CONTRACEPTION MYTH BUSTER

(Your Life, 2012)

Contraception (History)
WITHDRAWAL (COITUS INTERRUPTUS) https://zenkworld.wordpress.com/2015/11/18/coi
tus-interruptus-aka-withdrawal/

• Coitus interruptus is probably the oldest form of birth control still

practised today. There is a lack of research on current prevalence, use-
effectiveness and safety of withdrawal.
• One of the earliest recorded use of contraception can be found in Genesis
38: 9 with story of Onan (Riddle, 1992) (Skuy, 2000). It was written there:
" ... that he spilled it on the ground, lest that he should give seed to his brother."
• Yahweh was dipleased because Onan refused to conceive a child in the
name of his older brother. This is a n example of withdrawal or coitus
interruptus.
Vaginal inserts
• Crocodile dung being used as a suppository (Egyptian Petri Papyrus,
1850 BC),
• Ebers Papyrus (1550 BC) recommended acacia, dates, seed wool and
honey to formulate an insert. They provided a blocking substance to
the cervix, and the acid pH created by the conversion of acacia to lactic
acid that acted as a mild spermicide.
• Elephant and crocodile dung alsohave an acid pH.
• Pepper as a vaginal suppository is mentioned in Greek and Roman
writings, as is the use of pomegranate.
• For thousands of years, women have inserted fruit acids, jellies,
pastes and various mixtures into their vagina in an attempt to prevent
conception. Environments that are either sharply acidic or alkaline are
hostile to sperm and therefore these methods may have had some
effect. (FPA, 2010)
• Since the 1600s, vaginal douches (water mixed with vinegar, baking
soda, or iodine) have been used after intercourse as contraceptives
but are not recommended as either safe or effective.
• Over 1,000 years ago, an
Indian Sanskrit source
described the use of
medicated wood taken from
the neem wood tree which
was placed on live coals
contained in a specially
shaped vessel. The medicated
steam would then be directed
into the vagina for fumigation
and the prevention of
pregnancy. (Skuy, 2010)
• 1885 The first commercial vaginal suppository using cocoa butter and quinine
sulphate was developed by Walter Rendell, an English pharmacist. This was later
replaced by hydroquinine, a more potent spermicide, and sponges soaked in
quinine sulphate.
• 1906 Friedrich Merz developed the first known commercially produced spermicidal
jelly, called Patentex.
• 1930s Numerous chemicals were investigated for potential spermicides. The work
led to the setting up of standardised testing of spermicides and their effectiveness.
During the 1950s, more effective chemicals such as nonoxinol-9 were developed.
• Today, there is only one spermicidal gel available in the UK. Research is ongoing into
a range of microbicides which will prevent infection with HIV and other sexually
transmitted infections (STIs), some of which may also be contraceptive.
MALE BARRIER METHODS: THE
CONDOM (SHEATH) (FPA, 2010)
• Early Egyptians used various forms of penis protectors for protection against disease and
insects, and as badges of rank and decoration.
• 1564 Gabriello Fallopius recommended a moistened linen sheath for protection against STIs.
• 18th century onwards Condoms were made from animal intestines.
• 1843 Vulcanisation of rubber developed by Goodyear and Hancock, and rubber condoms
replaced skin condoms.
• 1930s Crepe rubber was replaced by latex.
• 1997 First polyurethane condom launched in the UK: stronger, less sensitive to heat and
humidity, and not damaged by oil-based lubricants.
• 2005 A new synthetic non-latex condom was launched in the UK.
• Modified designs and types of condoms are now available to provide greater variety and
choice.
NATURAL FAMILY PLANNING (FPA,
2010)
• Periodic abstinence has been used as a birth control method ever since it was first discovered
that sexual intercourse led to pregnancy. In the mid-19th century, Von Baer identified the female
ova, and in the 1930s studies by Ogino in Japan and Knaus in Austria showed when ovulation and
thus fertilization occurred. This knowledge enabled improved calculation of the fertile and
infertile times of a woman’s menstrual cycle. The Ogino–Knaus theory, which became known as
the Calendar Method in 1934, was promoted by the Roman Catholic faith, which continues to
denounce all artificial birth control methods.
• 1930s and 1940s Improved understanding of ovulation and temperature changes led to
development and use of the temperature method.
• 1964 Following research into cyclical changes in cervical mucus, the Billings method (also known
as ovulation or cervical mucus method) was introduced.
• 1990s The sympto-thermal method combines all fertility indicators and is highly effective.
Various devices are now available which monitor changes in a woman’s menstrual cycle, based
on changes in temperature, urinary hormones or saliva.
• Handmade bead counter used
woman in India. Made up of wool
threaded with coloured beads-
white for the safe part of the cycle,
green for the unsafe period, and
