community health nursing, public heath, nursing, contraception, contraceptive methods, family planning, india

1. By. Kailash Nagar
Asst. Professor
Dept. Community Health

3. INTRODUCTION
Family planning is the term given for pre-pregnancy
planning and action to delay, prevent or actualize a
pregnancy.
DEFINITION:
Family planning is a way of thinking and living that is adopted
voluntarily, upon the bases of knowledge, attitude and
responsible decision by individuals and couples in order to
promote the health and welfare of family group and thus
contribute effectively to the social development of country
-B T BASVANTHAPPA

4. FAMILY PLANNING
Family planning is defined as the voluntary,
responsible decision made by individuals and
couples as to the desired family size and
timing of births.

5. OBJECTIVES FAMILY PLANNING
( WHO ) “the use of a range of methods of a fertility
regulation to help individuals or couples attain
certain objectives:
avoid unwanted birth.
bring about wanted birth.
Produce a change in the no. of children born.
Regulate the intervals betweenpregnancies.
Control time at which birthoccur.”

6. DEFINITION OF ELIGIBLE COUPLE-
An eligible couple refers to a currently married couple
wherein the wife is in the reproductive age, which is
generally assumed to lie between the ages of 15-45 years.
There will be at least 150-180 such couples per 1000
populations in India.

7. DEFINITION OF TARGET COUPLE
The term target couples are applied who have 2-3
living children, and family planning was largely
directed to such couples.

8. DEFINITION OF SMALL FAMILY NORM
it is composed of mother , father and few children.
Slogan for SMN
•Hum Do, Hamara Ek
•Hum Do, Hamara do (1970)
•A Small Family is a happy Family.
• Small family-small conflicts
• Small family-small demands
• two child complete the family
• Chota Parivar Ghar Sansar.

9. FAMILY PLANNING
Family planning is the ability for a
woman or couple to determine when
and how many children they are going
to have by practicing safe sexual
practices.

10. OBJECTIVES
( WHO ) “the use of a range of methods of a fertility
regulation to help individualsorcouplesattain certain
objectives:
 avoid unwanted birth.
 bring about wantedbirth.
 Producea change in the no. of children born.
 Regulate the intervals betweenpregnancies.
 Control time at which birthoccur.”

11. Proper
spacing
Proper
timing
No. of
pregnanci
es
Elements of family planning
3 important elements in familyplanning:

12. Benefits
Benefits to Mother
 Reduce the healthrisk
 Below 20y, And above 35 y.At risk of developingcomplications
during pregnancy.
physical strain of child bearing.
 reduce number of maternaldeath.
 reduce the risk of ovariancysts.

13. Health Benefits to Children:
Ensures betterchanceof survival at birth.
 Promote better childhoodnutrition.
 Promote physical growth anddevelopment.
 Prevent birthdefects.

14. Health Benefits toFather
Allows father to keepaconstant balance between
their physical, mental, social well–being.
Increase father sense of respect because he is able to
provide the typeof education and homeenvironment.

15. Benefits to WholeFamily
Health
Benefits to Whole Family Health - help the family
enjoy the better kind of life.

16. CONCEPTION
It is the fertilization of a
female ovum by a male
sperm. Every 28 days, in an
adult female, one ovum
leaves the ovary and is
directed into fallopian tube
by the fimbriated end,
which passes along with
the tube.

17. CONTRACEPTION
it is the voluntary prevention of pregnancy, a
process with individual and social implications.
Contraception (birth control) prevents pregnancy
by interfering with the normal process of ovulation,
fertilization, and implantation. There are different
kinds of birth control that act at different points in
the process.

18. Human fertilization
is the union of a
human egg and
sperm, usually
occurring in the
ampulla of the
fallopian tube.

19. Characteristics of the ideal
contraceptive method would be:
highly effective;
no side effects or risks;
cheap;
independent of intercourse and requires no regular
action on the part of the user;
non-contraceptive benefits;
acceptable to all cultures and religions;
easily distributed and administrated by non
healthcare personnel.

