The end of family planning


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The end of family planning

  1. 1. Family Planning
  2. 2. What is Family planningFamily planning is the planning of when to have children (the moms‘ age of their first birth and the interval between the children) •Use of birth control and other techniques to implement the planning of when to have children. •Other techniques commonly used include sexuality education, prevention and management of sexually transmitted infections, pre-conception counseling and management, and infertility management •Family Planning does not mean stopping to have children.
  3. 3. Family planning Family planning is sometimes used as a synonym for the use of birth control. It is most usually applied to a female- male couple who wish to limit the number of children they have and/or to control the timing of pregnancy (also known as spacing children). Family planning may encompass sterilization, as well as abortion.
  4. 4. Family planning Family planning services are defined as "educational, comprehensive medical or social activities which enable individuals, including minors, to determine freely the number and spacing of their children and to select the means by which this may be achieved".
  5. 5. SOCIOLOGY OF FAMILY PLANNING • Basic social cell. • Sociologists and economists believed that living standards of the people cannot be improved while population growth unchecked. • 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 believes. • Attitudes and practices favoring larger families.
  6. 6. • Preference for male children. • Most of these beliefs stem from ignorance and lack of communication. • The experience of all countries which a successful population control shows 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.
  7. 7. Purposes of Family Planning • Raising a child requires significant amounts of resources: – time, – social, – financial, and – environmental. • Planning can help assure that resources are available. • The purpose of family planning is to make sure that any couple, man, or woman who has the desire to have a child has the resources that are needed in order to complete this goal.
  8. 8. • With these resources a couple, man or women can explore the options of natural birth, surrogacy, artificial insemination, or adoption. • In the other case, if the person does not wish to have a child at the specific time, they can investigate the resources that are needed to prevent pregnancy, such as birth control, contraceptives, or physical protection and
  9. 9. History of Family Planning – 1900 • Distributing information and counseling patients about contraception and contraception devices was illegal under federal and state laws – 1912 • The modern birth-control movement began • Margaret Sanger an American born activist, founded the American Birth Control League and was instrumental in opening the way to access birth control
  10. 10. – 1916 • Margaret Sanger challenged the laws that suppressed the distribution of family planning information by opening the first family planning clinic in Brooklyn, New York. • The police closed her clinic, but the court challenges that followed established a legal precedent that allowed physicians to provide advice on contraception for health reasons. - 1930’s- a few state health departments and public hospitals had begun to provide family planning services
  11. 11. – 1960- the era of of modern contraception began – birth control pill and Intrauterine device became available – 1965- Pill became the most popular method followed by the condom and contraceptive sterilization – 1965 Supreme Court (Griswold vs Connecticut) struck down stat laws prohibiting contraceptive use by married couples – The United Nations Conference on Human Rights at Teheran in 1968 recognized family planning as a basic human right. – 1973 -Supreme Court (Roe vs Wade) legalizes abortion. – 1973 - First National Survey of Family Growth conducted
  12. 12. – The Bucharest Conference on the World Population held in August 1974 endorsed the same view. '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". – 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‖. – 1976: Marie Stopes International was established to provide accessible family planning services globally.
  13. 13. World Contraception Day • September 26 is designated as World Contraception Day, devoted to raising awareness of contraception and improving education about sexual and reproductive health, with a vision of "a world where every pregnancy is wanted".
  14. 14. Family Planning in other Country • China's one-child policy • the policy was instated to control the rapid population growth that was occurring in the nation at that time. • With the rapid change in population, China was facing many impacts of the rapid population growth including poverty and homelessness. • As a developing nation, the Chinese government was concerned that a continuation of the rapid population growth that had been occurring would
  15. 15. • In Hong Kong and Vietnam the ‖Two is Enough‖ campaign encouraged people to have 2 or fewer children in each family. It contributed to the reduced birth rate in the following decades.
