Family planning Methods

Sandip D. Barfe
MSc Nursing (MHN)

Family planning
Definition :-
It refer to practices that help to individual & couple
to attain certain objective:
 To avoid unwanted birth.
 To bring about wanted birth.
 To regulate interval between pregnancies.
 To control the time at which birth occur in relation to the age of parent.
 To determine the number of children in family.
MR. SANDIP D. BARFE MSc NURSING(MHN) 2

Scope of family planning services
 Timing of Birth:-
 It implies considering the age at which the women
should conceive pregnancy.
 Age group of 20 – 30 year consider as safe to conceive
&give the birth to child

 Spacing of birth:-
 It is advisable to have 2 to 3 year interval between last confinement
& beginning of next pregnancy.
 Finding of studies shows high mortality when birth interval was
less.
 Limiting Number of birth:-
 The risks of complication during pregnancy & delivery time increase
with the increase in number of gestational age .
 It reduce the risk of the maternal mortality & morbidity , foetal &
neonatal mortality.

 Care of infertile couple:-
 The couple who are not able to conceive should provide
comprehensive package of servicer . E.g. clinical examination , lab
investigation , therapeutic care, follow up, education & counseling
etc
 Sex education :-
 Should provide right from pre adolescence for both sex.
 It shoulde include all aspects i. s anatomy & physiology of reproductive
system sex hygiene.

 Preparation of parenthood:-
 Education should imparted to all future parent or newly married
couple.
 Other services :-
 Screening of gynecological problem.
 Genetic counseling.
 Marriage counseling.
 Pregnancy testing.

Small family norm
 India launched the national family planning
programme in 1952.
 In 1997 India redesign it as national family welfare
programme.
 The objective of family welfare programme is in India
to promote , on voluntary basis , a two child norm or
small family norm.
 National target to achieve net reproductive is 1 by year
2006

 In 1970 the famous slogan was “DO YA TEEN BAS”
 In 1980s the campaign has advocated the 2 – child
norm.
 The current emphasis is on three themes:
1. “Son or daughter - two will do”
2. “Second child after 3 year”
3. “Universal immunization”

Methods of family planning
 There are basically two types of methods of family
planning:
1. Temporary:-
2. Permanent:-

Temporary methods include:-
A. Barrier methods:-
i. Physical methods:- Condom, female condom.
ii. Chemical methods:- creams, pastes and jellies.
iii. Combined methods:- physical as well as chemical
B. Intrauterine devices:- Copper T
C. Hormonal Methods:- Oral contraceptive pills
D. Miscellaneous methods:- safe period or rhythm
method, withdrawal method.

Permanent methods:-
A. Tubectomy for females
B. Vasectomy for males.

Barrier methods:-
 Also called as “occlusive” method.
 It prevent the live sperm to meeting to ovum.
 3 major type ………………….
i. Physical methods:- e.g. Condom, female condom.
ii. Chemical methods:- e.g. creams, pastes and jellies.
iii. Combined methods:- e.g. physical as well as chemical

Physical methods
 Condom :-
 In India it also known as NIRODH.
 Effective simple “spacing” method of contraception,
without side effect.
 In addition to prevent the pregnancy, it protect men &
women from sexually transmitted disease.
 It prevent the deposition of the semen in the vagina.

 It is highly effective method, if use correctly at each
coitus with a spermicidal jelly.
 Failure rate for the condom is low.

 How to Use:-
 It is fitted in the erect penis before intercourse .
 Air must be expelled teat end to make room for
ejaculation.

 Advantages :-
1. Simple & effective method of contraception.
2. Safe & inexpensive.
3. Easy to use ; do not required medical supervision.
4. No any side effect.
5. Light , compact & disposable.
6. Provide protection not only from pregnancy but also
from STD

 Disadvantages:-
1. It may slip or tear during coitus.
2. It interferes in sex sensation.
3. Person may have allergy to rubber.

 Diaphragm:- ( Dutch cap )
 It is vaginal barrier .
 Invented by the German physician in 1882.
 It is shallow cup made of synthetic rubber or plastic
material.
Range in diameter from 5 – 10 cm.
It has flexible rim made of spring
or mental .
It is important that women should
fitted proper size of diaphragm.

 It is inserted before the sexual intercourse & must
remain in the place for not less than 6 hrs.
 Spermicidal jelly must use along with it.
 Failure rate is 6 to 22 per 100 women.

