Table of Content


Family Planning

  • When to have children,
  • Use of birth control
  • Other techniques
    • Sex education
    • Preconceptional counselling
    • Infertility management
  • Couple who wish to limit the number of children they have and/or to control the timing of pregnancy

Couple Protection

  • Eligible couples (EC): currently married couples, wife in reproductive age, 150-180/1000 population
  • 54% EC still not using contraception

Unintended Pregnancies

78 % of pregnancies are unintended

While at least 25 % are unwanted

Reasons of Unintended Pregnancy

  • Poor sex education
  • Poor use of contraception
  • Myths/scare of contraception
  • Illiteracy, Ignorance, No proper guidance
  • Discontinuation
  • Males not using/supporting contraception
  • Unsure about wanting pregnancy
  • Religion
  • No women empowerment for decision making


  • Methods that prevents conception or pregnancy
  • Pregnancy can be avoided by
    • Blocking the production of ovum or sperm
    • Preventing the meeting of ovum and sperm (fertilisation)
    • Stopping the attachment of fertilised egg to the endometrium (implantation)

Contraceptive Methods

  • Spacing methods (Temp)
    • Barrier methods
      • Male & Female Condoms
    • Chemical methods
      • Spermicide pessary
    • IUD
      • 1st, 2nd, 3rd generation
    • Hormonal methods
      • COC, Mini pill, EC, Injectable, vaginal rings, patch
    • Miscellaneous
      • Safe period, Coitus interruptus
  • Terminal methods (Perm)
    • Male sterilization
    • Female sterilization

What contraceptive methods do women use?
Currently married women who use specific methods

Spacing Methods

Barrier Methods


Male Condoms

  • Most widely known and used
  • Prevents deposition of semen in vagina
  • Effectiveness increased with a spermicide
  • Fitted on erect penis before intercourse & to be withdrawn carefully
  • Reversible
  • Effectiveness
    • Used correctly, - 90% effective
    • With spermicide are 95% effective
  • Advantages
    • Protection against pregnancy, STD, HIV
    • Easily available, safe and inexpensive,
    • Easy to use, no medical supervision/prescription
  • Disadvantages
    • Slip off or tears during intercourse
    • Emergency contraceptive pill for female partner

Female Condoms

  • Worn inside the vagina during intercourse
  • One ring, at the closed end of the sheath, lies inside the vagina
  • Other ring, at the open end of the sheath, lies outside the vagina
  • Effectiveness
    • Instructions followed - 95%

  • Advantages
    • Protection against pregnancy and many STDs
    • No danger of the spilling
    • Protects vagina against infection,
    • Can be inserted up to 8 hrs before intercourse
  • Disadvantages
    • Outer ring visible
    • Difficult to insert and to remove.

Chemical Methods

Spermicide Pessary/Gel

  • Vaginal pessary/Gel
  • Kills sperms
  • Inserted deep into vagina, 5-10 minutes before intercourse.
  • On dissolving, releases an effective spermicide which destroys sperms on contact
  • To be used with condom
  • Advantages
    • Safe
    • Effective
    • Lubricant
  • Disadvantages
    • Not effective when used alone, messy
    • Does not protect against STD & HIV
    • Rarely local allergic reaction,
    • May increase risk of urinary tract infection

Intra Uterine Device (IUD)

1st, 2nd, 3rd generation

  • Most effective reversible methods of contraception
  • Inserted into uterus & kept for required period (3-5 years)
  • Last few days of menses/any time if pregnancy excluded
  • 6-8 weeks after delivery/3 months after caesarean
  • Immediately after abortion
  • Interferes with sperm's ability to reach the egg
  • There are 2 types of IUDs - non-medicated (first generation) and medicated (second and third generation)

First Generation IUD

  • Inert, non-medicated devices e.g. Lippes loop
  • Loop with threads projecting into vagina
  • Effectiveness
    • Approximately 97%

Second Generation IUDs

  • Copper added to the IUD,
  • Strong anti-fertility effect
  • Lesser chances of expulsion
  • Lower side effects
  • Can be kept for 3-5 yrs
  • Effectiveness
    • Approximately 97-99%

Third Generation IUDs

  • Slowly release the hormone levonorgestrel
  • Lower menstrual blood loss
  • Fewer days of bleeding
  • Lesser side effects
  • Can be used up to 5 years
  • Effectiveness
    • More than 99%

  • Advantages
    • Simple & quick procedure
    • Can be kept as long as required
    • No need to use every day or with every intercourse
    • Reversible, decreases painful menses
    • Safe in smoking, breast feeding & sexually active women of any age
  • Disadvantages
    • Visit to doctor for IUD insertion,
    • Can cause heavy menstruation or spotting
    • Does not protect against STD or HIV infection,
    • Expulsion, infection, unusual vaginal discharge etc
    • Rarely IUD might tear the uterus

Hormonal Methods

Combined Oral Contraceptive (COC, OCP)

  • 2 hormones, oestrogen & progesterone
  • Prevents release of ovum, changes cervical mucus & changes lining of uterus
  • Orally - 21/24 consecutive days followed by 7/4 pill-free days
  • Next pack on day after the 7/4 pill-free days
  • Does not protect against STD or HIV
  • Effectiveness - more than 99%
  • Advantages
    • Reduces menstrual cramps and PMS (premenstrual syndrome),
    • Improves menstrual regularity, lowers risk of anaemia,
    • Return of fertility
    • Less chances of PID (pelvic inflammatory disease).
    • Long term use - decrease the incidence of ovarian and endometrial cancer.
  • Disadvantages
    • Nausea, vomiting, weight gain
    • Breast discomfort, moodiness, pimples, vaginal infections
    • Long term use - may increase the risk of heart problems (increases with age and cigarette smoking), cancer (of breast, cervix and liver), elevation of blood pressure and blood glucose, increased blood clotting, decrease of HDL (good cholesterol)
    • OCPs do not protect against STD or HIV infection.

