The document discusses the urgent need for population control in India due to rapid population growth, which has implications for health and social development. It explains various family planning methods including temporary, permanent, hormonal, and natural methods, highlighting their mechanisms, advantages, and disadvantages. In addition, it describes specific contraceptive devices and methods, including barriers like condoms, intrauterine devices (IUDs), and hormonal contraceptive pills.

1. 6/15/2024 1
FAMILY PLANNING
Ms. Jyoti Chand
MSc Nursing
Community Health Nursing

2. Introduction
■ The rate of growth of population increased after industrial
revolution. It was 500 million in 1650, one billion in 1800 and
touched to 6 billion in 1999. It is expected to reach 8 billion in 2025 .
■ The main reasons of population explosion are advances in medicines,
increase in birth rate, decrease in death rate, improved obstetrical
services, invention of antibiotics and other life saving drugs and
progress in sanitation and hygiene condition.

3. Need for population control
■ India is a country of vast population, if we see the trends of
population growth by decades then the population of India is
increasing rapidly. Some demographer projects that if the population
of India is not control then it would become the first country with
large population after china by 2050. earlier in the last century, the
rate of increase population was about 10 million per year but it is
now increasing at 100 million per year.
■ Population control refers to the practice of artificially altering the
rate of growth of a human population.

4. Family:
■ It refers two or more individuals who depends on one other for emotional ,
physical and financial support.

5. Family Planning:
“ Family planning is a way of thinking and living that is adopted
voluntarily upon the basis of knowledge, attitude 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 country”.

6. Family planning methods
To have gap
between children
To limit the size of
family
Temporary /
spacing methods
Permanent
methods

7. Temporary family planning methods
■ Barrier methods : a) Physical method
b) Chemical Method
■ Intra uterine devices
■ Hormonal methods
■ Post- conceptional methods
■ Natural methods

8. Permanent family planning methods
■ Vasectomy
■ Tubectomy

9. Temporary family planning methods:
1. Barrier method
a)Physical Method

10. Condom
■ Condom is the most widely known and used barrier device by the
males around the world.
■ In India, it is better known by its trade name NIRODH, a Sanskrit
word, meaning prevention.
■ A new condom should be used for each sexual act.
■ Condom prevents the semen from being deposited in vagina.

11. ADVANTAGES
(a) they are easily available
(b) safe and inexpensive
(c) easy to use; do not require medical supervision
(d) no side effects
(e) light, compact and disposable, and
(f) provides protection not only against pregnancy but also against STD.

12. DISADVANTAGES
■ It may slip off or tear during coitus due to incorrect use, and
■ Interferes with sexual sensation locally about which some complain
while others get used to it.
■ The main limitation of condoms is that many men do not use them
regularly or carefully, even when the risk of unwanted pregnancy or
sexually transmitted disease is high.

13. Female condom
■ The female condom is a pouch made of polyurethane, which lines the
vagina.
■ An internal ring in the close end of the pouch covers the cervix and
an external ring remains outside the vagina.

14. Advantages
Protect against sexually transmitted diseases and PID
Disadvantages
It is expensive

15. Diaphragm
■ It was invented by a German physician in 1882. Also known as "Dutch
cap“.
■ the diaphragm is a shallow cup made of synthetic rubber or plastic
material. It ranges in diameter from 5-10 cm (2-4 inches).
■ The diaphragm is inserted, before sexual intercourse and must
remain in place for not less than 6 hours after sexual intercourse. A
spermicidal jelly is always used along with the diaphragm.

16. ADVANTAGES:-
• Cheap
• Can be used repeatedly for a long time
Disadvantages
•Requires help of a doctor or paramedical person to measure the size
required.
• Risk of vaginal irritation and urinary tract infection are there.
• Not suitable for women with uterine prolapsed.

19. Vaginal sponge
■ It has been commercially marketed in USA under the trade name is
marketed TODAY for the purpose of preventive contraception.
■ The sponge is shaped in a way that it can be filled on to the cervix and has a
loop on its outer surface which can be to pull out the sponge after use. It
Should be inserted before the coitus.
■ Provides protection for 24 hours. It should remain be there for at least 6
hours after coitus.
■ Sperms are trapped on in the sponge and are destroyed. It is a small
polyurethane foam sponge measuring 5cmx26cm, saturated with the
spermicide, nonoxynol -9.

21. Chemical methods
■ Foams:- Foam tablets
■ Creams, jelly and pastes
■ Suppositories

22. Merits:-
■They are Simply, safe and easy
■They offer contraception just when needed.
■Do not require medical assistance.
Demerits –
■They have a high failure rate
■ they may cause mild burning or local allergic reaction and urinary
tract infection

23. Intra Uterine Devices
These are the devices which are placed in the uterine cavity. Three
different types of IUD'S generations are:
■ First Generation IUD’S
■ Second Generation IUD’S
■ Third Generation IUD'S

24. First Generation IUDs
■ These devices were made of polyethylene and are non-medicated.
These are available in different sizes and shapes such as coils, spirals,
loops. The lippes loop is the most popular and commonly used
devices under the first generation.
■ Lippes loop:- It is made of polyethylene and contains barium
sulphate which makes it possible to be located when required by x-
ray. The loop is double 'S' shaped and has an attached made of Fine
Nylon Threads.

26. Second Generation IUDs
■ These are also made of polyethylene but copper is added into these.
■ The copper enhances the contraceptive effect. Variety of copper
devices are:
 Copper-7 and copper t-200
 Variants of T devices: TCU: 220C and TCU: 380A
 Multi load devices: ML-CU: 250, ML:375
 Nova T: TCU-380
 The number included the surface area (in sq. mm) of the copper on
the device.

