This document provides information on various aspects of family planning. It discusses the objectives and goals of family planning, which include reducing birth and family size rates. It outlines the scope of family planning services. Different contraceptive methods are described, including spacing methods like barrier methods, IUDs, hormonal methods and terminal methods like sterilization. Natural family planning methods involving basal body temperature, cervical mucus and symptothermal methods are also summarized. The health impacts and aspects of family planning on women's health, fetal health and child health are highlighted.

1.  III YR Diploma in
nursing
 IV YR Bsc[nursing]
 II yr PBBsc[nursing]
 Family
planning
methods

2. Family planning
 In simple it is planning of
family
 But it is not synonymous with
birth control; it is more than of
that.

3.  Definition-
“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 a country.”

4. Objectives of FP
 To avoid unwanted births
 To bring about wanted births
 To regulate the intervals between
pregnancies
 To control the time at which
births occurs in relation to the
age of the patient
 To determine the number of
children in the family

5. Goals of FP
 To reduce birth rate [20/1000]
 To reduce family size
 NRR=1
 Spacing of pregnancy at least 2-3
years
 60% of eligible couple have to
adopt one or another method of
contraceptives
 Adopt small family norm

6. Scope of family planning
 The proper spacing and
limitation of birth
 Advice on sterility
 Education for planned parent
hood
 Sex education
 Screening for pathological
conditions

7.  Genetic screening
 Marriage counseling
 Providing services for
unmarried mothers
 Providing adaptation services
 Carrying out pregnancy test
 Premarital consultation and
examination

8. Health aspects of family planning
Summarized under 3 heading
WOMEN’S HEALTH
 Reducing of maternal death by
 Avoiding unwanted birth [mental
disturbances, induced labor, illegal
abortion]
 Limiting the number of births and
proper spacing [repeated pregnancy
leads high risk of MMR, anemia]
 Timing of birth [risk of MMR before
20yr of age and ofter30-35 of age
becoming pregnancy]

9. FETAL HEALTH
 Reduction of congenital anomalies [DOWN;S
syndrome]
 Mother with history of leprosy and psychosis
CHILD HEALTH
 Family size and spacing
 Child mortality-frequent pregnancy is the
high risk of child mortality and morbidity
 Child growth, development and nutrition
 Infectious diseases
 Intelligence-lower IQ scores among children
in large families

10. The family welfare concept
 Family planning was strongly
associated with misconception of
people mind that “it is an
sterilization or birth control”
 The concept of welfare is very
compressive-i.e. is “to improve
the quality of life of the people”

11.  Eligible couple; refers to a
currently married couple wherein
the wife is in the reproductive
age, which is generally assumed
to lie between the ages of 15 and
45
 150-180/1000 population
 2.5million couples join the
reproductive group/year

12. Contraceptive methods [fertility
regulating methods]
 It means when ever mother wants
she can become pregnant by
discontinuing the contraceptive
methods
Definition
 Preventive methods which help
women to avoid unwanted
pregnancies, which include both
temporary and permanent measures
to prevent pregnancies.

13. Contraceptives are
 Safe
 Effective
 Acceptable
 Inexpensive
 Reversible
 Simple to administer
 Long lasting
 Little or no medical supervision
 Avoids frequent administration

14. Contraceptive methods-
Broadly classified into 2 types
I-SPACING METHOD
A-Barrier method
Physical method
Chemical method
Combined method
B-Intrauterine devices
C-Hormonal method
D-Post-conceptional method
E-Miscellaneous

15. II-TERMINAL METHOD
A-Male termination
B-Female termination

18. I-SPACING METHOD
A-Barrier method
 Suitable for both men and women
 Prevents fusion of live sperm and ovum
 Absence of side effects
 Also protection from STD/RTI Infection
 It requires high degree of motivation on
the part of user
 It is more effective if it is used
consistently and regularly

