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RCFP_ Family Planning methods English |
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SPACING
METHODS
OF
FAMILY PLANNING
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about PFI
Population Foundation of India (PFI) is a national NGO which promotes and
advocates for the effective formulation and implementation of gender-sensitive
population and development strategies and policies. PFI was founded in 1970 by a
group of socially committed industrialists under the leadership of the late JRD Tata
and Dr Bharat-Ram.
PFI addresses population issues within the larger discourse of empowering women
and men, so that they are able to take decisions related to their lives, health and well-
being. The organisation works with the government and like-minded NGOs to give
men and women the knowledge and means to plan and raise healthy families. PFI is
guided by an eminent governing board and advisory council comprising renowned
personalities from the civil society, the government and the private sector.
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Contents
CENTCHROMAN
DIAPHRAGM
FEMALE CONDOMS
IMPLANTS
LEVONORGESTREL INTRAUTERINE SYSTEM
INJECTABLE CONTRACEPTIVES
PROGESTIN-ONLY PILLS
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Spacing Methods of Family Planning
CENTCHROMAN
Evidence and Experience in India
Developed by the Central Drug Research Institute of India in the late Nineties, Centchroman (or
Ormeloxifene), a non-steroidal weekly oral contraceptive pill, has undergone extensive clinical trials.
Centchroman is a selective Estrogen Receptor Modulator. It acts on the estrogen receptor in the body to
either stimulate or suppress it.
While it acts as a birth control pill by suppressing the receptor organs like the ovaries, the uterus, and
the breasts, it helps in the formation of new bones by stimulating estrogen receptors in the bones. The
role of centchroman in prevention of breast and uterine cancers is significant. Since December 1995,
Centchroman (popularly known as Saheli and Novex), used to prevent pregnancy, is being subsidised by
the Government of India.
Centchroman acts at three points in the reproductive cycle:
1. It increases the movement of the fertilised ovum through the fallopian tubes so that it reaches the
uterus ‘too early’ when the endometrium is not ready for implantation at the time.
2. It increases the rate of maturation of the ovum, so that it is hypermature when it reaches the
endometrium and fails to implant in it.
3. It slows down the growth and development of the endometrium so that it is not adequately prepared
to receive the fertilised ovum when it reaches the uterus.
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About the method
Centchroman (or Ormeloxifene) is a Selective Estrogen Receptor Modulator (SERM), a potent non-steroidal,
non-hormonal birth control method. It acts on estrogen receptors in the body by either stimulating or
suppressing them, possessing potent estrogen antagonistic and weak estrogen agonistic activities.
Centchroman is available as 30mg tablets. A single tablet should be taken twice a week (For example on a
Sunday and a Wednesday) for the first three months, and then weekly (every Sunday) thereafter. The first pill is
taken on the first day of the period. Additional contraceptives like condoms should be used for the first month.
Effectiveness
It has a failure rate of less than 2%.
Advantages
It is highly effective.
It is safe to use, but a thorough pelvic examination is necessary as ovarian cyst formation may occur, and it is
important to exclude pre-exixting cysts.
Being non-hormonal, it does not cause nausea, dizziness, weight gain and other side effects associated with
birth control pills.
It has no adverse effect on blood coagulation, liver function and lipid profile. So there are no chances of blood
clots or increase in the cholesterol level due to centchroman.
It is not toxic. In women, who became pregnant while on centchroman, nocongenital anomalies were noted
in the babies.
Since it does not stop ovulation, return to fertility is faster once the pills are stopped and the risk of infertility
is minimal.
Possible side effects
Centchroman causes delayed periods in some women. But this occurs in less than10% of users and usually
in the first three months. The periods tend to settle down to a rhythm once the body gets used to the drug.
There may be heavier periods in the first three months with tender breasts, water retention, and some
amount of acne.
Periods can get scanty over time in some women.
Sources
1. Gupta RC, P. J. (1995 Nov). Centchroman: a new non steroidal oral contraceptive in human milk. Contraception, 52(5): 301-305.
2. Lal J, A. O. (1995 Nov). Pharmacokinetics of Centchroman in healthy female subjects after oral administration. Contraception, 52(5): 297-300.
3. Lal J, Nityanand. S. (2001 Jan). Optimization of contraceptive dosage regimen of Centchroman. Contraception , 63(1): 47-51.
