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April 2010 Meera Beharry, MD Division of Adolescent Medicine University of Rochester Medical Center ACT for Youth Center of Excellence

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family planning 101 key concepts in adolescent health care

April 2010

Meera Beharry, MD

Division of Adolescent MedicineUniversity of Rochester Medical Center

ACT for Youth Center of Excellence

Cornell University Family Life Development CenterCornell University Cooperative Extension of New York CityNew York State Center for School SafetyUniversity of Rochester Medical Center Div. of Adolescent Medicine

Family Planning 101: Key Concepts in Adolescent Health Care

objectives
Objectives
  • Define family planning
  • Describe methods of contraception
  • Identify resources for adolescents
family planning
Family Planning
  • The use of education and birth control to limit the number of offspring and the population of a country.

American Heritage® New Dictionary of Cultural Literacy, 3rdEd, 2005 by Houghton Mifflin Company

legal issues
Legal Issues
  • Distributing information and counseling patients about contraception was illegal under federal and state laws.

AP

Margaret Sanger, 1914

us fertility rates 1917 1997 and key family planning events
US fertility rates: 1917-1997 and Key Family Planning Events

Title X established

Birth Control Pills, IUD approved by FDA

Timing of ovulation established

MMWR, Dec 03, 1999 48(47);1073-1080

myriad of methods

Ring

Patch

Cap

Implant

Diaphragm

Condoms

Spermicides

Abstinence

Pills

Injection (“shot”)

IUD

Myriad of Methods
decision 1

Decision 1

Hormonal, Non-hormonal or both?

non hormonal barrier10

Spermicide

Cervical Cap

Spermicides

Diaphragm

Non-Hormonal/Barrier
  • Condoms
  • Diaphragm
  • Cervical Cap
non hormonal barrier11
Non-Hormonal/Barrier
  • Condoms
  • Diaphragm
  • Cervical Cap
  • Copper IUD
non hormonal barrier12
Non-Hormonal/Barrier
  • Condoms
  • Diaphragm
  • Cervical Cap
  • Spermicide
  • Copper IUD
  • Abstinence1
  • Period abstinence/fertility awareness1
  • “Withdrawal”, coitus interruptus

1 Society for Adolescent Med., J Adolesc Health 2006;38:83–87

hormonal
Hormonal
  • Pill
    • Daily
    • Emergency (not recommended as a regular form of birth control)
hormonal14

Patch

Hormonal
  • Pill
  • Patch
hormonal15
Hormonal
  • Pill
  • Patch
  • Injection
hormonal16
Hormonal
  • Pill
  • Patch
  • Injection
  • Ring
hormonal17

IUD

Hormonal
  • Pill
  • Patch
  • Injection
  • Ring
  • Progesterone IUD
hormonal18
Hormonal
  • Pill
  • Patch
  • Injection
  • Ring
  • Progesterone IUD
  • Implantable device
non hormonal barrier20
Advantages

No hormones

Fewer or no medical contraindications*

Can prevent STD

Disadvantages

Event based use

Some need a doctor’s visit

Non-Hormonal/Barrier
hormonal21
Advantages

Not event dependent

Additional health benefits

Menstrual symptoms

Acne

Lower cancer risk

Less blood loss

Disadvantages

Require use as prescribed

Some medical contraindications

Hormonal
quick quiz

Quick Quiz

Does a young woman need to have a pelvic exam before starting birth control?

decision 2 if hormonal method

Decision 2: if hormonal method

Any contraindications?

w h o absolute contraindications to estrogen containing products
Blood clotting problems

Stroke

Very high blood pressure

Some cancers

Some liver diseases

Major surgery with prolonger immobilization

Migraine headaches with aura

W.H.O. Absolute Contraindications to Estrogen Containing Products

http://whqlibdoc.who.int/hq/2008/WHO_RHR_08.19_eng.pdf

decision 3 if hormonal method

Decision 3: if hormonal method,

How often do you take it?

quick quiz33

Quick Quiz:

Match the method

what if
What if….

…the condom broke or slipped off...

…you forgot your regular birth control...

…you were forced to have sex...

Association of Reproductive Health Professionals

emergency contraception38
Emergency Contraception
  • What is it?
    • A method for preventing implantation
    • A method for preventing fertilization
  • There are three types available in the U.S.
emergency contraception pills
Emergency Contraception Pills
  • What they are not:
    • They are not the “abortion pill”
    • They are not a form of family planning
resources
Resources
  • Internet:
    • http://youngwomenshealth.org/
    • www.plannedparenthood.org
    • http://ec.princeton.edu/
  • Current health care provider
    • www.adolescenthealth.org
  • Family Planning Benefit Program
    • www.nyhealth.gov/community/pregnancy/family_planning/program_sites.htm
slide42

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