FAMILY PLANNING methods in india free of cost government national family planning programme

1. NATIONAL FAMILY PLANNING PROGRAMME OF INDIA

2.  India, the second most populous country of the
world, harbors 17.5% of the world’s population in
only 2.4% of the global land mass.
 India became the first country in the world to
initiate the family planning program in 1952 with
the goal of lowering fertility and slowing the
population growth rate.
 Over the decades, the programme has
undergone transformation in terms of policy and
actual programme implementation and currently
being repositioned to not only achieve
population stabilization goals but also promote
reproductive health and reduce maternal,
infant & child mortality and morbidity.

3. Factors influencing population growth can be
grouped into following 3 categories-
 Unmet need of Family Planning: includes the married
women, who wish to stop child bearing or wait for next two
or more years for the next child birth, but not using any
contraceptive method. Total unmet need of Family Planning
is 12.9 (NFHS-IV) in our country.
 Age at Marriage and first childbirth: In India 26.8%
(NFHS-IV)of the girls get married below the age of 18 years
and out of the total deliveries 7.9% are among teenagers
i.e. 15-19 years.. Delaying the age at marriage and first
child birth could reduce the impact of Population
Momentum on population growth.
 Spacing between Births: Healthy spacing of 3 years
improves the chances of survival of infants and also helps
in reducing the impact of population momentum on

4.  The public sector provides the following contraceptive
methods at various levels of health system:

5. NIRODH

6. NIRODH
 first condom brand produced in India
 "Nirodh", meaning "protection" in Hindi
 Introduced in family planning for 1st time in 1968
 Barrier method
 ADVANTAGES
easily available
safe and inexpensive
no side effects
protection against STD
light compact and disposable
 DISADVANTAGES
may slip off or tear off
interfere with sex sensation locally

7. MALA - N

8. Combined oral contraceptives
COCs contain low doses of two synthetic hormones- progestin and
an oestrogen which are similar to the natural hormones in woman’s
body.
 Mala N contains Levonorgestrel (0.15mg) + Ethinyl estradiol (30
micrograms).
 Each strip of Mala-N contains 21 hormonal tablets and 7 non
hormonal (iron) tablets.
 Pill should be taken every day at fixed time preferably before
going to bed at night
WHEN TO START :
 within 5 days after the start of her monthly bleeding
 In case of breastfeeding : after return of normal menstrual cycle
 Not breastfeeding : 3 weeks after delivery.
 After miscarriage or abortion: Immediately, within 7 days

9. MISSED PILL
 Missed 1 or 2 pills : Take one hormonal pill as
soon as possible or two pills at scheduled time.
There is little or no risk of pregnancy.
 Missed 3 or more pills in the first or second week :
Take one hormonal pill as soon as possible and
continue the scheduled pill.Use a backup
method for the next 7 days.Also can consider
taking ECPs, if she had sex in the past 72 hours.
 Missed 3 or more pills in the third week : Take one
hormonal pill as soon as possible and finish all
hormonal pills in the pack as scheduled. Throw
away the 7 non-hormonal pills in a 28-pill pack.

10. MODE OF ACTION
 INHIBITION OF OVULATION
 PRODUCING STATIC ENDOMETERIAL
HYPOPLASIA
 ALTERATION OF CERVICAL MUCUS
 INTERFERES WITH TUBAL MOTALITY

11. HEALTH BENEFITS
 Protection against unwanted pregnancy
 Convenient to use
 Reversibility
NON CONTRACEPTIVE
 Regulation of menstrual cycle
 Decrease dysmenorrhea
 Decrease menorrhagia
 Protection against PID , Endometriosis , fibroid uterus
, hirsutism , acne , RA and osteopenia
 Prevent endometrial , ovarian and colorectal cancer

12. ADVERSE EFFECTS
MINOR : nausea , vomiting , headache , leg cramps ,
breast tenderness , weight gain , Irregular or unexpected
bleeding , decreased libido.
MAJOR: Depression , hypertension , cholestatic jaundice
, thrombosis .

13. PROGESTRONE ONLY PILLS

14. POPs
 POPs are also called “Minipills”
 Contains levonorgestrel 75mcg
 One pill should be taken every day and at the
same time until the pack is empty. Delayed intake
of the pill may increase failure/risk of pregnancy.
WHEN TO START:
 Any day within 5 days of menstrual cycle
 In case of breast feeding : anytime after delivery
 After miscarriage or abortion: Immediately, within 7
days
 After ECP :Same day, there is no need to wait for
her next . . . monthly bleeding to start
her pills.

