2. DEFINITION
“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”. --WHO
3. DEFINITION
Family planning is action taken by
an family or couples to regulate
the number and spacing their
children in accordance with their
personal preference
--Dictionary
4. OBJECTIVES
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.
5. Classification of contraceptive methods
I. SPACING
METHODS
Barrier
Methods
Physical
Methods
Chemical
Methods
Combined
Methods
Intrauterine
Devices
Hormonal
Methods
Post
Conceptional
Methods
.
Miscellaneous
II. TERMINAL METHODS
Male
sterilization
Female
sterilization
Natural
method
6. Natural family planning methods
Natural methods avoid pregnancy
by abstain from sexual intercourse
during fertile phase ,coitus
interruptus,rhythm method etc.
Basal body temperature
Cervical mucus method
Calendar method
8. Barrier method
Barrier methods are those methods which
prevent meeting of sperm with ovum .
There are three types…
1. Physical barrier methods
2. Chemical barrier methods
3. Combined methods
9. physical barrier method
MALE CONDOMS
It is a thin rubber sheath which is used
by men. Its is rolled over the erect penis
before having sex.This rubber sheath
prevents the entry of semen into the
vagina.
In India, dry condoms are manufactured
and supplied free of cost by the
government under brand name ‘Nirodh’
10. Condom cont…
ADVANTAGE:
Simple spacing method
No side effects
Easily available, safe & inexpensive
Protects against STDs
No medical supervision
DISADVANTAGE:
Chances of slip off and tear off
Rare cases allergic to rubber
11. DIAPHRAGM
The diaphragm is used by women in her vagina to
from a barrier in front of the cervix .
The diaphragm is dome shaped and Is like
shallow cap
It made of soft synthetic rubber or plastic with a
stiff or flexible rim around the edge .its also
known as Dutch cap
It is held in position partly because of tension
created by the spring and partly by the muscle
12. Diaphragm cont…
Advantages
Effective with spermicidal
Failure rate is low
Prevents STDs including HIV/AIDS
No risk /contraindications
Disadvantages
Requires assistance by health personal
Requires periodical check up
Requires privacy to place
Requires facilities for storage
13. VAGINAL SPONGE
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
Must be removed and thrown away after
8-24 hrs but not before 6 hrs of last act
14. 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
16. MERITS
Cheapest but least effective
Melt at body temperature
Manual insertion high in vagina 10-15
minutes before sexual act
Available in all health centers
Easy to administer
Increases vaginal lubrication
17. DEMERITS
Must be inserted deep down where
sperm is likely to reach
Must be applied each time before
coitus
May cause irritation and burning
18. Intra uterine devices
The control of conception by introducing a
foreign body into the uterine cavity .
There are three types of IUD’S
First generation IUD’S
Second generation IUD’S
Third generation IUD’S
20. First generation iud
20
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
Easy detected by x ray
21. Second generation Iud
21
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
22. Third generation iud
9/30/2018 22
Hormone releasing IUD
Progestastert
Most commonly used
T shaped device
filled with progesterone
Effective for 1 yr
LNG-20 (Minera)
Contains levonorgesterol.
Effective for 5 yrs
Effective rate 99%
23. ADVANTAGES OF IUDs:
Safe, Effective, Reversible
Inexpensive
High continuation rate
Does require hospitalisation
DISADVANTAGES OF IUDs:
Heavy bleeding and pain
Pelvic Inflammatory diseases
Ectopic pregnancy
May come out accidently if not properly
inserted9/30/2018 23
24. 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.9/30/2018 24
25. 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
9/30/2018 25
26. Classification of hormonal contraceptives
Hormonal
contraceptives
Oral Pills
Combined pills
Progesterone
only pills (POP)
Once – a –
month (long
acting) pills
Male pill
Post coital pill
Depot
Preparations
Injectables
Sub dermal
Implants
Vaginal Rings9/30/2018 26
27. Combined pills
Composition
Oestrogen - 100-200µg and
Progesterone - 10mg
Greater side effects
Taken from 5th to 25th day of menstrual cycle,
followed by a break of 7 days (withdrawal
bleeding).
30. Merits
100% effective if taken regularly
Easy to use
Reduces risk of anemia
Reduces risk of pelvic inflammation
disease
31. Demerits
Failure rate increases if irregularly taken
Minor side effects are like
dizziness,nausea,vomiting,headache,breast
tenderness and weight gain
Increase risk of heart problems
Increases risk of gall bladder disease and
cervical cancer.
Decrease the quantity of breast milk.
32. Progesterone only pills
Minipill or Micropill.
Composition:
Low dosage of progesterone, mainly
Norethisterone (or) Levonorgestrel.
Dosage:
One tab daily throughout the menstrual cycle
Efficacy 96-98%
High failure rate
Not widely used
33. Once a month (long acting) pill
In this method a long acting
oestrogen (Quinestrol) + short acting
progesterone is given.