red at the end for the menstrual
flow-to allow her to keep track of
the days of her cycle.
• Some women apparently using this
counting method do not properly
understand the rationale behind
the use of the beads and simply
move the beads along a little faster
if they wish to have intercourse
earlier. (Skuy, 2010)
Key Facts about Contraception(WHO, 2014)
• An estimated 222 million women in developing countries would like to delay or stop
childbearing but are not using any method of contraception. `
• Contraceptive use prevented 218 million unintended pregnancies in developing
countries in 2012, and, averting 55 million unplanned births, 138 million abortions (of
which 40 million are unsafe), 25 million miscarriages and 118,000 maternal deaths.
• Some family contraceptive methods help prevent the transmission of HIV and other
sexually transmitted infections.
• Programmes should ensure that the contraceptive needs of such vulnerable groups as
adolescent women, poor women and rural women are met and that inequities in
information and access are reduced.
• Family planning reinforces people’s rights to determine the number and spacing of
their children.
Global use of Contraception(UN, 2015)
• Contraceptives are used by the majority of married or in-union
women in almost all regions of the world.
• In 2015, 64 % of married or in-union women of reproductive age
worldwide were using some form of contraception.
• Contraceptive use was much lower in the least developed countries
(40%) and was particularly low in Africa (33 %).
• Among the other major geographic areas, contraceptive use was
much higher, ranging from 59 % in Oceania to 75 % in Northern
America
Source: Your Guide to Contraception: ALL ABOUT CONTRACEPTION Retrieved from:
https://www.your-life.com/static/media/pdf/educational-material/waiting-room/WC
D-Contraception-Compendium-Screen.pdf
• Modern contraceptive methods constitute most contraceptive use in
2015. (UN, 2015)
• Globally, 57 % of married or in-union women of reproductive age used a
modern method of family planning, constituting 90 % of contraceptive users.
• Growth in contraceptive prevalence until 2030 is expected mainly in
the regions of sub-Saharan Africa and Oceania.
• Contraceptive prevalence is projected to increase from 17 to 27% in
Western Africa, from 23 to 34% Middle Africa, from 40 to 55% in
Eastern Africa, and from 39 to 45% in Melanesia, Micronesia and
Polynesia. (UN, 2015)
• Nearly 800 million married or in-union women are projected to be
using contraception in 2030, and growth in the number of
contraceptive users will be uneven across regions.
• The global number of married or in-union women using contraception
is projected to rise by 20 million, from 758 million in 2015 to 778
million in 2030. Growth in the number of contraceptive users is
projected to be high for all regions of Africa and in Southern Asia.
(UN, 2015)
• Female sterilization and the IUD are the two most common methods
used by married or in-union women worldwide in 2015
• 19% of married or in-union women relied on female sterilization and 14 per
cent used the IUD.
• Short-term methods are less common
• 9% of women used the pill
• 8% relied on male condoms
• 5% used injectables
• 6% used rhythm or withdrawal.
Source: Trends in Contraceptive Use Worldwide. Retrieved From:
https://www.un.org/en/development/desa/population/publications/pdf/family/trendsContraceptiveUse2015Report.pdf
Contraception in the Philippines
• Women in the Philippines increasingly want smaller families.
• Women aged 15–49 want 2.4 children but have an average of 3.3. (Likhaan 2010)
• The poorest women have about two more children than they want, while those
in the richest quintile have only 0.3 more children than they want
• Only 41% of the poorest women use contraceptives, compared with 50% of the
wealthiest. Most of this difference is due to lower use of sterilization among
poor women.
• Premarital sexual activity is increasing, creating a greater need for contraceptives
among young women and men. Among all young adults aged 15–24, premarital
sexual activity increased from 18% in 1994 to 23% in 2002 (from 26% to 31%
among young men and from 10% to 16% among young women). (Likhaan 2010)
• Contraceptive use has hardly increased in the Philippines over the past
decade. Yet women are having, on average, about one more child than
they would like.
• More than one-fifth of married women do not want to have a child soon
or at all but are not using a contraceptive method. (Likhaan 2010)
• Cutbacks in publicly funded contraceptive services and supplies since
2004 have reduced women’s and couples’ access to contraceptives.
• National surveys from 1998 to 2008 show that women have relied increasingly on
pharmacies for contraceptive services.
• This switch to private-sector suppliers is likely to involve higher costs and lead to
reduced access, particularly for low-income women and couples.
Barriers in Using Contraceptives in the Philippines (Likhaan, 2010)
• Health concerns about contraceptive methods
