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Family PlanningWomen’s Health Training Day 2014
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Outline
Contraceptive options– Barrier– Short-term hormonal
options– Long-term options– Permanent– Other
Pregnancy options– Continuing the
pregnancy– Terminating
pregnancy
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Learning Objectives
• Become comfortable discussing family planning options with patients
• Advise patients according to their needs, including:– Lifestyle– Discretion– Adherence– Economic status– Personal values
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Barrier methods• Male condom• Female condom• Diaphragm• Cervical Cap• Sponge
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Short-term options
• Oral contraceptives – progestin only– combined estrogen + progestin– combined triphasic
• Patch• Nuva-ring• Depo-provera• Spermicide (non-hormonal)
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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
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Contraindications (estrogen + progestin methods)
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Long-term optionsLARC = long-acting reversible contraceptive
• Implanon, Nexplanon (hormonal implant)• Mirena, Skyla (hormonal IUD)• ParaGuard (copper IUD)
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Permanent options
• Vasectomy• Tubal ligation (blocks fallopian tubes distally)• Essure (blocks fallopian tubes proximally)
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Methods that are free
• Fertility awareness (“rhythm method”)– Clue App for smartphone
• Withdrawal
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Typical vs. Perfect use
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Emergency contraception
• Plan B (Levonorgestrel-based pills)
• Ella• ParaGuard• Yuzpe Regimen (dependent on birth control pill)
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How to distill the contraception options?
bedsider.org
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The user-experience
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Pregnancy Options
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Pregnancy OptionsContinuing pregnancy
• Parenting– Resources at
http://www.usa.gov/Topics/Parents.shtml • Adoption– Resources at
https://www.childwelfare.gov/adoption/
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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
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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.
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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
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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
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• 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
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References
• Guttmacher Institute• Association of Reproductive Health
Professionals (ARHP)• www.bedsider.org • Centers for Disease Control