Tubal Ligation Female Sterilization Session II Objectives By the end of this session participants will be able to State who can have female sterilization Describe the medical eligibility criteria for female sterilization ID: 730827
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Session II: Who Can Have Tubal Ligation (Female Sterilization)?Slide2
Session II Objectives
By the end of this session, participants will be able to:
State who can have female sterilization
Describe the medical eligibility criteria for female sterilization
Use the medical eligibility criteria to screen clients for eligibility
Describe female sterilization use by women living with HIV and AIDSSlide3
Female Sterilization Is Safe for All Women
With proper counseling and informed consent, any woman can safely have a female sterilization procedure, including women who:
Are not married
Have no children or few children
Do not have spousal permission
Are young
Just gave birth (within the last seven days)
Are breastfeeding
Are infected with HIV, whether or not they are receiving antiretroviral therapySlide4
When Can Women Have a Sterilization?
But they may need to wait if they:
Most women can have a sterilization procedure
at any time.
May be
pregnant
Gave birth 1–6
weeks ago
Have an infection or other problem
Have s
ome other serious health condition
Source: WHO decision making tool for FP2005Slide5
Medical Eligibility Criteria
What are the Medical Eligibility Criteria (MEC)?
WHO evidence-based guidelines on contraceptive use
5
th
Edition, 2015
The Quick Guide and MEC Wheel cover nine commonly used contraceptives.The MEC recommend a different category for permanent methods.Slide6
Medical Eligibility Criteria (cont.)
No medical condition absolutely restrict a woman’s eligibility for sterilization.
Some clients may have a medical condition that requires certain precautions to be taken, such as delaying the procedure or going ahead with it under special conditions.
There are other effective reversible contraceptives that may be appropriate for the client. Slide7
Medical Eligibility Criteria (cont.)
Categories
A
—Accept There is no medical reason to deny sterilization to a person with this condition.
C
—Caution The procedure is normally conducted in a routine setting, but with extra preparation and precautions.
D—Delay Postpone the female sterilization procedure. These conditions must be treated and resolved before female sterilization can be performed.S—Special The procedure should be undertaken in a setting with an experienced surgeon and staff, equipment needed to provide general anesthesia, and other back- up medical support. For these conditions, the capacity to decide on the most appropriate procedure and anesthesia regimen is also needed. Give the client another method to use until the procedure can be performed.Slide8
Case Studies on MEC
Instructions:
Read the case allocated to your group carefully, discuss the condition(s), and agree on the category that fits the client’s condition, based on MEC classification.
List your comments and reasons for the classification, and summarize your plan for managing the client, including the minilaparotomy procedure.
When you are through with your assigned case, review the other cases also. This will allow you to participate in the plenary discussions.Slide9
Female Sterilization Use by Postpartum and Postabortion Clients
Condition
Category
A=Accept; D=
Delay;
C=Caution;
S=Special Clarification/EvidencePostpartum 1-7 daysA
Postpartum 7–42 daysDPostpartum >42 daysAManage as interval clientPostpartum with other medical condition (e.g., severe anemia, sepsis, severe hypertension)DPostabortion (uncomplicated) 1–7 daysAPostabortion (complicated, with severe anemia, sepsis, genital trauma)DIncreased risk of complications
Postabortion (complicated, with uterine perforation)SMay include perforation of other viscera and increased risk of complicationsSlide10
Female Sterilization: Use by Interval Clients
Sterilization can be performed:
At any time, if the provider is certain that the client is not pregnant and that no other medical condition is present
Preferably in the first half, or proliferative phase, of the menstrual cycle
However, providers should exercise caution if the client is young, to avoid regret in the future.Slide11
Female Sterilization Use by Clients with HIV
Sterilization does
not protect against STIs
Condition
Category
A=Accept; D=
Delay;C=Caution; S=Special Clarification/EvidenceHigh risk of HIVA
No routine screening needed.HIV infected (asymptomatic or mild HIV clinical disease—WHO stages 1 or 2)ANo routine screening needed.Severe or advanced HIV clinical disease (WHO stages 3 or 4)SCondition may require delay of procedure to manage AIDS-related illness.Slide12
Understanding the MEC for Female Sterilization Checklist
How to determine client eligibility for female sterilization
Ask about known medical conditions
WHO checklist on MEC for female sterilization
Source: Adapted from WHO, Family Planning: A Global Handbook for Providers 2018