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4 Module 4
Contraception and family planning
Integrating harm reduction and
sexual and reproductive health and
rights

Module 4 Contraception and Family Planning
LEARNING OBJECTIVES 1 hour 50 mins
• To explore misbeliefs associated with contraception and the full range of
contraceptive methods
• To know the main components of family planning and contraceptive services
• To provide quality counseling on contraception and contraceptive choices to
women and gender non-conforming people who use drugs
• To identify the main barriers to accessing contraception and potential
approaches to overcome the barriers

Module 4 Contraception and family planning
GAME:
• Find your correct match!
• 3 contraceptive methods
• 3 profiles
DISCUSSION:
15 mins
15 mins

BASIC INFORMATION AND CHOICES
• There are a lot of beliefs and misconceptions associated with contraceptives methods. For
example:
 Contraceptive methods can cause infertility
 Women lose libido with hormonal contraception
 Contraceptive methods can cause birth defects
• Health professional and harm reduction providers may also share these beliefs.
• The lack of accurate information will impact and limit people’s choices around pregnancy
prevention.
• Every person will have different needs and preferences for contraception.
Give them a choice!

METHODS OF CONTRACEPTION
• The main effective methods of contraception are:
• Hormonal methods: implants, pills (progestogen and
combined),IUD, injectables
• Other methods: copper IUD, vasectomy and female
sterilisation
• Barrier methods: internal (female) and external (male)
condoms, diaphragm
• Other methods exist but are less effective and are not under the
control of women (for instance the natural method of withdrawal).

HORMONAL METHODS
Implant
• Small, flexible rods or capsules placed under the skin of the upper arm;
contains progestogen hormone only.
• A healthcare provider must insert and remove it.
• It can be used for 3–5 years, depending on implant.
• Irregular vaginal bleeding common but not harmful.
• Efavirenz-based ART may reduce the effectiveness of the implant.
Women living with HIV should receive appropriate counselling to
choose the contraceptive method most suited to their situation.
Progestogen-only pills
• It thickens cervical mucous to block sperm and egg from meeting and
prevents ovulation.
• It is highly effective when taken correctly and consistently.
• Can be used while breastfeeding.
• Must be taken at the same time each day
Combined
contraceptive pills
• Contains two hormones (estrogen and progestogen).
• Prevents the release of eggs from the ovaries (ovulation).
• Reduces risk of endometrial and ovarian cancer but not other cancers.
• It is highly effective when taken correctly and consistently.
• For women who use drugs it may increase the risk of vein problems,
such as venous thrombosis or varicose veins. Check with a health
professional.

OTHER METHODS
The copper IUD
(Intrauterine device)
• Small flexible plastic device containing copper sleeves or wire that
is inserted into the uterus.
• Copper component damages sperm and prevents it from meeting
the egg.
• Longer and heavier periods during first months of use are common
but not harmful.
Vasectomy • Permanent contraception to block or cut the vas deferens tubes
that carry sperm from the testicles.
• It keeps sperm out of ejaculated semen.
• It is highly effective after three months.
• Does not affect male sexual performance.
• Voluntary and informed choice is essential.
Female Sterilisation • Permanent contraception to block or cut the fallopian tubes.
• Eggs are blocked from meeting sperm.
• It is highly effective and informed choice is essential.

BARRIER METHODS
Diaphragm, cervical
cap, sponge
• The diaphragm and cervical cap are dome-shaped and made of silicone. The
cap covers only the cervix.
• The diaphragm is larger. It lodges behind your pubic bone. You need to use
spermicide with the diaphragm or cap to help prevent pregnancy.
• The diaphragm, cervical cap and sponge are among the least effective forms of
birth control.
External condom (male
condom)
• Made of very thin latex or polyurethane, it fits over an erect penis.
• Forms a barrier to prevent sperm and egg from meeting.
• It is effective when used correctly and consistently, with lubricant.
• Can prevent unintended pregnancy and also protects against sexually
transmitted infections, including HIV.
Internal condom
(female condom)
• Made of very thin, transparent, soft polyurethane – most are latex-free.
• It fits loosely inside the vagina.
• Unlike external condoms, internal condoms can be used even when the penis isn’t
erect.
• Can be used for vaginal and anal sex.
• It is best to insert the internal condom ahead of time, and always before and until
vaginal or anal sex is finished.
• It is effective when used correctly and consistently (with lubricant). It can prevent
unintended pregnancy and HIV, and it offers increased protection against SITs by
partially covering external genitalia.

