Kesehatan dan KB

Farid Agushybana
Biostatistik & Kependudukan

1
 Visi Program KB
“Keluarga Berkualitas 2015”

2
 Misi Program KB
(1) memberdayakan masyarakat untuk membangunkeluarga
kecil berkualitas,
(2) menggalang kemitraan dalam peningkatan kesejahteraan,
kemandirian, dan ketahanan keluarga,
(3) Meningkatkan kualitas pelayanan KB dan kesehatan
reproduksi,
(4) meningkatkan promosi, perlindungan dan upaya
mewujudkan hak-hak reproduksi,
(5) Meningkatkan upaya pemberdayaan perempuan untuk
mewujudkan kesetaraan dan keadilan gender melalui
program KB, dan
(6) mempersiapkan SDM berkualitas sejak pembuahan dalam
kandungan sampai dengan lanjut usia.
(7) menyediakan data dan informasi keluarga berskala mikro
untuk pengelolaan pembangunan, khususnya menyangkut
upaya pemberdayaan keluarga miskin.

3
 Strategi
1. Prinsip Integrasi:
 Konsep kespro & hak reproduksi dan
kesetaraan gender.
 Pemberdayaan keluarga & perempuan
dengan pelayanan KB.
 KRR dgn prog KB dan kespro
 Penguatan jaringan & kelembagaan KB
 Prog KB dgn prog pembangunan
lainnya.
4
 Strategi
2. Prinsip Desentralisasi
• Penegasan jenis & peningkatan
kewenangan
• Sistem & Kebijakan SDM
• Dukungan infrastruktur lint. Sektoral.
• Mekanisme pengendalian.
• Pendelegasian wewenang operasional
dgn pendekatan wilayah paripurna

5
 Strategi
3. Prinsip Pemberdayaan
• Peningkatan kapasitas pengelola dan
pelaksana
• Peningkatan kualitas kepemimpinan
• Pemberdayaan institusi masy dan
pemberdayaan keluarga.
• Pemberdayaan masy, kelg, dan individu
untuk kemandirian
• Pemberdayaan perempuan
• Pemantapan jaringan KB nasional
6
 Strategi
4. Prinsip Kemitraan
• Kemitraan yg tulus dan setara.
• Partisipasi aktif masyarakat.
• Kerjasama internasional

7
 Strategi
5. Prinsip Segmentasi Sasaran
• Keberpihakan pd keluarga rentan.
• Perhatian kpd segmen khusus.
• Data dan Informasi keluarga.
• Partisipasi dlm kesetaraan dan keadilan
jender.

8
 Pokok-pokok Program
A. Program Pemberdayaan Keluarga
B. Program Kesehatan Reproduksi
Remaja.
C. Program Keluarga Berencana.
D. Program Penguatan Kelembagaan
dan Jaringan KB.

9
 Manfaat KB
 Manfaat untuk Suami, Istri dan
Anak:
• Mental / Psikologis
• Kesehatan fisik

Pemberdayaan Keluarga
10
Metode Kontrasepsi
 Contraception
 There are many types of contraception widely used now days
for family planning purposes.
 Each method has its advantages and suits special cases and
not necessarily suits others and the choice of contraception
depends on different needs of the patients like the period of
contraception and also doctor should decide which method
suits needs more.
 No method of contraception is completely effective and failure
rates for most reversible methods are strongly influenced by
compliance.
 Types:-
1. Natural contraception
2. Mechanical contraception
3. Hormonal contraception
4. Surgical contraception
 Characteristics of ideal contraceptive:
 Safe
 100% effective
 Free of side effects
 Easily obtainable
 Affordable
 Acceptable to the user and sexual
partner
 Free of effects on future pregnancies
 Conditions of family planning
 Pregnancy
 Lactation
 Before puberty
 After menopause
 Abstinence
 Natural Family planning methods
 These methods involve finding out when a
woman is at her most fertile, so that
she can be extra careful or avoid sex
altogether during these times. This can be
done by using techniques such as the woman
keeping a daily record of her body temperature
using a special fertility thermometer.
 A combination of techniques is recommended
to increase the effectiveness of these methods.
 These are a natural alternative to hormonal
and barrier methods but the
techniques used require a significant level of
motivation and a clear understanding of how to
monitor fertility. Natural methods of
contraception also do not take into account
fluctuations in the menstrual cycle.
 Natural Family planning methods
 They include:
• Calendar (Rhythm) method
• Basal body temperature
• Cervical mucous method
• Symptothermal method
• Ovulation awareness method
• Lactational amenorrhea method
• Withdrawal ( Coitus interruption )
 Rhythm method
 This method can be used for patients with regular
cycles only.
 This is done depending on the exact knowledge of
ovulation day and avoiding intercourse during the
days before and after ovulation;
 for example in a regular period that occurs every
28 days the exact day of ovulation should be the
day 14 so intercourse should be avoided 4-5 days
before and after this days.
 There are many methods to detect ovulation
days;
1- Increase in body temperature by about o.5 C.
2- Change in type cervical mucous
3- Ovulation kits nowadays are available for
ovulation day detection by measuring LH surge
 Withdrawal
 When having sex, the man has to take his
penis out of the vagina before ejaculation.
 This is intended to stop sperm from entering
the woman.
 This method frequently fails as drops of
sperm can already escape from the penis
into the vagina before the man ejaculates.
 Effectiveness: Failure rate can be as high
as 15% (15 pregnancies per 100 women).
 More reliable methods are advised.
 Mechanical family planning methods

