Family planning

1. Unit V:Family Planning
Ibne Amin
Lecturer-KMU

2. Objectives
• Describe The consequences of Population Growth In
Pakistan
• Identify Family Planning(FP) services available in
Pakistan
• Identify Social, economic, political and religious
aspects of FP in Pakistan
• Discuss the responsibilities/role of a nurse for FP
• Describe the indications, contraindications,
advantages and side effects of different
contraceptive methods
• Discuss the importance and counselling skills for FP

3. Population Growth and Its consequences
Key Facts
• World population continues to grow and is expected to peak around
at a level of almost 9.7 billion by 2050 and 10.4 billion by 2100.
• Most of this growth will take place in low-income and lower
middle-income countries.
• Because of the momentum of past growth, it is unlikely that the
increase of global population over the next 30 or 40 years will be
substantially faster or slower than anticipated in the population
projections of the United Nations
• Rapid population increase can exacerbate the challenge of ensuring
that future development is sustainable and inclusive.

4. Population Growth and Its consequences
Key Facts
• Achieving the Sustainable Development Goals, particularly
those related to health, education and gender equality, can
contribute to slowing global population growth.
• In countries with relatively high levels of fertility today,
investments in education and health can significantly increase
the positive but temporary economic impact of a favorable
age distribution created by a sustained decline in fertility
• Population growth magnifies the harmful impact of economic
processes on the environment; yet the rise in per capita
income has been more important than population growth in
driving increased production and consumption

5. Population Growth and Its consequences
Key Facts
• https://www.worldometers.info/world-population/pakistan-population/
• The current population of Pakistan is 232,376,803 as of Thursday, March
9, 2023, based on World meter elaboration of the latest United Nations
data.
• Pakistan 2020 population is estimated at 220,892,340 people at mid year
according to UN data.
• Pakistan population is equivalent to 2.83% of the total world population.
• Pakistan ranks number 5 in the list of countries (and dependencies) by
population.
• The population density in Pakistan is 287 per Km2 (742 people per mi2).
• The total land area is 770,880 Km2 (297,638 sq. miles)
• 35.1 % of the population is urban (77,437,729 people in 2020)
• The median age in Pakistan is 22.8 years.

6. Population Growth and Its consequences
Main consequences of population growth. The consequences are:
1. Investment: Faster population growth makes the choice more scarce
between higher consumption now and the investment needed to bring
higher consumption in the future
2. Overuse of Resources :Rapid population growth tends to overuse the
country’s natural resources. This is particularly the case where the
majority of people are dependent on agriculture for their livelihood
3. Urbanization: With rapidly growing population, it becomes difficult to
manage the adjustments that accompany economic and social change.
Urbanization in UDCs creates such problems as housing, power, water,
transport, etc. Besides, growing population threatens permanent
environmental damage through urbanization in some rural areas

7. Population Growth and Its consequences
4. Per Capita Income :The effect of population growth on per capita
income is unfavorable:
• It increases the pressure of population on land;
• it leads to rise in costs of consumption goods because of the
scarcity of the cooperant factors to increase their supplies; and
• it leads to a decline in the accumulation of capital because with
increase in family members, expenses increase.
5. Standard of Living: Since one of the important determinants of the
standard of living is the per capita income, the factors affecting per
capita income in relation to population growth equally apply to the
standard of living. A rapidly increasing population leads to an increased
demand for food products, clothes, houses.

