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Pomeroy MethodFemale sterilization provides permanent contraception for women who do not want more children. It is a safe and simple surgical procedure and can
usually be done with local anesthesia and light sedation.
A small incision is made by the doctor in the woman’s abdomen and the two fallopian tubes are blocked off or cut. These tubes carry eggs from the ovaries to the
uterus. With the tubes blocked, the woman’s egg cannot meet the man’s sperm.
The effectiveness of this method depends partially on how the tubes are blocked, but all pregnancy rates are low. Only 0.5 pregnancies per 100 women (1 in 200) have
been recorded in the first year after the procedure. Within 10 years, this figure increases to 1.8 pregnancies per 100 women (1 in 55).
Postpartum tubal litigation (immediately after the childbirth) is one of the most effective female sterilization techniques. In the first year after the procedure only, 0.05
pregnancies per 100 women (1in 2000) has been recorded.
Advantages:

1. Very effective.
2. It is permanent. A single procedure leads to lifelong, safe and very effective family planning.
3. Nothing to remember, no supplies needed and no repeated clinic visits required.
4. No interference with sex. Does not affect a woman’s ability to have sex.
5. No known long-term side effects or health risks.

Disadvantages:
It is usually painful for several days after the operation. Certain uncommon complications of the surgery can occur:

* Infection or bleeding at the incision

* Internal infection or bleeding
* Injury to internal organs
* Anesthetic risk: With local anesthesia alone or with sedation, rare risks of allergic reaction or overdose. With general anesthesia, occasional delayed recovery and
side effects. Complications are more severe than with local anesthesia. There is also a risk of overdose.

Clip Method Reversal surgery is difficult, expensive and not available in most areas. Successful reversal too is not guaranteed. Women who may want to become
pregnant in the future should choose a different method.

The right time to undergo Female Sterilization

A woman can have female sterilization procedure anytime that:

* She decides that she will never want children in future.

* It is reasonably certain that she is not pregnant. These times can include:

---Immediately after childbirth or within 7days, if she has made a voluntary informed choice in advance;

--- Six weeks or more after childbirth; or

--- Immediately after abortion (within 48 hours), if she has not decided voluntarily in advance; and

--- Any other, but NOT between 7 days and 6 weeks postpartum.

Important points to remember

1. Permanent family planning method. A woman must think carefully and decide she will never want any more children, before she makes the choice.

2. It is very effective and involves a safe and simple surgery.

Introduction to Combined Oral Contraceptives

Women who use oral contraceptives swallow a pill each day to prevent pregnancy. Combined oral contraceptives contain two hormones similar to the natural
hormones in a woman’s body---an estrogen and a progestin. Also called combined pills, COC’s, OC’s, the pill and birth control pills.
How do they work?
-Stop ovulation (release of eggs from ovaries)
-Also thicken cervical mucus, making it difficult for sperm to pass through.
-They do not work by disrupting existing pregnancy.

How effective?
Effectively as commonly used – 6 to 8 pregnancies per 100 women in first year of use (1 in every 17 to 1 in every 12).
Very effective when used correctly and consistently – 0.1 pregnancies per 100 women in first year of use (1 in every 1,000).

Advantages
Very effective when used correctly
No need to do anything at time of sexual intercourse
Increased sexual enjoyment because no need to worry about pregnancy
Monthly periods are regular; lighter monthly bleeding and fewer days of bleeding; milder and fewer menstrual cramps

Can be used at any age from adolescence to menopause

Fertility returns soon after stopping
Can be used as an emergency contraceptive after unprotected sex
Can prevent or decrease iron deficiency, anemia

Helps prevent:
-Ectopic pregnancies
-Endometrial cancer
-Ovarian cancer
-Ovarian cysts
-Pelvic inflammatory disease
-Benign breast disease