 Advantages :-
1. Failure rate is low when use along with spermicidal.
2. No any contraindication.
 Disadvantages:-
1. Initially the physician or other trained person required
to demonstrate the technique of insertion .
2. Can’t use after delivery.
3. Require privacy & time to insertion.
4. Require facilities for proper care & storage

 Vaginal sponge:-
 Small polyurethane foam sponge diffuse with
spermicidal .
 Measuring from about 5 cm to 2 cm.
 Inserted before coitus in vagina ; fitted on the cervix &
has loop to full out.
 Provide protection for 24 hrs.

 Advantages :-
1. Convenient to use
 Disadvantages:-
1. Less effective than diaphragm.
2. It should insert 18 hrs before coitus.

Chemical methods
 It also known as spermicides.
 It help to prevent pregnancy.
 Chemical contraceptive are………..
1. Foams tablet
2. Cram , jelly & pastes.
3. Suppositories.
4. Soluble films

 Advantages :-
1. Easy administer.
2. Available free in health center.
3. Increase vaginal lubrication
 Disadvantages:-
1. Must be inserted deep to down & all such point where
sperm can reach.
2. Must be apply each time before sex.
3. Must cause irritation & burning.

INTRAUTERINE DEVICES
 It is the devices which are place in the uterine cavity .
 Use early in 1909 which was made of silk worm , silk &
gold.
 Japan was 1st manufacture & utilize IUD of plastic
material
 Basically 2 type ……………
1. Non-medicated.
2. Medicated

1st Generation IUD
 It is the type of non medicated device , usually made of
polyethylene or other polymer.
 Appear in different shape & size e.g. loop ,coil, rings

Lipper Loop :-
 Double ‘S’ shaped device made from polyethylene.
 It contain small amount of barium salphate ( allow X-ray
observation )
 Has threat or ‘tail’ made from nylon, which can easily felt
& reassurance that loop is in its place.
 There are 4 size of lipper loop……… A, B ,C, D

2nd Generation IUD
 It is tried in 1970.
 Made from polyethylene; but copper is added into
these .( because cooper has anti fertility effect )
 Different types………..
1. Copper –T 200 B
 Widely use ( about 99.7% )
 It has to replace after 3 year
2. Variant of T devices:-
 E.g. TCU-220C & TCU-380 a .
 More effective , stay for long period ( 5 year )

3. Multi-load devices:-
 ML-CU-250 , ML-Cu-375.
 More amount of copper present.
 stay for long period ( 5 year )
4. Nava T:- e.g. Tcu-380
 Silver core wrapped with copper is use.
 More effective

3rd Generation IUD
 It contained hormones which release slowly in uterus.
 2 type of hormones use in IUD
1. Progestasert:-
 T shaped device
 Contained progesterone which is natural hormones.

1. Levonorgestrel:-
 T shaped device
 Contained Levonorgestreal which is a synthetic steroid.
 Very effective, need to be change every 5 year.

Mode of action
 Unknown.
 It cause as foreign body reaction in the uterus causing
cellular & biochemical changes in the endometrium &
uterine fluids & these change impair viability of sperm
& reduce chance of fertilization
 Hormones make endometrium unfavorable for implant.

Selection of IUD client
 Who has given birth to at least one child.
 Does not have any kind of infection
 Does not have any major disease.
 Has normal menstrual cycle.
 Has access to follow up & treatment potential problem.

Time of insertion
 Best time:-
 Between 3 – 7 day of menstrual cycles.
 1 -2 week after normal delivery or clear abortion.
 Post- pueperial period

Contraindication
 Absolute:-
i. Suspected pregnancy.
ii. Pelvic inflammatory disease.
iii. Vaginal bleeding of undiagnosed etiology.
iv. Cancer of cervix or uterus.
v. Previous ectopic pregnancy
 Relative:-
i. Anemia.
ii. Menorrhagia.
iii. History of PID
iv. Purulent cervical discharge

Side effect
1. Bleeding
2. Backache
3. Lower abdominal pain.
4. Spotting.
5. Menorrhagia.

Advantages
 Low failure rate ( 2-3 per 100 women)
 Suitable for women who are on breast feeding.
 “ one time method” , that is , no any attention required after
insertion.
 It is aesthetic; does not interfere with sexual intercourse.
 No hospitalization required.
 Reliable method for spacing child birth

Disadvantages
 May be painful when inserted or removed.
 Side effect may occur.
 May be expelled spontaneously or perforate uterus.
 Ectopic pregnancy may occure.

Hormonal Contraceptives
 two type of hormonal contraception……………..
A. Oral pills:-
i. Combined pill
ii. Progestogen only pill
iii. Post coital pill
iv. Once a month pill
v. Male pill
B. Depot formulation:-
i. Injectables
ii. Subcutaneous implant
iii. Vaginal rings.

