reproductive health

1. CHAPTER FIVE
FAMILY PLANNING
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2. Golis university,Gabilay
Campus
Introduction
Family planning
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3. Learning objectives
• At the end of this class the students will be able to:
 Explain the concepts & principles of FP
 Describe the Rationale & Benefits of FP
 Familiar with all Family planning methods
 State Family planning Counselling
 Identify FP Delivery Strategies & Barriers
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4. Contents
Concepts & principles of FP
Rationale & Benefits of FP
Family planning methods
Family planning Counselling
FP Delivery Strategies & Barriers
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5. Concepts and principles of FP
• What is family?
• What is planning?
• What is family planning?
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6. 6

7. Types of family planning most
common
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8. 8

9. 9

10. Concepts….
• Family
• Any combination of two or more persons who are bound together
over time
• Mutual consent, Birth and/or adoption or placement
• Together, assume responsibilities for variant combinations of some
of functions:
• Physical maintenance and care of group members
• Addition of new members through procreation or adoption
• Socialization of children
• Social control of members
• Production, consumption, distribution of goods and services,
• Affective nurturance — love
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11. Concepts….
• Family planning:
Refers to the use of various methods of
fertility control that will help individuals or
couples to have the number of children they
want when they want them in order to assure
the well being of children and the parents.
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12. Concepts….
Concepts in the definition:
• Prevent unwanted pregnancy & have when needed
• Deciding on number of children
• Child spacing
• Matching the No. of children they desire to have with their economic
capacity
• Enables individuals and couples to determine the number and spacing
• It is a recognized basic human right.
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13. Principles of family planning
• Individuals should decide freely the number and spacing
of their children
• Individuals/couples have the right to information &
means to exercise this choice.
• Women and men should have access to the widest
possible range of safe and effective family planning
• Family planning programs should cater for all people
who may be sexually active
• Improving the Quality of care in family planning 13

14. Benefits of family planning
To individuals:
• Improved maternal and infant health
• Expanded opportunities for women’s
education, employment and social
participation;
• Reduced exposure to health risks; and
• Reduced resource to abortion 14

15. Benefits…
To families:
• Reduced competition & dilution of resources;
• Reductions in household poverty; and
• More possibility for shared decision-making
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16. Benefits….
To the society:
• Accelerated demographic transition;
• Opportunity to use the “demographic
bonus” to speed economic dev’t
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17. Rationale for family planning
1. Demographic 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 welfare
• Economic productivity
• Natural resources
• Environment
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18. Rationale…
2. 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 18

19. 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 benefits
• Prevents STIs including AIDS, cancers
• Protect menstrual problems- cramp, bleeding, anemia
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20. Rationale…
3. Human rights rationale
• Emphasized in 1990s
• Individuals & couples have a right to control reproductive
decisions including family size and timing of birth.
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21. History of family planning
• Contraceptives have been used in one form or another for
thousands of years
• But,
• Effectiveness ?
• Safety ?
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22. History …
• Traditional methods
• Chinese women drank drink lead & mercury to control fertility- often cause
sterility & death
• Herbs, Olive oil, ginger, tobacco juices- were frequently smeared on or around
the vagina to kill semen
• Greek women used to jump backward seven times after intercourse.
• French prostitutes had been using douches since 1600
• As recently as the 1990s, teens in Australia have used candy bar wrappers as
condoms
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23. History…
• Modern methods
• Planned Parenthood is very proud of the historical role it
continues to play in making safe and effective family planning
• In 1916- Margaret Sanger opened the first birth control clinic
in America
• In 1950, Planned Parenthood underwrote the initial search
for a best oral contraceptive
• Most of the modern contraceptive methods were introduced
during the 2nd half of 20thC 23

