1. Pre-service Education on FP and AYSRH
Session III Topic 6 Contraception and Safe Sex
Contraception and Safe Sex, Session III Topic 6 Slide 1

2. No Risk Sex
There are many ways explore sexuality that are not risky. Some of them include hugging, holding hands, massaging, rubbing against each other with clothes on, sharing fantasies, masturbating the partner or masturbating together, as long as men do not ejaculate near any opening or broken skin on their partners.
Slides 9-13
Ask students to reflect on the following terms. Go around the group in a circle and ask them to share the first thing that pops into their head when you say each of the terms:
Unprotected sex
Risk behaviors
Safe sex
Protected sex
Encourage students to freely say the first thing that pops into their heads and not worry about “right” or “wrong” answers.
Pass out Handout #2: Sexual Safety Questionnaire and ask students to spend 10 minutes filling out the questionnaire
Using the answer key (which is in the Instructors Manual) read the questions and ask students to give the correct answers.
Discuss questions the students found difficult or answers where they did not agree.
Explain that practicing safer sex also provides protection from pregnancy. Counseling adolescents on safer sex and sexual protection focuses on first building their capacity to assess the relative risk of various sexual practices.
Show the slides that differentiate between sex that is no risk, low risk, medium risk and high risk.
Discuss dual protection, which provides protection from both pregnancy and STI/HIV.
Contraception and Safe Sex, Session III Topic 6 Slide 2

3. Low Risk Sex
There are other activities that are mostly safe such as using a latex or polyurethane condom or other barrier for every penetrative act of sexual intercourse (penis, fingers, or other objects in vagina, anus, or mouth), using a barrier (such as a latex dental dam, a cut-open condom or plastic wrap) for oral sex on a woman or for any mouth to anus contact. Most kissing is also safe, provided neither partner has any cuts or sores on, in, or around their mouths.
Contraception and Safe Sex, Session III Topic 6 Slide 3

4. Medium Risk Sex
There are activities that carry some additional risk, such as introducing an injured finger or hand into the vagina or anus or sharing sexual toys (rubber penis, vibrators, etc.) without cleaning them.
Contraception and Safe Sex, Session III Topic 6 Slide 4

5. High Risk Sex
There are activities that are very risky, because they lead to exposure to the body fluids in which most STIs, including HIV, live. These include having any kind of sexual intercourse without using a condom or having oral sex without a latex barrier. Sex which is coerced or non-consensual and forceful may also carry additional risk due to likelihood of small cuts or tears resulting from violence.
Contraception and Safe Sex, Session III Topic 6 Slide 5

6. Dual Protection
Dual protection is the consistent use of a male or female condom alone or in combination with a second hormonal or permanent contraceptive method. Often adolescents come to a clinic for contraception and are given a method that protects them only from pregnancy. As providers, we should ensure that all adolescents are using a method or combination of methods that protect them from both pregnancy and STIs/HIV.
Contraception and Safe Sex, Session III Topic 6 Slide 6

7. Risks and Consequences of Adolescent Pregnancy
Health Risks
Cephalopelvic disproportion (CPD)
• Pre-eclampsia (hypertension of pregnancy)
• Anemia
• Unsafe abortion
• Premature Birth
• Spontaneous Abortion and Still Births
Ask students, what are the health risks related to early pregnancy?
Using Slide #2: Risks and Consequences of Adolescent Pregnancy fill in any missing information.
The Health Risks of Adolescent Pregnancy include:
Cephalopelvic disproportion (CPD): Adolescents younger than 17 often have not reached physical maturity and their pelvises may be too narrow to accommodate the baby's head. In these cases, obstructed delivery and prolonged labor are more likely, thereby increasing the risk of hemorrhage, infection, and fistula.
Pre-eclampsia (hypertension of pregnancy): If pre-eclampsia is left uncontrolled, it can progress to extreme hypertension, seizures, convulsions, and cerebral hemorrhage.
Anemia: The World Bank reports that anemia is 2 times more common in adolescent mothers than among older ones.
Unsafe abortion: Few young women have sufficient money to pay for an abortion. They tend to wait later in their pregnancy before seeking an abortion and often resort to cheaper and more dangerous methods.
Premature Birth: Infants born to adolescent mothers are more likely to be premature, of low birth weight, and to suffer consequences of retarded fetal growth.
Spontaneous Abortion and Still Births: Young adolescents under the age of 15 are more likely to experience spontaneous abortion and still births than older women
Contraception and Safe Sex, Session III Topic 6 Slide 7

8. Psychological, Social, and Economic Consequences of Adolescent Pregnancy
For Girls • Can’t continue education • Changes choice of career, opportunities, and future marriage • Early marriage • Stigma of illegitimacy if no marriage • Young mothers are often ill prepared to raise a child • Girls resorting to commercial sex work are at higher risk for gender-based violence, substance abuse, and STIs such as HIV.
Draw a picture of a tree on a flipchart. The trunk of the tree should be labeled "Unwanted pregnancy.”
Ask students to remember some of the reasons adolescents may not practice safe sex that were discussed earlier. Label the roots with the reasons that adolescents don’t use protection (such as lack of access, myths and misperceptions about contraceptives, etc)
Ask students to think of as many social, psychological, and economic consequences of an unwanted pregnancy as possible for the adolescent mother, father, and infant. Each student answer should be drawn as a piece of fruit on the tree. Supplement answers with the content on the slides # 3 and 4.
Explain that an early pregnancy has serious consequences for the adolescent mother, father, and child. It is important that childbearing is delayed as much as possible.
Remind students of how to support young men and women to practice healthy timing and spacing of pregnancy.
Show Slide 5: Healthy Timing and Spacing of Pregnancy (HTSP) and remind them of the importance of timing and spacing pregnancies.
Contraception and Safe Sex, Session III Topic 6 Slide 8

