Family planning method

Population control

1. PRESENTED BY,
MR. KAILASH NAGAR
ASSIST. PROF.
DEPT. OF COMMUNITY HEALTH NSG.
DINSHA PATEL COLLEGE OF NURSING, NADIAD

3. INTRODUCTION
Family planningis the term given for pre-pregnancy
planning and action to delay,preventoractualizea
pregnancy.
DEFINITION:
Family planning is a way of thinking and living that isadopted
voluntarily, upon the bases of knowledge, attitude and
responsible decision by individuals and couples in order to
promote the health and welfare of family group and thus
contribute effectively to the social development ofcountry
-B TBASVANTHAPPA

4. •FAMILYPLANNING
•Family planning is defined as the voluntary,
responsible decision made by individuals and
couples as to the desired family size and timing of
births.

5. OBJECTIVES FAMILYPLANNING
( WHO ) “the use of a range of methods of a fertility
regulationtohelpindividualsorcouplesattain
certain objectives:
avoid unwantedbirth.
bring about wantedbirth.
Produceachangeintheno.ofchildrenborn.
Regulate the intervals betweenpregnancies.
Control time at which birthoccur.”

6. DEFINITION OF ELIGIBLECOUPLE-
•An eligible couple refers to a currently married
couple wherein the wife is in the reproductive
age, which is generally assumed to lie between
the ages of 15-45 years. There will be at least
150-180 such couples per 1000 populations in
India.

7. DEFINITION OF TARGETCOUPLE
Thetermtargetcouples areappliedwho have2-3
living children, and family planning was largely
directed to suchcouples.

8. DEFINITIONOF SMALL FAMILYNORM
it is composed of mother , father and fewchildren.
Slogan for SMN
•Hum Do, Hamara Ek
•Hum Do, Hamara do (1970)
•A Small Family is a happy Family.
• Small family-small conflicts
• Small family-small demands
•two child complete the family
•ChotaParivarGharSansar.

9. FAMILYPLANNING
Familyplanningistheabilityfora
womanorcoupletodeterminewhen
andhowmanychildrentheyaregoing
tohavebypracticingsafesexual
practices.

10. OBJECTIVES
( WHO ) “the use of a range of methods of a fertility
regulationtohelpindividualsorcouplesattaincertain
objectives:
avoid unwantedbirth.
bring about wantedbirth.
Produceachangeintheno.ofchildrenborn.
Regulate the intervals betweenpregnancies.
Control time at which birthoccur.”

11. Proper
spacing
Proper
timing
No. of
pregnanci
es
Elements of familyplanning
3 important elements in familyplanning:

12. Benefits
Benefits toMother
Reduce the healthrisk
Below 20y, And above 35 y. At risk of developingcomplications
duringpregnancy.
physical strain of childbearing.
reduce number of maternaldeath.
reduce the risk of ovariancysts.

13. Health Benefits toChildren:
Ensuresbetterchanceofsurvivalatbirth.
Promote better childhoodnutrition.
Promote physical growth anddevelopment.
Prevent birthdefects.

14. Health Benefits toFather
Allowsfathertokeepaconstantbalancebetween
their physical, mental, social well–being.
Increase father sense of respect because he is able to
providethetypeofeducationandhomeenvironment.

15. Benefits to WholeFamily
Health
BenefitstoWholeFamilyHealth-helpthefamily
enjoy the better kind oflife.

16. CONCEPTION
It is the fertilization of a
female ovum by a male
sperm. Every 28 days, in an
adult female, one ovum
leaves the ovary and is
directedinto fallopian tube
by the fimbriated end,
which passes along with
thetube.

17. CONTRACEPTION
it is the voluntary prevention of pregnancy, a
process with individual and socialimplications.
Contraception (birth control) prevents pregnancy
by interfering with the normal process of ovulation,
fertilization, and implantation. There are different
kinds of birth control that act at different points in
theprocess.

18. •Humanfertilizationi
s the union of a
human egg and
sperm, usually
occurring in the
ampullaof the
fallopian tube.

19. Characteristics of the ideal
contraceptive method wouldbe:
highlyeffective;
no side effects orrisks;
cheap;
independent of intercourse and requires no regular
action on the part of theuser;
non-contraceptivebenefits;
acceptable to all cultures andreligions;
easily distributed and administrated by non
healthcare personnel.

