Family Planning Methods, Spacing

Techniques and Counseling

 Objectives
After completing this unit, you will be able to:

• Enlist various temporary and permanent methods of contraception along with the benefits, side
effects and contraindications of each
• Detect complications, if any, at the earliest following each method for appropriate management
and timely referral
• Provide support through counseling to the adopters (couples) of family planning method, their
family and community
• Supervise the ASHAs and ANMs while they offer services to the beneficiaries
 FP Methods
For delaying the first child For healthy spacing between two For limiting future
childbirths pregnancies

• Condoms • Condoms • Female sterilization

• COCs, POPs, • COCs, POPs, Centchroman • Male sterilization/
Centchroman • IUCD Vasectomy
• IUCD • Inj. MPA • IUCD (after completing the
• Inj. MPA • LAM (Needs to be followed up total duration, the old IUCD
• EC Pills (Not to be used as by any other method, before should be replaced by a new
a regular method) completing 6 months after one)
childbirth)

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 Contraceptive Methods

Spacing Limiting

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 List of Contraceptive Methods available under RMNCH+A
Program
Temporary (Spacing) Methods (Delaying Permanent (Limiting) Methods (Limiting
first pregnancy) the family after achieving the desired
family size.)
IUCD 380 A and Cu IUCD 375 • Female Sterilization:
 Laparoscopic
Injectable Contraceptive DMPA (Antara)
 Minilap
Combined Oral Contraceptive (Mala-N)
Centchromen (Chhaya) Male Sterilization:
 No Scalpel Vasectomy (NSV)
Emergency Contraceptive Pill (Ezy Pill/E-
 Conventional Vasectomy
Pill)
Progesterone-Only Pill (POP)
Male Condoms (Nirodh)
Spacing and Limiting methods are provided at various health facilities by various health care
providers
 • To understand how various contraceptives work, it is important to know about:

- Menstruation
- How reproduction happens

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 Menstruation

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 Menstruation

• Duration of bleeding: 3-5 days

• Bleeding recurs after: 21-35 days

• Flow: Without clots

• In a regular 28-day menstrual cycle the mid 10 days (10th-20th day) of the cycle are fertile period
during which pregnancy can occur, the first day being the day when the bleeding starts

• A woman can become pregnant from the age of 12-13 (when her periods begin, which is called
menarche), up to 45-55 years, (when they ultimately stop). When they stop, it is called menopause

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 How Reproduction Occurs

• All female produce “egg” and male produce “sperms” which unite inside the womb of the
woman and produce a foetus. This grows into a baby

• A woman’s egg has X chromosome and a man’s sperm has either X or Y chromosome (which
we may call girl sperm or boy sperm respectively)

• If X chromosome of egg meets with X chromosome of sperm – Results in a girl child

• If X chromosome of egg meets with Y chromosome of sperm – Results in a boy child

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 Checklist to be Reasonably Sure a Woman is NOT Pregnant
(Important to rule out pregnancy before initiating a contraceptive)
Ask these 6 questions:
1. 1. Ask for the following 3 criteria for LAM
(All 3 must be met)
• The baby is less than 6 months old
• Menstrual period has not returned after last childbirth
• The baby is fully or nearly fully breastfed, fed often, day and night at least 8-10 times a day, at least
once in 4 hours, and at least once at night (at least 85% of feeding should be breast milk).
2. Have you abstained from sexual intercourse since your last monthly bleeding or delivery?
3. Have you had a baby in the last 4 weeks?
4. Did the first day of your monthly bleeding start within the past 7 days (or within the past 12 days if the
client is planning to use an IUD)?
5. Have you had a miscarriage or abortion in the past 7 days? (or within the past 12 days if the client is
planning to use an IUD)?
6. Have you been using a reliable contraceptive method consistently and correctly?
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 Checklist to be Reasonably Sure a Woman is NOT Pregnant

IF CLIENT ANSWERS THEN

If the client answered “Yes” to at least one You can give her the method she has chosen.
of the questions, and she
has no signs or symptoms of pregnancy
If the client answered “No” to all questions Pregnancy cannot be ruled out. The client should
wait for her next monthly bleeding or do a Urine
Pregnancy Test for Confirmation.

