methods of population control

1. METHODS OF POPULATION CONTROL
INTRODUCTION TO FAMILY PLANNING METHODS
BY
DR R BAMILAN
FIRST YEAR POSTGRADUATE
DEPARTMENT OF COMMUNITY
MEDICINE
STANLEY MEDICAL COLLEGE

2. INTRODUCTION
• Demography- scientific study of human population
• Three observable human phenomena
i) changes in population size
ii)composition of the population
iii)Distribution of population
Deals with five demographic processes
i)Fertility
ii)Mortality
iii)Marriage
iv)Migration
v)Social mobility

3. DEMOGRAPHIC CYCLE
• FIRST STAGE( High stationary) Eg; India in 1920
• SECOND STAGE( Early expanding) Eg; South asia and Africa
• THIRD STAGE( Late expanding) Eg; India, China, Singapore
• FOURTH STAGE( Lowstationary) Eg; Uk, Denmark, Sweeden
• FIFTH STAGE( Declining) Eg; East European Germany, Hungary

4. FACTORS AND POSSIBLE RESONS BEHIND
EACH FACTOR FOR POPULATION EXPLOSION
HIGH BIRTH RATE LOW DEATH RATE MIGRATION
Universal marriage norm Advancement in medical sciences Illegal migration from neighbouring
countries
Early age at marriage Health awareness and increased
investment on health
Teenage pregnancies Political will for universal health
coverage
Poverty and illiteracy
Role of women in decision making

5. METHODS FOR POPULATION CONTROL
Family welfare measures
Social welfare measures
FAMILY PLANNING:
OBJECTIVE:
i) Prevent unwanted pregnancies
ii) Limit the number of children
iii) Limit the age of female ( at the 1st child birth)

6. PLANNED FAMILY:
i) The 1st child birth is after 20yrs of the mother’s age.
ii) Minimum of 3 years between 2 children.
iii) Limited size of children (2 or 3).
Stable Population means CPR of 60%~TFR of 2.1~NRR 1
Eligible couple: couple in reproductive age group.( 15- 18%)
Target couple: couple in reproductive age group and achieved desired family size.

7. CONTRACEPTIVE METHODS
• TEMPORARY
a) Barrier
b) Natural methods
c) Intrauterine devices
d) Oral contraceptive pills
e) Injectables
f) Implants
g) others/newer methods
• PERMANENT
a) Tubectomy
b) Vasectomy
c) Other methods

8. • BARRIER METHODS:
i) Condoms: Male condoms- latex, failure rate 2 or3 to 14/ HWY
Female condoms- polyurethane, prelubricated with
silicone, two rings, failure rate 5 to 20/HWY
ii) Diaphragm: Vaginal barrier, dutch cap, used before intercouse and left for six
hours Chances of Toxic syndrome, 6-12 /HWY.
iii) Vaginal sponge: soaked in vinegar or olive oil, Today, 5× 2cms, nonoxynol-9.
20- 40 /HWY.
. CHEMICAL METHOD:
i) Foams
ii) Creams,jellies and pastes
iii) Suppositories

9. This Photo by Unknown Author is licensed under CC BY
This Photo by Unknown Author is licensed under CC BY-NC-ND

10. • NATURAL METHODS:
i) Standard days method: fertile period from day 8 to 19 days. Regular cycle.
ii) Calendar rhythm method: short cycle minus 18 and long cycle minus 11. that is 8day
to 21 days of the cycle. 9/HWY
iii) Basal body temperature: 0.3 to 0.5 degree C as a result of progesterone. First day to
third day of rise of temperature.20/HWY
iv) Billing method/ cervical mucus secretion: fertile period usually 4 to 7 days prior to
ovulation. After three days after ovulation mucous become thick.
v) Lactational amenorrhoea method: During this period, prolactin inhibits ovulation.

11. INTRA UTERINE DEVICES(IUD)
• FIRST GENERATION: During 1965,Lippes loop ,Polyethylene,double S shaped,
fine thread, four size A,B,C,D.
• SECOND GENERATION:During 1970, Earlier devices copper-7, copper T-200.
Newer devices Cu-T-220c, Cu-T-380 AorAg, Nova T, ML-Cu-375.
• THIRD GENERATION: i)Mirena( LGN-20) 7-8 yrs 20mcg
progesterone/day.Lowest failure rate 0.2 /HWY
ii)Progestasert(1yr) Natural Progesterone, loading dose
38mg and 65mcg/day. Lowest expulsion rate.