4. Nityanand S, et. al. (1994). Contraceptive efficacy and safety of centchroman with biweekly-cum-weekly schedule. Current Concepts in Fertility
Regulation and Reproduction. Eds. C.P. Puri and P.F.A. Van Look , 61.
5. Puri V. S. R. (1986). Prostanoid mediated effects of centchroman, a nonsteroidal oral contraceptive. Agents Actions, 18:596–9.
6. Roy S, et. al. (1976, Sept). Induction of ovulation in the human with centchroman: a preliminary report. (27 (9):1108-10).
7. Singh MM, et. al. (1986 Jan). Effect of centchroman on tubal transport and preimplantation embryonic development in rats. J Reprod Fertil.,
76(1):317-24.
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Spacing Methods of Family Planning
DIAPHRAGM
Global Evidence and Programme Experiences
The diaphragm has been in use as a contraceptive method for a long time. Women in developed
countries find these devices acceptable1. The SILCS diaphragm – a new, single-size device – is part of an
effort to develop new cervical barrier devices for prevention of STI/HIV and pregnancy. The design has
had high acceptability, efficacy and is easy to administer and use2.
In a 2008 study conducted among couples in South Africa and Thailand3, women reported that the
SILCS diaphragm was easy to use and provided good comfort in over 80% of all product uses. Men also
reported good comfort in over 60% of all product uses.
In a comparative crossover study of the SILCS diaphragm with a traditional diaphragm in the Dominican
Republic, 19 of 20 women preferred the SILCS diaphragm after short-term use. Data from clinical
studies confirm the single-size device fits most women4.
In INDIA
In the 1960s and 1970s, diaphragms were a part of the National Family Planning Programme. However,
the introduction of Intrauterine Devices (IUDs) led to the decline in their use. Studies on the SILCS
product are being conducted in Rajasthan and Karnataka by PATH.
1 Maher JE, Harvey MS, Thorburn Bird S, Stevens VJ, Beckman LJ. Acceptability of the vaginal diaphragm among current users. Perspect Sex Reprod Health
2004; 36: 64–71.
2 Mauck CK, Creinin MD, Rountree W, Callahan NM, Hillier SL. Lea’s Shield: Colposcopic and microbiological testing during 8 weeks of use. Contraception
2005; 72: 53–59.
3 Short-term acceptability of a single-size diaphragm among couples in South Africa and Thailand; Patricia S Coffey, Maggie Kilbourne-Brook, Mags
Beksinska and Earmporn Thongkrajai. J Fam Plann Reprod Health Care 2008 34: 233-236 doi: 10.1783/147118908786000569
4 Technology Solution for Global Health. ‘SILCS Diaphragm’, PATH, July 2013. http://www.path.org/publications/files/TS_update_silcs.pdf . Accessed on 20
December 2015.
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About the method
A diaphragm is a soft latex, plastic or silicone cup (comes in different sizes) with a flexible rim to keep it in
place. It is placed deep in the vagina before sex and covers the cervix.
The first time use of diaphragm must be prescribed by a health care provider or clinician who will make sure
that you get the right size, and teach how to insert and remove the device. Pelvic examination is needed
before it is inserted.
Effectiveness
84 of every 100 women using the diaphragm in the first year will not become pregnant.
The use of diaphragms with spermicide during every intercourse reports 6 pregnancies per 100 women.
Fertility returns immediately after stopping the use of diaphragms.
Requires correct use during every intercourse for greater effectiveness.
Advantages
No hormonal side effects.
May help protect against certain STIs (chalmydia, gonorrhea, pelvic inflammatory disease, and
trichomoniasis), cervical pre cancer and cancer.
Can be inserted ahead of time, so does not interfere with sexual activity.
Possible side effects
Irritation in or around the vagina or penis.
Vaginal lesions.
Health risks:
• Common to uncommon: Urinary tract infection.
• Uncommon: Bacterial vaginosis, Candidiasis.
• Rare: Frequent use of nonoxynol-9, a spermicide may increase risk of HIV infection.
• Extremely rare: Toxic shock syndrome.
• Diaphragms should not be used when the user has any history of vaginoplasty, rigid vaginal walls, vaginal
malformations, strictures, recurrent cystitis (urinary tract infection), or toxic shock syndrome.
Source: Family Planning: A Global Handbook for Providers, 2011, WHO, John Hopkins and USAID.
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Spacing Methods of Family Planning
FEMALE CONDOMS
Global Evidence and Programme Experiences
The female condom is a contraceptive for use by women. It also protects from HIV.