• Fear of side effects. 44% shared these reasons in 2008; 41% in 2003.
• Believe of the unlikeliness to become pregnant—41% in 2008; 26% in 2003.
• Specific reasons includehaving sex infrequently, experiencing lactational
amenorrhea (temporary infertility while nursing) and being less fecund than normal.
• The cost of contraceptive supplies.
• Opposition to family planning by women, their partners or their families is a
decreasingly important factor in the Philippines. Personal or religious (10%
in 2008, down from 18% in 2003).
Different types of contraception (NICHD,
2017)
1. Long Acting Reversible Contraception (LARC)
1. IUD
2. Implant
2. Hormonal
1. Short-Acting Hormonal Methods
2. Combined Hormonal Methods
3. Barrier
4. Emergency Contraception
5. Sterilization
I. Long Acting Reversible Contraception (LARC)
(NICHD, 2017)
• Intrauterine Methods
• An intrauterine device (IUD), also known as an intrauterine system (IUS), is a
small, T-shaped device that is inserted into the uterus to prevent pregnancy. A
health care provider inserts the device’
• hormonal IUD or IUS releases a progestin hormone (levonorgestrel) into the uterus. 3
 The released hormone causes thickening of the cervical mucus, inhibits sperm from
reaching or fertilizing the egg, thins the uterine lining, and may prevent the ovaries from
releasing eggs.
• copper IUD prevents sperm from reaching and fertilizing the egg, and it may prevent
the egg from attaching in the womb. If fertilization of the egg does occur, the physical
presence of the device prevents the fertilized egg from implanting into the lining of the
uterus. The failure and expulsion/reinsertion rates of a copper IUD is similar to those of
a hormonal IUD. Copper IUDs may remain in the body for 10 years
https://www.wslhd.health.nsw.gov.au/ArticleDocuments/
1023/Fact%20Sheet%20General%20Information%20on%2
0Contraception%20V0.1%20JG%206.6.2017.pdf.aspx
Intra-Uterine Device (IUD) (Center for Young Women’s Health, 2017)
Success Rate with Typical Use: 99%
Pros Cons
•Very effective against pregnancy •Doesn’t protect against STIs and shouldn’t be selected
•Provide protection against pregnancy as long as in if high risk of STI
place in your uterus- protects as soon as inserted (so •Needs to be inserted by a health care provider
don’t need to remember to use contraception if you •Can fall out or can rarely puncture the uterus
have sexual intercourse) •The copper IUD can have side effects such as
•Doesn’t need daily attention- just need to check to menstrual cramping, longer and/or heavier menstrual
make sure in place at least once a month at time of periods, and spotting between menstrual periods
menstrual period •Slightly higher risk for infection in the first 20 days
•Comfortable- you and your partner cannot feel the after insertion
IUD, although you partner may feel the string
•The levonorgestrel IUD (Mirena, Skyla) lessens
menstrual flow and can be used to treat heavy periods
•Can be removed at any time and you can get pregnant
right after removal
I. Long Acting Reversible Contraception
(LARC)
Implants
• Implants are implantable rods. Each rod is matchstick-sized, flexible, and
plastic. The method has a failure rate of less than 1%.3 A physician
surgically inserts the rod under the skin of the woman's upper arm.
• The rod releases a progestin and can remain implanted for up to 5 years.
Currently, Implanon® and Nexplanon®, which release etonogestrel, are
the only implantable rods available in the United States. A two-rod
method, Jadelle®, which releases levonorgestrel, is FDA approved but
not currently distributed in America. A new levonorgestrel-releasing,
two-rod method, Sino-implant (II)®, is in clinical development.
Implant.
https://www.thesun.co.uk/archives/reallife/893274/women-told-contr
aceptive-implants-lost-in-your-body/
Hormonal Implants (CYWH, 2017)
Success Rate with Typical Use: 99%
Pros
•Long-term method of birth control (protects against
pregnancy for 3 years after insertion–it can be
removed by a health care provider when you want to
or you can wait for 3 years when it’s time for a change
of implant)
•Very effective against pregnancy
•May cause light or no menstrual periods
Cons
•Doesn’t protect against STIs
•Requires minor surgery and insertion of the tiny
rod(s) underneath the skin
•Requires minor surgery to remove device
•Can cause side effects such as irregular menstrual
periods, depression, nervousness, hair loss, and
weight gain
•Could get infection at area where capsule is implanted
•Can’t be used by women with certain medical
conditions and by women who use certain medications
II. Hormonal Methods (NICHD, 2017)
1. Short-Acting Hormonal Methods
- Hormonal methods of birth control use hormones to regulate or stop ovulation
and prevent pregnancy.
- Short-acting hormonal methods (e.g., injectables, pills, patches, rings) are highly
effective if used perfectly, but in typical use, they have a range of failure rates.
A. Injectable birth control. This method involves injection of a progestin, Depo-
Provera® (depot medroxyprogesterone acetate [DMPA]), given in the arm or