19. Condom:
barrier device for male
 Named as nirod
(prevention)
 Preventing pregnancy,
protect from STD both
men and women
 Fitted on erect penis
 Remove air before
fitting
 Failure rate is 2-3%

20. Advantage
 Easily available
 Safe and
inexpensive
 Easy to use
 No side effects
 Prevent STD
Disadvantage
 Slipping off,
tear
 Risk of
unwanted
pregnancy &
irregular use
 Allergic
reaction

21. Types of (Brands of
nirodh)
Dry Nirodh
Deluxe Nirodh
(lubricated)
Upper deluxe Nirodh

22. Diaphragm: (Dutch cap)=femlae
condum
 Vaginal barriers
 Shallow
 Selecting depending on the size of
cervix
 Inserted before sexual intercourse
& remains for 6 hours
 Use spermicidal jelly

24. Advantages
 Total absence of
risk
Disadvantage
 Training from
medical person
 Storing and
privacy is
difficult
 Chance of
infertility

25. Vaginal sponge
 Available in
the form of
TODAY
 Sponge socked
on vinegar or
olive oil
 Poly urethane
form sponge

26.  Foams. Foams tablet
 Creams , jellies & pastes
 Suppositories
 Soluble film
(Inhibits oxygen uptake &
kills sperms)
 Draw backs:
 high failure rate
 Immediate before
intercourse
 Repeat before
 Mild burning and irritate.

27.  Middle east areas in
(introducing small
round stone)
 German 1928
gynecologist used
IUD made of silver
thread
 Japanese were the
first to utilize plastic
material in
manufacture of IUDs

29. Types of IUD
Non medicated – first
generation
Medicated – second
generation IUD
Third generation IUD

30. FIRST GENERATION IUDs
 Non medicated made up of polythene
or polymers (loops, spirals, coils, rings
or )
 Stainless steel ring are popular in
china.
 Lippies loop – polythene, plastic
material
 tail made of nylon
 four size of A,B,C,D
 tail Barium sulfate

31. Second generation IUDs
 Which is hormone - releasing
IUDs
 Copper - T (metallic copper
had a strong anti – fertility
effect)
 Earlier devices - Copper –7
- Copper – T 200
 Newer devices - 220C
 Nova T
 Multiload devices.

32. Advantages of IUD
 Low expulsion rate
 Lower incidence of side - effects,
e.g., pain and bleeding
 Easier to fit even in nulliparous
women
 Better tolerated by nullipara
 Increased contraceptive effectiveness
 Effective as post- coital
contraceptives, if inserted within
 3 -5 days of unprotected – intercourse

33. Third generation IUDs
 Which release hormone
 I.e. progestasert (T shape
device filled with
progesterone) (30 mg)/ 65
mcg/daily
 Levonorgestrel (20 mcg)
-10 yr

34. Action of IUDs
 which causes a foreign body reaction
in the uterus causing curricular &
biochemical changes
 In the endometrial & uterine fluids,
which changes impair the viability of
the sperm & reduces Chances of
fertilization
 Copper and iron affects - sperm motility
survival of IUDs
 2 to 10 year
 Periodically replaced at interval of 2-4
year

35. Advantages
 Simplicity (Simple produce)
 Placed for longer duration.
 Insertion takes few minutes.
 In expensive
 No need of takes pill daily.
Contraindication
 Suspected pregnancy
 Pelvic inflammatory diseases
 Vaginal bleeding
 Cancer of cervix

36. Ideal candidate for IUD
 Who has borne at least one child
 Has no history of pelvic disease
 Has normal menstrual periods
 Is willing to check the IUD tail
 Monogamous relationship
Timing of insertion
 Any time during reproductive years
(except during pregnancy)
 First week after delivery

37. Side effects and complication
 Bleeding
 Pain (3 months)
 Pelvic infection
 Uterine perforation
 Pregnancy (3 to 5%)
 Ectopic pregnancy
 Expulsion
 Cancer and teratogenesis
 Mortality

