Family planning programs that work

Midwives help individual women and men decide about family planning methods. In this work, they may find that family planning is difficult to get in their communities. Midwives may then get involved in making family planning programs work better.

What makes a family planning program work to improve a woman's health, her knowledge, and her control over her body?

• A wide choice of methods, for both men and women, with clear information about benefits and risks.

• Good testing to know if a woman has a health problem, such as high blood pressure, that means she should not use a certain method. Good follow-up care to make sure a method is not causing problems and to help the woman try another if it is.

• Health services that include family planning along with care before, during, and after birth, support for breastfeeding, treatment for infertility, and treatment and prevention of STIs.

• Encouragement for men and women to share responsibility for birth control.

• Respect for local health providers and safe traditional practices, including traditional methods of regulating monthly bleeding and family planning. Midwives often have good experience combining traditional methods with modern methods of care.

• Freedom from pressure and coercion. Coercion means a health worker or someone else pushes a woman to use family planning or a certain method when she does not want to. This happens when programs limit the choice of method or set targets (a certain number of one method must be given). Targets make health workers push people to accept a method against their will or without full information. These can be problems with family planning programs funded by large groups outside the community, such as international donors and national governments.

Health workers should be free from pressure about which methods to offer women.

Chapter 1 8

Sexually transmitted infections

In this chapter:

What are sexually transmitted infections?

How STIs are passed 322

Discharge from the vagina

Chlamydia and gonorrhea (clap, the drip, gono, VD) 323

Trichomonas (trich) 326

Yeast (candida, white discharge,

Sores on the genitals (genital ulcers) ...

Syphilis 329

Chancroid 331

STIs that affect the whole body

HIV infection and AIDS 334

Teaching women how to prevent STIs

How to help stop STIs in your community

Treating STIs 322

fungus) 326

Bacterial vaginosis (BV, gardnerella) 328

Genital herpes 331

HPV (genital warts) 333

Hepatitis B 336


Sexually transmitted infections and other infections of the genitals What are sexually transmitted infections?

Sexually transmitted infections (STIs) are infections that are passed from one person to another during sex. Men, women, and their children can all be affected by STIs. Some common STIs are gonorrhea, chlamydia, trichomonas, syphilis, chancroid, herpes, hepatitis B, and HIV.

If a person has any of these signs, he or she may have an STI:

• bad-smelling discharge

• itching genitals

• painful genitals

• sores or blisters on the genitals

• pain in the pelvis or pain during sex

It is also very common to have an STI and have no signs at all.

Many women and men have STIs but do not know it.

Untreated STIs can lead to very serious health problems, so anyone with an STI needs treatment as soon as possible. A woman with an untreated STI can develop a tubal pregnancy (see page 113), cancer of the cervix, or can become infertile (see page 30). An untreated STI in a pregnant woman can cause a baby to be born too early, too small, blind, sick, or dead. A person who has one STI can more easily get another — including HIV.

This chapter describes the most common STIs and explains how to treat them and prevent them. It also describes some other infections of the genitals that are common but are not transmitted sexually.


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