9. Psychological, Social, and Economic Consequences of Adolescent Pregnancy (continued)
For Boys • In some societies, early fatherhood may enhance a young man's social status, which may encourage boys to practice unprotected sex. • Some boys refuse to take responsibility for the pregnancy which contributes to hardship for the mother and child and also can lead to future remorse. •Lost opportunities for education and economic advancement. • Often ill prepared to raise a child • Marriages are frequently unstable and end in divorce
Contraception and Safe Sex, Session III Topic 6 Slide 9

10. Healthy Timing and Spacing of Pregnancy (HTSP)
Support men and women practice healthy timing and spacing of pregnancy.
This means that:
After a live birth, couples should wait at least 24 months before trying to become pregnant again.
After a miscarriage or abortion, couples should wait at least six months before trying to become pregnant again.
Adolescents should delay pregnancy until at least 18 years of age.
Women and men should use a family planning method of their choice to delay and space their pregnancies.
Contraception and Safe Sex, Session III Topic 6 Slide 10

11. Contraceptive Methods for Adolescents
All methods of contraception are safe for use with adolescent clients.
Important issues for discussion include:
Safety
Appropriateness
Special Considerations
Counseling Issues
Divide students into 2 or 3 teams.
Give each team a different colored piece of paper. This piece of paper will be used by the team leader to signal that their team has an answer.
Ask each of the questions below, one at a time. Each team should talk amongst themselves to come up with their answer. When the team has an answer, the team leader should raise the colored piece of paper. The team that raises the paper first has the opportunity to share their answer. If they don’t get it right the next team to raise their paper can share their answer. The team gets one point for each correct answer.
The team with the most points at the end wins a small prize (e.g., candy).
When the game is over, the trainer should review the questions and the correct answers using the content below.
Question 1: Which contraceptive methods are safe for young women under age 25 to use who have not had children?
Answer 1: Nearly all contraceptive methods are safe for women of all ages, this include pills, injectables, implants, IUDs, condoms, and more.
Continue on next slide note pages
Contraception and Safe Sex, Session III Topic 6 Slide 11

12. Side effects are the major reason that clients stop using a method.
Common Side Effects of Contraceptive Methods and Their Impact on Clients
Most side effects from contraceptive methods pose no health risk to clients. However, providers should take them seriously because they can be uncomfortable, annoying, or worrisome to clients.
Side effects are the major reason that clients stop using a method.
Question 2: What methods can be used while a woman is breastfeeding?
Answer 2: A woman is only preventing pregnancy through breastfeeding (LAM) if the baby is less than 6 months old, the baby is fully breastfed (no other food or water is given to the baby, not even water), and the woman’s monthly bleeding has not returned. A woman/couple can use the progestin-only pills (POPs), implants, progestin-only injectables, IUDs, and male and female condoms during the post- partum period and while breastfeeding. The IUD can be inserted within 48 hours post-partum. After the 48 hour post-partum window, delay insertion until 4 weeks post-partum. Progestin-only pills and implants can be used immediately after birth. Progestin-only Injectables can be used starting 6 weeks after childbirth.
Question 3: True or False: The Standard Days Method which is a Natural Family Planning Method may not be appropriate for adolescents unless their cycles are regular.
Answer 3: True. Menstrual cycle irregularities are common in young women in the first several years after their first monthly bleeding. Identifying the fertile time may be difficult, so SDM may not be the best method for adolescent clients.
Question 4: True or False: Married or cohabitating couples should not use contraception until they have finished having all the children they want to have.
Answer 4: False. Contraception enables a couple to practice healthy spacing of pregnancies to ensure that the mother and the baby are healthier.
Continue on next slide note page
Contraception and Safe Sex, Session III Topic 6 Slide 12

13. Counseling About Side Effects
Side effects are the major reason that clients stop using a method; therefore, providers should:
Treat all client complaints with patience, seriousness, and empathy.
Offer clients an opportunity to discuss their concerns.
Reassure the client that side effects are reversible.
Differentiate side effects from complications.
Offer clients good technical and practical
Answer 5: False: All clients should be told that only male or female condoms alone or condoms used with another family planning method (dual method use) offer protection from both unintended pregnancy and STIs, including HIV.
Question 6: Which methods of contraception may not be not be suitable for the adolescent client?
Answer 6: While age is not a clinical contraindication for any method, sterilization is the only method that is considered contraindicated for most young men and women due to their stage in life and the permanent nature of this method. The Standard Days Method (SDM) is suitable for adolescents only if they have regular menstrual cycles.
Question 7: Annie is a 16 year old who has just delivered her first baby. She decided to breast feed her baby for the first 6 months, until she goes back to school. Annie tells her mother that she will use breastfeeding to prevent pregnancy. Her mother tells her she is mistaken and could still become pregnant. What advice should her care provider give her to ensure that she has effective contraceptive protection?
Answer 7: Lam is an effective method for Annie as long as:
Her menses have not returned
She is fully or nearly fully breastfeeding
The infant is less than 6 months oldIf any one of these changes, she must start another contraceptive method immediately. It would be best if she began another method before one of these changes occurs.
See Session Plan for additional questions
Contraception and Safe Sex, Session III Topic 6 Slide 13