FAMILY PLANNNING METHODS

1. R.SRIDEVI
HOD OF COMMUNITY HEALTH NSG DEPT,GCON,RIMS
UNIT-VII
Population and its control

6.  Per minute = 51
 Per hour = 3060
 Per day = 73440
 Per month = 2,276,640
 Per year = 27,319,680

11. CONSEQUENCES OF OVERPOPULATION.
 Land or Space
 Housing problems
 Food supply
 Water supply
 Sewage disposal
 Sanitation
 Health care and education
 Unemployment and poverty
 Crimes
 Traffic problem
 Fuel and energy problems

23.  Family Planning
 DEFINITION
Family planning to regulate the number and
spacing of children in a family through the
practice of contraception or other methods of
birth control.

24.  To avoid unwanted births
 To bring about wanted births
 To regulate the intervals between pregnancies
 To control the time at which birth occurs in
relation to the age of the parent
 To determine the number of children in the
family.

25.  The proper spacing and limitation of birth
 Advice on sterility
 Education for parenthood
 Sex education
 Screening for pathological conditions of Reproductive
health
 Genetic counselling
 Premarital consultation and examination
 Carrying out pregnancy test
 Marriage counselling
 Preparation of couple for the arrival of their 1st child
 Teaching home economics and nutrition
 Providing adoption services

26.  FP is the one of the most effective and
inexpensive way of improving the present and
future quality of life on earth.
 FP could save the life of maternal deaths.
 Also prevent the damage caused by high risk and
undesired pregnancies.
 Could prevent most or all 50,000 illegal
abortion/day and resulting1,50,000 death/year.

27.  Decrease the physical and mental exhaustion resulting from
large family and poorly time pregnancy.
 Women would have more time for: education, vocational
development, income production ,recreation and care of
existing children
 Save millions of infant lives per year by reducing the number of
high risk births.
 Lead to significant improvement in infants nutrition and
health.
 Decrease the number of teenage pregnancies
 Decrease the incidence of cervical cancer
 Decrease the incidence of sexually transmitted diseases.

28. SMALL - FAMILY NORM
 The objective of the Family Welfare Programme in
India is that people should adopt the "small family
norm" to stabilize the country's population at the
level of some 1,533million by the year 2050.
 SYMBOLISED
 In the 1970s, - do ya teen bas.
 In the 1980s - 2 - child norm.

29.  The current emphasis is on three themes:
 "Sons or Daughters – two will do";
 "Second child after 3 years", and universal
immunization”.
 Small differences in the family size will make big
differences in the birth rate. A significant achievement
of the Family welfare Programme in India has been
the decline in the fertility from 6.4 in 1950s to 2.6 in
2010.
 The national target to achieve a Net Reproduction
Rate of 1 by the year 2006, which is equivalent to
attaining approximately the 2-child norm.

32.  Include both physical and chemical barriers.
 Condoms (male & female)
 Cervical barriers (diaphragm & cervical cap)
 Spermicidal (foam, sponge)
 Work by preventing sperm from reaching an
ovum.
 Only condoms provide protection against
STIs.

33.  The only temporary method of birth control for
men
 Only form of contraception that effectively reduces
STI transmission
 Made of thin latex, polyurethane, or natural
Membrane, Sheath that fits over the erect penis
 Many varieties Different features, textures,
colours, flavours available.
 Some “extended pleasure” types have a
desensitizing agent on the inside to delay
ejaculation
 Lubricated or non-lubricated

34.  Pinch reservoir tip of condom before unrolling
 condom over the penis to leave room for ejaculate
which reduces chance of condom breaking.
 Unroll condom over erect penis before any contact between
the penis and vulva occurs.
 Use a water-based lubricant to reduce risk of
condom breaking (oil-based lubricants deteriorate condom).
 Hold condom at the base of the penis before withdrawing
from the vagina to avoid spilling semen inside vagina.

36.  Consists of two flexible polyurethane rings and a soft, loose-
fitting polyurethane sheath
 One ring at closed end fits loosely against cervix; other ring at
open end encircles the labial area
 Can be inserted several hours before sexual activity; don’t
need to remove it immediately following ejaculation.

