 30 minutes
                                              Either 2
Afterwards:                                  openings
                                             made here
• You should rest for 2 days                        or 1 opening made here
• Avoid heavy work for a few days
• Important! Use condoms for                         What questions
  next 3 months                                       do you have?
      Medical reasons to return

Come at once if:
• Swelling in first few hours after
  surgery
• Fever in first 3 days
                g
• Pus or bleeding from wound
• Pain, heat, redness of wound
              Female Sterilization
                                                Tubes
• A surgical procedure                        blocked or
                                               cut here
• Womb is NOT removed. You will still
  have menstrual periods.
• Permanent—for women who will not
  want more children
     y
• Very effective
• Very safe
        g
• No long-term side-effects


              Do you want to know more
            b     hi      h d      lk b
           about this method, or talk about
                 a different method?
 When you can have sterilization
Most women can have
sterilization at any time




But may need to wait if:




   Gave birth
  •G    bi th      •M b
                    May be        Infection or
                                • I f ti         • S
                                                   Some other
between 1 and 6    pregnant   other problem in   serious health
   weeks ago                   female organs       conditions
                 Before you decide
Let’s discuss:
 Temporary methods are also available
•T           th d       l      il bl
• Sterilization is a surgical procedure
• Has risks and benefits
• Prevents having any more children
• Permanent—decision should be
  carefully considered
• You can decide against procedure
  any time before surgery                 Are you ready to choose
                                                this method?
                                          Want to know more about
                                              the procedure?
                   The procedure
                                     Small cut either
1. Medication helps you keep calm    here
     dh l           t i
   and helps prevent pain
                                        or
2. You stay awake                       here
3. Small cut is made — not painful
4. Tubes are blocked or cut
5. Opening closed with stitches
6. Rest a few hours

Afterwards:
• You should rest for 2 or 3 days
• Avoid heavy lifting for a week
• No sex for at least 1 week
        Medical reasons to return
In first week, come at once if:




 • High fever    • Pus or  • Pain, heat,       • Steady or     • Fainting
                  bleeding    swelling,         worsening        or very
                from wound redness of         p ,        p ,
                                              pain, cramps,       dizzy
                               wound          tenderness in
                                                   belly
At any time in the future, come at once if:

• You think                       • Pain or
  you may be                        tenderness
  pregnant                             belly
                                    in belly, or
                                    fainting
               The Male Condom
• Protects against both pregnancy AND
  STIs including HIV/AIDS
• Very effective when used
  EVERY TIME you have sex
                y
• Can be used alone or with another family
  planning method
• Easy to get, easy to use                   Would you like to see
                                             a condom and learn
• Usually partners need to discuss              how to use it?



             Do you want to know more
           b     hi      h d      lk b
          about this method, or talk about
                a different method?
 Condoms

                            How to use a condom



Use a new condom            Place condom on              Unroll condom                    After ejaculation,         Throw away
 for each sex act            tip of penis with            all the way to               hold rim of condom so        used condom
                            rolled rim facing             base of penis                 it will not slip off, and     properly
                             away from body                                              withdraw penis from
                                                                                       vagina while still erect


• Open package carefully.   • Put condom on          • If condom does not unroll           • Move away              Always throw away
• Check the expiry or         before penis             easily, it may be backwards           from partner first.    in bin or trash can
  manufacturing date.         touches vagina.          or too old. If old, use a new       • Do not spill semen       as appropriate.
• Condoms should be         • If uncircumcised,        condom.                               on vaginal opening.
  used within 3 years of         ll back foreskin.
                              pull b k f      ki     • Lubricants can be used
  the manufacturing date.                              (water-based, not oil-
                                                       based) and should be used
                                                       during anal intercourse.
                 What to remember
• Use a condom             • Use only water-
  EVERY TIME                 b   dl b i    t
                             based lubricants
  you have sex

• Make sure you always
  have enough              • Store condoms
  supplies of condoms        away from
                             direct sunlight
                             di   t    li ht
• If a condom                and heat
  breaks,
        id
  consider
  emergency
  contraception
  as soon as possible
        How to use a female condom
Outer
ring                                                                                     Inner
                                                                                         ring
                                                                                            g


                                                                                  Open
                                                                                  end

