General Health and Wellness ATP GROUP DISCUSSION – FAMILY PLANNING (DR ROTIMI ADESANYA)
Family planning (FP) allows individuals and couples to anticipate and attain their desired number of children and the spacing and timing of their births. It is achieved through use of contraceptive methods. Contraception means prevention of pregnancy, it is just one part of FP. In Nigeria alone a lot of women die from childbirth, More than 10 women out of every 1000 die in the rural areas. It’s slightly lower in the urban areas.
FP gives women opportunity to space their children. The risk of maternal depletion such as anemia, malnutrition, exhaustion, and emotional stress is reducedWhy are we talking about this on this platform: FP is one of the key points of child survival strategy. Considerations when choosing contraception should include accurate information about: Effectiveness in pregnancy prevention, health issues which may limit some choices, ease of use side effects including changes to usual periods, benefits other than contraception, cost and availability , reversibility, protection against sexually transmissible infections (STIs),religious or moral beliefs. No method is 100% effective except abstinence
Abstinence: Effectiveness (chances of NOT getting pregnant) is 100%.
Is abstinence possible in marriage, yes, if your partner is on vacation for study, career or abroad for greener pastures!
There are a number of different methods and it is important to choose one that best meets your needs and circumstances.
The most effective reversible methods are the “fit and forget”Intrauterine devices (IUDs) popularly called coil and contraceptive implants because they last longer.
We called them fit and forget because they are long-acting reversible contraceptives. IUDs and implants: are suitable for women of any age, can be used by most women, even if they have any significant health issues, can be removed easily at any time by a trained health professional and are immediately reversible on removal, involve an insertion and removal procedure by a doctor or nurse, provide no protection against STIs.
The Copper intrauterine device is a small device made from plastic and copper that is fitted inside the uterus. They stop sperm from reaching the egg and any fertilized egg from sticking to the wall of the uterus. They have no hormones and therefore have no effect on the normal female cycle but periods may become heavier when using a copper IUD. Cu-IUDs are 99.2% effective. IUDs need to be replaced every 5-10 years depending on their type or can be removed easily at any time. The hormonal IUD – Mirena®is a small T-shaped device that is fitted inside the uterus (womb). Over a 5 year timeframe, it slowly releases a very low dose of progestogen hormone into the uterus. Periods usually become lighter or may stop when using a hormonal IUD. It is very expensive, the price is about 20xce the other forms of IUD.The hormonal IUD is 99.8% effective. The good news is that all the methods mentioned so far don’t affect breastfeeding.
The advantages of the IUD are; it is easy to use, does not interfere with breastfeeding. has low maintenance method, can be easily inserted and removed in a clinic or doctor’s office, has no systemic side effects. Also depending on the type they can be left in place 1, 5, or 10 years and reduces the risk of tubal pregnancy.
The disadvantages of the IUD are; must be inserted and removed in a clinic or doctor’s office. Maybe some cramping or pain at the time of insertion may experience increased bleeding or cramping during periods. Also, there might be spotting between periods.
The contraceptive implant is inserted directly under the skin, on the inner arm above the elbow, where it continuously releases a low dose of a progestogen hormone into the blood stream over a 3-5 year timeframe. The implant works by preventing ovulation (egg release from the ovary). Devices need to be replaced every 3-5 years depending on the type or can be removed earlier if required.Implants are 99.9% effective. Commonly available implants are Implanon, Jadelle, and Norplant.
Contraceptive injections – Depot medroxyprogesterone acetate (DMPA).The contraceptive injection is given by an injection into a muscle every 12 weeks. It prevents pregnancy by stopping ovulation. Periods may stop while using DMPA and there may be a short delay in return to usual fertility. Only need to get a shot 4 times a year. You must go to the clinic or doctor’s office 4 times a year.DMPA is 94-99.8% effective.
