―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‖.
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.
1. The United Nations Conference on Human Rights
at Teheran in 1968 recognized family planning as
a basic human right.
2. The Bucharest Conference on the World
Population held in August 1974 endorsed the same
'Plan of Action' that
"all couples and individuals have the basic
human right to decide freely and responsibly the
number and spacing of their children and to have
the information, education, and means to do so".
3.The World Conference of the International
Women's Year in 1975 also declared -
―The right of women to decide freely and
responsibly on the number and spacing of their
children and to have access to the information
and means to enable them to exercise that right‖.
SCOPE OF FAMILY PLANNING
(1)The proper spacing and limitation of births.
(2) Advice on sterility,
(3)Education for parenthood.
(4) Sex education,
(5) Screening for pathological conditions related
(7) Premarital consultation and examination,
(8) Carrying out pregnancy tests,
(9) Marriage counseling,
(10) The preparation of couples for the arrival of their
(11) Providing services for unmarried mothers,
(12) Teaching home economics and nutrition,
(13) Providing adoption services
HEALTH ASPECTS OF
Maternal mortality, morbidity of women
of child bearing age, nutritional status (weight
changes,haemoglobin level, etc.) preventable
complications of pregnancy and abortion.
2. FOETAL HEALTH
Foetal mortality (early and late
foetal death);abnormal development.
3.INFANT AND CHILD HEALTH
- Neonatal, infant and
pre- school mortality ,
- Health of the infant at birth
- Vulnerability to diseases.
THE WELFARE CONCEPT
Family planning is associated with numerous
misconceptions - one of them is its strong
association in minds of people with sterilization.
The recognition of its welfare concept came only
a decade and half after its inception, when it was
named Family Welfare Programme.
The concept of welfare is very comprehensive
and basically related to quality of life.
SMALL - FAMILY NORM
The objective of the Family Welfare Programme
in India is that people should adopt the "small
family norm" to stabilize the country's population
at the level of some 1,533million by the year 2050
In the 1970s, - do ya teen bas.
In the 1980s - 2 - child norm.
The current emphasis is on three themes:
"Sons or Daughters – two will do";
"Second child after 3 years", and
Small differences in the family size will make big
differences in the birth rate.
A significant achievement of the Family welfare
Programme in India has been the decline in the
fertility from 6.4 in 1950s to 2.6 in 2010.
The national target to achieve a Net Reproduction
Rate of 1 by the gear 2006 which is equivalent to
attaining approximately the 2-child norm.
A currently married couple wherein the wife is in
the reproductive age, which is generally assumed
to lie between the ages of 15 - 45.
There will be at least 150 to 180 such couples per
1000 population in India.
20 % of eligible couples - age group 15- 24 yrs
On an average 2.5 million couples are joining
the reproductive age group every year.
The "Eligible Couple Register" is a basic
document for organizing family planning work.
Couples who have had 2-3 living children, and
family planning was largely directed to such
The definition of a target couple has been
gradually enlarged to include families with one
child or even newly married couples with a view
to develop acceptance of the idea of family
planning from the earliest possible stage.
In effect, the term target couple has lost its
to higher order
of birth (3&
above) = 50.3
= 45.4 million
TOTAL ECs = 197.4 million
As on march 2010
COUPLE PROTECTION RATE
An indicator of the prevalence of
contraceptive practice in the community.
It is defined as ―the per cent of eligible
couples effectively protected against childbirth
by one or the other approved methods of
Demographers are of the view that the
demographic goal of NRR : 1 can be achieved
only if the CPR exceeds 60 per cent.
National Population Policy was to attain a CPR
of 42 per cent by 1990 , and 60 per cent by the
During 2010-2011, the total number of family
planning acceptors by different methods .
Sterilization- 5 million
Vasectomy- 0.219 million
Tubectomy- 4.78 million
IUD insertion- 5.6 million
Condom users- 16 million
Oral pill users- 8.3 million
However about 60 per cent eligible couples
are still unprotected against conception.
Punjab, Gujarat, Maharashtra, Karnataka,
Haryana and Tamil Nadu etc – ahead
Bihar, Uttar Pradesh, Assam, Rajasthan, West
Bengal, Jammu and Kashmir etc - low
National population policies intended to
decrease the birth rate or growth rate.
