Family Planning - Mother's e-Guide

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------ Male Condom Female Condom Pills DMPA Implants Injectables IUD Female Sterilization Male Sterilization SDM LAM Withdrawal Method

There are two types of child spacing techniques: the artificial and natural type. The natural includes: withdrawal practised by men, SDM known as Standard Days Method and LAM - Lactational Amenorrhea Method (both for women). The artificial are categorised into two, they are temporary and permanent methods. Examples of temporary family planning methods include: Male/ Female Condom, Pills, IUD, Implant, Injectables, DMPA etc. while permanent methods are: vasectomy and tubal ligation. Click on each item on the navigational menu for details.

MALE CONDOM

DESCRIPTION

It is a thin rubber sheath that fits over the erect penis
It holds the sperm and prevents it from entering the womb
To be most effective, this method must be used correctly and consistently during sex

HOW IT WORKS

It is rolled onto the erect penis before it touches the vagina
A small place should be left between the condom and the tip of the penis for collection of seminal fluid (that contains the sperm)
The condom should be removed after sex before the penis loses its erection
It should be properly disposed (put it in latrine, or buried)
A vagina foaming tablets can be used at the same time to increase protection

ADVANTAGES

It can prevent both pregnancy and sexually transmitted infections (e.g. Gonorrhoea, Syphilis, HIV)
It is convenient and affordable.
It does not affect woman’s monthly bleeding.
It can be purchased from clinics, chemists and pharmacy shops.

DISADVANTAGES

Some couples find that the condom decreases sexual sensitivity and pleasure.
It can break or slip.
Some people may feel embarrassed to buy and/ or initiate condom use.
It interrupts sexual activity- the couple must pause to use a condom during sex.
Need to use one condom for each sexual act.

FEMALE CONDOM

DESCRIPTION

It is a pre-lubricated, strong rubber sheath that is place inside the vagina
It has a flexible ring at each end
The inner ring is used for insertion and helps to hold the condom in place
The outer ring remains outside the vagina when the condom is inserted and covers the opening to the vagina.
It holds the sperm and prevents it from entering the womb.
To be most effective, this method must be used correctly and consistently during sex.

HOW IT WORKS

It gently lines the vagina to create a barrier against pregnancy and germs that cause sexually transmitted infections, (e.g. gonorrhoea syphilis and HIV).

ADVANTAGES

All women can use it (young, old and menopausal, women who have had their wombs removed and women who are breastfeeding).
It can be worn earlier (few hours) before the sexual act to minimize interference during sex.
It generates heat and therefore increases sexual stimulation.
It prevents both pregnancy and sexually transmitted infections, (e.g. Gonorrhea, syphilis and HIV).
It does not affect a woman’s monthly bleeding.
It can be purchased at clinics, chemists and pharmaceutical shops.

DISADVANTES

It could interrupt sexual activity.
Some people may feel embarrassed to buy and /or initiate condom use.
Need to use one condom for each sexual act.

DAILY PILLS AND EMERGENCY CONTRACEPTIVE PILLS

PILLS

DESCRIPTION

It is a small tablet taken once a day at the same time every day.
The pills must be taken every day, whether or not a woman has sex that day.
It contains low dose hormone(s).
There are two types of pills:
One that contains only one hormone and can be used by all women including breastfeeding mothers.
One that contains two hormones and can be used by all women except breastfeeding mothers.

HOW IT WORKS

It prevents eggs from being released so that the woman cannot become pregnant.
It prevents monthly ovulation.
It thickens cervical mucus.
It makes the implantation of egg less likely.
It reduces sperms movement in the fallopian tube.

ADVANTADES

It can be taken by most women from menarche to menopause.
After stopping its use, a woman can become pregnant after a brief period.
It does not interfere with sex.
It protects against certain types of diseases.
It can help reduce monthly bleeding problems such as irregular bleeding.
For women who are breastfeeding, the pills with only one hormone can delay the return of the monthly period.

