PRESENTER

JANE KAONGA BOTHA

 Family planning is a key
component of reproductive health
and one of the most effective
interventions for the attainment of
the high level of reproductive
health.
 It plays a major role in the reduction of
maternal and newborn mortality and hence
contributes to the achievement of the
Millennium Development Goals as well as the
legacy goals.
 Family planning is recognized as a key
intervention for improving the health of
women, men and children.
 The use of family planning helps to
empower women by allowing them to
decide the number and spacing of
their children, which, in turn, provides
them with increased opportunities for
participation in educational, economic
and social activities.
 Define the key terms
 Outline the strategies for family planning
 Benefits of family planning
 Family planning counselling and the
profiling methods
 Types of family planning methods
 Family planning history started as far
as human being existed as natural
family planning methods.
 The birth control initially focused on
the individual woman and her well-
being.
 However death rates in the twentieth
century reduced without reduction in
numbers of births which led to
concerns about the adverse effects of
large populations.
 Actions were taken to tackle the
potential problem of population
growth.
 Between1950s and the 1980s the
International Planned Parenthood
Foundation and the Population Council
were established, thus marking the
start of the modern family planning
movement (WHO, 2008).
 Family planning and Child health concerns
were spear headed by Dr Noek and his
friends just after independence 1964 from
Netherlands.
 The first hospital was opened in Kabwe
(Broken Hill) in 1966 where 15 nurses trained
to serve the nation but was not enough.
 Family planning programme was later
incorporated in the nursing school’s
curriculum in order to train health
workers to continue offering the
services.
DEFINITION FAMILY PLANNING

1. It is a decision made by a couple or

individual on the number of children,
how to space their children, when to
start a family and when to stop family
(MOH, 2006).
2. FAMILY PLANNING is a voluntary
decision made by an individual or a
couple on the appropriate number of
children they wish to have, and when to
have the children.
(ITG,2002)
 PROFILING: It is a way of grouping
clients according to their reproductive
needs during counselling session, in
order to meet each individual client’s
specific needs.
 COUNSELLING: It is a therapeutic and
helping relationship through which
individuals are helped to define goals,
make decisions, and resolve problems
related to personal, educational, health
and psychosocial concerns (MoH, 2001)
1. Integrating family planning services
with other Reproductive Health
programme such as STI/HIV Prevention
and Control programme, Maternal Child
Health or Safe Motherhood, Adolescent
and Reproductive Health, Male
involvement, Prevention and
Management of Abortion.
2. Private sector
3. Social marketing
4. Community based programmes
5. Information Education and
Communication
Benefits to the individual

1. Prevents unwanted pregnancies

2. Promotes healthy child spacing.
3. Family planning can help assure that
adequate resources are available.
4. Family planning also reduces and
prevents maternal deaths and diseases.
5. Having the children at the age of 18
years or above improves maternal and
child health.
6. It prevents infections such as STIs,
HIV infection besides protecting against
unwanted pregnancy.
Benefits to the community
1. Family planning contributes
positively to the community welfare in
terms controlled population growth.
2. It reduces and prevents Maternal and
child morbidity and mortality
associated with poor family planning.
3. It improves standards of living and
women’s status (Sellers, 2010)
1. Understand and respect client’s
rights, earn their trust and encourage
them to ask questions
2. Understand benefits and limitations
of all available methods; present
complete and accurate information in
an unbiased client sensitive manner
3. Understand cultural and emotional
factors that may affect service provision
or utilization by the woman or couple
4. Do not be judgemental and listen to
client concerns actively
5. Understand the effects of non-verbal
communication
6. Recognize your own insufficiency to
effectively provide the service and refer
GATHER is used as a guide in client counselling
for Family Planning services
1. Greet
2. Ask
3. Tell
4. Help,
5. Explain
6. Return
1. Counselling is a vital part of family
planning which helps the client to arrive
at an informed decision of reproductive
options and to use the chosen method
safely and effectively.
2. Adequate counselling focuses on the
individual client’s needs and situation
because every client is different and has
different needs.
PROFILING APPROACH
1. The provider follows a flow chart
with profiling questions that assist her
to know more about the client and meet
his/her needs.
2. Profiling also helps providers to
integrate information on other
reproductive health issues such as
breastfeeding, STIs, and especially
HIV/AIDS, as the needs are identified.
1. Establish if client is in a single-
partner, faithful relationship with one who
is faithful.
2. Is the client currently breast feeding a
child who is less than 6 months?
3. Do the client and her/his partner wish
to have more children?
1. SPACERS OR DELAYERS- are clients
who want to wait before having a first
or another child

2. LIMITERS - clients who do not wish

to have any more children
3. BREAST FEEDERS - clients with a
baby less than 6 months postpartum.