Studies from 40 countries show acceptability rates ranging from 37% to 93%1. In a pilot study from
Thailand, protected sexual acts increased from 57% to 88%, and STI prevalence decreased from
52% to 40% when both male and female condoms were available.
A study on male acceptance of female condoms in Zimbabwe, Cameroon and Nigeria in 2011
revealed that nearly all participants believed in the superior effectiveness of the female condom
for prevention of pregnancy and protection against HIV/ STIs, in comparison to other contraceptive
methods and male condoms2.
Research conducted on the first generation of female condoms ( FC1®) in Brazil, India, Thailand,
the United States and Zambia indicated an increase of protected sexual acts and a decrease in STI
prevalence when FC1® is available alongside male condoms.
In INDIA
Female condoms are available only in the private sector. The female condoms programme of National
AIDS Control Organization (NACO) in India empowers female sex workers (FSWs) to protect themselves
from HIV infection in low-negotiable environments. NACO’s female condom programme implemented
through NGOs in six high prevalence states indicated high levels of acceptance among FSWs and close
to 5% reduction in unprotected sex. NACO is currently funding the female condom scale-up programme
in four states - Tamil Nadu, Andhra Pradesh, West Bengal and Maharashtra. NACO also plans to scale
up the programme in two to three districts each in nine more states. Another female condom scale-
up programme funded by UNFPA is being implemented in four states - Bihar, Jharkhand, Orissa and
Rajasthan. NACO provides female condoms at a highly subsidized rate 3.
1 ‘Female Condom’ - PRODUCT BRIEF: Caucus on New and Underused Reproductive Health Technologies, Reproductive Health
Supplies Coalition. Last updated on January 2012. http://www.path.org/publications/files/RHSC_fem_condom_br.pdf Accessed
on 30 December 2015.
2 Winny Koster, Marije Groot Bruinderink and Wendy Janssens. Empowering Women or Pleasing Men? Analyzing Male Views
on Female Condom Use in Zimbabwe, Nigeria and Cameroon. Int Perspect Sex Reprod Health. 2015 Sep;41(3):126-35. doi:
10.1363/4112615.
3 NACO Website available at: http://www.naco.gov.in/NACO/Divisions/Condom_Promotion/
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About the method
Female condoms are sheaths, or linings, made of thin, transparent, soft plastic film that fits loosely
inside a woman’s vagina. They have flexible rings at both ends.
Effectiveness
As commonly used, there would be about 21 pregnancies per 100 women using female
condoms over the first year, i.e 79 of every 100 women using female condoms will not become
pregnant.
When used correctly with every sexual activity, the effectiveness increases to about 5
pregnancies per 100 women over the first year.
Female condoms reduce the risk of STIs and HIV when used correctly with every act of sex.
Advantages
Female condoms help protect against both pregnancy and STIs, including HIV.
They have a soft, moist texture that feels more natural than male latex condoms during
intercourse.
No known health risk.
Possible side effects
Mild irritation in or around the vagina or penis (itching, redness or rash).
Source: Family Planning: A Global Handbook for Providers, 2011, WHO, John Hopkins and USAID
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Spacing Methods of Family Planning
IMPLANTS
Implant as a Contraceptive Choice
Contraceptive use has recently increased substantially in a number of Eastern and Southern African
countries1. While this has been mainly due to increased use of injectables, the use of implants has also
risen notably over a short time span in countries such as Ethiopia, Malawi, Rwanda, and Tanzania.
For example, one in every seven women using modern contraception in Rwanda currently relies on
an implant, compared with less than one in 25 in 2005. These trends suggest that wider availability
of implants could lead to much greater use in countries where they are currently available easily. High
rates of user satisfaction (79%) and continuation (around 84% at one year of use) further support this
likelihood2,3,4.
Between 2008 and 2012, Marie Stopes International (MSI)5 provided 1.7 million contraceptive implants
in Sub-Saharan Africa as part of a comprehensive method mix. High levels of client satisfaction were
attained, service quality maintained, and access increased for underserved clients through mobile
outreach, social franchising and clinics.
Key Characteristics of the 3 Available Contraceptive Implants
IMPLANON®
Manufacturer
Merck
Active ingredient and amount
68 mg etonogestrel
Labeled duration of effective use
3 years
Number of rods
1
Approximate insertion and removal time
Insertion: 1 min
Removal: 2–3 min
Cost of implant (US$)
$16.50*
* The cost of Implanon may be lowered in the future to be comparable with that of Jadelle.
