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CONTRACEPTION,
Workshop Manual
FIRST EDITION
Acknowledgements
Contraception
Authors:
Margaretha Goosen, Barbara Klugman and Emelda Boikanyo
Editors:
Daphney Conco, Makhosazana Xaba and Sharon Fonn
Sub-editor:
Martha Molete, Umanyano Media Service
Specialist reader: Katrien Dehaeck
Illustrations:
Sharone' Cohen
Funders:
ICCO, Interfund, Oxfam UK and Terre des Hommes
The research for and production of this manual was funded directly by the Department for
International Development, DFID (British Development Assistance Programme). In
addition, funding from the Carnegie Corporation, ICCO and Oxfam UK covered the costs of
the involvement of other staff members in conceptualisation and supervision.
We thank them all.
© Women's Health Project 2000
Women's Health Project has copyright over this manual. It cannot be reproduced
without our permission. You can contact us at:
Women's Health Project
POBox 1038
Johannesburg 2000
Third Floor, Spencer Lister Building
South African Institute for Medical Research
Corner De Korte and Hospital Streets
Braamfontein
Johannesburg
Telephone: (011) 489-9917 / 489-9905
Fax: (011) 489-9922
Email: [email protected]~
This manual should be used with
The Facilitator's Guide: Introduction to the Health Workshop Manuals
Other manuals in this series are:
Your Body, Sexual Rights, Sexually Transmitted Diseases,
AIDS Prevention, Abortion, Cervical Cancer
We suggest that Your Body should always be the fIrst workshop because it provides basic
information that is needed for this workshop.
ISBN 0-620-22897-0
CONTENTS
1. Preparing for the workshop
2
2
Glossary
Before you begin
About the workshop
Things you will need
4.
4
5
2. The workshop
6
Introductions
What are we going to do today?
What are contraceptives?
Why do we use contraceptives?
Our reproductive systems
Hormonal methods
Injectable contraceptives
The Pill
Norplant
Emergency contraception
Barrier methods
Condoms
Role-play
Barrier methods continued
Female condoms
The diaphragm
Spermicides
Intra-uterine contraceptive device (IUCD)
Female and male sterilisation
Final discussion: role-play
Closing the workshop
6
6
6
7
9
10
10
11
13
14
15
15
16
18
18
19
20
21
22
23
25
3. Extra information
26
26
Questions and answers about contraception
I
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of oontrace ives
Different
4. Posters
(separate
package)
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How fertilisation takes lace
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How to use the fem,lIe condom
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Contraception
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Wh do we use tontrace lives?
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1
1. PREPARING FOR THE WORKSHOP
Glossary
Acne:
Acne is when the skin produces red pimples, especially on the face. Acne
often happens in teenagers due to the hormone changes. It is also caused
by oily skin.
Antibiotic:
An antibiotic medicine can kill or prevent the growth of germs called bacteria in the body. Antibiotics are used when someone has a bacterial infection.
Anti-epileptic: Anti-epileptic medicine helps to control epilepsy, which is a brain disorder
causing convulsions (fits) and sometimes even loss of consciousness.
Cortisone:
Cortisone is a hormone produced in our bodies and by drug companies to
stop swelling and allergies.
Cramps:
Cramps are muscular pains, often in the abdomen.
Ejaculate:
When a man ejaculates, he releases liquid from his penis because he is
sexually excited due to sexual intercourse, masturbation or a wet dream.
This is also commonly known as "coming".
Fallopian tubes: Each woman has two fallopian tubes, one on either side of the womb.
Each tube is connected to the womb on one end. The other end of each
tube has a funnel-shaped mouth that opens close to each ovary. When
an egg is released from one of the ovaries each month (ovulation), the egg
is swept up into this mouth. Once in the tube, the egg begins its movement to the womb.
:2
Fertilisation:
Fertilisation is when the sperm from a man joins with an egg from a
woman inside the fallopian tube. This is the start of a foetus.
Fertility:
Your fertility is how able you are to reproduce. For example, if you are
very fertile, you easily get pregnant or you easily get someone pregnant.
The opposite of fertility is infertility, when a couple cannot reproduce.
Hormones:
Hormones are chemical messengers that travel in your blood. Some hormones come from the brain. Others come from the ovaries and other
parts of our bodies. Hormones make our bodies do certain things. For
instance, they cause the physical changes in our bodies that make us
grow from girls to women (and from boys to men). Hormones also help to
arouse (excite) us during sex.
Contraception workshop manual
Migraines:
Migraines are severe headaches that usually come with nausea, vomiting,
being highly sensitive to light and irritability. These headaches tend to
happen again and again.
Pessary:
A pessary is a special tablet for putting inside the vagina. A pessary can be
used, for example, as a contraceptive or medication.
Spermicides:
Spermicides are gels or creams that kill sperm. They are put inside the
vagina before sexual intercourse and should be used with another form of
contraception, such as condoms or the diaphragm.