4. MULTIPLE PARTNERS - clients with

several sexual partners or who suspect
that their partners have several
partners.
MULTI-PARTNERS –male and female
condoms, abstinence.
DELAYERS/SPACERS –condoms (female
and male), oral contraceptives,
injectable, Norplant, scientific natural
family planning (NSFP), and
internal/intra uterine device (IUD).
BREAST-FEEDERS - condoms (female and
male), mini pill, injectables, Norplant, scientific
natural family planning (NSFP), lactational
amenorrhoea method (LAM) internal/intra
uterine device (IUD).
LIMITERS –injectables, Norplant, vasectomy and
tubal ligation.
Artificial birth control refers to the use of any
medication, barrier or device to prevent
pregnancy;
1. Hormonal Contraceptives
2. Emergency Contraceptives
3.Mechanical methods/Barrier
4. Surgical methods
Natural Family Planning methods are
based on fertility awareness, with
couples practicing abstinence during
the fertile period of the menstrual cycle
(Myles 2009).
1. Natural Family planning (basal body
temperature and mucus changes)
2. Abstinence
3. Withdrawal method
4. Lactational Amenorrhoea
Oral Contraceptives (Pill) – POPs, COCs)
Action
1. Stop ovulation
2. Change the uterine lining
(endometrium)
3. Thicken the cervical mucus hence
inhibiting the sperm from
penetrating.
Its a reversible method of birth control
Effectiveness
100% if manufactured to acceptable
standards, stored, distributed and used
correctly
1. Does not interfere with sex.
2. Quick return of fertility
3. Regulates the menstrual cycle.
4. Reduces menstrual flow and
cramping.
5. Reduces the risk of ovarian cysts,
endometriosis, PID, ovarian and
endometrial cancer.
1. Must be taken every day at the same
time.
2. Lactation is suppressed (COC).
3. Additional methods of birth control
when on other drugs e.g. Rifampicin.
 4. Increased risk of heart attack, stroke,
or blood clots.
5. Possible mood swings or depression.
6. May decrease sexual desire.
7. Does not prevent sexually
transmitted infections, HIV/AIDS or
Hepatitis B.
Injectable hormonal methods contain
synthetic progesterone
ACTION
1. Inhibits ovulation
2. Thickens the cervical mucus to
prevent sperm from passing through.
3. Change the rate of ovum transport
through the fallopian tubes
4. Makes the endometrium unsuitable
for implantation.
Reversible method of birth control given
only by prescription.
Examples of these methods of
contraceptives
1. Depo-Provera (DMPA)-every three
months
2. Noristerat (NET-EN) - two months
interval.
Effectiveness
> 99%
1. Does not interfere with sex.
2. Can be used during Lactation after six
weeks post-partum
3. Ensures periodic contact of client with
the health provider.
4. May stop menses or make them very
light.
5. Excellent alternative for women 35 or
older.
6. Reduces the risk of ovarian and
endometrial cancer, PID, may cause
recession of benign breast lamps and
ovarian cysts.
1. Irregular or unpredictable bleeding or
spotting.
2. It may delay chances of getting
pregnant after the doses are stopped. It
can take between six and eighteen months
for menstruation and ovulation to return
to normal.
3. Does not protect against sexually
transmitted diseases or HIV/AIDS.
4. Client must go to the family planning
clinic every time for the injection.
5. Possible hair loss.
6. Weight gain, especially right after
pregnancy.
Flexible plastics containing synthetic hormones
inserted under the skin of client’s upper arm
which slowly release hormones into the
bloodstream over a 5 -year period.