buttocks once every 3 months
B. Progestin-only pills (POPs). A woman takes one pill daily, preferably at the
same time each day. POPs may interfere with ovulation or with sperm
function. POPs thicken cervical mucus, making it difficult for sperm to swim
into the uterus or to enter the fallopian tube.
Depo-Provera Hormonal Injection (CYWH, 2017)
Success Rate with Typical Use: 94%
Pros
•Each injection provides 3 months of protection
against pregnancy
•Very effective against pregnancy if used correctly
•Many women stop getting their menstrual period
while getting injections. (This is not a medical problem
and menstrual periods usually return 6-18 months
after you stop taking injections)
•Helps protect against uterine cancer
•Doesn’t interrupt sexual activity
Cons
•Doesn’t protect against STIs
•Need to see your health care provider every 3 months
for an injection
•Depending on your insurance, your birth control may
be free or there may be a co-pay
•May have side effects such as weight gain, tiredness,
and possibly a decrease in bone density
•Many women have very irregular menstrual bleeding
or spotting for the first 3 to 6 months and sometimes
longer
Birth Control Pills (CYWH, 2017)
Success Rate with Typical Use: 91%
Pros
•Very effective against pregnancy if used correctly
•Makes menstrual periods more regular and lighter
•Decreases menstrual cramps and acne
•Makes you less likely to get ovarian and uterine
cancer, pelvic inflammatory disease, ovarian cysts, and
anemia
•Doesn’t interrupt sexual activity
Cons
•Doesn’t protect against STIs
•Depending on your insurance, your birth control may
be free or there may be a co-pay.
•Need to remember to take every day at the same
time
•Can’t be used by women with certain medical
problems or by women taking certain medications
•Can occasionally cause side effects such as nausea,
increased appetite, headaches, and, very rarely, blood
clots
•Need a prescription
•Still need condoms to lower the risk of STIs
II. Hormonal Methods (NICHD, 2017)
2. Combined Hormonal Methods
• Combined hormonal methods contain a synthetic estrogen (ethinyl estradiol)
and one of the many progestins. The combined estrogen/progestin drugs can be
delivered by pills, a patch, or a vaginal ring.
A. Combined oral contraceptives (COCs, "the pill"). COCs contain a synthetic estrogen and
a progestin, which functions to inhibit ovulation. A woman takes one pill daily,
preferably at the same time each day.
B. Contraceptive patch. This is a thin, plastic patch that sticks to the skin and releases
hormones through the skin into the bloodstream. The patch is placed on the lower
abdomen, buttocks, outer arm, or upper body.
C. Vaginal ring. The ring is thin, flexible, and approximately 2 inches in diameter. It delivers
a combination of ethinyl estradiol and a progestin. The ring is inserted into the vagina,
where it continually releases hormones for 3 weeks.
Hormone Patch (Ortho-Evra) (Xulane) (CYWH, 2017)
Success Rate with Typical Use: 91%
Pros
•Very effective against pregnancy if used correctly
•Makes menstrual periods more regular and lighter
•Decreases menstrual cramps and acne
•Makes you less likely to get ovarian and uterine
cancer, pelvic inflammatory disease, ovarian cysts, and
anemia
•Doesn’t interrupt sexual activity
Cons
•Doesn’t protect against STIs
•Still need condoms to lower the risk of STIs
•Can’t be used by women with certain medical
problems or by women taking certain medications
•Can occasionally cause side effects such as nausea,
increased appetite, headaches, and irregular bleeding
in the first few cycles
•Increased risk of blood clots
•Need a prescription
Vaginal Hormonal Ring (Nuva-Ring) (CYWH, 2017)
Success Rate with Typical Use: 91%
Pros
•Very effective against pregnancy if used correctly
•Makes menstrual periods more regular and lighter
•Decreases menstrual cramps and acne
•Makes you less likely to get ovarian and uterine
cancer, pelvic inflammatory disease, ovarian cysts, and
anemia
•Doesn’t interrupt sexual activity
Cons
•Doesn’t protect against STIs
•Still need condoms to lower the risk of STIs
•Can’t be used by women with certain medical
problems or by women taking certain medications
•Can occasionally cause side effects such as nausea,
increased appetite, headaches
•Increased risk of blood clots
•Need a prescription
III. Barrier Methods (NICHD, 2017)
I. Barrier methods that do not require a health care provider 
1. Male condoms. This condom is a thin sheath that covers the penis to
collect sperm and prevent it from entering the woman's body
2. Female condoms. These are thin, flexible plastic pouches. A portion
of the condom is inserted into a woman's vagina before intercourse
to prevent sperm from entering the uterus.
3. Contraceptive sponges. These are soft, disposable, spermicide-filled
foam sponges. One is inserted into the vagina before intercourse.
4. Spermicides. A spermicide can kill sperm cells. A spermicide can be
used alone or in combination with a diaphragm or cervical cap. T
Male Condom(CYWH, 2017)

