methodsofpopulationcontrol-230417173501-2ce7e467.pptx

population control methods

1. METHODS OF POPULATION CONTROL INTRODUCTION TO FAMILY PLANNING METHODS

2. INTRODUCTION Demography- scientific study of human population Three observable human phenomena changes in population size ii)composition of the population iii)Distribution of population Deals with five demographic processes i)Fertility Mortality iii)Marriage iv)Migration v)Social mobility

3. DEMOGRAPHIC CYCLE FIRST STAGE( High stationary) Eg; India in 1920 SECOND STAGE( Early expanding) Eg; South asia and Africa THIRD STAGE( Late expanding) Eg; India, China, Singapore FOURTH STAGE( Lowstationary) Eg; Uk, Denmark, Sweeden FIFTH STAGE( Declining) Eg; East European Germany, Hungary

4. FACTORS AND POSSIBLE RESONS BEHIND EACH FACTOR FOR POPULATION EXPLOSION HIGH BIRTH RATE LOW DEATH RATE MIGRATION Universal marriage norm Advancement in medical sciences Illegal migration from neighbouring countries Early age at marriage Health awareness and increased investment on health Teenage pregnancies Political will for universal health coverage Poverty and illiteracy Role of women in decision making

5. METHODS FOR POPULATION CONTROL Family welfare measures Social welfare measures FAMILY PLANNING : OBJECTIVE: Prevent unwanted pregnancies Limit the number of children Limit the age of female ( at the 1 st child birth)

6. PLANNED FAMILY: The 1 st child birth is after 20yrs of the mother’s age. Minimum of 3 years between 2 children. Limited size of children (2 or 3). Stable Population means CPR of 60%~TFR of 2.1~NRR 1 Eligible couple: couple in reproductive age group.( 15- 18%) Target couple: couple in reproductive age group and achieved desired family size.

7. CONTRACEPTIVE METHODS TEMPORARY Barrier Natural methods Intrauterine devices Oral contraceptive pills Injectables Implants others/newer methods PERMANENT Tubectomy Vasectomy Other methods

8. BARRIER METHODS: Condoms: Male condoms- latex, failure rate 2 or3 to 14/ HWY Female condoms- polyurethane, prelubricated with silicone, two rings, failure rate 5 to 20/HWY Diaphragm: Vaginal barrier, dutch cap, used before intercouse and left for six hours Chances of Toxic syndrome, 6-12 /HWY. Vaginal sponge: soaked in vinegar or olive oil, Today, 5× 2cms, nonoxynol- 9. 20- 40 /HWY. . CHEMICAL METHOD: Foams Creams,jellies and pastes Suppositories

9. This Photo by Unknown Author is licensed under CC BY This Photo by Unknown Author is licensed under CC BY-NC- ND

10. NATURAL METHODS: Standard days method: fertile period from day 8 to 19 days. Regular cycle. Calendar rhythm method: short cycle minus 18 and long cycle minus 11. that is 8day to 21 days of the cycle. 9/HWY iii) Basal body temperature: 0.3 to 0.5 degree C as a result of progesterone. First day to third day of rise of temperature.20/HWY Billing method/ cervical mucus secretion: fertile period usually 4 to 7 days prior to ovulation. After three days after ovulation mucous become thick. Lactational amenorrhoea method: During this period, prolactin inhibits ovulation.

11. INTRA UTERINE DEVICES(IUD) FIRST GENERATION: During 1965,Lippes loop ,Polyethylene,double S shaped, fine thread, four size A,B,C,D. SECOND GENERATION:During 1970, Earlier devices copper- 7, copper T- 200. Newer devices Cu- T- 220c, Cu- T- 380 AorAg, Nova T, ML-Cu- 375. THIRD GENERATION: i)Mirena( LGN- 20) 7-8 yrs 20mcg progesterone/day.Lowest failure rate 0.2 /HWY ii)Progestasert(1yr) Natural Progesterone, loading dose 38mg and 65mcg/day. Lowest expulsion rate.