8. Population Growth and Its consequences
6. Agricultural Development :In UDCs, people mostly live in rural
areas. Agriculture is their main occupation. So with population growth
the land-man ratio is disturbed. Pressure of population on land
increases because the supply of land is inelastic. It adds to disguised
unemployment and reduces per capita productivity further
7. Employment A rapidly increasing population plunges the economy
into mass unemployment and under-employment. As population
increases, the proportion of workers to total population rises. But in
the absence of complementary resources, it is not possible to expand
jobs
8. Social Infrastructure :Rapidly growing population necessitates large
investments in social infrastructure and diverts resources from directly
productive assets. Due to the scarcity of resources, it is not possible to
provide educational, health, medical, transport and housing facilities
to the entire population

9. Population Growth and Its consequences
9. Labor Force: The labor force in an economy is the ratio of working
population to total population
10. Capital Formation: Population growth retards capital formation. As
population increases, per capita available income declines. People are
required to feed more children with the same income. It means more
expenditure on consumption and a further fall in the already low
savings and consequently in the level of investment
11.Population Growth Leads to Environmental Damage: Scarcity of
land due to rapidly increasing population pushes large number of
people to ecologically sensitive areas such as hillsides and tropical
forests. It leads to overgrazing and cutting of forests for cultivation
leading to severe environmental damage

10. Population Growth and Its consequences
12. World Economy. Rapid population growth also affects UDCs in relation to
the world economy in a number of ways.
• Rapid population growth tends to increase income disparities between
UDCs and developed countries because the per capita incomes decline
with growth in numbers in the former.
• Rapid population growth encourages international migration.
• emigration tends to increase wages of workers substantially at home
• Another beneficial effect of this is that emigrants remit large sums of
money back home. This increases family incomes and their living
standards at home
• Rapid population growth the domestic consumption of even exportable
goods increases. Consequently, there is a decline in the exportable
surplus. On the other hand, to meet the demand of rapidly increasing
population, more food and other consumer goods are required.

11. Population Growth Consequences in
Pakistan
https://issi.org.pk/wp-content/uploads/2022/09/IB-
Ramsha_Qamar_Sept_6_2022.pdf

12. FAMILY PLANNING
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13. Family Planning
According to WHO:
• “Family planning is 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 health & welfare of the family and thus
contribute effectively to the social development of a country”.

14. Family Planning
• Family Planning means deciding when is the right time to have
children, and what is the appropriate number of children for a
couple to have.
• The right time to have children is:
i. when a woman is between 20 and 35 years old;
ii. when a woman has not been pregnant for the last 2-3 years;
iii. when a woman has fewer children;
iv. when a woman has no illness that would place herself or her baby
in danger and;
v. when the couple wants to have a baby.

15. Family Planning
• If the above factors are not satisfied, then the woman, her baby,
and her pregnancy are at risk because:
1. There are more chances for the pregnancy to end in abortion or
miscarriage;
2. The woman is more likely to become anemic and malnourished.
3. She is prone to develop obstetrical complications such as
hemorrhage as well as gynecologic problems such as uterine
prolapse;
4. The baby has more chances of being born premature or with low
birth weight.
5. The incidence of stillbirths and fetal death will be higher.

16. Family Planning
• A woman’s ability to space and limit her pregnancies has a direct
impact on her health and well-being as well as on the outcome of
each pregnancy.
• Family planning reduces maternal mortality and improves women's
health by:
i. Preventing unwanted and high-risk pregnancies
ii. Reducing the need for unsafe abortions
iii. Reducing the likelihood of STDs/HIV
iv. Protecting against certain cancers and health problems

18. Family Planning
• Family planning allows individuals and couples to anticipate and
attain their desired number of children and the spacing and timing
of their births.
• Family planning is an essential component of welfare programs.
Parallel efforts to improve women’s status and expand
opportunities for the very poor would make family planning much
easier to achieve.

19. Contraception
• Contraception may refer specifically to “mechanisms which are
intended to reduce the likelihood of conception”.
• Family Planning is achieved through use of contraceptive methods
and the treatment of involuntary infertility.

