This document discusses various methods of family planning. It begins by defining family planning and outlining its objectives according to the WHO. The three main elements of family planning are proper spacing, timing, and number of pregnancies. Natural family planning methods like rhythm, basal body temperature, and cervical mucus methods are described. Barrier methods including condoms, diaphragms, and spermicides are also summarized. Long-acting reversible contraceptives such as IUDs, implants, injections, and patches are discussed in detail.

2. INTRODUCTION
Family planning is the term given for pre-pregnancy
planning and action to delay, prevent or actualize a
pregnancy.
DEFINITION:
Family planning is a way of thinking and living that is adopted
voluntarily, upon the bases of knowledge, attitude and
responsible decision by individuals and couples in order to
promote the health and welfare of family group and thus
contribute effectively to the social development of country
-B T BASVANTHAPPA

3. OBJECTIVES
( WHO ) “the use of a range of methods of a fertility
regulation to help individuals or couples attain certain
objectives:
 avoid unwanted birth.
 bring aboutwanted birth.
 Produce a change in the no. of children born.
 Regulate the intervals between pregnancies.
 Control time at which birth occur.”

4. Proper
spacing
Proper
timing
No. of
pregnanci
es
Elements of family planning
3 importantelements in family planning:

5. Benefits
Benefits to Mother
Reduce the healthrisk
Below 20y,And above 35 y.At risk of developingcomplications
during pregnancy.
physical strain of childbearing.
reduce number of maternal death.
reduce the risk of ovarian cysts.

6. Health Benefits to Children:
Ensures better chance of survival at birth.
 Promote betterchildhood nutrition.
 Promote physical growth and development.
 Prevent birth defects.

7. Health Benefits toFather
Allows father to keep a constant balance between
their physical, mental, social well –being.
Increase father sense of respect because he is able to
provide the type of education and home environment.

8. Benefits to WholeFamily
Health
Benefits to Whole Family Health - help the family
enjoy the better kind of life.

9. TYPES OF FAMILY PLANNING
Natural family planning
Barrier family planning
Permanent/surgical family
planning

10. INTRODUCTION OF NATURAL
FAMILY PLANNING
No introduction of chemical of foreign material into
the body.
Practice may be due to religious belief, “natural” way
is best forthem.
Effectiveness varies greatly, depends on couples ability
to refrain from having intercourse on fertile days.
 Failure Rates: about 25% Poses no risk to fetus

11. NATURAL FAMILY PLANNING
Rhythm (Calendar) method
Basal Body Temperature (BBT)
Ovulation or Cervical Mucus Method
Symptothermal method
Coitus Interruptus
Lactation amennorhea

12. The rhythm method, also called the fertility
awareness method, is a form of pregnancy
prevention where couples calculate a woman's fertile
time using a calendar .
Abstaining from coitus on the days of menstrual cycle
when a woman is most likely to conceive (3 or 4 days
before until 3 or 4 days after ovulation). Woman keeps
a diary of 6 menstrual cycles.
RHYTHM (Calendar)
METHOD

13. This method may be used by women whose menstrual
cycles are always between 26 and 32 days in length .
 To calculate:
18 from shortest cycle documented –11from
longest cycle = represents her last fertile day.
Example: If she has 6 menstrual cycles ranging from
25 to 29 days, fertile period would be from 7 th day (25-
18) to the 18 th day (29-11). To avoid pregnancy, avoid
coitus/use contraceptive during those days.

14. Disadvantages
Lifespan
of Sperm
Failure of
method
Reliability

15. . Basal Body Temperature (BBT)
Identifying fertile and infertile period of a woman’s
cycle by daily taking and recording of the rise in body
temperature during and after ovulation.
 Just before ovulation, a woman’s BBTfalls about 0.5ºF
At time of ovulation, her BBT rises a full degree
(influence of progesterone). This higher level is
maintained the rest of menstrual cycle.

16. DISADVATAGES
NOT reliable method: of birth control, especially for
women with irregular cycles. Plus, outside factors,
such as a lack of sleep, can cause a woman’s
temperature tovary.

