Family Planning

PRESENTED BY : SITA SHRESTHA

SUNITA SAPKOTA
SURAJ THAPA
SUSHMA NEUPANE
YAMJEE MAHATO
Contents :-

 Definition and concept of Family planning

 Types, modes of action, benefit, side effects, indication, contra-
indication of contraceptive device and recent trend in
contraception
 Importance of counselling, counselling of eligible couple and
follow up
 The role of men in FP
Definition and concept of Family
planning
Introduction :
In the past, family planning was considered as a means of
population control and to prevent unwanted pregnancy.
But now after decades, it is recognized that family planning
intervention has a lot of benefits for improving overall aspect of
development- health, social and economic status of a family,
community and nation.
The family planning programmes helps all couples to decide freely
the number and timing of children in their life and it provides
opportunity to attain the highest standard of sexual and
reproductive health.
Definition :

An expert committee of the WHO defined family planning as “a way of

thinking and living that is adopted voluntarily, upon the basis of knowledge
, attitudes and responsible decisions by the couples, in order to improve
the health and welfare of the family and thus contribute effectively to the
social development of a country”.
Another expert committee defined as “Family planning helps individuals or
couples to attain certain objectives-
1. To avoid unwanted birth
2. To bring about wanted birth
3. To regulate the intervals between pregnancies
4. To control time at which birth occur in relation to the ages of the parent
5. To determine the number of children in the family
Benefits of the family planning :

Quality family planning services bring a wide range of benefits to

women, their families and society. They are :-
 Preventing pregnancy- related health risk in women
 Reducing infant mortality
 Helping to prevent HIV/AIDS
 Reducing the need for unsafe abortion
 Empowering people
 Reducing adolescent pregnancies
 Slowing population growth
Contraceptive methods :

Contraceptive methods are preventive methods to help women

avoid unwanted pregnancy.
They include all natural and modern methods to prevent pregnancy.
 Natural method :-
A. Calendar method (95% effective)
B. Basal body temperature method (98% effective)
C. Cervical mucus method (97% effective)
D. Lactational amenorrhoea method (98- 99% effective)
E. Coitus interruptus method (73% effective)
A. Calendar method :-

This method is the most widely used of the periodic abstinence

techniques.
The calendar method is a calculation-based approach where previous
menstrual cycles are used to predict the first and the last fertile day in
future menstrual cycles.
This method requires a good understanding of the fertile and infertile
phases of the woman’s menstrual cycle. It is based on the regularity of the
menstrual cycle.
A regular menstrual cycle is when monthly bleeding happens every month
or 28 days.
An irregular menstrual cycle is when monthly bleeding is variable from
month to month, for example it can vary from 25 to 32 days in some
women.
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Calculation :
It is important for you to know that before relying on this method a
woman needs to record the number of days in each of her
menstrual cycles for a period of at least 6–8 months (remembering
that the first day of menstrual bleeding is always counted as day 1).
For irregular menstruation, Identify the longest and the shortest
cycles recorded over six to eight cycles.
Subtract 18 from the shortest cycle (gives the first day of the fertile
phase).
Subtract 11 from the longest cycle (gives the last day of her fertile
time).
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For example, A woman’s last six menstrual cycles were 28, 26, 29, 27, 29 and 27
days. Using this information,
Her shortest cycle is 26 days.
Her longest cycle is 29 days.
First day of her fertile phase is 26 - 18 = 8.
Last day of her fertile phase is 29 - 11 = 18.
Therefore, the fertile period of this client is between the 8th–18th days, so she
should avoid sex during this period to prevent pregnancy.
However, if the client’s menstrual cycle is regular and comes every 28 days or
close to it, ovulation should occur about 14 days before the next period. For this
reason, the woman should count backwards 14 days from her next period to
calculate the day she will ovulate. Consequently, she should avoid sex from about
seven days before that day until about two days after ovulation is expected.
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For example, A client comes and asks about using the calendar
method to prevent pregnancy. On asking her about the history of her
menstrual cycle over the last six months, she tells it comes regularly
every 30 days. Then ,
Regular cycle= 30 - 14 = 16
First day of fertile phase= 16 - 7 = 9
Last day of fertile phase=16 + 2 = 18
Therefore, her fertile period is between the 9th and 18th days, and she
should avoid sex between these days of the cycle.
This method is about 95% effective if a woman uses it correctly
(Family Planning: A Global Handbook for Providers, World Health
Organization (WHO), 2007).
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 Modern method : It is further classified as temporary and

