Family planning INDIA

FAMILY PLANNING methods in india
free of cost
government
national family planning programme

1. NATIONAL FAMILY PLANNING PROGRAMME OF INDIA

2. India, the second most populous country of the world, harbors 17.5% of the world’s population in only 2.4% of the global land mass. India became the first country in the world to initiate the family planning program in 1952 with the goal of lowering fertility and slowing the population growth rate . Over the decades, the programme has undergone transformation in terms of policy and actual programme implementation and currently being repositioned to not only achieve population stabilization goals but also promote reproductive health and reduce maternal, infant & child mortality and morbidity.

3. Factors influencing population growth can be grouped into following 3 categories- Unmet need of Family Planning: includes the married women, who wish to stop child bearing or wait for next two or more years for the next child birth, but not using any contraceptive method. Total unmet need of Family Planning is 12.9 (NFHS-IV) in our country. Age at Marriage and first childbirth: In India 26.8% (NFHS-IV)of the girls get married below the age of 18 years and out of the total deliveries 7.9% are among teenagers i.e. 15-19 years .. Delaying the age at marriage and first child birth could reduce the impact of Population Momentum on population growth. Spacing between Births: Healthy spacing of 3 years improves the chances of survival of infants and also helps in reducing the impact of population momentum on population growth. SRS 2016 data shows that In India, spacing between two childbirths is less than the recommended period of 3 years in 48.1% of births .

4. The public sector provides the following contraceptive methods at various levels of health system: The public sector provides the following contraceptive methods at various levels of health system:

5. NIRODH

6. NIRODH first condom brand produced in India " Nirodh ", meaning "protection" in Hindi Introduced in family planning for 1 st time in 1968 Barrier method ADVANTAGES easily available safe and inexpensive no side effects protection against STD light compact and disposable DISADVANTAGES may slip off or tear off interfere with sex sensation locally

7. MALA - N

8. Combined oral contraceptives COCs contain low doses of two synthetic hormones- progestin and an oestrogen which are similar to the natural hormones in woman’s body . Mala N contains Levonorgestrel (0.15mg) + Ethinyl estradiol (30 micrograms). Each strip of Mala-N contains 21 hormonal tablets and 7 non hormonal (iron) tablets . Pill should be taken every day at fixed time preferably before going to bed at night WHEN TO START : within 5 days after the start of her monthly bleeding In case of breastfeeding : after return of normal menstrual cycle Not breastfeeding : 3 weeks after delivery. After miscarriage or abortion: Immediately, within 7 days

9. MISSED PILL Missed 1 or 2 pills : Take one hormonal pill as soon as possible or two pills at scheduled time. There is little or no risk of pregnancy . Missed 3 or more pills in the first or second week : Take one hormonal pill as soon as possible and continue the scheduled pill.Use a backup method for the next 7 days.Also can consider taking ECPs, if she had sex in the past 72 hours . Missed 3 or more pills in the third week : Take one hormonal pill as soon as possible and finish all hormonal pills in the pack as scheduled. Throw away the 7 non-hormonal pills in a 28-pill pack. Start a new pack the next day .

10. MODE OF ACTION INHIBITION OF OVULATION PRODUCING STATIC ENDOMETERIAL HYPOPLASIA ALTERATION OF CERVICAL MUCUS INTERFERES WITH TUBAL MOTALITY

11. HEALTH BENEFITS Protection against unwanted pregnancy Convenient to use Reversibility NON CONTRACEPTIVE Regulation of menstrual cycle Decrease dysmenorrhea Decrease menorrhagia Protection against PID , Endometriosis , fibroid uterus , hirsutism , acne , RA and osteopenia Prevent endometrial , ovarian and colorectal cancer

12. ADVERSE EFFECTS MINOR : nausea , vomiting , headache , leg cramps , breast tenderness , weight gain , Irregular or unexpected bleeding , decreased libido. MAJOR: Depression , hypertension , cholestatic jaundice , thrombosis .

13. PROGESTRONE ONLY PILLS

14. POPs POPs are also called “ Minipills ” Contains levonorgestrel 75mcg One pill should be taken every day and at the same time until the pack is empty. Delayed intake of the pill may increase failure/risk of pregnancy . WHEN TO START: Any day within 5 days of menstrual cycle In case of breast feeding : anytime after delivery After miscarriage or abortion: Immediately, within 7 days After ECP : Same day, there is no need to wait for her next . . . monthly bleeding to start her pills .

