Training of Roma Health Mediators in Reproductive Health

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Trainer document NATURAL FAMILY PLANNING METHODS (presentation) LACTATIONAL AMENORRHEA METHOD (LAM) LAM (Lactation = breastfeeding. Amenorrhea = absence of menses. M=method) is a family planning method for breastfeeding mothers which provides natural protection against pregnancy for up to 6 months after birth. Mechanism of Action Lactational Amenorrhea Method can be used by breastfeeding women and is based on the physiological infertility during this time, demonstrated by the absence of menses. Women’s fertility is reduced because they do not ovulate. Without ovulation, fertilization and pregnancy cannot take place. Effectiveness If using the LAM perfectly, only 1 woman out of 200 women will get pregnant in the first 6 months after childbirth. As commonly used, 2 women out of 100 may become pregnant in the first 6 months. In order for LAM to be effective, the woman must meet the following criteria: • She is less than six months postpartum • She is amenorrheic (she has had no menstrual periods) • She is fully and regularly breastfeeding, without giving the baby any other food The woman should start another contraceptive method before any of the three criteria expire. A woman needs an alternative method before 6 weeks postpartum to begin immediately if she should menstruate or reduce breastfeeding intensity. Advantages • Can be used immediately after delivery • Is very convenient for the mother who breastfeeds during the first 6 months after delivery • Requires no prescription • Has no side effects or precautions • Is economical (free of charge) • Requires no chemical substances or mechanical devices • Helps protect the infant from diarrhea and other infectious diseases Disadvantages/Limitations • Can be used only during the postpartum period • May be difficult for woman to maintain a pattern of fully or almost fully breastfeeding • Provides no protection against STD/HIV • In HIV-positive mothers, the babies have the risk of infection through breastfeeding 56 RFHI/JSI Romania Training of RHMs in Reproductive Health Session 4: FP Methods
FERTILITY AWARENESS METHODS Fertility Awareness Methods are methods that rely on various techniques to identify a woman's fertile days (the days in which she can become pregnant). In using these methods, a woman monitors the various changes and signs that occur in her body during each menstrual cycle, which may indicate when she is fertile and when she is not (the "safe" days to have sex). By avoiding intercourse on "unsafe" days, a woman may avoid pregnancy. These methods have varying degrees of reliability. Each method requires careful instruction and a high level of motivation and commitment on the part of the couple in order to be used successfully. Mechanism of Action The Rhythm (or Calendar) Method, one of the oldest and most widely practiced fertility awareness methods worldwide, requires the woman to calculate the fertile days of her cycle. She keeps a strict record of the length of her last six cycles (counting the first day of bleeding as the first day of a new cycle) and then uses a simple formula to identify her fertile days. She counts the number of days in the shortest cycle, and subtracts 18, using the answer to estimate the first day of fertility in a cycle. The woman then determines the number of days in her longest cycle, subtracts 11, and uses the answer to estimate the last day of fertility in a cycle. The Basal Body Temperature (BTT) Method requires the woman to take her own temperature every morning on awaking and record it on a chart over several months to determine her time of ovulation. A drop in the BBT sometimes precedes ovulation by 12 to 24 hours and rises immediately after ovulation, staying elevated slightly (0.2 to 0.5 degrees C) until her next menstrual period. To use the Cervical Mucus Method (Billings Method), the woman monitors and records on a daily basis the changes in her cervical mucus discharge. Typically, there is little mucus discharge for a few days following menstruation. Then the mucus becomes sticky/pasty or crumbly/slightly yellow or white. As ovulation nears, the mucus becomes slippery, white, clear and wetter. Following ovulation, the mucus becomes sticky/pasty again. The Symptothermal Method combines several techniques to predict ovulation. The woman monitors her cervical mucus (as in the Billings Method) and her temperature changes (as in the BBT method), including other signs of ovulation, like breast tenderness, back pain, abdominal pain, and light intermenstrual bleeding. She must abstain from the first sign of wet cervical mucus until her body temperature has remained elevated for three days after the peak day (the last day of clear, slippery mucus) or until the fourth day after the thin mucus is no longer observed, which ever is later. Effectiveness Fertility awareness methods have a typical pregnancy rate of about 20% in the first year. Depending on variables such as consistency of use, regularity of menstrual cycles, and user-related factors, consistent and correct use can reduce the pregnancy rate to 2%. When used in combination with a barrier method, effectiveness is increased. Advantages • No or low cost • No chemical products/no physical side effects 57 RFHI/JSI Romania Training of RHMs in Reproductive Health Session 4: FP Methods
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Romanian Family Health Initiative A
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2005 - JSI Research & Training Inst
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INTRODUCTION JSI Research and Train
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Acknowledgements This manual was de
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SESSION 1: INTRODUCTION OBJECTIVES:
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Common group norms: • Respect the
Page 13 and 14: Flip chart/ Participant document TR
Page 15 and 16: Participant document HEALTH MEDIATO
Page 17 and 18: Matching questions Below are two li
Page 19 and 20: Multiple Choice Questions Each of t
Page 21 and 22: SESSION 2: BASIC CONCEPTS OF REPROD
Page 23 and 24: Possible Answers: • Not to have c
Page 25 and 26: ‣ How many children do you have?
