Contraceptive Technology Overview

1. Contraceptive Technology Overview

2. Session Objectives At the end of this session, the participants will be able to: Identify how contraceptive methods physiologically work on the male and female reproductive system Compare and contrast, using reference materials, mechanism of action, advantages, disadvantages, special issues and instructions for each contraceptive method presented Identify contraceptive methods for birth spacing versus birth limiting Become familiar with the “Decision Making Tool for FP Clients and Providers”

3. Session Objectives (2) Define “medical eligibility,” name the source of international standards for eligibility Use the pregnancy checklist. Name at least two new methods of FP Identify the contraceptive methods that are particularly appropriate for sexually active youth

4. Name traditional methods women use in your region

5. What are the main categories of contraception? Birth Spacing - Temporary Methods of contraception Natural methods Artificial methods Short term Long term Birth Limiting - Permanent Methods of Contraception Emergency Contraception Please cite methods that women traditionally use to prevent pregnancy in your setting? Please cite methods that women traditionally use to prevent pregnancy in your setting?

6. Birth Spacing - Temporary Methods of Contraception Lactational Amenorrhea Method (LAM or Exclusive Breast Feeding) Natural methods. Fertility awareness/Periodic abstinence Cervical Mucus (BOM – Billing ovulatory method) Calendar method/Rhythm (Safe days)/Ogino-Knaus Standard Day Method (SDM) TwoDay Method Basal Body Temperature Symptothermal

7. Birth Spacing - Temporary Methods of Contraception (2) Artificial Short term: Barriers Male condoms (Latex, synthetic non-latex e.g. Durex Avanti, eZ-on, Tectylon ) Female Condom (Reality/FC female condom, VA female condom, PATH Woman’s condom) Diaphragm (SILCS, Lea’s Shield) Cervical caps (FemCap, Oves) Vaginal rings e.g. NuvaRing Sponge (Today sponge, Protectaid sponge) Spermicides, jellies, creams,

8. Birth Spacing - Temporary Methods of Contraception (3) Artificial Short term met: Transdermal e.g. contraceptive patch (Ortho Evra), Spray (Nesterone Metered Dose Transdermal System) The pill COCs e.g. Microgynon,Nordette, Trinordial, Marvelon, Seasonale, Yasmin (contains dropirenone) POPs e.g. Microlut, Exluton, microval, Cerazette (contains desogestrel)

9. Birth Spacing- Temporary Methods of Contraception (4) Artificial Short term met: Injectables Progestogen only DMPA, Uniject – depo – subQ Provera 104 (DMPA – SC) Net en/Noristerat) Combined Mesigyna (Norigynon) Cylofem (Nunelle, Lunella, Cyclo-Provera, Novafem, Feminera)

10. Birth Spacing - Temporary Methods of Contraception (5) Long term: IUCDs, Copper e.g. CuT380A (12 yrs), Multiload 375 (7 yrs), Progestin - releasing e.g. Minera (5 yrs), Femilis, Femilis Slim (for nulliparous), FibroPlant (3 yrs) Frameless e.g. GyneFix, FibroPlant – LNG (3 yrs) Implants e.g. Norplant (5 yrs), Jadelle (5yrs), Implanon (3yrs), Nesterone (2 yrs )

11. Birth Limiting - Permanent Methods of Contraception Sterilization Transcervical (through hysteroscopy) Chemicals e.g. Quinacrine Plugs e.g. Adiana procedure Microcoils e.g. Essure Tuballigation Laparotomy Minilaparotomy Vasectomy Classical, No-scalpel Other male methods: Longer- acting formulations of testosterone alone or in combination with a progestin

12. What are the main categories of emergency contraception? Emergency Contraception Yuzpe method Progestin only IUD

13. What do family planning clients desire in a family planning method?

14. Clients Desire for FP Methods More choices – helps ensure that users are satisfied with their FP method Highly effective protection Costs less Easier to use

15. Pregnancies per 100 Women in 1st 12 Months of FP Use Method Typical Use Perfect Use No method 85 85 Spermicides 26 6 Female condoms 21 5 Male condoms 14 3 Fertility awareness 20 9 * BTT 20 2 * Cervical mucus 20 3 * Calendar 13 9 * SDM 12 5 * LAM – 6 months 2 0.5 Diaphragm with Spermicide 20 6 COCs 8 0.1 POPs + breastfeeding 1 0.5 TCu-380A 0.8 0.6 Female sterilization 0.5 0.5 DMPA & NET EN 0.3 0.3 Vasectomy 0.15 0.1 Norplant implant 0.1 0.1

16. For services to be of quality All FP clients should have services that include: Providers trained in counseling Informed choice Informed consent Rights of the client Adequate and appropriate equipment and supplies Service providers should be provided with guidelines for screening clients Methods requiring surgical approaches need trained staff, equipped facilities and infection prevention procedures must be in place