Success Rate with Typical Use: 82%

Pros Cons

•Lowers risk of STIs
•Contraception that provides the most protection
against sexually transmitted infections (latex condoms
are best)
•Don’t cost much (50 cents each), can buy at almost
any drug store (don’t need a prescription)
•Men feel they can “last longer” when using a condom
•Allow men to have an active part in preventing
pregnancy
•Have to use a new one every time you have sexual
intercourse (can only be used once)
•May disrupt/interrupt sexual activity as it needs to be
put on just before penetration
•Can break
•Women may be allergic to latex
Female Condom (CWYH, 2017)

Success Rate with Typical Use: 79%

Pros Cons

•Provide protection against STIs (new product, so not •May move, be noisy, or uncomfortable
clear how much protection given) and pregnancy •Can only use for one act of sexual intercourse
•Can be inserted well before intercourse so less •Cost about $2.50 each
interruption of sexual activity
•Male does not need to withdraw right after
ejaculation, as he does with a male condom
III. Barrier Methods (NICHD, 2017)
II. Methods that require a health care provider
1. Diaphragms. Each diaphragm is a shallow, flexible cup made of latex or
soft rubber that is inserted into the vagina before intercourse, blocking
sperm from entering the uterus. Spermicidal cream or jelly should be
used with a diaphragm. The diaphragm should remain in place for 6 to 8
hours after intercourse to prevent pregnancy, but it should be removed
within 24 hours. A diaphragm should be replaced after 1 or 2 years
2. Cervical caps. These are similar to diaphragms but are smaller and
more rigid. The cervical cap is a thin silicone cup that is inserted into the
vagina before intercourse to block sperm from entering the uterus
Diaphragm (CYWH:2017)
Success Rate with Typical Use: 88%
Pros
•Can be put in place right before intercourse or 2-3
hours before intercourse
•Don’t need to take out between acts of sexual
intercourse (protects against pregnancy for about 6
hours, but need to reapply spermicide)
Cons
•Doesn’t protect against STIs
•Need to get fitted by a health care provider and need
a prescription
•May be difficult to find
•Can’t take out until 6 hours after intercourse
•Cost $25-$45, plus the cost of spermicidal gel
•May get moved out of place during sexual intercourse
•Some women may be allergic to the diaphragm or to
the spermicide
•Need to be re-fitted after a 10 pound weight gain or
loss and after pregnancy
•Can be messy
•Need to reapply spermicide with each act of sexual
intercourse
•Can cause an increase in urinary tract infections
IV. Emergency Contraception (NICHD,
2017)
• Emergency contraception can be used after unprotected intercourse or if a
condom breaks.
1. Copper IUD. The copper IUD is the most effective method of emergency
contraception. The device can be inserted within 120 hours of unprotected
intercourse. The method is nearly 100% effective at preventing pregnancy and
has the added benefit of providing a highly effective method of contraception
for as long as the device remains in place.
2. Emergency contraceptive pills (ECPs) are hormonal pills, taken either as a
single dose or two doses 12 hours apart, that are intended for use in the event
of unprotected intercourse. If taken prior to ovulation, the pills can delay or
inhibit ovulation for at least 5 days to allow the sperm to become inactive.
V. Sterilization (NICHD, 2017)
• Sterilization is a permanent form of birth control that either prevents a woman from getting
pregnant or prevents a man from releasing sperm. A health care provider must perform the
sterilization procedure, which usually involves surgery. These procedures usually are not
reversible.
1. Sterilization implant is a nonsurgical method for permanently blocking the fallopian
(pronounced fuh-LOH-pee-uhn) tubes.11 A health care provider threads a thin tube through the
vagina and into the uterus to place a soft, flexible insert into each fallopian tube. No incisions
are necessary.
2. Tubal ligation (pronounced TOO-buhl lahy-GEY-shuhn) is a surgical procedure in which a doctor