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 Comparing Effectiveness of Family Planning Methods

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 Safe Time for Initiation of Various FP Methods

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 1. IUCD
Two Types:
• Copper 380 A (For use up to 10 years)
• Copper 375 (For use up to 5 years)
Can be inserted in a woman immediately after childbirth up to 48 hours of delivery or after 6
weeks of childbirth
How it prevents Prevents fertilization of ovum by sperms
pregnancy
Advantages • Very effective method (like limiting methods)
• No activity needed by woman after insertion
• Effective immediately after insertion and immediate return of fertility
after removal (reversible)
• No effect on breastfeeding
• Used as both long term and short term

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 1. IUCD (Cont.)

Limitations & Side • Possibility of minor side effects which decrease after initial few
effects months and are not harmful:
- Longer and heavier menstrual periods
- Bleeding or spotting between periods
- More cramps or pain during periods
• Does not protect against STIs and HIV
• Requires a trained health care provider to insert and remove the IUCD
• May be expelled spontaneously, in a few cases

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 1. IUCD (Cont.)
Who can use • Have just had a delivery or an abortion (if no evidence of infection)
the method • Are breastfeeding
• Have or had breast cancer
• Have headaches
• Have high blood pressure (>140/90 mm hg), diabetes, liver or gall bladder disease,
epilepsy, non-pelvic tuberculosis
• Are HIV positive and/or have AIDS who are clinically well
Who cannot • Pregnancy • Pelvic infections
use the • Current or high risk for infections • 48 hours to less than 6 weeks postpartum
method in genital organs • Malignant trophoblastic disease
• Women with AIDS who are not For PPIUCD:
clinically well • Puerperal sepsis
• Immediately after a septic • Prolonged rupture of membranes for more than
abortion 18 hours
• Pelvic tuberculosis • Unresolved postpartum haemorrhage
• Distorted uterine cavity • Substantial genital trauma
• Unexplained vaginal bleeding
• Genital tract cancer
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 1. IUCD (Cont.)
Warning signs in Needs to come back to the facility soon if any of the following signs develop:
IUCD clients P: Period related problems or absence of periods and/or pregnancy symptoms
A: Abdominal pain or pain during intercourse
I: Foul smelling/unusual vaginal discharge
N: Not feeling well, fever, chills
S: String problems or expulsion of IUCD

Time for first Routine follow up for interval IUCD – after 1 month/after next menses
follow-up Routine follow up for PPIUCD – after 6 weeks of childbirth

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 Misconceptions about IUCD

• Thread can trap the penis during intercourse - Wrong

• A woman with IUCD cannot do heavy work - Wrong

• The IUCD might travel inside a woman’s body to her heart or her brain - Wrong

• Causes pregnancy outside the uterus - Wrong

• Causes cancer or rotting of the uterus - Wrong

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 2. Inj MPA (Medroxy Progesterone Acetate)
Two Types:
• Intramuscular Inj MPA (One dose = one vial of 150 mg/1 ml)
• Subcutaneous Inj MPA (One dose =104 mg/0.65 ml)

Injection is given once in 3 months or 13 weeks (Can also be given up to 4 weeks late or 2 weeks
early from the scheduled date)
 Can be initiated in a woman after 6 weeks of childbirth

How it prevents Prevents release of eggs from ovary

pregnancy
Advantages • Highly effective and reversible method (fertility returns 7-10 months after last
injection)
• Suitable for breast feeding women (after 6 weeks postpartum)
• Protects against cancer of lining of uterus (endometrial cancer), uterine
fibroids, may protect against iron deficiency anemia
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 2. Inj MPA (Cont.)
Limitations & • Does not protect against STI/RTI and HIV infection
Side effects • Once taken its action cannot be stopped immediately
• Causes changes in the menstrual cycle and bleeding
• Has to be repeated every three months to achieve desired contraceptive
effectiveness
• Return of fertility takes 7-10 months from date of last injection (Average 4-
6 months after 3 month effectivity of last injection is over)
• Decreases bone density, but users are not likely to have fractures. After
stopping Inj MPA, bone density increases again

