Family planning methods and welfare services

Family planning methods and welfare services

1. Family Planning methods and family welfare services Mrs.Jagadeeswari.J m.Sc nursing

2. DEFINITION “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 a country”. -- WHO

3. DEFINITION Family planning is action taken by an family or couples to regulate the number and spacing their children in accordance with their personal preference --Dictionary

4. OBJECTIVES To avoid unwanted births To bring about wanted births To regulate the intervals between pregnancies To control the time at which births occur in relation to the ages of the parent ; and To determine the number of children in the family.

5. Classification of contraceptive methods II. TERMINAL METHODS Male sterilization Female sterilization Natural method

6. Natural family planning methods Natural methods avoid pregnancy by abstain from sexual intercourse during fertile phase ,coitus interruptus,rhythm method etc. Basal body temperature Cervical mucus method Calendar method

7. Miscellaneous methods Abstinence Coitus Interruptus Safe period method 9/30/2018 7

8. Barrier method Barrier methods are those methods which prevent meeting of sperm with ovum . There are three types… Physical barrier methods Chemical barrier methods Combined methods

9. physical barrier method MALE CONDOMS It is a thin rubber sheath which is used by men. Its is rolled over the erect penis before having sex.This rubber sheath prevents the entry of semen into the vagina. In India, dry condoms are manufactured and supplied free of cost by the government under brand name ‘Nirodh’

10. Condom cont… ADVANTAGE: Simple spacing method No side effects Easily available, safe & inexpensive Protects against STDs No medical supervision DISADVANTAGE: Chances of slip off and tear off Rare cases allergic to rubber

11. DIAPHRAGM The diaphragm is used by women in her vagina to from a barrier in front of the cervix . The diaphragm is dome shaped and Is like shallow cap It made of soft synthetic rubber or plastic with a stiff or flexible rim around the edge .its also known as Dutch cap It is held in position partly because of tension created by the spring and partly by the muscle

12. Diaphragm cont… Advantages Effective with spermicidal Failure rate is low Prevents STDs including HIV/AIDS No risk /contraindications Disadvantages Requires assistance by health personal Requires periodical check up Requires privacy to place Requires facilities for storage

13. VAGINAL SPONGE Soft, disposable foam sponge made of polyurethane. Round shaped with depression at centre of upper surface to fit over cervix Saturated with spermicide nonoxynol 9 Attached nylon loop for removal Moistened with water, squeezed gently to remove excess water and inserted high up in vagina to cover cervix Acts for 24 hrs Must be removed and thrown away after 8-24 hrs but not before 6 hrs of last act

14. DRAWBACKS May get broken – difficult removal High pregnancy rate Toxic shock syndrome Allergic reactions Vaginal dryness, soreness May damage vaginal epithelium – increase risk of HIV transmission

15. CHEMICAL BARRIER METHODS Foam tablets Cream jelly and pastes -spermicides Suppositories Soluble films

16. MERITS Cheapest but least effective Melt at body temperature Manual insertion high in vagina 10-15 minutes before sexual act Available in all health centers Easy to administer Increases vaginal lubrication

17. DEMERITS Must be inserted deep down where sperm is likely to reach Must be applied each time before coitus May cause irritation and burning

18. Intra uterine devices The control of conception by introducing a foreign body into the uterine cavity . There are three types of IUD’S First generation IUD’S Second generation IUD’S Third generation IUD’S

19. classification 9/30/2018 19

20. First generation iud 20 They are inert or nonmedicated devices made up of polyethylene Different shapes and sizes Lippe’s loop: Double ‘S’ shaped device made up polyethylene material non toxic, non tissue reactive & extremely durable Easy detected by x ray

21. Second generation Iud 21 Made up of metal – copper. EARLIER DEVICES Copper - 7 Copper - T 200 NEWER DEVICES Variants of T device T copper 220C T copper 380A Nova T Multi load devices

22. Third generation iud 9/30/2018 22 Hormone releasing IUD Progestastert Most commonly used T shaped device filled with progesterone Effective for 1 yr LNG-20 (Minera ) Contains levonorgesterol. Effective for 5 yrs Effective rate 99%