cuts, ties, or seals the fallopian tubes. This procedure blocks the path between the ovaries and
the uterus. The sperm cannot reach the egg to fertilize it, and the egg cannot reach the uterus.12
3. Vasectomy (va-SEK-tuh-mee) is a surgical procedure that cuts, closes, or blocks the vas deferens
(pronounced vas DEF-uh-renz). This procedure blocks the path between the testes and the
urethra (yoo-REE-thruh).13 The sperm cannot leave the testes and cannot reach the egg.
Other Methods
Fertility Awareness Based Methods (CYWH:2017)
Success Rate with Typical Use: 76%
Pros
•Natural
•Approved by many religions
•Woman gets to know her body and menstrual cycles
•Can be helpful for partners who are very careful and
don’t have sex during ovulation period and several
days before and after
Cons
•Doesn’t protect against STIs
•Need to figure out when ovulating for each month,
since this can differ from one month to the next and
young women often have irregular periods
•Requires a lot of work- need careful instruction and
the woman needs to figure out when ovulating
•Can’t have sexual intercourse for at least a week each
month (during ovulation and several days before and
after) Teens and women with irregular periods should
not use- failure rate is high
Withdrawal (CYWH:2017)
Success Rate with Typical Use: 78%
Pros Cons
•Natural, so no side effects •Doesn’t protect against STIs
•Doesn’t cost anything •Not very effective method of contraception
•Allows men to be an active part of preventing •Difficult for male to always predict ejaculation
pregnancy •May decrease sexual pleasure of woman since need
to always be thinking about what is happening during
sexual intercourse
•No control by women- need to rely completely on
men to prevent pregnancy
Benefits of family planning and contraception
(WHO, 2014)
1. Preventing maternal morbidity and mortality
• Family planning allows spacing of pregnancies, delaying pregnancies in young
girls who are at increased risk of health problems and death from early
childbearing, and preventing pregnancies among older women who also face
increased risks.
2. Reducing unsafe abortion from unintended pregnancies
• An estimated 20 million unsafe abortions take place each year— resulting in
67,000 deaths annually, mostly in developing countries. Family planning can
prevent many of these tragic deaths by reducing the number of unintended
pregnancies with a higher risk of pregnancy complications and unsafe
abortions.
Benefits of family planning and contraception
3. Reducing infant mortality
• Contraception can prevent closely spaced and illtimed pregnancies and births,
which contribute to some of the world’s highest infant mortality rates. Closely
spaced births result in higher infant mortality
4. Helping to prevent HIV/AIDS
• Contraception reduces the risk of unintended pregnancies among women
living with HIV, resulting in fewer infected babies and orphans. In addition,
male and female condoms provide dual protection against unintended
pregnancies and against STIs including HIV.
Benefits of family planning and contraception
5. Empowering people and enhancing education
• Family planning and contraception enables people to make informed choices
about their sexual and reproductive health, and creates an opportunity for
women for enhanced education and participation in society, including paid
employment.
6. Reducing adolescent pregnancies
• Pregnant adolescents are more likely to have preterm and low birth-weight
babies. Babies born to adolescents have higher rates of neonatal mortality.
Many adolescent girls who become pregnant have to leave school. This has
long-term implications for them as individuals, their families and
communities.
Reasons for not using any method of contraception
• Limited access to contraception, particularly among young people
• Poorer segments of populations, or unmarried people
• Limited choice of methods
• Fear or experience of side-effects
• Cultural or religious opposition
• Poor quality of available services
• Gender-based barriers.
Social Determinants of Health Framework
“Freedom to go where I want”: improving access to sexual and
reproductive health for women with disabilities in the Philippines