 Male condoms
 Female condoms
 Diaphragms
 Spermicidal
 Intrauterine devices (IUD)
 Sponge
 Male condom
 It's a thin latex or plastic sheath placed over a
man's erect penis during sex to trap
sperm at the point of ejaculation. It must be put
on the penis as soon as it becomes erect and
before any contact takes place with the vagina.
Men should withdraw as soon as they have
ejaculated and take care not to spill any semen.
 Condoms must be used with care as they can slip
off or split. They should never be used with oil-
based products such as petroleum jelly or suntan
oil as these will damage the rubber.
 Advantages: easily available; offers protection
against sexually transmitted infections including
HIV/AIDS.
 Effectiveness: 94%-98% depending on correct
use. Only use condoms that have been
manufactured.
 Female condom
(Femidom)
 It's a thin polyurethane sheath placed inside
the vagina (also covering the cervix and the
area outside) to stop sperm from entering.
It can be put in at any time before sex and
is
actually stronger than the male condom.
 It need to be sure that the penis enters the
condom
and is not inserted between the condom and
the vaginal wall.
 Advantages: offers protection against
sexually transmitted infections, including
HIV/AIDS.
 Effectiveness: 95% if used correctly.
Diaphragms/cervical cap
 A diaphragm or cap is a dome of rubber
which is fitted by the woman over her
cervix before sex. It acts as a barrier to
stop sperm getting through to the uterus.
It should be used with a spermicidal
cream, jelly or pessaries that contain a
chemical that kills sperm.
 The diaphragm must stay in place for six
hours after sex.
 Advantages: only needs to be used when
the couple has sex
 Spermicides may cause irritation or an
allergic reaction.
 Effectiveness: 92%-96% if used
correctly.
 Spermicides
 These are creams, gels, sponges or
pessaries that contain a chemical
that kills sperm.
 They can increase the effectiveness
of certain barrier methods of
contraception such as a diaphragm.
 However, they don't provide reliable
contraception when used alone.
 The IUD
 An IUD - also known as a Coil - is a small
plastic and copper device, usually shaped like
a 'T', which is fitted into the woman's uterus
by a doctor using a simple procedure.
 It works by preventing an egg from settling in
the womb. An IUD can stay in place for five
years - sometimes for 10. It can also be used
as an emergency method of contraception
within five days of unprotected intercourse.
 Advantages: no need to think about it once
it is in place and it last for a long time.
 Considerations: There is a higher risk of
infection for women with more than one
partner. It may cause heavier, more painful
periods.
 Effectiveness: 98%-99%.
 VAGINAL SPONGE
 Vaginal contraceptive sponges are soft
synthetic sponges saturated with a
spermicide. Prior to intercourse, the sponge
is moistened, inserted into the vagina, and
placed over the cervix . After intercourse,
the sponge is left in place for 6 to 8 hours.
 It is quite similar to the diaphragm as a
barrier mechanism.
 About 18 to 28 pregnancies occur over one
year for every 100 women using this
method. The sponge may be more effective
in women who have not previously delivered
a baby.
 This method was removed from the U.S.
market, but plans are underway to re-
introduce it in the near future.
 Hormonal family planning methods