DISADVANTAGES

It must be taken every day therefore may not be easy to forget.
It does not protect against STIs, including HIV.
It can cause some side effects such as changes in monthly bleeding patterns, headaches and breast tenderness.
For non-breastfeeding women, the pills with only one hormone can cause frequent or irregular bleeding.
For the pills with two hormones, it is common to experience irregular bleeding; then lighter, shorter and more irregular monthly bleeding.
These side effects are normal and disappear after a few months of use.
Take each pill at the same time each day to help reduce irregular bleeding
Skipping pills can make some side effects worse. Vomiting or diarrhoea can also sometimes cause irregular bleeding.

EMERGENCY CONTRACEPTIVE PILL

It is a tablet which can prevent pregnancy when taken up to 72 hours after having unprotected sex, when irregular contraceptive fails or when a woman has been forced to have sex (i.e. raped)
It should be taken as soon as possible after unprotected sex. The sooner they are taken after sex, the better they prevent pregnancy.
It is for emergencies and not appropriate for regular use. They should not be taken more than twice in a month. There is increased risk of the emergency contraceptive pill’s failure if repeatedly use as a childbirth spacing method.
The emergency contraceptive pill is not the same as abortion pills. It will not end pregnancy once it has started.

ADVANTAGES

A woman can use it right away or up to three days after sex.
The pills have no long term or serious side effects and it is safe for almost every woman.
It can be obtained at clinics, chemists and pharmacy shops.

DISAVANTAGES

It can cause some side effects such as changes in monthly bleeding patterns, nausea, abdominal pain and headache.
It can cause some women to experience irregular bleeding for 1-2 days after use and the timing of their next bleeding may be a little off.

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DMPA-SC

DMPA (Depot-medroxyprogesterone Acetate) – SC (Subcutaneous) is regarded as hormonal contraceptive to be administered subcutaneously (i.e. into the fatty tissue) with the use of pre-filled uniject technology (an injector). The artificial progestin preparation which resembles the naturally occurring female hormone progesterone is usually given in 104 mg per 0.65 ml dose, which gives three months protection following injection. This method is prescribed when a woman wants to prevent pregnancy for a long period of time, but she is having problem in remembering to take an oral contraceptive pill on a daily basis. In this case, the DMPA injectable contraceptive remains another available alternative.

** DMPA-Sc is one of the variants of Injectable Contraceptives.

HOW IT WORKS

Inhibition of ovulation (the primary mechanism of action).
Thickening of cervical mucus to stop sperm penetration.
Thinning of the endometrium of the uterus to make it unfavourable for implantation of the fertilised egg.

Slowing of sperm and ovum transport through reduced fallopian tube peristalsis (wave-like muscular contractions of the fallopian tube by which contents are forced onward towards the uterus).

ADVANTAGES

Very effective.
Maintains privacy as it is easy to use; any trained person can administer it, including community health workers, pharmacists, and even women themselves. Click for step by step guide
Reversible.
Suitable for breastfeeding women; no oestrogen side-effects
Best choice for those with gastritis or peptic ulcer diseases (ulcer of stomach or duodenum).
Protects against ectopic pregnancy since ovulation does not occur.

It reduces the chance of seizures in women with epilepsy.
It helps prevent uterine tumours. It also has the capability to protect against pelvic inflammatory disease by making the cervical mucus thick and impenetrable for microorganisms.

DISADVANTAGES

Disturbance of menstrual cycle.
Delayed return of fertility.
No protection against STIs.
Its action cannot be stopped immediately.
If ovulation occurs, the chance of ectopic pregnancy is high.

IMPLANT

DESCRIPTION

They are set of small plastic sticks that are placed under the skin of a woman’s arm and slowly release hormone into the body to prevent pregnancy.

HOW IT WORKS

They work by thickening cervical mucus, making it difficult for sperms to penetrate (to pass through).
They partially inhibit ovulation.
They reduce sperm movement.
They make implantation less likely.

ADVANTAGES

Lasts for 3 - 5 years.
They are immediately effective (within 24 hours).
After they are removed, a woman can become pregnant after a brief period.
They can be used by women of any reproductive age or parity.
Safe for use for breastfeeding mothers.
They do not require the woman to do anything once they are inserted.
Implants do not interfere with sex.