permanent method.
1. Temporary method :
a) Barrier method
b) Intra-uterine device (IUCD)
c) Hormonal method
d) Emergency method
A. Barrier method :

A variety of barrier or occlusive methods suitable for both men and

women are available.
The aim of these methods is to prevent live sperm from meeting the
ovum.
Barrier methods are of 2 types.
 Physical methods
 Chemical methods
Physical method :
1. Male condom :
Condom is the widely known and used barrier device by the males around the world.
Condom prevents the semen from being deposited in vagina.
Effectiveness :
• In perfect users : 98%
• In typical users : 86%
Advantages :
• They are easily available and easy to use.
• Safe and inexpensive
• If used perfectly, it is about 98% effective.
• No side effect
• Provide protection not only against pregnancy but also against STIs.
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Disadvantages :
I. It may slip off or tear during coitus due to incorrect use.
II. May inter fare with sex sensation
III. Sometimes allergy may occur
IV. Failure rate is relatively high (overall 13%) and especially due to
faulty techniques
Physical method :

2. Female condom
The female condom is a pouch made of polyurethane, which lines
the vagina.
An internal ring in the close end of pouch covers the cervix and an
external ring remains outside the vagina.
High cost and acceptability are the major problems related to the
use of female condom.
For perfect users it is 95% effective and for typical users, it is only
79% effective.
Work by forming a barrier that keeps sperm out of the vagina,
preventing pregnancy.
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3. Diaphragm :
The diaphragm is a vaginal barrier made up of synthetic rubber or
plastic material.
It is inserted into the cervix before coitus.
It covers the entrance of the uterus and cream of jelly blocks sperm
movement.
The users should be properly instructed and when diaphragm is put
into vagina, spermicidal jelly should be used with it.
Effectiveness :-
As commonly used, about 16 pregnancies per 100 woman using
diaphragm with spermicide over the first year.
Side effects : irritation around vagina or penis, vaginal lesion etc.
Chemical methods :

Foaming tablet and spermicidal products :

Spermicides inserted into vagina prior to intercourse, inactivate
sperm and physically block sperm from entering uterus.
The recommended time for sexual intercourse is 10-15 minutes to 1
hour after insertion of the spermicides.
Spermicides comprises 4 groups :
o Foams : foam tablet, foam aerosols
o Creams, jelly and pastes
o Suppositories
o Soluble films
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Mechanism of action :
Causes the sperm cell breaks, which decreases sperm movement and their
abilities to fertilize eggs.
Benefits :
 Easy to use and Effective immediately
 No systemic side effect
 Increases wetness (lubrication) during intercourse
disadvantages :
 Can not protect from STIs.
 Can’t use to those who is allergic to spermicide
 Short duration of effectiveness
B. Intra uterine contraceptive
device (IUCD)
The first version of the modern IUCD was developed in 1909 by a
German gynecologist and sex researcher named Ernst Grafenberg.
An IUCD is a long- acting contraceptive method intended to be used
for several months or years.
It is a small device that is usually made of plastic and copper or with
hormones and of ‘T’ shape so it is also called copper ‘T’.
It is placed in uterus where copper metal in this device has strong
anti- fertility effect.
Time of insertion is found best within 7 days of the beginning of the
menstruation and it is effective for 12 years.
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Advantages :
 Insertion takes only a few minutes.
 Highly effective
 Once inserted IUCD stays in place as long as required.
 Inexpensive
 Contraceptive effect is reversible by removal of IUCD.
Disadvantages :
 Not recommended to women with no child
 Medical expert is required.
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Side effects :
 Bleeding (10-20% of removals)
 Pain (15-40% of removal)
 Pelvic infection (2-8 times higher than nonusers)
 Uterine perforation
 Abdominal cramping
Contraindications :
 PID
 Suspected pregnancy
 Vaginal bleeding
C. Hormonal method