15. ADVANTAGES : used as lactation pill , reduce risk of
PID and endometrial cancer , can be prescribed in
patients with hypertension , diabetes , smoking and
fibriod .
SIDE EFFECTS : Irregular or unexpected bleeding ,
Heavy menstrual bleeding, No menstrual bleeding ,
Severe lower abdominal pain , Headache , Dizziness ,
Nausea , Breast tenderness.
CONTRAINDICATION : unexplained vaginal bleeding ,
recent breast cancer , thromboembolic disease,
women taking antiseizure drugs .

16. MISSED PILL
 3 or more hours late taking a pill or misses one
completely: take a pill as soon as possible. Keep
taking pills as usual, one each day. (She may
take 2 pills at the same time or on the same day).
 If she has severe vomiting or diarrhoea: If she
vomits within 2 hours after taking a pill, take
another pill from the pack as soon as possible
and continue with the schedule pill as usual. If her
vomiting or diarrhoea continues, follow the
instructions for making up for missed pills above

17. CHHAYA

18. Centchroman (Ormeloxifene)
 is a non steroidal, non- hormonal.
 acts as selective estrogen receptor modulator (SERM).
 Product of central research institute Lucknow
HOW TO START: For initiation of the Centchroman
(Ormeloxifene) 30 mg , the first pill is to be taken on the first day
of period (as indicated by the first day of bleeding) and the
second pill three days later. This pattern of days is repeated
through the first three months. Starting from fourth month, the
pill is to be taken once a week on the first pill day and should be
continued on the weekly schedule regardless of her menstrual
cycle.
MISSED PILL :Take a pill as soon as possible after it is missed.
If pill is missed by 1 or 2 days but lesser than 7 days, the normal
schedule should be continued and client needs to use a back-up

19. EZY PILL

20. Emergency Contraceptive Pill
 ECPs are also called “morning-after pills” or post coital
contraceptives
 EC pills contains only progestin – Levonorgestrel (1.5 mg per
tablet).
 1.5 mg single dose or 0.75 mg two doses 12 hours interval
 Should be taken within 72 hours , may also be taken upto 120
hours
 Side effects : nausea , vomiting
 MODE OF ACTION : prevent ovulation , interferes with
fertilization , cause leuteolysis , prevent implantation
 No fetal adverse effects has been observed in case of failure of
contraception.
Copper IUCD can also be used as an emergency contraceptive method if
inserted within 5 days of unprotected intercourse/contraceptive accident.

21. ANTARA

22. Injectable Contraceptive (MPA)
 Medroxy Progesterone Acetate is a Progesterone -only
Injectable (POI) 150 mg given deep intra-muscular
every three months.
MODE OF ACTION:
 Inhibiting ovulation
 Thickening of cervical mucus
 Thinning of endometrial lining - due to high
progesterone and depleted oestrogen, making it
unfavourable for implantation of fertilized ovum.

23. ADVANTAGES :
 long term contraceptive
 Convenient and easy to use (does not require daily routine
or additional supplies).
 Pelvic examination not required prior to use.
 Suitable for women who are not eligible to use an
oestrogen containing contraceptive.
 Suitable for breast feeding women (after 6 weeks
postpartum) as it does not affect quantity, quality and
composition of breast milk.
 May decrease menstrual cramps and reduce pre-
menstrual syndrome/tension
 Improves anaemia by reducing menstrual blood loss due to
menstrual changes such as amenorrhea.
 Reduces the symptoms of endometriosis.
 Decreases benign breast disease, ovarian cyst , fibroids
and pelvic inflammatory disease (PID)
 Protect against endometrial cancer and possibly ovarian
cancer.

24. LIMITATIONS :
 It does not protect against STI/RTI and HIV
infection
 Once taken its action cannot be stopped
immediately.
 It has to be repeated every three months to
achieve desired contraceptive effectiveness.
 Return of fertility takes 7-10 months from date of
last injection
 Cannot be given in few medical
conditions/diseases ( osteoporosis , breast
cancer )

25. IUCD

26.  In India, IUCD was introduced in 1965 under the
National Family Planning Programme
 Currently there are two types of IUCDs available
under the National Family Planning Programme:-
1. IUCD 380 A, effective up to 10 years
2. IUCD 375, effective up to 5 years

31. Mechanism of action
 Copper ions decrease sperm motility and function
by altering the uterine and tubal fluid
environment, thus preventing sperm from
reaching the fallopian tubes and fertilizing the egg
(Rivera et al. 1999)
 The device stimulates foreign body reaction in
the endometrium that releases macrophages and
prevents implantation

