Family planning involves cognitive decisions and behavioral practices that help individuals or couples regulate pregnancy, including avoiding unwanted births and determining family size. Methods include natural options like breastfeeding and abstinence, barrier methods like condoms, and medical interventions like IUDs, implants, pills, injections, and sterilization. In Jordan, the fertility rate is 3.7 and over half of married women use contraception, most commonly pills and IUDs. Any counseling should provide a proper assessment and discussion of benefits, side effects, and options to allow couples to choose a suitable method for their needs and situation.

1. Family planning methods

2. Family planning (WHO definition)
Involves cognitive decisions and behavioral
practices that help individuals or couples
avoid unwanted births, bring about wanted
births, regulate the intervals between
pregnancies, and determine the number of
children in the family.
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3. Aims of the FPM to promote health to:
1. The mother give chance for more care and decreased
her weight and protect from any diseases such as
anemia.
2. The child give chance for more care and
breastfeeding.
3. Family and community, socioeconomic aspects,
decreases infant and maternal morbidity and mortality
rate.
 Any pregnancy must be planned before 3 months from
the occurrence of the pregnancy. Our job as a
counselors and educators, provide proper assessment
discuss with the couples the benefits and side effect
for each method and give family the chance to choice
the suitable method.

4. Family planning & Jordan
According to 2007 JPFHS:
-Fertility rate is 3.7
-Contraceptive Prevalence rate for married women
in the 2007 JPFHS is 57%: 42% using modern
methods, 15% using traditional methods.
-All over married women in Jordan know at least
one method of family planning.
-Among modern methods the pills 38% and IUD
47% are the best known.
-The least recognized methods were emergency
contraception & female condom (one percent or
less(
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5. Methods of the family planning

6. Natural methods
Breastfeeding: increased blood prolactin level
lead to decreased estrogen and progesterone
levels( suppression of the ovulation).
Breastfeeding (LAM, lactation amenorrhea
method), highly effective first 6 months after
delivery if breastfeeding regular and frequently
and infant age less than 6 months and 1st
mens
after delivery occur after 56 days.
Exclusive breastfeeding.

7. Coitus interrupts: withdrawal of the
penis prior to ejaculation.
Uncontrolled method leakage of the
seminal fluids, high failure rate).
Abstinence: avoiding sexual intercourse
around the time of ovulation. Ovulation
associated with watery vaginal discharge
and increase body tempreture0.3-0.5 c.

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9. Vaginal douching: douching after
intercourse, not safe method because
sperm can reach the internal cervical os
with 90 sec of ejaculation.
Calendar or rhythm method: used to
calculate the period during which
intercourse is most likely to result in
pregnancy, 2 days before and 2 days after
the time of ovulation.

10. Barrier methods
Male condom: cover the penis with condom to
prevent the sperm from entering the vagina,
failure rate 3%, decreased to 2% if used with
spermicidal with the condoms.
Male may not accept it because it is decrease
enjoyment.
Not safe may rupture and leakage the sperm.
Other method not usable in our MCHC:
Female condom( 8 hrs before sexual
intercourse)

12. Diaphragm ( for 6 hrs after sexual
intercourse) and not more than 24 hrs.
Failure rate is 6%.
Cervical cap: can remain in place for 24-
48hrs.
Vaginal supp and vaginal foam.
All these methods high failure rate
around 25%.

14. Intrauterine device IUD
T shape inserted into the uterine cavity through the
cervix to prevent the pregnancy, failure rate less 1%.
Can insert within 10 mints after delivery of the placenta
or 5 days of the mens cycle.
Copper for 7 years, mirena for 5 days.
Complication:
Perforation of the uterus.
Not recommended for woman who have cardiac
disorder, DM, salpingitis.
Adverse reaction: dysmenorrhea, infection, PID,
irregular mens, expulsion 10%, increase incidence of
spontaneous abortion, and premature labor.
Contraindication: liver disease, copper allergy, uterine
abnormality, pelvic infections, breast cancer mirena.

15. Hormonal therapy
Injectable type( Depo-Provera): long acting injection,
single injection is given every 3 month.
Progestin: it alter the cervical mucus and impair
ovulation and implantation.
Adverse effect: menstrual spotting, headache, wt gain.
Advice the woman to take additional ca++ and exercise
to minimize the risk of osteoporosis.
The injection site should not be massage to avoid
altering absorption rate.
The effect of the injection may last up 1 year after
injection.

16. Implant contraceptive ( nor plant):
Norplant progestin implant consist of 6
subdermal hormonal implants effective for
5 yrs.
Act by suppressing ovulation.
Increase thickness of the cervical mucus
which inhibit sperm penetration.

17.  Oral contraceptive:
 Prevent pregnancy by suppressing ovulation
and increase thickness of the cervical mucus
and alter the lining layer of the uterus to
prevent implantation. Effectiveness rate 99%.
 Two types:
1. Minipill progesterone only used for lactated
woman.
2. Combination estrogen and progesterone, more
effectives (suppression ovulation), use for non
lactated women.

18. It is important to take the pill at the same time
daily to keep the hormone levels stable. If one or
two pills is missed take it as soon as her
remember it.
If more than 2 used another method such as
male condom.
Adverse effect: thrombosis, pulmonary
embolism, MI, stroke, HTN, headache, infection,
cervical cancer.
OC can be started after pp 4 weeks to decrease
thromboemblic risk

19. Surgical methods
For female (tubal ligation) cutting or
clipping the fallopian tube ( both side).
For male (vasectomy): small incision 3 cm
cut of vas deferens on each side of the
scrotum.
Instruct the couples to use other method
for 3 months to clear the remaining sperm
from the vas deference ( 36 ejaculation).

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