Family planning methods CHN..pptx

FAMILY PLANNING
METHODS
Palak Mahajan
201182053
B.Sc. nursing 4th yr
Community health nursing

• What is family?
• What is family planning?
• Why family planning is
important?
• What are family planning
methods? Enlist them.

Family: it refers to two or more individuals who depend on
one other for emotional , physical and financial support.
Family planning : family planning is the way of thinking and
living that is adopted voluntarily, upon the basis of knowledge,
attitude and responsible decisions by individuals and couple in
order to promote health and welfare of family groups and thus
contribute effectively to the social development of a country.
[WHO,1971].

WHY FAMILY PLANNING IS IMPORTANT?
India is the one of the most populated country in the world with the
population of 1.428 billion [ Uttar Pradesh is the most populated state].
From the last century population of India is increasing with an alarming
rate [high birth rates with declining death rates leads to [population
explosion]causing serious consequences related to quality of human life [
hunger, unemployment , high living cost, lost living standards, law and
order problems and increased crime rate]

PURPOSE
WHO use the range of methods of fertility regulation to help individuals or couples to
attain certain objectives:
• To avoid unwanted births
• To bring out wanted births
• produce a change in the number of children born
• Regulate the intervals between pregnancies
• Help to prevent STDs/ HIV/ AIDS.
• To improve the health of the mother and child.
• To plan and assure that all the resources are available [time , social ,financial and
environment].

FAMILY PLANNING
METHODS:
Introduction:
Contraceptive methods are, by definition preventive methods
to help women avoid unwanted pregnancies. They include all
temporary and permanent methods to prevent pregnancy
resulting from coitus or intercourse. The contraceptive
methods may be broadly grouped into two classes: spacing
methods and terminal methods.

CRITERIA FOR IDEAL CONTRACEPTIVE
• It should be safe for you means free from any kind of side
effects
• It should be reliable
• It should be easy to administer and convenient
• It should be cost effective
• It should be culturally feasible and acceptable

Methods of
family planning
Spacing
methods
Non- hormonal
Natural methods Barrier methods
Hormonal
Oral pills,
emergency pills
Implants,
injections,
patches
Terminal
methods
tubectomy vasectomy

SPACING METHODS
• Also known as temporary methods. It
help in prevention of pregnancy as long
as they are used. These methods can help
in bringing and spacing of pregnancy,
preventing unwanted children.
It is of
two types:
Non-
hormonal
hormonal

A. NATURAL METHODS
These methods contraception prevent pregnancy
without the use of chemical or physical
agent[man-made devices].
It includes:
• Total sexual abstinence
• Periodic abstinence
• Temperature method
• Coitus interrupts
• Lactation amenorrhea method(LAM)
1. NON-HORMONAL
CONTRACEPTIVE

• Total abstinence: A practice of brahmacharya. Failure rate is nil if
followed properly.
• Periodic abstinence: also known as rhythm or calendar method or
safe period.
• Temperature method: prediction of basal body temperature (BBT) at
the time of ovulation.(temp. 0.5 C). This method is not practiced
with high level of illiteracy.
• Coitus interruptus: also called withdrawal method. This requires the
male to withdraw his penis from the vagina immediately before the
ejaculation of semen.
• Lactation amenorrhea method [LAM]: the women is amenorrheol
while breastfeeding in first 6 months postpartum until first spotting
or menses begins

B. BARRIER METHODS
Barrier methods are those which prevents sperm meeting with ovum.
Types of barrier methods:
Physical
methods
• Condom
• Diaphragm
• Cervical cap
• Vaginal
sponge
Chemical
methods
• Foam tablets
• Creams, gels
• suppositories
Intrauterine
devices (IUDs)
• Lippes loop
• Copper-T

I) PHYSICAL BARRIERS
1. Male Condom (nirodh):
• The male condom is a latex or synthetic rubber sheath that is placed on the erect penis before
vaginal penetration to trap the sperm during ejaculation.
• It can prevent STIs and can be bought over the counter without any fitting needed.
• Male condoms have an ideal fail rate of 2% and a typical fail rate of 15% due to a break in the
sheath’s integrity or spilling.
• After sexual intercourse, the condom is removed to be disposed.
• available free of cost in both urban or ruler family welfare centers. In 1982, condom with
spermicide (nonoxynol) was introduced.
Types : 1) dry nirodh 2) deluxe nirodh 3)super deluxe nirodh

FEMALE CONDOM
• These are also latex rubber sheaths that are specially designed for
females and prelubricated with spermicide.
• It has an inner ring that covers the cervix and an outer, open ring that is
placed against the vaginal opening.
• These are disposable and require no prescription.
• The fail rate of female condoms is 12% to 22%.