  16. 16. Religious View • Many Christians began to consider sex as a gift from God and a positive force that could strengthen the institution of marriage if couples did not feel threatened by the possibility of having children they could not support. The majority of Protestant denominations, theologians, and churches allow contraception and may even promote family planning as an important moral good. As with all issues of Christian morality, it stresses that members use birth control as dictated by their consciences.
  17. 17. Health and Benefits • Family welfare – a state of well – being of the family as a whole and the individual. Means a level of satisfaction of the basic needs of family (adequate food, water, shelter, employmen t, health and education).
  18. 18. • Responsible Parenthood – the essence of family planning. Pregnancy is planned and a child us desired and is assured of parent's love, protection, etc.
  19. 19. For the Mother • Help mother to fully recover from physical strain of child bearing. Those more than 4 children – considered high risk. Help reduce number of maternal death due to abortion.
  20. 20. • For the Father Family Planning helps the father shoulder his responsibility and enables him to give his children equal attention. It also lightens his load because he will not be obliged to provide for and support too many children.
  21. 21. For the Children: • Through Family Planning, the children are better taken care of. The parent could meet the basic needs of the children Benefits to Whole Family Health • help the family enjoy the better kind of life.
  22. 22. For the Community, the Country and the World: Family Planning can provide a peaceful, orderly, and self- sustaining community with fewer problems, like juvenile delinquency. For the World , overcrowding can be minimized, and governments can focus their economic efforts on production rather than consumption.
  23. 23. World population
  24. 24. Philippine‘s population
  25. 25. About one half of all pregnancies in the Philippines are unplanned. Most women can become pregnant from the time they are in their early teens until they are in their late 40s. Birth control can help couples postpone having a baby until the time is right for them—if ever.
  26. 26. Basic conditions of pregnancy First, health of the woman. The woman must have attained puberty and she better be under about 35 years of age and must not have reached menopause stage. Her monthly periods must be regular and her ovaries must be producing eggs systematically. She should not have any other present or past health problems that can affect her physical and mental condition - her natural biological functions of becoming a mother.
  27. 27. Second, health of the man: The man must have crossed puberty, must have a well developed sex organ that has proper erectile function, must produce enough count of sperms that have mobility in his semen. He should not have any other present or past health problems that can affect his physical and mental condition - his manliness or the capacity of healthy sperm production.
  28. 28. Timing • A woman have a normal 28-day menstrual cycle which ovulation takes place approximately at the mid period - about 14 days before the next menstrual discharge. The egg produced in one of the 2 ovaries reaches a woman's uterus via fallopian tubes. It waits for the arrival of male sperm for the next 24 hours. • Taking averages and probabilities into consideration in a normal menstrual cycle, if a hassle-free intercourse takes place between the 12th day to 16th day after previous last day menstrual discharge, there is a good possibility for the woman to get pregnant.
  29. 29. The Act The physical intercourse has to take place without much of tension in a normal and natural way in the above mentioned conducive period. Ideally, the man and woman should keep their organs clean before intercourse. The ejaculation should take place fully inside, deep in the vaginal passage; Ideally, the woman's posture must be such (facing upwards) that it receives the discharge without allowing it to flow out and it is conducive for the sperms to find their way into the uterus though the cervix passage.
  30. 30. • It is recommended that the woman keeps lying in the bed for about 15 to twenty minutes after intercourse, facing upwards, thighs together but relaxed, knees raised up with toes touching the rear of the theighs. This is to facilitate the ejaculated semen to reach the cervix and travel down into the uterus. The woman should not wash her vaginal passage immediately after intercourse.
  31. 31. Contraceptive methods How many kinds of contraception methods do you know? (From film or books)
  32. 32. CONTRACEPTIVE METHODS • Preventive methods to help women avoid unwanted pregnancies. IDEAL CONTRACEPTIVE • Safe Effective • Acceptable Inexpensive • Reversible Simple to administer • Independent of coitus • Long lasting to avoid frequent administration • Requiring little or no medical supervision
  33. 33. • The present approach in family planning programs 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.