In April 1976 India formed its first
National Population Policy.
Legal minimum age of marriage was
increased from 15 to 18 for girls and from
18 to 21 for boys
IMMEDIATE OBJECTIVE :
– To address the unmet needs for contraception,
– Health care infrastructure and health personnel and
– To provide integrated service delivery for basic reproductive
and child health care.
MEDIUM TERM OBJECTIVE:
– To bring the TFR to replacement level by 2010 through
vigorous implementation of inter sectoral operational
LONG TERM OBJECTIVE:
– Achieve a stable population by 2045 at a level consistent with
requirement of sustainable economic growth, social
development and environmental protection.
NATIONAL SOCIO -
DEMOGRAPHIC GOALS FOR 2010
1. Address the unmet needs for basic RCH services, supplies and infrastructure.
2. Make school education up to age 14 years free and compulsory, and reduce drop
outs rate from primary and secondary school levels to below 20 percent for both
boys and girls.
3. Reduce IMR to 30/1000 live births.
4. Reduce maternal mortality ratio (MMR) to less than 100 per 1000 live births.
5. Achieve universal immunization of children against all Vaccine Preventable
6. Promote delayed marriage for girls, at age not less than 18,and preferable after 20
7. Achieve 80% institutional delivery and 100% by trained personnels
8. Achieve universal access to information/ counseling services for fertility
regulation and contraceptive with wide basket of choices.
9. Achieve 100% registration of births, deaths, marriage, and pregnancy.
10. Containment of AIDS, and greater integration between the management
of AIDS and STD.
11. Prevention and control of communicable diseases.
12. Integration of Indian system of medicine in provision of RCH services,
and in reaching out to households.
13. Promote small family norm to achieve replacement level of Total
Fertility Rate 2.1.
14. Bring about convergence in implementation of related social sector
programmes so that family welfare become people centered programme.
Preventive methods to help women avoid
Reversible Simple to administer
Independent of coitus
Long lasting to avoid frequent administration
Requiring little or no medical supervision
The present approach in family planning
programmes is to provide a "cafeteria choice"
that is to offer all methods from which an
individual can choose according to his needs
and wishes and to promote family planning
as a way of life.
The term conventional contraceptives is
used to denote those methods that require
action at the time of sexual
intercourse, e.g., condoms, spermicides, etc.
Classification of contraceptive methods
I. SPACING METHODS
II. TERMINAL METHODS
Mostly made of fine
Silicon used nowdays
to produce semi-
Spermicidal – coated
with nonoxynol 9 on
inner and outer surfaces.
In India, dry condoms are
manufactured and supplied
free of cost by the
government under brand
Simple spacing method
No side effects
Easily available, safe &
Protects against STDs
Chances of slip off and tear off
Failure rate: 2-3/HWY
Woman controlled method
Prevents STDs including HIV/AIDS
Not damaged by oils and other chemicals
Only women who can use diaphragms can use
Failure rate 21% with typical use and 5% with
correct and consistent use
Most common and easiest to fit and use
Thin, nearly hemispherical dome made of
rubber or latex material, with circular,
covered metal spring at periphery (flat type
and coil type)
External diameter of rim is size of
diaphragm – 45 mm diameter rising in steps
of 5 mm to 105mm (most common 60, 65,
70, 75, 80)
Coil spring type (ortho diaphragm mostly
CERVICAL CAP OR CHECK PESSARY
Small dome shaped rubber appliances designed to cover the
Remain in place by suction
Cap must be tailored to fit cervix
Loosely fit caps may be displaced during intercourse
Not suitable if cervix lacerated or irregular in shape
3 or 4 sizes between 22 and 31 mm
Hemispherical, dome shaped rubber or plastic cap
that fits into vaginal vault covering the cervix
Rim is thick but does not contain metal spring
External diameter of rim is size of vault cap, ranging
from 50 to 75 mm in 5mm steps
Correct size – smallest that fits evenly in vaginal vault
Type of cervical cap made of rubber, fairly rigid
String attached for easy removal