Disadvantages
Nausea (most common in first three months)
Spotting or bleeding between menstrual periods, especially if woman forgets to take her pills or takes them late (most common in first three months)
Breast tenderness
Slight weight gain
Not recommended for breast feeding women because they effect quality and quantity of milk
Very rarely can cause stroke, blood clots in deep veins of the legs, or heart attack. Those at highest risk are women with high blood pressure and women who are age 35
or old and at the same time smoke more than 20 cigarettes per day
Do not protect against sexually transmitted diseases (STDs)
Starting Low-Dose Combined Oral Contraceptives

When to start?
The first day of the menstrual bleeding is best
Any of the first 7 days after her menstrual bleeding has already stopped, some programs advise avoiding sex or using condoms or spermicide for seven days
After she stops breast feeding or 6 months after child birth—whichever comes first
3 to 6 weeks after childbirth. No need to wait for menstrual periods to return to be certqain that she is not pregnant

Some important points for the user to remember

Pills can be very effective if taken regularly every day
Safe-Serious problems are very rare
Please come back or see another health care provider at once if you have severe , constant pain in the chest, leg, or belly, or very bad headaches, if you see flashing
lights or zigzag lines, or if your skin or eyes become unusually yellow (jaundice)
Pills do not prevent sexually transmitted diseases (STDs) including HIV/ AIDS. If you think you might get an STD, use condoms regularly along with your pills.

DMPA Injectible Contraceptives

Women receive these injections to prevent pregnancy. This method is seen to be very effective. A rate as low as 0.3 per 100 women in the first year of use have been
recorded when injections are regularly spaced 3 months apart.

How does it work?

1. It mainly stops ovulation (release of eggs from ovaries).

2. It thickens the cervical mucus, making it difficult for sperm to pass through.
3. It does not disrupt existing pregnancy.

Advantages and Disadvantages:

Advantages:

1. It is very effective, and results in long term pregnancy prevention, which is reversible. One injection can prevent pregnancy for 3 months.

2. It does not interfere with sex and can be used at any stage.

3. Breast-feeding mothers can feel safe, as it does not harm the quantity and quality of breast milk. It can be used by nursing mothers as soon as six weeks after
childbirth.

4. It has no estrogen side effects. It does not increase the risk of estrogen related complications such as heart attack.
 5. It helps prevent endomaterial cancer and uterine fibroids. It may also help prevent ovarian cancer.

Disadvantages:

1. Common side effects (not signs of sickness):

Changes in menstrual bleeding are likely, including--- light spotting or bleeding, which is most common in the beginning. Heavy bleeding, though rare, too
can occur in the beginning. Amenorrhea is a normal effect especially after the first year of use.

2. These injections may cause weight gain (average of 1-2 kilos, or 2-4 lbs., each year). Changes in the diet can prevent weight gain. But some women also see
it as an advantage.

3. Headaches, breast tenderness, moodiness, nausea, hair loss, less sex drive, and or acne in some women.

4. Does not protect against sexually transmitted diseases including HIV/AIDS.

When to Start?

During Menstruation: A woman can start anytime she is reasonable certain that she is not pregnant. If started during the first seven days after the menstrual bleeding
starts, and if she is still bleeding, no back up method is needed for extra protection.

Breast-feeding: It can be taken as early as six weeks after childbirth. If the woman is not breast-feeding after childbirth, it can be taken immediately or in the first six
weeks after childbirth. She need not wait for her menstrual period to return. It can also be taken after six weeks, or any time it is reasonably certain that she is not
pregnant. If not reasonably certain, then it is advisable to avoid sex, or use of condom or spermicide until her first periods begin and then start DMPA.

After miscarriage or abortion: It can be started immediately or in the first 7 days after either first or second trimester miscarriage or abortion, or later when reasonable
certain that she is not pregnant.

Use of DMPA Injectibles:

1. They are very effective and safe.

2. Changes in vaginal bleeding are very normal. It is not harmful and not a sign of danger.

Progestin-only Oral Contraceptives

Women who use Progestin-only Oral Contraceptives should swallow a pill every day to prevent pregnancy. It contains very small amounts of only one kind of
hormone, a progestin. Again, they contain only one-half to one tenth as much progestin as combined oral contraceptives. They do not contain estrogen. These are
known as progestin-only pills (POPs), POCs and mini pills.