23. ADVANTAGES OF IUDs: Safe, Effective, Reversible Inexpensive High continuation rate Does require hospitalisation DISADVANTAGES OF IUDs: Heavy bleeding and pain Pelvic Inflammatory diseases Ectopic pregnancy May come out accidently if not properly inserted 9/30/2018 23

24. TIMING OF INSERTION: Inserted with a plunger Any time during women’s reproductive period Except in pregnancy Most ideal time is during or within 10 days of the beginning of menstruation t he diameter of cervical cavity is greatest at this time. 9/30/2018 24

25. IDEAL IUD CANDIDATE: Who has borne at least 1 child Has no history of PID Has normal menstrual periods Is willing to check IUD tail Has an access to follow up and treatment of potential problems Is in monogamous relationship 9/30/2018 25

26. Classification of hormonal contraceptives 9/30/2018 26

27. Combined pills Composition Oestrogen - 100-200µg and Progesterone - 10mg Greater side effects Taken from 5 th to 25 th day of menstrual cycle, followed by a break of 7 days ( withdrawal bleeding ).

28. Main type MALA-D MALA-N Mechanism of action : Prevents ovulation Prevents implantation Makes cervical secretions thick

29. E.g.. MALA-D MALA-N Combined pills

30. Merits 100% effective if taken regularly Easy to use Reduces risk of anemia Reduces risk of pelvic inflammation disease

31. Demerits Failure rate increases if irregularly taken Minor side effects are like dizziness,nausea,vomiting,headache,breast tenderness and weight gain Increase risk of heart problems Increases risk of gall bladder disease and cervical cancer. Decrease the quantity of breast milk.

32. Progesterone only pills Minipill or Micropill. Composition: Low dosage of progesterone, mainly Norethisterone (or) Levonorgestrel. Dosage: One tab daily throughout the menstrual cycle Efficacy 96-98% High failure rate Not widely used

33. Once a month (long acting) pill In this method a long acting oestrogen ( Quinestro l) + short acting progesterone is given. But the results are highly disappointing. High pregnancy rate 9/30/2018 33

34. Injectable contraceptives 9/30/2018 34 CLASSIFICATION

35. Progesterone only injectables DMPA: Dose: 150mg IM every 3 months. MOA: suppresses ovulation Advantage: doesn’t affect lactation, useful in postpartum period. Can be used in the multiparae of age >35yr NET-EN: Dose: 200mg IM every 2 months Both DMPA & NET-EN are given in 1 st 5 days of menstrual cycle. They are given deep IM in gluteus muscle. 35

36. Combined injectables Containing long-acting progesterone with short action estrogen Given once a month and produce a menstruation like pattern. The trials are currently taking place in India. Mode of acion : Suppression of ovulation A lteration of cervical and endometrial secretions. Contraindications Pregnancy Thrombo embolytic disorders C erebrovascular disease Coronary artery disease M igraine Breast cancer DM 36

37. NORPLANT Sub dermal implants A flexible plastic single flexible rod 4cm long x 2mm diameter Contains 35mg LEVONOGESTREL 9/30/2018 37

38. Vaginal ring ( Nuvaring) Contains small amount of oestrogen Use for three weeks with a withdrawal week Inhibits ovulation Cycle control good Non-latex Implanted intra vaginally The progesterone is absorbed slowly through the vaginal mucosa. Store 2-8 degrees; if room temperature, up to 4-12 Effectiveness: Overall perfect use 9/30/2018 38 38

39. Post conceptional methods Classification 9/30/2018 39

40. Menstrual regulation No legal restriction Aspiration of uterine content Within 6-14 days of missed period Cervical dilatation needed in nullipara Early complications : Bleeding, Uterine perforation and trauma. Late complications : Tendency to abortion or premature births, infertility, menstrual disorders, ectopic pregnancy & Rh isoimmunization 40