Useful in cystocele or mild prolapse where diaphragm
External diameter of rim is size – 45 to 51 mm in
DIAPHRAGM: 18-28% with
typical use and 6% with correct
and consistent use
CAPS: parous women – 30-40%
with typical use 20-26% with
correct and consistent use
nulliparous – 16-20% with
typical use 9% with correct and
No gross medical side effects
Control of pregnancy in hands of woman
Reasonably safe when properly used
Prevent spread of STDs though less effective than condom
Use of spermicidal unacceptable and messy for some
Suitable for intelligent, highly motivated women of middle
or high socioeconomic groups
Allergy to rubber
Infection may occur if used for long time
Urinary tract infection
Occlusive caps do not prevent spread of AIDS
Rarely, toxic shock syndrome
Introduced in 1980s
‗Today‘ most popular
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
Acts for 24 hrs
Failure rate – 9 – 27 per 100 women years
Must be removed and thrown away after 8-24 hrs
May get broken – difficult removal
High pregnancy rate
Toxic shock syndrome
Vaginal dryness, soreness
May damage vaginal epithelium – increase risk of
Non ionic surfactants which alter sperm surface
membrane permeability, resulting in killing of
Developed in late 19th century
Use decreasing due to high failure rate
Types and distribution: spermicidal agents
contain nonoxynol 9. few products contain
octoxynol 9 and menfegol
Cheapest but least effective
Melt at body temperature
Manual insertion high in vagina 10-15 min before
2. Contraceptive creams and jellies
liquefy at lower temperature than most creams so more suitable for women with
3. Foam tablets
effervesce on contact with vaginal moisture
placed deep in vagina close to cervix
more effective than pessaries
Tablets have to be used about 10 min before act and action lasts for 1 hour
Failure rate – 0.3-5 per 100 women years
4. Aerosols or foams
foaming chemical contraceptive creams with butane propellant stored under
pressure that may be released by pressing valve
slightly more effective but more messy
5cm squares of water soluble , semitransparent plastic impregnated with
either placed over glans penis before coitus or high in vagina 3-5 min before
active for 2 hrs
No instructions by doctors or nurses
Easily available and easy to use
No gross medical side effects
Messy to use
Failure rate high when used alone
Can increase spread of HIV infection by
irritating vaginal and cervical mucosa
Failure rate – 21% with typical use and
6% with correct and consistent use.
Eg. Hormonal IUD
Eg. Copper IUD
Eg. Lippe’s loop
First generation iud
They are inert or Nonmedicated devices made
up of polyethylene
Different shapes and sizes
Double ‗S‘ shaped device
Made up polyethylene material
Non toxic, non tissue reactive &
Small amount of Barium Sulphate is also
added for radiological examination
Available in 4 sizes A,B,C &D
Failure rate: 3-5 / HWY 39
Second generation Iud
Made up of metal – copper.
Copper - 7
Copper - T 200
Variants of T device
T copper 220C
T copper 380A
Multi load devices Failure rate: 0.8/HWY
Third generation iud
Hormone releasing IUD
Most commonly used
T shaped device
filled with 38mg of progesterone
Releasing rate 65µg/day.
Effective for 1 yr Failure rate: 0.2 / HWY
Releases 20µg of levonorgesterol.
Effective for 5 yrs
Effective rate 99%
ADVANTAGES OF IUDs:
Safe, Effective, Reversible
High continuation rate
DISADVANTAGES OF IUDs:
Heavy bleeding and pain
Pelvic Inflammatory diseases
May come out accidently if not properly inserted
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 the diameter of
cervical cavity is greatest at this time.
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
Classification of hormonal
Progesterone only pills
Once – a – month
(long acting) pills
Post coital pill
Vaginal Rings8/6/2013 45
In early 1960s –
Oestrogen - 100-200µg and
Progesterone - 10mg
Greater side effects
Oestrogen - 30-35µg and
Progesterone - 0.05-0.15mg.
Taken from 5th to 25th day of menstrual cycle, followed by
a break of 7 days (withdrawal bleeding).
FAILURE RATE: 0.1/HWY
A) MALA-D: (Levonorgestrol 0.15mg + EE 0.03mg)
Packet of 28 tabs. 21 are white and 7 are brown
coloured containing Ferrous Fumarate.(Rs – 3/-)
B) MALA-N : (Levonorgestrol 0.15mg + EE0.03mg)
Packet of 28 tabs.
