community health nursing family planning

1. Presented by : Neethu liza jose
Msc nursing first year
Apollo college of nursing

2. INTRODUCTION
Family planning is the term given for pre-pregnancy
planning and action to delay, prevent or actualize a
pregnancy.
DEFINITION:
Family planning is a way of thinking and living that is adopted
voluntarily, upon the bases of knowledge, attitude and
responsible decision by individuals and couples in order to
promote the health and welfare of family group and thus
contribute effectively to the social development of country
-B T BASVANTHAPPA

3. OBJECTIVES
( WHO ) “the use of a range of methods of a fertility
regulation to help individualsorcouplesattain certain
objectives:
 avoid unwanted birth.
 bring aboutwanted birth.
 Producea change in the no. of children born.
 Regulate the intervals between pregnancies.
 Control timeatwhich birth occur.”

4. Proper
spacing
Proper
timing
No. of
pregnanci
es
Elements of family planning
3 importantelements in family planning:

5. Benefits
Benefits to Mother
☑ Reduce the health risk
☑Below 20y, And above 35 y
. At risk of developing complications
during pregnancy.
☑physical strain of child bearing.
☑ reduce numberof maternal death.
☑ reduce the risk of ovarian cysts.

6. Health Benefits to Children:
Ensures betterchanceof survival at birth.
 Promote betterchildhood nutrition.
 Promote physical growthand development.
 Prevent birthdefects.

7. Health Benefits to Father
Allows father to keepaconstant balance between
theirphysical, mental, social well –being.
Increase father sense of respect because he is able to
provide the typeof education and homeenvironment.

8. Benefits to Whole Family
Health
Benefits to Whole Family Health - help the family
enjoy the better kind of life.

9. TYPES OF FAMILY PLANNING
Natural familyplanning
Barrier family planning
Permanent/surgical family
planning

10. INTRODUCTION OF NATURAL
FAMILY PLANNING
No introductionof chemical of foreign material into
the body.
Practice may bedue toreligious belief, “natural” way
is best for them.
Effectivenessvaries greatly, depends on couplesability
torefrain from having intercourseon fertiledays.
 Failure Rates: about 25% Poses no risk to fetus

11. NATURAL FAMILY PLANNING
Rhythm (Calendar) method
Basal Body Temperature (BBT)
Ovulationor Cervical Mucus Method
Symptothermal method
Coitus Interruptus
Lactation amennorhea

12. ⚫The rhythm method, also called the fertility
awareness method, is a form of pregnancy
prevention where couplescalculatea woman's fertile
time using a calendar .
⚫Abstaining from coituson thedaysof menstrual cycle
when awoman is most likely toconceive (3 or 4 days
before until 3 or 4 daysafterovulation). Woman keeps
adiary of 6 menstrual cycles.
RHYTHM (Calendar)
METHOD

13. This method may be used bywomen whose menstrual
cycles arealways between 26 and 32 days in length .
 Tocalculate:
18 from shortestcycledocumented –11 from
longestcycle = represents her last fertileday.
Example: 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). Toavoid pregnancy, avoid
coitus/usecontraceptiveduring thosedays.

14. Disadvantages
Lifespan
of Sperm
Failureof
method
Reliability

15. . Basal Body Temperature (BBT)
Identifying fertile and infertile period of a woman’s
cycle bydaily taking and recording of the rise in body
temperatureduring and afterovulation.
 Just beforeovulation, a woman’s BBT fallsabout 0.5ºF
At time of ovulation, her BBT rises a full degree
(influence of progesterone). This higher level is
maintained the restof menstrual cycle.

16. DISADVATAGES
⚫NOT reliable method: of birth control, especially for
womenwith irregularcycles. Plus, outside factors,
such as a lack of sleep, can causeawoman’s
temperature tovary.

17. ⚫Cervical mucus is a fluid produced by small glands
near the cervix
⚫ This fluid changes throughout her cycle, from
scantand sticky, tocloudy and thick, toslick and
stringy.
⚫Each of these types of mucus is related to the
hormonal shifts that naturally occurduring
the menstrual cycleas her body prepares forand
achieves ovulation.
Cervical Mucus/Ovulation

18. Right before ovulation, the mucus from the cervix
changes from being cloudyand scanty to being clear
and slippery.
The consistency of ovulation mucus is like that of an
egg whiteand itcan be stretched between the fingers.
It is the peak of her fertility.
Afterthe ovulation, the mucus tends todry upagain.
Thesearealsosafe days.
Ideal Failurerate: 3%

19. DISADVANTAGES
⚫ It is not a particularly reliable method of birth
control, especially forwomen with irregularcycles .
⚫Remember that cervical mucus does not let you know
whenyou will soon beovulating, butsperm can live up
to seven days inside the vagina. Any sperm deposited
ahead of timecan still impregnate thewoman.