But the results are highly
disappointing.
High pregnancy rate
9/30/2018 33
35. Progesterone only injectables
DMPA:
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
NET-EN:
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. 35
36. Combined injectables
Containing long-acting progesterone with short action estrogen
Given once a month and produce a menstruation like pattern.
The trials are currently taking place in India.
Mode of acion:
Suppression of ovulation
Alteration of cervical and endometrial secretions.
Contraindications
Pregnancy Thrombo embolytic disorders
Cerebrovascular disease Coronary artery disease
Migraine Breast cancer
DM
36
37. NORPLANT
Sub dermal implants
A flexible plastic single
flexible rod 4cm long
x 2mm diameter
Contains 35mg
LEVONOGESTREL
9/30/2018 37
38. Vaginal ring (Nuvaring)
Contains small amount of oestrogen
Use for three weeks with a withdrawal week
Inhibits ovulation
Cycle control good
Non-latex
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
9/30/2018 38
38
39. Post conceptional methods Classification
Post
conceptional
methods
Menstrual
Regulation
Menstrual
Induction
Oral
Abortifacient
Abortion9/30/2018 39
40. Menstrual regulation
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 isoimmunization40
41. Menstrual induction
Based on disturbing the normal progesterone-
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.
9/30/2018 41
43. abortion
Definition:
Termination of pregnancy before the foetus
becomes viable .
LEGALISATION
Medical termination of pregnancy act
1971
1) Conditions under which abortion is done
Medical
Eugenic
Humanitarian
Socio-economic
In failure of contraceptive device
9/30/2018 43
44. 2) Who can perform abortion?
If < 12 weeks 1 RMP having
experience in OB-GYN
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.
9/30/2018 44
45. Drawbacks:
Irregular cycle so difficult to
predict
Only for educated and responsible
couples
Programmed Sex
Complication:
Embryonic Abnormalities, Ectopic
Pregnancy
9/30/2018 45
47. VASECTOMY
Vasectomy is sterilisation of male
It is very simple and minor operation which
takes hardly 15-20minutes
The operation involves a small cut on both
sides of the scrotum then a small portion of vas
deferens about 1cm on either side of the
scrotum is cut and ligated, folded back and
sutured
Sperms are produced but not ejaculated
48. MERITS
• Permanent cheaper than tubal ligation
• 100% effective
DEMERITS:
• Requires surgery
• Not effective immediately
• May not be reversible
51. TUBECTOMY
Its done by resecting a small part of fallopian
tubes and ligate the sected ends
The closing of the tubes can be done by using
other methods like closing the tubes with bands,
clips and electrocautery
This surgery is done through abdominal and
vaginal approach
Most common is abdominal laparoscopy
Done after delivery or after abortion
52. POST-COITAL
COTRACEPTIVE
Emergency contraception is a
method of contraception which is
used after intercourse and before the
potential time of implantation
No prescription is needed for
women aged 17 years
This can be used within 72 hours
and should be taken for 5 days after
coitus
53. Mechanism of action:
Hypermotility of fallopian tube
Hypermotility of uterus hence
no implantation and
fertilization
Disadvantages:
Nausea and vomiting.
Next period may start earlier
or later
Do not protect against STI &
55. Aims and objectives of family
welfare programmes
To promote the adoption of small family
size norm on basis of voluntary
acceptance
To promote the use of spacing methods
To ensure adequate supply of
contraceptives to all eligible couples
within easy reach
To arrange for clinical and surgical
services so as to achieve the set targets
56. Cont..
Participation of voluntary
organization/local leaders/local self
government, in family welfare
programme at various levels
Using the means of mass
communications and interpersonal to
overcome the social and cultural
hindrance in adopting the programme
or extensive use of public health
education for family planning
57. IMPACT OF FAMILY PLANNING
SERVICE
Awareness of one or more methods of
contraception
Increases in contraception use over years
Increase in use of condoms
Knowledge of female sterilization
Increase knowledge about contraceptive pills
Fertility rate low among educated women
Fertility rate low among higher income group
58. ROLE OF COMMUNITY HEALTH NURSE IN
FAMILY WELFARE SERVICES
Survey work
Collecting demographic facts
Collecting information about pregnant
mothers, eligible couples, infants and
children below the school going age.
59. Cont..
Education functions and motivation:
Explaining the importance and necessity of
family planning to mass
Using various techniques of teaching and
communication to propagate the message of
family planning to common man
Motivating the eligible couple to use
contraceptive
Motivating people for permanent contraception
60. Cont..
Managerial functions:
Conducting clinics
Organizing family planning camps
Maintaining the records
Liaison work- soliciting the co-
operation of NGO’s /Voluntary
organization