17. Cervical mucus is a fluid produced by small glands
near the cervix
This fluid changes throughout her cycle, from
scant and sticky, to cloudy and thick, to slick and
stringy.
Each of these types of mucus is related to the
hormonal shifts that naturally occur during
the menstrual cycle as her body prepares for and
achieves ovulation.
Cervical Mucus/Ovulation

18. Right before ovulation, the mucus from the cervix
changes from being cloudy and scanty to being clear
and slippery.
The consistency of ovulation mucus is like that of an
egg white and it can be stretched between the fingers.
It is the peak of her fertility.
After the ovulation, the mucus tends to dry up again.
These are also safe days.
Ideal Failure rate: 3%

19. DISADVANTAGES
It is not a particularly reliable method of birth
control, especially for women with irregular cycles .
Remember that cervical mucus does not let you know
when you will soon be ovulating, but sperm can live up
to seven days inside the vagina. Any sperm deposited
ahead of time can still impregnate the woman.

20. Symptothermal Method
Combines the cervical mucus and BBTmethods
Watches temp. daily and analyzes cervical mucus daily.
Watch for midcycleabdominal pain Couple must
abstain from intercourse until 3 days after rise in temp.
or 4 th day after peak of mucus change.
More effective than BBTor CM method alone Ideal
Failure rate: 2%

21. COITUS INTERRUPTUS
One of oldest known methods of contraception
Couple proceeds with coitus until the moment of
ejaculation which Offers little protection.

22. LACTATION
AMENNORRHEA
The lactation amenorrhea method (LAM) is a natural
birth control technique based on the fact that
lactation (breast milk production) causes amenorrhea
(lack of menstruation).

23. How it works:
Breastfeeding interferes with the release of the
hormones needed to trigger ovulation.
ADVANTAGES:
Breastfeeding on demand improves health for mother
and baby.
Nothing to buy or use.

24. DISADVANTAGES
 an use this method only for the first six months after
birth or until the first menstrual period.
 LAM does not provide protection against SEXUALLY
TRANSMITTED INFECTIONS.

25. CLASSIFICATION OF
CONTRACEPTIVE METHOD
CLASSIFICATION
SPACING
METHOD
BARRIER
METHOD
INTRAUTERIN
E METHOD
HORMONAL
METHOD
POST COITAL
METHOD
TERMINAL
METHOD

26. BARRIER METHODS
Condoms (male and female)
Spermicidal
Sponge
Diaphragm
Cervical cap

27. Male condoms:
 These are made up of polyurethane or latex.
 Silicon used now a days to produce semi dry pre-
lubricated forms.
 In India one particularly brand is widely marketed as
‘Nirodh’.
 Spermicidal – coated with nonoxynol on inner and
outer surfaces.

28. MALE
CONDOM

29. ADVANTAGES:
 Simple spacing method
 No side effects
 Easily available, safe &inexpensive
 Protects against STDs
 DISADVANTAGES
Chances of slip off and tear off
Allergic reaction to latex
Failure rate: 16%

30. Female condoms:
It is a pouch made up of polyurethane which lines the
vagina and also external genitalia.
It is 17cm in length with one flexible polyurethane
ring at each end.
ADVANTAGES:
Prevents STDs including HIV/AIDS
Not damaged by oils and other chemicals

32. DISADVANTAGES:
 High motivation
Only women who can use diaphragms can use female
condom
Slippage occurs
Expensive
Failure rate 21%with typical use and 5% with correct
and consistentuse.

33. diaphragm
 Most common and easiest to fit and use .
 Thin, nearly hemispherical dome made of rubber or
latex material, with circular, covered metal spring at
periphery (flat type and coil type)

 External diameter of rim is size of diaphragm – 45 mm
diameter rising in steps of 5 mm to 105mm (most
common 60,65,70,75,80)

34. The device is introduced up to 3 hrs. before
intercourse and is to be kept for at least 6 hrs after
intercourse.
ADVANTAGES:
cheap
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

35. DIAPRAG
HM

36. DISADVANTAGES:
Requires help of doctor to measure the size required.
Need high motivation
Allergic reaction torubber
Erosion
UTI’s

37. SPERMICIDES
Available as vaginal foams ,gels ,creams ,tablets and
suppositories.
contain surfactantlike nonoxynol-9,benzalkonium
chloride.
Alter the sperm surface membrane permeability
resulting in killing ofsperm.

