Methods of family planning

FAMILY PLANNING METHODS WITH CLEAR CONTENT AND IMAGES OF VARIOUS METHODS LIKE VASECTOMY AND TUBECTOMY

1. METHODS OF FAMILY PLANNING PRESENTER: A.PRABHAKARAN M.Sc (N) TUTOR, VMSON SALEM

2. Introduction Contraceptive methods are, by definition, preventive methods to help women avoid unwanted pregnancies. They include all temporary and permanent measures to prevent pregnancy resulting from coitus. The contraceptive methods may be broadly grouped into two classes spacing methods and terminal methods,

3. I. Spacing methods 1. Barrier methods (a) Physical methods (b) Chemical methods (c) Combined methods 2. Intra-uterine devices 3. Hormonal methods 4. Post-conceptional methods 5. Miscellaneous. II. Terminal methods Male sterilization Female sterilization.

4. PHYSICAL METHODS

5. PHYSICAL METHODS Condom Condom is the most widely known and used barrier device by the males around the world. In India, it is better known by its trade name NIRODH. Condom is receiving new attention today as an effective, simple "spacing" method of contraception, without side effects. In addition to preventing pregnancy, condom protects both men and women from sexually transmitted diseases. Female condom The female condom is a pouch made of polyurethane, which lines the vagina. An internal ring in the close end of the pouch covers the cervix and an external ring remains outside the vagina. It is prelubricated with silicon, and a spermicide need not be used. It is an effective barrier to STD infection. However, high cost and acceptability are major problems .

6. Diaphragm The diaphragm is a vaginal barrier. Also known as "Dutch cap'\ the diaphragm is a shallow cup made of synthetic rubber or plastic material. It ranges in diameter from 5-10 cm (2-4 inches). It has a flexible rim made of spring or metal. It is important that a woman be fitted with a diaphragm of the proper size. The diaphragm holds the spermicide over the cervix. Vaginal sponge Another barrier device employed for hundreds of years is the sponge soaked in vinegar or olive oil, but it is only recently one has been commercially marketed in USA under the trade name TODAY for the sole purpose of preventing conception. It is a small polyurethane foam sponge measuring 5 cm x 2.5 cm, saturated with the spermicide, nonoxynol-9. The sponge is far less effective than the diaphragm, but it is better than nothing. The failure rate in parous women is between 20 to 40 per 100 women-years and in nulliparous women about 9 to 20 per 100 women years.

7. b. CHEMICAL METHODS a ) Foams: foam tablets, foam aerosols b) Creams, jellies and pastes squeezed from a tube c) Suppositories inserted manually, and d) Soluble films - C-film inserted manually . C. COMBINED DEVICES Using chemical contraceptives with condoms is known as combined devices or method. It provides deep and double protection against pregnancy

8. 2. Intra-uterine devices Intrauterine Contraceptive Devices are the ones, which are placed in the uterus and provide protection from pregnancy: of these devices is an ancient method. Intra-uterine devices available today can be divided into two groups. 1. Non-Medicated - e.g. Lippe's loop 2. Medicated - e.g. Copper T.

9. Types of IUCDs Some important devices (IUCDs) are discussed here: Lippe's Loop Copper – T: Copper - T-200, Tcu - 380 A, Tcu - 220 C, Nova T, M2 Cu – 250, ML - Cu 375 & 250 Progestasert T Shaped Device Insertion of IUCD Loop can be fitted at any time except the pregnancy, during reproductive age . Also Copper T should be inserted, 6-8 weeks after the pregnancy. Before that the body might expel it. It should not be inserted during menstrual period.

10. Advantages of IUCD Inexpensive, easy to use and can be inserted in minimum time. Effective contraceptive. Fertility can be restored after the removal of Copper-T / loop. Free from any harmful effects like those of hormonal devices. Can be used up to 10 years (maximum). Doesn't require continuous supervision. Disadvantages of IUDS Spontaneous expulsion of Copper-T / Loop. Pain and bleeding. Ectopic pregnancy. Infection and ailments of pelvis Perforation of uterus.

11. 3. HORMONAL CONTRACEPTIVES Hormonal contraceptives when properly used are the most effective spacing methods of contraception. Oral contraceptives of the combined type are almost 100 per cent effective in preventing pregnancy. Classification Hormonal contraceptives currently in use and/or under study may be classified as follows : A. Oral pills 1. Combined pill 2. Minipill 3. Post-coital pill 4. Weekly pill 5. Long term / Monthly pill 6. ECPs B. Depot (slow release} formulations 1. Injectable 2. Subcutaneous implants 3. Vaginal rings

12. Oral Pills Popularity of pills can be gauged from the fact that 65 million people in the world and more than 10 million women in India use pills. These are available in various combinations. Mixed Pills It includes both oestrogen and progestogen. This pill is to be taken orally from 5th day of menstrual cycle to 21st day, continuously. After this, there is a break or rest period of 7 days, during which the cycle begins again. The day bleeding starts, is considered to be the first day of next menstrual cycle. Mala-N : Norethisterone acetate + Ethynyl oestradiol . Mala-D :D Norgestrol + Ethynyl Oestradiol .