Withdrawal:
Withdrawal is a method of contraception whereby the man withdraws
his penis from the woman's vagina before he ejaculates. This way the
sperm does not enter the vagina and cause a pregnancy.
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Contraception workshop manual
3
Before you begin
Read the Facilitator's Guide: Introduction to the Health Workshop
Manuals to fmd out how to facilitate a workshop. This facilitator's guide also
has useful background information on reproductive rights and health as well as
safer sex.
Read carefully through this manual before you run the workshop and make
sure you feel comfortable with its contents. Also plan which words to use if you
are translating this information into another language. Use the glossary at the
front of this manual to help you with words you don't know. When you start
the workshop you may want to ask the group which words they are comfortable with - see the Facilitator's Guide for details on how to do an exercise to
decide with the group on what words to use.
You don't have to use the exact words we give you. They are there to guide and
help you.
About the workshop
The aim of this workshop is to give women and men basic information about
different forms of contraception. This includes the good things and the problems
with each method:
In order to understand how different contraceptive methods work, we need to
know how our bodies and our reproductive systems work. This is why we suggest that you fIrst run the workshop called Your Body unless the participants
already have this information.
This manual opens with a group discussion about why we use contraceptives.
Then it explains the reproductive system and all the different contraceptives. It
has a role-play on condoms to help people talk about contraception with their
sexual partners. At the end of the workshop another role-play helps people gain
confidence to demand good services from health workers.
You may find that participants have many stories to tell about their experiences
with contraception. They may also want to talk about sex and sexual pleasure.
Encourage them to do so. Talking about these things often helps us to make our
own decisions more clearly.
This manual looks briefly at various methods of contraception. The group may
ask questions which you cannot answer. That is okay. Tell them from the start
that you do not have all the answers and that they can get more information
from a health worker or a book. Ask your group for their ideas on what they
think are the good things and problems of each method of contraception. You
can write up their ideas but make sure all the correct ideas are covered. If the
4
Contraception workshop manual
*
group misses some ideas, add them yourself by fIrst explaining them to the
group. If someone gives incorrect information, discuss this with the group.
If you feel you need more information to help you to run this workshop, make a
list of questions and ask a health worker, or read a book.
This workshop talks about the following topics:
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What are contraceptives?
Why do we use contraceptives?
Our reproductive systems
Hormonal methods
Injectable contraceptives
The Pill
Norplant
Emergency contraception
Barrier methods
Female and male condoms
The diaphragm
Spermicides
Intra-uterine contraceptive device (IUCD) or loop
Female and male sterilisation
1lHOURS
You need at least two-and-a-half hours for this workshop.
Things you will need
This manual and its seven posters.
Something to write on, such as a black or white board or newsprint. You can also use
big sheets of workshop paper.
Something to write with, such as different coloured pens, chalk or crayons.
Sticky tape, Prestik or anything to stick up posters and newsprint sheets.
Condoms which you can distribute to members of the group. Ask your local clinic for a
batch of condoms to distribute at the workshop. You can also try to get examples of
other forms of contraception to show the group what they look like.
Don't worry if you don't have all of the things we have listed above. Run the workshop
without them. Just find a way to display the posters so that everybody can see them as
this will help you to explain how contraceptive methods work.
Make sure the venue is set up as you want it with chairs in a circle or semi-circle.
Contraception workshop manual
5
1. THE WORKSHOP
Facilitator's
notes
Introduce yourself.
Help the group feel
more comfortable
together. Choose one of
the ice breakers in the
Facilitator's Guide or
make up your own icebreaker.
Information for participants
Say: I'm using the information in this manual, but I'm
not an expert. During the workshop you may have questions. I will answer those that I know. But I would also like
you to know that I may not be able to answer every question. We must remember the questions I can't answer so
we can ask someone like a nurse to answer them.
If the ice breaker has
not included introductions, then ask each person to introduce herself
or himself.
ffi
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Tell the group members
what the workshop's
objectives are.
Say: By the end of the workshop you will know:
o
o
o
what contraception is and how it works;
the different methods of contraception; and
what is easy and difficult about these methods.
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Say: Contraceptives stop us from getting pregnaIit. People
in all societies have always found ways to stop themselves
from getting pregnant. Some of these ways are social
rules -like rules that you can't have sex when you are
breastfeeding, or rules that young people can touch each
other but can't actually have sex. Some of these ways are
sexual practices -like a man withdrawing his penis
before he ejaculates. Some of these ways use herbs and
other substances to stop pregnancy.
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Contraception workshop manual
Facilitator's
notes
Information for participants
'\'-"----~'.LJ.1il:"--"-':.......L!"----!!._L.;
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Put Poster 1 on the wall.
Say: These days there are many modern contraceptives,
made in factories.
Point to the poster.