22. Classification ofcontraception
methods:
Combinedhormonal
contraception
Thepill
Patches
The vaginalring
Progestogen-only
preparations
Progestogen-onlypills
lniectables
Subdermalimplants
Hormonalemergency
contraception
Intrauterinecontraception
Copper intrauterinedevice
HUD)
Hormone-releasing
intrauterine system(IUS)
Barriermethods
Condoms
Femalebarriers
Coltusinterruptus
Natural familyplanning
Sterilization
Femalesterilization
Vasectomy

23. Classification of contraceptivemethods
I.SPACINGMETHODS
Barrier
Methods
Physical
Methods
Chemical
Methods
Combined
Methods
Intrauterine
Devices
Hormonal
Methods
Post
Conceptional
Methods
.
Miscellaneous
II.TERMINALMETHODS
Male
sterilization
Female
sterilization

24. TYPES OF FAMILYPLANNING
Natural familyplanning
Barrier familyplanning
Permanent/surgicalfamily
planning

25. classification
IUD
Medicated
Second
Generation
Eg. CopperIUD
Third
Generation
Eg. HormonalIUD
Nonmedicated
First
Generation
Eg. Lippe’sloop
38

26. Firstgeneration iud
They are inert or Nonmedicated devices made
up of polyethylene
Different shapes andsizes
LIPPE‘SLOOP:
Double ‗S‘ shapeddevice
Made up polyethylenematerial
Non toxic, non tissue reactive&
extremelydurable
Small amount of Barium Sulphate is also
added for radiologicalexamination
Available in 4 sizes A,B,C&D
Failurerate: 3-5 /HWY
39

27. Second generationIud
Made up of metal –copper.
EARLIERDEVICES
Copper -7
Copper -T200
NEWERDEVICES
Variants of Tdevice
 T copper220C
 T copper380A
NovaT
Multi loaddevices Failure rate:0.8/HWY
ML-Cu250
ML-Cu375 40

28. Third generationiud
Hormone releasingIUD
Progestastert
Most commonly used
T shapeddevice
filled with 38mg ofprogesterone
Releasing rate65µg/day.
Effective for 1yr
Failure rate: 0.2 /HWY
LNG-20(Minera)
Releases 20µg oflevonorgesterol.
Effective for 5 yrs
Effective rate99%
41

29. INTRODUCTION OF NATURAL
FAMILYPLANNING
No introduction of chemical of foreign materialinto
thebody.
Practicemaybeduetoreligiousbelief, “natural”way
is best forthem.
Effectivenessvariesgreatly,dependsoncouplesability
torefrainfromhavingintercourseonfertiledays.
FailureRates:about25%Posesnorisktofetus

30. NATURAL FAMILY PLANNING
Rhythm (Calendar)method
Basal Body Temperature (BBT)
Ovulation or Cervical MucusMethod
Symptothermalmethod
Coitus Interruptus
Lactationamennorhea

31. The rhythm method, also called the fertility
awareness method, is a form of pregnancy
preventionwherecouplescalculateawoman'sfertile
time using a calendar.
Abstainingfromcoitusonthedaysofmenstrualcycle
when a woman is most likely to conceive (3 or 4 days
beforeuntil3or4daysafterovulation).Womankeeps
a diary of 6 menstrualcycles.
RHYTHM(Calendar)
METHOD

32. Thismethodmaybeusedbywomenwhosemenstrual
cyclesarealwaysbetween26and32daysinlength.
Tocalculate:
18 from shortest cycle documented –11from
longestcycle=representsherlastfertileday.
Example: If she has 6 menstrual cycles ranging from
25to29days, fertileperiodwouldbefrom7thday(25-
18) to the 18 th day (29-11).To avoid pregnancy, avoid
coitus/use contraceptive during thosedays.

38. Disadvantages
Lifespan
ofSperm
Failureof
method
Quality of
Sperms

39. . Basal Body Temperature(BBT)
Identifying fertile and infertile period of a woman’s
cyclebydailytakingandrecordingoftheriseinbody
temperature during and afterovulation.
Justbeforeovulation,awoman’sBBTfallsabout0.5ºF
Attimeofovulation,herBBTrisesafulldegree
(influenceofprogesterone).Thishigherlevelis
maintainedtherestofmenstrualcycle.

42. DISADVATAGES
NOT reliable method: of birth control, especiallyfor
womenwithirregularcycles.Plus,outsidefactors,
suchasalackofsleep,cancauseawoman’s
temperature tovary.

