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Family Planning

Family Planning. Women’s Health Training Day 2014. Outline. Contraceptive options Barrier Short-term hormonal options Long-term options Permanent Other Pregnancy options Continuing the pregnancy Terminating pregnancy. Learning Objectives.

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Family Planning

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  1. Family Planning Women’s Health Training Day 2014

  2. Outline Contraceptive options • Barrier • Short-term hormonal options • Long-term options • Permanent • Other Pregnancy options • Continuing the pregnancy • Terminating pregnancy

  3. Learning Objectives • Become comfortable discussing family planning options with patients • Advise patients according to their needs, including: • Lifestyle • Discretion • Adherence • Economic status • Personal values

  4. Barrier methods • Male condom • Female condom • Diaphragm • Cervical Cap • Sponge

  5. Short-term options • Oral contraceptives • progestin only • combined estrogen + progestin • combined triphasic • Patch • Nuva-ring • Depo-provera • Spermicide (non-hormonal)

  6. Risks of hormonal therapy (pill, patch) • General complaints: weight gain, breakthrough bleeding • Estrogenic effects: nausea, breast tenderness, fluid retention, 3x risk of DVT • Progestin effects: hair growth, male-pattern baldness, and nausea

  7. Contraindications (estrogen + progestin methods)

  8. Long-term optionsLARC = long-acting reversible contraceptive • Implanon, Nexplanon (hormonal implant) • Mirena, Skyla (hormonal IUD) • ParaGuard (copper IUD)

  9. Permanent options • Vasectomy • Tubal ligation (blocks fallopian tubes distally) • Essure (blocks fallopian tubes proximally)

  10. Methods that are free • Fertility awareness (“rhythm method”) • Clue App for smartphone • Withdrawal

  11. Typical vs. Perfect use

  12. Emergency contraception • Plan B (Levonorgestrel-based pills) • Ella • ParaGuard • Yuzpe Regimen (dependent on birth control pill)

  13. How to distill the contraception options? bedsider.org

  14. The user-experience

  15. Pregnancy Options

  16. Pregnancy OptionsContinuing pregnancy • Parenting • Resources at http://www.usa.gov/Topics/Parents.shtml • Adoption • Resources at https://www.childwelfare.gov/adoption/

  17. Pregnancy OptionsTerminating pregnancy • Medical abortion (<8.4 weeks) • Two consecutive pills • Done at home • Pros include privacy, support, feeling “more natural” • Procedural abortion • Options depend on how far along the pregnancy is • Done in the office – can be outpatient clinic • Pros include privacy, feeling “more taken care of”, over with faster

  18. USA Abortion Facts • 50% of pregnancies are unintended • 21% of pregnancies end in abortion • In 2011, 1.06 million abortions were performed, • This is down 13% from 1.21 million in 2008. • From 1973 through 2011, nearly 53 million legal abortions occurred.

  19. By age 45… • At least half of American women will experience an unintended pregnancy by age 45 • At 2008 abortion rates: • one in 10 women will have an abortion by age 20 • one in four by age 30 • three in 10 by age 45

  20. Abortion laws in GA • Abortion must be provided by a licensed physician • Prohibited after “viability” except in case of life or health endangerment • “Partial birth abortion” (intact dilation & extraction) banned post-viability • Public funds can only be used towards abortions in cases of life endangerment, rape, or incest

  21. Abortion laws in GA • Providers and institutions may refuse to participate • Mandatory counseling must include information on fetal pain, but not breast cancer risk or psychological distress risk • Mandatory 24-hour waiting period (initial consult may be done via phone) • Mandatory parental notice (not consent)

  22. References • Guttmacher Institute • Association of Reproductive Health Professionals (ARHP) • www.bedsider.org • Centers for Disease Control

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