            Inner
            ring
             i                                                               • Gently insert the inner ring into
                                                                               the vagina
                                                                             • Place the index finger inside
• Open package      • Choose a comfortable          • Squeeze the inner        condom, and push the inner ring
  carefully           position – squat, raise one     ring at the closed       up as far as it will go
• Make sure the       leg, sit or lie down            end                    • Make sure the outer ring is outside
  condom is well-                                                              the vagina and the condom is not
  lubricated inside                                                            twisted
                                                                             • Be sure that the penis enters
                                                                               i id the condom and stays in
                                                                               inside h         d       d        i
                                                                               it during intercourse
           Are you ready to
             choose this                                                   • To remove, twist the
                 th d?
               method?                                                       outer ring and pull gently
                                                                           • Throw away condom
                                                                             properly
                 What to remember
• Use a condom EVERY TIME you have sex

• Make sure you always have
  enough supplies of condoms
      g     pp

• If a condom is not used correctly,
  consider emergency contraception
  as soon as possible

  Can
• C use more
  lubricant if needed
                   Vaginal Methods
• Includes spermicides and diaphragm
• Must be placed in the vagina each time before sex
• Some users have side-effects
• May be messy
Spermicides:
• Less effective than other methods
Diaphragm:
• Can be effective when used correctly every time
• Needs pelvic exam to check for size
• Possible protection
  against some STIs                          Do you want to know more
                                             b t th         th d    talk
                                            about these methods, or t lk
                                             about a different method?
             Who can and cannot
             use vaginal methods
Most women can safely use
vaginal methods



But usually should not use SPERMICIDES           And if you are thinking about the
or DIAPHRAGM with spermicides if:                DIAPHRAGM, tell me if you:

                                                             • Recently had a baby
                                                               or abortion


• Have a medical   • More than one sex partner               • Are allergic to latex
  condition that      or partner has sex with
                                                             • Ever had toxic
makes pregnancy        others (high HIV risk)                  shock syndrome
   dangerous            • Have HIV/AIDS
        How to use the diaphragm
                                                                        After sex:
                                                                  • Leave the
                                                                    di h       i  l
                                                                    diaphragm in place
                                                                    for AT LEAST 6
                                                                    hours but NO MORE
                                                                    THAN 24 hours
                                                                  • To remove, gently
                                                                    slide a finger under
Squeeze plenty of        Press the rim                              the rim and pull the
   spermicidal        together and push                             diaphragm down
  cream or jelly      the diaphragm into    Touch the diaphragm     and out
 into diaphragm        the vagina as far       to make sure it
 and around rim            as it goes         covers the cervix

ALSO: For each additional act of intercourse, use
an applicator to insert additional spermicide into
the vagina. DO NOT remove the diaphragm.                    Do you want to try
                                                          using this method and
                                                           see how you like it?
          How to use spermicides
                                                            Film

                                            Tablets or
                                            suppositories



• Insert before sex (up to 1 hour before)
• Insert deep into vagina using
  applicator or fingers
• Do not wash vagina for at least 6 hours after sex
• If possible, store in a cool, dry place


                    Do you want to try
                  using this method and
                   see how you like it?
                What to remember
Come back if:
• You need more spermicide

  Diaphragm becomes stiff or thin or
• Di h      b         iff     hi
  develops holes

• You or your partner has reaction
  (itching, rash, irritation)

• You feel pain when urinating

             Anything else I can
             repeat or explain?
            Any other questions?
                                  LAM
                      Lactational Amenorrhoea Method


            p
• A contraceptive method
  based on breastfeeding
• LAM means breastfeeding often, day
      night
  and night, and giving baby little or no
  other food
• Effective for 6 months after giving birth
• Breast milk is best food for babies




          Do you want to know more
        about this method, or talk about
              a different method?
      When you can use LAM
If breastfeeding now, can use LAM if:
   Baby is less than 6 months old
AND
   B b gets little or no food or drink
   Baby t littl          f d     di k
    except breast milk
AND
   Menstrual periods have not come back
                   How to use LAM
• Can start LAM as soon as baby is born
• Breastfeed often

What to do after LAM:
• Start giving baby other foods when
  he/she is 6 months old, but continue
  to breastfeed
• Start another method at the right time

    Are you ready to
      choose this
        method?
   Fertility Awareness-Based Methods

• Learn on which days of the menstrual
  cycle you can get pregnant
• To prevent pregnancy, you and your
  partner either avoid sex OR use a
  condom on fertile days
                                   y
• Can be effective if used correctly
• No side-effects