DISADVANTAGES

A trained health provider is needed to insert and remove it.
A small incision or cut is required for insertion and removal.
They can cause some side effects such as mood swing and changes in monthly bleeding pattern; breast tenderness, dizziness and headache.
It is common to experience irregular bleeding in the first year of use that can last more than 8 days at a time. Then lighter and fewer days of monthly bleeding or infrequent bleeding, these side effects are normal.
They do not provide protection against STIs, including HIV.

INJECTABLES

DESCRIPTION

It is an injection given in the arm or buttocks
There are three kinds of injectables:

One that lasts for one (1) month,
Another one that lasts for two (2) months and
A type that last for three (3) months.

HOW IT WORKS

It prevents eggs from being released so hence pregnancy cannot take effect.
It prevents monthly ovulation.
It thickens cervical mucus.
It makes the implantation of the egg less likely.
It reduces sperm's movement in the fallopian tubes.
When a woman wants to get pregnant, she stops taking it.

ADVANTAGES

It does not interfere with sex.
It is safe for breastfeeding mothers after the infant is six weeks of age.

DISADVANTAGES

It can take some time for a woman to become pregnant again.
It can cause side effects such as: changes in monthly bleeding pattern, weight gain, dizziness and headache.
With ‘progestin-only’ injectables, women commonly experience irregular bleeding for the first several months and then no monthly bleeding.
With regular monthly injectables, women typically experience lighter monthly bleeding, fewer days of bleeding, or irregular/ infrequent bleeding - these side effects are normal.
It does not protect against STIs including HIV.

IUD (Intra Uterine Device)

DESCRIPTION

It is a small plastic device placed in the woman’s womb to prevent pregnancy.
It can be inserted at anytime by a trained health provider, as long as the woman is not pregnant.
After a vaginal delivery, it can be inserted within 48 hours of delivery or after 6 weeks. Meanwhile, it can be inserted after 6 weeks in the case of a caesarean section.

HOW IT WORKS

It causes changes in the body of the woman that damages the sperm and the egg cells before they meet

ADVANTAGES

It is long lasting (up to 10 years), no constant supplies needed.
It prevents pregnancy from the day it is inserted.
It can be removed at anytime a woman wants to get pregnant.
It does not interfere with sex. It does not cause discomfort for the woman during sex. A man can not feel the IUD during sex.
It can be left in place for years with little medical supervision. If a woman is concerned about whether the IUD is in place, she can check for the string in her vaginal or see a health provider.
It does not require the woman to do anything once they are inserted.

DISADVANTAGES

A trained provider is needed to insert and remove IUD.
The IUD may cause some discomfort immediately; following the insertion.
It is not harmful; as it causes no longer and heavier bleeding and more cramps or pain during monthly bleeding, especially in the first 3 - 6 months of use.
It provides no protection against STIs, including HIV

FEMALE STERILIZATION

DESCRIPTION

It is an operation in which the tubes that carry the woman’s eggs to the womb are cut and blocked. During the operation, a doctor makes a small cut in the woman’s belly and closes the tubes.

HOW IT WORKS

The eggs cannot meet the man’s sperm so the woman cannot get pregnant
The woman still has a period every month till she reaches menopause
The woman looks and feels the same as she did before the sterilization

ADVANTAGES

It has no side effect.
After the operation, there is no more worry about pregnancy.
It does not interfere with sex.
It does not affect a woman monthly bleeding.
It can be done soon after the birth of a baby so that re-admission to the hospital or clinic is avoided.

DISADVANTAGES

There is a chance of regret.
It has a high cost at the time of procedure but there is no further cost after the operation.
It does not give protection from STIs, including HIV.
There may be some discomfort during and after the procedure.

MALE STERILIZATION

DESCRIPTION

It is a simple operation in which the tubes that carry the sperms in a man are cut and closed

HOW IT WORKS

When the tubes are cut, the man still makes semen (the milky liquid) when he has sex, but there are no sperms in it. Since there are no sperms in the man’s liquid, the woman cannot get pregnant.
The man can still have an erection, ejaculate and enjoy sex like before the operation.
The man looks and feels the same as he did before the operation.
It is not effective immediately so it is good to use condoms for 3 months after the procedure.