Mechanism of action:
A) Prevents ovulation
B) Prevents implantation
C) Makes cervical secretions thick
100% effective if taken correctly.
Contraindications to OCP Use
Cancer of breast and Genitals
H/O venous thrombo-
Vascular disease- CAD or
Liver disease ( i.e. Viral
Congenital hyper lipidaemia
Age above 40 yrs.
Smoking and age above 35
HTN with SBP>160, DBP>99
Chronic renal diseases
Epilepsy , Migraine
Hyper lipidaemia LDL>160
DM with secondary
Progesterone only pills
Minipill or Micropill.
Low dosage of progesterone, mainly
Norethisterone (or) Levonorgestrel.
One tab daily throughout the
It is mainly given in older women in
whom combined pills are C/I as in
Mechanism of action:
Makes cervical mucosa thick – action starts in 2-4 hrs last
Decreases the motility of Fallopian tubes.
Prevent pregnancy without preventing ovulation, as
ovulation occurs in 20-30% women.
Smokers above 35 yrs old
Estrogen sensitive women
Higher risk of neoplasia in women taking POP than in
women on Combined Pills
Poor control of cycle.
(a) IUD : WITH IN 5 DAYS
(b) HORMONAL : More often a hormonal
method may be preferable. In India
Levonorgestrel 0.75 mg tablet is approved .(
1Tab-with in 72 hrs)
2 tab-50mcg of EE with in 72 hrs after
intercourse & same dose after 12 hrs.
4 tab-30-35 mcg of EE with in 72 hrs& 4 tab-
after 12 hrs (or) mifepristone 10 mg in 72 hrs
Mechanism of action:
Hypermotility of fallopian tube
Hypermotility of uterus hence no
implantation and fertilization
Nausea and vomiting.
Next period may start earlier or later
Do not protect against STI & HIV
1 % failure rate
The hormones which reduce
sperm count tend to reduce
testosterone levels hence they
affect potency and libido
Cotton seed derivative
Causes azoospermia and severe
Use for 6 months leads to
Once a month (long acting) pill
In this method a long acting
oestrogen (Quinestrol) + short
acting progesterone is given.
But the results are highly
Progesterone only injectables
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
Dose: 200mg IM every 2 months
Both DMPA & NET-EN are given in 1st 5 days
of menstrual cycle.
They are given deep IM in gluteus muscle. 57
New formulation of DMPA (Uniject)
Prefilled, single use syringe
could be particularly
They contain a special
formulation of DMPA, called
DMPA-SC (104 mg).
Short needle meant for
Useful to provide DMPA in
Injections by appropriately
trained community health
workers is safe, effective,
and acceptable. 58
Disruption of normal menses
Undiagnosed uterine bleeding
FAILURE RATE: 0.3/HWY
Containing long-acting progesterone with short action estrogen
25 mg DMPA + 15 mg estradiol cypionate (Cyclofem) and
50 mg NET-EN + 5 mg estrdiol valerate (Mesigyna)
Given once a month and produce a menstruation like pattern.
The trials are currently taking place in India.
Suppression of ovulation
Alteration of cervical and endometrial secretions.
Pregnancy Thrombo embolytic disorders
Cerebrovascular disease Coronary artery disease
Migraine Breast cancer
Sub dermal implants
A flexible plastic single
flexible rod 4cm long x
3 years pregnancy rate 0.7
Reliable long term
Improvement in menorrhagia
Beneficial effect on acne in
No adverse effects on bone
No significant effect on
lipids, haemostasis or liver
Adverse side effects
Bleeding pattern altered:
Weight gain of >10% in 21%
Hormonal ‗nuisance‘ effect
eg breast pain, headache, libido
decrease, dizziness, nausea
Other (<2.5%) alopecia,
depression, change in libido
The Patch (OrthoEvra)
Is a thin & plastic patch
That sticks to the skin.
The sticky part of the patch contains
the hormones: norelgestromin (progestin)
and ethinyl estradiol (estrogen).
Weekly for 3wks then patch free 1 week.
These hormones are absorbed
continuously through the skin and into
Vaginal ring (Nuvaring)
Etonorgestrel 120mcg +Ethinylestradiol 15mcg daily
Use for three weeks with a withdrawal week
Cycle control good
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 failure rate
0.3%, typical use failure rate 8%
Post conceptional methods Classification
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
Based on disturbing the normal progesteron-
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.