           Do you want to know more
          about these methods, or talk
           about a different method?
           Who can and cannot use
           Standard Days Method
Most women can use
Standard Days Method




You can use if:          You may need to wait if:
• Your menstrual         • Your periods have
  cycles are regular,      not returned after
  between 26 and 32        childbirth
  days long              • You recently stopped
• You and your partner     using a long-acting
  can avoid sex or use     injectable
  condoms on fertile
  days
How to use Standard Days Method
                                                                       Every morning move
                                                                       the rubber ring to the
THE RED BEAD                                                                bead.
                                                                       next bead
is day 1 of cycle.                                                     Always move the ring in
On the first day of your                                               the direction of the arrow.
p
period, move the rubber
ring onto the red bead.                                                    WHITE BEAD
                                         Each bead                         DAYS
Mark a calendar to help
                                     represents a day                      are days when
remember.
                                     of your menstrual                     you CAN get
                                           cycle                           pregnant.
   BROWN BEAD                                                              Use a condom or
   DAYS                                                                    do NOT have sex
   are days when                                                           on these days to
   pregnancy                                                               prevent
   is unlikely.                                                            pregnancy.
   You can have sex on these days. No
           needed.
   condom needed
                                                           Are you ready to
   When your next period starts, move
                                                         choose this method?
   the ring to the red bead again. Skip
   over any remaining beads.
                   What to remember
                     g                      y y
• Move the rubber ring one bead forward every day
• Always use condoms or avoid sex on
  fertile “white bead” days

Consult a Doctor:
• You get your period early                  Dark brown
 (it starts before you put the ring on the   bead

 dark brown bead)
                                             Last brown
• You get your period late                   bead
 (it does NOT start by the day after you
 put the ring on the last brown bead)

• You have unprotected sex on a
  fertile “white bead” day
           Which methods meet your needs?
What is most important to you?
• Very effective                 • Permanent

• Good while breastfeeding       • Few side-effects

• Can have more children later   • Private
                                 • Easy to use
                                 • Easy to stop
                                 • Nothing to do before sex
                                 • Used only when needed
                                 • Avoids touching genitals
                                 • Others?
                      3: Comparing effectiveness of methods
               This chart shows how effective methods are as usually used. The top four methods are most effective; the user has nothing to do.
               The effectiveness of the other methods depends on the user’s behaviour. These other methods are more effective when used correctly.

  Generally Most     effective                                                                                  How to make your
  2 or fewer                                                                                                    method most effective
 pregnancies                                                                                                    One-time procedures. Nothing to do
   per 100                                  Implants         Vasectomy              Female                      or remember.
women in one                                                                      Sterilization       IUD

     year                                                                                                       Need repeat injections
                                                                                                                every 1 to 3 months
                                                                   Injectables


                                                                                                                Must take a pill each day
                                                                          Pills



                                                                                                                Must follow LAM instructions
                                                                         LAM (up to 6 months postpartum)
   About 15
 pregnancies
                                                                                                                Must use every time you have sex;
   per 100                                                               Male
                                                                                                                requires partner’s cooperation.
women in one                                                           Condoms
     year
                                                                                                                Must use every time
                                                                        Diaphragm                                o ha e sex
                                                                                                                you have se

                                                                       Female
                                                                                                                Must use every time you have sex;
                                                                       Condom                                   requires partner’s cooperation.
                     *This ranking is based on a simplified calendar
                     method.                        awareness-based
                     method Some other fertility awareness based
   About 30          methods that more accurately identify the
                                                                                         Fertility Awareness-   Must abstain or use condoms on fertile
                                                                                          Based Methods*
 pregnancies         fertile period, including the Standard Days                                                days; requires partner’s cooperation.
   per 100
                     Method, are more effective.

women in one                                                                                                    Must use every time                  AP
     year Least      effective
                                                                        Spermicides
                                                                                                                you have sex                          3
                    The female reproductive system

            Ovary             Fallopian tube
                                                  Clitoris   Pubic hair




                                               Opening         Inner lip
Womb lining                                    for urine       Outer lip
(endometrium)



                                                Vaginal
 Womb
                                                opening
 (uterus)
                                                             Anus