ACTION
1. Inhibit ovulation
2. Thicken mucus in the cervix preventing the
sperm from penetrating it.
3. Examples include Norplant and Jadelle which
has 5 and 2 flexible tubes respectively.

Effectiveness
> 99%
1. It is a reversible

2. Long term protection up to 5 years.

3. Are highly effective in preventing pregnancy

even in obese women.
4. Are effective immediately after insertion.
5. Protects against Anaemia by decreasing the
amount of menstrual flow.
6. Can be removed anytime, and the woman
can become pregnant right away.
7. Does not interfere with sex.
8. Reduces risk of ovarian or endometrial
cancer.
1. Causes menstrual Changes and
irregularities.
2. Does not offer protection against STI/HIV
3. Insertion or removal requires a trained
health provider in a health facility.
4. It is expensive
5. It requires minor surgery for insertion and
removal of the capsules which is done under
aseptic techniques.
6. Effectiveness is lowered by most
anticonvulsant medications.
7. May cause discomfort during insertion and
removal
Used when contraception is not used, used
incorrectly or failed.
There are two methods of PCC
1. The progesterone only method
2. The Copper Intra Uterine Device (IUCD).
Emergency Contraceptive Pill is a hormonal
contraceptive method used after unprotected
sex.
COMPOSITION
 Comprises of two Pills each containing
750micrograms of Progestogen
levonorgestrel.
Effectiveness
98%.
The first pill is taken within 72 hours of
unprotected sex and the second taken 12
hours later
ACTION
1. Emergency Contraceptive Pill only works if a
woman is not already pregnant.
2. Interferes with egg development.
3. Prevents or delays ovulation.
4. Prevents implantation if pregnancy occurred.
250g levanorgesterel and 50g ethynil estradiol
given as four(4) pills.
Are not abortifacient hence no harm to
growing foetus.
1. Method of contraception used to prevent
pregnancy after unprotected sex, after
contraception accident.
2. The effect of nausea is minimised
1. Does not work if already pregnant.
2. Limited time frame (Emergency
Contraceptive Pills must be used within 72
hours after unprotected sex).
3. Is not an on-going method of contraception
4. Ectopic (tubal) pregnancy may be a possible
result.
5. Emergency Contraceptive Pills change the amount,
duration, and timing of the next menstrual period in
about 10 to 15% of women treated.
6. There is still a chance of pregnancy. If menstrual
cycle does not start in 7 days, contact your family
planning clinician to rule out pregnancy.
7. Does not provide protection from sexually
transmitted infections and HIV/AIDS.
Intrauterine Contraceptive Device (IUCD)
DEFINITION: It is a small plastic device which is
placed in the uterus by a trained family
planning clinician.
Prevents fertilisation by;
1. impeding sperm transport,
2. Interference with implantation and even by
3. Damaging the sperm.
Effectiveness
98% - 99%
With an IUCD in situ, all the various types of
defence cells resulting from a foreign body
reaction are present in the uterine cavity and
spread to the tubes. The foreign body reaction
is potentiated by copper.
Other forms of IUCD contain synthetic
progesterone hence making it both a
mechanical as well as a hormonal method
depending on the type.
1. It is a reversible method of birth control
2. Effective immediately

3. Easily inserted and removed in a clinic.

4. Has no systemic side effects

5. Depending on the type they can be left in
place up to 10 years.
6. Reduces the risk of tubal pregnancy.
7. Does not interfere with breast-feeding.
8. Return to fertility is immediate if no
infection has occurred.
9. Must be inserted and removed in a clinic.
10. May be some cramping or pain at the time
of insertion.
11. May experience increased bleeding or
cramping during periods.
12. May experience spotting between periods.
13. Should not be used by women with
multiple sex partners because this increases
exposure to STI's, which significantly increases
the risk of pelvic inflammatory disease (PID).
The male condom is a thin usually latex sheath
that a man wears over his penis during sexual
intercourse. It is an over the counter barrier
method of birth control