20. Symptothermal Method
Combines the cervical mucus and BBT methods
Watches temp. dailyand analyzes cervical mucusdaily.
Watch for midcycle abdominal pain Couple must
abstain from intercourseuntil 3 days afterrise in temp.
or 4 th dayafterpeak of mucuschange.
Moreeffective than BBT or CM method alone Ideal
Failure rate: 2%

21. COITUS INTERRUPTUS
⚫One of oldest known methods of contraception
Coupleproceedswith coitus until the momentof
ejaculationwhich Offers littleprotection.

22. LACTATION AMENNORRHEA
The lactation amenorrhea method (LAM) is a natural
birth control technique based on the fact that
lactation (breast milk production) causesamenorrhea
(lack of menstruation).

23. How itworks:
Breastfeeding interfereswith the releaseof the
hormones needed to triggerovulation.
ADVANTAGES:
Breastfeeding on demand improves health for mother
and baby.
Nothing to buyoruse.

24. DISADVANTAGES
 an use this method only for the first six monthsafter
birth oruntil the first menstrual period.
 LAM does not provideprotection against SEXUALLY
TRANSMITTED INFECTIONS.

25. CLASSIFICATION OF
CONTRACEPTIVE METHOD
CLASSIFICATION
SPACING
METHOD
BARRIER
METHOD
INTRAUTERINE
METHOD
HORMONAL
METHOD
POST COITAL
METHOD
TERMINAL
METHOD

26. BARRIER METHODS
⚫Condoms (maleand
female)
⚫Spermicidal
⚫Sponge
⚫Diaphragm
⚫Cervical cap

27. Male condoms:
 Theseare made upof polyurethaneor latex.
 Silicon used nowa days toproducesemi dry pre-
lubricated forms.
 In Indiaone particularly brand is widely marketed as
‘Nirodh’.
 Spermicidal – coated with nonoxynol on innerand
outersurfaces.

28. MALE CONDOM

29. ADVANTAGES:
 Simplespacing method
 No sideeffects
 Easily available, safe & inexpensive
 Protectsagainst STDs
 DISADVANTAGES
Chancesof slip off and tearoff
Allergic reaction to latex
Failure rate: 16%

30. Female condoms:
⚫It is a pouch made upof polyurethanewhich lines the
vagina and alsoexternal genitalia.
⚫It is 17 cm in length with one flexible polyurethane
ring ateach end.
ADVANTAGES:
Prevents STDs including HIV/AIDS
Notdamaged byoilsand otherchemicals

32. ⚫DISADVANTAGES:
 High motivation
Onlywomen whocan usediaphragms can use female
condom
Slippageoccurs
Expensive
Failure rate 21% with typical useand 5% with correct
and consistentuse.

33. diaphragm
 Mostcommonand easiest to fit and use .
 Thin, nearly hemispherical dome made of rubber or
latex material, with circular, covered metal spring at
periphery (flat typeand coil type)

 External diameterof rim is size of diaphragm – 45 mm
diameter rising in steps of 5 mm to 105mm (most
common 60,65,70,75,80)

34. ⚫The device is introduced up to 3 hrs. before
intercourseand is to be kept forat least 6 hrs after
intercourse.
ADVANTAGES:
cheap
Nogross medical side effects
 Control of pregnancy in handsof woman
Reasonablysafewhen properlyused
 Preventspread of STDs though less effective than
condom

35. DIAPRAGHM

36. DISADVANTAGES:
⚫Requires helpof doctorto measure the size required.
⚫Need high motivation
⚫Allergic reaction torubber
⚫Erosion
⚫UTI’s

37. SPERMICIDES
⚫Availableasvaginal foams ,gels ,creams ,tabletsand
suppositories.
⚫ contain surfactant like nonoxynol-9,benzalkonium
chloride.
⚫Alterthe sperm surface membrane permeability
resulting in killing of sperm.

38. SPERMICIDE

39. ADVANTAGES:
☑ No instructions bydoctorsor nurses
☑ Easilyavailableand easy to use
☑ Nogross medical side effects
DISADVANTAGES
 Failure rate high when used alone
Can increase spread of HIV infection by irritating
vaginal and cervical mucosa
Failure rate – 21% with typical useand 6%

40. Vaginal contraceptive sponge
(TODAY)
The sponge is a doughnut-shaped device madeof soft
foamcoated with spermicide.
Made upof polyurethanewith 1gm of nonoxynol-9 as
a spermicide.
It releases spermicideduring coitus, absorbsejaculate
and blocks theentranceof cervical canal.
To use the sponge, it must be moistened with water.
Once inserted in the vagina, it covers the cervix and
blockssperm from entering the uterus.