Say: There are Pills, injections, condoms, creams as well
as operations. We are going to talk about how all of these
work; their advantages and disadvantages. But fIrst let us
talk about how we feel about contraception.
Put.Poster 2 on the wall.
Say: This poster shows adults and children in different situations. Let us look at the drawings. What can you say
about what is in the drawings?
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Let the group discuss
the drawing for a few
minutes.
Contraception workshop manual
7
_ _-...J
Facilitator's
notes
Divide the group into
small groups with four
to six people in each
group. Ask the groups
to look at the poster, and
discuss the following
questions:
After 5 minutes, ask
everyone to come back
into the big group to
talk about why people
use contraception. Let
different members of
the group give their
ideas - take about 10
minutes.
'I,
After the group has spoken about this, you can
make some conclusions.
Information for participants
VVho looks after children?
VVho decides to have children?
VVho cares for unwanted children?
Say: Discuss these questions in your group for 5 minutes.
Say: Now that we have discussed how people have children and who looks after them, let us share our ideas
about why people use contraception.
Say: All over the world people use contraception. In some
countries most people use old methods like withdrawal. In
others, like Japan, most people use condoms. In others,
like South Africa, most people use injectables. Sometimes
it is a man who takes responsibility for contraception;
sometimes the woman takes the responsibility. Sometimes
men and women talk about this together. But often
women and men fmd it difficult to talk to each other
about getting pregnant and having children. It is very
important that women should not get pregnant when
they don't want to have a baby.
Say: There have been many debates about this around
the world. Two conferences where all the countries of the
world came together to discuss these issues were the Cairo
population conference in 1994 and the Beijing women's
conference in 1995. Our government went to these conferences and helped to write the final agreement. The
fmal agreement says that:
D (it is) the basic right of all couples and individuals to
decide freely and responsibly the number, spacing and
timing of their children and to have the information
and means to do so; and
D reproductive rights include the right to make decisions
concerning reproduction free of discrimination, coercion and violence.
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Contraception workshop manual
Facilitator's
not~s
Ask members of the
group if they have any
questions. Talk about
them.
Information for participants "-,,'i:'-"----"""'''-''-'.<''----''-----'''---''-_''-'
Say: As women and men, we need information in order to
ensure our reproductive rights. We need to know how we
can prevent pregnancies. We need to know how we can
prevent infertility too. We also need to develop our confidence to have discussions with our sexual partners about
sexual relationships and pregnancy. Let's start by looking
at how the body works.
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Stick on the wall Poster
.3 of the female and·
male reproductive systems, and Poster 4 of
how fertilisation takes
place.
Say: Before we can talk about contraceptive methods, we
must know how our bodies work and how fertilisation
takes place. (Point) Poster 3 shows a woman and a man's
reproductive parts. Here you can see the woman's vagina,
her womb, her tubes and her ovaries. And here are the
man's testes and his penis.
Say: Once a young woman has started to have periods,
she is fertile and can have children. A boy is fertile if he
has had his first wet dream. How does fertilisation happen? (Point) Look at Poster 4. When a woman and man
have sexual intercourse, the man ejaculates a fluid that is
made of male eggs called sperm. Each sperm is very small.
When a man ejaculates, he leaves sperm in the vagina.
The sperm swim up through the cervix, into the womb
and into the tubes, in the direction of the female egg.
Each month a woman's ovary releases an egg which goes
into a fallopian tube. Fertilisation takes place if a man's
sperm joins with a woman's egg. The fertilised egg travels
into the womb.
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Contraception workshop manual
9
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Facilitator's
Information for participants
notes
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Give the group a chance
to look at the posters
and ask questions. Make
sure that everybody is
satisfied with the explanations.
Ask: Do you have any questions about the reproductive
system? Do you understand how fertilisation takes place?
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Use Poster 3 on the
reproductive systems to
explain how the Pill
works.
Say: The injectable and the Pill are the most commonly
used contraceptive methods in South Africa. Once a
woman takes them, tiny parts of them get into her bloodstream and carry messages to her hormones. Hormones
are chemicals that control our reproductive systems. In
women, hormones can tell ovaries to stop producing eggs
each month, help our bodies to form a plug at the mouth
of our wombs to stop semen from passing into the womb,
or prevent the formation of the lining of the womb in
which the egg implants itself. In this way they prevent fertilisation from taking place.
Injectable contraceptives
Say: There are two different kinds of injectables:
1. Depo Provera is given every three months.
2. Nuristerate is given every two months.
During apartheid, some women were forced to take an
injectable or they were given the injectable without their
permission. Despite that, this is still the most commonly
used method of contraception.
Say: What do you think the good things about the
injectable are?
o The injectable is very effective at preventing pregnancy.
o The injectable does not interfere with sex.
o It is safe with no serious side-effects.
o It enhances breast-milk production.
o You don't need to remember to use contraception
o
every time you have sex or on a daily basis.