OCPs Not to be Used

  • Past history/Family history of clots
  • Severe hypertension/Severe diabetes
  • Known or suspected carcinoma of the breast, endometrium
  • Undiagnosed abnormal genital bleeding
  • Jaundice (active or with prior pill use)
  • Known or suspected pregnancy
  • Heavy smoking (>/= 15 cigarettes per day) and over age 35
  • Nursing mothers

New Generation OCP

  • Reduces pimples, oily skin & male pattern hair growth
  • No weight gain
  • No increased blood pressure
  • No changes in blood glucose or cholesterol levels

Mini Pill

  • Only progesterone given in small doses throughout the cycle
  • Inhibits sperm penetration by thickening cervical mucus, or
  • Changes uterine lining causing difficult implantation
  • Effectiveness
    • Approximately 95%
  • Advantages
    • Used by breast feeding women,
    • Older women with cardiac risks
  • Disadvantages
    • Spotting
    • Breakthrough bleeding
    • Does not protect against STD or HIV

Emergency Contraceptive Pills

  • Progesterone alone or both e.g. OCP.
  • Orally within 72 hours of unprotected sex
  • Stops an egg being released, thickens the mucus thus stops fertilisation
  • Effectiveness
    • 95% effective < 24 hrs
    • 85% between 25 - 48 hrs
    • 58% if taken between 49 - 72 hours
  • Advantages
    • Back up
      • Sex without using a contraceptive
      • After forced sex
      • Failure of a contraception method (e.g. tearing of condom or having missed 2 or more contraceptive pills)
    • Safe to use for almost all women
    • No long-term or serious side effects
  • Disadvantages -
    • Nausea, vomiting, lower abdominal pain,
    • Breast discomfort, headache
    • Does not protect against STD or HIV infection.
  • Pregnancy : No effect on foetus
  • Nursing Mothers : No adverse effect
  • Paediatric Use : Not used before menarche
  • Fertility following discontinuation : Rapid return
  • Drug interaction : No significant interaction


Injectable Contraceptive

  • Intramuscular single progestogen injection
  • Inhibits ovulation
  • On or before 5th day of menstrual cycle, 3 monthly
  • > 5 days, barrier contraceptives to be used for 7 days
  • Can be given at any time after delivery or abortion
  • Repeat injections can be given up to 5 days late
  • Effectiveness
    • 99%
  • Advantages
    • Highly effective, long lasting, reversible, do not affect breast feeding.
  • Disadvantages
    • Disruption of normal menstrual cycle, no menses, bleeding between menses, spotting
    • Weight gain
    • Delayed return to fertility
    • Does not protect against STD or HIV


Safe period

  • Period in the menstrual cycle when pregnancy is least likely to occur
  • Ovulation occurs 12-16 days before onset of menstruation
  • The days on which pregnancy is likely to occur are calculated as follows -
  • The shortest cycle minus 18 days gives the first day of the fertile period
  • The longest cycle minus 10 days gives the last day of the fertile period
  • Intercourse should be avoided or barrier contraceptives should be used during this period.

  • Effectiveness
    • 75%
  • Disadvantages
    • Calculations are not easy as a female's cycles are irregular, high failure rate due to wrong calculations
    • Does not protect against STD or HIV infection.

Coitus interruptus

Male withdraws before ejaculating trying to prevent deposition of semen into vagina
  • Effectiveness
    • 75% if practiced properly,
  • Advantages
    • No cost and appliances required, no side effects
  • Disadvantages
    • Needs practice, even a slightest mistake in withdrawal timing can lead to pregnancy
    • Does not protect against STD or HIV infection.

Terminal Methods

Male Sterilization or Vasectomy

  • Piece of the vas deferens (part of the male tube that carries the sperms) is removed.
  • Male is not immediately sterile & contraceptives to be used for 1st 20 ejaculations/3 months (whichever comes first) until absence of sperms
  • Effectiveness -
    • almost 100% effective.
  • Advantages
    • Simple, fast and less expensive operation
    • Does not affect male sex hormone secretion,
    • Under local anaesthesia
  • Disadvantages -
    • Operative procedure
    • Does not protect against STD or HIV infection.

Female Sterilization

  • After delivery/at time of abortion/any other time she desires.
  • Effectiveness - 0.5% failure rate
  • 2 ways -
    • Tubectomy - tubes that carry the eggs (fallopian tubes) are tied & cut
    • Tubal ligation- fallopian tubes are clamped, blocked or tied
  • It can be done by-
    • Laparotomy -Cut in the abdominal wall.
    • Laparoscopy - Laparoscope is passed through a small surgical cut made in the abdominal wall & then tubes are tied
    • Minilaparotomy - tubes are tied through a small cut in the lower abdomen

  • Should not be used in case of -
    • Postpartum patients for 6 weeks following delivery,
    • Haemoglobin < 8%,
    • Heart and respiratory diseases,
    • Diabetes, hypertension.
  • Advantages
    • No long term side effects,
    • Short operating time, shorter stay in hospital,
    • No repeated clinic visits required
    • Minilap done under local anaesthesia
  • Disadvantages
    • Operative procedure has to be done only by specialist gynaecologists
    • Does not protect against STD or HIV infection.

Which Contraceptive??

  • Individualized

"Being able to plan your family is critical to staying in school, being able to have a job and stay in the work force and planning your family's own economy,"




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