EMERGENCY CONTRACEPTIVE PILLS
• Also called the ‘morning after’ pill.
• Emergency contraception is not an abortive method as the pill helps avoid conception.
• Pills are high dose hormonal pills that can be taken up to 72 hours AFTER intercourse
but the sooner someone uses emergency contraception the more effective it is.
• If it contains two pills, take both at the same time.
• There are no major side effects, but some people may experience vomiting, headache
or breast tenderness.
• If the period does not start in three weeks after taking the pill, check for pregnancy.

DUAL PROTECTION
People who use drugs and their sexual partners must be counselled on dual protection
strategies to prevent the transmission of HIV and STIs, as well as to avoid unintended
pregnancy. These include:
• Condoms, plus another contraceptive method
• Condoms, plus emergency contraception if condom fails
• Selectively using condoms and another method (for example, using the pill
with the main partner, but the pill plus condoms with others).

METHADONE AND CONTRACEPTION
• Offering contraception services in conjunction with substance use treatment like
methdaone could help the women and gender non-conforming people who use drugs
meet their needs for contraception.
• It can reduce unintended pregnancy. There is no evidence that methadone is
incompatible with contraceptive methods.
HIV treatment and hormonal contraception
• There is no evidence of incompatibility between ARVs and hormonal contraceptives.

FERTILITY/INFERTILITY
• Infertility is a problem for both men and women, but women are often
the ones who are blamed.
• Infections, some reproductive cancers, abnormalities of the
reproductive tract (including blocked fallopian tubes), fibroids or long-
term hormone use among trans-women can cause infertility.
Environmental and lifestyle factors play also a role.
• Contraceptives do not cause infertility problems.

KEY FAMILY PLANNING AND
CONTRACEPTIVE SERVICES INCLUDE:
• Accurate information on a wide range of methods
• Counselling about the desire to have children
• Availability of condoms and lubricants and other contraceptives methods
• Emergency contraception
• Encouraging shared responsibility between partners
• Addressing infertility issues and their social consequences

ROLE PLAY:
Based on the stories, provide counselling on contraceptive methods.
• One person plays the role of a women who uses drugs, the other the
health professional/harm reduction provider.
DEBRIEFING AND DISCUSSION:
• Do you think the counsellor provided accurate information?
• As a client, do you feel you were given a choice (informed choice)? Why?
• As a counsellor, did you feel you could respect the choice of the woman?
• In your opinion, what are the most important skills needed to provide
counselling on contraception?
20 mins
10 mins

COUNSELLING SKILLS
• Importance of providing accurate information
• Non-judgmental attitudes
• Active listening
• Clear communication without technical words – use simple language
• Respect people’s right to confidentiality, privacy and informed choice
• Non-discrimination (regardless of their age, family or social status, sexual behaviour,
kind and frequency of drug use, etc.)

BRAINSTORMING
• What are the main barriers to accessing
contraception?
15 mins

GROUP EXERCISE:
What do you need to do to address the barriers?
In groups of 5 or 6:
• Consider the different barriers and propose
approaches to overcome them
• Think of 2 or 3 solutions/actions to improve
access to contraception in your
organisation/community
DISCUSSION:
15 mins
10 mins

BARRIERS:
Lack of access to services and limited choice of
methods in the country/area
Legal restriction and lack of access to services for
‘under age’ (under 18 or 16 years old) and unmarried
women, etc.
Low quality of services (like lack of confidentiality)
and negative attitudes of the professionals
(judgement), internalised-stigma
Gender-based violence
Lack of autonomy in making health decisions
Lack of meaningful involvement of women and
gender non-conforming people who use drugs in
service provision
Stigmatisation, and fear of stigma and hostility
Fear of violence or coercion to adopt long-acting or
irreversible methods of contraception
Discrepancies between representations of women's
sexuality and contraceptive needs
Lack of financial means
Lack of knowledge, misbeliefs and fear of side effects,
perceived health risks
APPROACHES TO OVERCOME BARRIERS
• Political level
• Advocacy to improve political priorities and funding to SRHR and to
improve supply chains
• Programmatic level
• Availability of appropriate services, including stocking a wide range of
contraceptive methods
• Emergency pills available with peers on outreach
• Involvement and training of health professionals and harm reduction
providers
• Support the meaningful involvement of women and gender non-
conforming people; support the development of skills and structure in
communities and networks
• Creation of new services, such as individual or couple counselling on
contraception
• Counselling couples on infertility
• Community level
• Empowerment of women and gender non-conforming communities;
participation of communities
• Participation and buy-in of men and the wider community
• Developing education materials on contraception and the importance
of individual choice selecting contraceptive methods

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