        Cervix

                                Vagina
                     4: The female reproductive system
    Ovary                                  Fallopian tube
                                                                                                                 Pubic Hair
    Where eggs are stored.                 An egg travels along one of these tubes
                                                                                                                 Hair that grows during
    One egg is released each               once a month, starting from the ovary.            Clitoris            puberty and surrounds
    month (ovulation). The egg             Fertilization of the egg (when egg meets          Sensitive ball of   the female organs.
    dies if not fertilized by              the sperm) occurs in these tubes.                 tissue creating
     p
    sperm within 12 to 24 hours                                                                      p
                                                                                             sexual pleasure.
    after release.
                                                                                                                             Inner lip
Womb lining                                                                                                                  Two folds of
(endometrium)                                                                                                                skin inside
                                                                                      Opening for                            the outer lip
Lining of the uterus,
                                                                                      urine                                  that extend
   hi h thickens and i
which thi k        d is
                                                                                      Opening                                from the
then shed once a
                                                                                      where urine                            clitoris.
month, causing
                                                                                      (liquid waste)
menstrual bleeding.
                                                                                      leaves the
During pregnancy, this
                                                                                      body.
lining is not shed but
instead changes and                                                                                                         Outer lip
nourishes the foetus                                                                                                        Two folds of
(growing baby).                                                                                                             skin, one on
                                                                                      Vaginal opening                       either side of
                                                                                      Opening of the vagina.                the vaginal
    Womb (uterus)                                                                         man s
                                                                                      The man’s penis is                    opening,
                                                                                                                            opening that
    Where a fertilized egg                                                            inserted here during                  protect the
    grows and develop                                                                 sexual intercourse. Blood             female
    into a foetus.                                                                    flows from here during                organs.
                                              Vagina                                  menstrual periods.        Anus
                                              Joins the outer sexual organs with                                  p    g
                                                                                                                Opening where
         Cervix
                                              uterus. Babies are born through this                              solid waste
         The entrance of the womb,
                                              passage. To clean itself, the vagina                              leaves the body.
         which stretches down into the
                                              sheds mucus every now and then
         back of the vagina. It produces
                                              (vaginal discharge).                                                                     AP
         mucus.
                                                                                                                                        4
                                       5: The menstrual cycle
Many clients, in particular younger clients, may not know basic biological facts. This page will help you explain the normal menstrual cycle.
  Key points about the menstrual cycle:
  • The menstrual cycle is the process through which a woman’s body       • The fertile time of the menstrual cycle (when a woman can get
    prepares for pregnancy.                                                 pregnant) can last for up to 6 days, starting 5 days before ovulation and
  • Young women usually start to have periods (menstruate) between          ending on the day of ovulation.
    the ages of 11 and 17. Women stop having periods between the          • Ovulation usually occurs between days 7 and 21 of the cycle (see
                      (menopause).
    ages of 45 and 55 (menopause)                                           below) It can however occur at ANY TIME in the cycle after the end of
                                                                            below). can, however,
  • The menstrual cycle is usually about 28 days long, but it varies        the menstrual period. The precise day of ovulation cannot be predicted.
    from woman to woman and from month to month. It can range             • For best protection from pregnancy, a couple should use contraception
    from 23 to 35 days.                                                     throughout the menstrual cycle.



                                                                                                    2. Thickening of the womb lining
1. Ovulation                                                                                        (usually about 14 days
(usually occurs                                                                                     long after ovulation)
between days                                                                                        The lining of the womb
7 and 21 of the                                                                                     (the endometrium) becomes
cycle,
cycle often                                                                                         thi k d i thi ti
                                                                                                    thicker during this time tto
                                                              Usually around 28 days
around day 14)                                                  long, but can range                 prepare for a fertilized egg.
One egg is released from the ovaries each                      from 23 to 35 days.                  Usually there is no pregnancy, and the
cycle (usually once a month). The egg travels                                                       unfertilized egg cell dissolves in the body.
down a fallopian tube towards the womb and
may become fertilized during this time by a
sperm cell that has travelled upwards from
the vagina.                                                                                     Note: When counting the days in the menstrual cycle,
                                                                                                always start with the first day of menstrual bleeding.
                                3. Menstrual bleeding (period)
                                    (bleeding usually lasts from 2 to 7 days, often about 5 days)
                                •                  pregnancy                                      shed.                               vagina.
                                    If there is no pregnancy, the thickened lining of the womb is shed It leaves the body through the vagina This
                                    monthly bleeding is called menstruation. Contractions of the womb at this time can cause period pains (cramps).
                                •   Menstruation is different in different women. Some women can bleed for a short time (for example, 2 days),
                                    while others can bleed for up to 8 days. Bleeding can be heavy or light.
                                                                                                                                                   AP
                                •   If the egg is fertilized by a man’s sperm, the woman will become pregnant, and she will stop having periods.
                                                                                                                                                        5
      The male reproductive system