13. Mini pill This contains only progestogen. These are to be taken throughout the menstrual cycle. These are not used much due to poor control on menstrual cycle and the higher rate of failure. These are also known as POP (Progestogen only pills). Post-Coital Contraception (Pill / IUCD) This pill should be taken within 48 hours of the unsafe coitus. Earlier estrogen tablets were advised for five days (diethyl- stilboestrol 50 mg.). At present, two mixed pills are advised to be taken immediately after the unsafe coitus. These pills have less harmful effects than the estrogen pills.

14. Male Pill Despite many experiments a safe male contraceptive pill is yet to be invented. Though some work has been done on Gossypol (derived from the cotton seed oil) but it has toxic effects, as well. No Steroidal Weekly Oral Pill Central drug research institute, Lucknow has developed a pill named " Centchroman ". This is a weekly pill that is to be taken orally. This pill is free from the side effects like vomiting, nausea, weight gain, dizziness and continuous or excessive bleeding, which generally arise by the use of other contraceptives. This pill is famous by the brand name " Saheli ”.

15. Long Acting / Once a Month Pill Long acting oestrogen and short acting progestogen are mixed in this tablet. Though this pill is taken only once a month, its harmful effects and rate of failure is very high. Therefore its use is almost negligible. Emergency Contraceptive Pills (ECPs or E-Pills) In India 21% pregnancies are unplanned and 6.5 million induced abortions are carried out (NRHM News letter - Jan.2007). Situations such as unprotected sex, improper use of contraceptive, failure of occlusive methods, sexual violence etc. often leads to an unwanted pregnancy. Emergency Contraceptive Pills (ECPs/E-Pills) are used to prevent pregnancy following an unprotected sexual intercourse, if taken within 72 hours.

16. Depot Formulation Injectable Contraceptives The base of these injections is progestogen and they are very effective. Important of these injections are: DMPA (Depot Medroxy Progesterone Acetate) Women are given one intramuscular injection of DMPA (150 mg.) every 3 months, which protects her against pregnancy for 3 months. NET-EN (Nor Ethisterone Enantate ) This is also an intra-muscular injection (200 mg) but it should be given at an interval of 2 months. This is a less effective contraceptive injection as compared to DMPA.

17. Sub-dermal-Implants Norplant or Norplant R-2 is used in these devices. Cilastic capsules or rods are implanted below the skin of upper arm. It can prevent pregnancy for the 5 years. After that, it is removed. Major disadvantages of this technique are the need of surgery and irregularity of bleeding in menstrual cycle. Vaginal Rings Vaginal rings containing levonorgestrel have been found to be effective. The hormone is slowly absorbed through the vaginal mucosa, permitting most of it to bypass the digestive system and liver, and allowing a potentially lower dose. The ring is worn in the vagina for 3 weeks of the cycle and removed for the fourth.

18. 4. POST-CONCEPTIONAL METHODS These are the methods, which lead to termination of pregnancy. For this, regulation of menstrual cycle and the methods of abortion are used. A short description of these methods is given below. 1. Menstrual Regulation and Induction In menstrual cycle regulation method, within 6 to 14 days of stopping the cycle, aspiration of uterine contents is done. This is very similar to primary abortion. Similarly, for menstrual induction, solution of prostelendin F2 is inserted in the uterus due to which uterus starts contracting and the menstrual bleeding begins, which continues for 7-8 days.

19. 2. Abortion/MTP Termination of pregnancy before the foetus reaches the state of independent survival, is termed as abortion. This duration is of almost 24-28 weeks. There are a number of reasons for abortion. Government of India has formed the Medical Termination of Pregnancy Act (1971) with the objective of reducing maternal mortality and morbidity rate. Simultaneously, it has also provided the abortion a medical look and recognition. This is popularly known as Medical Termination of Pregnancy (MTP). It is an important part of the family planning programme. MMA (Medical Methods of Abortion) is also an important tool for termination of early pregnancies

20. 5. MISCELLANEOUS METHODS Abstinence Coitus Interruptus Breast-feeding Birth Control Vaccine Safe Period Cervical Mucus Method Mix Calculation Methods Genetic Engineering