The document discusses family planning and contraceptive methods. It defines family planning as deciding the number and timing of children in a family. It discusses various contraceptive methods including barrier methods like condoms and diaphragms, hormonal methods like oral contraceptive pills, and intrauterine devices. It explains how these methods work and their effectiveness in preventing pregnancy. Factors affecting fertility and ways to measure fertility are also summarized.

1. MD DANISH RIZVI
COMMUNITY

2. Family
Planning
 Means to
decide
 Number &
 Timing of
 Children
 In family.

3. Family Planning
Definitio
n
“Family planning means to
decide number & timing of
children in family.”

4. Objectiv
e
 To avoid unwanted birth
 To bring about wanted birth
 To regulate the intervals
between
the pregnancies.
 To control the at which birth is
occur
To determine number of children
in the family.

5. Family
Planning
Fertility:
“Ability of people or animals to produce healthy
offspring”
 I t is procreation or child bearing.
Fertility rate:
“The actual bearing of children”

6. Factors affecting
fertility
1. Age at marriage:
2. Duration of
marriage life
3. Spacing of children
4. Education
5. Economic status
6. Caste & religion
7. Nutrition
8. Family planning

7. Factors Affecting
Fertility
1.Age of marriage :
Lower age- high level of
fertility. female age from
15 to 18
male age from 18 to 21
2.Duration of married life :
first 10 to 15 yrs. Of married life majority
of birth. so first 5 to 10 years to have
desire effect.
use of spacing method
sterilization operation after complete

8. Factors Affecting
Fertility
3.Spacing of children:
couple are advised to keep spacing of
2 to 3 yrs. by using spacing method
so fertility will be reduced.
4.Education:
fertility related with
education inverse related
to educated status.
5.Economical status:
fertility related with economical
status inverse related to
economical status.

9. Factors Affecting
Fertility
6.Caste & religion:
Some caste have higher
fertility. effect fertility.
some low caste having high fertility rate.
7.Nutrition :
indirectly affect on fertility.
high and well feed societies having low fertility and
vice versa.
8.Family planning:
proper family planning will reduce fertility.

10. Measurement of
Fertility
Various indicators, rates and ratios to
measure the fertility.
1.Crude birth rate
2.General fertility rate
3.General marital fertility
rate 4.Net reproduction
rate 5.Vital statistics
6.Maternal mortality ratio

11. Millennium development goals
(MDGs)
Goals:
1.Eradicate extreme poverty & hunger.
2.Achieve universal primary education.
3.Promote gender equality & empower
women.
4.Reduce child mortality.
5.Improve maternal health.
6.Combat HIV/AIDS, malaria & other
disease

12. Millennium development goals
(MDGs)
Goals:
7.Ensure environment sustainability
8.Develop a global
partnership for
development.

13. Contraceptive
Method
s

14. Contraceptive
Methods
 methods
 which can prevent
 the unwanted
pregnancies.
E.g.: Condoms etc.

15. Contraceptive
Methods
“Contraceptive methods
which can prevent the
unwanted pregnancies.”
E.g.: Condoms
etc.

16. Contraceptive
Methods
It should be,
1.Safe
2.Effective
3.Acceptable
4.Inexpensive
5.Simple to administer
6.Easier to use
7.Require little or no medical
supervision
8.Independent of coitus.

17. Contraceptive
Methods
 no one fulfill all requirement.
 Suitable to one group of people.
So people have to choose any one method
depending upon,
1. Needs
2. Wish and
3. Suitability etc.
The couple can choose any one methods by
considering their suitability – cafeteria
approach.

18. Classification Of
Contraceptive
A. Temporary methods:
1.Barrier
methods
a.Physical methods
b.Chemical methods
2.Intra- uterine methods
(IUDs)
a.non medicated IUDs
b.medicated IUDs
3.Hormonal methods
a.oral pills
b.slow release
preparations
4.Post contraceptive
methods

19. A. Temporary
methods:
1.Barrier methods
a. Physical methods:
E.g.: Condoms, Diaphragm
etc.
b. Chemical methods:
E.g.: Foams, Creams etc.
2.Intra - uterine methods
(IUDs)
a.Non - medicated IUDs:
b.medicated IUDs:
i. metal containing IUD’s
ii. Hormones containing IUD’s
3.Hormonal methods
a.oral pills:
i. combined pills
ii. Progestogen only pills
iii. Male pills.
iv. Once a month pill
b.slow release
preparations :
4.Post contraceptive
methods
a.menstrual regulations
b.Menstrual induction
c.abortion
5.Miscellaneous methods
a.abstinence
b.coitus interrupts
c.safe periods
d.natural family
planning methods
e.breast feeding
f. birth control vaccine
B. Permanent methods:
1.male sterilization
(Vasectomy)

20. Barrier
Method
s
 Suitable for both Male & Female.
Objective – prevent the live
sperm from meeting ovum
(Female egg)
 Of 3 different types
1. Physical Methods
2. Chemical Methods
3. Combined Methods

21. Physical
Method
s
 Available & Suitable for both Male &
Female.
 For Male : Condoms etc
 For Female : Diaphragm etc
Objective – prevent the live sperm from
meeting ovum (Female egg) by
physically or chemically
 Advantages:
1.Free from side effect
2.Easy to use
3.Prevent STD’s & AIDS etc.