41. DISADVANTAGES
 May get broken
 difficultremoval
 High pregnancy rate
 Allergicreactions
 Vaginal dryness, soreness
 Maydamagevaginal epithelium
 increase risk of HIV transmission

42. INTRAUTERINE DEVICES
⚫ Intrauterine Device The IUD is a small, T-shaped,
plasticdevice that is inserted and left inside the uterus
topreventpregnancy.

43. CLASSIFICATION OF
IUDs
INTRAUTERINE
DEVICE
NON-
MEDICATED
FIRST
GENERATION
SECOND
GENERATION
MEDICATED
THIRD
GENERATION

44. First generation
 Non-medicated made upof polyethylene.
 Different shapesand sizes
 LIPPE’S LOOP
 Double ‘s’ shaped device , made upof polyethylene
material.
 Non- toxic, non-tissuereactiveand extremelydurable.
 Small amountof barium sulphate isalsoadded for
radiological examination
 Available in 4 sizes A,B,C,D

45. Second generation
 Made upof metal Cu
 Earlierdevices Cu-7 , Cu-T 200
 Newerdevices T copper 220 C ,T copper 380 C ,novaT
 multiload devices:
 ML-Cu 250
 ML-Cu 375

46. Third generation
 Hormones releasing IUD
 PROGESTASTERT :
 Mostcommonly used T shaped device filled with 38 mg
progesterone
 Effective for 1 year
 LNG- mirena
 Mirena (levonorgestrel-releasing intrauterinedevice) is a
form of birth control that is indicated for intrauterine
contraception for up to 5 years and Releases 20 µg of
levonorgestrol.
 Effective for 5 years.

47. SIDE EFFECTS
Amenorrhea
 Intermenstrual bleeding and spotting
Abdominal/pelvicpain
 Ovariancysts
 Headache/migraine
 Acne
 depressed/altered mood.

48. ADVANTAGES OF IUD
 Safe
 effective , Reversible
 Long action ,Inexpensive
 DISADVANTAGES
 Heavy bleeding and pain
 Pelvic inf lammatorydiseases
 Ectopicpregnancy
 Maycomeoutaccidently if not properly inserted.

49. CONTRAINDICATION
Historyof PID
Abnormal shaped uterus
Ectopic pregnancy
Menorrhagia

50. CLASSIFICATION OF HORMONAL
CONTRACEPTIVES
HORMONAL
CONTRACEPTIVES
COMBINED
PREP.
ORAL
SINGLE
PREP
.
INJECTABLES
PARENTERAL
IMPLANTS

51. HORMONAL CONTRACEPTIVES
⚫With hormonal birth control , a women takes
hormones similarto those her body makes naturally .
⚫Hormonal contraceptivesare mostly for femalesex
steroids.

52. Oral contraceptives
⚫Combined oral contraceptive pills
⚫Commonly used progestin areeither levonorgestrol or
norethisterone and estrogens are ethiyl estradiol or
menstranol
⚫COMMERCIAL NAMES
⚫Mala–N
⚫Mala –D
⚫Loette(desogestrel 0.15)
NO. OF TABLETS
21+7 iron tab.
21+7 iron tab.
21 tab.

53. TYPES
Monophasic biphasic triphasic
Monophasic:
fixed dosesof both estrogenand progesterone
throughout 21 daycycle.

54. Biphasic:
constant amount of estrogen throughout cycle BUT
increased amountof progestinduring the last 11 days .
 Triphasic:
Varies level of estrogen and progesterone. Closely
mimic natural cycle, reducing breakthrough bleeding
(bleeding outside the normal menstrual flow)

55. contraindications
ABSOLUTE:
Circulatorydiseases
Severe HTN
Angina,ischemic heartdis.
Liverdisease
Tumors
Pregnancy
breastcancer,breast feeding.

56. ⚫RELATIVE:
⚫Age>40 yrs.
⚫Smoker, historyof jaundice
⚫Diabetes

57. benefits
⚫contraceptive benefits:
⚫Protection against unwanted pregnancy
⚫Convenient touse.
⚫Non-contraceptives benefits:
⚫Regulationof menstrual cycle
⚫Reductionof dysmenorrhea
⚫Protection against PID, fibroids, ovarian cysts, chances
of cancer.

