Overview of Family Planning, Sterilization, and Abortion Methods
Family Planning
Kamal Kumar Gupta
Sterilization
•
Sterilization is a procedure that renders an individual
incapable
of further reproduction. The principal method for
sterilization of males is a
vasectomy (described in the
Clinical Connection on
page 1091). Sterilization in females
most often is achieved by performing a
tubal ligation , in
which both uterine
tubes are tied closed and then cut. This
can be achieved in a few different ways. “Clips” or “clamps”
can be placed on the uterine tubes, the tubes can be tied
and/or cut, and sometimes they are cauterized. In any case
the result is that the secondary oocyte cannot pass through
the uterine tubes, and sperm cannot reach the oocyte.
Tubal ligation reduces the risk of pelvic inflammatory
disease in women who are exposed to sexually transmitted
infections; it may also reduce the risk of ovarian cancer.
Abortion
•
Refers to the premature expulsion of the
products of
conception from the uterus,
usually before the twentieth week of
pregnancy. An abortion may be
spontaneous
(naturally occurring;
also called
miscarriage)
or
induced (intentionally performed).
Abortion
•
There are several types of induced abortions.
One involves
mifepristone, called miniprex in
the United States and RU 486
in Europe. It is a
hormone approved only for pregnancies 9
weeks or less when taken with misoprostol (a
prostaglandin).
Abortion
•
Mifepristone is an antiprogestin; it blocks the action of
progesterone by binding to and blocking progesterone
receptors. Progesterone prepares the uterine
endometrium for implantation and then maintains the
uterine lining after implantation. If the level of
progesterone falls during pregnancy or if the action of
the hormone is blocked, menstruation occurs, and the
embryo sloughs off along with the uterine lining.
Within 12 hours after taking mifepristone, the
endometrium starts to degenerate, and within 72
hours it begins to slough off. Misoprostol stimulates
uterine contractions, and is given after mifepristone to
aid in expulsion of the endometrium.
Abortion
•
Another type of induced abortion is called
vacuum aspiration
(suction) and can be performed up to the sixteenth week of
pregnancy. A small, flexible tube attached to a vacuum source is
inserted into the uterus through the vagina. The embryo or fetus,
placenta, and lining of the uterus are then removed by suction. For
pregnancies between 13 and 16 weeks, a technique called
dilation
and evacuation is commonly used. After the cervix is
dilated,
suction and forceps are used to remove the fetus, placenta, and
uterine lining. From the 16th to 24th week, a
latestage abortion
may be employed using surgical methods similar
to dilation and
evacuation or through nonsurgical methods using a saline solution
or medications to induce abortion. Labor may be induced by using
vaginal suppositories, intravenous infusion, or injections into the
amniotic fluid through the uterus.
Emergency Contraception
•
Emergency contraception is NOT a regular method of birth
control. Emergency contraception can be used after no
birth control was used during sex, or if the birth control
method failed, such as if a condom broke.
•
Copper IUD
—Women can have the copper T IUD inserted
within five days of unprotected sex.
•
Emergency contraceptive pills—Women can take
emergency contraceptive pills up to 5 days after
unprotected sex, but the sooner the pills are taken, the
better they will work. There are three different types of
emergency contraceptive pills available in the United
States. Some emergency contraceptive pills are available
over the counter.
Female Sterilization—Tubal ligation
•
Female Sterilization—Tubal ligation or “tying
tubes”
— A woman can have her fallopian tubes
tied (or closed) so that sperm and eggs cannot
meet for fertilization. The procedure can be done
in a hospital or in an outpatient surgical center.
You can go home the same day of the surgery and
resume your normal activities within a few days.
This method is effective
•
Typical use failure rate: 0.5%.
Female sterilization (tubal ligation)
•
Permanent contraception to block or cut the
fallopian tubes
•
Eggs are blocked from meeting sperm >99%
•
Voluntary and informed choice is essential
Tubal Ligation and Tubectomy
Male Sterilization–Vasectomy
•
This operation is done to stop a man’s sperm
from going to his penis, so his ejaculate never has
any sperm in it that can fertilize an egg. The
procedure is typically done at an outpatient
surgical center. The man can go home the same
day. Recovery time is less than one week. After
the operation, a man visits his doctor for tests to
count his sperm and to make sure the sperm
count has dropped to zero; this takes about 12
weeks. Another form of birth control should be
used until the man’s sperm count has dropped to
zero. Typical use failure rate: 0.15%.