12. MECHANISM OF ACTION OF IUD
• Foreign body reaction in the uterus causing biochemical changes in the
endometrium and uterus fluid ,inhibits viability of gametes rather than implantation.
• Alters the biochemical composition of cervical mucus inhibits the sperm motility,
capacitation and survival.
• Hormonal releasing devices increases the viscosity of cervical mucus thus inhibits
the sperm entering the cervix. High progesterone and low Oestrogen unfavourable
for implantation

13. • CONTRAINDICATION:
• TIME OF INSERTION:
-within 10 days from the beginning of menstruation ideal 4 to 5 days.
-After delivery early within 24 hrs , Late after 6 weeks of delivery.
Absolute contraindications Relative contraindications
Pregnancy Previous inflammatory disease
Undiagnosed vaginal bleeding Congenital malformation
Pelvic inflammatory disease Cervical discharge
Cerival cancer Anemia
Carcinoma of genital tract menorrhagia
Previous ectopic pregnancy Unmotivated females

14. ADVERSE EFFECTS OF IUD
• Pain : MC cause of removal 15 to 40%.
• Bleeding : MC side effect. Removal 10 to 17 %.
• Ectopic pregnancy: due to delayed tubal motility cause by progesterone.
Rate 6.8%.
• Pelvic inflammatory disease.
• Perforation: Dangerous AD.
• Expulsion : MC cause is pain.
• Pregnancy with IUD insitu Mostly abort,
Continue-Thread not visible, sepsis.
Thread visible pull out.

15. ORAL CONTRACEPTIVE
HORMONAL :
i) combined hormonal contraceptive
ii) progesterone only contraceptive pill
iii) emergency contraceptive pill
iv) injectable hormonal pill
NON HORMONAL: Centchroman(chhaya)

16. • Combined oral contraception: ethinylestradiol and norethindrone(1)
levonorgestrol(2)
desogestrol, gestodene(3)
Mala N, Mala D containing Levonorgestrel and Ethinyl Estradiol in the dose of
0.15mg and 0.03mg ,21 tablets and 7 tablets of ferrous fumarate 60mg
Mechanism of action: Disrupts the Hypothalamus –Pituitary axis.
Estrogen inhibits FSH increase.
Progesterone inhibits LH surge

17. ADVERSE EFFECTS OF OCPs
Metabolic Cardiovascular Carcinogenic Others
Weight gain Atherosclerosis Ca cervix Liver
diseases
Obesity Thromboembolism Ca Breast Slight
inhibition of
lactation
Hypertension Dvt Hepatocellular
Ca
Dysplipidemia Stroke
Coronary heart disease
Benefits
Regularisation of MC
Decreases BBD,
fibroadenoma
Decreases Ca
ovary,endometrium,ovarian
cyst
Decreased PID
Decreases Anaemia

18. CONTRAINDICATION
ABSOLUTE RELATIVE
Ca breast, Genital cancers Age>40yrs
Pregnancy Smoking, age >35yrs
Severe liver disease Diabetes, gall stones
DVT, Thromboembolism Epilepsy, migraine
Cardiac anomalies
Congenital hyperlipedmia
Undiagnosed vaginal bleed

19. INJECTABLE METHOD OF CONTRACEPTION
• Progesterone only injectables:DMPA (depot medroxy progesterone acetate)
150mg mg IM 3 months>35yrs old female
• NET-EN( Norethisterone) 200mg, 2 monthly
• Depo Sub Q Provera 104(Subcutaneous)
• Antara Program 150mg MPA, 3 monthly
Contraindication:
i)Pregnancy ii)Undiagnosed vaginal bleed iii) Ca cervix
iv)Active thrombophlebitis/ thromboembolic disoders.

20. NON HORMONAL ORAL CONTRACEPTION
• Chhaya( Centchroman): non steroidal, non carcinogenic, non teratogenic pill is a
selective esterogen receptor modulator, 30mg of methoxychroman hydrochloride,
main chemical for action is ormeloxifene
• Mechanism:Increased the movement of ovum, increases the rate of maturation and
inhibits for implantation
• Dose:twice weekly for three months then once weekly till it require.
• Contraindication: PCOD, Lactation, Hepatic disease, Cervical hyperplasia

21. IMPLANTS:
i)Sub dermal : Norplant , six silastic capsules containing 35 mg each of
levonorgesterol.
Norplant (R)-2. two small rods, easy to remove and insert
POST COITAL/EMERGENCY CONTRACEPTION:
i)IUD within 5 days of unprotected sex.
ii)LNG- 1.5 mg single dose with 72hrs
iii)Mifepristone(RU-486)- 10mg within 72hrs
GOSSYPOL:
Male contraceptive, Inhibition of spermatogenesis, cotton seed.
Side effect: Azoospermia

22. PERMANENT METHOD:
• TUBECTOMY: Minilap procedure,incision 2.5 to 3 cms under local anesthesia,
mass sterilization.
• VASECTOMY: NSV, funded by UDFPA, complication like pain, local
infection,Hematoma, sperm granules, spontaneous recanalization failure rate
0.15 /HWY. They should use alternate contraception for 8-9 weeks or 30
ejaculation.
• ESSURE: a microfilament stent is inserted into fallopian tube, blockage is created.

23. SOCIAL WELFARE MEASURES AND INITIATIVES
TO CONTROL POPULATION
MEASURES REQUIRED
i) Raising age at marriage
ii) Increases in literacy level
iii)Reduce poverty
iv)Women empowernment
v) Raising standard of living

24. THANK YOU