Family planning involves conscious efforts by couples to regulate births. It aims to avoid unwanted births and determine family size. Methods include hormonal, mechanical, surgical, and emergency contraception. Hormonal methods prevent pregnancy by stopping ovulation or thickening cervical mucus. DMPA injections contain progestin and prevent pregnancy for 3 months by suppressing ovulation. Jadelle implants contain levonorgestrel and are 99.7% effective over 5 years by blocking ovulation and thickening cervical mucus. Both have minimal side effects and are reversible options for long-term birth spacing.

2. FAMILY PLANNING
PREPARED BY
MALLIKA TAKO
MANDIRA DAHAL
MELINA GHIMIRE

3. DEFINITION OF FAMILY
PLANNING
It 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 the health and
welfare of the family group and
thus contribute effectively to the
social development of the

4. OR
It is the conscious effort of couples to regulate the
number and spacing of births through artificial and
/or natural methods of contraception.

5. PURPOSES OF FAMILY PLANNING
To avoid unwanted births
To bring about wanted births
To regulate the interval between pregnancy
To control the time at which births occur in relation to
the ages of the parents
To determine the numbers of children in the family
To decrease the maternal and child mortality and
morbidity rate

6. METHODS OF CONTRACEPTION
Hormonal Mechanical Surgical
Emergency
contraceptives
Post abortion
contraception

7. HORMONAL METHODS
• Hormonal methods of birth control contain estrogen and
progestin, or progestin only, and are a safe and reliable
way to prevent pregnancy for most women.
• Mechanisms of hormonal methods are:
-preventing ovulation
-keeping the mucus in the cervix thick and impenetrable to
sperm
-keeping the lining of the uterus thin

8. Hormonal Methods
Oral
Combined
preparation
Single
preparation
Parenteral
Injectable
-DMPA
Implant
-JADELLE

9. PARENTERALINJECTABL
E
• DMPA contains the progestin
hormone named “Depot-Medroxy
progesterone acetate”. The brand
name is Depoprovera and commonly
called “Depo”. It is also called
“Sangini” in Nepal.
I. Depot- Medroxy
progesterone acetate (DMPA)

10. DOSE:
Single dose vial, each vial contains 150mg of Depot-
Medroxy progesterone acetate/ml for every 3 month.
It is administered intramuscularly.
Mechanism of action:
-They prevent pregnancy by:
Suppressing ovulation by suppressing the mid cycle
LH peak.
Making thin atrophic endometrium so ovum can not

11. Causing cervical mucus thick, which prevent sperm
penetration.
Indication of DMPA
• The timing of the return fertility is not important
• A risk of increased cardiovascular complications from
COCs is present
• Other methods requiring daily use are not suitable
• Estrogen related complications develop while using
COCs. (headache or high BP)

12. • Amenorrhea is acceptable or desirable
• Contact with service providers on a regular basis is
difficult
Timing of injection
A women can have first injection any time during the
menstrual cycle if it is reasonably certain that she is
not pregnant
Within the 7 days after the start of period
Within 4 weeks of postpartum

13. If appropriately using LAM after 6 months
If partially breast feeding after 6 weeks
If no breast feeding immediately
Advantages
Highly effective (99.7%)
Nothing needs to be taken at the time of sexual act.
Women lose less blood using depot-medroxy
progesterone and have less menstrual cramping. Often
after these injections women stop periods. This is safe.

14. Nursing mother can receive Depo-Provera injections.
Its best after the baby is 6 weeks old
Reversible
Decrease anemia , PIVD and endometrial cancer
Does not interfere intercourse or sexual desire
Rapidly effective (within 24 hours)

15. Disadvantages
• Depo. Injections can lead to very irregular periods
• Some women gain weight
• A person has to return clinic every three months for
injection
• Depo. May lower estrogen level and cause bone loss
• Health personals are needed for injections

16. Client instruction
• Instruct the client to return to the
health clinic for another injection
every 12 weeks (3months).
However the next DMPA can be
given 2 weeks before and 2
weeks after
• If heavy vaginal bleeding, lower
abdominal pain, severe headache,
and depression return to the
clinic

17. IMPLANT
JADELLE

18. JADELLE
• The newer Norplant-R-2(consisting of two rods).These
devices contain the progestin levonorgesterol 75mg in each
of 2 silicon rubber capsule and are surgically inserted under
the skin of the women’s upper arm by a trained medical
practitioner. The tube allows a steady diffusion of the drug
into blood stream. Each rod is 2.5cm in diameter and
43mm in length.
• It works for 5 years. The implant must be removed
surgically when it is used up in about 5 years or when the
women wish to discontinue the method.

19. Mode of action
• By blocking ovulation
• Causing thick cervical
mucus
• Thin atrophic
endometrium

20. Timing of implant
• A woman can have first injection qny time during the
menstrual cycle if it is reasonably certain that she is
not pregnant
• Within the 7 days after the start of period
• Within 4 weeks of postpartum
• Within 7 days of post abortion
• If appropriately using LAM

21. Indications
• Want long term spacing that is 5 years

22. Advantages
• Highly effective 99.7%
• Immediately effective within
24hours of insertion
• Long term protection 5years
• Reversible
• Can be remove any time if
for any reason
• Doesn’t interfere with the
lactation and blood pressure
Disadvantage
s
• Frequently cause menstrual
irregularities, and about
10%of users discontinue
using of this reason.
• Doesn’t protect from
std/aids
• Client doesn’t discontinue
the method on her own wish
• Need small surgical
procedure and medical

23. Contraindication
• Suspected pregnancy
• Liver disease
• Breast cancer
• Unexplained uterine bleeding and blood clots

24. Use with caution
• High blood pressure
• Gallbladder disease
• High cholesterol
• Irregular period
• Headache
• Drugs (rifampicin, antiepileptics)

25. Client’s
instruction
• Insertion area should be
clean and dry with pressure
dressing in place for 2 days
and band aid for 5 days
• Routine work can be done
immediately but avoid
straining the area for few
days
• If sign of infection such as
inflammation, pain at site
• Follow up after 7 days
for the check up of
insertion site and
anytime if warning signs
is present