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 2. Inj MPA (Cont.)
Who can use • Have or have not had children; Are not married; Are of any age
the method • Have just had an abortion or miscarriage
• Are breastfeeding (Inj can be started from 6 weeks after childbirth)
• Smokers
• Infected with HIV, whether or not on ARV therapy
Who cannot • Women breastfeeding infant less than • Current or past history of Breast Cancer
use the method 6 weeks • Current or history of Ischemic Heart
• Unexplained vaginal bleeding Disease
• High blood pressure (160/100 or • Diabetes with for more than 20 years or
more) with complications in arteries, vision,
• Severe cirrhosis, liver tumors (benign kidneys, nervous system
or malignant) • H/o stroke, blood clot in your legs or
• Migraine with aura at any age lungs, heart attack. Or other serious
heart problems

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 2. Inj MPA (Cont.)

Giving advice on Thorough counselling about bleeding changes should be done before giving
side effects injection.
Also, counselling about bleeding changes may be the most important help a
client needs to keep using the method
Describe the most • Lighter and fewer days of bleeding
common side • Weight gain, headache, dizziness, breast tenderness
effects
Explain about • Side effects are not harmful
side effects • Usually becomes less or stop within first few months of injection
• Client can come back any time, if side effects bother her
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 3. Lactational Amenorrhea Method (LAM)
Method can be effective only in the first 6 months after delivery as long as as the woman
exclusively breastfeeds her baby including night feeds & also if menses have not returned
• Benefits of LAM:
 Immediate and Exclusive breastfeeding (EBF) promotes health benefits to the infant
and increases the survival by providing additional protection against infections
• Fertility Based Awareness Method
› Based on the awareness regarding body signs that change during menstrual cycle
• Criteria:
1. Baby is being only breastfed
› The baby is not receiving any other solid food or liquids; only breast milk
› Breastfeeding on demand - Gap between two consecutive feeds is not more than 4
hours during day and 6 hours during night
2. Menstruation has not returned since the birth of the child
3. Baby is less than 6 months old
 Oral Contraceptives

Hormonal Non-hormonal

Combined Oral Centchroman (Ormeloxifene)

Contraceptives (COC)

Progestin Only Pill (POP)

Levonorgestrel Emergency
Contraceptive Pill (ECP)

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 4. Combined Oral Contraceptives (COCs)-Mala-N
• Available in public sector as free and ASHA
supply (Mala-N)

• Each of the white 21 hormonal tablets contain

Levonorgestrel (0.15mg) and Ethinyl Estradiol
(.03 mg)

• There are 7 black tablets containing 60 mg of

Ferrous Fumarate

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 4. COCs (Mala-N) contd..
1. One pill to be taken daily
2. Missed pills or delay in starting packet can result in pregnancy if guidelines not followed
3. Can be started soon after abortion or 6 months after delivery in breast feeding women
4. Side effects like giddiness, nausea, breast tenderness
5. Makes menstrual cycle regular and reduces bleeding/pain and improves anemia
6. Works primarily by preventing release of eggs from ovaries
7. Safe and Effective
8. Can be started any time if it is reasonably certain that she is not pregnant (Use pregnancy
checklist)
9. Should not be given to breastfeeding women till 6 months postpartum

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 4. COCs (Mala-N) contd..

Non • Protection against endometrial and ovarian cancer,

contraceptive • Protection against iron deficiency anemia, ovarian cysts
benefits
CoCs are not • Breastfeeding <6 months • With high BP
appropriate for postpartum • With breast cancer
women • With suspected pregnancy • With DVT
• Who smoke >15 cigarettes/day • With heart disease
and ≥ 35 years of age • With recurrent migraine
• With liver disease • On anticonvulsants

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 4. Management of Missed Pills (COCs)
Missed pills How to manage
Missed 1 or 2 pills/ • Take one hormonal pill as soon as possible or two pills at
started new pack 1 or scheduled time
2 days late?

Missed 3 or more • Take one hormonal pill as soon as possible and continue the
pills in the first or scheduled pills
second week/started • Use a backup method for the next 7 days
new pack 3 or more • Also can consider taking ECPs, if she had sex in the past 72
days late? hours.

