3.3.8 Family Planning

Question 1

Why dues family planning save lives

Answer 1

The risk of pregnancy is far greater than the risk of contraceptives. Unplanned pregnancies often have a greater risk. 50% of unplanned pregnancies result in abortion and 48% of these abortions are unsafe.

Question 2

Why should provision ur family planning be essential in preventative Public Health programs

Answer 2

To save lives and prevent pregnancy related deaths

Question 3

What are LARCS

Answer 3

Long acting reversible contraceptives. They last long, are temporary. Once removed, fertility return is prompt. Examples include un IUD, and a birth control implant.

Question 4

The 7 global causes of maternal deaths

Answer 4

Haemorrhage, abortion ( spontaneous and induced), sepsis, hypertensive disease, obstructed labour , other direct causes and indirect causes

Question 5

Advantages of family planning

Answer 5

1) better health outcome for the children -neonatal deaths associated with unplanned pregnancies. Increased visit if there are more than 7 children and if the spacing between children is less than 2 years
2) gives choice to women- with regards to fertility, spacing, age and number of pregnancies
3) better education and literacy→ complete schooling
4) improved economical activity → less poverty

Question 6

What happens to maternal and child deaths in couples aim to space their children more than 2 years apart

Answer 6

3 in 10 maternal deaths can be avoided. 1 in 10 child deaths can be avoided.

Question 7

What percentage of women in their reproductive age have un unmet need for contraception

Answer 7

25%

Question 8

Reasons for unmet family planning need (6)

Answer 8

Fear of social disapproval, resources and services unavailable, choices are limited, partners opposition, lack of knowledge about contraceptive, health concerns

Question 9

Why does family planning fail for so many people

Answer 9

1) were not given clear instructions on how it works/ how to use
2)could not get a method that was best suited for them
3) were not properly prepared for the side effects
4) supplies ran out

Question 10

What is periodic abstinence / fertility awareness

Answer 10

• recognition of the fertile period and avoidance of intercourse
• observing fertility signs - mucus plug and basal body temperature
• monitoring calendar days

Question 11

The 2 types of family planning methods.

Answer 11

1. Hormonal → combined hormonal methods or progesterone only methods
2. Non-hormonal→ lactational amenorrhea method, fertility awareness, barrier contraception, copper intrauterine devices, sterilisation

Question 12

Explain the mechanism of action of a copper IUD

Answer 12

Copper has toxic effects
Primary mechanism of action →prevents fertilisation, disrupting the motility of sperm and development of the ovum
Secondary mechanism of action → blocks implantation due to the inflammatory response in the endometrium
Egg lives for 12 -24 hours and sperm lives for 5-7 days

Question 13

The human steroid hormones

Answer 13

Progestagens, androgens and oestrogens

Question 14

Synthetic oestrogens used in contraception

Answer 14

Ethinyloestradiol, oestradiol valerate, oestradiol, estetriol, 17 beta estradiol: the oestrogen produced by a women’s ovaries- rapidly metabolised and nigh protein binding

Question 15

Why is Ethinyloestradiol is slowly metabolised compared to others

Answer 15

Increased biologic activity vs natural oestrogens, ethanol group inhibits metabolism, long half life, nigh bioavailability

Question 16

What is progestogen derived from

Answer 16

Progesterone, testosterone und spironolactune

Question 17

Biological findings associated with the progesterone receptor

Answer 17

Establish and maintain pregnancy, endometrial antiproliferation

Question 18

Biological findings associated with the androgen receptor

Answer 18

Acne, hirsutism and hyperlipidaemia

Question 19

Biological findings associated with the oestrogen receptor

Answer 19

Hyper coagubility and endometrial proliferation

Question 20

Biological findings associated with the mineralocorticoid receptor

Answer 20

Salt and water retention hypertension and weight gain

Question 21

Biological findings associated with the glucocorticoid receptor

Answer 21

Decreased bone mineral density and immunosuppression

Question 22

How does oestrogen work in contraceptives

Answer 22

Suppresses gnrh, suppresses FSH with 70%, little effect on LH

Question 23

How does progesterone work in contraceptives

Answer 23

Reduced LH levels and Peak, little effect on FSH, endometrial changes, cervical mucus change

Question 24

What tool do we use to provide contraception safely

Answer 24

The world Health organisation’s medical eligibility tool- look at when the risks outweigh the benefits

Question 25

What does method specific counselling include

Answer 25

• What is the method
• how does it work → mode of action
  -how well does it work→ typical use of effective vs perfect use of effectiveness, pearl index what factors influence effectiveness
• how to use the method- fit and forget vs others
• common side effects
• common risks or complications
• does the method prevent STDs
• drug interactions
• return to fertility
• follow up

Question 26

How is effectiveness measured using the pearl index

Answer 26

The number of pregnancies that would occur it 100 women Had to use the contraceptive for I year

Question 27

An approach to breakthrough bleeding on contraception

Answer 27

Increase progesterone and decrease oestrogen

Question 28

Non contraceptive benefits of contraception

Answer 28

• regular, light and less painful menstruation
• prevention or improvement or Iron deficiency anaemia
• decrease in incidence of pelvic inflammation disease
• reduces symptoms of endometriosis and PCOS
• can improve or worsen ache
• protection from pregnancy associated risks

Question 29

Side effects related to progesterone deficiency and oestrogen excess

Answer 29

Excessive bleeding, clots, break through bleeding headaches during active pills,breast tenderness, leucorrhoea

Question 30

Side effects related to progesterone excess and oestrogen deficiency

Answer 30

’ Increased appetite, Acne oily skin, headaches during placebo, oligomenorrhoea, amenorrhoea, irritability, depression and mood swings vaginal dryness