22. Classification of contraception
methods:
Combined hormonal
contraception
 The pill
 Patches
 The vaginal ring
Progestogen-only
preparations
 Progestogen-only pills
 lniectables
 Subdermal implants
Hormonal emergency
contraception
 Intrauterine contraception
 Copper intrauterine device
HUD)
 Hormone-releasing
intrauterine system (IUS)
Barrier methods
 Condoms
 Female barriers
 Coltus interruptus
 Natural family planning
Sterilization
 Female sterilization
 Vasectomy

23. 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

24. TYPES OF FAMILY PLANNING
Natural familyplanning
Barrier familyplanning
Permanent/surgical family
planning

25. classification
IUD
Medicated
Second
Generation
Eg. Copper IUD
Third
Generation
Eg. Hormonal IUD
Non medicated
First
Generation
Eg. Lippe’s loop
38

26. 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
Failure rate: 3-5 / HWY 39

27. 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 Failure rate: 0.8/HWY
 ML-Cu250
 ML-Cu375 40

28. Third generation iud
Hormone releasing IUD
Progestastert
Most commonly used
T shaped device
filled with 38mg of progesterone
Releasing rate 65µg/day.
Effective for 1 yr Failure rate: 0.2 / HWY
LNG-20 (Minera)
Releases 20µg of levonorgesterol.
Effective for 5 yrs
Effective rate 99%
41

29. INTRODUCTION OF NATURAL
FAMILY PLANNING
No introduction of chemical of foreign materialinto
the body.
Practice may bedue toreligious belief, “natural” way
is best forthem.
Effectivenessvaries greatly, depends on couplesability
torefrain from having intercourseon fertiledays.
 Failure Rates: about 25% Poses no risk to fetus

30. NATURAL FAMILY PLANNING
Rhythm (Calendar) method
Basal Body Temperature (BBT)
Ovulation or Cervical MucusMethod
Symptothermal method
Coitus Interruptus
Lactation amennorhea

31.  The rhythm method, also called the fertility
awareness method, is a form of pregnancy
prevention where couplescalculatea woman's fertile
time using a calendar.
 Abstaining from coituson thedaysof menstrual cycle
when a woman is most likely to conceive (3 or 4 days
before until 3 or 4 daysafterovulation). Woman keeps
a diary of 6 menstrualcycles.
RHYTHM (Calendar)
METHOD

32. This method may be used bywomen whose menstrual
cycles arealways between 26 and 32 days in length .
 Tocalculate:
18 from shortest cycle documented –11from
longestcycle = represents her last fertileday.
Example: If she has 6 menstrual cycles ranging from
25 to 29 days, fertile period would be from 7 th day (25-
18) to the 18 th day (29-11).Toavoid pregnancy, avoid
coitus/use contraceptive during thosedays.

38. Disadvantages
Lifespan
of Sperm
Failureof
method
Quality of
Sperms

39. . Basal Body Temperature (BBT)
Identifying fertile and infertile period of a woman’s
cycle bydaily taking and recording of the rise in body
temperature during and afterovulation.
 Just beforeovulation, a woman’s BBT fallsabout 0.5ºF
At time of ovulation, her BBT rises a full degree
(influence of progesterone). This higher level is
maintained the rest of menstrualcycle.

42. DISADVATAGES
 NOT reliable method: of birth control, especiallyfor
womenwith irregularcycles. Plus, outside factors,
such as a lack of sleep, can causeawoman’s
temperature tovary.

43.  Cervical mucus is a fluid produced by smallglands
near thecervix
 This fluid changes throughout her cycle, from
scantand sticky, tocloudy and thick, to slick and
stringy.
 Each of these types of mucus is related tothe
hormonal shifts that naturally occurduring
the menstrual cycleas her body prepares forand
achieves ovulation.
Cervical Mucus/Ovulation

44. Right before ovulation, the mucus from the cervix
changes from being cloudyand scanty to being clear
and slippery.
The consistency of ovulation mucus is like that of an
egg whiteand itcan be stretched between the fingers.
It is the peak of herfertility.
Afterthe ovulation, the mucus tends todry upagain.
Thesearealsosafe days.
Ideal Failure rate: 3%

45. DISADVANTAGES
 It is not a particularly reliable method of birth
control, especially forwomen with irregularcycles .
 Remember that cervical mucus does not let you know
whenyou will soon beovulating, butsperm can live up
to 4 days inside the vagina. Any sperm deposited
ahead of timecan still impregnate thewoman.