22. Condom
s
 For Males
Widely used overall in world
 I n India NIRODH (meaning prevention)
Made from latex
Used by male beforeintercourse
 1 5 – 20 cm in length & 2- 3.5 cm in
diameter.
Mechanism :
Prevent entry of sperm in female

23. Condom
s
Advantages
Less sideeffect
Protection against
STD’s &
AIDS
 N o medical
examinationisrequired
Cheap
Safe
Disposable
Light
Compact
Disadvantage
s
Chances of slip
during coitus
 May get tear
during coitus
Allergic in some
males

24. Female Condom
(Femidom)
thin polyurethane sheath placed inside the
vagina (also covering the cervix and the area
outside)
 t o stop sperm from entering.
 I t can be put in at any time before sex and
 i s actually stronger than the male condom.
 I t need to be sure that the penis enters the
condom and
 i s not inserted between the condom and the
vaginal wall.
Advantages:
offers protection
against STD’s

25. Diaphrag
m
Used for females
Shallow dome shaped
Synthetic of rubber or plastic material.
Diameter 2 – 4 inches
 I t having Flexible rim
Used before intercourse & remains on its
position fornotless than 6 hrs after intercourse.
Mechanism:
Prevent entry of sperm in female
reproductive tract.

26. Diaphrag
m
Advantage
s:
Easy to
use
Absence of risk
 N o interference in sexual
pleasure
 N o medical
contraindication
Disadvantages:
Initially demonstration is

27. Vaginal
Spong
e
Small polyurethane foam
sponge
Saturated with nonoxynol-
9
Nonoxynol-9 : –
spermicidal
Marketed under name :-
TODAY


28. Chemical
Method
s
Contain
spermicidal.
Used before
intercourse.
Used in the forms
of,
a. Foams
b. Creams
c. Jellies
d. Pastes
e. Suppositories

29. Chemical
Method
s
Mechanism:
Kill the sperms by different
mechanism.
Advantages:
1. High failure rate
2. Need to be used
repeatedly
3. Mild burning
4. Irritating effect
5. Possible teratogenic
effect.

30. (IUDs
)
Introduced into uterus
 To control pregnancies.
Arabs first use for camels
Originally used in 1909 – made up of
silk wormgut.
1959 – Japan introduce IUDs of
plastic.
 6 5 million women's using IUDs.

31. TypesOf
IUD’s

32. Typesof
IUDs
a. First generation
IUDs
•
•
Non medicated or inert IUDs
Made up of polyethylene or other
polymers. E.g.: Loops, springs and
bows etc
a. Second generation
IUDs
•
•
Copper containing devise Smaller and
easier to fit. Incorporation of copper in
plastic IUD’s
E.g.: copper 7 , copper T- 200 etc
a. Third generation
IUDs
•
•
T shaped device filled with hormone like
progesterone Release slowly hormone in
uterus.

33. Mechanism of
IUDs
a. First generation
IUDs
• Prevent
pregnancy
a. Second generation
IUDs
•
•
Copper – anti fertility agent.
Create unfavorable condition for sperm
so it cant survive in uterus – prevent
pregnancy
a. Third generation
IUDs
•
•
Hormone released increase viscosity of
cervical uterus Also make uterus
unfavorable for implantation of fertilized

34. Advantagesof
IUD’s
1. Insertion is simple
2. Effective for few year
3. No systemic side effects
4. Reversible
5. Safe
6. Effective
7. Not require daily
exercise etc.

35. IUD’
s
Effectiveness:
Most effective reversible method
Less failure rate (5/100)
Effective directly proportional to surface area
of
copper.
Contraindications:
 I n pregnancy
 GIT carcinoma
Inflammations and pelvis cancer etc.

36. Side effect and
complication
s IUD’s
Bleeding
Pain
Pelvic
inflammation
Ectopic pregnancy
Expulsion of IUD’s
etc.

37. Lippes
loo
p
Double S shaped device
Made up of polyethylene
Inert, non toxic and
durable
Advantages:
Cheap
Easy for insertion
 Not interfere with sexual
pleasure
Disadvantages:
 May causes pain and

38. Hormonal
method
s
100% effective method
Available in in both oral and injectables
preparation.
Mainly classified in 2 types:
1. Oral pills(Oral Contraceptives):
1. Combined pill
2. Progesterone only pill
3. Post coital pill
4. Once a month pill
5. Male pill
2. Depot formulations (slow release
preparations):
1. Injectables
2. Subcutaneous implants
3. Vaginal rings.