Young women who have already started their periods
may use the injectable.
Contraception workshop manual
\
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Facilitator's
notes
Information for participants· \u..-~tL.!.!.il:L..L:=-..a.:........rL_L...J
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Say: Some women say they prefer injectables because
they can hide it from their partners. Do you think there is
another option if your partner does not want you to take
contraceptives?
Say: All women who want to take the injection should be
told about these possible side-effects so that they know
about these and they can make a decision knowing what
they may have to cope with:
~
o periods may disappear completely with the injection;
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o
o
o
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weight gain of about 2 kg is common;
it may take up to six months to become fertile after you
stop taking the injectable;
you may get depressed;
it is common to have increased bleeding during your
periods;
you may be less interested in sex; and
your breasts may get larger, which can be painful.
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While some people suffer from two or three of the above
side-effects, some do not experience any side-effects at all.
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Say: What are the problems with using the injectable?
o The injectable stays in your body for 2 to 3 monthstherefore it is not readily reversible.
o You depend on a health worker to give you the
injectable.
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The Pill
Say: The Pill is made of two kinds of hormones and prevents pregnancy very effectively.
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Say: Let's talk about how to use the Pill. Pills are ~abelled
with the days of the week. Some of the Pills are in a
coloured section of the packet. Start taking the Pill on the
fIrst day of your period from the coloured section of the
packet. From then onwards take one Pill every day at the
same time of day. If you don't take one every day, it does
not work and you could get pregnant.
Point to Poster 1.
Contraception workshop manual
11
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Facilitator's
notes
Information for participants
Say: If one day you forget to take a Pill, take it as soon as
you remember. If you remember the next day, take two
Pills, and then keep going with one Pill each day after
that. If you forget two Pills two days in a row, stop taking
them until your next period comes. Then start again with
a new packet. Have sex using a condom or another barrier method if you have stopped using the PilL Otherwise
you could get pregnant.
Say: Also, in the fIrst two weeks that you use the Pill you
can still get pregnant, so you must use another contraceptive (like a condom) for the fIrst two weeks.
Ask: What do you think are the good things about using
the Pill?
o It doesn't interfere with sex.
o Many women have lighter periods with fewer cramps.
o Some women with acne report improvements in their
skin condition.
o Women have less pre-menstrual tension on the Pill.
o It is a very effective contraceptive if used correctly.
o It has minimalside~effects.
o It protects agaiIist the development of ovarian cysts.
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Say: When is it dafigerous to take the Pill?
o It is dangerous to take the Pill if you have high blood
pressure, serious heart disease or if you have had previous problems with clots in the legs, lungs or brain.
o Women who have migraines or liver disease should not
use the Pill.
o Women with breast cancer should not use the Pill.
,0 Smokers over the age of 35 years should not use the Pill
because of the danger of developing clots in the legs.
Say: If you are using the Pill it is important to remember
the following:
,
o If you cannot move your legs for some ~ason, for
example your leg is in a plaster cast or you are going to
have an operation, you should stop using the Pill.
o Certain drugs make the Pill less effective, for instance,
anti-epileptic medication, cortisone 'and antibiotics it is important to inform the doctor or health worker
that you are using the Pill befote they give you ariy
medication.
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Contraception workshop manual
Facilitator's
notes
Information for participants
\'-'>-.---""'Jl.i.JJ.L!LL::..-<2::.......L!._LJ
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Say: What do you think are the problems with using the
Pill?
o It can be an expensive contraceptive method unless
you get it from a clinic.
o You must remember to take the Pill every day at the
same time.
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Say: The side-effects of using the Pill are the following: it
can cause the skin around your eyes, cheeks and forehead
to become darker.
Say: There are two kinds of Pills - the mini-Pill and the
combined Pill. The mini-Pill has only one hormone and is
not as effective in preventing pregnancy as the combined
Pill. The combined Pill which is most commonly used has
two hormones. But while you're breastfeeding it is better
to take the mini-Pill because it is does not decrease breast
milk production. The mini-Pill can be used immediately
after birth and is also safe for smokers or women who
have clots in the leg.
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Norplant
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Say: Norplant is a new kind of contraceptive that is being
introduced in South Africa. It is made of capsules shaped
like small matchsticks, with a hormone in them, which
are put under the skin of a woman's upper arm. They can
last about five years. Women in South Africa have not
used Norplant much because it is still new.
Point to the picture of
Norplant in Poster 1.
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Let's talk about things that are known to be good about
Norplant:
o you can forget about contraception once you have it in;
o it is very effective in preventing pregnancy; and
o it can be removed and is, therefore, safe and reversible.
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Let's talk about some problems that we can experience
with Norplant:
o Norplant is new so we don't know how it affects the
body over a long period of time;
o you have the hormones in your body even when you
are not having sexual relations;
o it is visible on the arm, especially in thin women; and
o a health worker must put it in and take it out.