46. Symptothermal Method
Combines the cervical mucus and BBT methods
Watches temp. dailyand analyzes cervical mucusdaily.
Watch for midcycleabdominal pain Couple must
abstain from intercourseuntil 3 days afterrise in temp.
or 4 th dayafterpeak of mucuschange.
Moreeffective than BBT or CM method alone Ideal
Failure rate: 2%

47. COITUS INTERRUPTUS
 One of oldest known methods of contraception
Coupleproceedswith coitus until the momentof
ejaculation which Offers littleprotection.

49. LACTATION AMENNORRHEA
The lactation amenorrhea method (LAM) is a natural
birth control technique based on the fact that
lactation (breast milk production) causesamenorrhea
(lack of menstruation).

50. How itworks:
Breastfeeding interferes with the release ofthe
hormones needed to trigger ovulation.
ADVANTAGES:
Breastfeeding on demand improves health formother
and baby.
Nothing to buy or use.

53. DISADVANTAGES
 an use this method only for the first six monthsafter
birth oruntil the first menstrual period.
 LAM does not provideprotection against SEXUALLY
TRANSMITTED INFECTIONS.

54. CLASSIFICATION OF
CONTRACEPTIVE METHOD
CLASSIFICATION
SPACING
METHOD
BARRIER
METHOD
INTRAUTERI
NE
METHOD
HORMONAL
METHOD
POST COITAL
METHOD
TERMINAL
METHOD

55. BARRIER METHODS
Condoms (male and female)
Spermicidal
 Sponge
 Diaphragm
Cervical cap

56. Male condoms:
 Theseare made upof polyurethaneor latex.
 Silicon used nowa days toproducesemi dry pre-
lubricated forms.
 In Indiaone particularly brand is widely marketed as
‘Nirodh’.
 Spermicidal – coated with nonoxynol on innerand
outersurfaces.

57. MALE CONDOM

58. ADVANTAGES:
 Simple spacing method
 No sideeffects
 Easily available, safe & inexpensive
 Protects againstSTDs
 DISADVANTAGES
Chances of slip off and tearoff
Allergic reaction tolatex
Failure rate: 16%

59. Female condoms:
 It is a pouch made upof polyurethanewhich lines the
vagina and also externalgenitalia.
 It is 17 cm in length with one flexible polyurethane
ring at eachend.
ADVANTAGES:
Prevents STDs including HIV/AIDS
Notdamaged byoilsand otherchemicals

61.  DISADVANTAGES:
High motivation
Onlywomen whocan usediaphragms can use female
condom
Slippageoccurs
Expensive
Failure rate 21% with typical useand 5% with correct
and consistentuse.

62. diaphragm
 Mostcommonand 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 coiltype)

 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)

63.  The device is introduced up to 3 hrs. before
intercourseand is to be kept forat least 6 hrs after
intercourse.
ADVANTAGES:
cheap
No gross medical sideeffects
 Control of pregnancy in hands ofwoman
Reasonably safe when properlyused
 Prevent spread of STDs though less effectivethan
condom

64. DIAPRAGHM

65. DISADVANTAGES:
 Requires helpof doctorto measure the size required.
 Need high motivation
 Allergic reaction torubber
 Erosion
 UTI’s

66. SPERMICIDES
 Availableasvaginal foams ,gels ,creams ,tabletsand
suppositories.
 contain surfactant likenonoxynol-9,benzalkonium
chloride.
 Alterthe sperm surface membrane permeability
resulting in killing of sperm.

67. SPERMICIDE

68. ADVANTAGES:
 No instructions bydoctorsor nurses
 Easilyavailableand easy to use
 No gross medical sideeffects
DISADVANTAGES
Failure rate high when usedalone
Can increase spread of HIV infection byirritating
vaginal and cervical mucosa
Failure rate – 21% with typical useand 6%

69. Vaginal contraceptive sponge
(TODAY)
The sponge is a doughnut-shaped device madeof soft
foam coated withspermicide.
Made upof polyurethanewith 1gm of nonoxynol-9 as
a spermicide.
It releases spermicideduring coitus, absorbsejaculate
and blocks the entrance of cervicalcanal.
To use the sponge, it must be moistened with water.
Once inserted in the vagina, it covers the cervix and
blocks sperm from entering theuterus.

