Unit 2
Unit 2
Unit 2
Structure
2.0 Introduction
2.1 Objectives
2.2 Current Family Planning Programme Under Public Health
2.3 Natural Methods of Family Planning
2.3.1 Lactational Amenorrhoea Method (LAM)
2.3.2 Fertility Based Awareness Method
2.4 Artificial (Barrier) Methods of Family Planning
2.4.1 Condoms
2.4.2 Intrauterine Devices (IUCD)
2.5 Hormonal Contraceptives
2.5.1 Oral Contraceptive Pills
2.5.2 Injectable Contraceptive Devices
2.6 Non Hormonal Oral Contraceptives
2.7 Permanent Methods
2.8 Post Partum Family Planning (PPFP) Choices
2.9 Family Planning 2020
2.10 Counselling
2.10.1 Principles, Approaches and Techniques of Family Planning Counselling
2.10.2 Counselling and Motivating Men
2.10.3 Common Myths and Misconceptions
2.11 Let Us Sum Up
2.12 Key Words
2.13 Model Answers
2.0 INTRODUCTION
In the previous unit, you have learnt about various gynaecological conditions,
risk factors, signs, symptoms and management. This unit deals with family
planning method, techniques and counselling.
India launched its first Family Planning Programme in 1952 in response to high
fertility and population growth rate with an aim to achieve population stabilisation
and reduce maternal, infant and child mortality and morbidity.
The National Population Policy 2000 provided a framework for prioritising the
strategies to achieve net replacement levels of Total Fertility Rate (TFR) by 2010
through a comprehensive package of reproductive and child health services. Over
the years TFR has constantly declined to a current value of 1.9 as per National
Family Health Survey (NFHS III) data.
40
The factors that affect the population growth are Unmet Need of Family Planning Family Planning Methods,
Spacing Techniques and
(21.3% as per District level Household and facility survey, age at marriage and Counselling
first child birth and spacing between the births. In India, 5.6% deliveries are
contributed by girls between 15–19 years of age and 22.1% of girls are married
at less than 18 years of age. Spacing between the births increases the chances
of survival of infants and thus impact on the fertility. An ideal spacing of three
years is recommended, however data from SRS 2013 shows that in 59.3% of
births, the ideals spacing is not followed.
2.1 OBJECTIVES
After completing this unit, you will be able to:
• enlist various temporary and permanent methods of contraception along with
the benefits, side effects and contraindications of each;
• detect complications, if any, at the earliest following each method for
appropriate management and timely referral;
• provide support through counselling to the adopters (couples) of family
planning method, their family and community; and
• supervise the ASHAs and ANMs while they offer services to the beneficiaries.
The manpower has been trained to provide all the services at various health
facilities as per the guidelines.The Spacing and Limiting methods are provided
at various health facilities by various health care providers as per the following
guidelines: (Table 2.2)
Table 2.2
IUCD 380 A, IUCD 375 Sub centre & higher levels Trained & certified ANMs,
LHVs, SNs and doctors
Oral Contraceptive Pills Village level Sub centre & Trained ASHAs, ANMs,
(OCPs) higher levels LHVs, SNs and doctors
LIMITING METHODS
Laparoscopic Sterilisa- Usually CHC & higher Trained & certified MBBS
tion levels doctors & Specialist
Doctors
NSV: No Scalpel PHC & higher levels Trained & certified MBBS
Vasectomy doctors & Specialist
Doctors
Fertility
Awareness
d) Standard Days Method: The women can be trained to keep a track of her
menstrual cycles and abstain from unprotected intercourse during fertile days.
But to use this method, the cycles of the women must be regular, and ranging
between 26 and 32 days.
All the methods involving Fertility Awareness are based on client support her
educational status and regularity, thus may not be very effective for long term
use.
2.4.1 Condoms
There are Condoms for use by both men and women however only Male Condoms
(Nirodh) are available under the programme. These are most effective when
combined with spermicides. (Fig. 2.4)
Condoms are barrier contraceptive that do not allow the semen to come into
contact with vagina. These are put on erect penis immediately before intercourse
and are for one time use only. The client should be advised to leave about 1cm
loose at the end of the condom to collect the semen after ejaculation, after which
it should be carefully removed holding from the base of the penis ensuring that
the semen doesn’t spill.
1) Besides increasing male participation, these are easily available, cheap and
easy to carry.
Disadvantages are:
2) Some men may not find it convenient as it decreases the penile sensitivity
and needs to interrupt the intercourse to be worn of the erect penis.