15. ADVANTAGES : used as lactation pill , reduce risk of PID and endometrial cancer , can be prescribed in patients with hypertension , diabetes , smoking and fibriod . SIDE EFFECTS : Irregular or unexpected bleeding , Heavy menstrual bleeding, No menstrual bleeding , Severe lower abdominal pain , Headache , Dizziness , Nausea , Breast tenderness. CONTRAINDICATION : unexplained vaginal bleeding , recent breast cancer , thromboembolic disease, women taking antiseizure drugs .

16. MISSED PILL 3 or more hours late taking a pill or misses one completely: take a pill as soon as possible. Keep taking pills as usual, one each day. (She may take 2 pills at the same time or on the same day ). If she has severe vomiting or diarrhoea: If she vomits within 2 hours after taking a pill, take another pill from the pack as soon as possible and continue with the schedule pill as usual. If her vomiting or diarrhoea continues, follow the instructions for making up for missed pills above

17. CHHAYA

18. Centchroman ( Ormeloxifene ) is a non steroidal, non- hormonal. acts as selective estrogen receptor modulator (SERM). Product of central research institute Lucknow HOW TO START : For initiation of the Centchroman ( Ormeloxifene ) 30 mg , the first pill is to be taken on the first day of period (as indicated by the first day of bleeding) and the second pill three days later. This pattern of days is repeated through the first three months. Starting from fourth month, the pill is to be taken once a week on the first pill day and should be continued on the weekly schedule regardless of her menstrual cycle . MISSED PILL : Take a pill as soon as possible after it is missed . If pill is missed by 1 or 2 days but lesser than 7 days, the normal schedule should be continued and client needs to use a back-up method (e.g. Condoms) till the next period starts . If pill is missed by more than 7 days, client needs to start taking it all over again like a new user that is twice a week for 3 months and then once a week.

19. EZY PILL

20. E mergency Contraceptive Pill ECPs are also called “morning-after pills” or post coital contraceptives EC pills contains only progestin – Levonorgestrel (1.5 mg per tablet ). 1.5 mg single dose or 0.75 mg two doses 12 hours interval Should be taken within 72 hours , may also be taken upto 120 hours Side effects : nausea , vomiting MODE OF ACTION : prevent ovulation , interferes with fertilization , cause leuteolysis , prevent implantation No fetal adverse effects has been observed in case of failure of contraception. Copper IUCD can also be used as an emergency contraceptive method if inserted within 5 days of unprotected intercourse/contraceptive accident.

21. ANTARA

22. Injectable Contraceptive (MPA) Medroxy Progesterone Acetate is a Progesterone -only Injectable (POI) 150 mg given deep intra-muscular every three months. MODE OF ACTION: Inhibiting ovulation Thickening of cervical mucus Thinning of endometrial lining - due to high progesterone and depleted oestrogen, making it unfavourable for implantation of fertilized ovum.

23. ADVANTAGES : long term contraceptive Convenient and easy to use (does not require daily routine or additional supplies). Pelvic examination not required prior to use. Suitable for women who are not eligible to use an oestrogen containing contraceptive. Suitable for breast feeding women (after 6 weeks postpartum) as it does not affect quantity, quality and composition of breast milk. May decrease menstrual cramps and reduce pre-menstrual syndrome/tension Improves anaemia by reducing menstrual blood loss due to menstrual changes such as amenorrhea . Reduces the symptoms of endometriosis. Decreases benign breast disease, ovarian cyst , fibroids and pelvic inflammatory disease (PID) Protect against endometrial cancer and possibly ovarian cancer. Protects against ectopic pregnancy (since ovulation does not occur ).

24. LIMITATIONS : It does not protect against STI/RTI and HIV infection Once taken its action cannot be stopped immediately . It has to be repeated every three months to achieve desired contraceptive effectiveness. Return of fertility takes 7-10 months from date of last injection Cannot be given in few medical conditions/diseases ( osteoporosis , breast cancer )

25. IUCD

26. In India, IUCD was introduced in 1965 under the National Family Planning Programme Currently there are two types of IUCDs available under the National Family Planning Programme:- 1 . IUCD 380 A, effective up to 10 years 2 . IUCD 375, effective up to 5 years