41. Menstrual induction Based on disturbing the normal progesterone- prostaglandin balance by IU application of 1.5mg solution or 2.5-5mg pellet of prostaglandin F 2. Causes sustained uterine contraction for 7 min. followed by cyclical contraction for 3- 4 hrs. Bleeding starts and continues for 7-8 days. 9/30/2018 41

42. Oral Abortifacient Mifepristone + Misoprostol – 95% successful in terminating pregnancies upto 9 weeks. 9/30/2018 42

43. abortion Definition: Termination of pregnancy before the foetus becomes viable . LEGALISATION Medical termination of pregnancy act 1971 1) Conditions under which abortion is done Medical Eugenic Humanitarian Socio-economic In failure of contraceptive device 9/30/2018 43

44. 2) Who can perform abortion? If < 12 weeks 1 RMP having experience in OB-GYN If > 12 weeks -20 weeks then 2 RMP opinion 3) Where can abortion be done? Place approved by Chief medical officer of district i.e. DM& HO. 9/30/2018 44

45. Drawbacks : Irregular cycle so difficult to predict Only for educated and responsible couples Programmed Sex Complication : Embryonic Abnormalities, Ectopic Pregnancy 9/30/2018 45

46. Terminal methods 9/30/2018

47. VASECTOMY Vasectomy is sterilisation of male It is very simple and minor operation which takes hardly 15-20minutes The operation involves a small cut on both sides of the scrotum then a small portion of vas deferens about 1cm on either side of the scrotum is cut and ligated, folded back and sutured Sperms are produced but not ejaculated

48. MERITS Permanent cheaper than tubal ligation 100% effective DEMERITS: Requires surgery Not effective immediately May not be reversible

49. COMPLICATIONS: Operative Sperm granules Spontaneous recanalisation Autoimmune response Psychological response 9/30/2018 49

50. Tubectomy 50

51. TUBECTOMY Its done by resecting a small part of fallopian tubes and ligate the sected ends The closing of the tubes can be done by using other methods like closing the tubes with bands, clips and electrocautery This surgery is done through abdominal and vaginal approach Most common is abdominal laparoscopy Done after delivery or after abortion

52. POST-COITAL COTRACEPTIVE Emergency contraception is a method of contraception which is used after intercourse and before the potential time of implantation No prescription is needed for women aged 17 years This can be used within 72 hours and should be taken for 5 days after coitus

53. Mechanism of action: Hypermotility of fallopian tube Hypermotility of uterus hence no implantation and fertilization Disadvantages: Nausea and vomiting. Next period may start earlier or later Do not protect against STI & HIV 1 % failure rate

54. Family welfare services DEFINITIONS: Family welfare includes not planning of births, but the welfare of whole family by means of total family health care.

55. Aims and objectives of family welfare programmes To promote the adoption of small family size norm on basis of voluntary acceptance To promote the use of spacing methods To ensure adequate supply of contraceptives to all eligible couples within easy reach To arrange for clinical and surgical services so as to achieve the set targets

56. Cont.. Participation of voluntary organization/local leaders/local self government, in family welfare programme at various levels Using the means of mass communications and interpersonal to overcome the social and cultural hindrance in adopting the programme or extensive use of public health education for family planning

57. IMPACT OF FAMILY PLANNING SERVICE Awareness of one or more methods of contraception Increases in contraception use over years Increase in use of condoms Knowledge of female sterilization Increase knowledge about contraceptive pills Fertility rate low among educated women Fertility rate low among higher income group

58. ROLE OF COMMUNITY HEALTH NURSE IN FAMILY WELFARE SERVICES Survey work Collecting demographic facts Collecting information about pregnant mothers, eligible couples, infants and children below the school going age.

59. Cont.. Education functions and motivation: Explaining the importance and necessity of family planning to mass Using various techniques of teaching and communication to propagate the message of family planning to common man Motivating the eligible couple to use contraceptive Motivating people for permanent contraception

60. Cont.. Managerial functions: Conducting clinics Organizing family planning camps Maintaining the records Liaison work- soliciting the co-operation of NGO’s /Voluntary organization

61. Thank you Thank you