Contraception workshop manual
13
. . . . . .-J
Facilitator's
notes
Information for participants
~_~.!.i.3....~...a::=.:..cL----L..I
Emergency contraception
Say: Emergency contraception is also known as the
morning-after Pill. The Pill is also used as a form of emergency contraception. If you had unprotected sex, you can
ask for emergency contraception at the clinic. If you cannot get to a clinic you can take two white Ovral tablets
within 72 hours after you had sex. Take two more Ovral
tablets 12 hours after you have talwn the fIrst two. Ovral
is a very strong Pill and if you cannot use Ovral you can
take four tablets of less strong Pills such as Nordette or
Triphasil within 72 hours after sex and again 12 hours
later. Do not take Pills from the coloured section. This
should stop you from getting pregnant. But it could mal(e
you feel very sick. You should only do this in an emergency. You can ask for the emergency contraceptives from
the clinic. They are also available from the chemist.
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Allow an open discussion for a few minutes
for people to make sure
they have the information they need.
Say: Do you have any more questions about the injection,
the Pill or emergency contraception?
Say: We have come to an end of our discussion on hormonal methods. Hormonal methods are meant to prevent
an unwanted pregnancy. For protection against both
unwanted pregnancy and sexually transmitted diseases,
you have to use barrier methods as well or you can decide ,"
to use barrier methods only. Now let us discuss barrier
methods.
Mter the discussion, let
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people stand up. Some
will want to go to the
toilet. Give people a
5-minute break.
Say: Let's stand and stretch. We'll have as-minute breal(
before we go on to other contraceptives.
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Contraception workshop manual
Facilitator's
notes
Information for participants
"--"-"-~""-!.L.!.,""",-L.:.-..a.-..!.!...--L-J
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Condoms
Point to Poster 1.
Say: Condoms and the diaphragm are called barrier
methods because they keep sperm out of the vagina, just
as a raincoat is a barrier between rain and the body.
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Pass the condoms
around the room so that
each person has one.
Ask the group members
to take the condom out
of its packet. Ask them
to look at the condoms
and feel them, and
become comfortable
with them.
How to use the female condom
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Say: The condom looks like a balloon and is made of a
substance called latex. It comes in a small packet. It must
go on the man's penis when it is erect before sexualintercourse. The condom keeps the sperm away from the
woman's vagina so she can't get pregnant.
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Say: This means that the penis must not have any contact
with the woman's vagina until it is covered with a condom. This is because sometimes some sperm comes out
before the man ejaculates.
Say: After the man ejaculates, he must withdraw his
penis before it becomes soft. He must hold the condom as
he withdraws, so that it doesn't come off in the vagina, or
leak any sperm. If it breaks, the emergency contraception
!
should be used.
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Say: Each condom must be used only once.
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Put up Posters 5 and 6
of the female and male
condoms and how to
insert them.
Contraception workshop manual
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Facilitator's
--...~
notes
Information for participants
Ask: What are some good things about the male condom?
o It prevents pregnancy and at the same time it protects
women and men against sexually transmitted diseases,
including HIV/AIDS.
o It has no uncomfortable or dangerous side-effects.
o You don't have anything in your body when you are
not having sex.
o You can get it free from clinics or buy it in chemists,
supermarkets or spaza shops.
o Both sexual partners are involved in using the condom
- this is good for some relationships since talking is
encouraged.
Ask: What are some problems with using th~ condom?
o In some relationships, communication is poor and this
creates a problem as condoms can only be used if you
and your partner can talk about it.
o It is not as safe as the Pill or the injection at preventing
pregnancy.
o A new one must be used each time you have sex.
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Timing:
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D setting up the roleplay - 5 minutes
o role-play - 5 minutes
o discussion -10 minutes.
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Give them their instructions separately, where
no-one else can hear.
16
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Say to the group: We are going to do a role-play. In a roleplay people act or pretend to be someone else. By listening
to how they talk to each other, we will understand why
they say and do things. Role-plays can also be fun!
Ask: Can we have two volunteers to act in a role-play.
(You can have a man playing a woman and the other way
around, or both men, or both women.)
Say to the "man": You are a migrant worker who has
been away from home for six months. You stay with
another woman in the city. You come home to your wife
Contraception workshop manual
Facilitator's
notes
Information for participants
\~~:L.i.l.iLl.....L::......L!=.L!.._L.J
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in a rural area. You have been missing your wife and you
cannot wait to have sexual relations with her. You hope to
make her pregnant while you are here, so that you do not
have to worry about her being unfaithful.
Say to the "woman": You are married to a man who
has been away as a migrant for almost a year. He has just
come home. You love your husband and enjoy having sex
with him but you also think you have enough children.
You have heard that your husband is staying with another woman in the city, so you are scared that he may
bring/give you sexually transmitted diseases or AIDS. So,
you want him to use a condom, especially because you
also do not want to get pregnant.