Oral Pills
i. Combined pill :-
 It is the combination of the two hormones i.e.
synthetic estrogen & progestogen.
 It entered in to market in 1960s.
 It contain not more than 30 – 35 mcg of a
synthetic estrogen & 0.5 – 1 mg of progestogen.

 Two type of pills available in market i.e. MALA-D &
MALA-N.
 MALA- D is commonly use.
 The packet contain 28 pills ,
1st 21 white pills are
contraceptive pills & brown
7 pills are iron tablet.
 1 pill is taken daily starting
from 5th day of the onset of
period before going to bed

 If any time , any pill missed , the missed pill should be
taken as soon as possible or 2 pills should taken on
next day ( 1 morning & 1 in evening.)

 Mechanism of action:-
 It inhabit the ovulation of ovum by blocking the secretion
gonadotropin from pituitary gland.

 Contraindication:-
 Pregnant women.
 Over 40 years & heavy smoker
 DM or history of DM to women or in family.
 Cancer of breast or genital organ.
 Cardiac abnormality.
 Bleeding
 Nursing mother.

 Side effect:-
 Nausea
 Dizziness
 Headache
 Intra – menstrual bleeding
 Spotting .
 Weight gain
 High BP.
 Cardiovascular complication e.g. MI ,

 Advantages:-
100% effective if use regularly.
Easy to use.
Does not interfere in coitus.
It correct preexisting menstrual problem.
Reduce the risk of anemia.
Reversible method

 Disadvantages:-
Prior medical examination needed before starting the
pills.
Side effect may occur.
Required strong motivation & self discipline to be able
to take the pill.
All women are not fit for pill.

Progestogen – Only Pill
 Also known as minipill.
 It contain small amount of the progestogen e.g. leonorgestrel.
 Prescribe to older women for whom the combine pills are
contraindicated.
 Failure rate is high.
 Action:-
 It thicken the cervical mucus which inhabit sperm
penetration.
 Also make endometrium unsuitable for implant of
fertilizes ovum

Post coital pill
 It is recommended within the 72 hours of an
unprotected intercourse.
 Advocated as an emergency method
 e.g. unprotected intercourse , rape or contraceptive
failure.

 Two methods………
1. IUD:- insert within 5 day.
2. Hormonal:-
 More preferable
 In India, Leonorgestrel 0.75 mg tablet is approved.
 1 tablet of 0.75 mg within 72 hours of unprotected sex & 2nd dose
after 12 hours of 1st dose.

 Once in month:-
 Modified combine pill.
 Contain long acting estrogen & short acting
progestogen.
 Not in use , because of high failure rate & irregular
menstruation.

Depot formulation:-
 Depot formulation which are highly effective , reversible ,
long- acting & estrogen free hormonal contraceptive.
OR
 They are long acting hormonal contraceptive contain only
synthetic progestogen.
 Single administration sufficient for several month.
 Available in 3 forms….
1. Injectable
2. Sub dermal implant
3. Vaginal ring

A. Injectable contraceptive:-
 There are two type ………………
1. Progestogen – only Injectable.
2. Combined Injectable
1. Progestogen – only Injectable.
 Only two Injectable hormonal contraceptive have
been found suitable.
1. DMPA ( depot- medroxyprogesterone acetate )
2. NET – EN ( Norethisterone enantate )

DMPA ( Depot- MedroxyProgesterone Acetate )
 It has been in use since 1960s.
 The standard dose is intramuscular injection of 150 mg
every 3 month.

DMPA ( Depot- MedroxyProgesterone Acetate )
 Action :-
 It exert effect primarily by suppression of ovulation.
 Also thickness the cervical mucus which interfere the
penetration of sperm in genital canal.
 Bring the change in endometrium to prevent implantation of
fertilized ovum.
 Gives protection from pregnancy in 99% of women

NET – EN (Norethisterone Enantate )
Use as contraceptive since 1966.
Less extensively from than DMPA.
Given 200 mg IM every 60 days.

NET – EN (Norethisterone Enantate )
Action :-
 Administration:-
 Initial should be given during 1st 5 days of the menstrual period.
 Both are given beep IM Gluteus maximus.

 Side effect:-
 Disruption normal menstrual cycle,
 Amenorrhea.
 Contraindication:-
1. Abnormal uterine bleeding
2. Suspected malignant growth.
3. Cancer breast
4. Suspected pregnancy.