Progestin-only contraceptives are also best recommended for breast-feeding women. They do not reduce milk production.

How do they work?

Progestin works in a manner similar to breast-feeding. It thickens the cervical mucus, making it difficult for sperm to pass through. It reduces ovulation (release of eggs
from ovaries) to half of that of menstrual cycle.

Progestin-only oral contraceptives do not disrupt existing pregnancy.

How effective are they?

• For breast feeding women: Progestin is more effective than combined oral contraceptives, which are commonly used, because breast feeding itself provides
protection against pregnancy. Pregnancy rates for women not breast-feeding are not available.
There is only about one pregnancy per 100 women in the first year of use. Mistakes in pill taking lead to pregnancy more often than with combined oral
contraceptives. However, pill taking maybe easier, because a woman takes the same pill every day without breaks.

• For all women: Progestin-only oral contraceptives are very effective when used correctly and consistently. There are 0.5 pregnancies per 100 women in the
first year of use (1 in every 200). Combined oral contraceptives which are used correctly and consistently are more effective than the above mentioned
contraceptives.

It is most effective when taken about the same time every day.

Advantages and Disadvantages:

Advantages:

1. It can be used by nursing mothers starting 6 weeks after childbirth. Neither the quantity nor the quality of milk is harmed. (In contrast, combined oral
contraceptives can slightly reduce milk production).

2. It does not increase risk of estrogen-related complications, such as heart attack or stroke. Women take one pill every day without break. It is easier to
understand than taking 21-day combined pills.
 3. It can be very effective during breast-feeding. Also there is less risk of progestin related side effects, like weight gain, acne etc. than with combined oral
contraceptives.

Disadvantages:

1. Women not breast-feeding may experience common side effects. Changes in menstrual cycle are normal, including irregular periods, spotting or bleeding
between periods (common), and amenorrhea (missed periods).

2. Less common side effects include headaches and breast tenderness.

3. Should be taken at about the same time each day to work best. For women not breast-feeding, even taking a pill more than a few hours late, increases the risk
of pregnancy, and missing two or more pills increases the risk greatly.

When to start?
A woman can be given progestin –only oral contraceptives at any time and told when to start taking them.

A breast-feeding woman can start as early as 6 weeks after childbirth. Fully or nearly fully breast-feeding effectively prevents pregnancy for at least 6 months or
until she has menstrual period.

A woman if not breast-feeding after childbirth, can take them immediately or at anytime in the first 4 weeks after childbirth. She need not wait for her menstrual
period to return.

A woman who has had a miscarriage or abortion can take progestin-only contraceptives immediately or on the first 7 days after either first or second trimester
miscarriage or abortion.

A woman having menstrual cycles may take these contraceptives in the first 5 days of her menstrual bleeding. The first day of the menstrual bleeding is the best.
No back up method is needed for extra protection.

Emergency Oral Contraception

What is Emergency Oral Contraception?

After unprotected sex, emergency oral contraception can prevent pregnancy. Sometimes called postcoital or ‘morning after’ contraception.

How does it work?

Mainly stops ovulation (release of egg from ovary) but perhaps also works in other ways. Does not disrupt existing pregnancy.

How effective?
Seems to prevent about three-fourths of pregnancies that would otherwise have occurred. (Average chance of pregnancy due to one act of unprotected
intercourse in the second or third week of the menstrual cycle is 8%; after emergency oral contraceptives, 2%). The sooner emergency control contraceptives are
used, the better they prevent pregnancy.

How to use Emergency Oral Contraception ?

Up to 72 hours after unprotected sex, the woman should take 4 low-dose or 2 "standard-dose" combined oral contraceptives, and then take another equal dose 12
hours later.

Vaginal methods

Vaginal methods are contraceptives that a woman places in her vagina shortly before sex. There are several vaginal methods:

• Spermicides, including foaming tablets or suppositories, melting suppositories, foam, melting film, jelly and cream.