20. Unmeet need for Contraception
Women with unmet need are those who are productive and
sexually active but are not using any method of contraception,
and report not wanting any more children or wanting to delay
the next child.
▪ The concept of unmet need points to the gap between
women's reproductive intentions and their contraceptive
behavior
Unmet need is especially high among groups such as:
– Adolescents
– Migrants
– Urban slum dwellers
– Refugees
– Women in the postpartum period

21. Unmeet need for Contraception
• Globally, many women and couples want to postpone or
avoid pregnancy.
• According to 2017 estimates, 214 million women of
reproductive age in developing regions have an unmet need
for contraception. Reasons for this include:
1. Limited choice of methods
2. Limited access to contraception, particularly among young
people, poorer segments of populations, or unmarried
people
3. Fear or experience of side-effects
4. Cultural or religious opposition
5. Poor quality of available services
6. Gender-based barriers.

22. Methods of Contraception
• A variety of methods are available--both permanent and reversible,
long-acting and short-acting, methods for women and men.
• In addition to their effectiveness in preventing pregnancy, some
contraceptives also have substantial non-contraceptive health
benefits.

23. Methods of Contraception
METHODS MALE FEMALE
CONVENTIONAL/
BARRIER
METHODS
- Coitus
Interruptus
(withdrawl
Method)
- Condoms
- Safe Period or Rhythum
Method
- Chemical spermicides
- Diaphragm
CLINICAL
METHODS
- Intrauterine Device
(IUCD)
- Hormonal contraception:
• Oral pills
• Injectables
SURGICAL
METHOD
Vasectomy Tubal ligation
(Tubectomy)

24. Conventional/ Barrier methods
Method Description How it works
Effectiveness to
prevent
pregnancy
Comments
Withdrawal (coitus
interruptus)
Probably the oldest
method of
contraception.
- Simple and widely
used.
Keeps sperm out
of the woman's
body, preventing
fertilization
96% with correct
and consistent use
One of the least
effective methods
Associated with
adverse emotional
reactions.
73% as
commonly used
Fertility awareness
methods (natural
family planning or
Safe Period /Rhythum
Method))
Calendar-based
methods:
monitoring fertile
days in menstrual
cycle; symptom-
based methods:
monitoring cervical
mucous and body
temperature
The couple
prevents
pregnancy by
avoiding
unprotected
vaginal sex during
these fertile days,
usually by
abstaining or by
using condoms
75%
Can be used to
identify fertile
days by both
women who want
to become
pregnant and
women who want
to avoid pregnancy

25. Conventional/ Barrier methods
Method Description How it works
Effectiveness to
prevent pregnancy
Comments
Male condoms
Sheaths or
coverings that fit
over a man‘s
external genitalia
Forms a barrier to
keep sperm out of
the vagina
98% with correct
and consistent
use
Also protects
against sexually
transmitted
infections,
including HIV
85% as commonly
used
Female
condoms/Diaphgra
m
Sheaths, or
linings, that fit
loosely inside a
woman's vagina,
made of thin,
transparent, soft
plastic film
Forms a barrier to
prevent sperm and
egg from meeting
90% with correct
and consistent
use
Also protects
against sexually
transmitted
infections,
including HIV
79% as commonly
used

26. Natural Method
Method Description How it works
Effectiveness to
prevent
pregnancy
Comments
Lactational
amenorrhea
method (LAM)
Temporary
contraception for
new mothers whose
monthly bleeding
has not returned;
requires exclusive
breastfeeding day
and night of an
infant less than 6
months old
Prevents the
release of eggs
from the ovaries
(ovulation)
99% with correct
and consistent use
A temporary
family planning
method based on
the natural effect
of breastfeeding on
fertility
98% as commonly
used

27. Hormonal Methods
Method Description How it works
Effectiveness to
prevent
pregnancy
Comments
Combined oral
contraceptives
(COCs) or “the
pill”
Contains two
hormones
(estrogen and
progestogen)
Prevents the
release of eggs
from the ovaries
(ovulation)
>99% with
correct and
consistent use
Reduces risk of
endometrial and
ovarian cancer;
should not be
taken while
breastfeeding
92% as commonly
used
Progestogen-only
pills (POPs) or
"the minipill"
Contains only
progestogen
hormone, not
estrogen
Thickens cervical
mucous to block
sperm and egg
from meeting and
prevents ovulation
99% with correct
and consistent use Can be used while
breastfeeding;
must be taken at
the same time each
day
90–97% as
commonly used