     Penis                         Seminal
                                   vesicles



Urethra                            Prostate



                                  Vas deferens
Foreskin

               Scrotum        Testicles
             6: The male reproductive system

Penis
Male sex organ made of                                                Seminal vesicles
spongy tissue. When a                                                 Where sperm is
man b becomes sexually ll                                             mixed with semen.
excited, it stiffens and
grows larger. Semen,
containing sperm, is
released from the penis
                     p                                                Prostate
during sexual                                                                 d i
                                                                      A reproductive organ
intercourse (ejaculation).                                            that produces a fluid
                                                                      to help sperm move.
Urethra
Tube through which
T b th      h hi h                                                   Vas deferens
semen and sperm                                                      2 thin tubes that carry
are released from the                                                sperm from the
body. Urine is                                                       testicles to the
released through the
               g                                                              vesicles
                                                                     seminal vesicles.
same tube.                                                           Vasectomy blocks
                                                                     these tubes.
                        Foreskin
                        Hood of skin
                                                                 Testicles
                        covering the end   Scrotum               Organs producing
                        of the penis.      Sack of thin loose    sperm.
                        Circumcision       skin containing the
                        removes the        testicles.                                     AP
                        forseskin.                                                         6
                                                      7: Starting a method
This chart shows when methods can be started, both during the menstrual cycle and after childbirth. ALL METHODS CAN BE STARTED
ON ANY DAY OF THE MENSTRUAL CYCLE, as long as you can be reasonably certain the client is not pregnant


                                                 Starting days in the
                                                                                                                      After childbirth
                                               menstrual cycle when no
   Method Type                                extra protection is needed                               Not breastfeeding                 Breastfeeding
                                                                                             Within 2 days, or from 4 weeks      Within 2 days, or from 4 weeks
   IUD                                                        1 to 12                                after childbirth                    after childbirth
   The pill                                                   1 to 5                             3 weeks after childbirth           6 months after childbirth

       mini-pill
   The mini pill                                              1 to 5                           Immediately after childbirth          6 weeks after childbirth

   Long-acting injectable                                     1 to 7                           Immediately after childbirth          6 weeks after childbirth

   Monthly injectable                                         1 to 7                             3 weeks after childbirth           6 months after childbirth

      p       p
   Norplant implants                                          1 to 7                                     y
                                                                                               Immediately after childbirth          6 weeks after childbirth

   Vasectomy for men                              Use extra protection for                                   --                                 --
                                                       next 3 months
   Female sterilization                        Any time, if reasonably certain               Within 7 days, or from 6 weeks      Within 7 days, or from 6 weeks
                                                     she is not pregnant                             after childbirth                    after childbirth
   Condoms (M & F)                                            Any time                         Immediately after childbirth        Immediately after childbirth

   Diaphragm                                                  Any time                    From 6 to 12 weeks after childbirth* From 6 to 12 weeks after childbirth*
   Spermicides                                                Any time                         Immediately after childbirth        Immediately after childbirth

                                                                                                             --                 Start immediately after childbirth;
   LAM                                                          --                                                                 can use for up to 6 months
  Fertility awareness                        Any time (as long as she knows                     After 3 menstrual cycles           After 3 menstrual cycles
  (Standard Days Method)                        when her period started)                             of 26–32 days                      of 26–32 days

                                                                                                                                                                      AP
 * Depending on when the uterus and cervix return to normal          --Not applicable to this method
                                                                                                                                                                       7
         9a: Promoting communication
               p              g
       between partners: It’s good to talk!