Hormonal contraceptives when properly used are the most effective

spacing methods of contraception.
Hormonal contraceptives currently in use may be classified as
follows :
a) Oral pills
 Combined oral pills
 Progestrogen only pills
b) Depot formulations
 Injections
 Sub- dermal implants
 Vaginal rings
A. Oral pills
Combined oral contraceptives
It contains a pill with 35 mcg of a synthetic oestrogen and 1 mg of
progestogen.
The pill is given orally for 21 consecutive days beginning on the 5th
day of the menstrual cycle, followed by a break of 7 days during
which menstruation occurs.
MOA :
 Presence of oestrogen and progesterone suppresses ovulation by
diminishing the secretion of gonadotropins.
 It alters the viscosity of cervical mucous.
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Advantage :
 Highly effective, relatively easy to use.
 Reduces menstrual cramping and blood loss
 Reduces risk of PID and ectopic pregnancy
 Reduce the risk of ovarian and uterine cancer.
Disadvantages :
 Failure rate is high if not taken regularly.
 Most common side effect with COCs are headache, breast
tenderness, changes in body weight, etc.
 Quantity of breast milk may be decreased.
Progestogen only pills/mini pills

It contain only progestogen which is given in small doses

throughout the cycle.
The commonly used progestogens are norethisterone and
levonorgestrel.
It is less popular owing to its properties of poor cycle control and
increased pregnancy rate.
Advantages :
 No estrogen related side effects.
 Amount of progestin in minipill is less than in combined pills
 Nursing mothers can take progestin after the baby is six week
old.
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Disadvantages :
 Menstrual irregularity is the most common problem
 Irregular bleeding and spotting can observe
 Failure rate is high
 Increase risk of ectopic pregnancy
B. Depot formulation
Depo- provera
It is depot medroxy progesterone acetate (DMPA).
It is intramuscular injection of 150mg depo given every 3 months
interval time period.
It gives protection from pregnancy in 99% of women for at least 3
months.
Advantages :
 It is independent of sexual intercourse.
 Reduce in blood loss and less menstrual cramping.
 Nursing mother can receive depo injection after baby is 6 week
old.
 Highly effective.
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Disadvantages :
 Weight gain
 Regain of fertility may be delayed.(up to 1 years)
 May lower estrogen level.

Side effects :
 Bleeding
 Weight gain
Norplant

Norplant consists of 6 silicons rubber capsule containing 35 mg each of

levonorgestrel.
It is inserted beneath the skin of forearm by trained medical practitioner.
The newer norplant R-2 consist of 2 rods .
It is effective for 5 years.
Advantages :
 it does not interfere with the lactation and blood pressure.
 It also helps protect against uterine cancer.
 Immediate return of fertility upon removal.
 Highly effective for long term.
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Disadvantages :
 Require access to trained person
 Removal more difficult than insertion
 Irregular menstrual bleeding
 Headache, dizziness, weight gain.
Vaginal ring

A contraceptive vaginal ring is a monthly hormonal contraceptive

which contain 15 mcg ostrogen and 120 mcg of progesterone.
It is slender, flexible, transparent ring which continuously provide
low dose of estrogen and progestin.
Marketed in USA under the name Nuva ring.
Its effectiveness with perfect use is 99% and with typical use 95%.
D. Emergency contraception

It is also called morning after contraception which is given in the

emergency condition. Thus, it is alao emergency contraception.
It is recommended within 72 hours of unprotected intercourse.
The failure rate of post coital contraception is less than one percent.
Emergency contraception should be promoted to reduce unwanted
pregnancies.
Pills and IUCDs are used as emergency contraception.
2. Permanent method

A. Vasectomy :
It is safe permanent method of contraception.
The tube through which sperm travels from testes to penis are cut
and blocked.
There is remove of piece of vas at least 1 cm after clamping.
It is instructed to use condom for at least 30 ejaculations.
Advantage :
 Can be performed on as OPD basis.
 Reversible is possible
 Highly effective
Cont..