Mifepristone + Misoprostol – 95% successful in
terminating pregnancies upto 9 weeks.
Commonly used regimen
Mifepristone 200mg oral on day 1 followed by
Misoprostol 800mcg vaginally immediately or
6 -8 hrs later.
Other regimen is
Mifepristone 600mg oral on day 1 followed by
Misoprostol 400mcg orally on day 3
Follow up visit is must within 14 days for clinical
and/or USG examination
Termination of pregnancy before the foetus becomes
Medical termination of pregnancy act 1971
1) Conditions under which abortion is done
In failure of contraceptive device
2) Who can perform abortion?
If < 12 weeks 1 RMP having experience in
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.
2. Coitus Interruptus: failure rate 25/HWY
3. Safe period/rhythm period/ calendar method
Basis: ovulation from 12th - 16th day before onset of menses
Calculation: 1st day of fertile period = shortest cycle-18days
Last day of fertile period = longest cycle-10days
Irregular cycle so difficult to predict
Only for educated and responsible couples
High Failure rate 9/ HWY
Embryonic Abnormalities, Ectopic
4) Natural family planning method:
Basis: same as calendar method but here the women
employs self recognition of certain signs and
symptoms associated with ovulation.
a) Basal Body temperature method
b) Cervical mucous method
c) Symptothermic : It is based on the observation
of changes in different body signs: cervical
secretions, basal body temperature and the
position of the opening of the cervix.
No scalpel vas
No scalpel vas occlusion
Elastomer plugs: Gets hardened and
plugs the vas
SHUG: preformed silicon rubber plug is
RISUG: Reversible Inhibition of Sperm
Under Guidance8/6/2013 77
Approaches to the fallopian tubes, surgical procedures, timing of
procedure,and related occlusion techniques
Evaluation of contraceptive methods
It is the measurement of unplanned pregnancies even after
the use of contraceptive measures.
1) Pearl Index: no. Of failures/100 woman-yr of exposure
Failure rate/HWY= Total accidental pregnancies × 1200
total months of exposure
2)Life-table analysis - calculates a failure rate of each
month of use.
1.New Male Pill
The pill contains desogestrel as well as
Blocks the production of sperm while
maintaining male characteristics and sex drive.
It must be taken daily.
100% effective and completely reversible in
preliminary clinical trials .
In clinical trials, all of the participants‘ sperm
counts dropped to zero, which means that the male
pill would be more effective than the condom and
even the female pill. 82
2. CatSper Blocker
Sperm rely on calcium ions in sperm-
tail for mobility and fertilization.
Humans -ion-channel gene -CatSper.
Blocking CatSper action - effective form of birth
Men or women could take this potential CatSper
―blocker‖ because it could be made to act ‖wherever
sperm are present.‖
3. Spray On -Contraceptive
Australian biotech company Acrux has come up
with a world‘s first — a contraceptive spray for women.
Metered Dose Transdermal System (MDTS) to administer a
pre-set dose of the Nestorone to the skin (forearm) every 14
The fast-drying spray gradually absorbed into the bloodstream.
Who cannot tolerate contraceptive pills with oestrogens.
Leaves no visible residue & less irritation than patches.
Because it does not have to be taken at the same time every
day, it will suit women who often forget to take the Pill.
4. Adjudin “the male patch”
is non-hormonal male contraceptive
drug, which acts by blocking the
maturation of sperm in the testes,
but without affecting testosterone
Normal spermatogenesis returned in 95% within 210 days
after the drug had been discontinued.
The oral dose effective for contraception is so high that
there have been side effects in the muscles and liver,
therefore the drug is being manufactured as implant or patch
5. contraction inhibitor pill “dry orgasm”
2 different types of smooth muscle in vasa deferentia
Longitudinal muscle fibers and circular muscle fibers.
When segments of vasa deferentia were exposed to
phenoxybenzamine or thioridazine , the longitudinal smooth
muscle fibers did not contract.
The circular smooth muscles did, causes, clamping the vas
Thioridizine‘s side effects were so extreme(hives,
difficult breathing;,swelling of face) that the
manufacturer discontinued it in 2005, the common side
effects of phenoxybenzamine are dizziness , fast
heartbeat & stuffy nose.