32. Benefits
 Long-term, highly effective reversible protection
against pregnancy
 Effective immediately after insertion
 Safe for use in breastfeeding women
 Acts as an emergency
 One time cost effective procedure
 No requirement of daily attention or special attention
before sexual intercourse
 Immediate return of fertility upon removal of IUCD
 No drug interaction
 May help protect against endometrial and cervical
cancer

33. COMPLICATIONS
IMMEDIATE : cramp like pain , syncopal attack , partial
or complete perforation.
REMOTE
 Pain
 Abnormal menstrual bleeding
 PID
 Spontaneous expulsion
 Perforation

34. Postpartum IUCD
 Insertion within 10 minutes after the delivery of placenta
following a vaginal delivery (Post Placental)
 Insertion within 48 hours of vaginal delivery
 Insertion during caesarean delivery, after removal of the
placenta and before closure of the uterine incision (Intra-
caesarean)
Advantages
 Convenient; saves time and additional visits
 lower risk of uterine perforation as compared to Interval IUCD,
because of the thickened wall of the uterus
 Reduced perception of initial side effects (bleeding and
cramping) by clients due to presence of normal puerperal
changes
 Reduced chance of heavy bleeding, especially among

35. Post Abortion IUCD
After Surgical Abortion: Immediately or within 12 days
of an abortion procedure, after ensuring that the
abortion is complete (there are no retained products of
conception)and infection and injury to the genital tract
are ruled out or resolved
After Medical Method of Abortion: within 15 days ,
provided the abortion process is complete and evidence
of infection is ruled out.
Advantages
 Less pain of insertion as the cervical os is open
 Convenient; saves time and additional visits
 Reduced perception of initial side effects (bleeding
and cramping) due to presence of normal post
abortion symptoms

37. Female Sterilization
 It is one of the most popular and effective methods of
contraception.
 In India female sterilization by tubectomy or tubal
occlusion is the most commonly accepted methods
among eligible couples. District Level House-hold
Survey (DLHS III) shows that 34% of the ever married
women accepted female sterilization as a contraceptive
choice
 There are two common surgical techniques for female
sterilization: Minilap Tubectomy and Laparoscopic
Tubal occlusion,

39. MINILAP TUBECTOMY
 Sterilization by can be interval sterilization using supra-
pubic approach or post-partum sterilization using sub-
umbilical approach.
 Interval sterilization: should be performed within 7 days of
the beginning of menstrual period (in the follicular phase of
the menstrual cycle) or anytime during the cycle if the
woman and the provider are reasonably sure that she is
not pregnant.
 Post-partum sterilization: should be done within 7 days of
delivery.
 Sterilization following spontaneous abortion: can be
performed concurrently or within seven days of abortion,
after excluding infection.
 Sterilization following MTP: can be performed
immediately after the procedure if the provider has

40. Laparoscopic tubal occlusion
 is usually performed in the ‘interval’ period (6 weeks
after delivery or any time when the woman is not
pregnant) or following first trimester abortion.
 For interval procedures, laparoscopy may be
performed at any time in the menstrual cycle
although it is preferable to do it at the end of the
menstrual period or shortly thereafter to ensure that
the client is not pregnant.
 It is not recommended in the postpartum period or
after 2nd trimester post-abortion because of the
possibility of injury to the larger, more vascular
postpartum uterus.

41. CRITERIA FOR STERLIZATION
 Clients should be ever-married.
 Female clients should be above the age of 22 years
and below the age of 49 years .
 The couple should have at least one child, whose
age is above one year,.
 Clients must be in a sound state of mind, so as to
understand the full implications of sterilization.
A relevant medical history, physical examination and
laboratory investigations need to be completed to
ascertain eligibility for surgery

42. MALE STERLIZATION
VASECTOMY is permanent sterilization done in males where
the segment of vas deferens of both sides are resected and
cut ends are ligated .
ADVANTAGES :
 Simple and require minimal training
 Outdoor procedure
 Failure rate 0.15 %
 Fair success of reversal
DISADVANTAGES :
 Require additional contraceptives for 3 months
 Psychological impotency

43. Selection of candidates
 least 22 years old and below the age of 60 years.
 Clients should be ever-married.
 The couple should have at least one child, whose age is
above one year .
 must be in a sound state of mind.

44. COMPLICATIONS
IMMEDIATE : wound sepsis , scrotal hematoma
LATE:
 Impotency: psychological
 Sperm granuloma
 Chronic intra scrotal pain and discomfort
 Spontaneous recanalization

45. Thank you