  34. 34. • Inhibiting the development and release of the egg • To prevent sperm and egg from uniting – Imposing a mechanical, chemical, or temporal barrier between sperm and egg • Altering the ability of the fertilized egg to implant and grow
  35. 35. I. SPACING METHODS Barrier Methods Intrauterine Devices Hormonal Methods Post Conceptional Methods Classification of contraceptive methods II. TERMINAL METHODS Male sterilization Female sterilization
  36. 36. Barrier methods • These include male condoms, the female condom, diaphragms and caps. • They prevent sperm entering the uterus. • You can use male and female condoms as soon as you feel ready to have sex.
  37. 37. MALE CONDOMS – Mostly made of fine latex rubber. – Silicon used nowdays to produce semi- dry, pre-lubricated forms. – Spermicidal – coated with nonoxynol 9 on inner and outer surfaces. • ADVANTAGE: • Simple spacing method • No side effects • Easily available, safe & inexpensive • Protects against STDs • DISADVANTAGE: • Chances of slip off and tear off • Penis must be withdrawn immediately after ejaculation • Failure rate: 16%
  38. 38. FEMALE CONDOM • Advantages – Woman controlled method – Prevents STDs including HIV/AIDS – Not damaged by oils and other chemicals • Disadvantages – High motivation – Only women who can use diaphragms can use female condom – Slippage occurs – Expensive – Failure rate 21% with typical use and 5% with correct and consistent use.
  39. 39. VAGINAL DIAPHRAGM – 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)
  40. 40. • Advantages – 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 • Disadvantages – 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 – Erosion – Urinary tract infection – Occlusive caps do not prevent spread of AIDS – Rarely, toxic shock syndrome
  41. 41. VAGINAL SPONGE • 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 cervix • Acts for 24 hrs • Failure rate – 9 – 27 per 100 women years • Must be removed and thrown away after 8- 24 hrs but not before 6 hrs of last act
  42. 42. • Drawbacks: – May get broken – difficult removal – High pregnancy rate – Toxic shock syndrome – Allergic reactions – Vaginal dryness, soreness – May damage vaginal epithelium – increase risk of HIV transmission
  43. 43. SPERMICIDES • Non ionic surfactants which alter sperm surface membrane permeability, resulting in killing of sperms • Advantages – No instructions by doctors or nurses – Easily available and easy to use – No gross medical side effects • Disadvantages – 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%
  44. 44. IUD Medicated Third Generation Eg. Hormonal IUD Second Generation Eg. Copper IUD Non medicated First Generation Eg. Lippe‘s loop Classification of Intrauterine Devices (IUD)
  45. 45. First generation iud They are inert or Nonmedicated devices made up of polyethylene Different shapes and sizes LIPPE’S LOOP:  Double ‘S’ shaped device  Made up polyethylene material  Non toxic, non tissue reactive & extremely durable  Small amount of Barium Sulphate is also added for radiological examination  Available in 4 sizes A,B,C &D
  46. 46. Second generation Iud Made up of metal – copper. EARLIER DEVICES Copper - 7 Copper - T 200 NEWER DEVICES Variants of T device  T copper 220C  T copper 380A Nova T Multi load devices ML-Cu250 ML-Cu375 47
  47. 47. Third generation iud Hormone releasing IUD Progestastert Most commonly used T shaped device filled with 38mg of progesterone Effective for 1 yr  LNG-20 (Minera) Releases 20µg of levonorgesterol. Effective for 5 yrs Effective rate 99%
  48. 48. ADVANTAGES OF IUDs: • Safe, Effective, Reversible • Inexpensive • High continuation rate DISADVANTAGES OF IUDs: • Heavy bleeding and pain • Pelvic Inflammatory diseases • Ectopic pregnancy • May come out accidently if not properly inserted
  49. 49. 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
  50. 50. Hormonal contraceptives Oral Pills Combined pills Progesterone only pills (POP) Once – a – month (long acting) pills Male pill Post coital pill Depot Preparations Injectables Subdermal Implants Vaginal Rings Classification of hormonal contraceptives
  51. 51. • What kinds of hormone has been used in hormone contraception? • How does the hormone work in the contraception?