28. ORAL CONTRACEPTIVE PILLS
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29. Hormonal Methods
Method Description How it works
Effectiveness to
prevent
pregnancy
Comments
Progestogen only
injectables
Injected into the
muscle every 2 or 3
months, depending
on product
Same mechanism
as POPs
>99% with
correct and
consistent use
Delayed return to
fertility (1–4
months) after use;
irregular vaginal
bleeding common,
but not harmful
97% as commonly
used
Monthly
injectables or
combined
injectable
contraceptives
(CIC)
Injected monthly
into the muscle,
contains estrogen
and progestogen
Same mechanism
as COCs
>99% with
correct and
consistent use Irregular vaginal
bleeding common,
but not harmful
97% as commonly
used

30. Hormonal Methods
Method Description How it works
Effectiveness to
prevent
pregnancy
Comments
Implants
Small, flexible rods
or capsules placed
under the skin of
the upper arm;
contains
progestogen
hormone only
Same mechanism
as POPs
>99%
Health-care
provider must
insert and remove;
can be used for 3–5
years depending on
implant; irregular
vaginal bleeding
common but not
harmful
Emergency
contraception
(levonorgestrel 1.5
mg)
Progestogen-only
pills taken to
prevent pregnancy
up to 5 days after
unprotected sex
Prevents ovulation
Reduces risk of
pregnancy by 60–
90%
Does not disrupt
an already existing
pregnancy

31. HORMONAL METHODS
IMPLANTS
INJECTABLES
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32. Intra-uterine contraceptive devices (IUCDs)
Method Description How it works
Effectiveness to
prevent
pregnancy
Comments
Intrauterine
device (IUD):
copper
containing
Small flexible
plastic device
containing
copper sleeves
or wire that is
inserted into the
uterus
Copper
component
damages sperm
and prevents it
from meeting
the egg
>99%
Longer and
heavier periods
during first
months of use
are common but
not harmful; can
also be used as
emergency
contraception
Intrauterine
device (IUD)
levonorgestrel
A T-shaped
plastic device
inserted into the
uterus that
steadily releases
small amounts
of levonorgestrel
each day
Suppresses the
growth of the
lining of uterus
(endometrium)
>99%
Reduces
menstrual
cramps and
symptoms of
endometriosis;
amenorrhea (no
vaginal
bleeding) in
20% of users

33. INTRA-UTERINE DEVICE CONTRACEPTIVE(I.U.C.D)
33

34. Surgical Methods
Method Description How it works
Effectiveness to
prevent
pregnancy
Comments
Male
sterilization
(vasectomy)
Permanent
contraception to
block or cut the
vas deferens
tubes that carry
sperm from the
testicles
Keeps sperm out
of ejaculated
semen
>99% after 3
months semen
evaluation
3 months delay
in taking effect
while stored
sperm is still
present; does not
affect male
sexual
performance;
voluntary and
informed choice
is essential
97–98% with no
semen
evaluation
Female
sterilization
(tubal ligation)
Permanent
contraception to
block or cut the
fallopian tubes
Eggs are
blocked from
meeting sperm
>99%
Voluntary and
informed choice
is essential

35. FEMALE STERILIZATION (TUBAL LIGATION)
35

36. Most effective
and nothing to remember.
Effective but must be
carefully used.
Fewer side-effects:
Very effective but must
be carefully used.
More side-effects:
Pills Injectables
Fertility
awareness-
based methods
Vaginal
methods
Male and
female
condom
IMPORTANT!
Only condoms
protect
against
both
pregnancy
and STIs/HIV/AIDS
Fewer side-effects,
permanent:
More side-effects:
Implants
IUD
Fewer side-effects:
LAM
Female
sterilization
Vasectomy
Comparing methods
Khyber Medical University Peshawar