38. Advantages
Easily Available
Inexpensive
Easy to use
No side effective
Disposable
STI protection
disadvantages
Can reduce sensation
Polyurethane transmits heat well, so
some say that
the female condom has less reduction
in sensation
Interruption of sexual
Experience
May slip off or tear out during coitus

39.  Most common and easiest to fit and useThin,
nearly hemispherical dome made of rubber or
latex material, with circular, covered metal spring
at periphery (flat type and coil type)
 Coil spring type (ortho diaphragm mostly
used in India
VAGINAL DIAPHRAGM

40.  CERVICAL CAP :
 Small dome shaped rubber appliances designed to
cover the cervix
 Remain in place by suction
 Cap must be tailored to fit cervix
 Loosely fit caps may be displaced during intercourse
 Not suitable if cervix lacerated or irregular in shape
 3 or 4 sizes between 22 and 31 mm

41.  Failure rate:
 DIAPHRAGM:
 18-28% with typical use and 6% with correct
and consistent use
 CAPS:
 parous women – 30-40%
 with typical use 20-26% with correct and
consistent use
 nulliparous – 16-20% with typical use 9% with
correct and consistent use

42.  Advantages
 No gross medical side effects
 Control of pregnancy in hands of woman
 Reasonably safe when properly used
 Prevent spread of STDs though less effective than condom
 Disadvantages
 Use of spermicidal unacceptable and messy for some
 Suitable for intelligent, highly motivated women of middle or high
socioeconomic groups
 Allergy to rubber
 Infection may occur if used for long time
 Erosion
 Urinary tract infection
 Occlusive caps do not prevent spread of AIDS
 Rarely, toxic shock syndrome

43.  Soft, disposable foam sponge made of polyurethane.
 Round shaped with depression at centre of upper surface to fit
over cervix
 Saturated with spermicidal nonoxynol 9
 Attached nylon loop for removal
 Moistened with water, squeezed gently to remove excess water
and inserted high up in vagina to cover cervix
 Acts for 24 hrs
 Failure rate – 9 – 27 per 100 women
 Must be removed and thrown away after 8-24 hrs .
VAGINAL SPONGE

44.  Disadvantages:
 May get broken – difficult removal
 High pregnancy rate
 Toxic shock syndrome
 Allergic reactions
 Vaginal dryness, soreness
 May damage vaginal epithelium – increase risk of HIV
transmission

45.  Non ionic surfactants which alter sperm surface
membrane permeability, resulting in killing of
sperms
Use decreasing due to high failure rate
 Chemical suppositories:
 Cheapest but least effective
 Melt at body temperature
 Manual insertion high in vagina 10-15 min
before sexual act
SPERMICIDES

46.  2. Contraceptive creams and jellies
 liquefy at lower temperature than most creams so more suitable for
women with dry vagina
 3. Foam tablets
 effervesce ( bubbles in liquid)on contact with vaginal moisture placed
deep in vagina close to cervix.
 Tablets have to be used about 10 min before act and action lasts for 1
hour
 4. Aerosols or foams
 foaming chemical contraceptive creams, keep 15mts before intercourse.
 5. C-film
 5cm squares of water soluble , semitransparent plastic impregnated (
sock) with Nonoxynol 9 either placed over glans (rounded part) of penis
before coitus or high in vagina 3-5 min before
 Coitus active for 2 hrs

47.  Advantages
No instructions by doctors or nurses
Easily available and easy to use
No gross medical side effects
 Disadvantages
 Messy (untidy) to use
 Failure rate high when used alone
 Can increase spread of HIV infection by irritating
vaginal and cervical mucosa
 Failure rate – 41% with typical use and 6% with
correct and consistent use.

49. They are inert (lack of movement)or Non
medicated devices made up of polyethylene
Different shapes and sizes
 LIPPE‘S LOOP:
 Double ‗S‘ shaped device
 Made up polyethylene material
 Non toxic, non tissue reactive & extremely durable
 Small amount of Barium Sulphate is also added for
radiological examination
 Available in 4 sizes A,B,C & D
FIRST GENERATION IUD

50.  Made up of metal – copper
NEWER DEVICES
 Variants of T device
 T copper 220C
 T copper 380A
 Nova T
 Multi load devices
 ML-Cu250
 ML-Cu375
 All devises are effective and less side
effects i.e pain & bleeding.
 Can be fitted to nullypara women can
be tolerate by them.
II GENERATION IUD

51.  Hormone releasing IUD
 Progestastert
 Most commonly used T shaped device
 filled with 38mg of progesterone
 Releasing rate 65μg/day.
 Effective for 1 yr
 LNG-20
 Releases 20μg of levonorgesterol.
 Effective for 5 yrs
 Effective rate 99%
THIRD GENERATION IUD

52.  TIMING OF INSERTION:
 Inserted with a plunger
 Any time during women‘s reproductive period
 Except in pregnancy
 Most ideal time is during or within 10 days of the
beginning of menstruation the diameter of cervical
cavity is greatest at this time.