Source: Modified from a table prepared by FHI 360, the RESPOND Project and USAID.
JADELLE®
Bayer HealthCare
150 mg levonorgestrel
5 years
2
Insertion: 2 min
Removal: 5 min
$8.50
SINO-IMPLANT II®
Shanghai Dahua
150 mg levonorgestrel
4 years
2
Insertion: 2 min
Removal: 5 min
$8.00
1 Somnath Roy, Deoki Nandan, Kiran Rangari and T.G. Shrivastav. New Developments in Hormonal Injectable and Implant Contraceptives for
Women: Programme Introduction Guidelines. http://medind.nic.in/hab/t08/i1/habt08i1p1.pdf
2 Trussell J.Contraceptive efficacy. In: Hatcher R A, Trussell J, Nelson A L, Cates W, Kowal D, Policar M , editors. Contraceptive technology. 20th rev
ed. New York: Ardent Media; 2011. Available from:http://www.contraceptivetechnology.org/CTFailureTable.pdf
3 International Family Planning Perspectives, Volume 28, Number 1, March 2002, DIGEST, http://www.guttmacher.org/pubs/journals/2805002a.html
4 Peipert J. F. et al. Continuation and satisfaction of reversible contraception. Obstet Gynecol. 2011;117(5), 1105–1113.
5 Susan Duvall, Sarah Thurston, Michelle Weinberger, Olivia Nuccio, Nomi Fuchs-Montgomery. Scaling up delivery of contraceptive implants in sub-
Saharan Africa: Operational experiences of Marie Stopes International. Glob Health Sci Pract. 2014 February; 2(1): 72–92. Published online 2014
February 4. doi: 10.9745/GHSP-D-13-00116
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In INDIA
In an Indian Council of Medical Research (ICMR) study conducted in 1993, a total of 8,077 women were
given a balanced presentation of all available contraceptive methods and Norplant® (one of the brands
of implant) was the first choice for 35% of women (Baveja et al 2000).
About the method
Implants are small plastic rods or capsules, each about the size of a matchstick, that release progestin, like
the natural hormone, progesterone.
A trained provider performs a minor surgical procedure to place the implant under the skin of a woman’s
upper arm.
These can be used by women who cannot use methods containing estrogen and can be used throughout
breastfeeding.
Effectiveness
Less than 1 pregnancy per 100 women using implants over the first year (5 per 10,000 women).
Fertility returns immediately after implants are removed.
Advantages
Helps to prevent unwanted pregnancy, symptomatic pelvic inflammatory disease and iron-deficiency
anemia.
Does not require the user to do anything once it is inserted.
Possible side effects
Some Implant users report the following changes in bleeding patterns:
First several months: Lighter bleeding and fewer days of bleeding; irregular bleeding; no monthly bleeding.
After about one year: Lighter bleeding and fewer days of bleeding; irregular bleeding.
Source: Family Planning: A Global Handbook for Providers, 2011, WHO, John Hopkins and USAID
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Spacing Methods of Family Planning
LEVONORGESTREL INTRAUTERINE SYSTEM
Global Evidence and Programme Experiences
A Levonorgestrel Intrauterine System (LNG-IUS) mobile outreach in Kenya showed that even
a limited introduction of the LNG-IUS, without any special promotion, resulted in good uptake.
Providers viewed it positively, particularly because of its non-contraceptive benefits1.
The Mirena™ LNG-IUS and the Paragard™ T380A are effective and safe contraceptive devices even
for women who have not given birth to a child (nulliparous). When compared to other methods
of contraception, LNG-IUSs have comparable or higher continuation rates of use in nulliparous
women. LNG-IUSs do not increase the risk of pelvic infection or infertility2.
In INDIA
LNG-IUS is sold under the brand name of Mirena in India. It is available only in the private sector. A study
conducted during 2008-11 concluded that LNG-IUS can be a good alternative to the medical and surgical
treatment for menorrhagia (excessive menstrual bleeding) with high acceptability rate and good efficacy.
It dramatically reduces the amount of bleeding within a few months. LNG-IUS has minimal side effects
leading to a good continuation rate3.
