Lecture 5 family planning

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Lecture 5 family planning

  1. 1. 11 Family PlanningFamily Planning Lecture 5Lecture 5 March, 2012March, 2012 Addis Ababa UniversityAddis Ababa University
  2. 2. 22 Learning objectivesLearning objectives  At the end of this class the students will beAt the end of this class the students will be able to:able to:  Explain the concepts & principles of FPExplain the concepts & principles of FP  Describe theDescribe the RationaleRationale & Benefits of F& Benefits of FPP  Familiar with all Family planning methodsFamiliar with all Family planning methods  State Family planning CounsellingState Family planning Counselling  Identify FP Delivery Strategies & BarriersIdentify FP Delivery Strategies & Barriers
  3. 3. 33 ContentsContents  Concepts & principles of FPConcepts & principles of FP  RationaleRationale & Benefits of F& Benefits of FPP  Family planning methodsFamily planning methods  Family planning CounsellingFamily planning Counselling  FP Delivery Strategies & BarriersFP Delivery Strategies & Barriers
  4. 4. 44 Concepts and principles of FPConcepts and principles of FP  What is family?What is family?  What is planning?What is planning?  What is family planningWhat is family planning
  5. 5. 55 Concepts….Concepts….  FamilyFamily  Any combination of two or more persons who areAny combination of two or more persons who are bound together over timebound together over time  Mutual consent, Birth and/or adoption or placementMutual consent, Birth and/or adoption or placement  Together, assume responsibilities for variantTogether, assume responsibilities for variant combinations of some of functions:combinations of some of functions:  Physical maintenance and care of group membersPhysical maintenance and care of group members  Addition of new members through procreation or adoptionAddition of new members through procreation or adoption  Socialization of childrenSocialization of children  Social control of membersSocial control of members  Production, consumption, distribution of goods and services,Production, consumption, distribution of goods and services,  Affective nurturance — loveAffective nurturance — love
  6. 6. 66 Concepts….Concepts….  Family planning:Family planning: Refers to the use ofRefers to the use of various methods ofvarious methods of fertility controlfertility control that will help individuals orthat will help individuals or couples to have thecouples to have the number of children theynumber of children they wantwant when they want them in order to assurewhen they want them in order to assure the well being of children and the parents.the well being of children and the parents.
  7. 7. 77 Concepts….Concepts…. Concepts in the definitionConcepts in the definition ::  Prevent unwanted pregnancy & have whenPrevent unwanted pregnancy & have when neededneeded  Deciding on number of childrenDeciding on number of children  Child spacingChild spacing  Matching the No. of children they desire to haveMatching the No. of children they desire to have with their economic capacitywith their economic capacity  Enables individuals and couples to determineEnables individuals and couples to determine the number and spacingthe number and spacing  It is a recognizedIt is a recognized basic human rightbasic human right..
  8. 8. 88 Principles of family planningPrinciples of family planning  Individuals should decide freely the number and spacingIndividuals should decide freely the number and spacing of their childrenof their children  Individuals/couples have the right to information &Individuals/couples have the right to information & means to exercise this choice.means to exercise this choice.  Women and men should have access to the widestWomen and men should have access to the widest possible range of safe and effective family planningpossible range of safe and effective family planning  Family planning programs should cater for all peopleFamily planning programs should cater for all people who may be sexually activewho may be sexually active  Improving the Quality of care in family planningImproving the Quality of care in family planning
  9. 9. 99 Benefits of family planningBenefits of family planning To individuals:To individuals:  Improved maternal and infant healthImproved maternal and infant health  Expanded opportunities for women’sExpanded opportunities for women’s education, employment and socialeducation, employment and social participation;participation;  Reduced exposure to health risks; andReduced exposure to health risks; and  Reduced resource to abortionReduced resource to abortion
  10. 10. 1010 Benefits…Benefits… To families:To families:  Reduced competition & dilution ofReduced competition & dilution of resources;resources;  Reductions in household poverty; andReductions in household poverty; and  More possibility for shared decision-More possibility for shared decision- makingmaking
  11. 11. 1111 Benefits….Benefits…. To the society:To the society:  Accelerated demographic transition;Accelerated demographic transition;  Opportunity to use the “demographicOpportunity to use the “demographic bonus” to speed economic dev’tbonus” to speed economic dev’t
  12. 12. 1212 Rationale for family planningRationale for family planning 1.1. Demographic rationaleDemographic rationale  The main intention of FP (1960s-1970s)  Reducing high fertility rates and slowing population growth rate  High fertility and rapid population growth had negative effect on:  Standards of living & human welfareStandards of living & human welfare  Economic productivityEconomic productivity  Natural resourcesNatural resources  EnvironmentEnvironment
  13. 13. 1313 Rationale…Rationale… 2. Health rationale2. Health rationale  Emphasized in 1980s  Reduces the consequences of high fertility on mothers and children  Closely spaced births causes high infant & child morbidity & mortality  Decreases MMR  FP could reduce MM by >=20%  Prevents unwanted pregnancies & its effects including abortion
  14. 14. 1414 Rationale…Rationale…  Reduces the occurrence of low birth weight, infant malnutrition and mortality rates  Birth intervals of at least 3 years reduce infant mortality by up to 50%  Empower couples to determine their family size and delay having a child.  Fewer children are better able to provide them with enough food, clothing, housing and schooling.  Non contraceptive benefitsNon contraceptive benefits  Prevents STIs including AIDS, cancersPrevents STIs including AIDS, cancers  Protect menstrual problems- cramp, bleeding,Protect menstrual problems- cramp, bleeding, anemiaanemia
  15. 15. 1515 Rationale…Rationale… 3. Human rights rationale3. Human rights rationale  Emphasized in 1990s (ICPD)Emphasized in 1990s (ICPD)  Individuals & couples have a right toIndividuals & couples have a right to control reproductive decisions includingcontrol reproductive decisions including family size and timing of birth.family size and timing of birth.