6. Anti-Fertility Vaccines
Contraceptive vaccine either target
Gamete production ( FSH and LH)
Gamete outcome (hCG).
CVs targeting gamete function are better choices but
induce oophoritis affecting sex steroids.
Antisperm antibody-mediated immunoinfertility
provides a naturally occurring model to indicate how
an antisperm vaccine will work in humans.
The hCG vaccine is the first vaccine to undergo
clinical trials in humans. Both the efficacy and the
lack of immunotoxicity have been reasonably well
Reversible Inhibition of Sperm Under Guidance
(RISUG), developed at IIT Kharagpur in India by Dr.
Sujoy K Guha.
It is currently undergoing clinical trials in India.
RISUG is a non-hormonal injectable contraceptive
composed of SMA (styrene maleic anhydride) mixed with
DMSO (solvent dimethylsulfoxide).
Partially blocks the vasa deferentia and destructs the sperm
The differential charge from the gel ruptures the sperm‘s
cell membrane, stopping the sperm before they can even
start their journey to the egg.
Reversals by multiple injection of dimethyl sulfoxide or
sodium bicarbonate – and several months to reverse.
8. Hydrothermal Male Control
Methods used include
Hot water applied to the scrotum
Heat generated by ultrasound
Artificial cryptorchidism (holding the testicles inside the
abdomen) using specialized briefs.
Raising the body temperature above 42 degrees Celsius initiates
certain processes, resulting in cells disability. It is called Heat Shock
Factor (HSF).It disable sperm cells.
Hot water bath (about 46.7 degrees Celsius)for 45 minutes daily for
3 weeks - simple wet heating - ensure up to 6 months of male
ultrasound method - the testicles are heated with the help of
ultrasound - only two procedures 48 hours - temporary infertility for
up to 10 months.
10. SILCS Diaphragm
The SILCS diaphragm is a silicone barrier
contraceptive device .
Its dome is filled with BufferGel that acts both as a
spermicide and microbicide that not only immobilizes
the sperms but also kills them and fights infections.
It avoids the need for many sizes and a pelvic exam
for a correct fit; it is designed as a ―one size fits most‖
The new device is being evaluated for comfort and
ease-of-use in studies, underway in the Dominican
Republic, South Africa, Thailand, and the United
11. Injectable silicone plugs
Often used by men in China as a potential alternative
There are two tested types of injected plugs:
Medical-grade polyurethane (MPU)
Medical-grade silicone rubber (MSR).
The polymer (special ingredient) is injected directly
into the vasa differentia, Once injected, the polymer
solidifies in place, forming a flexible plug.
The procedure takes less than 30 minutes under local
It is easier to reverse. It takes 2 to 4 years after the
The Essure procedure involves placing a
small & flexible device called a Micro-
insert into each fallopian tubes.
The Micro- inserts are made from materials
that have been well studied and used
successfully in the heart and other parts of
the human body for many years.
Once the Micro-inserts are in place, body
tissue grows into the Micro- inserts, blocking
the fallopian tubes.
SOCIOLOGY OF FAMILY
Basic social cell.
Sociologists and economists believed that
living standards of the people can not be
improved while population growth
Attitude surveys have shown that awareness
of family planning is very widespread and
over 60 per cent people have favorable to
restricting or spacing births.
Studies have shown that the population problem
complicated by deep-rooted religious and other
Attitudes and practices favoring larger families.
Preference for male children.
Most of these beliefs stem from ignorance and lack
The experience of all countries which a successful
population control show that the best motivation is
economic, a desire to improve standard of living.
The solution to the problem is one of mass
education and communication.
Women have an unmet need if they
are sexually active
do not want to have a child soon or at all
are not using any contraceptive method
are able to conceive
In 1960s – “KAP – gap”
In 1977 - Unmet Need
Who has unmet need?
Fifteen percent of married women in
24% in Sub-Saharan Africa
11% in South and Southeast Asia
10% in North Africa and West Asia
12% in Latin America and the
More than 100 million married women have an
unmet need for contraception
South & Southeast Asia
Latin America & Caribbean
North Africa & West Asia
Number (in millions) and % distribution of married women with unmet need
Reasons for nonuse can be grouped into a few
Opposition to family planning
Lack of knowledge
Access and cost
Health concerns and side effects of methods
Misconceptions about pregnancy risk
10 and 20 per cent of all pregnancies- developing
countries - USA.
