Family Planning 101: Key Concepts in
Adolescent Health Care
April 2010
Meera Beharry, MD
Division of Adolescent Medicine
University of Rochester Medical Center
ACT for Youth Center of Excellence
Cornell University Family Life Development Center
Cornell University Cooperative Extension of New York City
New York State Center for School Safety
University of Rochester Medical Center Div. of Adolescent Medicine
Objectives
• Define family planning
• Describe methods of contraception
• Identify resources for adolescents
Family Planning
• The use of education
and birth control to
limit the number of
offspring and the
population of a
country.
American Heritage® New Dictionary of Cultural Literacy,
3rdEd, 2005 by Houghton Mifflin Company
Legal Issues
• Distributing information
and counseling patients
about contraception was
illegal under federal and
state laws.
AP
Margaret Sanger, 1914
US fertility rates: 1917-1997 and
Key Family Planning Events
Title X established
Timing of
ovulation
established
Birth
Control
Pills, IUD
approved
by FDA
MMWR, Dec 03, 1999
48(47);1073-1080
Myriad of Methods
Ring
Patch
Condoms
Implant
Cap
Diaphragm
Spermicides
Abstinence
Injection (“shot”)
IUD
Pills
How do you choose?
Decision 1
Hormonal, Non-hormonal or
both?
Non-Hormonal/Barrier
• Condoms
Condoms
Non-Hormonal/Barrier
• Condoms
• Diaphragm
• Cervical Cap
Spermicide
Diaphragm
Cervical
Cap
Spermicides
Non-Hormonal/Barrier
•
•
•
•
Condoms
Diaphragm
Cervical Cap
Copper IUD
Non-Hormonal/Barrier
•
•
•
•
•
•
•
•
Condoms
Diaphragm
Cervical Cap
Spermicide
Copper IUD
Abstinence1
Period abstinence/fertility awareness1
“Withdrawal”, coitus interruptus
1 Society
for Adolescent Med., J Adolesc Health 2006;38:83–87
Hormonal
• Pill
– Daily
– Emergency
(not recommended
as a regular form of
birth control)
Hormonal
• Pill
• Patch
Patch
Hormonal
• Pill
• Patch
• Injection
Hormonal
•
•
•
•
Pill
Patch
Injection
Ring
Hormonal
•
•
•
•
•
Pill
Patch
Injection
Ring
Progesterone IUD
IUD
Hormonal
•
•
•
•
•
•
Pill
Patch
Injection
Ring
Progesterone IUD
Implantable device
Advantages/Disadvantages
Non-Hormonal/Barrier
Advantages
• No hormones
• Fewer or no medical
contraindications*
• Can prevent STD
Disadvantages
• Event based use
• Some need a
doctor’s visit
Hormonal
Advantages
• Not event dependent
• Additional health
benefits
–
–
–
–
Menstrual symptoms
Acne
Lower cancer risk
Less blood loss
Disadvantages
• Require use as
prescribed
• Some medical
contraindications
Quick Quiz
Does a young woman need to
have a pelvic exam before starting
birth control?
NO!
Decision 2: if hormonal method
Any contraindications?
W.H.O. Absolute Contraindications to
Estrogen Containing Products
•
•
•
•
•
•
Blood clotting problems
Stroke
Very high blood pressure
Some cancers
Some liver diseases
Major surgery with prolonger
immobilization
• Migraine headaches with aura
http://whqlibdoc.who.int/hq/2008/WHO_RHR_08.19_eng.pdf
Decision 3: if hormonal method,
How often do you take it?
How Often Do You Take It?
Method
Pills
Frequency
Every day
How Often Do You Take It?
Method
Frequency
Pills
Every day
Patch
Once a week
How Often Do You Take It?
Method
Frequency
Pills
Every day
Patch
Once a week
Ring
Once a month
How Often Do You Take It?
Method
Frequency
Pills
Every day
Patch
Once a week
Ring
Once a month
Injection
Every 3 months*
How Often Do You Take It?
Method
Frequency
Pills
Every day
Patch
Once a week
Ring
Once a month
Injection
Every 3 months*
Implant (Implanon®)
Every 3 years*
How Often Do You Take It?
Method
Frequency
Pills
Every day
Patch
Once a week
Ring
Once a month
Injection
Every 3 months*
Implant
Every 3 years*
IUD
Every 5 years*
Quick Quiz:
Match the method
Match the Frequency & the Method
Frequency
Match Columns
Method
a) Once a month
1-Implant
b) Once a week
2-Injection
c) Daily
d) Every 3 months
3-IUD
4-Patch
e) Every 5 years
5-Pills
f) Every 3 years
6-Ring
Match the Frequency & the Method
Frequency
Correct Answer
Method
a) Once a month
a-6
1-Implant
b) Once a week
b-4
2-Injection
c) Daily
c-5
3-IUD
d) Every 3 months
d-2
4-Patch
e) Every 5 years
e-3
5-Pills
f) Every 3 years
f-1
6-Ring
Emergency Contraception
What if….
…the condom broke or
slipped off...
…you forgot your
regular birth
control...
…you were forced to
have sex...
Association of Reproductive Health Professionals
Emergency
Contraception
• What is it?
– A method for preventing implantation
– A method for preventing fertilization
• There are three types available in the U.S.
EC Available in the United States
Combined Pills
Progestin-only
Pills
Copper-T IUD
Dedicated Product:
®
Plan B
Trussell J, Raymond EG. 2007.
Association of Reproductive Health Professionals
Emergency Contraception Pills
• What they are not:
– They are not the “abortion pill”
– They are not a form of family
planning
Resources
• Internet:
– http://youngwomenshealth.org/
– www.plannedparenthood.org
– http://ec.princeton.edu/
• Current health care provider
– www.adolescenthealth.org
• Family Planning Benefit Program
– www.nyhealth.gov/community/pregnancy/family
_planning/program_sites.htm
ACT for Youth Center of Excellence
Was this presentation useful? Please give us your feedback:
http://www.zoomerang.com/Survey/WEB22AEZWMYJH3
The ACT for Youth Center of Excellence connects positive youth
development resources and research to practice in New York State and
beyond. The Center provides:
 Technical support, training, and evaluation for youth-serving
programs funded by the NYS Department of Health.
 Youth Development resources: www.actforyouth.net, publications,
training and events, and the e-letter ACT for Youth Update. Email
act4youth@cornell.edu to subscribe.
 A home base for the ACT Youth Network. Visit the network at
www.nysyouth.net
act4youth@cornell.edu • 607-255-7736 • http://www.actforyouth.net