Talking with your partner can bring benefits:

“It helps to talk with your partner about contraception and sex.”
“When partners are given good information about family planning
and
understand its importance for your lives, they can offer their
support.”
• Explain the value of sharing information with partners:
 -shows concern for his/her health, and helps them think about
  their own health,
 -both partners make a good choice together about contraception,
            g                    p,
 -can strengthen the relationship,
 -can show that you expect honest and respectful treatment.
                                10: Myths about contraception
FALSE: Contraception permanently prevents pregnancy.
TRUE: The l           th d th t              tl
TRUE Th only methods that permanently prevent pregnancyt
are female sterilization and vasectomy. Women can become           FALSE: You cannot get pregnant or get an STI if there is no
pregnant again soon after stopping all other methods (except       penetration.
long-acting injectables: fertility returns but takes longer).      TRUE: It is possible, although rare, to get pregnant even without
FALSE: If contraception fails, the baby could be born with         penetration. And it is certainly possible to get some STIs through genital
abnormalities.
 b        liti                                                     contact even if the penis does not enter the vagina or anus
                                                                   contact,                                                anus.
TRUE: No method causes birth defects.                              FALSE: Contraception is bad for your health.
FALSE: Contraception causes large weight gain or                   TRUE: For nearly all women, the health benefits of any method of
disfigurement.                                                     contraception are far greater than any risks from the method.
TRUE: No contraceptive method causes disfigurement or
                                                                 • Some methods can cause side-effects such as nausea, headaches, or
swelling.
swelling Hormonal methods may cause small changes in               heavy menstrual bleeding. Women with bad side-effects can switch
weight, either gain or loss. Long-acting injectables cause the     methods.
most noticeable changes, with users gaining on average 1 to 2    • Contraception does not affect strength or cause weakness in healthy
kg each year.                                                      women.
FALSE: Some methods work by causing an abortion.
                                                                 • There has been a concern that hormonal methods (pills, injectables,
                 p                       p
TRUE: Contraception does not interrupt an established                                                  risk,
                                                                   implants) may increase cancer risk but substantial evidence now
pregnancy and so does not cause an abortion. Pills, injectables,   shows that there is little risk for most women:
implants and the IUD prevent pregnancy mainly by preventing       - Users of the pill and long-acting injectables are at low risk of breast
ovulation and/or fertilization, and also by thickening cervical     cancer. Studies show that women who are using or who recently
mucus (which blocks sperm).                                         stopped using these methods (in the last 5 to 10 years) are more likely
FALSE: Younger women should not use family planning.                to have breast cancer diagnosed than non-users. This may result from
TRUE: Younger women who have started their menstrual periods        earlier detection of existing disease.
can safely use any method. Those with multiple partners or who    - Women who have persistent HPV infection and who have been using
change partners often should not use the IUD and should be          the pill for 5 years or more may have an increased risk for cervical
encouraged to use condoms, either on their own or with another      cancer. Where possible, it is important that women are regularly
method.                                                             screened for cervical cancer.
FA SE You need to have breaks from contraceptive use.
FALSE: Y          d     h     b k f                     i                                                                cancer,
                                                                  - The pill protects against ovarian and endometrial cancer particularly if
TRUE: All methods can be used for many years, and none              used for a long time. Long-acting injectables protect against
requires                                                            endometrial cancer.
breaks in use or rests.                                           - There is not enough evidence to know if monthly injectables, the mini-
                                                                    pill or implants modify the risk of cancer, but available studies have
                                                                    not shown any increased risk.
     11a: Sexual and reproductive health tips

Breast awareness                                       Pap smear tests
• Breast cancer is one of the most common forms        • A Pap smear (done with a cervical
  of cancer in women.                                    swab) can help find whether a woman
• Those most at risk are women over 40 and those         has cervical cancer or changes in her
  whose mother or a sister has had breast cancer.        cervix that could lead to cervical cancer.
• All women should be aware of changes in their          The result of this test does not affect
  breasts. They should watch for:                        contraceptive choices. Having a Pap
                                                         smear should not be required to g a
                                                                                  q         get
  lumps
–lumps or thickening;
                                                         family planning method.
–any changes in appearance or shape;
                                                       • Cervical cancer is caused by the human
–change in the position or level of a nipple;            papilloma virus (HPV), a sexually
–changes in the skin surface;                            transmitted infection. Thus women at
–nipples that go inwards;
  nipples                                                risk for STIs also face higher risk for
–unusual discharge or bleeding from nipples.             cervical cancer.
• If she feels a lump, she should go to a doctor for   • Where a national testing programme
  a thorough check-up.                                   exists with high-quality laboratory
                                                         services, sexually active women should
                                                                          y
                                                         be tested regularly, at least every 3
                                                         years from age 20 to 65.
                                                       • Providers need special training to take a
                                                         Pap smear.