  16. 16. 1616 History of family planningHistory of family planning  Contraceptives have been used in oneContraceptives have been used in one form or another for thousands of yearsform or another for thousands of years  But,But,  Effectiveness ?Effectiveness ?  Safety ?Safety ?
  17. 17. 1717 History …History …  Traditional methodsTraditional methods  Chinese women drank drink lead & mercury to controlChinese women drank drink lead & mercury to control fertility- often cause sterility & deathfertility- often cause sterility & death  Herbs, Olive oil, ginger, tobacco juices- were frequentlyHerbs, Olive oil, ginger, tobacco juices- were frequently smeared on or around the vagina to kill semensmeared on or around the vagina to kill semen  Greek women used to jump backward seven times afterGreek women used to jump backward seven times after intercourse.intercourse.  French prostitutes had been using douches since 1600French prostitutes had been using douches since 1600  As recently as the 1990s, teens in Australia have usedAs recently as the 1990s, teens in Australia have used candy bar wrappers as condomscandy bar wrappers as condoms
  18. 18. 1818 History…History…  Modern methodsModern methods  Planned ParenthoodPlanned Parenthood is very proud of theis very proud of the historical role it continues to play in making safehistorical role it continues to play in making safe and effective family planningand effective family planning  InIn 1916- Margaret Sanger1916- Margaret Sanger opened the first birthopened the first birth control clinic in Americacontrol clinic in America  In 1950, Planned Parenthood underwrote theIn 1950, Planned Parenthood underwrote the initial search for a best oral contraceptiveinitial search for a best oral contraceptive  Most of the modern contraceptive methods wereMost of the modern contraceptive methods were introduced during the 2nd half of 20thCintroduced during the 2nd half of 20thC
  19. 19. Family planning methodsFamily planning methods  Methods or ways by which unwanted pregnancy isMethods or ways by which unwanted pregnancy is preventedprevented  Not all these methods are equallyNot all these methods are equally effectiveeffective oror acceptableacceptable  Therefore,Therefore, individualization of contraceptive choiceindividualization of contraceptive choice isis important for successful prevention of unwantedimportant for successful prevention of unwanted pregnancypregnancy  Two broad categoriesTwo broad categories 1.1. Traditional/Natural Contraceptive MethodsTraditional/Natural Contraceptive Methods • uses the body’s natural physiological changes anduses the body’s natural physiological changes and symptoms to identify the fertile and infertile phases ofsymptoms to identify the fertile and infertile phases of menstrual cycle.menstrual cycle. 2.2. Modern Contraceptive MethodsModern Contraceptive Methods
  20. 20. 1.1. Traditional/Natural Contraceptive MethodsTraditional/Natural Contraceptive Methods  Periodic Abstinence (Fertility awarenessPeriodic Abstinence (Fertility awareness methods)methods)  Avoiding sexual intercourse during fertile phaseAvoiding sexual intercourse during fertile phase  Requires couple’s ability, motivation, disciplineRequires couple’s ability, motivation, discipline  BBT, Cervical Mucus, Calendar/RhythmBBT, Cervical Mucus, Calendar/Rhythm  Lactational Amenorrhea Method (LAM)Lactational Amenorrhea Method (LAM)  Contraceptive method based on breastfeedingContraceptive method based on breastfeeding  Effective for up to 6 months after childbirthEffective for up to 6 months after childbirth  Needs exclusive breast-feedingNeeds exclusive breast-feeding  Three criteria- no mens returned, exclusive BF, less than 6Three criteria- no mens returned, exclusive BF, less than 6 monthsmonths  Withdrawal (Coitus interrupts)Withdrawal (Coitus interrupts)  Ejaculation outside the vaginaEjaculation outside the vagina  High failure rate – pre-ejaculation spermHigh failure rate – pre-ejaculation sperm Methods…Methods…
  21. 21. 2.2. Modern Contraceptive MethodsModern Contraceptive Methods  Hormonal MethodsHormonal Methods  PillsPills • Combined Oral ContraceptivesCombined Oral Contraceptives (COCs)(COCs) • Progestin Only PillsProgestin Only Pills (PoP)(PoP)  Subdermal ImplantsSubdermal Implants (Progestrone only(Progestrone only :: • Norplant Implants- six rodes (5- 7 years protection)Norplant Implants- six rodes (5- 7 years protection) • Jadelle- two rods (5 years protection)Jadelle- two rods (5 years protection) • Implanon- single rod (3 years protection)Implanon- single rod (3 years protection)  Injectables (Progestrone only)-Injectables (Progestrone only)- • DMPA (DMPA (depot medroxy progesterone acetate or Depo-depot medroxy progesterone acetate or Depo- Provera)- 3 months protectionProvera)- 3 months protection • Noristerat (NET-EN- norethisterone enanthateNoristerat (NET-EN- norethisterone enanthate )) –– 2month protection2month protection Methods…Methods…