Say to the group to set the scene: We are in a rural
home here and the man has just arrived to visit his wife.
He has come from the city where he is working.
Ask the actors to do
their scene. Give them
about 5 minutes.
When they are finished,
ask the group to discuss
the scene.
Ask the group:
D Do you think what they said could happen in real life?
D Ask the "woman": How did you feel playing your role?
D Ask the "man": How did you feel playing your role?
You could try another
role-play, or choose this
one instead:
Ask for two members to
volunteer to be a young
man and a young
woman.
Say to the "man": You are a young man. You want to
have sex with your girlfriend but you are scared she will
get pregnant. Also you lmow about AIDS and you think
it would be a good idea to use a condom. You don't know
how to talk about sex with your girlfriend. You are
embarrassed.
You can ask the group any of these questions to open the
discussion:
D Why is this?
D What did you think about how the man and the
woman behaved with each other?
D Should women and men behave differently?
D Do you think it would have been different if the woman
was the migrant worker and the man was at home?
D How do you think women and men could become confident to use condoms?
Contraception workshop manual
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Facilitator's
_ _.......J
notes
Information for participants
You can ask the group
similar questions to
those above.
Say to the woman: You are a young woman. You want
to have sex with your boyfriend but you are shy to talk to
him about this. Your friends have told you that condoms
are uncomfortable and break. You are also afraid of contracting AIDS.
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Female condoms
Point to the female condom in Poster 6.
How to use the female condom
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How to use the female condom
o The female condom must be put in before the man's
penis touches the woman's vagina or the area around
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Say: The female condom is put inside the woman's vagina
to prevent pregnancy and disease. It is made of very
strong, thin plastic. It is open at one end and closed at the
other, and is held in place by two rings that can bend. It is
put into the woman's vagina before having sex. It stays in
place during sex and catches the man's sperm. It can be
used only once.
. :
it.
Open the package by tearing at the arrow.
Remove the condom from the package and rub the
sides of the condom together to spread the lubrication
inside.
The inner ring helps to keep the condom in position
over the cervix. The inner ring must always stay inside
the condom.
When putting in the female condom, you can stand,
squat or lie down. It is easier to put the condom in if
you are relaxed.
Let the open end hang downwards and grip the inner
ring between your fingers.
.
Slide the condom into your vagina.
Put your finger inside the condom and push the inner
ring upwards so that it lies behind your pubic bone.
The inner ring keeps the condom in place during sex.
Contraception workshop manual
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Facilitator's
Information for participants "-"\'""-----""O.J~'---.L-'----"'-----"'-~L.J
notes
o
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Make sure the condom is not twisted inside your vagina. When you start having sex, guide your partner's
erect penis into the condom. Make sure that his penis
stays inside the condom and does not go in next to the
condom.
After sex, take the condom out by twisting it to prevent
the man's fluid from spilling.
Wrap the used condom up and throw it away in a rubbish bin, out of the way of children and animals. Don't
flush it down the toilet as it may cause a blockage.
!I
Say: What are some good things about the female condom?
.
o It offers protection against sexually ftansmitted diseases, and HIV/AIDS.
o It has no dangerous side-effects.
o It does not stay in your body when you are not having
sex.
o It gives women more control over using it because they
wear it on their bodies.
Say: What are some problems with the female condom?
o At the moment it is hard to buy and expensive,
although it is being introduced to some clInics.
o The female condom can only be used if you and your
partner can talk about contraception.
o You and your sexual partner must both agree to use it.
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The diaphragm
Say: The diaphragm is a rubber cap which must fIrst be
fItted by a health worker. Thereafter you can apply it yourself. The health worker should show you how to put it in
when you are on your own. The diaphragm, which fIts
over your cervix, must be used with spermicides. You can
put it in your vagina just before you have sex, or even
some hours before. You must leave it in your vagina for at
least eight hours after you have had sex so that all the
sperm have died before you take it out.
Say: What are some good things about the diaphragm?
o It has minimal side-effects.
o It can be put in before sex, so that you don't have to
think about it during sex.
o The woman controls her own contraception.
Contraception workshop manual
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Facilitator's
notes
Information for participants
1!...h""-_""-'-L!.1..!..C-L.:.-..a:::::-.1!...----L..J
o It protects to some extent against sexually transmitted
diseases.
Say: What are some problems with the diaphragm?
o It does not protect from pregnancy as well as other
kinds of contraception like the Pill or injection.
o Most clinics don't provide them so you have to go to a
doctor to get one - which can be expensive.
o The diaphragm can only be used if you and your partner can talk about contraception.
o You or your partner must be comfortable with touching your genitals.
o The woman must plan ahead to put it in before going
to bed, or else she must interrupt sex to put it in.
o You or your partner must be comfortable with putting
your hands into your vagina.
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Point to the picture of
spermicides in Poster 1.
