Includes all the decisions an individual or couple make about having children.
As possible, pregnancies should be intended.
If unintended: mother less likely to breastfeed, less careful to protect fetus, greatest risk for low birth weight, dying in first year, being abused, undernourished .
THE FAMILY PLANNING PROGRAM
In 2003 – 84 million pop. Expected to grow annually at 2.36%. So: pop. expected to double in 29 years.
Fertility rate: 3.5 children/woman= (2.5 desired)
Contraceptive prevalence rate: 15.4% (1996) to 48.9%(NDHS,2003)
Every year = 3 to 4 million women getting pregnant
NDHS-National Demographic and Health Survey
According to NDHS:
44% = got pregnant 1 st child at ages 20-24 yrs. 6.1% = ages 15-19
High fertility rate coincides with low contraceptive prevalence rate
= 47.3% among all Filipino women(15-49 yrs old)
= 70.6% among married women
= Highest % using contraceptives*: 35-39 age group
= Lowest % using contraceptives*: 15-19 age group
* Any method
Overall Goal of Family Planning Is to provide Universal access to family planning information & services wherever & whenever these are needed .
Family Planning aims to contribute to:
Reduce infant deaths
Laws Governing Population and Family Planning
Presidential Decree No. 791
– the revised Population Act defines the objectives, duties and functions of the POPCOM. Among others it empowers nurses and midwives to provide, dispense and administer acceptable methods of contraception after having training and authorization by the POPCOM in consultation with the appropriate licensing bodies
EO No. 2009. The Family Code of the Philippines.
Things to consider about contraceptive methods :
Ability to use a method correctly
How the method will affect sexual enjoyment
Status of a couple’s relationship
Free of side effects
Easy to use and acceptable to both user and sexual partner
Free of effects on future pregnancies
I. Natural Family Planning methods
No introduction of chemical of foreign material into the body.
Practice maybe due to religious belief, “natural” way is best for them.
Effectiveness varies greatly, depends on couples ability to refrain from having sex on fertile days.
Failure Rates: about 25%
Poses no risk to fetus
Natural family planning (NFP)
term referring to the family planning methods approved by the Roman Catholic Church .
In accordance with the requirements for sexual behavior maintained by this church, NFP forbids the use of contraception ,
as well as all orgasmic acts outside of those achieved through unprotected vaginal intercourse with the user's spouse.
From Wikepedia. The free encyclopedia
NATURAL FAMILY PLANNING
Rhythm (Calendar) method
Basal Body Temperature (BBT)
Ovulation or Cervical Mucus (Billings Method)
Lactation Amenorrhea Method
A. RHYTHM (Calendar) METHOD
Abstaining from coitus on the days of menstrual cycle when a woman is most likely to conceive (3 or 4 days before until 3 or 4 days after ovulation).
Woman keeps a diary of 6 menstrual cycles
An illustration of the Standard Days Method. This method may be used by women whose menstrual cycles are always between 26 and 32 days in length Background B.C. typenatural birth control First use1999 (Standard Days) 1930 (Knaus-Ogino) Ancient ( ad hoc methods)
-18 from shortest cycle documented.
-11 from longest cycle
ans. = represents her last fertile day.
If she has 6 menstrual cycles ranging from 25 to 29 days, fertile period would be from 7 th day (25-18) to the 18 th day (29-11).
To avoid pregnancy, avoid coitus/use contraceptive during those days.
B. Basal Body Temperature (BBT)
Identifying fertile and infertile period of a woman’s cycle by daily taking and recording of the rise in body temperature during and after ovulation.
Just before ovulation, a woman’s BBT falls about 0.5 ◦F. At time of ovulation, her BBT rises a full degree (influence of progesterone).
This higher level is maintained the rest of menstrual cycle.
How: Woman takes her temp each morning immediately after waking, before she undertake any activity.
She has ovulated, slight drip in temp followed by
Usually combined with calendar method
Ideal Failure rate: 9%
an example of a chart completed by a woman using BBT, cervical secretions, cervical position and feel, and other minor indicators.
C. Cervical Mucus/Billings/Ovulation
Use changes in cervical mucus with ovulation
Woman: must be conscientious in assessing her vaginal secretions.
Ideal Failure rate: 3%
Would your lifestyle be enhanced if you could: Manage your fertility naturally ? Achieve pregnancy naturally ? While breastfeeding, regulate fertility naturally ? Manage menopause naturally ? The Billings Ovulation Method can assist you with all these areas of your life.
Before ovulation: - thick and does not stretch With ovulation (peak day): - copious, thin, watery, transparent . Feels slippery and stretches at least 1 inch before the strand breaks = property known as “spinnbarkeit”. These are Fertile days
C. Symptothermal Method
Combines the cervical mucus and BBT methods
Watches temp daily and analyzes cervical mucus daily.