39. Hormonal
method
s

40. Contraceptive
)
1. Combined
Pill:
•
•
•
•
•
Contain combination of hormones
Contain 30-35 mcg of synthetic Estrogen
with 0.5- 10 mg of Progestogen.
Take one pill each day for 21 days
starting from 5th days of menstrual cycles.
In some cases 28 days regimen
with tablet of ferrous fumarate.
GOI prepare 2 types of low dose oral pills
1. Mala – N
2. Mala - D

41. Oral Pill (Oral
Contraceptive)

42. Combined
Pill
s
1. Mala - N
: •
•
Contain norethisterone
acatate -10
mg & ethynyl oestradiol - 0.03
mg
Provided free of cost by GOI.
1. Mala - D
: •
•
Levonorgestrol – 0.15 mg & ethinilestradiol
– 0.03 mg
Avialable in 28 tablet (21 hormonal pills + 7
ferrous fumarate brown pills)
Mechanism of Action:
Prevent release of ovum from ovary by
blocking pituitary

43. Combined pill
 the pill does not interfere with the activity or
pleasure o
fsex.
 A full medical history is essential
 who smoke or are very overweight may be
advised t
o
choose another method of
contraception.
 The combined pill is not reliable if taken over 12
hourslate
Effectiveness: 99% if taken correctly.

44. Progesterone-only pill
(Mini
Pill)
only contains the hormoneProgesterone.
Referred as “Mini pill”
This type of pill is good for women who are
breast-feeding,
older women,
 smokers and
others who cannot use the combined pill.
Mechanism of Action:
 It works by thickening the cervical mucus,
which acts as abarrier to stop sperm entering
the womb.
 I t also makes the lining of the womb thinner,
to prevent i
taccepting a fertilized egg.

45. Progesterone-only pill
(Mini
Pill)
 I t can also help with pre-menstrual syndrome
(PMS) andpainful periods.
Advantages: the pill does not interfere with the
spontaneity of sex.
 I t must be taken at the same time each day or at
most within three hours of that time.
 I t will not work if taken over three hours late, or
 i f have vomiting and diarrhea
cause irregular bleeding and periods may
stop altogether while are taking it.
Effectiveness: 98% if taken correctly.

46. Post – Coital
Contraception
(Emergency
Contraception)
Situations
• sexual intercourse where no contraceptive
is used.
• When there is a contraceptive method
failure or a method is used incorrectly,
such as:
Condom leakage
Failure to take pills for 3 consecutive days
Delaying contraceptive injection more than
2 weeks
Miscalculation of the infertile (safe) period
Failed coitus interrupts.

47. Post – Coital
Contraception
(Emergency
Contraception)
• Within 72 hrs.
• Two methods
available
1. Hormonal
2. IUD’s
1.Hormonal:
•
•
•
Most acceptable
Single tablet within 72 hrs.
Levonorgestrol 1.5 mg (Unwanted, I –
Pill etc)
1.
IUD’s:
• Inserted within 3 – 5
days

48. • Yuzpe regimen: LNG 0.5mg+EE 0.1mg
• E-pill: LNG 0.75mg (2 tab at the interval of
12 hrs).
• I-pill: LNG 1.5mg.
• EE: 1 mg for 5 days.
• LNG 600 μg or D-Norgestrol:
1.5 mg for 5 days within 72 hrs.
• Centchroman: 60 mg within 24 hours.
• Mifepristone (RU 486): 600 mg taken within
72 hrs.
• Cu-T
Post – Coital Contraception
(Emergency Contraception)

49. Once – a – month (long acting) pill
− Long acting
− Quinesterol (long acting estrogen given with
progesterone)
− High failure rate, irregular bleeding
Male pill
Preventing spermatogenesis
Interfering with sperm storage & maturation
Preventing sperm transport in vas
Affecting constituents of the seminal fluid
Gosssypol (cotton seed oil)
 Not any affective drug available tilldate

50. Beneficial effects of
OCP’S
• Almost 100% effective in preventing
pregnancy
• Protection from at least six
diseases, e.g.
1.benign breast disorders,
2.ovarian cysts,
3.iron deficiency
anemia, 4.ectopic
pregnancy,
5.ovarian cancer

51. Adverseeffects of
OCP’s
1)Cardiovascular side effects:
have 40% more risk of mortality than non users due to
cardiovascular causes
2)Carcinogenesis:
increased risk of cervical cancer
3)Metabolic side effects:
deranged lipid profile, glucose intolerance, increased
blood pressure 4)Other side effects:
a) liver disorders: hepatocellular carcinoma,
adenoma of gall bladder, cholestatic
jaundice
b)decrease in breast milk if used during lactation
c)more chance of ectopic pregnancy in case of mini pill
d)ill effect on foetal development not proved yet