Disadvantages :
 Requires skilled health practitioner
 Permanent method
 Chance is low even if tubal recanalization is done
Laparoscopy

This is the technique of female sterilization through abdominal

approach with a specialized instrument called laparoscope.
The abdomen is inflated with gas like co2 or air and instrument is
introduced into abdominal cavity to visualize tube and falope rings
are applied to occlude the ring.
Advantages :
 Reduced hemorrhaging
 Smaller incision, which reduces pain and shortens recovery time.
 Although procedure times are usually slightly longer, hospital
stay is less, and often with a same day discharge which leads to
a faster return to everyday living.
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Disadvantages :
 The surgeon has limited range of motion at the surgical site
resulting in a loss of dexterity.
 Poor depth perception.

Minilap :
Minilaparotomy, generally referred to as “minilap,”is an abdominal
surgical approach to the fallopian tubes by means of an incision less
than 5 cm in length.
Those women, who have atleast 2 children and want no more, can
adopt this method.
Recent trend in contraception

Nowadays, almost all people are informed about family planning and are
use of contraceptive device also increase day by day.
According to NDHS 2016, The most well-known method among women and
men are:
Female male
injectables (99%) injectables(95%)
female sterilization (98%) female sterilization(95%)
male condoms (96%) male condom(100%)
the pill (93%) male sterilization (94%).
Emergancy contraception(36%) emergency contraception(55%)
lactational amenorrhea method (LAM)25% LAM 15%
Continous :

Among married women, female

sterilization is the most commonly
used method (15%), followed by
injectables (9%), male sterilization
(6%), the pill (5%), male condoms
(4%), implants (3%), and IUDs (1%).
Counseling :

Counselling is face to face, unbiased or objective, two way

communication between service providers and the client.

Family planning counselling is a process of communication in which the

counselor gives accurate and complete information to a client and
voluntary decisions about their fertility and contraceptive option.

The role of counselor is to make sure that the clients know the benefits
and risk of all available contraceptive methods.
Help them to consider their needs, options and feelings so that they
can make up their own mind on what they want to do about their
fertility.
Purpose of FP counselling :

Counselling helps clients to :

 Arrive at an informed choice of reproductive options.
 Select a family planning method with which they are satisfied.
 Use the chosen method safely and effectively.
 Initiate and continue family planning
 Learn the objective, unbiased information about available
methods of family planning.
Principles of counselling :

 Focus on individual clients needs

 Confidentiality
 Informed consent
 Empowerment
 Voluntary choice
 Clients rights
Benefit of counselling :

 Increases acceptance
 Improves continuation
 Dispels rumors and misconception
 Promote effective use
 Increases client satisfaction
 Receiving contraceptive of choice increases continuous use
 Counseling reduce early discontinuation
Steps of counselling :

Deciding on FP methods and using it for eligible couple involve step

by step process.
Step of counselling is summarized by formula GATHER.
 Greet the clients
 Ask client about themselves
 Tell
 Help
 Return
Role of male in family planning

Male involvement in the family planning includes the number of

men who encourage and support their partner and their peers to
use FP and influence the policy environment to be more conducive
to developing male- related programs.
In the past, family planning programs have focused attention
primarily on women to reduce maternal and infant mortality by the
use of modern contraceptive method.
But involving men and obtaining their support and commitment to
family planning is of crucial importance because most decisions that
affect family life are made by men.
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Men can play role in these 3 area :

 Role of men in knowledge level.
 Role of men in supportive level
 Role of men in acceptor level