1 ‘Introduction of the levonorgestrel intrauterine system in Kenya through mobile outreach: Review of service statistics and
provider perspectives’, David Hubacher,a Vitalis Akora,b Rose Masaba,a Mario Chen,a Valentine Veenaa. Global Health: Science
and Practice 2014 | Volume 2 | Number 1
2 ‘Use of the Mirena™ LNG-IUS and Paragard™ CuT380A intrauterine devices in nulliparous women’, Release date 15 December
2009, SFP Guideline 20092, Abstract. Society of Family Planning. Elsevier Inc. doi:10.1016/j.Contraception.2010.01.010
3 Gupta Taru, Gupta Nupur, Gupta Sangeeta*, Bhatia Pushpa, Jain Jyoti, Kumar Sushma. Levonorgestrel Intrauterine System (LNG
IUS) in Menorrahgia: A Follow-Up Study. Open Journal of Obstetrics and Gynecology, 2014, 4, 190-196. http://dx.doi.org/10.4236/
ojog.2014.44032
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About the method
The LNG-IUS is a T-shaped plastic device that steadily releases small amounts of levonorgestrel
each day.
It is inserted into the uterus by a trained provider.
Effectiveness
The method is highly effective with less than 1 pregnancy per 100 women using an LNG-IUS
over the first year, i.e. 998 of every 1000 women using LNG-IUSs in the first year will not become
pregnant.
Fertility returns immediately after its removal.
Advantages
LNG-IUS helps to protect risks of pregnancy, iron-deficiency anemia and pelvic inflammatory
disease. It reduces menstrual cramps and symptoms of endometriosis (pelvic pain, irregular
bleeding).
No known health risks.
Possible side effects
Changes in bleeding patterns, including lighter bleeding and fewer days of bleeding, irregular
bleeding, no monthly bleeding and prolonged bleeding.
Other side-effects could be: Acne, headaches, breast tenderness or pain, nausea, weight gain,
dizziness.
Mood changes.
Source: Family Planning: A Global Handbook for Providers, 2011, WHO, John Hopkins and USAID
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Spacing Methods of Family Planning
INJECTABLE CONTRACEPTIVES
Global Evidence and Program Experiences
Depot-medroxyprogesterone acetate (DMPA) and Norethisterone Enanthate (NET-EN) have been
available in many countries since 1983. The United States approved DMPA in 1992, which greatly
increased access to the method in the country. Across continents, the percentage of users is highest
in Africa.
Recent studies in Madagascar, Malawi and Uganda have demonstrated that community health
workers who receive proper training in screening, injection technique and counselling can administer
DMPA injections to women in rural areas just as safely as clinic-based providers and with comparable
rates of acceptability and continuation.
Injectable contraception was first made available to women in Asia in 1970s, and remains one of the
most popular methods in the region. The proportion of injectable use to total use of modern methods
(mCPR) is 42% in Bhutan, 22% in Bangladesh, 21% in Nepal and 55% in Indonesia.
In INDIA
DMPA is available in India only through commercial and social marketing channels. About 0.2% women in
India (both urban and rural) are using the three-monthly progestin-only injectable contraceptive. About
0.4% women have reported an earlier use of injectables and 0.3% used them before adopting sterilisation
(NFHS 3, 2005-06). The cost of injectable contraceptives ranges from Rs 25 through social marketing
agencies to Rs 250 for commercial products.
Recent initiatives to make DMPA available through the public sector include: In Rajsamand district of
Rajasthan where DMPA has been introduced in Community Health Centres, Primary Health Centres and
some sub-centres, and the Urban Health Initiative project implemented by FHI 360 in public facilities of
11 towns of Uttar Pradesh (UP).
A recent study1 in Rajsamand and UP revealed that young married women (mean age of 27) were using
DMPA for spacing births, about 21% women had adopted DMPA after first child. The study revealed that
among the current users of DMPA, 41% had taken four or more doses. Eighty per cent women believed
that DMPA is a good long acting contraceptive method for spacing births.
1 Khan, M.E., Dixit, A., Gita Pillai. Documentation of the introduction of DMPA in public facilities: Case study of Uttar Pradesh and
Rajasthan. 2015. Population Council India. http://www.popcouncil.org/uploads/pdfs/2015RH_DMPA-ProjectBrief.pdf. Accessed
on 30 December 2015.
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About the method
Progestin-only injectable contraceptives include Depot-medroxyprogesterone acetate (DMPA)
and Norethisterone Enanthate (NET-EN). Combined injectable contraceptives (with progestin
and estrogen), also called monthly injectables, include Cyclofem.
DMPA is given every three months in the arm, hip or buttock.