Missed 3 or more • Take one hormonal pill as soon as possible and finish all
pills in the third hormonal pills in the pack as scheduled. Throw away the 7 non-
week? hormonal pills in a 28-pill pack.
• Start a new pack the next day
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 5. Progestin-only- Pills (POPs)

• Contain very low dose of a synthetic hormone

known as progestin (like natural hormone
Progesterone)

• All 28 pills in a packet are hormone tablets (either Levonorgestrel or Desogestrel)

• One pill to be taken every day at the same time without any break

• These are safe for breastfeeding women and can be started earlier than 6 weeks postpartum
(MEC 2015)

Can be given to women after childbirth

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 5. Progestin-only- Pills (POPs) Contd..
• More effective along with breast feeding than when taken after breast feeding stops

• Bleeding changes are common but not harmful

• Decreases risk of ectopic pregnancy

• Can be taken any time if it is reasonably certain that she is not pregnant (Use pregnancy checklist)

• New pack to be started on the next day at the same time as starting a pack late risks pregnancy

• No delay in return of fertility after POPs are stopped

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 5. POPs (Cont.)…..
How POPs work
• Thickening cervical mucus (this blocks sperm from meeting an egg)
• Preventing the release of eggs from the ovaries (ovulation)

Common side effects of POPs:

• Irregular bleeding/amenorrhea
• Nausea, headache, dizziness
• Breast tenderness
• Occasional ovarian follicular enlargement

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 5. How to Use POPs?
• One pill to be taken every day and at same time until the packet is empty
• Linking pill intake to a daily activity may help her remember to take the pill daily and reduce some
side effects
• When she finishes one pack, first pill from the next pack should be taken on the very next day at
the same time
Conditions where POPs should be avoided
› Treatment with anticonvulsants or rifampicin
› History of breast cancer
› Deep vein thrombosis or Pulmonary embolism
› Liver cirrhosis
› Suspected pregnancy

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 5. POPs (Cont)…..
• What are the limitations and side effects of POPs?

Side-Effects:

• Changes in bleeding patterns –

Limitations:
irregular/prolonged/no bleeding
• Effectiveness decreases when
• Postpartum amenorrhea may be breastfeeding stops
prolonged in breastfeeding women • Do not protect against
• In some women – headache, STIs/HIVs
dizziness, mood changes, breast
tenderness

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 5. Management of Missed Pills (POPs)
1. Three or more hours late taking a pill or misses one completely
• Take a pill as soon as possible.
• Keep taking pills as usual, one each day. (She may take 2 pills at the same time or on the
same day)
2. If she has monthly bleeding
• A backup method should be used for the next 2 days
• Also, can consider taking ECPs, if she had sex in the past 72 hours
3. If she has vomiting or diarrhoea
• If she vomits within 2 hours after taking a pill, she should take another pill from the pack as
soon as possible and continue with the schedule pill as usual.
• If her vomiting or diarrhoea continues, follow the instructions for missed pills above

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 6. Centchroman (Ormeloxifene)

• Non steroidal, non-hormonal and once-a week pill, which will be available in public
sector as free and ASHA supply (Chhaya)

• It has weak estrogenic action on bones but strong anti-estrogenic action on uterus, breasts

• Safe for breast feeding mothers, even soon after childbirth

Can be given to women soon after childbirth

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 6. Centchroman (Ormeloxifene) Contd..

• Prolongation of menstruation cycle is the only side effect. It occurs in 8% cases usually in
first 3 months

• It makes the periods lighter and can help anemic women

• Can be used safely in conditions where hormonal contraceptives are not advised

• Decreases the risk of ectopic pregnancy

• Return of fertility on stopping the drug is prompt

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 6. When to Start and How to Use Centchroman
• One pill (30 mg)is taken twice a week for first three months, followed by once a week
thereafter

• Starting from fourth month, the pill is to be taken once a week on the first pill day and
should be continued on the weekly schedule regardless of her menstrual cycle

If 1st day of First 3 months After 3

• For initiation: 1st pill is to be taken pill is months
on 1st day of period (1st day of Sunday Sun, Wed Sun
bleeding) and the 2nd pill 3 days
later Monday Mon, Thu Mon
Tuesday Tue, Fri Tue
Wednesday Wed, Sat Wed
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 6. Centchroman (Cont.)….
• Major advantages of Centchroman include that they:
 Are highly effective if taken correctly
 Can be given after childbirth. Safe in breastfeeding women
 Decreases the risk of ectopic pregnancy
• Centchroman are not appropriate for the following women:

 Polycystic ovarian disease  Severe allergic state

 Cervical hyperplasia  Chronic illness, like
 Recent history of jaundice or tuberculosis or renal disease
liver disease

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 6. Centchroman: Managing Missed Pills

• Take a pill as soon as possible after it is missed

• If pill is missed by lesser than 7 days, take the missed pill ASAP and normal schedule to be
continued; and a back-up method (condom) to be used till the next period starts

• If pill is missed by more than 7 days, client needs to start taking it all over again like a new
user i.e. twice a week for 3 months and then once a week

• if periods are delayed by more than 15 days, pregnancy needs to be ruled out

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 7. Emergency Contraceptive Pill (ECP)
• To be used within 72 hours of unprotected sex (accidental sex or
contraceptive accident like condom rupture or missed pills)

• Sooner it is taken, more effective

• Safe for all women even for those who cannot use regular hormonal
contraceptives, no known health risks

• Not appropriate as a regular contraceptive method due to less effective than

other contraceptives, chances of menstrual irregularities

• In national program, EC pill contains only progestin - Levonorgestrel (1.5

mg per tab) and available as free and ASHA supply (ezy-pill)
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 7. Emergency Contraceptive Pill (ECP) – Cont.

• Do not disrupt an existing pregnancy

• Provides an opportunity for women to start using a regular

contraceptive method

How to Use ECP?

• To be taken immediately after unprotected/accidental intercourse or

as soon as possible within next 3 days (72 hours)

How ECP Works?

• Works primarily by preventing or delaying release of eggs from
ovaries (ovulation)
• Does not work if woman is already pregnant
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 7. ECP: Side Effects

› Side effects like nausea, vomiting and bleeding irregularity

Management of Side Effects

› Nausea: Anti-nausea medication not recommended. If user had h/o nausea with previous
use of ECP, client can take anti-emetic 1 or 1½ hour before taking ECP
› Vomiting: If woman vomits within 2 hours of taking ECP, she should take another dose
(can take anti-emetic with this repeat dose)
› Slight bleeding irregularity: Subsides on it’s own

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 7. ECP: Important Counselling Points
• Counsel to choose a regular FP method

• Most contraceptive methods can be started on the same day of ECP use

• ECP does not protect from STI/HIV

• ECP will not harm an existing pregnancy

• Advise to return to health care provider, if her next monthly bleeding:

- Is very light (possible pregnancy)
- Period is delayed beyond one week of expected date
- Is unusually painful (possible ectopic pregnancy)

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 8. Artificial Methods of Family Planning: Condoms
Condoms
Male Condoms Female Condoms
Barrier contraceptive that do not allow the Pre-lubricated plastic polyurethane tube with a closed
semen to come into contact with vagina end, collects sperm before, during and after ejaculation
Advantages: Advantages:
• Easily available, cheap and easy to • Safe, simple, and convenient
carry. • Triple advantage of preventing unwanted pregnancy,
• Triple protection against STDs, STDs and HIV
pregnancy, HIV and Ca Cervix • Substitute for those with allergies to latex
Disadvantages: Disadvantages:
• High rates of failure due to • Do not feel natural, cause slippage of penis causing a
slippage/breakage during intercourse pause in intercourse
• Cause irritation to the vagina or penis
• Decreases the penile sensitivity
 Permanent Methods
• Irreversible methods and involve surgical intervention

• Two types:

› Vasectomy for men

› Tubectomy (Tubal ligation) for women

 Vasectomy
• ‘Vas deferens’ is surgically cut and the two ends are tied to prevent entry of sperms into seminal
vesicle and thereby semen has no sperms
• Two methods: Conventional and No Scalpel Vasectomy (NSV)