Say: Spermicides come in the form of jellies, foams, pessaries or a thin square film like a piece of paper. They are
available at clinics or pharmacies. They kill sperm.
However, spermicides are not very effective unless used
with one of the barrier methods (condoms or diaphragm)
described above.
Ask: What are some good things about the spermicides?
o Spermicides with the chemical Noxynol-9 are thought
to also prevent HIv. But they must also be used with a
condom.
o They help to moisten the vagina to make sex more
pleasurable.
Ask: What are some problems with spermicides?
o They are expensive unless you get them at a clinic.
o They are not very effective when used on their ?wn.
20
Contraception workshop manual
Facilitator's
Information for participants \~~t.L.!..l.iL:L...L:......L!:::........!L_L..J
notes
Point to the drawing of
the loop in Poster 1.
I!.J'
Say: The intra-uterine contraceptive device (ruCD) or
"loop" is inserted into the womb by a health worker. It
creates an environment in the womb that makes it difficult for a fertilised egg to implant itself. An ruCD must be
removed by a health worker.
Ask: What are some good things about the loop?
o Once it is in you can forget about it for between 3 and
5 years - you don't have to do anything to prevent
pregnancy when you have sex.
o It does not cause any damage to the body as long as
the woman does not develop an infection.
Ask: What do you think some problems with the loop
could be?
o You depend on a health worker to put it in and take it
out.
o The method is not as effective as Pills or injections.
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Say: For some women it is dangerous to use the loop:
o women with heart problems or problems with heart
valves should not use it; and
o it should not be used by women who have had pelvic
inflammatory disease or women who do not practise
safe sex as it could cause infection.
Say: Side-effects of using the loop are the following:
o it often causes pain for a few days after it has been
inserted; and
o it may make periods heavy which means women with
heavy and painful periods should not use it.
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Contraception workshop manual
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Facilitator's
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Information for participants
Put up Poster 7 and
point to it.
Female and male sterilisation
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Say: Female and male sterilisation can be called permanent contraceptive methods. When this manual was written, male sterilisation was not widely available. Plans
were being made by the government to make female and
male sterilisation more widely available in the public
health service.
Say: Female sterilisation is called tubaligation. The fallopian tubes are closed off during an operation. This stops
eggs from going from the fallopian tubes into the
woman's womb.
Say: Male sterilisation is called vasectomy. The tubes
which carry the sperm from his testes to his penis are
closed off. This prevents fertilisation.
Say: As soon as a woman is sterilised, she does not need
any contraceptive. But for the fIrst three months after a
man has been sterilised, his partner can still get pregnant
because there may be sperms still in his tubes. So they
need to use another contraceptive until three months
later, when he gets tested to make sure there are no
sperms in his semen.
Say: Why do you think female and male sterilisation is a
good contraceptive?
o It is the most effective method to prevent pregnancy.
o It may improve sex because there is no worry about
contraception.
o The procedure is safe to perform.
o There are no side-effects and it does not affect sexual
performance.
o The operation is offered free of charge in South Africa.
Say: What problems are there with sterilisation? i
o It is very diffIcult to reverse sterilisation so you must be
sure that you do not want any more children.
o Both operations require general or local anaesthesia.
Ask if there are any
questions and discuss
the answers to them.
22
Say: Remember if you want to protect yourself from sexually transmitted diseases or HIV/ AIDS, you have to also
use the barrier methods discussed above.
Contraception workshop manual
Facilitator's
notes
You need to fmd out if
the group has all the
information that they
need. You can then have
a general discussion
about contraception.
We think it is important
to explore a number of
issues:
D how women or men
can speak -with their
partners about using
contraception and about
protecting themselves
from sexually transmitted diseases; and
how people can
ensure that the health
service gives them the
information and service
that they need.
You can ask the group
what they want to discuss, or make a decision
from their comments in
the previous section.
Then you can open the
discussion with another
role-play. You can decide
on the roles. Here are
examples of role-plays
you can use.
Information for participants
~----,,<C:.l.LlJ..iLL~..d:::::....!1..--LJ
Role-play: a woman and health worker talk about contraception
Actor 1 is a health worker: You work in a clinic. You are
tired. You have a 16-year-old daughter. You are scared
that she will get pregnant. You have never spoken to her
about contraception. You don't know how to talk to
young girls who come to the clinic about contraception
- they remind you of your daughter. You are tired at the
end of the day when a woman arrives to see you.
Actor 2 is a young man: All the boys and girls at your
school have sexual relations. You have been having sex
with your girlfriend. Recently a friend became pregnant
and you got a fright. So now you want to use contraception, but you don't know what to ask for. You go to the
clinic.
Actor 3 is a middle-aged woman: You have four children.
Your husband wants more children but you do not want
more. You do not know much about contraception, and
are afraid to talk about this with the health worker. But
you want information and you want to use a contraceptive, so you go to the clinic.