  52. 52. • Hormonal contraception are COMMONLY for female sex steroids • Synthetic estrogen and a synthetic progesterone (progestin), or a progestin only
  53. 53. Mechanism of Hormonal Contraception Estrogen: 1) prevents the recruitment of the dominant follicle by suppressing FSH 2) allows for reduction of progesterone dose by recruitment of progesterone receptors, 3) minimizes side effect of break through bleeding by stabilizing the endometrium
  54. 54. Progesterone: 1) prevents ovulation by suppression of LH surge 2) thickened cervical mucus impedes sperm penetration into the upper genital tract. 3) produces an atrophic endometrium that is less receptive to implantation. 4) impairs secretion and peristalsis within fallopian tubes
  55. 55. Short-acting contraceptives Combined oral contraceptive pill (COCP) • often just called 'the pill'. • It contains estrogen and progestogen • stopping egg production (ovulation). • started from 21 days after the birth. • not recommended if you are breast-feeding, aS it can affect your milk supply.
  56. 56. • Some advantages - it is very effective. Side-effects are uncommon. It helps to ease painful and heavy periods. It reduces the chance of some cancers. When you stop taking it, you quickly become fertile again. • Some disadvantages - there is a small risk of serious problems (eg blood clots). Some women have side- effects. You must remember to take it. It can't be used by women with certain medical conditions, such as uncontrolled high blood pressure .
  57. 57. Progestogen-only pill (POP) • used to be called the 'mini-pill'. • It contains just a progestogen hormone. • It is commonly taken if the COCP is not suitable,. • causing a plug of mucus in the neck of the womb (cervix) that blocks sperm. • One type stops ovulation. • The POP can be started from 21 days after the birth. You need to remember to take it at the same time every day because, if you take a pill more than three hours later than usual you lose protection.
  58. 58. • Some advantages - less risk of serious problems than the COCP. When you stop taking it, you quickly become fertile again. • Some disadvantages - periods often become irregular. Some women have side-effects. Most types are not quite as reliable as the COCP.
  59. 59. Contraceptive patch • This contains the same hormones as the COCP • in patch form. • It is as effective as the COCP at preventing pregnancy. • The contraceptive patch can be started from 21 days after the birth. • not recommended if you are breast- feeding, as it can affect your milk supply.
  60. 60. • Some advantages - it is very effective and easy to use. You do not have to remember to take a pill every day. Your periods are often lighter, less painful and more regular. If you have vomiting or diarrhoea, the contraceptive patch is still effective. When you stop using it, you will quickly become fertile again. • Some disadvantages - some women have skin irritation. Despite its discreet design, some women still feel that the contraceptive patch can be seen.
  61. 61. Long-acting contraceptives These are more suitable for women who do not want to get pregnant again or for a few years. Contraceptive injection (such as Depo- Provera® and Noristerat®) • This contains a progestogen hormone. • It works by preventing ovulation • similar actions as the POP. • An injection is needed every 8-12 weeks. • It is usually recommended that you wait until six weeks after the birth to start the contraceptive injection because you may get heavy and irregular bleeding.
  62. 62. • Some advantages - it is very effective. You do not have to remember to take pills. • Some disadvantages - periods may become irregular (but often lighter or stop all together). After stopping, there may be a delay in your return to normal fertility for several months. Some women have side- effects. You cannot undo the injection, so if side-effects occur they may persist for longer than 8-12 weeks.
  63. 63. Contraceptive implant (such as Nexplanon®) • An implant is a small device placed under the skin. • It contains a progestogen hormone • It works in a similar way to the contraceptive injection. • It involves a small minor operation using local anaesthetic. • Each one lasts three years.
