Family planning

overall about family planning

1. Family planning Prepared by Mallika tako Mandira dahal Melina ghimire

2. Definition of family planning It is “a way of thinking and living that is adopted voluntarily, upon the basis of knowledge, attitudes and responsible decisions by individuals and couples, in order to promote the health and welfare of the family group and thus contribute effectively to the social development of the country”. - WHO

3. or It is the conscious effort of couples to regulate the number and spacing of births through artificial and /or natural methods of contraception.

4. Purposes of family planning To avoid unwanted births To bring about wanted births To regulate the interval between pregnancy To control the time at which births occur in relation to the ages of the parents To determine the numbers of children in the family To decrease the maternal and child mortality and morbidity rate

5. Methods of contraception

6. Hormonal methods H ormonal methods of birth control contain estrogen and progestin, or progestin only, and are a safe and reliable way to prevent pregnancy for most women. Mechanisms of hormonal methods are: -preventing ovulation -keeping the mucus in the cervix thick and impenetrable to sperm -keeping the lining of the uterus thin

7. parenteral injectable DMPA contains the progestin hormone named “Depot- M edroxy progesterone acetate”. The brand name is D epoprovera and commonly called “Depo”. It is also called “ S angini ” in N epal. D epot - M edroxy progesterone acetate (DMPA)

8. DOSE: Single dose vial, each vial contains 150mg of Depot-Medroxy progesterone acetate/ml for every 3 month. It is administered intramuscularly. Mechanism of action: -They prevent pregnancy by: Suppressing ovulation by suppressing the mid cycle LH peak. Making thin atrophic endometrium so ovum can not implant

9. C ausing cervical mucus thick, which prevent sperm penetration. Indication of DMPA The timing of the return fertility is not important A risk of increased cardiovascular complications from COCs is present Other methods requiring daily use are not suitable Estrogen related complications develop while using COCs. (headache or high BP)

10. Amenorrhea is acceptable or desirable Contact with service providers on a regular basis is difficult Timing of injection A women can have first injection any time during the menstrual cycle if it is reasonably certain that she is not pregnant Within the 7 days after the start of period Within 4 weeks of postpartum Within 7 days of post abortion

11. If appropriately using LAM after 6 months If partially breast feeding after 6 weeks If no breast feeding immediately Advantages Highly effective (99.7%) Nothing needs to be taken at the time of sexual act. Women lose less blood using depot- medroxy progesterone and have less menstrual cramping. Often after these injections women stop periods. This is safe.

12. Nursing mother can receive Depo-Provera injections. Its best after the baby is 6 weeks old Reversible Decrease anemia , PIVD and endometrial cancer Does not interfere intercourse or sexual desire Rapidly effective (within 24 hours)

13. Disadvantages Depo. Injections can lead to very irregular periods Some women gain weight A person has to return clinic every three months for injection Depo. May lower estrogen level and cause bone loss Health personals are needed for injections

14. Client instruction Instruct the client to return to the health clinic for another injection every 12 weeks (3months). However the next DMPA can be given 2 weeks before and 2 weeks after If heavy vaginal bleeding, lower abdominal pain, severe headache, and depression return to the clinic Explain about possible side effect and their management

15. implant JADELLE

16. JADELLE The newer Norplant-R-2(consisting of two rods).These devices contain the progestin levonorgesterol 75mg in each of 2 silicon rubber capsule and are surgically inserted under the skin of the women’s upper arm by a trained medical practitioner. The tube allows a steady diffusion of the drug into blood stream. Each rod is 2.5cm in diameter and 43mm in length. It works for 5 years. The implant must be removed surgically when it is used up in about 5 years or when the women wish to discontinue the method.

17. Mode of action By blocking ovulation Causing thick cervical mucus Thin atrophic endometrium

18. Timing of implant A woman can have first injection qny time during the menstrual cycle if it is reasonably certain that she is not pregnant Within the 7 days after the start of period Within 4 weeks of postpartum Within 7 days of post abortion If appropriately using LAM

19. Indications Want long term spacing that is 5 years

20. Advantages Highly effective 99.7% Immediately effective within 24hours of insertion Long term protection 5years Reversible Can be remove any time if for any reason Doesn’t interfere with the lactation and blood pressure Disadvantages Frequently cause menstrual irregularities, and about 10%of users discontinue using of this reason. Doesn’t protect from std /aids Client doesn’t discontinue the method on her own wish Need small surgical procedure and medical person for insertion and removal

21. Contraindication Suspected pregnancy Liver disease Breast cancer Unexplained uterine bleeding and blood clots

22. Use with caution High blood pressure Gallbladder disease High cholesterol Irregular period Headache Drugs (rifampicin, antiepileptics )

23. Client’s instruction Insertion area should be clean and dry with pressure dressing in place for 2 days and band aid for 5 days Routine work can be done immediately but avoid straining the area for few days If sign of infection such as inflammation, pain at site and fever returned to clinic Follow up after 7 days for the check up of insertion site and anytime if warning signs is present

24. Thank u