Why should I be concerned about family planning?

Family Planning means deciding when is the right time to have children is, spacing the pregnancy and what is the appropriate number of children for a couple to have. The right time to have children is when a woman :

• Age between 20 and 35 years old
• Last child birth at least 2 years ago or if the medical problems are well controlled & optimised
• Has no illness which can affect the woman’s and the baby’s wellbeing
• Couple wants to have a child

The woman and the baby would be at risk if the above factors are not met. Therefore these women are encouraged to use a form of effective contraception method.

What are the methods of contraception available?

1. Natural method
   • Fertility awareness based method
   • Basal body temperature
   • Cervical mucus method
   • Combination method
   • Lactation Amenorrhoea method
2. Barrier method
   • Condom
   • Cervical cap
   • Diaphragm
3. Hormonal
   • Tablet
   • Implant
   • Injection
4. Intrauterine contraceptive device (IUCD)
5. Permanent method
   • Permanent method

What is the benefit of contraception?

Benefits of contraception includes :

• Improves quality of life for the women, spouse and children
• Helps women to plan their pregnancy and spacing in order to give better health for themselves and their children
• To avoid unwanted pregnancy
• To save mother’s and children’s lives
• Family Planning improves family wellbeing

Which method of contraception is suitable for me?

You will have to decide which method is best for you with the helps of the health care provider. Partner has a very important role in giving support to ensure woman received effective family planning. Factors that should be considered in method selection are :

• Woman’s age
• Woman’s health status
• Method’s efficacy
• Personnel preference
• Method available in the clinic
• Obstetric & gynaecological

How shall I know that I am not pregnant before starting on contraception?

Before starting on contraception, you have to make sure that you are not pregnant. A women is not pregnant if she has no symptoms and sign of pregnancy and meet the criteria as below :

• Within the first 7 days after normal menses
• Within the first 7 days post abortion or miscarriage
• Within 4 weeks postpartum for non-lactating mother
• Given birth within the last 4 months for breast feeding mother and not yet had a menstrual period.
• Has not had sexual intercourse since her last menses or last childbirth.

If pregnancy cannot be ruled out, you should :

• have urine pregnancy test done or
• wait until her next menstrual period (condom or spermicidal can be used while waiting for next menses)

When to start contraception?

1. Hormonal (Tablet)
   • Non pregnant women- Anytime, preferably within the first 7 days
   • After abortion- start immediately
   • After delivery-
     • If non lactating- start three weeks after delivery
     • If lactating- start 6 weeks after delivery or earlier if stopped lactating or if milk substitute is given.
2. Injection Hormonal
   • Start within 7 days of menses
   • Start immediately after abortion
   • After delivery
     • If non lactating- immediately after delivery
     • If lactating- 6 weeks after delivery
3. Intrauterine device
   • During menses
   • Immediately after abortion
   • 6-8 weeks after delivery before starting on sexual activity
4. Sterilisation
   • Female sterilization (Tubal ligation)
     • Immediately after delivery or
     • 6 weeks after delivery or
     • During caesarean section or
     • Anytime
   • Male sterilization (Vasectomy)
     • Anytime

Is emergency contraception effective in preventing pregnancy?

Emergency contraception pill gives about 75% efficacy whereas IUD is 99.9% effective to keep a woman from getting pregnant.

What shall I do if I miss my 21 pill packet combined oral contraceptive pills? (e.g. Marvelon, Nordette)

What shall I do if I miss my progestin only pill? (e.g. Noriday)

Take the last missed pill immediately. Avoid sexual activity. Then continue the rest of the pill. If sexual activity can’t be avoided, use other method of contraception for 48 hours.

If I had tubal ligation done , can reversal operation be done on me if I decide to get pregnant again?

Surgical method is permanent and reversal operation can be done but may not be successful. Where can I get help for family planning? Family Planning services are available at all Government health clinic, National Population and Family Development Board (LPPKN ) clinic and Family Planning Association (FPA) clinic.

References

• Starting late
  • Abstain from sex or use condoms or use spermicidal until you have taken the first 7 pills
• Missed 1 pill
  • Take one now and take the rest as usual
• Missed 2 or more pill
  • Use condoms for 7 days
  • Take a hormonal pill at once
  • Count how many hormonal pills left in the packet. If 7 or more pills left, take the rest of the pills as usual. If fewer than 7 hormonal pills left take the rest of the pills as usual and start a new pack on the next day.

• WHO 1998 Health workers’ manual on FAMILY PLANNING OPTIONS
• KKM 21-22June 2001 Family Planning program guideline
• WHO 2002 Selected practice recommendations for contraceptive use
• The National Women’s Health Information center Nov 2002 Emergency Contraception