ADVANTAGES

After the operation, there is no more worry about a woman getting pregnant.
It does not interfere with sex.

DISADVANTAGES

There is a chance of regret.
Condoms should be use for 3 months after the procedure until all sperms have cleared from the semen.
There may be some pain and discomfort during and right after the procedure.
It does not gives protection from STIs, including HIV.

STANDARD DAYS METHOD

DESCRIPTION

Women track the days of the month that they are fertile hence they can become pregnant by using cycle beads or a calendar.
It can be used to identify which days a woman can become pregnant-for both women who want to avoid pregnancy and women who want to become pregnant.
A woman can use it if most of her menstrual cycles are 26 to 32 days long.
If a woman has recently given birth or breastfeeding, this method should not be used until she has had at least 3 menstrual cycles and her cycles are regular again. For several months after regular cycles have returned, use with caution
If a woman has recently had a miscarriage, this method should not be used until the start of her next monthly bleeding.
If a woman’s monthly bleeding has just stated or has become less frequent or stopped due to older age, cycle irregularities are common. Identifying the days when a woman can become pregnant may be difficult.

HOW IT WORKS

It prevents pregnancy by avoiding unprotected sex during the days a woman is most able to become pregnant.
A woman keeps track of the days of her menstrual cycle, counting the first day of monthly bleeding as day 1.
Days 8 through 19 of every cycle are considered days that a woman can become pregnant.
The couple will avoid vaginal sex or use condoms during days 8 through 19.
The couple can have unprotected sex on all the other days of the cycle- days 1 through 7 at the beginning of the cycle and from day 20 until the woman’s next monthly bleeding begins.
Each bead represent a day of the menstrual cycle.
On day 1- the first of monthly bleeding- move the rubber ring to the red bead.
The next day move the ring to the next bead. Do this every day, even bleeding days.
White bead days are days when the woman can become pregnant. She should avoid unprotected sex.
Brown bead days are days when pregnancy is unlikely and she can have unprotected sex.
If monthly bleeding begins again before reaching the brown bead, her menstrual cycle is shorter than 26 days.
If monthly bleeding does not begin before reaching the last brown bead, her menstrual cycle is longer than 32 days.
If a woman has more than 2 longer or shorter cycles within a years, the Standard Days Method will be less effective and she may want to choose another method.

ADVANTAGES

No side effects.
It does not affect a woman’s monthly bleeding.
Helps women learn about their bodies and the times they are likely and not likely to get pregnant.

DISADVANTAGES

Requires discipline and self-control by the couple.

LACTATIONAL AMENORRHEA METHOD (LAM)

DESCRIPTION

It is the use of breastfeeding as a temporary family planning. It provides natural protection against pregnancy and encourages couples to start making alternative arrangements for another family planning method at the proper time.

HOW IT WORKS

baby’s suckling suppresses the production of the hormones that are necessary for ovulation and without ovulation, pregnancy cannot occur.
A woman is naturally protected against pregnancy when:
* She exclusively breastfeeds her baby including feeding at night and on demand.
Exclusively means nothing but breast milk (no water)
* Her menstrual period has not returned after delivery
* Her baby is less than six months old

ADVANTAGES

It ensures the baby gets needed nutrients and protection from diseases.
It is highly effective and easy to use.
No supplies are needed.
It does not interfere with sex.
It has no side effect.
It has health benefits for both mother and infant.
It encourages bonding between mother and baby.

DISADVANTAGES

It is not an option for women who do not breastfeed.
Breastfeeding pattern may be difficult to maintain.
Duration of the method is limited.
There is no protection against Sexually Transmitted Infections (STI) including HIV/ AIDS.

MALE WITHDRAWAL METHOD

(Coitus Interrupt)

This is a method in which the man pulls out his penis from a woman's vagina before ejaculation during sexual intercourse. This is meant to prevent sperm from being released into the vagina. Often times, this method is not advisable; because some people are not emotionally strong enough to control the urge or speed at which the sperm is being realised. This method demands that a man must understand his body system very well: both physiologically, pschologically and emotionally.