• Diaphragm, a soft rubber cup that covers the cervix. It should be used with spermicidal jelly or cream.

• Cervical cap is like the diaphragm but is smaller. It is not widely available outside North America, Europe, Australia and New Zealand.

Spermicides work by killing sperm or making sperm unable to move towards the egg. Diaphragms block the sperm from entering the uterus and tubes, when sperm
could meet an egg.

Advantages:

1. Safe, woman controlled methods that almost every woman can use.
2. Help prevent some STDs and conditions caused by STDs--- pelvic inflammatory disease (PID), infertility, ectopic pregnancy and possibly cervical
cancer. May offer some protection against HIV/AIDS, but this has not been demonstrated yet.
3. It offers contraception when needed. No daily action needed.
4. No side effects from hormones.
5. No effect on breast milk.

Disadvantages:
 1. Side effects:
--- Spermicide may cause irritation to woman or her partner, especially if used several times a day.

--- Spermicide may cause local allergic reaction (rarely) in the woman or her partner.

--- Can make urinary tract infections more common. (A woman can avoid this by always after sex).
2. Effectiveness requires having method at hand and taking correct action before each act of sexual intercourse.
A woman can begin using a vaginal method any time during her monthly cycle and soon after childbirth, abortion or miscarriage.

The diaphragm and cervical cap generally should not be fitted, however, in the first 6 to 12 weeks after full-term delivery or second-trimester spontaneous or
induced abortion, depending on when the uterus and cervix return to their normal sizes. If needed a woman can use the spermicidal alone or with condoms
until then.

Vasectomy

Vasectomy provides permanent contraception for men who decide they do they will not want more children. It is a safe, simple and quick surgical procedure and can
be done in a clinic or office with proper infection prevention procedures. It is not castration, and does not affect the testes, and it does not affect sexual ability.

The doctor makes a small opening in the man’s scrotum (the sac of the skin that holds his testicles) and closes off both tubes that carry sperm from his testicles. This
keeps the sperm out of his semen. The man can have erections and ejaculate semen, while his sperm no longer makes a woman pregnant.

This method has been found to be very effective, with 0.15 pregnancies per 100 men (1 in 700) in the first year after the procedure. It is even more effective when
correctly used. Correct use means using condoms or another family planning method consistently for the first 20 ejaculations or the for 3 months after the procedure---
whichever comes first.

Advantages:

1. It is very effective and is a permanent method.

2. Nothing to remember except to use condoms or another effective method for the first 20 ejaculations or the first three months, whichever comes first.
3. It does not affect the ability to have sex.
4. No apparent long-term health risks.

Disadvantages:

1. Common minor short term complications of surgery

:
--- Usually uncomfortable for 2 to 3 days
---Usually uncomfortable for 2 to 3 days
--- Brief feeling of faintness after the procedure

2. Uncommon complication of surgery:

--- Bleeding or infection at the incision site or inside the incision
--- Blot clots in the scrotum

3. Not immediately effective. The first 20 ejaculations after vasectomy may contain sperm. The couple must use another contraceptive method for the first 20
ejaculations or the 3 months---whichever comes first.

4. Reversal surgery is difficult, expensive and not available in most areas of the world. Success cannot be guaranteed. Men who may want to have more children in the
future should choose a different method.Important points to remember:

1. It is a permanent family planning method. A man must think carefully and decide that he will never want more children before choosing Vasectomy.
2. It is very effective after 20 ejaculations or three months--- whichever comes first.
3. Involves safe and simple surgery.

Norplant Implants

The Norplant (a registered trademark of The Population Council for levonorgestrel subdermal implants) implant system is a set of six small plastic capsules. The
capsules are placed under the skin of a woman’s upper arm.

Norplant capsules contain aprogestin, similar to natural hormone that a woman’s body makes. It is released very slowly from all six capsules. Thus the capsules supply
a steady, very low dose. Norplant implants contain no estrogen.

A set of Norplant capsules can prevent pregnancy for at least five years. It may prove to be effective longer.