43. Cervical mucus is a fluid produced by smallglands
near thecervix
This fluid changes throughout her cycle, from
scantandsticky,tocloudyandthick,toslickand
stringy.
Each of these types of mucus is related tothe
hormonal shifts that naturally occurduring
themenstrualcycleasherbodypreparesforand
achievesovulation.
CervicalMucus/Ovulation

44. Right before ovulation, the mucus from the cervix
changesfrombeingcloudyandscantytobeingclear
andslippery.
The consistency of ovulation mucus is like that of an
eggwhiteanditcanbestretchedbetweenthefingers.
It is the peak of herfertility.
Aftertheovulation,themucustendstodryupagain.
Thesearealsosafedays.
Ideal Failure rate:3%

45. DISADVANTAGES
It is not a particularly reliable method of birth
control,especiallyforwomenwithirregularcycles.
Remember that cervical mucus does not let you know
whenyouwillsoonbeovulating,butspermcanliveup
to 4 days inside the vagina. Any sperm deposited
aheadoftimecanstillimpregnatethewoman.

46. SymptothermalMethod
Combines the cervical mucus and BBT methods
Watchestemp.dailyandanalyzescervical mucusdaily.
Watch for midcycleabdominalpainCouple must
abstainfromintercourseuntil3daysafterriseintemp.
or4thdayafterpeakofmucuschange.
MoreeffectivethanBBTorCMmethodaloneIdeal
Failure rate:2%

47. COITUSINTERRUPTUS
One of oldest known methods of contraception
Coupleproceedswithcoitusuntilthemomentof
ejaculation which Offers littleprotection.

49. LACTATIONAMENNORRHEA
The lactation amenorrhea method (LAM) is a natural
birth control technique based on the fact that
lactation (breast milk production) causesamenorrhea
(lack ofmenstruation).

50. How itworks:
Breastfeeding interferes with the release ofthe
hormones needed to triggerovulation.
ADVANTAGES:
Breastfeeding on demand improves health formother
andbaby.
Nothing to buy oruse.

53. DISADVANTAGES
anusethismethodonlyforthefirstsixmonthsafter
birthoruntilthefirstmenstrualperiod.
LAMdoesnotprovideprotectionagainstSEXUALLY
TRANSMITTEDINFECTIONS.

54. CLASSIFICATION OF
CONTRACEPTIVE METHOD
CLASSIFICATION
SPACING
METHOD
BARRIER
METHOD
INTRAUTERI
NE
METHOD
HORMONAL
METHOD
POSTCOITAL
METHOD
TERMINAL
METHOD

55. BARRIERMETHODS
Condoms (male andfemale)
Spermicidal
Sponge
Diaphragm
Cervicalcap

56. Malecondoms:
Thesearemadeupofpolyurethaneorlatex.
Siliconusednowadaystoproducesemidrypre-
lubricatedforms.
InIndiaoneparticularlybrandiswidelymarketedas
‘Nirodh’.
Spermicidal–coatedwithnonoxynoloninnerand
outersurfaces.

57. MALECONDOM

58. ADVANTAGES:
Simple spacingmethod
No sideeffects
Easily available, safe &inexpensive
Protects againstSTDs
DISADVANTAGES
Chances of slip off and tearoff
Allergic reaction tolatex
Failure rate:16%

59. Femalecondoms:
Itisapouchmadeupofpolyurethanewhichlinesthe
vagina and also externalgenitalia.
Itis17cminlengthwithoneflexiblepolyurethane
ring at eachend.
ADVANTAGES:
Prevents STDs includingHIV/AIDS
Notdamagedbyoilsandotherchemicals

61. DISADVANTAGES:
Highmotivation
Onlywomenwhocanusediaphragmscanusefemale
condom
Slippageoccurs
Expensive
Failurerate21%withtypicaluseand 5%withcorrect
and consistentuse.

62. diaphragm
Mostcommonandeasiesttofitanduse.
Thin,nearlyhemisphericaldomemadeofrubberor
latexmaterial,withcircular,coveredmetalspringat
periphery(flattypeandcoiltype)

External diameter of rim is size of diaphragm –45 mm
diameter rising in steps of 5 mm to 105mm (most
common60,65,70,75,80)

63. The device is introduced up to 3 hrs. before
intercourseandistobekeptforatleast6hrsafter
intercourse.
ADVANTAGES:
cheap
No gross medical sideeffects
Control of pregnancy in hands ofwoman
Reasonably safe when properlyused
Prevent spread of STDs though less effectivethan
condom

64. DIAPRAGHM

65. DISADVANTAGES:
Requireshelpofdoctortomeasurethesizerequired.
Need highmotivation
Allergic reaction torubber
Erosion
UTI’s

66. SPERMICIDES
Availableasvaginalfoams,gels,creams,tabletsand
suppositories.
contain surfactant likenonoxynol-9,benzalkonium
chloride.
Alterthespermsurfacemembranepermeability
resulting in killing ofsperm.