2. DIAPHRAGM
• The diaphragm is you used to buy women in her vagina to form a
barrier in front of the cervix. Diaphragm is dome like shaped and is
a shallow cap.
• It is made of soft synthetic rubber or plastic with a stiff but flexible
rim around the edge(rests b/w posterior fornix and symphysis
pubis). Before insertion spermicide should br applied. It is also
known as DUTCH CAP.
• Diaphragm is available in different sizes ranging from 5 to 10 cm
• It is headed imposition partly because of the tension created by
the spring and partly because of the muscle tone of vagina. It is
very important to observe the vagina muscle tone otherwise the
diaphragm may not remain in position (slip)

POINTS TO REMEMBER AS A NURSE
• Before insertion, spermicide is applied.
• After insertion the woman must check that her cervix is covered.
• Diaphragm can be inserted every evening as a matter of routine.
• It is inserted by hand or using introducer.
• It must be placed for atleast 6 hrs after the last intercourse.
• On removal, it should be washed with mild soap, dried and inspected for any damage.
• If alterations in weight (3 kgs), postpartum, one must buy new one.
*CERVICAL CAP is another device as functional as diaphragm.

3. VAGINAL SPONGE
• It is a small polyutherane foam sponge, diffused with spermicide.
• Sponge is shaped in a way that it can be filled on the cervix and loop
on its outer surface which can be to pull out the sponge after use
should be inserted before coitus.
• It provides protection for 24 hours and should remain in place for
atleast 6 hrs after intercourse.
• Sperms are trapped on the sponge and are destroyed.

II) CHEMICAL METHODS
• Chemical barriers are usually spermicidal (killing ) or spermistatic (stopping)
• These are designed to keep the vaginal ph near 4.0 (while ovulating). As sperm
best thrive at alkaline ph of 8.5 to 9.0.
• These are less expensive and needs no prescription.
• It also provides protection from some STDs and AIDS to some extent.
• These are quite effective when used with nirodh or diaphragm (but alone have
high failure rates.

III) INTRAUTERINE DEVICES (IUDS)
IUDs are the devices which are placed in the womb. These are of many types:
lippes loop and copper-T are most commonly used in India.
1.Lippes Loop: the loop is a small double-S shaped device
made up of polythene and inert plastic material being
produced in India. It is attached to one of the two ends in a
fine plastic filament which extends through the cervix to the
vagina where the loop is inserted into the uterine cavity by s
plunger.
• It remains in uterine cavity for years and does not interfere
with sex life.
• In case the couple want an extra child, the loop can be
removed and conception can take place.

POINTS TO REMEMBER:
Loops should not be used in
women who had
• Suspected pregnancy
• Pelvic infection
• History of bleeding
• Suspicion of malignancy
• Erosion of cervix
*IUDs danger signs {PAINS}
• P: period of late pregnancy
suspected abnormal spotting or
bleeding
• A: abdominal pain or pain with
intercourse
• I: infection (abnormal vaginal
discharge)
• N: not feeling well, fevers, chills
• S: stringing lost, shorter or longer.

2. COPPER-T
• It is the most effective contraceptive. It is T-
shaped object made of plastic but is wrapped with
fine copper which enhances its contraceptive
effect.
• In this, white thread with two strands is attached
to the copper-t, to check that it is in place.
Types :
• non-hormonal ( cu containing IUDs).
• Hormonal (progestin-releasing IUD)

POINTS TO REMEMBER
CU-T should not be used in following:
• Abnormality of uterus or other reproductive organ
• Allergy to copper
• Anemia
• Bleeding between periods
• Blood clotting disorder
• diabetes treated with insulin
• Heart disorder
• Heavy menstrual flow
• suspected pregnancy
• Pelvic infection
• Recent abortion or miscarriage
• Severe menstrual cramps
SIDE EFFECTS with CU-T
• Bleeding
• Painful periods
• Painful intercourse
• Erosion of uterus
• Infection
• Pregnancy outside the uterus
• Allergic reactions
• Expulsion
• Backache, pain in legs
• Vaginal discharge

2. HORMONAL METHODS
Hormonal contraceptives provides the best means of ensuring spacing
between one child to another.
Oral pills
• Combined pills
• Progestrone only
pill
• Once-a-month pill
Depot formulations
• Injectable
• Subdermal
implants
• Vaginal rings

1.ORAL PILLS
1.Combined pills: These pills are composed of two hormones i.e. synthetic oestrogen and progesterone
in very small doses.
• It’s action is to inhibit ovulation of ovum by blocking the secretion of gonadotropin from pituitary
gland.
• It is of two types: MALA-D and MALA-N.
• MALA-N is free in government settings under free distribution scheme (FWP) and MALA-D under social
marketing programs with the very minimal cost. Where MALA-D thickens the cervical secretion and
prevent sperm from entering and MALA-N stops or prevent the ovulation.
• It contain 28 tablets in total, 21 white contraceptive pills and 7 brown Iron pills. One pill is taken daily
beginning from the 5th day of the onset of menstruation.
• If the pill is missed, take 2 pills( one in morning and other in afternoon) the next day.
• Advised to carry an extra pack.
• Pills can be prescribed by doctor or any trained nurse with the help of checklist.