53. Bleeding and Pain
 Pelvic infection : 2-8 times
higher than normal
 Uterine perforation
 Ectopic pregnancy
 Expulsion: 12-20%
Cancer and teratogenicity
 women – years of use
Suspected pregnancy
Undiagnosed vaginal bleeding
Ca cervix, uterus
Previous ectopic pregnancy
Anaemia , PIDs
Congenital malformation of
Reproductive organs
Side effects Contraindication

54.  Advantages
 ◦Very effective (essentially no “user error”)
 ◦ Long-term protection
 ◦ No interruption of sexual activity
 ◦ Don’t have to remember to use
 ◦ Can be used during breast-feeding
 Disadvantages
 ◦ No STI protection
 ◦ Risk of PID (usually within first 1-2 months
following insertion)
 ◦ Rare incidence of perforating uterine wall

56.  Composition:
 In early 1960s –
 Oestrogen - 100-200μg and
 Progesterone - 10mg
 Greater side effects
 Now a days
 Oestrogen - 30-35μg and
 Progesterone - 0.05-0.15mg.
 Taken from 5th to 25th day of menstrual cycle, followed
by a break of 7 days (withdrawal bleeding).
 FAILURE RATE: 0.1%
Combinedpills

57.  Main type
 A)MALA-D: (Levonorgestrol 0.15mg + Ethinyl Estrodiol 0.03mg)
Packet of 28 tabs. 21 are white and 7 are brown coloured
containing Ferrous Fumarate.(Rs – 3/-)
 B) MALA-N : (Levonorgestrol 0.15mg + Ethinyl Estrodiol
0.03mg) Packet of 28 tabs. Govt Supply.
 Mechanism of action:
 It makes the mucous of the cervix thick making it hard for
sperm to get into the uterus. It prevents pregnancy by
changing the lining of the uterus making it unlikely for the
fertilized egg to be implanted
 A) Prevents ovulation
 B) Prevents implantation
 C) Makes cervical secretions thick
 Effectiveness
 100% effective if taken correctly.

59.  DEMERITS
 Failure rate increase if take irregularly.
 Minor side effects like dizziness, nausea, vomiting,
headache, weight gain etc.
 Increases the risk of heart problems if women
is already at risk.
 May increases the risk of gall bladder disease
and cervical cancer.

60. Contraindications to OCP Use
 Absolute Contraindications
 Cancer of breast an Genitals
 H/O venous ‘thrombo embolism
 Vascular disease- CAD or
 CVD
 Liver disease ( i.e. Viral
 hepatitis, cirrhosis)
 Pregnancy
 Congenital hyper lipidaemia
 Age above 40 yrs
Smoking and age above 35
Yrs
HTN with SBP>160,
DBP>99
Chronic renal diseases
Epilepsy , Migraine
Hyper lipidaemia LDL>160
DM with secondary
Complications
frequent bleeding,
Amenorrhea.

61.  ii. PROGESTRONONLYPILL:-
 The pill also known as mini pill. It contain only
progestogen and it thickens the cervical mucus in
cavity.
 mini pills are taken throughout the menstrual cycle
and these are not used widely because of its high
failure rate.
 iii. Once –A MONTH PILL:-
 it is modified combined pill. It contains long acting
oestrogen and short acting progestogen. These pills
are not in use because experimental results revealed
high pregnancy rate and irregularity in the menstrual
cycle.