38. SPERMICI
DE

39. ADVANTAGES:
No instructions by doctors or nurses
Easily available and easy to use
No gross medical side effects
DISADVANTAGES
 Failure rate high when used alone
Can increase spread of HIV infection by irritating
vaginal and cervicalmucosa
Failure rate – 21%with typical use and 6%

40. Vaginal contraceptive
sponge
(TODAY)
The sponge is a doughnut-shaped device made of soft
foam coated withspermicide.
Made up of polyurethane with 1gm of nonoxynol-9 as
a spermicide.
It releases spermicide during coitus, absorbs ejaculate
and blocks the entrance of cervical canal.
To use the sponge, it must be moistened with water.
Once inserted in the vagina, it covers the cervix and
blocks sperm from entering the uterus.

41. DISADVANTA
GES
 May get broken
 difficult removal
 High pregnancy rate
 Allergic reactions
 Vaginal dryness, soreness
 May damagevaginal epithelium
 increase risk of HIVtransmission

42. INTRAUTERINE
DEVICES
Intrauterine Device The IUD is a small, T-shaped,
plastic device that is inserted and left inside the uterus
to preventpregnancy.

43. CLASSIFICATION OF
IUDs
INTRAUTERINE
DEVICE
NON-
MEDICA
TED
FIRST
GENERA
TION
SECOND
GENERA
TION
MEDICATED
THIRD
GENERA
TION

44. First generation
 Non-medicated made up of polyethylene.
 Different shapes and sizes
 LIPPE’S LOOP
 Double ‘s’shaped device , made up of polyethylene
material.
 Non- toxic, non-tissue reactive and extremely durable.
 Small amount of barium sulphate is also added for
radiological examination
 Available in 4 sizesA,B,C,D

45. Second generation
 Made upof metal Cu
 Earlier devices Cu-7 , Cu-T200
 Newer devices T copper 220 C ,T copper 380 C ,nova T
 multiload devices:
 ML-Cu 250
 ML-Cu 375

46. Third generation
 Hormones releasing IUD
 PROGESTASTERT :
 Most commonly used T shaped device filled with 38 mg
progesterone
 Effective for 1year
 LNG- mirena
 Mirena (levonorgestrel-releasing intrauterine device) is a
form of birth control that is indicated for intrauterine
contraception for up to 5 years and Releases 20 µg of
levonorgestrol.
 Effective for 5years.

47. SIDE EFFECTS
Amenorrhea
 Intermenstrual bleeding andspotting
Abdominal/pelvic pain
 Ovarian cysts
 Headache/migraine
 Acne
 depressed/altered mood.

48. ADVANTAGES OFIUD
 Safe
 effective , Reversible
 Long action ,Inexpensive
 DISADVANTAGES
 Heavy bleeding and pain
 Pelvic inflammatory diseases
 Ectopic pregnancy
 May come out accidently if not properly inserted.

49. CONTRAINDICATION
History of PID
Abnormal shaped uterus
Ectopic pregnancy
Menorrhagia

50. CLASSIFICATION OF
HORMONAL
CONTRACEPTIVES
HORMONAL
CONTRACEPTIVES
COMBINED
PREP.
ORAL
SINGLE
PREP
.
INJECTABLES
PARENTERAL
IMPLANTS

51. HORMONAL CONTRACEPTIVES
With hormonal birth control , a women takes
hormones similar to those her body makes naturally .
Hormonal contraceptives are mostly for female sex
steroids.

52. Oral contraceptives
Combined oral contraceptive pills
Commonly used progestin are either levonorgestrol or
norethisterone and estrogens are ethiyl estradiol or
menstranol
COMMERCIAL NAMES
Mala–N
Mala –D
Loette(desogestrel 0.15)
NO. OF TABLETS
21+7iron tab.
21+7iron tab.
21tab.

53. TYP
ES
Monophasic biphasic triphasic
Monophasic:
fixed doses of both estrogen and progesterone
throughout 21day cycle.

54. Biphasic:
constant amount of estrogen throughout cycle BUT
increased amount of progestin during the last 11days .
 Triphasic:
Varies level of estrogen and progesterone. Closely
mimic natural cycle, reducing breakthrough bleeding
(bleeding outside the normal menstrual flow)

55. contraindications
ABSOLUTE:
Circulatory diseases
Severe HTN
Angina,ischemic heart dis.
Liver disease
Tumors
Pregnancy
breast cancer,breastfeeding.