52. Contraindicationsof
OCP’s
Absolute :
1. Cancer of breast
2. Liver disease
3. Cardiacabnormalities
4. Undiagnosed uterine bleeding
Special problems requiring special
surveillance :
1. Age over 40 or age over 35 &
smoking
2. Mild hypertension
3. Chronic liver disease
4. Migraine

53. (Slow
Releas
e
Preparation)
1. Injectable contraceptives:
Started on 5thday of menstruation.
A. Progestogen only injectables
I. DMPA (depomethoxy progesterone
acetate):
–
–
–
–
–
–
99% protectio for 3 months
150 mg IM every 3 months
99% protection: suppression of
ovulation
I. NET – EN: (Norethisterone
enatate)
Not commonly

54. Contraceptive
implan
t
small stick
containing the hormone progesterone
inserted under the skin in the arm.
hormone is slowly released into the body,
Mechanism of action:
1. preventing eggs from being released from the
ovaries,
2. sperm from reaching an egg or
3. an egg settling in the womb.
Advantages:
implants are a good method for women who want
a long-term contraceptive, as each implant lasts
for three years.
Periods can become irregular or stop altogether.
Effectiveness: 99%.

55. Subcutaneous
Implant
s
Marketed under name – Norplant
Contain 6 silicon rubber capsule
Each contains – 35 mg of
levonorgestral.
Implanted beneath skin of forearm or
upper arm
Provide protection for 5 years.
Small failure rate.
Side effect-Disruption of normal
menstrual cycle
Contra indications:
 C a breast, all genital cancers

56. Sub dermal
implants
Norplant:
6 silastic (silicon rubber) capsules
containing 35mg each of LNG
Norplant (R) – 2 :
 Easier to remove
Rods are inserted beneath the skin of
forearm / upper arm
 Effective contraception for 5yrs

57. Vaginal
Rin
g
 soft, flexible vaginal ring,
 2 inches in diameter,
delivers low doses of estrogen and progestin
into the body.
ring is inserted into the vagina and left for 3
weeks.
then removed for 1 week, during which
a woman menstruates,
 a new ring is inserted after the 1-week "break."
Mechanism of Action:
1. prevent pregnancy by suppressing ovulation
and

58. Side effects of Hormonal
family planning
methods
Nausea
Weight gain
Headache
Breast
tenderness
Breakthrough
bleeding
Vaginal infections
Mild hypertension
Depression

59. Absolute Contraindicationsof
Hormonal family planning
methods
Breast feeding
Family history of CVA or CAD
History of thromboembolic
disease
History of liver disease
Undiagnosed vaginal bleeding

60. Possible Contraindicationsof
Hormonal family planning
methods
 Age > 40years
Breast or reproductive tract
malignancy
 D M
Elevated cholesterol and triglyceride
High bloodpressure
Mental depression
Migraine and other types of vascular
headache

61. Post Conceptional
Methods
1. Menstrual
regulation :
− aspiration of uterine content within 6-14
days of missed periods
1. Menstrual induction :
 by intra uterine installation of
prostaglandin F2
1. Abortion :
−
−
−
may be first or second trimester.
This procedure is governed in India by
MTP Act of 1971
Allow only if contraceptive is fail

62. Natural Family
planning
methods
involve finding out when a woman is at her
most fertile,
 s o extra careful or avoid sex altogether during
these times.
 can be done by usingtechniques
woman keeping a daily record of her body
temperature using aspecial fertility thermometer.
combination of techniques is recommended to
increase theeffectiveness of these methods.
natural alternative to hormonal and barrier
methods but
techniques used require a significant level of
motivation &
 a clear understanding of how to monitor

63. Natural Family planning
methods
They include:
1. Calendar (Rhythm) method
2. Withdrawal ( Coitus
interruption )
3. Basal body temperature
4. Cervical mucous method
5. Sympto - thermal method
6. Ovulation awareness method
7. Lactational amenorrhea

64. Rhythm
metho
d
used for patients with regular cyclesonly.
depending on the exact knowledge of
ovulation day
avoiding intercourse during the days
before and after ovulation;
For Example
in a regular period that occurs every 28 days
,day of ovulation should be the day 14 so
intercourse should be avoided 4-5 days
before and after this days.
There are many methods to detect ovulation
days;
1- Increase in body temperature by

65. Withdrawal ( Coitus
interruption
)
When having sex, the man has to take his
penis outo
fthe vagina before ejaculation.
This is intended to stop sperm from
enteringthewoman.
This method frequently fails as drops of
sperm can already escape from the penis
into the vagina before the man ejaculates.
Effectiveness: Failure rate can be as high
as 15% (15pregnancies per 100 women).
More reliable methods areadvised.