45
Reproductive Health and
Adolescent Health
Female Condoms: These are not available under the programme, however are
available over the counter and can be purchased from the chemist for use during
intercourse. It has a triple advantage of preventing unwanted pregnancy, reducing the
risk of STDs and HIV. It is a pre-lubricated plastic polyurethane tube that has a closed
end. It functions by collecting sperm before, during and after ejaculation. (Fig. 2.5)
The advantages of Female condoms are safe, simple, and convenient. Both men
and women can benefit from the use of female condoms for a variety of reasons,
include:
• The sharing of responsibility as it relates to STD’s.
• Can be conveniently purchased from pharmacies and some supermarkets.
• Can be inserted by either partner before intimacy.
• They are a substitute for those with allergies to latex.
• They can be used with both oil and water based lubricants.
• Remains in place with or without an erect penis.
However, the disadvantages attached to these are that they do not feel natural,
may cause slippage of penis causing a pause in intercourse. Sometimes, it may
also cause irritation to the vagina or penis.
Progestasert
Fallopian tubes
All married women, living with their partner, preferably less than 45 years of age
and above 22 years of age, having atleast one child more than one year of age,
52 mentally sound with partner not using any method of contraception are eligible
for tubectomy. There are no conditions that are absolute contraindications for the Family Planning Methods,
Spacing Techniques and
procedure except a few like psychiatric illnesses (where the women cannot give Counselling
informed consent) or physical conditions like moderate to severe anaemia.
2.10 COUNSELLING
Counselling is a two way process of exchange of ideas between health worker
and a client with an aim to facilitate the decision by the client or helping him/her
address concerns/problems. For a successful counselling, there should be mutual
trust between the provider and the client. The rights of the clients should be
taken into consideration. These are right to information, access to safe and
continuous services, informed choice, right to dignity, comfort, opinion, privacy
and confidentiality.
The client and health care provider should share relevant, accurate and complete
information so that the client is able to make the right decision. The objectives of
counselling are:
i) Helping Clients to assess their needs for a range of health services, information
and emotional support.
ii) Providing information as per the problems and need of the client.
iii) Assisting/Enabling clients in making voluntary and informed choices.
Iv) Clearing myths, misconceptions and doubts regarding the available
contraceptive methods.
An acronym CLEAR is used to briefly describe about the procedure of counselling-
Communicate with clarity, Listen, Encourage/Emphathize, ask questions and
respect the constraints and decision of the client.
55
Reproductive Health and For a counsellor to be effective, he/she should be:
Adolescent Health
i) accepting, respecting, non judgemental and objective while dealing with
clients.
ii) able to and psychological factors with sensitivity that may influence the
client’s decision to adopt family planning methods.
iii) able to maintain client’s privacy and confidentiality.
iv) thorough with knowledge on the technical aspects of the services and be
able to judge when and where the person has to be referred.
v) able to use audio visual aids and provide technical information to the client
in a simple language that he can understand.
vi) confidently and comfortably handle questions on sex and sexuality,
reproductive and personal matters, rumours and myths.
For effective counselling, the health worker should use GATHER approach.
Greet the client and build rapport in a polite, friendly and respectful manner.
Ask about their problem in simple, open and brief questions. Express empathy
and avoid opinions and judgements.
Tell the client about available methods and possible choices in a personalised
manner that suits his/her current needs put in terms of his own life.
Help them to make decisions by choosing solutions that best fit their own personal
circumstances.
Explain the method, possible side effects and their management,when and where
to report back for follow up.
Return: Schedule a return or follow up visit.
1) State True/False:
Condoms
Delaying the first
Oral contraceptive pills
child
Intra Uterine Contraceptive Devices (IUCD)
Emergency contraceptive pills (not to be used routinely)
Condoms
Healthy spacing IUCDs
between two OCPs (need to be related to breastfeeding)
deliveries Lactational Amenorrhoea Method (needs to be followed-up by
other methods 6 months after delivery)
Female sterilisation
Limiting methods Male sterilisation/ Vasectomy
Each method has its merits and demerits and the clients have a right to make
informed choice depending on their need. It is the responsibility of the health
worker to counsel the client to make the right decision about whichever method
suits her/his need the best. The health worker must also ensure that the client is
referred to the right facility for seeking the service he/she chooses and is then
adequately followed up for continuation. The role of health worker is to provide
a constant support to the client by clearing myths and misconception and
handholding in case of initial period of acceptance after the choice of method has
been made.
60
Family Planning Methods,
2.12 KEY WORDS Spacing Techniques and
Counselling
Total Fertility Rate : The number of children who would be born per woman
(TFR) (or per 1,000 women) if she/they were to pass through
the childbearing years bearing children according to a
current schedule of age-specific fertility rates.
Unmet need of : This includes the currently married women, who wish
Family Planning to stop child bearing or wait for next two or more years
for the next child birth, but not using any contraceptive
method.
61