62. POST-COITAL COTRACEPTIVE
(a) IUD : WITH IN 5 DAYS
(b) HORMONAL : More often a hormonal method may be
preferable. In India
 Levonorgestrel 0.75 mg tablet is approved .(1Tab-with in 72 hrs)
(or) 2 tab-50mcg of EE with in 72 hrs after intercourse & same
dose after 12 hrs. (or) 4 tab-30-35 mcg of EE with in 72 hrs& 4
tab after 12 hrs (or) mifepristone 10 mg in 72 hrs

63.  Mechanism of action:
 Hyper motility of fallopian tube
 Hyper motility of uterus hence no implantation
and fertilization
 Disadvantages:
 Nausea and vomiting.
 Next period may start earlier or later
 Do not protect against STI & HIV
 1 % failure rate

64. Malepills
 The hormones which reduce
 sperm count tend to reduce testosterone levels
hence they affect potency and libido
 Gossypol:
 Cotton seed derivative
 Causes azoospermia and severe oligo spermia
 Use for 6 months leads to complete sterility

65. Onceamonth(longacting)pill
 In this method a long acting
 oestrogen (Quinestrol) + short acting
progesterone is given.
 But the results are highly disappointing.

67. Progesteroneonlyinjectables
 DMPA(deport medroy
progestorone acetate)
 Dose: 150mg IM every 3 months.
 MOA: suppresses ovulation
 Advantage: doesn‘t affect lactation, useful
in postpartum period. Can be used in the
multi parae of age >35yr
 NET-EN:
 Dose: 200mg IM every 2 months
 Both DMPA & NET-EN are given in 1st 5
days of menstrual cycle.
 They are given deep IM in gluteus muscle.

68. New formulation of DMPA (inject)
 Prefilled, single use syringe could be
particularly
 They contain a special formulation of DMPA,
called DMPA-SC (104 mg).
 Short needle meant for subcutaneous
injection
 Useful to provide DMPA in the community.
 Injections by appropriately trained
community health workers is safe, effective,
and acceptable.

69.  Side effects:
 Disruption of normal menses
 Amenorrhoea
 Contraindications
 Breast cancer
 Genital cancer
 Undiagnosed uterine bleeding
 Suspected malignancy
 Lactating women

70. Combinedinjectables
 Containing long-acting progesterone with short action estrogen
 25 mg DMPA + 15 mg estradiol cypionate (Cyclofem) and 50 mg NET-
EN + 5 mg estrdiol valerate
 Given once a month and produce a menstruation like pattern.
 The trials are currently taking place in India.
 MOA:
 Suppression of ovulation
 Alteration of cervical and endometrial secretions.
 Contra indications
 Pregnancy Thrombo embolytic disorders
 Cerebro vascular disease Coronary artery disease
 Migraine Breast cancer
 DM

71.  There are two varieties. The earlier one is known as
Norplant and latest one is Norplant R-2
 • The Norplant has six small silicon rubber tubes.
each of these tubes contains 30mg of progestogen
.
 • The norplant-R-2 has two small rods.
 • Both of these devices are placed under the skin of
the arm. The tubes or the rods allow steady diffusion
of steroids into the blood stream for a period of five
years to give effective contraceptive effects.
Subdermalimplants
NorplantImplant

73.  Benefits
Reliable long term
contraception
 Improvement in
menorrhagia and
dysmenorrhoea
 No adverse effects on bone
mass
 No significant effect on
lipids, haemostasis or liver
function
Adverse side effects
Bleeding pattern altered:
Amenorrhoea 20%
Weight gain of >10% .
Hormonal ‗nuisance‘ effect
eg breast pain, headache, libido
decrease, dizziness, nausea
Other …. alopecia,
depression, change in libido

74. ThePatch
 Is a thin & plastic patch That sticks
to the skin.
 The sticky part of the patch contains
the hormones: nore lgestromin
(progestin) and ethinyl estradiol
(estrogen).
 Weekly for 3wks then patch free 1
week.
 These hormones are absorbed
continuously through the skin and
into ’the bloodstream.

76. Menstrualregulation
 Need legal restriction
 Aspiration of uterine content
 Within 6-14 days of missed period
 Cervical dilatation needed in nullipara
 Early complications : Bleeding, Uterine
perforation and trauma.
 Late complications : Tendency to abortion or
premature births, infertility, menstrual disorders,
 ectopic pregnancy & Rh isoimmunisation

77. Menstrualinduction
 Based on disturbing the normal progesterone
prostaglandin
 balance by IU application of 1.5mg solution or 2.5-
5mg pellet of prostaglandin F 2.
 Causes sustained uterine contraction for 7 min.
 followed by cyclical contraction for 3- 4 hrs.
 Bleeding starts and continues for 7-8 days.