67. SPERMICIDE

68. ADVANTAGES:
Noinstructionsbydoctorsornurses
Easilyavailableandeasytouse
No gross medical sideeffects
DISADVANTAGES
Failure rate high when usedalone
Can increase spread of HIV infection byirritating
vaginal and cervicalmucosa
Failurerate–21%withtypicaluseand6%

69. Vaginal contraceptive sponge
(TODAY)
Thespongeisadoughnut-shapeddevicemadeofsoft
foam coated withspermicide.
Madeupofpolyurethanewith1gmofnonoxynol-9as
aspermicide.
Itreleasesspermicideduringcoitus,absorbsejaculate
and blocks the entrance of cervicalcanal.
Tousethesponge,itmustbemoistenedwithwater.
Onceinsertedinthevagina,itcoversthecervixand
blocksspermfromenteringtheuterus.

70. DISADVANTAGES
May getbroken
difficultremoval
High pregnancyrate
Allergicreactions
Vaginal dryness,soreness
May damage vaginalepithelium
increase risk of HIVtransmission

71. INTRAUTERINEDEVICES
Intrauterine Device The IUD is a small, T-shaped,
plasticdevicethatisinsertedandleftinsidetheuterus
to preventpregnancy.

72. CLASSIFICATION OF
IUDs
INTRAUTERINE
DEVICE
NON-
MEDICATED
FIRST
GENERATION
SECOND
GENERATION
MEDICATED
THIRD
GENERATION

73. Firstgeneration
Non-medicated made up ofpolyethylene.
Different shapes andsizes
LIPPE’SLOOP
Double‘s’shapeddevice,madeupofpolyethylene
material.
Non-toxic,non-tissuereactiveandextremelydurable.
Smallamountofbariumsulphateisalsoaddedfor
radiologicalexamination
Available in 4 sizesA,B,C,D

74. Secondgeneration
Made up of metalCu
Earlier devices Cu-7 , Cu-T200
NewerdevicesTcopper220C,Tcopper380C,novaT
multiloaddevices:
ML-Cu250
ML-Cu375

75. Thirdgeneration
Hormones releasingIUD
PROGESTASTERT:
MostcommonlyusedTshapeddevicefilledwith38mg
progesterone
Effective for 1year
LNG-mirena
Mirena (levonorgestrel-releasing intrauterine device) isa
form of birth control that is indicated for intrauterine
contraception for up to 5 years and Releases 20 µg of
levonorgestrol.
Effective for 5years.

76. SIDEEFFECTS
Amenorrhea
Intermenstrual bleeding andspotting
Abdominal/pelvicpain
Ovariancysts
Headache/migraine
Acne
depressed/alteredmood.

77. ADVANTAGES OFIUD
Safe
effective ,Reversible
Long action,Inexpensive
DISADVANTAGES
Heavy bleeding andpain
Pelvic inflammatorydiseases
Ectopicpregnancy
Maycomeoutaccidentlyifnotproperlyinserted.

78. CONTRAINDICATION
History ofPID
Abnormal shapeduterus
Ectopicpregnancy
Menorrhagia

79. CLASSIFICATION OF HORMONAL
CONTRACEPTIVES
HORMONAL
CONTRACEPTIVES
COMBINED
PREP.
ORAL
SINGLE
PREP.
INJECTABLES
PARENTERAL
IMPLANTS

80. HORMONAL CONTRACEPTIVES
With hormonal birth control , a women takes
hormonessimilartothoseherbodymakesnaturally.
Hormonalcontraceptivesaremostlyforfemalesex
steroids.

81. Oralcontraceptives
Combined oral contraceptivepills
Commonlyusedprogestinare either levonorgestrolor
norethisterone and estrogens are ethiyl estradiol or
menstranol
COMMERCIALNAMES
Mala–N
Mala–D
Loette(desogestrel0.15)
NO. OFTABLETS
21+7 irontab.
21+7 irontab.
21tab.

82. TYPES
Monophasic biphasic triphasic
Monophasic:
fixed doses of both estrogen andprogesterone
throughout 21 daycycle.

83. Biphasic:
constant amount of estrogen throughout cycle BUT
increasedamountofprogestinduringthelast11days.
Triphasic:
Varies level of estrogen and progesterone. Closely
mimic natural cycle, reducing breakthroughbleeding
(bleeding outside the normal menstrualflow)

84. contraindications
ABSOLUTE:
Circulatorydiseases
SevereHTN
Angina,ischemic heartdis.
Liverdisease
Tumors
Pregnancy
breast cancer,breastfeeding.