 Skin patch
 Vaginal ring
 Pills ( Combined & Minipill )
 Injection
 Implant
Contraceptive skin patch
 The Contraceptive Patch looks like a square
band-aid. It is applied to the abdomen,
buttocks, upper arm, or upper torso. The
Patch is changed each week for a schedule of
3 weeks on and 1 week off.
 It works by slowly releasing a combination of
estrogen and progestin hormones through
the skin. These hormones prevent ovulation
(release of an egg from the ovary) and
thicken the cervical mucus, creating a barrier
to prevent sperm from entering the uterus.
 Effectiveness: When used correctly, it’s
about 99% effective as birth control except
for women
weighing 198 pounds or more when it is only
about 92% effective.
 Vaginal Ring
 A soft, flexible vaginal ring, which is about 2
inches in diameter, delivers low doses of
estrogen and progestin into the body. This
helps prevent pregnancy by suppressing
ovulation and thickening the cervical mucus,
which helps block sperm from entering the
uterus. The ring is inserted into the vagina
and left for 3 weeks. It is then removed for
1 week, during which a woman menstruates,
and a new ring is inserted after the 1-week
"break."
 The vaginal ring is at least 98 percent
effective with perfect use, which refers to
always correct and consistent use.
 Combined pill
 This is the most common type. It contains two hormones -
estrogen and Progesterone which prevent an egg from being
released from a woman's ovary each month.
 The combined pill can reduce pre-menstrual syndrome (PMS)
and period pain. There is evidence that it also offers some
protection against cancer of the uterus and ovaries.
 Advantages: the pill does not interfere with the spontaneity of
sex.
 A full medical history is essential as this pill is not suitable for
women who have certain conditions such as high blood
pressure, circulatory disease or diabetes. Women over 35
who smoke or are very overweight may be advised to choose
another method of contraception.
There are several different types of pill so if one does not suit
then another might.
 The combined pill is not reliable if taken over 12 hours late or if
have vomiting and diarrhea, when extra protection is required.
Some drugs like antibiotics can also affect its reliability.
 Effectiveness: 99% if taken correctly.
Progesterone-only pill (mini pill)
 Unlike the combined pill, this only contains the hormone
Progesterone. It works by thickening the cervical mucus,
which acts as a barrier to stop sperm entering the womb. It
also makes the lining of the womb thinner, to prevent it
accepting a fertilised egg. This type of pill is good for women
who are breast-feeding, older women, smokers and others
who cannot use the combined pill. It can also help with pre-
menstrual syndrome (PMS) and painful periods.
 Advantages: the pill does not interfere with the
spontaneity of sex.
 It must be taken at the same time each day or at most
within three hours of that time. It will not work if taken over
three hours late, or if have vomiting and diarrhea, in these
cases extra protection is needed. It can cause irregular
bleeding and periods may stop altogether while are taking
it.
 Effectiveness: 98% if taken correctly.
 Contraceptive injection
 It's an injection of hormones that provides a longer-
acting alternative to the pill. It
works by slowly releasing the hormone
progesterone into the body to stop ovulation. Each
injection lasts for 8-12 weeks. Injections may
reduce heavy or painful periods and may give some
protection against cancer of the uterus.
 Advantages: unlike the pill don’t need to
remember to take a tablet every day.
 Periods can become irregular or stop altogether. It
can take over a year for fertility to return to normal
after stopping contraceptive injections, so if patient
is planning to start a family in the near future, it
may not be suitable.
 Effectiveness: 99%.
 Contraceptive implant
 It's a small stick containing the hormone
progesterone which is inserted under the skin in
the arm. The hormone is slowly released into the
body, preventing eggs from being released from
the ovaries, sperm from reaching an egg or an
egg settling in the womb.
 Advantages: implants are a good method for
women who want a long-term contraceptive, as
each implant lasts for three years.
 Periods can become irregular or stop altogether.
 Effectiveness: 99%.
 Side effects of Hormonal family planning
methods
 Nausea
 Weight gain
 Headache
 Breast tenderness
 Breakthrough bleeding
 Vaginal infections
 Mild hypertension
 Depression
 Absolute Contraindications of Hormonal
family planning methods
 Breast feeding
 Family history of CVA or CAD
 History of thromboembolic disease
 History of liver disease
 Undiagnosed vaginal bleeding
Possible Contraindications of Hormonal family
planning methods
 Age > 40 years
 Breast or reproductive tract malignancy
 DM
 Elevated cholesterol and triglyceride
 High blood pressure
 Mental depression
 Migraine and other types of vascular
headache
Cont. Possible Contraindications of Hormonal
family planning methods
 Obesity
 Pregnancy
 Seizure disorders
 Sickle cell and or other
hemoglobinopathies
 Smoking
 Use of medication or drug with drug
interaction effect
 Surgical family planning methods
(Sterilization)
 Vasectomy (Male)
 Tubal ligation (Female)
• Minilaprotomy
• Laparoscopy
 Essure
 Male sterilization
 Vasectomy:-division or occlusion of the vas
deference prevents the passage of sperms.
 Methods:-
1- Clips
2- Diathermy
3- Percutaneous injection of sclerosing agents or
occlusive substances.
 The success of the procedure is verified by the
absence of sperms from two consecutive samples
of ejaculate collected at least 4 weeks apart.
 Contraception must be continued until
confirmation of two negative semen results has
been achieved and this is achieved after 16-18
weeks of performing the vasectomy.
 Female sterilization
 Female sterilization is done surgically by
blocking both fallopian tubes by three ways:
Laparotomy minilaparatomy laparoscopy
 Laparotomy: Bilateral salpingectomy or
hysterectomy may be preferable when there
is a coexistent pathology while the other two
ways are more preferable, safe and effective
 A number of chemical agents have been
tested for their ability to occlude the fallopian
tube when installed into the tube either
directly or transcervically via the uterus.
Inflammation and fibrosis result and occlude
the tubes. However, safety of quinacrine
sterilization has not yet been determined so
surgical method is safer
 Female sterilization
 Methods of tubal occlusions:-
• Ligation by absorbable or non-absorbable sutures
the ends left free or buried in the broad ligament or
uterine cornue.
• Electrocautery:-Bipolar diathermy allows only the
tissue held between the jaws of the forceps to be
cauterized.
• Falope ring:- ring of silicone or rubber is placed over
a loop of the tube with a specially designed
applicator. This destroys 2-3 cm of tube.
• Clips: - a variety of clips are available tlulka-clemens
clip (stainless steel and polycarbonal and filshie clip)
(titanium lined with silicon rubber). Smaller length
of the tube is destroyed via this method.
• Laser; CO2 laser divides tube very cleanly but may
allow a high incidence of recanalization.