70. DISADVANTAGES
 May getbroken
 difficult removal
 High pregnancyrate
 Allergicreactions
 Vaginal dryness, soreness
 May damage vaginalepithelium
 increase risk of HIVtransmission

71. INTRAUTERINE DEVICES
 Intrauterine Device The IUD is a small, T-shaped,
plasticdevice that is inserted and left inside the uterus
to preventpregnancy.

72. CLASSIFICATION OF
IUDs
INTRAUTERINE
DEVICE
NON-
MEDICATED
FIRST
GENERATION
SECOND
GENERATION
MEDICATED
THIRD
GENERATION

73. First generation
 Non-medicated made up of polyethylene.
 Different shapes andsizes
 LIPPE’S LOOP
 Double ‘s’ shaped device , made upof polyethylene
material.
 Non- toxic, non-tissuereactiveand extremelydurable.
 Small amountof barium sulphate isalsoadded for
radiological examination
 Available in 4 sizesA,B,C,D

74. Second generation
 Made up of metal Cu
 Earlier devices Cu-7 , Cu-T200
 Newerdevices T copper 220 C ,T copper 380 C ,novaT
 multiload devices:
 ML-Cu 250
 ML-Cu 375

75. Third generation
 Hormones releasing IUD
 PROGESTASTERT :
 Mostcommonly used T shaped device filled with 38 mg
progesterone
 Effective for 1year
 LNG- mirena
 Mirena (levonorgestrel-releasing intrauterine device) isa
form of birth control that is indicated for intrauterine
contraception for up to 5 years and Releases 20 µg of
levonorgestrol.
 Effective for 5years.

76. SIDE EFFECTS
Amenorrhea
 Intermenstrual bleeding and spotting
Abdominal/pelvicpain
 Ovariancysts
 Headache/migraine
 Acne
 depressed/altered mood.

77. ADVANTAGES OFIUD
 Safe
 effective , Reversible
 Long action ,Inexpensive
 DISADVANTAGES
 Heavy bleeding and pain
 Pelvic inflammatorydiseases
 Ectopic pregnancy
 Maycomeoutaccidently if not properly inserted.

78. CONTRAINDICATION
History of PID
Abnormal shaped uterus
Ectopic pregnancy
Menorrhagia

79. CLASSIFICATION OF HORMONAL
CONTRACEPTIVES
HORMONAL
CONTRACEPTIVES
COMBINED
PREP.
ORAL
SINGLE
PREP
.
INJECTABLES
PARENTERAL
IMPLANTS

80. HORMONAL CONTRACEPTIVES
 With hormonal birth control , a women takes
hormones similarto those her body makes naturally .
 Hormonal contraceptivesare mostly for femalesex
steroids.

81. Oral contraceptives
 Combined oral contraceptivepills
 Commonly used progestin are either levonorgestrolor
norethisterone and estrogens are ethiyl estradiol or
menstranol
 COMMERCIAL NAMES
 Mala–N
 Mala –D
 Loette(desogestrel 0.15)
NO. OF TABLETS
21+7 iron tab.
21+7 iron tab.
21 tab.

82. TYPES
Monophasic biphasic triphasic
Monophasic:
fixed doses of both estrogen andprogesterone
throughout 21 daycycle.

83. Biphasic:
constant amount of estrogen throughout cycle BUT
increased amountof progestinduring the last 11 days .
 Triphasic:
Varies level of estrogen and progesterone. Closely
mimic natural cycle, reducing breakthrough bleeding
(bleeding outside the normal menstrualflow)

84. contraindications
ABSOLUTE:
Circulatorydiseases
Severe HTN
Angina,ischemic heartdis.
Liverdisease
Tumors
Pregnancy
breast cancer,breastfeeding.

85.  RELATIVE:
 Age>40 yrs.
 Smoker, history of jaundice
 Diabetes

86. benefits
 contraceptive benefits:
 Protection against unwantedpregnancy
 Convenient touse.
 Non-contraceptives benefits:
 Regulation of menstrualcycle
 Reduction of dysmenorrhea
 Protection against PID, fibroids, ovarian cysts,chances
of cancer.