Effectiveness
99.72 of every 100 women using progestin only injectables regularly over the first year will not
become pregnant.
The return of fertility is on an average about 4 months for DMPA and 1 month for NET-EN.
Advantages
DMPA helps protect against:
Risk of pregnancy.
Cancer of the lining of the uterus.
Uterine fibroids
Symptomatic pelvic inflammatory disease.
Iron-deficiency anemia.
DMPA can reduce:
• Sickle cell crises among women with sickle cell anemia.
• Symptoms of endometriosis (pelvic pain, irregular bleeding).
Possible side effects
Some users report the following:
Weight gain, headaches, dizziness, abdominal bloating and discomfort, mood changes, decreased sex
drive, and loss of bone density.
Changes in bleeding patterns in DMPA:
• First three months: Irregular to prolonged bleeding.
• At one year: No monthly bleeding to infrequent bleeding or irregular bleeding.
NET-EN users have fewer days of bleeding in the first six months and are less likely to have no monthly
bleeding after one year than DMPA users.
Source: Family Planning: A Global Handbook for Providers, 2011, WHO, Johns Hopkins and USAID
2 (i) Trussell J, Kost K: Contraceptive failure in the United States: A critical review of the literature. Stud Fam Plann 18:237, 1987.
(ii) Trussell J. Contraceptive efficacy. In: Hatcher RA, Trussell J, Nelson AL, Cates W, Stewart FH, Kowal D. Contraceptive
Technology: Nineteenth Revised Edition. New York NY: Ardent Media, 2007.
(iii) WHO Medical Eligibility Criteria for Contraceptive Use -- 4th ed. © World Health Organization 2009.
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Spacing Methods of Family Planning
PROGESTIN-ONLY PILLS
Global Evidence and Programme Experiences
The current desogestrel Progestin-Only Pill (PoP) combines safety with high levels of effectiveness
and was first approved in 2003. A World Health Organization case-control study found no
significant increase in the risk of stroke, myocardial infarction, and venous thromboembolism
among users of PoPs compared with non-users (WHO 1998). Although there are some concerns
regarding the impact of combined oral contraceptives on lactation, there are no such concerns for
PoPs (Moggia 1991; Dunson 1993; McCann 1994; Bjarnadóttir 2001; FFPRHC 2004)1.
In INDIA
The first desogestrel PoP was launched in 2005. Currently five brands of desogestrel PoPs are available in
the Indian commercial market. The total market is estimated at around 180,000 cycles per year. Cerazette
is the market leader with annual sales of approximately 145,000 cycles, growing at a compounded annual
growth rate of over 15% over the last three years.
1 Grimes DA et al. Progestin-only pills for contraception. Cochrane Database Syst Rev. 2013 Nov 13;11:CD007541. doi:
10.1002/14651858.CD007541.pub3.
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About the method
PoPs contain very low doses of progesƟn, like the natural hormone, progesterone, in a woman’s body.
Effectiveness
PoPs prevent unwanted pregnancies:
• 99 of every 100 breastfeeding women using PoPs in the first year will not become pregnant.
• 90-97 of every 100 women (not breastfeeding) using PoPs in the first year will not become
pregnant.
Fertility returns immediately after PoPs are discontinued.
Advantages
PoPs can be used while breastfeeding. They add to the contraceptive effect of breastfeeding.
They can be discontinued at any time without a provider’s help.
PoPs can be used by women who cannot use methods that contain estrogen.
There is no known health risk.
Possible side effects
PoPs affect bleeding patterns:
• Longer delay in the return of monthly bleeding after childbirth for breastfeeding women.
• Frequent, irregular, prolonged or no monthly bleeding.
Headaches, dizziness, mood changes, breast tenderness, abdominal pain and nausea.
Enlarged ovarian follicles for women who are not breastfeeding.
Source: Family Planning: A Global Handbook for Providers, 2011, WHO, John Hopkins and USAID
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Realising Commitments to
Family Planning
The programme aims to provide information to key influencers and
decision makers (Members of Parliament, officials of the Ministry
of Health and Family Welfare and related departments, the media
and civil society organisations) on family planning. It works at
increasing availability and access to quality family planning services
with an expanded basket of contraceptive choice. It advocates for
improved policies using a human rights and women’s empowerment
framework.
B-28, Qutab Institutional Area, Tara Crescent, New Delhi - 110 016, INDIA
info@populationfoundation.in | www.populationfoundation.in