Effectiveness: 86 - 97%.
They create a barrier between the penis and
the vagina preventing sperm and/or any
disease from entering the woman's cavity or
from vagina to the penis.
1. Easy to get and relatively inexpensive.
2. Can be discontinued at any time.
3. Provides some protection from STI/HIV,
Cervical cancer.
4. Reliable method for people who cannot use
hormonal birth control methods.
5. It provides dual protection for on a client
who is just commenced on COCs.
6. Responsibility of both partners.
7. Can be purchased without a prescription.
8. Does not interfere with breast-feeding.
9. Does not interfere with fertility.
10. May be used immediately after birth or
after abortion, the period when infection
occurs easily.
1. Requires a man’s cooperation for a woman
to protect herself from pregnancy and disease.
2. Some irritation or sensitivity to latex.
3. Difficulty using condoms correctly.
4. Must use a new condom with every sex act.
5. Some men say it reduces sexual feelings.
6. Must be rolled onto an erect penis before
sexual intercourse, can interrupt foreplay.
7. Spillage or leaking of sperm is possible if
condom is put on or removed incorrectly.
A female condom is a strong odourless,
transparent sheath that transmits heat and
lines the vagina to create barrier against sperm
and STIs.

It is polyurethane (plastic) sheath with an inner

ring that fits inside the vagina, around the
cervix (like the diaphragm) and an outer ring
that covers the external genitalia.
After the man ejaculates, client must twist the
end closed and gently pull from the vagina.

Effectiveness: 79% - 95%

1. Can be inserted into the vagina up to eight
hours before sexual intercourse.
2. Can be used with Spermicides to increase
STIs protection.
3. Over the counter barrier method of birth
control and can be purchased without a
prescription.
4.Provides protection against some STIs.
5. Can be used by people allergic to latex or
spermicides or by those who can't take
hormones.
6. Made from polyurethane plastic, which
conducts body heat.
7. Erection unnecessary to keep female
condom in place.
8. Some women and men have an increased
sensitivity or "natural" feel compared to male
condoms.

9. Does not interfere with breast-feeding.

1. Difficult to insert or keeping in place.

2. Cannot be combined with male condoms as

they pull each other off.

3. May be noisy if not correctly put on.

4. May irritate vagina or penis.
5. More expensive than male latex condoms.
6. Must be used every time one has sex.
7. After the man ejaculates, the open end must
be twisted and gently pull from the vagina.
A Diaphragm is a barrier method of birth
control that uses a dome shaped rubber cup
with flexible rim that covers the cervix and is
inserted into the vagina before intercourse. It is
used in combination with spermicidal jelly or
cream.
Cervical cap is a barrier contraceptive method.
It is a soft rubber cup like device that fits
snugly around the base of the cervix. It can be
used with Spermicides for prolonged and
additional pregnancy prevention.
Vaginal spermicides are a chemical birth
control method that kills sperm on contact to
prevent pregnancy. These come in the form of
gel, foam, cream, film, suppository, or tablet
FEMALE STERILIZATION/BILATERAL
TUBALIGATION (BTL)
Female sterilization is a surgical intervention
that mechanically blocks the fallopian tube to
prevent the sperm and egg from uniting
(fertilization).

Effectiveness: > 99%

1. Very reliable and effective method of
contraception.
2. Permanent method.
3. No long term side effects.
4. Does not interrupt sexual intercourse.
5. Does not interfere with breast-feeding.
1. Permanent method hence unsuitable for the
young who may still want children
2. Difficult and expensive to reverse surgical
procedure.
3. Requires skilled surgeon to perform the
procedure.
4. Possible ectopic (tubal) pregnancy if method
fails.
5. No protection against sexually transmitted
infections and HIV/AIDS.
Vasectomy is a surgical procedure is a
procedure where one or two cuts are made in
the scrotum and then the vas deferens are cut
or blocked so that no sperm are contained in
the ejaculate and the ovum cannot be
fertilised.
Effectiveness is not immediate as it requires
one to have about 20 or more ejaculations to
clear off all the sperms from the ejaculate
otherwise it is 99% or more effective.
Additional methods may be used as a temporal
measure.
1. Permanent highly effective method
of contraceptive.
2. Very safe surgical procedure.
3. Removes the responsibility of
contraception from the woman.
4. No significant long term side
effects.
5. Does not interrupt sexual relations.
6. Highly acceptable method.
1. Protection for the male only (females are at
risk for pregnancy).
2. Usually irreversible.
3. Not immediately effective.
4. Procedure requires skilled medical
personnel.
5. Lack of protection from sexually transmitted
infections, including HIV.
6. The procedure may be expensive.
Considered natural because they are not
mechanical and not a result of hormone
manipulation. Instead, these methods require
that a man and woman not to have sexual
intercourse during the time when an egg is
available to be fertilized by a sperm.
The fertility awareness methods (FAMs ) are
based upon knowing when a woman ovulates
each month. In order to use a FAM, it is
necessary to watch for the signs and symptoms
that indicate ovulation has occurred or is about
to occur.
On the average, the egg is released about 14
(plus or minus 2) days before a woman's next
menstrual period. FAMS can be up to 98%
effective, but they require a continuous and
conscious commitment with considerable
monitoring and self-control.
The calendar rhythm method relies upon
calculating a woman's fertile period on the
calendar.