24. Family planning methods
• Methods or ways by which unwanted pregnancy is prevented
• Not all these methods are equally effective or acceptable
• Therefore, individualization of contraceptive choice is important for successful prevention of
unwanted pregnancy
• Two broad categories
1. Traditional/Natural Contraceptive Methods
• uses the body’s natural physiological changes and symptoms to identify the fertile and infertile phases
of menstrual cycle.
2. Modern Contraceptive Methods

25. Methods…
1. Traditional/Natural Contraceptive Methods
• Periodic Abstinence (Fertility awareness methods)
• Avoiding sexual intercourse during fertile phase
• Requires couple’s ability, motivation, discipline
• BBT, Cervical Mucus, Calendar/Rhythm
• Lactational Amenorrhea Method (LAM)
• Contraceptive method based on breastfeeding
• Effective for up to 6 months after childbirth
• Needs exclusive breast-feeding
• Three criteria- no mens returned, exclusive BF, less than 6 months
• Withdrawal (Coitus interrupts)
• Ejaculation outside the vagina
• High failure rate – pre-ejaculation sperm

26. Methods…
2. Modern Contraceptive Methods
• Hormonal Methods
• Pills
• Combined Oral Contraceptives (COCs)
• Progestin Only Pills (PoP)
• Subdermal Implants (Progestrone only :
• Norplant Implants- six rodes (5- 7 years protection)
• Jadelle- two rods (5 years protection)
• Implanon- single rod (3 years protection)
• Injectables (Progestrone only)-
• DMPA (depot medroxy progesterone acetate or Depo-Provera)- 3
months protection
• Noristerat (NET-EN- norethisterone enanthate) – 2month protection

27. Methods…
• Intrauterine Contraceptive Devices (IUCD) – Loop
• Barrier Methods
• Condoms (male and female)
• Diaphragm
• Spermicidal: Creams, jelly, foaming tablets
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28. Modern Methods…
• Emergency Contraception
• used as an emergency procedure to prevent unintended
pregnancy due to unprotected sex
• Prevents about 75% of pregnancies
• Types:
• Emergency contraceptive pills (ECPs) – within 5 days after
unprotected sexual intercourse
• Copper releasing IUDs – up to 5 days
• Voluntary Surgical Contraception
• Female Sterilization (Tubaligation)
• Male Sterilization (Vasectomy)

29. Family planning Counselling
• Providing good information to clients about proper
contraceptive use and about risks and benefits is a major
responsibility for programs.
• Good counselling helps clients choose and use family
planning methods that suit them.
• Clients differ, their situations differ, and they need
different kinds of help.
• The best counselling must be tailored to the individual
client. 29

30. FP counselling…
• The elements of good counselling can be summarized with acronym
GATHER (Gallen and Lettenmaier 1987).
• That is the counsellor should:
G - Greet clients in a polite and friendly manner
A - Ask them about their family planning needs
T - Tell them about method choices
H - Help clients decide on the methods they want
E - Explain how to use the chosen methods
R - Remind clients the need for return visits
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31. FP Delivery Strategies
• The most common service delivery strategies:
1. Clinic Based Services
• Methods that are more medically complex,
• IUDs, hormonal implants, injectables, and sterilization.
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32. Strategies….
2. Community Based Distribution (CBD)
• Condoms, pills and spermicides & if trained can give injectables
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33. Strategies….
3. Commercial Retail Sales (Social marketing)
• Pills, condoms, and spremicides are sold at reduced, subsidized
prices in
• Pharmacies, stores, shops, bars and are advertised on the mass
media.
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34. Strategies….
iv. Other Approaches
• Workplace
• Post partum in health facilities
• Private physicians.
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35. Barriers to FP Use
• In spite of significant increase in the prevalence of
contraceptive use around the world there remain
important barriers to even wider use of contraceptives.
1. Limited access to and availability of FP products and services
2. Limited alternative delivery approach (no method mix)
3. Limited resources of skilled providers
4. Cultural and religious barriers including gender issues/Male dominance
and opposition
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36. END
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