27. Cu T 220 C
Cu T 380 A

28. Multiload device NOVA T

29. Third Generation IUDs
■ These contains hormones which is released slowly in the uterus. The
hormone affects the lining of the uterus and cervical mucus. It may
affects the sperm. There are two types of hormone IUD’S:
1. Progestasert
2. Levonogestrel device(Mirena) {LNG-20}

30. Mirena

31. Lifespan
Cu T 380 A 10 years
Multiload devices 5 years
Mirena 5-7 years
Progestasert 1 years

32. Merits-
Can be used for longer period
 Can be easily removed when couple wants to have child
Do not interfere with coitus
Inexpensive Very effective and failure rate if less.
 Do not require hospitalization
DEMERITS
Bleeding, pain, perforation of uterus, expulsion.

33. Timing for insertion
■ During mensuration or within 10 day of the beginning of a
mensuration period.
■ Within 24 hours of delivery(Post-partum)
■ A convenient time for loop insertion is 6-8 weeks after the delivery

34. Hormonal contraceptive methods
A) Oral pills
 Combined pill
 Progesterone only pill(POP)
 Post coital pill
 Once a month pill
B) Depot formulation
 Injectables
 Subcutaneous implant

35. Combined pills
■ Progesterone+ estrogen
■ The pill is given orally for 21 consecutive days beginning on
the 5th day of the menstrual cycle, followed by a break of 7
days during which menstruation occur.
■ The pill should be taken everyday at a fixed time.

36. Types of pills
■ Mala N
■ Mala D

37.  Levonorgesterol- 0.15 mg
 Ethinyl estradiol- 0.03mg
Mala D in a Package of 28 pills (21 OCP & 7 brown color 60 mg ferrous
fumarate tablets)
Mala N contains 21 tablets
Mala N is supplied free of cost through all PHCs And urban family
welfare centers.

38. Progesterone only pill
■ Minipill or micropill
■ It contains only progesterone.

39. Post coital contraception
■ Post coital ( morning pill) contraception is recommended within 72
hours of an unprotected intercourse.
Eg- levonorgesterol 0.75 mg
■ 1 tablet of 0.75 mg within 72 hours of unprotected sex and the 2nd
tablet after 12 hours of 1st dose.

41. Weekly pill/ Non-steroidal/ Non hormonal
■ Central drug research institute lucknow developed a pill :-
 Centchroman / SAHELI
 This pill should be taken once a week.

42. Injectable contraceptives
 Progesterone only injectables
DMPA ( depot medroxy progesterone acetate)
DMPA SC

43. DMPA / ANTARA
■ Good to use among multiparae women >35 years
■ IM injection of 150 mg every 3 month
■ Duration- given at 1st 5 days of menstrual cycle
■ Mode of action- stop ovulation and thickens the cervical mucus

44. DMPA sc
■ Subcutaneous injection of 104 mg at 3 month intervals

45. Subdermal implants
■ Also known as Norplant
■ It consist of 6 Silastic capsules containing 35 mg of levonorgesterol.
■ These capsules or rodes are implanted beneath the skin of the
forearm.
■ Effective contraception is provided for 5 years.

46. Natural methods
■ Abstinence
■ Coitus interrupts
■ Basal body temperature:- there is slight increase in body
temperature during the fertile period
■ How does it work?
It is based on identifying the woman's fertile days and avoiding
intercourse during the fertile days to prevent pregnancy.

47. Terminal methods
 Vasectomy
 Tubectomy

48. Vasectomy
■ It is the simple, safe, effective, cheap, convienient permanent and
quick surgical method of family planning for men who decide that
they do not want any more children.
■ The passage of the sperm along with the vas deference is blocked, so
that the sperm that is ejaculated does not contain sperm.
■ The patient is not sterile immediately after the operation, at least 30
ejaculations may be necessary.
■ During this Immediate period another method of contraception must
be used.

50. Tubectomy
■ This is also known as ‘ voluntary surgical contraception’ and ‘ Tubal
ligation’ and 'Minilap’
■ It is a simple, cheap, safe and permanent method of contraception for
women, it consist of blocking both the fallopian tubes.

52. Instructions after surgery
■ Rest for 2-3 days and avoid strenuous work for one week.
■ Keep the wound clean and dry
■ Not to have intercourse for at least one week or until pain gone.

54. Q. Identify the Contraceptive device shown in the image and which
Spermicidal used in this Contraceptive ?

55. Q) Which of the following method of contraception can prevent
STI?
a) Oral pills
b) CuT
c) Condom
d) Dutch cap

56. Q) Multiload device refers to?
a) 1st generation IUCD
b) 2nd generation IUCD
c) 3rd generation IUCD
d) Oral contraceptives

57. Q ) All of the following are physical barrier methods used for birth
spacing except-
a) Diaphragm
b) Vaginal sponge
c) Cu T
d) Nirodh

58. Q. A woman using diaphragm for contraception should be
instructed to leave it in place for at least how long after
intercourse?
(a) 6 hours
(b) 12 hours
(c) I hour
(d) 28 hours

59. Q) DMPA is an injectable contraceptive given every:
A) 2week
B) 2year
C) 2 month
D) 3 month

60. Q. Identify the Contraceptive device shown in the image:
a) Cu T b) cu T 200 A
c)Cu T 380 A d)cu T 220 B

61. Q. Contraceptive oral pills help in birth control by:
(a) Killing of Ova
(b) Preventing Ovulation
(c) Killing of sperms
(d) Forming barrier between sperms and Ova