Based upon her 12 previous menstrual cycles, a

woman subtracts l8 days from her shortest
menstrual cycle to determine her first fertile
day, and 11 days from her longest menstrual
cycle to determine her last fertile day. She can
then calculate the total number of days during
which she may ovulate.
If a woman's menstrual cycles are quite
irregular from month to month, there will be a
greater number of days during which she
might become pregnant.

Effectiveness is 80% in preventing pregnancy

and when used alone is considered outdated
and ineffective.
The Basal Body Temperature (BBT) method is
based upon the fact that a woman's
temperature drops 12 to 24 hours before an
egg is released from her ovary and then
increases again once the egg has been
released. Unfortunately, this temperature
difference is not very large. It can about a half
of a degree Celsius in the body at rest.
It requires that a woman take her temperature
every morning before she gets out of bed and
records on a chart.

To use the basal body temperature as a birth

control method, a woman should refrain from
having sexual intercourse from the time her
temperature drops until at least 48 to72 hours
after her temperature increases again.
She may choose to have intercourse between
the time of her last menstrual period and the
time of change in the cervical mucus. If the
woman does not wish to become pregnant, she
should not have sexual intercourse at all for 3
to 4 days after she notices the change in her
cervical mucus.
It depends on the presence or absence of a
particular type of cervical mucus that a woman
produces in response to oestrogen.

A woman will generate larger amounts of more

watery mucus than usual (like raw egg white)
just before release of an egg from her ovary.
This so-called egg-white cervical mucus
stretches for up to an inch when pulled apart.
A woman can learn to recognize differences in
the quantity and quality of her cervical mucus
by examining its appearance on her underwear,
pads, and toilet tissue; or she may gently
remove a sample of mucus from the vaginal
opening using two fingers.
This method combines certain aspects of the
calendar, the basal body temperature, and the
mucus inspection methods.

Other symptoms such as slight cramping and

breast tenderness are also considered.

Some women experience lower abdominal

discomfort (in the area of the ovaries) during
ovulation.
1. Can be used to avoid or achieve pregnancy
2. No systemic side effects
3. It is cheap.
4. It promotes male involvement in family
planning
5. It improves knowledge of reproductive
system.
6. Enhances bonding between couples.
1. Requires daily record keeping
2. Does not protect against STIs and HIV
3. Requires abstinence during the fertile phase
to avoid conception.
4. Moderately effective. About 9-20
pregnancies per 100 women during the first
year of use.
Using the withdrawal method, the man
withdraws his penis from a woman's vagina
before he ejaculates so that the sperm released
from his penis does not enter her vagina.
Withdrawal is also called coitus interrupts.

Efficacy is 75-80%.
1. No cost involved.
2. Requires no devices.
3. Involves no chemicals.
4. Available in any situation.
1. Chances of getting pregnant with this
method are much higher than with any other
method.
2. Some men have difficulty telling when they
will ejaculate.
3. Some men may not withdraw in sufficient
time -needs discipline
5. Interruption of the excitement or plateau
phase of the sexual response cycle may
decrease pleasurable experience.
6. High risk of contracting sexually transmitted
infections.
LAM is based upon the idea that a woman
cannot become pregnant as long as she is
breastfeeding her baby.