Male Sterilization–Vasectomy
Male sterilization (vasectomy)
•
Permanent to block or cut the vas deferens
tubes that carry sperm from the testicles
•
Keeps sperm out of ejaculated semen
•
>99% after 3 months Effectiveness to prevent
pregnancy 97–98% with no semen evaluation
•
3 months delay in taking effect while stored
sperm is still present; does not affect male
sexual performance; voluntary and informed
choice is essential
Contraceptive use
•
Contraceptive use has increased in many parts of the
world, especially in Asia and Latin America, but continues
to be low in sub-Saharan Africa. Globally, use of modern
contraception has risen slightly, from 54% in 1990 to 57.4%
in 2015. Regionally, the proportion of women aged 15–49
reporting use of a modern contraceptive method has risen
minimally or plateaued between 2008 and 2015. In Africa it
went from 23.6% to 28.5%, in Asia it has risen slightly from
60.9% to 61.8%, and in Latin America and the Caribbean it
has remained stable at 66.7%.
•
Use of contraception by men makes up a relatively small
subset of the above prevalence rates. The modern
contraceptive methods for men are limited to male
condoms and sterilization (vasectomy).
Global unmet need for contraception
•
214 million women of reproductive age in developing countries
who want to avoid pregnancy are not using a modern contraceptive
method. Reasons for this include:
limited choice of methods;
limited access to contraception, particularly among young people,
poorer segments of populations, or unmarried people;
fear or
experience of side-effects; cultural or religious opposition;
poor
quality of available services;
users and providers bias
gender-
based barriers.
•
The unmet need for contraception remains too high. This inequity is
fuelled by both a growing population, and a shortage of family
planning services. In Africa, 24.2% of women of reproductive age
have an unmet need for modern contraception. In Asia, and Latin
America and the Caribbean – regions with relatively high
contraceptive prevalence – the levels of unmet need are 10.2 % and
10.7%, respectively (Trends in Contraception Worldwide 2015,
UNDESA).
Family planning involves various methods such as sterilization and abortion for reproductive choices. Sterilization methods, including vasectomy and tubal ligation, prevent further reproduction. Abortion refers to the termination of a pregnancy through different techniques like medication-induced or surgical procedures. This comprehensive guide explains the procedures and implications of family planning methods.
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Presentation Transcript
Family Planning Kamal Kumar Gupta
Sterilization Sterilization is a procedure that renders an individual incapable of further reproduction. The principal method for sterilization of males is a vasectomy (described in the Clinical Connection on page 1091). Sterilization in females most often is achieved by performing a tubal ligation , in which both uterine tubes are tied closed and then cut. This can be achieved in a few different ways. Clips or clamps can be placed on the uterine tubes, the tubes can be tied and/or cut, and sometimes they are cauterized. In any case the result is that the secondary oocyte cannot pass through the uterine tubes, and sperm cannot reach the oocyte. Tubal ligation reduces the risk of pelvic inflammatory disease in women who are exposed to sexually transmitted infections; it may also reduce the risk of ovarian cancer.
Abortion Refers to the premature expulsion of the products of conception from the uterus, usually before the pregnancy. An abortion may be spontaneous (naturally occurring; also called miscarriage) or induced (intentionally performed). twentieth week of
Abortion There are several types of induced abortions. One involves mifepristone, called miniprex in the United States and RU 486 in Europe. It is a hormone approved only for pregnancies 9 weeks or less when taken with misoprostol (a prostaglandin).