How do they work?

Norplant capsules thicken cervical mucus making it difficult for sperm to pass through. It stops ovulation (release of eggs from ovaries) in about half of the menstrual
cycles after the first year of use.

How effective are they?

They are very effective and have a rate of 0.1 pregnancies per 100 women in the first year of use (1 in every 1000). Over 5 years, 1.6 pregnancies per 100 women.

Advantages and Disadvantages:

Advantages:

1. Norplant capsules are very effective even in heavier women.

2. It provides long term pregnancy protection, but is reversible.
3. A single decision can give very effective contraception up to five years.
4. It gives increased sexual enjoyment, as there is no need to worry about pregnancy.
5. Fertility returns almost immediately after the capsules are removed.
6. It does not harm the quality and quantity of the breast milk and can be used by nursing mothers starting six weeks after childbirth.
7. It has no estrogen side effects.

Disadvantages:

1. Common side effects (not signs of sickness)---

Changes in menstrual bleeding is normal, including:
---Light spotting or bleeding between monthly periods (common),
--- Prolonged bleeding (uncommon, and often decrease after first few months), or
--- Ammenorrhea. (Some women see Ammenorrhea as an advantage.)
Some women have:
--- Headaches,
--- Enlargement of ovaries or enlargement of ovarian cysts,
--- Dizziness,
--- Breast tenderness and/or discharge,
--- Nervousness,
--- Nausea,
--- Acne or skin rash,
--- Change in appetite,
--- Weight gain (though a few women lose weight),
--- Hair loss or more hair growth on the face.
Most women do not have any of these side effects, and most side effects go away without treatment within the first year.

2. The woman cannot start or stop use on her own. Capsules must be inserted and removed in by a specially trained practitioner.

3. Discomfort for several hours to one day after insertion for some women has been noticed. This may even continue for several days for a few women.
Removal is sometimes painful and often more difficult than insertion.

4. These capsules do not protect against sexually transmitted diseases including HIV/AIDS.

When to start?

1. For women having menstrual cycles, any time it is certain that she is not pregnant.

2. Breast feeding women may start as early as six weeks after birth.

3. A women not breast feeding after childbirth may start immediately or at any time in the first six weeks after childbirth. She need not wait for her menstrual
period to return.

4. A woman who has had a miscarriage or abortion may start immediately or in the first seven days after either first or second trimester miscarriage or abortion.

5. It can be started immediately after any other method is stopped.

Important points for the user to remember.

1. Changes in vaginal bleeding are normal. The are not a sign of danger.

2. You should have the implants removed 5 years after the insertion.

3. You can choose to remove the capsules any time you want, for any reason.

4. You are advised to consult a doctor at once if your arm is sore for more than a few days, or if infection occurs (pain, heat and redness), capsules come out,
severe headaches start or become worse after you begin using implants, or you think you might be pregnant, have unusually heavy vaginal bleeding or severe
pain or tenderness in the lower belly, your skin or eyes become unusually yellow or you feel faint.
 Norplant implants do not prevent sexually transmitted diseases (STDs) including HIV/AIDS. If you think you might get an STD, use condoms regularly along
with implants.

Intrauterine Devices

An intrauterine device (IUD) usually is a small, flexible plastic frame. It often has copper wire or copper sleeves on it. It is inserted into a woman’s vagina through her
uterus. Almost all brands of IUDs have two strings, or threads, tied to them. The strings hang through the opening of the cervix into the vagina. A provider can remove
the IUD by pulling gently on the strings with forceps.

The type now most widely used is:

Copper bearing IUDs (made of plastic wit copper sleeves and/or copper wire on the plastic). Tcu380A and MLCu-375 are this type.hormone-releasing IUDs (made of
plastic; steadily release small amounts of hormone progesterone or another progestin such as levenorgesterel). LNG-20 and Progestasert are this type.
IUDs work chiefly by preventing sperm and egg from meeting. Perhaps the IUD makes it hard for sperm to move through the woman’s reproductive tract, and it
reduces the ability of sperm to fertilize the egg. It could also prevent the egg from implanting itself in the wall of the uterus.
It is very effective as commonly used. And shows a rate of only 3 pregnancies per 100 women.