• NSV: Minimum intervention procedure where the ‘vas deferens’ is reached through a small
puncture in the scrotum that does not need stitching; safe and simple procedure
• All cases should be visited by the health worker within 48 hours
• Since this procedure doesn’t render the client sterile immediately and it takes at least 20
ejaculations or 3 months
 Tubal Ligation
• Procedure done on women, who have completed their family
• Cutting, sealing or blocking the fallopian tubes which carry an egg from the ovary to the uterus
(womb)
• Interval tubectomy can be performed any time within 7 days after menstrual period is over
• Post partum sterilization can be performed within 48 hours upto 7 days of delivery whereas post MTP
sterilization can be performed concurrently along with MTP
• Conditions that are absolute contraindications for procedure are psychiatric illnesses or moderate to
severe anemia
 Fertility Based Awareness Method/ Symptothermal
Basal Body • Temperature of body increases by 0.5–1 degree F
Temperature during ovulation and remains high till the end of
(BBT) her menstrual cycle
Method
• Fertile days can be predicted by the pattern of
Cervical Mucous mucous discharge from the vagina
Method (Billings • 3-4 days around ovulation are the unsafe days
or Ovulation when the mucous will be copious, slippery and
Method) clear like white of a raw egg
• Circle first day of period on a calendar and count
the total number days of the cycle for at least 8
cycles.
Calendar Method • Subtract 18 and 11 from the shortest and longest
cycle respectively.
• The period between these days is fertile and thus
unsafe period
 Family Planning 2020
• A national initiative/momentum for access to quality contraceptive services

• Involves partnership of government with International agencies, civil social agencies and
private sector for expanding access to voluntary family planning services

• Emphasize on the indirect indicators of fertility like age of marriage, women literacy and
other socio cultural barriers towards access to services
 Family Planning 2020: Current Interventions
• Post-partum family planning
• Fixed facility strategy, increasing male participation
• Community based services through ASHAs like home delivery of contraceptives, rapid diagnostic
pregnancy kits
• Family planning counselors
• Compensation scheme
• Family Planning Indemnity Scheme and Public Private Partnership etc
 Family Planning 2020: Area of focus under the RMNCH+A
• Community based promotion and delivery of services through ASHAs
• Promotion of Spacing Methods with emphasis on spacing methods like Interval IUCD including
PPIUCD
• Sterilization Services (Tubectomies and Vasectomies): The focus is on Mini lap tubectomy and
increased men participation through NSV
• Prerna (Responsible Parenthood Scheme): Strategy is for couples below poverty line (BPL)
where the couples are awarded Rs 10,000/- at the time of birth of a Boy child or Rs 12,000/- if it is
a girl
• Santushti is a scheme of Jansankhya Sthirta Kosh (JSK) for high populated states namely Bihar,
Uttar Pradesh, Madhya Pradesh, Chhattisgarh, Jharkhand, Odisha, and Rajasthan
 Family Planning 2020: Area of focus under the RMNCH+A, cont…
• Mission parivar scheme: Key Strategic Actions:
1. Delivering assured services-
a) Roll out of Injectable Contraceptive DMPA (Antara) at one go till Sub centre level
b) Augmentation of PPIUCD Services to all delivery points
c) Augmentation of Sterilization services through HFD compensation scheme
d) Condom Boxes at strategic locations (like Heath Facilities, Gram Panchayat Bhavan etc)
e) Social Marketing of condoms and pills: Social Marketers under the government’s scheme
 Family Planning 2020: Area of focus under the RMNCH+A,
cont…

2. Promotional Schemes:
a) “NAYI PAHEL” – an FP KIT for “Newly Weds”
b) Saas Bahu Sammelan
c) SAARTHI - Awareness on Wheels
d) Local Radio Spots with messages from local actors.
 Counselling
• Two way process of exchange of ideas between health worker and client with an aim to facilitate
decision by client or helping him/her address concerns/problems
• For a successful counseling, mutual trust should be there between the provider and the client
• Objectives:
› Helping clients to assess their needs for a range of health services, information and emotional
support
› Providing information as per the problems and need of the client
› Assisting/Enabling clients in making voluntary and informed choices
› Clearing myths, misconceptions and doubts regarding the available contraceptive methods
 Approaches of Family Planning Counseling
• For effective counseling, the health worker should use GATHER approach:

› G- Greet the client and build rapport in a polite and friendly manner
› A- Ask about their problem in simple, open and brief questions.
› T- Tell the client about available methods and possible choices in a personalized manner
› H- Help them to make decisions by choosing solutions that best fit their own personal
circumstances
› E- Explain the method, possible side effects and their management
› R- Return: Schedule a return or follow up visit
 Principles of Family Planning Counseling
• Besides privacy and confidentiality, the counsellor should be caring, non-judgmental and accepting
to the client’s social and personal constraints
• Language should be simple and culturally appropriate with brief and specific key messages
• Good interpersonal communication skills should be used
• Client should be encouraged to ask more questions
• Appropriate anatomic models, audiovisual aids and contraceptive samples should be used to
explain it better to the client
• Appropriate feedback should also be provided to the client after the session and repeat the key
messages
 Types of Family Planning Counselling
General Counselling Method Specific Counselling Return/Follow up Counseling

• Orient the client about • Counselling is done after the • Counselling is done to illicit
benefits of methods available client has made decision on the the satisfaction and response
for family planning choice of method of the client with the method
prescribed
• Reproductive goals and needs • Involves more information on
of clients are discussed, the method chosen, screening • The problems and queries of
myths and misconceptions are for the method, detailed the clients are addressed and
cleared and decision making is information on the procedure, solved
facilitated common problems & adverse
effects • The satisfied clients can be
encouraged to motivate other
• Clients are given handouts and couples to use this method
printed matter to carry back
home
 Common Myths and Misconceptions: Oral Contraceptives
• Woman only need to take the Pill when slept with her husband
› Ans: A woman must take her pills every day not to become pregnant
• Woman will face difficulty in getting pregnant again if she has been using it long enough
› Ans: A woman is only protected for as long as she actually takes the pill every day
• Pills make you weak and can cause cancer
› Ans: MALA N and MALA D have hormonal pills for 21 days followed by Iron containing
tablets for subsequent seven days. Regular consumption of these pills tablets would rather
improve the general well-being of the women by decreasing the menstrual blood loss and also
building up iron reserve
 Common Myths and Misconceptions: Condoms
• If a condom slips off during sexual intercourse, it might get lost inside the woman’s body
› Ans: A condom cannot get lost inside the woman’s body because it cannot pass through the
cervix

• There is too much danger of condoms breaking or tearing during intercourse

› Ans: Condoms are made of thin but very strong latex rubber and they undergo extensive
laboratory tests for strength. Condoms are meant to be used only once.
› There is less chance that a condom will break or tear
 Common Myths and Misconceptions: IUDs
• The thread of the IUD can trap/irritate the penis during intercourse.
› Ans: The cut thread of the IUD (Cu T) is short enough to be able to be grasped by a forceps,
soft and flexible, clings to the walls of the vagina and are rarely felt during intercourse

• A woman who has an IUD cannot do heavy work.

› Ans: Use of an IUD should not stop a woman from carrying out her regular activities in any
way

• The IUD causes ectopic pregnancy.

› Ans: There is no risk of an ectopic pregnancy with use of IUD
 Common Myths and Misconceptions: Vasectomy
• Vasectomy is the same as castration. A man who undergoes vasectomy has his manhood
taken away and he will no longer enjoy sex
› Ans: Castration is removal of testes whereas in vasectomy, the vas deferens are cut and
tied so that sperms are not ejaculated in the semen ejaculated during sexual intercourse.
Vasectomy does not alter the hormone status of an individual thus the man continues to
produce hormones and stays “masculine” and heterosexual

• Sperm that is not ejaculated during intercourse will collect in the scrotum and cause the
scrotum to burst
› Ans: Sperm that is not ejaculated is absorbed by the body. It cannot collect in the scrotum.
 Common Myths and Misconceptions: Tubectomy
• A woman who has undergone sterilization loses all desire for sex
› Ans: Tubal ligation has no effect on the hormones produced by the ovaries of the woman,
but only prevents the egg from meeting the sperm thereby preventing fertilization

• A woman who has undergone sterilization becomes sickly and unable to do any work
› Ans: A woman who has been ligated can resume regular activities as soon as she is free
from post-surgical discomfort
 Model Questions
• Mention two conditions when IUD should not be inserted?
• What are Symptothermal methods of Family Planning?
• What is the focus of the Government in limiting methods of planning?
• Use of Oral Contraceptive Pills (OCPs) may cause weakness in the users: State True/False?
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