"At Risk―-Many are undesired, and occur in
unmarried adolescents who then resort to legal or
illegal abortion, performed under unsatisfactory
PREVENTION-Through educational programmes
dealing with responsible sexual behavior.
Adolescents are ambivalent about family planning
to request contraception is to reveal one's sexuality.
For this reason, adolescent girls sometimes
choose the risk of an undesired pregnancy and
of an abortion.
Hormonal methods are perfectly suitable for
adolescents, who generally do not suffer from
such problems as cardiovascular
The demographic future of the world will
depend on them, on how well informed they
are, and on their sense of responsibilities.
AT CETRE FWP
of Health &
SERVICE DELIVERY SYSTEM OF
The National Institute of Health and Family
Welfare acts as an apex technical institute for
promoting health and family welfare in the country
through education, training services, research and
“Central Family welfare Council” consisting of
all the State Health Ministers to review the
implementation of the programme.
―A Population advisory Council‖ headed by the
Union Health Minister, members of Parliament,
and persons from the fields related to population
control was set up in 1982.
This body acts like a ―think tank‖ .
State welfare bureau part of
state director of health &
family welfare (25)
Dist. Family welfare bureau
Dist. Mass Education and
CHCs(4,535) PHCs(147,069) At village level
centers(1,083)10 city family
1979 family welfare and national malaria
AT STETE LEVEL
Community Needs Assessment Approach
Involvement of private sector
Incentives and Dis-incentives
Family Welfare linked health insurance
The Family Planning Association of India,
The Family Planning Foundation and the
Population Council of India.
The Indian Red Cross,
The Indian Medical Association,
Christian Missionaries and Private Hospitals.
―International Planned Parenthood Federation‖ is
the world's largest private voluntary organization
supporting family planning services in developing
The United Nations Fund for Population Activities
the US Agency for International Development
Ford Foundation, The Pathfinder fund and World
Bank besides WHO and UNICEF.
NATIONAL FAMILY WELFARE
India launched a nation-wide family planning
programme in 1952,first country in the world.
Beginnings the programme were modest with the
establishment of a few clinics and distribution of
educational material, training and research.
Third Five Year Plan (1961-66)- "the very centre of
planned development‖.- the purely ―clinic approach"
to the more vigorous "extension education approach"
for motivating the people for acceptance of the
'small family norm".
The introduction of the Lipples Loop in 1965
necessitated the creation of a separate Department
Family Planning in 1966 in the Ministry of Health.
Fourth Five Year Plan (1969-74)- "top priority" to
The Programme was made an integral part of MCH
activities of PHCs and their sub-centres.
In 1970- All India Hospital Postpartum Programme
1972 - Medical Termination of Pregnancy (MTP)
act were introduced.
Fifth Five Year Plan (1975-80)- 1976- National
1977- Ministry of Family Planning was renamed
― Family Welfare‖
The 42nd Amendment of the Constitution has made
"Population control and Family Planning" .
The acceptance of the programme is now purely
on voluntary basis.
The Rural Health Scheme in 1977 and the
involvement of the local people.
1978- the Alma Ata Declaration - The acceptance
of the primary health care approach to the
achievement of HFA/2000 AD led the formulation
of a National Health Policy in 1982.
The Sixth and Seventh Five Year Plans were
accordingly set to achieve these goals.
1985 – 86- Universal Immunization
The oral rehydration therapy
1992 these programmes were integrated under
Child Survival and Safe Motherhood (CSSM)
1994- the International Conference on
Population and Development in Cairo-
implementation of Unified Reproductive and
Ninth Five Year Plan the RCH Programme
integrates all the related programmes of the Eighth
Five Year Plan.
The concept of RCH is to provide
high quality integrated services.
The investment on family welfare programme
0.65 crores during the first plan,
the Eleventh Plan period-136,147 crores
Evaluation of Family Planning
1. Evaluation of need
2. Evaluation of plans
3. Evaluation of performance
c. Cost analysis
d. Other activities
4. Evaluation of effects
5. Evaluation of impact