27. Mechanism of action Copper ions decrease sperm motility and function by altering the uterine and tubal fluid environment, thus preventing sperm from reaching the fallopian tubes and fertilizing the egg (Rivera et al. 1999 ) The device stimulates foreign body reaction in the endometrium that releases macrophages and prevents implantation

28. Benefits Long-term, highly effective reversible protection against pregnancy Effective immediately after insertion Safe for use in breastfeeding women Acts as an emergency One time cost effective procedure No requirement of daily attention or special attention before sexual intercourse Immediate return of fertility upon removal of IUCD No drug interaction May help protect against endometrial and cervical cancer

29. COMPLICATIONS IMMEDIATE : cramp like pain , syncopal attack , partial or complete perforation. REMOTE Pain Abnormal menstrual bleeding PID Spontaneous expulsion Perforation

30. Postpartum IUCD Insertion within 10 minutes after the delivery of placenta following a vaginal delivery (Post Placental) Insertion within 48 hours of vaginal delivery Insertion during caesarean delivery, after removal of the placenta and before closure of the uterine incision (Intra- caesarean) Advantages Convenient; saves time and additional visits lower risk of uterine perforation as compared to Interval IUCD, because of the thickened wall of the uterus Reduced perception of initial side effects (bleeding and cramping) by clients due to presence of normal puerperal changes Reduced chance of heavy bleeding, especially among exclusively breastfeeding mothers, since they experience amenorrhea

31. Post Abortion IUCD After Surgical Abortion : Immediately or within 12 days of an abortion procedure, after ensuring that the abortion is complete (there are no retained products of conception)and infection and injury to the genital tract are ruled out or resolved After Medical Method of Abortion : within 15 days , provided the abortion process is complete and evidence of infection is ruled out. Advantages Less pain of insertion as the cervical os is open Convenient; saves time and additional visits Reduced perception of initial side effects (bleeding and cramping) due to presence of normal post abortion symptoms

32. Female Sterilization It is one of the most popular and effective methods of contraception . In India female sterilization by tubectomy or tubal occlusion is the most commonly accepted methods among eligible couples. District Level House-hold Survey (DLHS III) shows that 34% of the ever married women accepted female sterilization as a contraceptive choice There are two common surgical techniques for female sterilization: Minilap Tubectomy and Laparoscopic Tubal occlusion,

33. MINILAP TUBECTOMY Sterilization by can be interval sterilization using supra-pubic approach or post-partum sterilization using sub-umbilical approach. Interval sterilization: should be performed within 7 days of the beginning of menstrual period (in the follicular phase of the menstrual cycle) or anytime during the cycle if the woman and the provider are reasonably sure that she is not pregnant . Post-partum sterilization: should be done within 7 days of delivery . Sterilization following spontaneous abortion: can be performed concurrently or within seven days of abortion, after excluding infection . Sterilization following MTP: can be performed immediately after the procedure if the provider has ensured that the abortion is complete and there is no infection. Medical Abortion: In the next menstrual cycle.

34. Laparoscopic tubal occlusion is usually performed in the ‘interval’ period (6 weeks after delivery or any time when the woman is not pregnant) or following first trimester abortion . For interval procedures, laparoscopy may be performed at any time in the menstrual cycle although it is preferable to do it at the end of the menstrual period or shortly thereafter to ensure that the client is not pregnant. It is not recommended in the postpartum period or after 2nd trimester post-abortion because of the possibility of injury to the larger, more vascular postpartum uterus.

35. CRITERIA FOR STERLIZATION Clients should be ever-married . Female clients should be above the age of 22 years and below the age of 49 years . The couple should have at least one child , whose age is above one year,. Clients must be in a sound state of mind , so as to understand the full implications of sterilization . A relevant medical history, physical examination and laboratory investigations need to be completed to ascertain eligibility for surgery

36. MALE STERLIZATION VASECTOMY is permanent sterilization done in males where the segment of vas deferens of both sides are resected and cut ends are ligated . ADVANTAGES : Simple and require minimal training Outdoor procedure Failure rate 0.15 % Fair success of reversal DISADVANTAGES : Require additional contraceptives for 3 months Psychological impotency

37. Selection of candidates least 22 years old and below the age of 60 years. Clients should be ever-married. The couple should have at least one child , whose age is above one year . must be in a sound state of mind .

38. COMPLICATIONS IMMEDIATE : wound sepsis , scrotal hematoma LATE: Impotency: psychological Sperm granuloma Chronic intra scrotal pain and discomfort Spontaneous recanalization

39. Thank you