1. Family Planning - Dr Sienna Tran
Australian South Asian Healthcare Association (ASHA)
Maternal Health Education Program

2. What is Family Planning
Family planning 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 and the treatment of involuntary infertility.
A woman’s ability to space and limit her pregnancies has a direct impact on her health and well-being as well as on the outcome of each pregnancy.
Reduces the need for unsafe abortions (the cause of 13% of maternal mortality worldwide)
Some methods of contraception reduce the transmission of sexually transmitted infections (including HIV)
(WHO, 2015)

3. The Menstrual Cycle Fertile window
5 days before ovulation and on the day of ovulation.

4. Contraception

5. Natural Methods of Birth Control
Fertility awareness methods – 76% effective
Avoidance of intercourse during the fertile phase of the
menstrual cycle
Methods:
Calendar/cycle method
Cycle length is recorded for at least 6 cycles and then fertile days are calculated
Temperature method
Ovulation causes your basal body temperature to increase by ˚C, intercourse should be avoided from the onset of menstruation until the third day on which the higher level temperature has been recorded
Cervical mucous method (Billing’s method)
“fertile mucous” looks like raw egg white – clear, slippery and stretchy
Ovulation most likely to happen on the final day of “fertile mucous”
Sympto-thermal method
A combination of above methods

6. Natural Methods of Birth Control
Lactational Amenorrhoea method - 98% effective
The use of breastfeeding as a contraceptive. Effective only if meets all criteria of:
Exclusive breastfeeding, including >1 overnight
<6 months post-birth
Menstrual periods have not returned post-birth
Coitus interruptus (withdrawal method) – 78% Effective
Where the male withdraws from the woman’s vagina before ejaculation

7. Does not interfere with the menstrual cycle
Advantages
Disadvantages
No cost
Natural
Does not interfere with the menstrual cycle
It can be difficult to predict ovulation especially in women with irregular periods
requires a lot of commitment and daily awareness of changes
requires varying periods of abstinence if it is the only method used
Sperm can be found in pre-ejaculatory fluid.

8. Barrier Methods
Provide a physical barrier which stopes the sperm from getting into the vagina or the upper genital tract
Male condoms - 82% effective
Female condoms – 79% effective
Caps – used in combination with spermicides
Female Diaphragm – 88% effective
Cervical and vault caps
Vaginal sponge
Use with spermicide
inserted into vagina to cover cervix
Spermicides

9. Advantages
Disadvantages
Male condoms protect against STIs
Low cost
Only need to be used during intercourse
Cost
Can be a problem if sensitive to latex, spermicide or lubricant
Condoms can break or slip off
Female condoms can be difficult to place
Diaphragms can cause local irritation

10. Progestogen Only Pill (POP)
91% effective
Contains low dose progestogen
Thickens cervical mucous so that sperm cannot enter the uterus
Changes lining of uterus making it unsuitable for pregnancy
May prevent ovulation
Must be taken at the same time every day (3 hour window)

11. Advantages
Disadvantages
Can be used if breastfeeding
Rapid return to fertility
Can be used by women who cannot use the COCP / oestrogen
Cost
Affects menstrual bleeding
Does not protect against STIs
Must be taken at the same time every day

12. Combined Oral Contraceptive Pill (COCP)
91% effective
Contraceptive pill containing 2 hormones – oestrogen and progestogen
Prevents ovulation
Thickens cervical mucous
Thins lining of uterus
Taken daily
Additional contraception needed if pills are missed
Monthly bleed occurs during the ‘inactive’ pills
Contraindications: Undiagnosed vaginal bleeding, cardiovascular disease, liver disease, some cancers, etc.

13. Advantages
Disadvantages
Highly effective
Rapid return to fertility
Can control when you have your period
Cost
A rare but serious risk of thrombosis (blood clots)
Does not protect against STIs
Must be taken daily
Side effects: nausea, headache, breast tenderness

14. Contraceptive Vaginal Ring
91% effective
Soft plastic ring inserted into the vagina, releases
low doses of oestrogen and progestogen
Prevents ovulation
Thickens cervical mucous
Changes lining of uterus
Insert ring on day 1-5 of cycle (day 1 is the day your period starts), ring is left in place for 3 weeks, then removed and a new ring inserted a week later.
A monthly bleed occurs in the week when there is no ring in place

15. Contraceptive Injection
94% effective
A hormonal contraceptive given by injection every 3 months
Contains progestogen
Prevent ovulation
Thickens cervical mucous

16. Contraceptive Implant (Implanon)
99% Effective
A small rod that is placed under the skin and releases the hormone progestogen into the blood stream
Lasts up to 3 years

17. Intrauterine Devices Mirena Copper intrauterine device 99% effective
Plastic, T-shaped device that sits in the uterus and releases progestrogen
Lasts up to 5 years
Not suitable for use in some circumstances e.g. recent pelvic infection, recent breast cancer
Copper intrauterine device
Prevent fertilisation
Can last up to 5-10 years

18. Advantages
Disadvantages
Highly effective
Long-acting
Fast return to fertility
Needs to be inserted by trained professional
May have irregular spotting
Does not protect against STIs
May fall out
Risks with insertion – perforation, infection

19. Sterilisation Female sterilisation Male Sterilisation (vasectomy)
99% effective
Surgical procedure that involved blocking or cutting the Fallopian tubes (where eggs travel from the ovaries to the uterus) to prevent the ova (eggs) from coming in contact with sperm
Permanent
Male Sterilisation (vasectomy)
Surgical procedure that involves blocking the path of
sperm by cutting or tying the tube that transports it

20. Emergency Contraception
Copper Intrauterine device
Can be inserted up to 5 days after unprotected sex
Not if there is any possibility of a sexually transmitted infection
Progestogen only emergency pill
Used up to 72 hours after unprotected sex
Works mainly through inhibiting ovulation
Can be used more than once in a cycle
Ulipristal acetate (selective progesterone receptor modulator)
Used up to 120 hours after unprotected sex
Inhibit or delay ovulation
Use only once per cycle

21. References
World Health Organisation, Family Planning/Contraception, 2015,
Family planning Australia
Luesly & Kilby, Obstetrics & Gynaecology: An evidence based text for the MRCOG, 3rd Ed, 2016