Reproductive and Sexual Health, Family Planning, and Safe Abortion Care
Core concepts
This domain covers contraceptive counselling, method effectiveness, and safe abortion care. Know the WHO medical eligibility criteria for combined hormonal contraceptives (avoid in uncontrolled hypertension, migraine with aura, smoking over 35, breastfeeding under 6 weeks). Understand long-acting reversible contraception (implants, IUDs), emergency contraception (levonorgestrel within 72 hours, copper IUD up to 5 days), and barrier and fertility-awareness methods. Learn safe abortion care principles: counselling, gestational age assessment, medical abortion with mifepristone plus misoprostol, manual vacuum aspiration, and post-abortion contraception and follow-up. Recognize unsafe abortion complications (haemorrhage, sepsis, retained products) and the legal and ethical framework of confidentiality and non-judgmental care.
Traps
Questions often test timing windows for emergency contraception and the difference between medical eligibility categories (category 1 = no restriction, category 4 = unacceptable risk). Another trap: assuming breastfeeding alone is reliable contraception - it is only effective under strict criteria (exclusive breastfeeding, amenorrhea, under 6 months). Also watch questions mixing mifepristone (antiprogestin) with misoprostol (prostaglandin) roles.
Worked rule of thumb
For emergency contraception, copper IUD is the most effective option and can be inserted up to 5 days after unprotected intercourse; levonorgestrel is used within 72 hours. Choose based on timing and availability.
Exam strategy
Prioritize client autonomy and confidentiality. In abortion-related questions, the correct answer is usually respectful, non-directive counselling and referral - never judgmental refusal.