56. RELATIVE:
Age>40 yrs.
Smoker, history ofjaundice
Diabetes

57. benefits
contraceptive benefits:
Protection against unwanted pregnancy
Convenient to use.
Non-contraceptives benefits:
Regulation of menstrual cycle
Reduction of dysmenorrhea
Protection against PID, fibroids, ovarian cysts, chances
of cancer.

58. Side effects
Dizziness
Nausea
Weight gain
Headache
Breast tenderness
vaginal infection
Mild HPN
Depression
increase blood clotting

59. Progesterone only pills
Also known as“Minipill”.
Contains just progesterone or progesterone hormone.
Causing plug of mucus in the neck of cervix
block the entry of the sperm.
Example: levonorgesrol 75 µg, desogestrel 75µg

60. advantages
No side effect on breast feeding or lactation
May be prescribed in patient having diabetes, HTN ,
smoking etc.
Reduce risk ofPID
DISADVANTAGES
Acne, mastalgia, headache

61. Long acting contraceptives
These are moresuitable for women who do not want
to pregnant again or for few years.
THESE ARE:
CONTRACEPTIVE INJECTIONS
IMPLANTS
PATCHES

62. CONTRACEPTIVE INJECTIONS
( DEPOPROVERA &
NORISTERET)
Contain progesterone hormone.
Prevents ovulation.
Commonly used as Depomedroxyl progesterone
acetate (DMPA) administered on deltoid muscle
within 5 days ofcycle.
DOSE: 150 mg
Provide protection for 3 months .

63. Contraceptive implants
It is a small device placed under the skin
Contains progesterone hormone.
Works in a similar way to injection
Contains 3ketodesogestrel
Releases hormone about 60 mcg, gradually reduced to
30 mcg per day over year.
Inhibts ovulation.
Lasts for 3years.
NORPLANT – II

64. NORPLANT- II
Two rods of 4cm long. Each rod containing 75 mg of
levonorgestrel releases 50 mcg per day.

65. Emergency contraceptives
Used whithin 72 hrs ,ovulation is either prevented or
delayed. It may be in form of : hormones, IUD,
antiprogesterone
INDICATIONS
Unprotected intercourse
Condom rupture
Sexual assault

66. HORMONES:
MORNING AFTER PILLS:
It preventing conception in case of accidental
intercourse.
drugs used ethinyl oestradiol 2.5mg,
premarin(conjugated oestrogen) 15mg.
Drug is taken orally twice daily for 5 days.

67. Emergency
contraceptives
DRUG DOSE
Levonorgesterel 0.75 mg stat and after 12 hrs.
Ethinyl oestradiol 50 µg + norgesterel
0.25 mg
2 tab stat and 2 after 12hours
Conjugated oestrogen 15mg BD× 5days
Thinyl oestradiol 2.5 mg BD 5 days
Mifepristone 10mg single dose
Copper IUDs Insertion within 5 days

68. PERMANENT STERLISATION
ÖVASECTOMY
ÖTUBECTOMY

69. TUBECTO
MY

70. STERILIZATION
It is most effective method its failure rate is 1/2000 so in
this there is permanent termination .
VASECTOMY:
Small incision made on each side of scrotum vas
deferens is then cut and tied , cauterized or plugged .
Blocking the passage of spermatozoa.
Does not interfere with production of sperms but does
not pass beyond vas deferens .

71. Very effective after 3 months of procedure
Permanent and safe
No apparent long term risks .
 DISADVANTAGES:
Slightly uncomfortable due slightly pain and swelling
after 2-3 days of the of the procedure .
Bleeding may result in the hematoma in scrotum .

72. TUBECTOMY:
It is one of the operative procedure where resection of
a both segment of both fallopian tubes is done to
achieve permanent sterilization
The approach may be :
Abdominally
Vaginally

73. ABDOMINAL
Ω CONVENTIONAL MINILAPROTOMY
Ω CONVENTIONAL:
In which a loop is made by holding the tube by Allis forceps in
such a way that the major part of loop consists mainly of isthmus
and ampullary part of tube . the loop is ligated with catgut and is
cut .

74. MINILAPROTOMY:
When the tubectomy is done through small
abdominal incision along with some device .
VAGINALLIGATION :
Tubectomy through vaginal route may be done along
with vaginal plastic operation or on isolation .

75. COMPLICATION :
Ectopic pregnancy
Menstrual irregularities
Loss of libido
Infection