1. Facts about Pakistan One birth every 7 seconds 3 mothers die during 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

2. Population Profile (2002) 3.2 million 1947 140 million 2002 160 million 2005 235 million By year 2015 Population below poverty line 33.1% Growth rate 2.5 % fertility rate 5.1%

3. Contraceptive prevalence rate (CPR) Iran23% Bangladesh40% Indonesia48% Malaysia51% Turkey72% Pakistan 21%

4. resulting in Unemployment, law and order problems,and social unrest.

6. CONTRACEPTION

7. Contraception Saves Lives

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

9. MOTIVATION

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

11. Counseling is the process of helping the clients to make informed and voluntary decision about choice of contraception

12. Counseling FM counceling has 06 elements GATHER Greet Help Ask Explain Tell Return

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

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

16. 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)

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

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

19. 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

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

21. Male condom Disadvantages Expensive Less satisfying sex Allergic reactions Failure rate - 6-18 per HWY

22. 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

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

24. IUCD COPPER—T

25. Intrauterine C.C device Copper 250 and 375, copper 7, copper –T- 200 Multiload Hormone releasing IUCDs Progestasert Levonorgesrel (intrauterine system) levonova Preloaded doesn't require to be loaded in the inserter.

26. 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.

34. Mode of action Immobilize the sperms and prevent it from fertilizing the ovum. Inflammatory reaction in the endometrium prevents embedding of the fertilized ovum. Hormonal Effects.

35. Contradictions Bicornuate uterus Nullipara Women with irregular,heavy periods, fibroids. Present & past PID Suspected pregnancy

36. Complications Insertion is painful Uterine bleeding Infection Uterine perforation Expulsion Complications relating to pregnancy: congenital malformation, abortion, ectopic pregnancy & prematurity

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

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

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

40. SEQUENTIAL PILL Two types of pill First 14 containing only oestrogen And last seven a combination of oestrogen and progesterone

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

42. ADVANTAGES - POP Do not reduce breast milk Suitable for women with contraindication of estrogens Minimal side effects No risk of circulatory or malignant disease

43. LONG ACTING PILLS Once a month Quinestrel + Levonorgestrel

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

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

46. DISADVANTAGES INJECTABLES Requires regular visits to the clinical for injections Not retrievable Return to fertility is delayed for months Menstrual irregularities Galactorrhoea Mild androgenic affects Enuresis

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

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

49. 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 estrogens -10 mg tds * 05 days

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

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

52. Surgical Contraception Female Sterilization Laparoscopic Minilap Vaginal tubectomy Male sterilization vasectomy

53. Non surgical Tubal Occlusion Quinacrine pellets Tetracycline methyl cyanoacrylate Oviduct plugs