Specific questions you can ask after this role-play:
D Whose responsibility do you think it is to provide information on contraception?
D What should a person do if the health worker is rude
or does not provide the information?
Role-play: a mother and daughter talk about contraception
Actor 1 is a mother: When your daughter developed
breasts and started her period you became very w6rried
that she would have sex with boys and become pregnant.
So you took her off to the clinic and asked the health
worker there to give her an injectable. You were too
embarrassed to discuss sexuality or contraception with
her. In the last month your relationship has changed and
she hardly speaks to you. You ask her why.
Contraception workshop manual
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Facilitator's
.........J_notes
Information for participants ~~~.!.i.A--"-=--~..L!..---L..J
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Actor 2 is a daughter: You have recently become a young
III
woman. Your breasts started growing and you started
having your periods. You wanted to discuss this with your
mother, but she wasn't interested. Then, about a month
ago, she took you off to the clinic for an injection. She did
not tell you what it was for. After listening to your friends
talking about sexual matters, you have started to suspect
that she had the health worker give you an injectable. You
feel resentful because she did not consult you. You feel as
if she doesn't trust you.
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Questions you can ask to get discussion going at the end
of any role-play:
[J Is this what usually happens in real life?
[J Ask each actor: "How did you feel playing this role?"
[J Ask the group: "What did you think of the role-play?"
[J Ask the group: "What did you think of the way they
spoke to each other?"
[J Why do you think they behave in this way?
[J Can we come up with ways that will make it possible
for them to communicate better with each other?
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Contraception workshop manual
Facilitator's
Information for participants
notes
~~""-'-'-!""",,,--"-'--"'-'--"'-----"'-J
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After the discussion, end
the workshop by giving
each person a turn to
say what she/he has
learnt. Then ask about a
commitment to action.
Say: Let's sit in a circle. Let's end the workshop by letting
each of us get a turn to say what is the most important
thing that we learnt today. Who wants to start?
Say: Before we end, we would like each of you to make a
commitment to action based on something you learned
today. For example, I will discuss contraception with all
my nieces and nephews who are teenagers. Let's go
around the circle and hear what you will do.
Key messages
Say: It is important to remember that:
o There is a range of contraceptive methods to meet
women's and men's different and changing needs.
o Each person can fmd out which method is most suitable for their needs.
o It is important that women do not get pregnant when
they do not want to.
o It is every woman's and man's right to use contraception when they decide to control their fertility.
o Barrier methods like condoms protect you from STDs,
HIV and AIDS.
Now end the workshop.
Say: We have come to the end of the workshop. We hope
this workshop has reinforced your belief that we all have
the right to control our own bodies and that we have the
right to information about contraception and how our
bodies work. We hope this workshop will help you to get
the contraceptive service you need from your health
worker. It is your right to know.
Contraception workshop manual
25
J. EXTRA INFORMATION
QUESTIONS AND ANSWERS ABOUT CONTRACEPTION
There are many false ideas about contraception. Some are even dangerous beliefs that bring
much heartache and cause many girls and women to become pregnant. We describe some
of them here, in case they come up in the workshop. Read these notes to help you answer
these during the workshop.
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Questions
1. When periods stop because of the
injectable, does blood collect in the
womb and head and cause overweight
and high blood pressure?
Answers
When periods stop as a result of the
injectable, the blood does not collect somewhere. While the injectable can result in
weight gain, it cannot cause high blood
pressure. However, women with high
blood pressure should not use the
injectable.
2. Does a cloth soaked in Coca-Cola and
inserted into the vagina kill sperm?
Coca-Cola does not kill sperm.
3. Do boys or men get acne when they
can't have sex?
No boy or man has to have sex. Also, boys
get pimples as a result of blocked glands
and male hormones, not because they
don't have sex. This belief is especially dangerous as it gives boys and men licence to
have sex without having to be responsible
for their actions.
4. If a girl or a woman drinks 20 glasses of
water before and after sex can she still
get pregnant?
4, 5 & 6. No amount of water or jumping
can prevent pregnancy. Water goes to the
bladder, not to the vagina, and even rinsing the vagina might not prevent pregnancy. Also, jumping will not prevent sperm
from travelling up the vagina to meet with
an egg. And urinating after sex canhot
prevent pregnancy.
5. If a girl or a woman jumps up and down
50 times after sex can she get pregnant?
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6. If a girl or a woman urinates (pees) after
sex, can she get pregnant?
7. If a girl or a woman has sex with many
partners can she get pregnant?
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If a girl or a woman has sex with many
partners she will not only become pregnant but also risks getting a sexually transmitted disease or HIV/AIDS. This belief is
very dangerous.
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Contraception workshop manual
8. Does contraception cause stretch marks
on the legs and stomach?
Some girls and boys, women and men
develop stretch marks on their bodies but
this has nothing to do with contraception.
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Contraception workshop manual
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