Couple must abstain from intercourse until 3 days after rise in temp or 4 th day after peak of mucus change.
More effective than BBT or CM method alone
Ideal Failure rate: 2%
D. Ovulation Awareness
Use an OTC ovulation detection kit.
These kits detect the midcycle surge of Luteinizing Hormone (LH) that can be detected in urine 12 to 24 hours before ovulation.
98% to 100% accurate in predicting ovulation
BeSure ™ Ovulation Prediction Test Kits Human LH Hormone Specific Lateral Flow Cassette Type Test All inclusive, 5 day ovulation prediction test kits. One-step, easy to perform, rapid developing, urine based test cassettes for identification of the increased levels of the human luteinizing hormone (LH) immediately proceeding the ovulatory period within the female reproductive cycle.
E. Lactation Amenorrhea Method
Temporary introductory postpartum method of postponing pregnancy based on physiological infertility experienced by Breast Feeding women
Universally available to all postpartum breastfeeding women.
No other FP commodities required
Contributes to improve maternal and child health and nutrition
Only temporary, effective only up to 6 months postpartum
Effectiveness may decrease if mother and child are separated for extended periods of time (working mother).
Difficult to maintain (up to 6 mos.)due to variety of social circumstances
Efficacy and duration of LAM are enhanced with more intense breastfeeding patterns, especially during the earlier weeks and months
F. COITUS INTERRUPTUS
One of oldest known methods of contraception
Couple proceeds with coitus until the moment of ejaculation.
Then the man withdraws & spermatozoa are emitted outside the vagina
Offers little protection
Adolescent boys may lack the control or experience to use the method effectively
II. BARRIER METHODS
Placement of a chemical or other barrier between the cervix and advancing sperm so that sperm cannot enter the uterus or fallopian tubes & fertilize the ovum.
Major advantage: lack hormonal side effects associated with COCs
Failure rates: higher & sexual enjoyment may be lessened.
Condom or “rubber” – men
Vagina pouch – women
Vaginal sponge with spermicidal agent
A. Male Condom
Condom – a latex rubber or synthetic sheath, placed over the erect penis before coitus begins.
Spermatozoa are deposited in the tip of condom
“ male-responsibility” birth control measures
Latex condoms: potential prevention against spread of STIs, major part of fight to prevent infection with Human immunodeficiency virus (HIV).
B. FEMALE CONDOMS
Latex sheaths made of polyurethane and prelubricated with a spermicide.
Inner ring (closed end)= covers cervix; Outer ring (open end)= rests against vaginal opening
May be inserted any time before sexual activity begins; then remove after ejaculation occurs.
Like male condoms, one time use only. Difficult to use
Offer protection against both conception and STI
OTC but more expensive than male condoms
The female condom, like the male condom, is a barrier contraceptive made of latex or polyurethane. The condom has a ring on each end. The ring that is placed inside the vagina fits over the cervix, while the other ring, which is open, rests outside of the vagina and covers the vulva. The female condom is sold over-the-counter.
Circular rubber disk placed over cervix before intercourse. Usually with spermicidal gel
Fitted initially by physician, nurse or midwife
Kept in place at least 6 hrs after coitus.
Should not stay for at least 24 hrs- may cause cervical inflammation (erosion) or urethral irritation
How to use:
Inserted into the vagina (rim coated with spermicidal gel) by sliding it along the posterior wall & pressing it up against the cervix.
Check with a finger after insertion to be certain that its fitted well by palpating the cervical os through diaphragm.
Remove by inserting a finger through diaphragm and loosening by pressing against the anterior rim and then withdrawing it vaginally.
After use, washes in mild soap & water, dries gently & stores in its protective case. May last for 2 to 3 years.
History of recurrent UTIs
If uterus is prolapsed, retroflexed, or anteflexed
With acute cervicitis
Allergy to rubber or spermicides
History of Toxic Shock Syndrome
a staphylococcal infection introduced through the vagina
How to prevent Toxic shock Syndrome
Wash hands thoroughly with soap & water before insertion or removal of a diaphragm or cervical cap
Do not use diaphragm or a cervical cap during your menstrual period
Do not leave the diaphragm in place longer than 24 hours
Be aware of the symptoms of TSS, such as elevated temperature, diarrhea, vomiting, muscle aches and a sunburn-like rash.
If symptoms of TSS should occur, immediately remove the diaphragm & telephone your health care provider
D. CERVICAL CAPS
Made of soft rubber, shaped like a thimble, and fit snugly over the uterine cervix
Failure rate as high as 32%
An abnormally short or long cervix
A previous abnormal Pap smear
A history of TSS
An allergy to latex or spermicide
A history of PID, cervicitis, or papilloma virus infection
A history of cervical cancer
Undiagnosed vaginal bleeding
Cervical cap Oves brand cervical cap Position of cervical cap
E. Vaginally Inserted Spermicidal Products
Cause death to spermatozoa before they enter the cervix
Also change the vaginal pH to a strong acid level (not conducive to sperm survival)
Purchased w/o prescription
Increase other methods effectiveness
Available in various preparations: gels, creams, sponges, films, foams & suppositories
How to use:
Gels or creams are inserted into the vagina before coitus with an applicator.
