2. OUTLINE  INTRODUCTION  EPIDEMIOLOGY  METHODS OF CONTRACEPTION  CONCLUSION

3. Family planning  The planning of when to have children  Choosing the number children to have in a family  Determine the length of time between their birth.  Involves use of techniques like Sexual education Use of contraception Preconception counseling and management Infertility management

4. Family planning services  Educational, comprehensive medical and social activities  To determine freely the number and spacing of children  To select the means of achieving these  Has direct impact on health and wellbeing.

5.  Benefits of family planning  Prevents pregnancy related health risks in women.  Allows to determine number and spacing  More than 4 children - sharp increase in maternal mortality.  Reduces unintended pregnancies and the need for unsafe abortion.  Prevents HIV/AIDS and other STIs

6.  Helps to reduce infant mortality  Reduces adolescent pregnancies  Empowering people and enhancing education  Reduces population explosion.

7.  Use of various methods and devices to prevent conception/impregnation  May be inform of sexual practices, drugs or surgical procedures.

8.  Current contraceptive prevalent rate in Nigeria 2008 14.6% 2009 11.0% 2010 13.0% 2012 10.0% Fertility rate in Nigeria is 5.6 UNFPA(2012)

9.  Life expectancy in Nigeria is 47.2years at birth  Maternal mortality ratio (600 ->800) in the last decade.  Globally 13% of maternal death are due to unsafe abortion (WHO 2011)  Infant mortality rate – 88 in every 1000 births. (UNICEF, WB Indices 2012)

10.  For every death 20 others suffer morbidities such as obstetric fistulas, infections and other disabilities.  Two-third of unintended pregnancies occur in women not using contraception.  75% of unintended pregnancies can be prevented by meeting family planning needs(Singh, S. 2009)  Contraception can reduce maternal death by 44%(Cleland J, Peterson H. 2012)

11.  Natural family planning methods  Barrier methods  Hormonal methods  Intrauterine devices  Permanent methods (female and male)  Emergency contraception

12. Natural family planning  Rhythm method (calendar method)  Basal body temperature  Cervical mucus(Billings method)  Symptothermal method(combined method) 10-20% failure rate  Lactational amenorrhea(0.9-1.2% first 6months 7.4% at 12months)  Withdrawal method(5-25% FR) not in premature ejaculation  Post coital douche

13. Barrier methods  Male condom (10-30% FR first year)  Female condom(15% FR)  Vaginal diaphragm(7%)  Cervical cap  Spermicides(Vaginal jellies, creams, sponge, gels, suppositories and foam nonoxynol-9, active for about 2hours). 10-30%FR

18. Hormonal methods  Oral contraceptive pills Combined pills Sequential Mini pills(progesterone only) Reduces incidence of ovarian and endometrial cancer, benign breast diseases, Also protects against development of colorectal cancer and progression of rheumatoid arthritis.

20. Contraindications;  Thromboembolic phenomenon  Breast cancer  Myocardial infarction  Hypertension  Active liver disease  Smoking  Pregnancy  Failure rate between 1-2% if taken appropriately.

21. Non contraceptive uses of OCPS  Menorrhagia  DUB  PCOS  Dysmenorrhea  Hirsutism  Acne

22. Injectables  Progesterone only( DMPA, NET-EN)  Combined contraceptive injections(cyclofem, mesigna)  Given monthly. Progestogens  Suitable for sickle cell disease patients  Protects against the risk of endometrial and cancers, endometriosis and PID.

23.  Irregular vaginal bleeding  Weight gain  Amenorrhea  Return to fertility may take few months  Failure rate 1%

24. Implants  Norplants  Jardelle  Implanon  Nexplanon Failure rate < 1%

26.  Vaginal ring  Transdermal patch

28.  Intrauterine contraceptive devices  Cu T 380A, 380S multiload Cu-250, 375. Heavy menstrual flow and abdominal cramps  Hormone releasing e.g progestasert(1year) mirena IUS LNG20(5-7years) More suitable in a patient with menorhagia Less abdominal cramps Effectiveness 95-98%

31. Sterilisation  Permanent  Male - Vasectomy  Female – Bilateral tubal ligation Minilaparotomy, per vagina or laparoscopy  Essure (Sterilisation implant).  > 99% effective  Regret 5% >35years 20% <35years

32. Emergency contraception  After unprotected sexual intercourse  Failure of contraceptive method  In cases of rape or incest  Following a single act of sexual exposure in young girls.

33.  Standard regimen (Yuzpe regime)  IUCD insertion  Failure rate 10%

34.  Family planning is a right of every individual and there is need to improve on the shortage of its services and also on the high unmet need for contraception. Contribute to improvement in our health indices and the path to MDG.