Advantages: A single decision leads to effective long-term prevention of pregnancy.Long lasting. The most widely used IUD (outside China), the Tcu-380A, lasts at
least 10 years. Inert IUDs need never be replaced.They are very effective and very little need be remembered.No interference with sex.Increased sexual enjoyment
because there is no need to worry about pregnancy.It can be inserted be inserted immediately after childbirth (except hormone releasing IUDs) or after induced abortion
(if there is no evidence of infection).
Disadvantages: Common side effects: Menstrual changes (common in the first 3 months but likely to lessen after three months:
---Longer and heavier menstrual periods
---Bleeding or spotting between periods
---More cramps or pain during periods

Other uncommon side effects and complications:

--- Severe cramps and pains beyond the first 3 to 5 years after insertion
--- Heavy menstrual bleeding or bleeding between periods, possibly contributing to anemia.
--- More likely with inert IUDs than with copper or hormone releasing IUDs.

Other uncommon side effects and complications:

--- Severe cramps and pain beyond the first 3 to 5 days after insertion
--- Heavy menstrual bleeding or bleeding between periods, possibly contributing to anemia. More like with inert IUDs than with copper or hormone-releasing
IUDs
--- Perforation (piercing) of the wall of the uterus (very rare if the IUD is properly inserted). Does not protect against sexually transmitted diseases (STDs)
including HIV/AIDS. Not a good method for women with recent STDs or with multiple sex partners (or partners with multiple sex partners).Pelvic inflammatory
disease (PID) is more likely to follow STD infection if a woman uses an IUD. PID can lead to infertility.

Condoms

A condom is a sheath or covering made to fit over a man’s erect penis. It is also called rubbers, sheaths, skins and prophylactics, and known by many different brand
names. Most common condoms are made of thin latex rubber. Some condoms are coated with a dry lubricant or with spermicide. Different sizes, shapes, colors and
textures maybe available.Condoms help prevent both pregnancy and sexually transmitted diseases (STDs). Used correctly, they keep sperm and any disease organisms
in the semen out of the vagina. Condoms also stop any disease causing organisms from entering the penis.To be highly effective, it must be used correctly every time.
Many men do not use condoms correctly or do not use them every time they have sex. Thus, they may risk causing pregnancy, getting STDs, or giving STDs to their
partners.It is somewhat effective for preventing pregnancy as commonly used. 14 pregnancies per 100 women in the first year of use are the rate. However, when
correctly used 3 pregnancies per 100 women have been recorded.

Advantages:

It prevents STDs, HIV/AIDS, as well as pregnancy, when used correctly, with every act of sexual intercourse.It helps protect against conditions caused by
STDs--- pelvic inflammatory disease, chronic pain and possibly cervical cancer in women, infertility in both men and women.Can be used to prevent STD
infection during pregnancy. Can be used immediately after childbirth.
--- No effect on breast milk (unlike combined oral contraceptives)
--- Protect against infection in the uterus at a time when such infection occurs easily.It is safe and has no hormonal side effects.Can be used by men of all
ages.Can be used without seeing a health care provider first. Often helps prevent premature ejaculation (helps the man last longer during sex.)

Disadvantages: Latex condoms may cause itching or for a few people who are allergic to latex. In addition, some people maybe allergic to the lubricant on some brands
of condoms.May decrease sensation, making sex less enjoyable for either partner.Couple must take time to put the condom on the erect penis before sex.It may be
embarrassing for some people to purchase, ask a partner to use, put on take off or throw away condoms.
Some important points to remember: Condoms protect against pregnancy as well as sexually transmitted diseases (STDs), including HIV/AIDS. Condoms work well
when used correctly with every act of sexual intercourse. However, a condom cannot work when it is not used. Have a condom before you need it, and be sure to use it.
Condoms seldom break if properly used.