12. MECHANISM OF ACTION OF IUD Foreign body reaction in the uterus causing biochemical changes in the endometrium and uterus fluid ,inhibits viability of gametes rather than implantation. Alters the biochemical composition of cervical mucus inhibits the sperm motility, capacitation and survival. Hormonal releasing devices increases the viscosity of cervical mucus thus inhibits the sperm entering the cervix. High progesterone and low Oestrogen unfavourable for implantation

13. CONTRAINDICATION : TIME OF INSERTION: - within 10 days from the beginning of menstruation ideal 4 to 5 days. - After delivery early within 24 hrs , Late after 6 weeks of delivery. Absolute contraindications Relative contraindications Pregnancy Previous inflammatory disease Undiagnosed vaginal bleeding Congenital malformation Pelvic inflammatory disease Cervical discharge Cerival cancer Anemia Carcinoma of genital tract menorrhagia Previous ectopic pregnancy Unmotivated females

14. ADVERSE EFFECTS OF IUD Pain : MC cause of removal 15 to 40%. Bleeding : MC side effect. Removal 10 to 17 %. Ectopic pregnancy: due to delayed tubal motility cause by progesterone. Rate 6.8%. Pelvic inflammatory disease. Perforation: Dangerous AD. Expulsion : MC cause is pain. Pregnancy with IUD insitu Mostly abort, Continue- Thread not visible, sepsis. Thread visible pull out.

15. ORAL CONTRACEPTIVE HORMONAL : combined hormonal contraceptive progesterone only contraceptive pill emergency contraceptive pill injectable hormonal pill NON HORMONAL: Centchroman(chhaya)

16. Combined oral contraception: ethinylestradiol and norethindrone(1) levonorgestrol(2) desogestrol, gestodene(3) Mala N, Mala D containing Levonorgestrel and Ethinyl Estradiol in the dose of 0.15mg and 0.03mg ,21 tablets and 7 tablets of ferrous fumarate 60mg Mechanism of action: Disrupts the Hypothalamus –Pituitary axis. Estrogen inhibits FSH increase. Progesterone inhibits LH surge

17. ADVERSE EFFECTS OF OCPs Metabolic Cardiovascular Carcinogenic Others Weight gain Atherosclerosis Ca cervix Liver diseases Obesity Thromboembolism Ca Breast Slight inhibition of lactation Hypertension Dvt Hepatocellular Ca Dysplipidemia Stroke Coronary heart disease Benefits Regularisation of MC Decreases BBD, fibroadenoma Decreases Ca ovary,endometrium,ovarian cyst Decreased PID Decreases Anaemia

18. CONTRAINDICATION ABSOLUTE RELATIVE Ca breast, Genital cancers Age>40yrs Pregnancy Smoking, age >35yrs Severe liver disease Diabetes, gall stones DVT, Thromboembolism Epilepsy, migraine Cardiac anomalies Congenital hyperlipedmia Undiagnosed vaginal bleed

19. INJECTABLE METHOD OF CONTRACEPTION Progesterone only injectables:DMPA (depot medroxy progesterone acetate) 150mg mg IM 3 months>35yrs old female NET- EN( Norethisterone) 200mg, 2 monthly Depo Sub Q Provera 104(Subcutaneous) Antara Program 150mg MPA, 3 monthly Contraindication: i)Pregnancy ii)Undiagnosed vaginal bleed iii) Ca cervix iv)Active thrombophlebitis/ thromboembolic disoders.

20. NON HORMONAL ORAL CONTRACEPTION Chhaya( Centchroman): non steroidal, non carcinogenic, non teratogenic pill is a selective esterogen receptor modulator, 30mg of methoxychroman hydrochloride, main chemical for action is ormeloxifene Mechanism:Increased the movement of ovum, increases the rate of maturation and inhibits for implantation Dose:twice weekly for three months then once weekly till it require. Contraindication: PCOD, Lactation, Hepatic disease, Cervical hyperplasia

21. IMPLANTS: Sub dermal : Norplant , six silastic capsules containing 35 mg each of levonorgesterol. Norplant (R)- 2. two small rods, easy to remove and insert POST COITAL/EMERGENCY CONTRACEPTION: IUD within 5 days of unprotected sex. LNG- 1.5 mg single dose with 72hrs Mifepristone(RU- 486)- 10mg within 72hrs GOSSYPOL: Male contraceptive, Inhibition of spermatogenesis, cotton seed. Side effect: Azoospermia

22. PERMANENT METHOD: TUBECTOMY: Minilap procedure,incision 2.5 to 3 cms under local anesthesia, mass sterilization. VASECTOMY: NSV, funded by UDFPA, complication like pain, local infection,Hematoma, sperm granules, spontaneous recanalization failure rate 0.15 /HWY. They should use alternate contraception for 8- 9 weeks or 30 ejaculation. ESSURE: a microfilament stent is inserted into fallopian tube, blockage is created.

23. SOCIAL WELFARE MEASURES AND INITIATIVES TO CONTROL POPULATION MEASURES REQUIRED i) Raising age at marriage ii) Increases in literacy level iii)Reduce poverty iv)Women empowernment v) Raising standard of living

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