58. Side effects
⚫ Dizziness
⚫Nausea
⚫ Weightgain
⚫ Headache
⚫ Breast tenderness
⚫vaginal infection
⚫Mild HPN
⚫Depression
⚫increase blood clotting

59. Progesterone only pills
⚫Also knownas “Minipill”.
⚫Contains justprogesteroneor progesterone hormone.
⚫Causing plug of mucus in the neck of cervix
block theentry of the sperm.
Example: levonorgesrol 75 µg, desogestrel 75 µg

60. advantages
⚫Nosideeffecton breast feeding or lactation
⚫May be prescribed in patient having diabetes, HTN ,
smoking etc.
⚫Reducerisk of PID
⚫DISADVANTAGES
⚫Acne, mastalgia, headache

61. Long acting contraceptives
⚫Theseare more suitable for womenwhodo notwant
topregnant again or for fewyears.
THESE ARE:
⚫CONTRACEPTIVE INJECTIONS
⚫IMPLANTS
⚫PATCHES

62. CONTRACEPTIVE INJECTIONS
( DEPOPROVERA & NORISTERET)
⚫Contain progesterone hormone .
⚫Preventsovulation.
⚫Commonly used as Depomedroxyl progesterone
acetate (DMPA) administered on deltoid muscle
within 5 daysof cycle.
⚫DOSE: 150 mg
⚫Provideprotection for 3 months .

63. Contraceptive implants
⚫It is a small device placed underthe skin
⚫Contains progesterone hormone .
⚫Works in a similarway to injection
⚫Contains 3 ketodesogestrel
⚫Releases hormoneabout 60 mcg, gradually reduced to
30 mcg perdayoveryear.
⚫Inhibtsovulation.
⚫Lasts for 3 years.
⚫NORPLANT – II

64. ⚫NORPLANT- II
⚫Two rods of 4cm long. Each rod containing 75 mg of
levonorgestrel releases 50 mcg perday
.
⚫

65. Emergency contraceptives
⚫Used whithin 72 hrs ,ovulation is eitherprevented or
delayed. It may be in form of : hormones, IUD,
antiprogesterone
⚫INDICATIONS
⚫Unprotected intercourse
⚫Condom rupture
⚫Sexual assault

66. HORMONES:
MORNING AFTER PILLS:
Itpreventing conception in caseof accidental
intercourse.
drugs used ethinyl oestradiol 2.5mg,
premarin(conjugated oestrogen) 15 mg.
Drug is taken orally twicedaily for 5 days.

67. Emergency contraceptives
DRUG DOSE
Levonorgesterel 0.75 mg stat and after 12 hrs.
Ethinyl oestradiol 50 µg + norgesterel
0.25 mg
2 tab stat and 2 after 12 hours
Conjugated oestrogen 15 mg BD× 5 days
Thinyl oestradiol 2.5 mg BD 5 days
Mifepristone 10 mg single dose
Copper IUDs Insertion within 5 days

68. PERMANENT STERLISATION
ÖVASECTOMY
Ö TUBECTOMY

69. TUBECTOMY

70. STERILIZATION
It is mosteffective method its failure rate is 1/2000 so in
this there is permanent termination .
VASECTOMY :
Small incision madeon each sideof scrotumvas
deferens is then cutand tied , cauterized orplugged .
Blocking the passageof spermatozoa.
Does not interferewith productionof sperms butdoes
notpass beyond vasdeferens .

71. Very effectiveafter 3 monthsof procedure
Permanentand safe
Noapparent long term risks .
 DISADVANTAGES:
Slightly uncomfortabledue slightly pain and swelling
after 2-3 daysof theof the procedure .
Bleeding may result in the hematoma in scrotum .

72. TUBECTOMY:
It is one of theoperative procedurewhere resection of
a both segment of both fallopian tubes is done to
achieve permanentsterilization
Theapproach may be :
Abdominally
Vaginally

73. ⚫ABDOMINAL
Ω CONVENTIONAL MINILAPROTOMY
Ω CONVENTIONAL:
In which a loop is made by holding the tube by Allis forceps in
such away that the majorpartof loopconsists mainlyof isthmus
and ampullary partof tube . the loop is ligated with catgutand is
cut .

74. MINILAPROTOMY:
When the tubectomy is done through small
abdominal incision along with somedevice .
VAGINAL LIGATION :
Tubectomythroughvaginal route may bedonealong
with vaginal plasticoperation oron isolation .

75. COMPLICATION :
Ectopic pregnancy
Menstrual irregularities
Lossof libido
Infection