  22. 22. Methods…Methods…  Intrauterine Contraceptive DevicesIntrauterine Contraceptive Devices (IUCD) –(IUCD) – LoopLoop  Barrier MethodsBarrier Methods • Condoms (male and female)Condoms (male and female) • DiaphragmDiaphragm • Spermicidal: Creams, jelly, foaming tabletsSpermicidal: Creams, jelly, foaming tablets 2222
  23. 23.  Emergency ContraceptionEmergency Contraception  used as an emergency procedure to preventused as an emergency procedure to prevent unintended pregnancy due to unprotected sexunintended pregnancy due to unprotected sex  Prevents aboutPrevents about 75%75% of pregnanciesof pregnancies  Types:Types:  Emergency contraceptive pills (ECPs) – within 5 days afterEmergency contraceptive pills (ECPs) – within 5 days after unprotected sexual intercourseunprotected sexual intercourse  Copper releasing IUDs – up to 5 daysCopper releasing IUDs – up to 5 days  Voluntary Surgical ContraceptionVoluntary Surgical Contraception  Female Sterilization (Tubaligation)Female Sterilization (Tubaligation)  Male Sterilization (Vasectomy)Male Sterilization (Vasectomy) Modern Methods…Modern Methods…
  24. 24. 2424 Family planning CounsellingFamily planning Counselling  Providing good information to clients aboutProviding good information to clients about proper contraceptive use and about risks andproper contraceptive use and about risks and benefits is a major responsibility for programs.benefits is a major responsibility for programs.  Good counselling helps clients choose and useGood counselling helps clients choose and use family planning methods that suit them.family planning methods that suit them.  Clients differ, their situations differ, and they needClients differ, their situations differ, and they need different kinds of help.different kinds of help.  The best counselling must be tailored to theThe best counselling must be tailored to the individual client.individual client.
  25. 25. 2525 FP counselling…FP counselling…  The elements of good counselling can beThe elements of good counselling can be summarized with acronymsummarized with acronym GATHERGATHER (Gallen(Gallen and Lettenmaier 1987).and Lettenmaier 1987).  That is the counsellor should:That is the counsellor should: G -G - Greet clients in a polite and friendly mannerGreet clients in a polite and friendly manner A -A - Ask them about their family planning needsAsk them about their family planning needs T -T - Tell them about method choicesTell them about method choices HH -- Help clients decide on the methods they wantHelp clients decide on the methods they want E -E - Explain how to use the chosen methodsExplain how to use the chosen methods R -R - Remind clients the need for return visitsRemind clients the need for return visits
  26. 26. 2626 FP Delivery StrategiesFP Delivery Strategies  The most common service deliveryThe most common service delivery strategies:strategies: 1.1. Clinic Based ServicesClinic Based Services  Methods that are more medicallyMethods that are more medically complex,complex,  IUDs, hormonal implants, injectables, andIUDs, hormonal implants, injectables, and sterilization.sterilization.
  27. 27. 2727 Strategies….Strategies…. 2.2. Community Based DistributionCommunity Based Distribution (CBD)(CBD)  Condoms, pills and spermicides & ifCondoms, pills and spermicides & if trained can give injectablestrained can give injectables
  28. 28. 2828 Strategies….Strategies…. 3.3. Commercial Retail Sales (SocialCommercial Retail Sales (Social marketing)marketing)  Pills, condoms, and spremicides are soldPills, condoms, and spremicides are sold at reduced, subsidized prices inat reduced, subsidized prices in  Pharmacies, stores, shops, bars and arePharmacies, stores, shops, bars and are advertised on the mass media.advertised on the mass media.
  29. 29. 2929 Strategies….Strategies…. iv.iv. Other ApproachesOther Approaches  WorkplaceWorkplace  Post partum in health facilitiesPost partum in health facilities  Private physicians.Private physicians.
  30. 30. 3030 Barriers to FP UseBarriers to FP Use  In spite of significant increase in the prevalence ofIn spite of significant increase in the prevalence of contraceptive use around the world there remaincontraceptive use around the world there remain important barriers to even wider use of contraceptives.important barriers to even wider use of contraceptives. 1.1. Limited access to and availability of FP products andLimited access to and availability of FP products and servicesservices 2.2. Limited alternative delivery approach (no method mix)Limited alternative delivery approach (no method mix) 3.3. Limited resources of skilled providersLimited resources of skilled providers 4.4. Cultural and religious barriers including genderCultural and religious barriers including gender issues/issues/Male dominance and oppositionMale dominance and opposition

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