78. OralAbortifacient
 Mifepristone + Misoprostol – 95% successful in
 terminating pregnancies up to 9 weeks.
 Commonly used regimen Mifepristone 200mg oral on
day 1 followed by Misoprostol 800mcg vaginally
immediately or 6 -8 hrs later.
 Other regimen is Mife pristone 600mg oral on day 1
followed by Misoprostol 400mcg orally on day 3
 Follow up visit is must within 14 days for clinical
and/or USG examination

79. ABORTION
 Termination of pregnancy before the 28 weeks of
pregnancy.
 Requires LEGALISATION
 Medical termination of pregnancy act 1971
 1) Conditions under which abortion is done
 Medical (pregnancy dangerous to the mother)
 Eugenic ( serious handicap…physical or mental)
 Humanitarian ( pregnancy result of rape)
 Socio-economic (injury to mothers health)
 In failure of contraceptive device

80. MTPAct1971
 MTP Act objectives:
 Aims to improve the maternal health scenario by
preventing large number of unsafe abortions and
consequent high incidence of maternal mortality &
morbidity
 Legalizes abortion services
 Promotes access to safe abortion services to
women
 Offers protection to medical practitioners who
otherwise would be penalized under the Indian
Penal Code (sections 315-316)

81. Legal framework
 MTP Act
 – lays down when & where pregnancies can be
terminated
 – Grants the central govt. power to make rules and
the state govt. power to frame regulations
 • MTP Rules
 – lays down who can terminate the pregnancy,
training
requirements, approval process for place, etc.
 • MTP Regulations
 – lays down forms for opinion, maintenance of
records
 – custody of forms and reporting of cases

82.  2)Who can perform abortion?
Authorising only a registered medical
practitioner..having experience in OBG to perform
abortion before 12 weeks only
 3)Where can abortion be done?
 Place approved by Chief medical officer of
district i.e DM& HO…..registered hospitals.

83. Abstinence
 This is the total avoidance of sexual activity.
 It carries a 0 (zero) percent chance of getting
pregnant.

84.  Withdrawal/Coitus interruption
 During sex the man withdraws his penis from the vagina
before he ejaculates.
 The effectiveness rate varies with the self-control of the
male.
 The male must recognize he is about to ejaculate and pull
out.
 With typical use about 20 out of 100 females
 would be pregnant after one year of using withdrawal.
 It is a natural method that does not require devices or
medicine in the body.
 There is a high rate of failure:
 ◦ If semen comes in contact with the opening of the vagina
the woman may become pregnant.
 Sex may not be as pleasurable for the couple.
 No protection against sexually transmitted infections.

86. Body temp in resting state on waking
Slight drop immediately before ovulation
After ovulation, release of progesterone
causes slight increase in temperature

87.  Breast feeding
 Lactation prolongs the post partum amenorrhea
and provides some degree of protection
 No t more than 5-10% women becomes pregnant
before 1st menstruation after delivery.
 Usually before child becomes 6 months and need to
frequent breast feeding.
 Birth control vaccine
 Immunization with a vaccine prepared from beta
sub unit of human chorionic gonadotrophin (HCG)
 Now in clinical trail and uncertainties are great.

89. vasectomy

90. COMPLICATIONS:
 Operative
 Sperm granules
 Spontaneous re canalisation
 Autoimmune response
 Psychological response

91. Tubectomy
Laparoscopy: specialized instrument Laparoscope inserted
through abdominal approach and fallopian tubes are blocke with
clip or rings.
Minilap: 2.5-3 cm incision in abdomen is done under local
anesthesia and fallopian tubes cut and blocked in both sides.

92. ROLEOFNURSEINPOPULATIONCONTROL
Identifying eligible couple
Create awareness
Explain importance of F.P
Free supply of contraceptives
Explain nature & methods of F.P
Explain resources available in community
Communication 7 health education
Motivating the people
Assist the doctor while inserting IUD s

93. Supervising & guiding the other health
personnel
Referrals
Record maintance
Conducting & participating camps&
programmes
Fallow up.