Abortion Mifepristone is an antiprogestin; it blocks the action of progesterone by binding to and blocking progesterone receptors. Progesterone endometrium for implantation and then maintains the uterine lining after implantation. If the level of progesterone falls during pregnancy or if the action of the hormone is blocked, menstruation occurs, and the embryo sloughs off along with the uterine lining. Within 12 hours after taking mifepristone, the endometrium starts to degenerate, and within 72 hours it begins to slough off. Misoprostol stimulates uterine contractions, and is given after mifepristone to aid in expulsion of the endometrium. prepares the uterine
Abortion Another type of induced abortion is called vacuum aspiration (suction) and can be performed up to the sixteenth week of pregnancy. A small, flexible tube attached to a vacuum source is inserted into the uterus through the vagina. The embryo or fetus, placenta, and lining of the uterus are then removed by suction. For pregnancies between 13 and 16 weeks, a technique called dilation and evacuation is commonly used. After the cervix is dilated, suction and forceps are used to remove the fetus, placenta, and uterine lining. From the 16th to 24th week, a latestage abortion may be employed using surgical methods similar to dilation and evacuation or through nonsurgical methods using a saline solution or medications to induce abortion. Labor may be induced by using vaginal suppositories, intravenous infusion, or injections into the amniotic fluid through the uterus.
Emergency Contraception Emergency contraception is NOT a regular method of birth control. Emergency contraception can be used after no birth control was used during sex, or if the birth control method failed, such as if a condom broke. Copper IUD Women can have the copper T IUD inserted within five days of unprotected sex. Emergency contraceptive pills Women can take emergency contraceptive pills up to 5 days after unprotected sex, but the sooner the pills are taken, the better they will work. There are three different types of emergency contraceptive pills available in the United States. Some emergency contraceptive pills are available over the counter.
Female SterilizationTubal ligation Female Sterilization Tubal ligation or tying tubes A woman can have her fallopian tubes tied (or closed) so that sperm and eggs cannot meet for fertilization. The procedure can be done in a hospital or in an outpatient surgical center. You can go home the same day of the surgery and resume your normal activities within a few days. This method is effective Typical use failure rate: 0.5%.
Female sterilization (tubal ligation) Permanent contraception to block or cut the fallopian tubes Eggs are blocked from meeting sperm >99% Voluntary and informed choice is essential
Male SterilizationVasectomy This operation is done to stop a man s sperm from going to his penis, so his ejaculate never has any sperm in it that can fertilize an egg. The procedure is typically done at an outpatient surgical center. The man can go home the same day. Recovery time is less than one week. After the operation, a man visits his doctor for tests to count his sperm and to make sure the sperm count has dropped to zero; this takes about 12 weeks. Another form of birth control should be used until the man s sperm count has dropped to zero. Typical use failure rate: 0.15%.
Male sterilization (vasectomy) Permanent to block or cut the vas deferens tubes that carry sperm from the testicles Keeps sperm out of ejaculated semen >99% after 3 months Effectiveness to prevent pregnancy 97 98% with no semen evaluation 3 months delay in taking effect while stored sperm is still present; does not affect male sexual performance; voluntary and informed choice is essential
Contraceptive use Contraceptive use has increased in many parts of the world, especially in Asia and Latin America, but continues to be low in sub-Saharan Africa. Globally, use of modern contraception has risen slightly, from 54% in 1990 to 57.4% in 2015. Regionally, the proportion of women aged 15 49 reporting use of a modern contraceptive method has risen minimally or plateaued between 2008 and 2015. In Africa it went from 23.6% to 28.5%, in Asia it has risen slightly from 60.9% to 61.8%, and in Latin America and the Caribbean it has remained stable at 66.7%. Use of contraception by men makes up a relatively small subset of the above prevalence rates. The modern contraceptive methods for men are limited to male condoms and sterilization (vasectomy).
Global unmet need for contraception 214 million women of reproductive age in developing countries who want to avoid pregnancy are not using a modern contraceptive method. Reasons for this include: limited choice of methods; limited access to contraception, particularly among young people, poorer segments of populations, or unmarried people; fear or experience of side-effects; cultural or religious opposition; poor quality of available services; users and providers bias gender- based barriers. The unmet need for contraception remains too high. This inequity is fuelled by both a growing population, and a shortage of family planning services. In Africa, 24.2% of women of reproductive age have an unmet need for modern contraception. In Asia, and Latin America and the Caribbean regions with relatively high contraceptive prevalence the levels of unmet need are 10.2 % and 10.7%, respectively (Trends in Contraception Worldwide 2015, UNDESA).
