Facts about Pakistan One birth every 7 seconds 3 mothers die in childbirth every hour 12 million children under 5 years are malnourished 50% of population are lacking safe drinking water. 60% lack safe sanitary facilities One doctor per 2008 persons One nurse per 6500 persons One hospital bed per 1506 persons Unemployment, law and order problems and social unrest increasing.

Population Profile 3.2 million million million By year 2015 Population below poverty line 33.1%

Surgical Contraception Female Sterilization Laparoscopic Minilap Vaginal tubectomy Male sterilization vasectomy

Non surgical Tubal Occlusion Quinacrine pellets Tetracycline methyl cyanoacrylate Oviduct plugs

Barrier methods of C.C Male condom Advantages Simple Responsibility on male Protects against the transfer of venereal diseases

Male condom Disadvantages Expensive Less satisfying sex Allergic reactions Failure rate per HWY

Diaphram Functions 1.Retainer of the spermicide 2.To keep sperms away from alkaline receptive cervical mucus 3.Prevent the cervical mucus reaching the vagina 4.Prevents the aspiration of the sperms into the cx & the uterus

Diaphram Advantages –Safe,cheap,easy –Orgasm Does not influence the orgasm of either partner. Disadvantage Less effective in case of prolapse and retroversion Failure Rate 2-15/100 women years

Intrauterine Devices Multiload Cu 250 and 375. These come preloaded and doesn't require to be loaded in the inserter.

Contraceptive prevalence rate (CPR) Iran23% Bangladesh40% Indonesia48% Malaysia51% Turkey72% Pakistan 12%

CONTRACEPTION

Contraception Saves Lives

Contraception means prevention of conception by any method with out abstinence from sexual intercourse.

MOTIVATION

Counselling Is the process of helping clients to make informed and voluntary decisions about choice of contraception.

Methods of Contraception Physiological methods –Rhythm method –Incomplete method Chemical methods Barrier methods Intrauterine contraceptive devices Hormones Sterilization Early abortion

Natural Family Planning Abstaining from sexual intercourse during fertile phase of menstrual cycle.

Fertility Cycle Phase I:Relatively infertile phase (approx first 7 days) Phase II:Fertile phase (approx 8 to 16 th day) Phase III: Absolutely infertile phase (approx 17 th to 28 th day)

Rhythm Method Advantage No expensive involved No side effects Disadvantage Planning of coitus Dependence on regularity of the cycle Suitable for educated,intelligent & cooperative women

AdvantageSafe,easy,cheap Orgasm doest not interfer with the orgasm of either partner. Disadvantage Less effective in case of prolaspe and retroversion Failure Rate2 – 15 /100 women years.

Intrauterine C.C device Copper 250 and 375 Multiload Hormone releasing IUCDs Progestasert Levonorgesrel (Mirena) levonova Preloaded doesn't require to be loaded in the inserter.

Method Pass uterine sound to measure the length of uterine cavity Introduce the multiload with the inserter until it touches the fundus Then withdraw the inserter.

Mode of action Immobilize the sperm and prevent it from fertlizing the ovum. Inflammatory reaction in the Endometrium prevents embedding of fertilzed ovum. Hormonal Effects.

Contradictions

Complications

Hormonal Contracption COC pills Progesterone only pill Long acting pill Intectables Vaginal rings implants

Contraindications oral contraception Absolute –Cholestatic jaundice of pregnancy –Porphyria –Pruritis of pregnancy –Herpes gestationalis –Cancer of breast.

Contraindications oral contraception Relative –Thromboembolism –Blood dyscrasias –Diabetes –Obesity –Chorea –Migraine –Varicose veins –Asthma –Depressive psychosis –Elective surgery

SEQUENTIAL PILL Two types of pill First 14 containj only oestrogen And last seven a combination of oestrogen and progestrogen

PROGESTRONE ONLY PILL Mini pell 28 or 35 packet - femules-500ug28 - Moridey-250ug28 - Microval-30ug35

ADVANTAGES - POP Do not treduce breast milk Suitable for women with contraindication of oestrogens Minimal side effects No risk of circulatory or malignant disease

LONG ACTING PILLS Once a month Quinestrel + Levonorgestrel

INJECTABLES DEPOPROVERA (DMPA) –150mg every 12 wks NORIGEST (NET-EN) 200 mg ever 08 wks CYCLOPROVERA Once a month

ADVANTAGES INJECTABLES Highly effective Easy to deliver Use independent of sexual intercourse Do not reduce breast milk May reduce anaemia Less dysmenorrhoea & PMT

DISADVANTAGES INJECTABLES Requires regulkar visits to the clinica for injections Not retrievable Return to fertility is delayed for months Menstrual irregularities Galactorrhoea Mild androgenic affects Enuresis

VAGINAL RINGS Shell type Core type Contain Oestrogen + Progesterone or only Progesterone Rings changed every 03 months

CONTRACEPTIVE IMPLANTS NON – Biodegradable –Norplant – 1 -5 yrs –Norplant – 2-3 yrs –Implnon-3yrs Biodegradable Capronor-one year

POST COITAL CONTRACEPTION Immediate insertion of copper- T The YUZPE method –2 tabs of COC at once and 02 tabs after 12 hours Ethinyl Oestradiol -2.5 mg bd * 05 days Conjugated equine oestrogens -10 mg tds * 05 days

MECHANISM OF ACTION POST COITAL CONTRACEPTION Block implantation Uterine fluid / genital tract mucus rendered hostile to sperm or blastocyst

RISK OF PREGNANCY POST COITAL CONTRACEPTION 20 % 30 % on the day of maximum risk