87. Side effects
 Dizziness
 Nausea
 Weightgain
 Headache
 Breast tenderness
 vaginal infection
 Mild HPN
 Depression
 increase bloodclotting

88. Progesterone only pills
 Also known as“Minipill”.
 Contains just progesterone or progesterone hormone.
 Causing plug of mucus in the neck ofcervix
block the entry of thesperm.
Example: levonorgesrol 75 µg, desogestrel 75 µg

89. advantages
 Nosideeffecton breast feeding or lactation
 May be prescribed in patient having diabetes, HTN,
smoking etc.
 Reduce risk of PID
 DISADVANTAGES
 Acne, mastalgia, headache

90. Long acting contraceptives
 These are moresuitable for womenwhodo notwant
topregnant again or for fewyears.
THESE ARE:
 CONTRACEPTIVE INJECTIONS
 IMPLANTS
 PATCHES

91. CONTRACEPTIVE INJECTIONS
( DEPOPROVERA &NORISTERET)
 Contain progesterone hormone.
 Preventsovulation.
 Commonly used as Depomedroxyl progesterone
acetate (DMPA) administered on deltoid muscle
within 5 days of cycle.
 DOSE: 150 mg
 Provide protection for 3 months.

92. Contraceptive implants
 It is a small device placed underthe skin
 Contains progesterone hormone.
 Works in a similarway to injection
 Contains 3 ketodesogestrel
 Releases hormone about 60 mcg, graduallyreduced to
30 mcg perday over year.
 Inhibtsovulation.
 Lasts for 3years.
 NORPLANT – II

93.  NORPLANT- II
 Tworods of 4cm long. Each rod containing 75 mgof
levonorgestrel releases 50 mcg perday.


94. Emergency contraceptives
 Used whithin 72 hrs ,ovulation is eitherprevented or
delayed. It may be in form of : hormones, IUD,
antiprogesterone
 INDICATIONS
 Unprotected intercourse
 Condom rupture
 Sexual assault

95. HORMONES:
MORNING AFTER PILLS:
It preventing conception in caseof accidental
intercourse.
drugs used ethinyl oestradiol 2.5mg,
premarin(conjugated oestrogen) 15 mg.
Drug is taken orally twicedaily for 5 days.

96. Emergency contraceptives
DRUG DOSE
Levonorgesterel 0.75 mg stat and after 12hrs.
Ethinyl oestradiol 50 µg + norgesterel
0.25 mg
2 tab stat and 2 after 12 hours
Conjugated oestrogen 15 mg BD× 5 days
Thinyl oestradiol 2.5 mg BD 5 days
Mifepristone 10 mg single dose
Copper IUDs Insertion within 5 days

97. PERMANENT STERLISATION
ÖVASECTOMY
ÖTUBECTOMY

98. TUBECTOMY

99. STERILIZATION
It is mosteffective method its failure rate is 1/2000 so in
this there is permanent termination.
VASECTOMY:
Small incision made on each side of scrotum vas
deferens is then cutand tied , cauterized orplugged .
Blocking the passage ofspermatozoa.
Does not interferewith productionof sperms butdoes
not pass beyond vas deferens.

100. Veryeffectiveafter 3 months of procedure
Permanent and safe
No apparent long term risks.
 DISADVANTAGES:
Slightly uncomfortabledue slightly pain and swelling
after 2-3 daysof theof the procedure .
Bleeding may result in the hematoma in scrotum .

101. TUBECTOMY :
It is oneof theoperative procedurewhere resectionof
a both segment of both fallopian tubes is done to
achieve permanentsterilization
The approach may be:
Abdominally
Vaginally

102.  ABDOMINAL
Ω CONVENTIONAL MINILAPROTOMY
Ω CONVENTIONAL:
In which a loop is made by holding the tube by Allis forceps in
such away that the majorpartof loopconsists mainlyof isthmus
and ampullary partof tube . the loop is ligated with catgutand is
cut .

103. MINILAPROTOMY:
When the tubectomy is done through small
abdominal incision along with somedevice .
VAGINAL LIGATION :
Tubectomythroughvaginal route may bedonealong
with vaginal plasticoperation oron isolation .

104. COMPLICATION :
Ectopic pregnancy
Menstrual irregularities
Loss of libido
Infection