To be effective: must be 1 hr before coitus, should not douche for 6 hrs after, to ensure that the agent has completed its spermicidal action.
Contraindicated: with acute cervicitis, and inconveniency
Adolescent usually uses: no parental permission or extensive expense
The Pill or COCs (combined oral contraceptives)
With varying amounts of synthetic estrogen combined with a small amount of synthetic progesterone (progestin)
Estrogen – acts on FSH and LH thus suppresses ovulation
Progesterone – cause a decrease in the permeability of cervical mucus thereby limiting sperm motility and access to ova.
Also interferes with tubal transport and endometrial proliferation .
fixed doses of both estrogen and progesterone throughout 21 day cycle
constant amount of estrogen throughout cycle BUT increased amount of progestin during the last 11 days .
Varies level of estrogen and progesterone. Closely mimic natural cycle, reducing breakthrough bleeding (bleeding outside the normal menstrual flow)
COCs must be prescribed by physician after pelvic examination and a Papanicolaou (Pap) smear.
Packed 21 or 28 pills to a container
28 pills ( 21 active pills/7 placebo pills)
Used correctly: 99.7% effective
Typical failure rate: 8%
Decreases incidence of the ff conditions:
Dysmenorrhea, due to lack o ovulation
Premenstrual dysphoric syndrome, because of increase progesterone levels
Iron deficiency anemia, due to reduced amount of menstrual flow
Acute pelvic inflammatory disease (PID) and the resulting tubal scarring
Endometrial and ovarian cancer and ovarian cysts
Fibrocystic breast disease
Possibly osteoporosis and uterine myomata(fibroid uterine tumors)
May have some metabolic effects: estrogen interferes with lipid metabolism, concentration of low-density lipoproteins (LDL) & HDL level
Main side effects:
Breakthrough bleeding (spotting outside the menstrual period)
Monilial Vaginal infections
Contraindications to Oral Contraceptive Use
Breast-feeding & less than 6 weeks postpartum
Age 35 years or older & smoking 15 or more cigarettes per day
Multiple risk factors for arterial cardiovascular disease, such as older age, smoking, diabetes, hypertension
Elevated blood pressure of 160 mm Hg systolic or above or 100 mm Hg diastolic or above
Current or history of deep vein thrombosis or pulmonary embolism
Major surgery that requires prolonged immobilization
Current or history of ischemic heart disease
Complicated valvular heart disease
Migraine with focal neurologic symptoms
Migraine w/o focal neurologic symptoms and age 35 years or older
Current breast cancer
Diabetes with nephropathy, retinopathy, neuropathy, vascular disease, or diabetes of more than 20 years duration
Oral contraceptives containing only progesterone.
Ovulation may occur but progestin halts endometrium to fully develop: implantation will not occur
Taken everyday, even through menstrual flow
May be taken during breast feeding
Transdermal patches that continuously release a combination of estrogen & progesterone
Approved in US FDA in 2001
Applied once a week for 3 weeks, a week when patch free a menstrual flow will occur
Effeciency equals COC, maybe less on women who weigh more than 90 kg
Advantages: increase adherence, easy concealment
Disadvantage: Mild breast discomfort & irritation at application site may occur
A silicone ring that surrounds the cervix & continuously release a combination of estrogen & progesterone
Hormones are absorbed directly by the mucous membrane of vagina, avoiding a “first-pass” through liver (as happens with COCs)
Also approved in 2001 by USA FDA
Ring is inserted by the woman and left in place for 3 weeks, then remove for 1 week. Menstrual bleeding occurs during ring-free week.
Efficiency is 99.7%
Emergency PostCoital Contraception
“ morning-after pills”
With high level of estrogen interfering with progesterone production, prohibiting good implantation
Eg. Yuzpe Regimen (Preven) – specially designed particularly after a sexual assault has occurred
Effectiveness: between 75% & 85%
Norplant is a contraceptive method 6 non-biodegradable Silastic Implants
Plastic, flexible rods are implanted under the skin of a woman's upper arm. Rods contain a synthetic progesterone hormone, released in small doses continuously over a 5 year period.
Prevents pregnancy by: inhibiting ovulation, cervical mucus becomes thicker & harder to be penetrated by sperm, & making the lining of the uterus unreceptive to a fertilized egg.
Disadvantage: Expensive (ave. $500-$750)
Advantage: long-term, reversible, effective & reliable alternative to COCs & their estrogen-related side effects
Sexual enjoyment not inhibited as with condoms, spermicides, diaphragms & natural family planning methods