17. Informed Choice and Informed consent Informed choice: An individual’s well-considered, voluntary decision based on: Options Information Understanding Informed consent: A medical, legal, and rights-based construct whereby the client agrees to receive medical treatment, to use a family planning method, or to take part in a study, (ideally) as a result of the client’s informed choice Individual: informed choice is something that is experienced by the client rather than something that is done by the provider. The client can reach an informed choice anywhere, at any time, and does not necessarily require the input of a healthcare worker. Well-considered: taking into consideration the client’s health status, relationship status, risk of STIs, preferences, beliefs and lifestyle; and confirmation that the client doesn’t have any unrealistic expectations about the method (e.g., wants sterilization to space births but wants more children in future). Voluntary: no pressure, coercion, stress or access barriers Options: awareness of, and access to, a choice of methods Information: about options, advantages and disadvantages, effectiveness, side effects, risks. Sources of information for the client vary widely; a health care provider may be only a minor source. Thus, the challenge for providers is to determine what information each client needs and how to provide enough information, without overwhelming the client with too much detail. Understanding: information from providers must be in language and terms client can understand; client need to understand consequences of different choices Individual: informed choice is something that is experienced by the client rather than something that is done by the provider. The client can reach an informed choice anywhere, at any time, and does not necessarily require the input of a healthcare worker. Well-considered: taking into consideration the client’s health status, relationship status, risk of STIs, preferences, beliefs and lifestyle; and confirmation that the client doesn’t have any unrealistic expectations about the method (e.g., wants sterilization to space births but wants more children in future). Voluntary: no pressure, coercion, stress or access barriers Options: awareness of, and access to, a choice of methods Information: about options, advantages and disadvantages, effectiveness, side effects, risks. Sources of information for the client vary widely; a health care provider may be only a minor source. Thus, the challenge for providers is to determine what information each client needs and how to provide enough information, without overwhelming the client with too much detail. Understanding: information from providers must be in language and terms client can understand; client need to understand consequences of different choices

18. Benefits of Informed Choice in Family Planning Increases the chances of correct method use, reducing unwanted pregnancy Reduces fear and dissatisfaction related to side effects, making continuation more likely Increases client’s ability to recognize serious warning signs, reducing health risks Increases client satisfaction and promotion of the program by positive word-of-mouth Increases a person’s sense of empowerment and self-esteem Promotes positive relationships between providers and clients

19. Clients Who Receive Their Method of Choice Are More Likely to Continue Using the Method The 1991 Pariani study shows that clients who receive their method of choice are much more likely to continue using the method. Approximately 90% of the women in the study who received their method of choice were continuing one year later. Whereas only 20% of the women who had not received their method of choice were still using a method after a year. The 1991 Pariani study shows that clients who receive their method of choice are much more likely to continue using the method. Approximately 90% of the women in the study who received their method of choice were continuing one year later. Whereas only 20% of the women who had not received their method of choice were still using a method after a year.

20. Medical Eligibility Criteria for Contraceptive Use (MEC) WHO’s - Evidence-Based Guidance For Contraceptive Use The Medical Eligibility Criteria address who can use contraceptive methods, for example, can women with hypertension use the pill or can women with diabetes use Depo-Provera? The Medical Eligibility Criteria address who can use contraceptive methods, for example, can women with hypertension use the pill or can women with diabetes use Depo-Provera?

21. Utilization of evidence-based information

22. Purpose of the Medical Eligibility Criteria (MEC) To base guidelines for family planning practices on the best available evidence To address and change misconceptions about who can and cannot safely use contraception To reduce medical policy and practice barriers (i.e., unjustified by the evidence) To improve quality, access and use of family planning services MEC meant to inform national policies and guidelines, and ultimately, by addressing misconceptions and other medical barriers, to improve service quality, access, and use Service guidelines necessary but not sufficient—research shows that adherence to recommended practices does not automatically occur or improve without active intervention, but that such adherence does in fact improve with active intervention such as training/seminars MEC meant to inform national policies and guidelines, and ultimately, by addressing misconceptions and other medical barriers, to improve service quality, access, and use Service guidelines necessary but not sufficient—research shows that adherence to recommended practices does not automatically occur or improve without active intervention, but that such adherence does in fact improve with active intervention such as training/seminars

23. MEC Categories The classification takes into account whether the client is initiating (I) a method or is a continuing user. The classification takes into account whether the client is initiating (I) a method or is a continuing user.

24. WHO Eligibility CriteriaBased on low dose formulations

25. Other Useful Resources Decision-making tool Checklists Pregnancy checklist CBD – DMPA checklist COC checklist Essentials of contraceptive technology

26. How a service provider can be reasonably sure that a woman is not pregnant No signs or symptoms of pregnancy, and No intercourse since last normal menses, or Correctly and consistently using another reliable method, or Within 7 days after onset of normal menses, or

27. How a service provider can be reasonably sure that a woman is not pregnant (2) Within 7 days post-abortion or miscarriage or Within 4 weeks postpartum (non-lactating), or Fully or nearly fully breastfeeding, amenorrheic, and less than 6 months postpartum.

28. Thanks for participating