85. RELATIVE:
Age>40yrs.
Smoker, history ofjaundice
Diabetes

86. benefits
contraceptivebenefits:
Protection against unwantedpregnancy
Convenient touse.
Non-contraceptivesbenefits:
Regulation of menstrualcycle
Reduction ofdysmenorrhea
Protection against PID, fibroids, ovarian cysts,chances
ofcancer.

87. Sideeffects
Dizziness
Nausea
Weightgain
Headache
Breasttenderness
vaginalinfection
MildHPN
Depression
increase bloodclotting

88. Progesterone onlypills
Also known as“Minipill”.
Containsjustprogesteroneorprogesterone
hormone.
Causing plug of mucus in the neck ofcervix
•block the entry of thesperm.
•Example: levonorgesrol 75 µg, desogestrel 75µg

89. advantages
Nosideeffectonbreastfeedingorlactation
May be prescribed in patient having diabetes, HTN,
smokingetc.
Reduce risk ofPID
DISADVANTAGES
Acne, mastalgia,headache

90. Long actingcontraceptives
These are moresuitableforwomenwhodonotwant
topregnantagainorforfewyears.
THESEARE:
CONTRACEPTIVEINJECTIONS
IMPLANTS
PATCHES

91. CONTRACEPTIVE INJECTIONS
( DEPOPROVERA &NORISTERET)
Contain progesterone hormone.
Preventsovulation.
CommonlyusedasDepomedroxylprogesterone
acetate(DMPA)administeredondeltoidmuscle
within5daysofcycle.
DOSE: 150mg
Provide protection for 3 months.

92. Contraceptiveimplants
Itisasmalldeviceplacedundertheskin
Contains progesterone hormone.
Worksinasimilarwaytoinjection
Contains 3ketodesogestrel
Releases hormone about 60 mcg, graduallyreduced to
30 mcg perday over year.
Inhibtsovulation.
Lasts for 3years.
NORPLANT –II

93. NORPLANT-II
Two rods of 4cm long. Each rod containing 75 mgof
levonorgestrel releases 50 mcg perday.


94. Emergencycontraceptives
Usedwhithin72hrs,ovulationiseitherpreventedor
delayed. It may be in form of : hormones, IUD,
antiprogesterone
INDICATIONS
Unprotectedintercourse
Condomrupture
Sexualassault

95. HORMONES:
MORNING AFTERPILLS:
It preventing conception in caseof accidental
intercourse.
drugs used ethinyl oestradiol 2.5mg,
premarin(conjugated oestrogen) 15mg.
Drugistakenorallytwicedailyfor5days.

96. Emergencycontraceptives
DRUG DOSE
Levonorgesterel 0.75 mg stat and after 12hrs.
Ethinyl oestradiol50µg+norgesterel
0.25mg
2 tab stat and 2 after 12hours
Conjugatedoestrogen 15 mg BD×5 days
Thinyloestradiol 2.5 mg BD 5days
Mifepristone 10 mg singledose
CopperIUDs Insertion within 5days

97. PERMANENT STERLISATION
ÖVASECTOMY
ÖTUBECTOMY

98. TUBECTOMY

99. STERILIZATION
Itismosteffectivemethoditsfailurerateis1/2000soin
this there is permanent termination.
VASECTOMY:
Small incision made on each side of scrotum vas
deferensisthencutandtied,cauterizedorplugged.
Blocking the passage ofspermatozoa.
Doesnotinterferewithproductionofspermsbutdoes
not pass beyond vas deferens.

100. Veryeffectiveafter3 months ofprocedure
Permanent andsafe
No apparent long term risks.
DISADVANTAGES:
Slightlyuncomfortabledueslightlypainandswelling
after2-3daysoftheoftheprocedure.
Bleedingmayresultinthehematomainscrotum.

101. TUBECTOMY:
Itisoneoftheoperativeprocedurewhereresectionof
a both segment of both fallopian tubes is done to
achieve permanentsterilization
The approach may be:
Abdominally
Vaginally

102. ABDOMINAL
ΩCONVENTIONAL MINILAPROTOMY
ΩCONVENTIONAL:
InwhichaloopismadebyholdingthetubebyAllisforcepsin
suchawaythatthemajorpartofloopconsistsmainlyofisthmus
andampullarypartoftube.theloopisligatedwithcatgutand is
cut.

103. MINILAPROTOMY :
When the tubectomy is done through small
abdominalincisionalongwithsomedevice.
VAGINAL LIGATION:
Tubectomythroughvaginalroutemaybedonealong
withvaginalplasticoperationoronisolation.

104. COMPLICATION:
Ectopicpregnancy
Menstrualirregularities
Loss oflibido
Infection