 Advantages:-
Safe , effective contraceptive.
Require minimum motivation or non at all.
Does not interfere in lactation.
Not interfere in sex.
 Disadvantages:-
 Have side effect
 Limiting the age group.(age over 35 year )

2. Combined injection contraceptive:-
 Contain both progestogen & estrogen.
 Given at monthly interval + or – 3 days.
 Action:-
 Contraindication :-
 Pregnancy
 Nursing mother
 DM
 Cardiovascular diseases

Sub-dermal Implant
 E.g. Norplant , Norplant (R) – 2
 Developed by the population council , new York.
 It is long-term contraceptive.
 Norplant consist of 6 capsule of containing 35 mg of
Leonorgestrel.
 The capsule is implant beneath the skin of upper arm.
 Contraception provide for 5 year.

Six capsule of containing 35
mg of Leonorgestrel.
The capsule is implant beneath the skin of upper
arm.
Sub-dermal Implant

Sub-dermal Implant
 Disadvantages:-
 Irregular menstrual bleeding.
 Required surgical procedure to insert.

Vaginal Ring
 It contained Leonorgestrel.
 The hormone slowly absorbed through the vaginal
mucosa.

Post- connectional method
1. Menstrual regulation:-
 Aspiration of uterine contents 6 to 14 day of missed
period.
 Complication:-
 Uterine perforation & trauma
 Tendency to abortion or premature
 Infertility
 Menstrual disorders

2. Menstrual induction:-
 It is based on disturbing normal uterine progesterone –
prostaglandin balance by intrauterine application of 1-5 mg
solution of prostaglandin f2.
 Within few minutes, uterus start contraction , bleeding start
& continues for 7 – 8 day

MISCELLANOUS METHODS
1. Safe periods:-
 Also called as calendar methods.
 1st described by the ogino in 1930.
 A week before & a week after the consider of the safe
period.
 Failure rate is 24 % per 100 women.

Infertile
Menstruation
Infertile
Fertile
Safe periods Method of Contraception

 Coitus interrupts:-
 Oldest method of voluntarily fertility control.
 The male withdraws just before the ejaculation & thereby
prevent deposition of semen in vagina.
 Failure rate is high as 25 %

Breast feeding:-
 It has national contraception effect .
 Lactation prolonged post partum amenorrhea & provide some
degree of protection against pregnancy

TERMINAL METHODS
 Sterilization methods.
 It include male Sterilization & female Sterilization.
 Currently female sterilization accounted for 85 % &
male Sterilization for 10 – 15 % of total Sterilization.
 Advantages:-
 It is one time method.
 Dose not require sustained motivation of the use for
effectiveness.
 Provide the most effective protection against pregnancy.
 Risk of complication is small.

FEMALE STERILIZATION
 It involves cutting & tying off the fallopian tubes.
 Two type of sterilization………………..
1. Postpartum sterilization:-
 When sterilization is performed 1 – 3 days after delivery
called postpartum sterilization.
2. Interval sterilization:-
 When sterilization is performed at any time other than
following childbirth called interval sterilization.

METHODS OF FEMALE STERILIZATION
 There are 3 main method……………..
1. Traditional Tubectomy:-
2. Mini-lap operation:-
3. Laparoscopy:-

1. Traditional Tubectomy:-
 An abdominal operation in which a small pieces of each
fallopian tube is removed & ligated.
 The operation is done under or spinal anesthesia.
 Hospitalization is 5 – 8 days require.
 Women can resume household work after about 10 days, but do
not carry heavy loads for at least 3 week.

 Mini-lap operation:-
 It is modification of the traditional Tubectomy.
 Less traumatic than traditional tubectomy.
 In which small suprapubic incision of 2.5 to 3 cm just
above the pubic hair.
 The tube are cut & end are blocked

 Laparoscopy:-
 Done by the specialized instrument called
Laparoscope.
 abdominal is inflated with gas & instrument is inserted
in abdomen to visualize tube .
 Falope ring or clip is applied to occlude tube.

 Patient selection:-
 Not advisable for patients for 6 week following delivery.
 HB should not be less than 8.
 There should be no any medical disorder e.g. heart
disease , respiratory disease etc.

MALE STERILIZATION/ VASECTOMY:-
 Simple & minor operative procedure can be perform in
PHC center.
 It involve a small cut of both side of scrotum, then
small of vas deferens on either side of the scrotum is
cut and ligated , folded back & sutured.
 After operation avoid any strenous Manual labour for
week.
 Advice to use Nirodh or other contraceptive for at 3
month.

MALE STERILIZATION/ VASECTOMY:-

 Advantages:-
 Operation is simple & minor.
 100% effective.
 Give permanent protection against unwanted pregnancy.
 No any side effect or complication.
 In comparison to Tubectomy it is cost effective.
 Disadvantages:-
 Patient is not immediately sterile after the operation. A
suitable contraceptive need to be use.
 Irreversible for all practical purpose.

SUMMARY

Family planning Methods

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