37. EFFECTIVENESS OF CONTRACEPTIVE METHODS
37

38. Indication & Contraindications
• https://www.who.int/publications/i/item/978
9241549158

39. Advantages & Disadvantages
• Word Document

40. Social, Economic, political ,Religious aspects of family
planning
• Discussion
• https://www.fp2030.org/news/political-
economy-family-planning

41. Nurses Responsibilities/Role in Family Planning
Nurses have a major role to play in achieving the objectives of
family planning:
• The community health nurse can educate the family and the
eligible couples on advantages of a planned family
• Nurses can distribute most methods of contraception and
disseminate information on family planning.
• Conduct survey to develop eligible couple list and use this for
carrying out family planning activities
• Motivate couples to adopt family planning methods and
arrange for facilities to provide these methods

42. Nurses Responsibilities/Role in Family Planning
• Offer follow-up services for mothers who have adopted FP
methods and treat side effects or minor complaints, if any
• Train and supervise health workers and maintain the record of
the services rendered through them
• Involve voluntary health guides, women leaders and other
voluntary members; give them training, guidance and supplies
• Encourage satisfied family planning acceptors to promote
family planning
• Give advice and refer if any couple needs infertility clinic
services

43. Nurses Responsibilities/Role in Family Planning
• Help women in availing facilities of Medical Termination of
Pregnancy, if required
• Communicate with individuals, groups and through mass
media
• Supervise dais and community level workers
• In antenatal and postnatal clinics and in surgical wards, they
can talk with mothers and make sure that their family
planning needs are made known to the community health
centers in their villages when they return.

44. Family Planning Counselling Importance
• The role of family planning counselling is to support a
woman and her partner in choosing the method of FP
that best suits them and to support them in solving any
problems that may arise with the selected method.
• Spacing
• Limiting
• Switching methods – address discontinuation rates
Poor counselling - fear or experience of side-effects;
cultural or religious opposition is one of the key reason
for unmeet needs of family Planning

45. Family Planning Counselling
• Contraceptive counseling is defined as the exchange of
information on contraceptive methods based on an
assessment of the client’s needs, preferences and lifestyle to
support decision-making as per the client’s intentions.
• This includes the selection, discontinuation or switching of a
contraceptive method.
• The key principles are based on coercion-free and informed
choice; neutral, understandable and evidence based
information; collaborative and confidential decision-making
process; ensuring respectful care, dignity and choice.

46. Approach to Family Planning Counselling(Gather)
• G: Greet the client respectfully. This will make the individual
relax and pour out his mind to you.
• A: Ask them about their family planning need.
• T: Tell them about different contraceptives options and
methods.
• H: Help them to make decision about of method
• E: Explain and demonstrate how to use the method
• R: Return /Refer, Schedule and carry out a return visit and
follow up

47. Family Planning Counselling Key Elements

48. Legal Issues related to Family Planning and Contraception
• May vary from state to state concerning minors, sterilization, and
abortions.
• Informed consent-need to document information provided and
understanding of client -the nurse should use (BRAIDED)when
counseling client on contraceptive methods
• Decision about contraception should be made voluntarily with
informed consent
• B- Benefits/Advantages
• R-Risks/Disadvantages
• A- Alternatives/Other methods available
• I-Inquiries/ Allow time for questions
• D-Decisions/opportunity to decide or change mind
• E-Explanation/about method/how to use
• D-Documentation /everything taught

49. References
• Basavanthappa, B. T. (2008). communnity health nursing
(2nd ed.). india newdehli: jaypee brothers medical publisher (p)
Ltd
• https://www.sociologydiscussion.com/demography/population
-growth/12-main-consequences-of-population-growth/3162
• https://www.worldometers.info/world-population/pakistan-
population/
• Family planning. Available at
http://www.who.int/reproductivehealth/topics/family_planning/e
n/
• https://www.who.int/news-room/fact-sheets/detail/family-
planning-contraception
• https://www.cdc.gov/reproductivehealth/contraception/index.ht
m
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50. Thank you