The other hormonal types are shorter acting hormonal methods include the contraceptive vaginal ring – NuvaRing®; contraceptive Patch, the Combined oral contraceptive pill (The Pill) and the Progestogen-only contraceptive pill (mini pill).Pills rely on regular and consistent daily use to be effective.
Barrier methods are condoms and the diaphragm. They prevent semen from entering the uterus and can be an effective method of contraception when used consistently and correctly. The male condom is 82-98% effective for pregnancy prevention and consistent use is very important if they are the sole method of contraception. Condoms can be used in conjunction with other methods to increase contraceptive effectiveness. The female condom is a polyurethane sheath, which is inserted into the vagina before sex. It has two flexible rings to keep it in place in the vagina. The female condom is 79-95% effective.
Lactational Amenorrhoea Method (LAM): LAM is the use of breastfeeding as a contraceptive method. Breastfeeding reduces the probability of ovulation (egg release) occurring, therefore reducing the chance of a pregnancy.LAM is 98% effective when all 3 criteria are met: menstrual periods have not returned, gave birth less than 6 months ago, fully breastfeeding ( not feeding the baby with any food or milk supplements).It is not an effective method of FP after 6 months.
Emergency contraception (EC) can reduce the risk of unintended pregnancy after unprotected sex.EC is not a method of regular contraception. There are two types of EC − the emergency contraception pill (ECP), a pill containing a progestogen hormone and the Cu-IUD.The ECP can be taken up to 5 days after unprotected sex but it is most effective if taken in the first 24 hours. When taken in the first 72 hours (3 days), it prevents about 85% of expected pregnancies.Example is the popular postinor 2 and Plan B, Only method used to prevent pregnancy when a female condom was inserted or removed incorrectly or after a torn male Condom. Risk of Ectopic (tubal) pregnancy may be a possible result.Most women don’t have this information that a copper intrauterine contraceptive device (Cu-IUD) can also be used as EC. When inserted in the first 120 hours (5 days) after sex, it prevents about 99% of expected pregnancies. A Cu-IUD then provides immediate and ongoing contraception.
Permanent contraception (sterilization) for men or women involves a small operation by a surgical doctor with general or local anesthesia. Sterilization is permanent contraception which can’t be reversed, sterilization methods are 99.5% effective.
Female sterilization (tubal ligation) involves an operation blocking the Fallopian tubes to stop the passage of the ovum (egg). It is usually performed under a general anesthetic.
Male sterilisation involves an operation on the vas deferens to prevent sperm formed in the testes from joining the ejaculate fluid. It can be performed under local anaesthetic, often with light sedation.After vasectomy, a man will look and feel the same as before. He can have sex the same as before. His erections will be as hard and last as long as before, and ejaculations of semen will be the same. He can work as hard as before, and he will not gain weight because of vasectomy. Contraceptive injections for men are not yet available, but clinical studies suggest that the combination of the hormones testosterone and progesterone may provide a safe, effective and reversible method of male contraception in the future.
Family planning methods can be used by both men and women. The methods are even more effective when both partners are involved and supportive of each other. FP does not cause infertility but when a woman goes off the family planning method, it may take a few months for cycles to return to normal or for her to get pregnancy.
Some family planning methods may cause side effects but these are manageable and usually disappear with time. Some women may experience headaches, irregular bleeding, mild abdominal pain, weight change among others. The injectable and implant DOES NOT cause cancer, they actually provides a protective effect from cancer of the ovaries and cancer of the endometrium.
Space your children so that they will get the best of social, health, psychological and mother care. Also, men should support the women in making choices about family planning, no woman should be allowed to suffer because of unplanned Family.
Contraceptive injections – Depot medroxyprogesterone acetate (DMPA).The contraceptive injection is given by an injection into a muscle every 12 weeks. It prevents pregnancy by stopping ovulation. Periods may stop while using DMPA and there may be a short delay in return to usual fertility. Only need to get a shot 4 times a year. You must go to the clinic or doctor’s office 4 times a year.DMPA is 94-99.8% effective.
Written by: Dr Rotimi Adesanya, A Family Physician
