Family Planning and Sexual and Reproductive Health
Family Planning and Sexual and Reproductive Health
This domain tests contraceptive counselling, method eligibility, emergency contraception, and respectful SRH care across adolescence, pregnancy, and postpartum. The exam uses WHO Medical Eligibility Criteria categories and real-life contraindications rather than memorised brand names.
Core rules
- Use WHO MEC: category 1 no restriction, 2 benefits outweigh risks, 3 risks usually outweigh benefits, 4 unacceptable risk.
- Combined hormonal contraception is category 4 with migraine with aura, current breast cancer, severe hypertension, or smoking at age ≥35 with ≥15 cigarettes/day.
- Long-acting reversible methods (implant, IUD) are highly effective; counsel on bleeding changes and return to fertility.
- Emergency contraception: levonorgestrel within 72 hours, ulipristal within 120 hours, or copper IUD within 5 days; the IUD is most effective.
- Offer dual protection, STI screening, and confidential care; know national abortion law and referral pathways. Screen for coercion and intimate partner violence before discussing methods.
Worked example
A 26-year-old woman with migraine with aura asks for the pill. Reasoning: combined pills are MEC 4 because of stroke risk. Offer progestin-only pill, implant, injectable, or IUD, and explain why the combined method is unsafe. Document the counselling.
Traps
Ignoring blood pressure before prescribing; telling adolescents they need parental consent when local law allows confidential care; quoting myths about infertility; and giving emergency contraception too late.