  64. 64. • Some advantages - it is very effective. You do not have to remember to take pills. You quickly become fertile again when the implant is removed. • Some disadvantages - periods may become irregular (but often lighter or stop altogether). Some women develop side-effects but these tend to settle after the first few months
  65. 65. Postcoital Contraception Pills (Emergency Contraception) • Emergency contraception can be used at any time if you had sex without using contraception. Also, if you had sex but there was a mistake with contraception. For example, a split condom or if you missed taking your usual contraceptive pills. • Emergency contraception pills - are usually very effective if started within 72 hours of unprotected sex. They can be bought at pharmacies or prescribed by a doctor. An emergency contraception pill works either by preventing or postponing ovulation or by preventing the fertilised egg from settling in the womb.
  66. 66. Postcoital Contraception Pills (Emergency Contraception) • An IUCD - inserted by a doctor or nurse, can be used for emergency contraception up to five days after unprotected sex. • You will not need emergency contraception if you have unprotected sex within 21 days of having your baby. You cannot get pregnant so soon after childbirth.
  67. 67. Coitus interruptus (withdrawal) • The penis is withdrawn from the vagina just before ejaculation occurs • Failure reasons – Live sperm leaks form the urethra before and during coitus – The withdrawal is delayed so that part of the semen is discharged within the vagina
  68. 68. Rhythm Method • Avoiding coitus during the period of greatest fertility • Human ovum can be fertilized no later than 24 to 48 hours after ovulation • Although motile sperm have been recovered from the uterus and the oviducts as long as 60 hours after coitus, their ability to fertilize the ovum probably lasts no longer than 24 to 48 hours Natural family planning
  69. 69. • Ovulation : – 14 days (12 to 16) before the onset of menstruation • Fertile period: – 4 days before, and for 3 or 4 days after ovulation • Safe period: – on the other days of the cycle
  70. 70. • Pregnancy is unlikely to occur if a couple refrains from fertile period • Unprotected intercourse on safe period should not result in pregnancy
  71. 71. Sterilization • Called tubal sterilization operation (tubal ligation) • Failure rate: 1/2000 • Permanence contraception • Have the risks of surgery • Pelvic inflammations • Skin (section site) inflammation • Fever (over 37.5 ℃ two times interval 4h during 24 h) • Severe disease couldn‘t tolerance operation • Psychological disease
  72. 72. Female Sterilization
  73. 73. Tubal clips
  74. 74. Male sterilization
  75. 75. Complications • Tubal recanalization • Pregnancy • Ectopic pregnancy • Menstrual irregularity • Loss of libido • Infection • Injury rectum or bladder
  76. 76. Family planning methods choice • Newly wedded couple – Male condom, female condom, spermicidal jelly – No IUD or oral hormonal contraceptives • Couple with one child – IUD, Male condom, oral hormonal contraceptives, Norplant, spermicidal jelly
  77. 77. • Couple with two or more children – Sterilization • Women during breastfeeding – IUD, condom – No hormonal contraceptives • Women in climacteric – No hormonal contraceptives • Condom for people with STDs or HIV
  78. 78. Percentage of failure in different contraception methods • Spermicides 21% • Withdrawal 19% • Periodic abstinence 15% • Condom female 21% • Condom male 12% • Pills 3% • IUD 2% • Implant 0.3% • Patch 5% • Copper IUD 0.8% • Female sterilization 0.4% • Male sterilization 0.15%
  79. 79. INTERNATIONAL LEVEL • ―International Planned Parenthood Federation‖ is the world's largest private voluntary organization supporting family planning services in developing countries. • The United Nations Fund for Population Activities (UNFPA). • the US Agency for International Development (USAID) • Population Council, • Ford Foundation, The Pathfinder fund and World Bank besides WHO and UNICEF.