Family PlanningWomen’s Health Training Day 2014

Outline

Contraceptive options– Barrier– Short-term hormonal

options– Long-term options– Permanent– Other

Pregnancy options– Continuing the

pregnancy– Terminating

pregnancy

Learning Objectives

• Become comfortable discussing family planning options with patients

• Advise patients according to their needs, including:– Lifestyle– Discretion– Adherence– Economic status– Personal values

Barrier methods• Male condom• Female condom• Diaphragm• Cervical Cap• Sponge

Short-term options

• Oral contraceptives – progestin only– combined estrogen + progestin– combined triphasic

• Patch• Nuva-ring• Depo-provera• Spermicide (non-hormonal)

Risks of hormonal therapy (pill, patch)

• General complaints: weight gain, breakthrough bleeding

• Estrogenic effects: nausea, breast tenderness, fluid retention, 3x risk of DVT

• Progestin effects: hair growth, male-pattern baldness, and nausea

Contraindications (estrogen + progestin methods)

Long-term optionsLARC = long-acting reversible contraceptive

• Implanon, Nexplanon (hormonal implant)• Mirena, Skyla (hormonal IUD)• ParaGuard (copper IUD)

Permanent options

• Vasectomy• Tubal ligation (blocks fallopian tubes distally)• Essure (blocks fallopian tubes proximally)

Methods that are free

• Fertility awareness (“rhythm method”)– Clue App for smartphone

• Withdrawal

Typical vs. Perfect use

Emergency contraception

• Plan B (Levonorgestrel-based pills)

• Ella• ParaGuard• Yuzpe Regimen (dependent on birth control pill)

How to distill the contraception options?

bedsider.org

The user-experience

Pregnancy Options

Pregnancy OptionsContinuing pregnancy

• Parenting– Resources at

http://www.usa.gov/Topics/Parents.shtml • Adoption– Resources at

https://www.childwelfare.gov/adoption/

Pregnancy OptionsTerminating pregnancy

• Medical abortion (<8.4 weeks)– Two consecutive pills– Done at home– Pros include privacy, support, feeling

“more natural”

• Procedural abortion– Options depend on how far along the

pregnancy is– Done in the office – can be outpatient

clinic– Pros include privacy, feeling “more

taken care of”, over with faster

USA Abortion Facts

• 50% of pregnancies are unintended• 21% of pregnancies end in abortion• In 2011, 1.06 million abortions were

performed, – This is down 13% from 1.21 million in 2008. – From 1973 through 2011, nearly 53 million legal

abortions occurred.

By age 45…

• At least half of American women will experience an unintended pregnancy by age 45

• At 2008 abortion rates:– one in 10 women will have an abortion by age 20 – one in four by age 30

–three in 10 by age 45

Abortion laws in GA• Abortion must be provided by a licensed

physician

• Prohibited after “viability” except in case of life or health endangerment

• “Partial birth abortion” (intact dilation & extraction) banned post-viability

• Public funds can only be used towards abortions in cases of life endangerment, rape, or incest

• Providers and institutions may refuse to participate

• Mandatory counseling must include information on fetal pain, but not breast cancer risk or psychological distress risk

• Mandatory 24-hour waiting period (initial consult may be done via phone)

• Mandatory parental notice (not consent)

Abortion laws in GA

References

• Guttmacher Institute• Association of Reproductive Health

Professionals (ARHP)• www.bedsider.org • Centers for Disease Control