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Page 31 and 32: Trainer document THE RIGHTS OF THE
Page 33 and 34: Trainer document RELATIONSHIP BETWE
Page 35 and 36: (HOLD THE THIRD/SMALLEST SIGN IN FR
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Page 39 and 40: • What is menstruation? • What
Page 41 and 42: Trainer document MALE REPRODUCTIVE
Page 43 and 44: lining like a pillow. If the girl/w
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Page 49 and 50: Participant document MALE AND FEMAL
Page 51 and 52: ‣ What do the terms “conception
Page 53 and 54: ‣ What are the situations in whic
Page 55 and 56: During the exercise move around the
Page 57 and 58: Distribute the participant document
Page 59 and 60: Emphasize that although insertion o
Page 61 and 62: SUMMARY At the end of this session,
Page 63: Flipchart FAMILY PLANNING METHODS N
Page 67 and 68: Trainer document STEPS FOR CONDOM U
Page 69 and 70: Correct Use of Condom • Check the
Page 71 and 72: 9. Explain the importance of withdr
Page 73 and 74: Trainer document COMBINED ORAL CONT
Page 75 and 76: Trainer document PROGESTAGEN-ONLY P
Page 77 and 78: Trainer document INTRA-UTERINE DEVI
Page 79 and 80: Trainer document VOLUNTARY SURGICAL
Page 81 and 82: Myths and Facts about Vasectomy Myt
Page 83 and 84: Male Condom Show the client the con
Page 85 and 86: Progestagen-Only Pills (POPs) Show
Page 87 and 88: Intrauterine Device (IUD) Show the
Page 89 and 90: Emergency Contraception Pills (ECPs
Page 91 and 92: Using the trainer’s document Stan
Page 93 and 94: • When do you expect your next pe
Page 95 and 96: Participant document CASE STUDIES (
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Page 99 and 100: Participant document The majority o
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Page 103 and 104: 6. If she recently had a miscarriag
Page 105 and 106: Participant document FREQUENT ASKED
Page 107 and 108: Recommended question: - Are you and
Page 109 and 110: SESSION 6: SAFE MOTHERHOOD - PREGNA
Page 111 and 112: ‣ What are the first signs of pre
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o Abdominal pain o Weakness, tiredn
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Discuss with participants how they
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Flipchart FACTS ABOUT WOMEN’S LIV
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Trainer document NORMAL BODY CHANGE
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Trainer document/Participant docume
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Trainer document MYTHS AND FACTS RE
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Work and domestic activities Pregna
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Trainer document CASE STUDIES Elena
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II-IV. POSTPARTUM VISITS (45 minute
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Suggest that another important topi
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Trainer document WOMEN’S NEEDS DU
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Participant document COUNSELING ON
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Explain why newborns need a lot of
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• Beside routine weekly visits of
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Trainer document ESSENTIAL NEWBORN
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Trainer document/Participant docume
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SESSION 9: BREASTFEEDING OBJECTIVES
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• Every child should be exclusive
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1. Demonstrate how to help a mother
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- for sick or disabled babies. 3. D
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Some women have very large areolas,
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• The baby suckles as often and f
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Flip chart BENEFITS OF BREASTFEEDIN
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Participant document PRINCIPLES OF
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Overhead BABY’S ATTACHMENT TO THE
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Participant document Sore or Cracke
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Trainer document ANSWERS TO FREQUEN
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Trainer document MYTHS ABOUT BREAST
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SESSION 10: SEXUALLY TRANSMITTED IN
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• The sexual act can be vaginal,
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sick and spread to others. ‣ How
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cells (which fight against infectio
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Participant document WAYS TO SIGNIF
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Trainer document HIV/AIDS: WHAT IS
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Participant document HOW IS HIV/AID
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o Sexually transmitted infections c
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Trainer document CAUSES OF INFERTIL
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SESSION 12: BREAST AND CERVICAL CAN
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• For health problems like cancer
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Participant document BREAST SELF-EX
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SESSION 13: BASIC CONCEPTS OF COMMU
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‣ What is the purpose of talking
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‣ How do you feel about asking wo
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• I was told to come • I learne
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Distribute the participant document
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Trainer document FACTORS INFLUENCIN
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• One's personal susceptibility t
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Participant document 7 stages BEHAV
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Participant document DECISION-MAKIN
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SESSION 14: INTERPERSONAL COMMUNICA
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o Note next to each of their respon
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IV-VII. ACTIVE LISTENING (20 minute
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‣ What did she communicate to the
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‣ Did you want to put conditions
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Open questions help women: • To a
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The person who was listening: • P
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Divide the group into 5 small group
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Refer the group to the flip chart F
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Ask participants to change roles wi
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Flip chart OBSTACLES TO COMMUNICATI
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"You're acting like a child." "You
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Participant document ACTIVE LISTENI
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Participant document EXAMPLES OF QU
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Flip chart / Participant document R
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SESSION 15: GROUP EDUCATION SESSION
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• How long people have held these
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o Involve simulations, role play an
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‣ How many people see: a young l
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o Introduce the subject o Invite th
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‣ What did the mediator do to put
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Participant document CONTINUUM IN T
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Flip chart CONTINUUM IN THE EFFECTI
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Common teaching/animation methods:
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Trainer document DESCRIPTION OF ANT
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255 RFHI/JSI Romania Training of RH
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Participant document FACILITATING G
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Participant document CHECKLIST FOR
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Possible questions for facilitating
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Note: It is important that all part
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SESSION 18: EVALUATION OF THE TRAIN
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Participant document HEALTH MEDIATO
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Matching questions Below are two li
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II. Other aspects of the training B
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Training of Roma Health Mediators in Reproductive Health

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