• The intersectionality of prejudice and discrimination experienced by

women with disabilities on account of their gender and disability means
that in many contexts, women with disabilities are more likely to
experience violations of their sexual and reproductive rights, compared to
women without disability
• Violations include forced and coerced sterilization; denial of maternity
and parenting rights; denial of legal capacity and decision-making; and a
lack of access to sexual and reproductive health services, programs,
information and education.
• Women with disabilities are also more likely to experience physical and
sexual abuse than woman without disability
Objectives:
1. To understand the sexual and reproductive health experiences and needs of women with disabilities;
2. To improve access to quality sexual and reproductive health, including violence response services, for
women with disabilities in the Philippines.
Specific objectives:
3. To increase participants’ sexual and reproductive health knowledge;
4. To increase participants’ awareness of their rights in relation to sexual and reproductive health and
disability;
5. To increase participants’ confidence to access and negotiate health services;
6. To support individual and/or collective action planning to further promote demand for sexual and
reproductive health within the women’s communities (as can be achieved with participatory
methods)
7. To facilitate peer support amongst groups of women with disabilities.
Methodology
• The PAG intervention consisted of supporting a series of ten peer-
facilitated meetings for five groups of women with disabilities and one
group for parents of children with disability (the latter will not be
discussed in this paper).
• Meetings were held approximately every fortnight over a 20-week period
between July 2015 and October 2015, with each meeting lasting for half
to a full day.
• All meetings were participatory, strengths based and comprised a
combination of structured activities and interactive methods to facilitate
discussion, with focus on key factors relevant to sexual and reproductive
health needs and rights and protection from violence.
Data sources
• Interview participants were asked to describe the most significant
change in their lives as a result of participating in the PAG intervention.
• Each PAG group then participated in a prioritization exercise and
discussed the de-identified stories to select, as a group, stories that
represented the most important collective change.
• Stories were collected from 30 participants in QC and 17 participants
in LC who completed the intervention.
Follow-up interviews: Nine months after the completion of the PAG
intervention in June 2016
• The PAG participants were recruited through the networks of
facilitators, partner DPOs and the Local Government Unit’s Persons
with Disability Affairs Office in each research site. The age range of
participants was 18–30 years of age. Potential participants were
provided with information about the intervention and the
requirements of participation
• All participants were given a small allowance to reimburse their travel
and child care costs or loss of income due to participating in the PAG
sessions.
• Five PAGs with women with disabilities were established across the
two research sites.
• 1 group for women who were Deaf or hard of hearing (16 participants
(Quezon City);
• 1 group for women with vision impairment (11 participants from QC)
• 1 group for women with mobility impairments (8 participants fromQC)
• 2 groups for women with mobility impairments (Ligao City) with a total of 19
women.
• Fifty-one of the 54 participants completed the intervention, with three women
dropping out due to work, illness and moving out of the area.
Ethics approval
• Ethics approval for the W-DARE program was obtained from the
University of Melbourne Health Sciences Human Ethics Sub
Committee and the De La Salle University Ethics Committee in August
2013, with approval for this specific component of the three-year
program obtained in October 2014.
• Informed consent was obtained from all participants to participate in
the PAG and the data collection processes.
Result
• The W-DARE PAG intervention led to positive outcomes for women with disabilities including those
enumerated in Table 1.
• The sustainability of these changes, however, varied between individuals, and was influenced by factors
such as:
1. Individual capacity and agency
2. Availability of resources including economic resources to support ongoing communication and
connections with PAG participants;
3. Accessibility of communities;
4. Family responsibilities and support for social inclusion;
5. Geographical location.

• Increased access to information, enhanced social networks and opportunities for participation have been
highlighted as essential for upholding the rights, and sexual and reproductive health rights of women with
disabilities
Recommendations:
• There is an urgent need to address systemic barriers to the participation of
women with disabilities in all other life domains such as education,
employment and general health programs.
• For this to be achieved, governments, service providers, DPOs and
development programers need to work alongside women with disabilities to
understand more about their experiences, needs and priorities.
• This will enable joint identification of context specific barriers to
participation across these life domains, as well as the development of local
solutions to reduce barriers and promote inclusion of people with
disabilities within their communities.
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