It is true that a breastfeeding woman may not

ovulate quite as soon after giving birth as she
would if she were not breastfeeding.
 The guidelines for LAM as family planning
method include three criteria all of which must
be met to ensure adequate protection and
these include
 Amenorrhoea
 Exclusive breastfeeding and
 less than 6 months postpartum
Hormones released during continuous
breastfeeding suppress ovulation.
When a woman breastfeeds, the stimulation of
the nipple by the infant’s suckling sends nerve
impulses to the mother’s hypothalamus which
responds by altering the production of pituitary
hormones (FSH,LH)
These hormones work to stimulate the ovaries
to produce estrogen and progesterone that
help in maturation of ova and eventually
ovulation.

Increase production of prolactin in lactation

suppresses this process hence inhibit
ovulation.
1. Encourages the best breastfeeding patterns.
2. Can be used immediately after childbirth
3. It is cheap
4. Does not require any supplies
5. Effectively prevents pregnancy for at least 6
months and may be longer if a woman keeps
breastfeeding often day and night.
6. No hormonal side effects
7. Encourages bonding between the mother
and the baby.
8. Provides the healthiest foods for the baby.
9. Effectiveness after 6 months is not certain.
10. Does not offer protection against STIs and
HIV
11. Does not protect the baby from contracting
HIV from the mother. It is easily passed on.
12. Frequent breastfeeding may be
inconveniencing for some women especially
working women.
Abstinence from sexual activity means not
having any sexual intercourse at all.

No sexual intercourse with a member of the

opposite sex means that there is no chance
that a man's sperm can fertilize a woman's
egg.
A man or a woman can practice abstinence
from sexual activity for a specific period of
time, or continuously throughout one's
lifetime.

It is100% effective in preventing pregnancy.

1. No risk of unintended pregnancy.
2. No risk of becoming infected with a sexually
transmitted disease.
3. Opportunities to express feelings and
affection for another in other ways.
4. markedly reduces the likelihood of
contracting HIV/STI.
5. Both partners must agree to honour this
choice.
6. Partners must have excellent communication
skills; ‘yes’ must mean ‘yes’ and ‘no’ must
mean ‘no’.
7. May need ECP if this method fails.
It is of great importance that health care
providers working from various levels of health
care system acquire necessary knowledge and
skills on Family Planning counselling, know the
benefits of various Family Planning methods,
their advantages and disadvantages.
Family Planning methods should be made
available to all clients in need and are eligible
regardless of their gender or marital status
through the strategies that have been put in
place by Ministry of Health and other
cooperating partners.
It is necessary that Information Education and
Communication is extensively given to increase
utilisation of Family Planning services which
will contribute to attainment of Millennium
Development Goals 4 and 5 which emphasises
on reduction of Infant and Maternal mortality
respectively.
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Generic Training Manual, Lusaka.
 Chanda A, (2012), Zambia increases Family
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http://www.ukzambians.co.uk/home/2012/0
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 Central Statistics Office, (2007), Zambia
Demographic and Health Survey, Lusaka.
 Fraser M.D, Cooper A.M, Nolte W.G.A, (2009),
Myles Textbook for Midwives, African Edition,
Elsevier Limited, Philadelphia.
 Hatcher A.R, Rinehart W, Blackburn R, Geller
S.J, Shelton D.J, (1998), The Essentials of
Contraceptive Technology, A Handbook for
Clinic Staff, Population Information Program
Centre for Communication Programs,
Baltimore
 Ministry of Health, (2002), Integrated
Technical Guidelines for Frontline Health
Workers, Lusaka.
 Ministry of Health, (2006), Zambia Family
Planning Guidelines and Protocols, Lusaka.
 Sellers M.P, (1994), Midwifery, Volume 1, Juta
and Co, Ltd, Pietermaritzburg.
 Stoppler CM, (2011), Natural Methods of Birth
Control, accessed at www.medicinet.com on
20/08/12.
 USAID/ZAMBIA(2011)Population Health and
Nutrition Transition, accessed at
usaid.gov/zm/population/phn on
2012/08/18.