• Norethisterone
• +
• Ethynyl oestradiol
Mala
-N
• Norgestrol
• +
• Ethynyl oestradiol
Mala-
D

PROGESTERONE ONLY PILL
• This pill is also known as mini pill. It
contain only progestron and it
thickens the cervical mucus cavity.
• It can be taken throughout the
menstrual cycle .
• It is not used widely because of
high failure rate.
ONCE-A-MONTH PILL
• It is modified combined pill. It
contains long lasting estrogen and
short acting progestron. These pills
are not in use because
experimental results revealed high
pregnancy rate and irregularity in
the menstrual cycle.

POINTS TO REMEMBER
Side Effects Of Oral Pills:
• Nausea
• Tender breasts
• Abdominal pain
• Weight gain
• Irregular bleeding
WARNING SIGNS ( ACHES)
• A: abdominal pain severe
• C: chest pain severe, cough, shortness
of breath [means blood clot]
• H:headaches severe, dizziness,
weakness [may mean hypertension or
impending shock]
• E: eye problem blurry vision, speech
problem [may mean stroke]
• S: severe pain in legs, calf or thighs
[may mean blood clot]
PILLS SHOULD NOT BE GIVEN IN CASE WOMEN IS PREGNANT , HAS
HAD JAUNDICE, CANCER OR A NURSING MOTHER

EMERGENCY CONTRACEPTIVE PILLS ECPS OR E-
PILLS
• ECPs are used to prevent pregnancy for
and unprotected sexual intercourse. If
taken within 72 hours ECPs are safe for all
women. It comes in a pack of 2.
• The first should be taken as soon as
possible but certainly before 72 hours.
• the second pill should be taken 24 hours
after the first pill is taken.

NON-STEROIDAL WEEKLY ORAL PILLS
• Central drug research institute Lucknow
has developed a pill named
“CENTCHRAMAN”
• This is a weekly pill that is to be taken
orally. This fill is also known by the brand
name “Saheli”

POST COITAL PILLS
• This pills should be taken
within 48 hours of unsafe
coitus.
• This pills should be taken
in case of emergency only
like rape, failure of
contraceptive and unsafe
sexual intercourse.

2. DEPOT FORMULATIONS
These are long acting hormonal contraceptive containing only
synthetic progesterone. These are available in three forms:
• Injectable e.g. DMPA [Depo-provera](depot medroxy
progesterone acetate) and NET Oen
• Subdermal implants e.g. norplant and Norplant R-2
• Vaginal ring

POST CONCEPTUAL METHODS
These methods are used after the misses period and pregnancy may or
may not have occurred. This method is used in regulating and inducing the
menstruation and termination of pregnancy or aborting the fetus.
These methods are:
1. Menstrual regulation
2. Dilatation and curettage
3. Suction evacuation
4. Abortion .

TERMINAL METHODS
These methods are used in cases where both the partners agree not to
have any more children or whether the health of one or both of them
makes further pregnancies undesirable.
Generally two methods are employed which are:
• Female sterilization or tubectomy
• Male sterilization or vasectomy

MALE STERILIZATION/ VASECTOMY
• This implies what is known as vasectomy. In this operation, vas deferens on each side is
divided and ligated. This prevents the passage of spermatozoa into the seminal vesicles and
so conception does not take place after intercourse.
• Points to teach patient after surgery:
• To ensure normal healing of wound and success of vasectomy patient should told that he is
not sterile immediately and need at least 30 ejaculations before seminal examination is
negative
• To use contraceptives until aspermia.
• Avoid taking bath for atleast 24 hrs.
• To wear T- bandage or scrotal support for 15 days.
• To avoid cycling or heavy lifting
• Recently ‘NO SCAPEL VASECTOMY’ is accepted and used.

FEMALE STERILIZATION/ TUBECTOMY
This implies bilateral tubal ligation or salpingectomy. This can be done during the operation of
cesarean section, or on the second or third postpartum day if the patient had vaginal delivery,
or as an elective procedure in a non-pregnant woman.
In women, tubal ligation is performed by occluding the fallopian tubes through cutting,
cauterizing, or blocking to inhibit the passage of the both the sperm and the ova.
After menstruation and before ovulation, the procedure is done through a small incision under
the woman’s umbilicus passage of the both the sperm and the ova.
A laparoscope is used to visualize the surgery, and the patient is under local anesthesia.
The woman may return to her sexual activities after 2 to 3 days of the operation.
The effectiveness of this method is at 99.5%.

• Points to remember:
• Educate that menstrual cycle
would still occur, and make sure
that coitus before ligation is
protected to avoid ectopic
pregnancy
• before the procedure is done, the
position regarding future
pregnancies must be adequately
explained to the husband and his
wife because the operation is, as a
rule, irreversible great thought
must be given to the problem
before operation is performed.
• The consent from both husband
and wife must be obtained.

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