42. Hormonal contraception
 Used as most effective method of
contraception and
 combined type and
 all most 100% effective in
preventing pregnancies.
 65 million in world
 10 million in India
 ( estrogen and progesterone or
gonadal steroids)

43. ORAL PILLS
 Combined pills
 Progesterone
only pill (POP)
 Post –coital pill
 Once a month
pill
 Male pill
Depot ( slow
release)
formulation
 Injectables
 Sub uterus
implants
 Vaginal rings

45.  synthetic
combination
of estrogen
progestrogen
 ( 0.5 mg of
progestogen ,
30-35 mg of
estrogen)

47. Progesterone only
pill(pop)
 Mini pill or micro
pill
 Only
progesterone
 Chance of
pregnancy
 Pill
contraindicated
for
cardiovascular
diseases

49. Recommended within 48
hours of an
unprotected
intercourse
Available in two form
 IUD
 Hormonal (estrogen
1/5 day)
 Oral pills- (2 pills
immediately , 2 pill 12
hours later)

50.  Once a month (
large acting)
 Quinestrol
(long acting
estrogen is
combination
with a short
acting
progestron )

52.  Made up of
gossypol
 Preventing
spermatogenesis
 Inter fearing with
sperm storage &
maturation
 Preventing sperm
transport in the vas
 Affecting content
of seminal fluid

53. Action of oral pills
 Prevent the release of the
ovum from ovary
 Thickening of cervical mucus
inhibit sperm entry
(progesterone)
 Inhibits the tubal motility
 Delay the transfer of sperm to
uterus

54. ADVERSE EFFECT
 Cardiovascular effect
 Carcinogenesis
 Metabolic effect
 Other adverse effect –liver
disorder
-lactation
-subsequent fertility
-ectopic pregnancy
-fetal development

55.  Common unwanted effects –
breast tenderness
-weight gain
-head ache
-bleeding disturbances
 Duration of use
 For younger women – more than
35 years
 Not for beyond 40 years (not
prescribe continuously)

56. Depot formulation
 Highly effective, reversible, long
acting a single administration
suffices for several months.
Those are:
 Inject able contraceptives –
progesterone only
Combined
 Sub dermal implant
 Vaginal ring

58. Inject able
contraceptive:
 Progesterone –only inject
able
 DMPA
 NET-EN
 DMPA-
 (depot-medroxy
progestrone acetate) (1960,
IM inject)
 150 mg every 3 months, 99
% guaranty
DMPA side effects
 Weight gain
 Irregular menstrual bleeding
 Prolonged infertility

59.  NET-EN:
Norethisterone
Enantate, 1966
 IM injuct-
200mg/60 days
 Time for
Administration
During first 5 days
of menstrual period.
 No massaging

60.  Sub dermal
implant
Nor plant
Norplant (R)-2, 5
years duration
,(35 mg)

62. vaginal ring
 containing
levonogestrel
(hormone)
 placed in
vagina
 3 weeks

63. MISCELLANIOUS
1. Abstinence – completely
avoiding sexual abstinence
2. Coitus interrupts- male
withdrawal before ejaculation
3. Safe period – calendar method
(1930)
 Ovulation occurs between 12 to
16 days

64. Safe period –
calendar method
(1930)
 Ovulation occurs
between 12 to 16
days
 Life span of sperm
after ejaculation is
1-2 days [in health
envt-5 days]
 Life span of Ovum is
12-24 hrs

66. Natural family planning
methods
 Basal body temperature
 Cervical mucus method
 Symptothermal method

67. Basal body temperature
 In women, ovulation causes an
increase of one-half to one
degree Fahrenheit (one-quarter to
one-half degree Celsius) in basal
body temperature (BBT);
 monitoring of BBTs is one way of
estimating the day of ovulation.

68.  The tendency of a woman to have
lower temperatures before
ovulation, and higher
temperatures afterwards, is
known as a biphasic pattern.
 Charting of this pattern may be
used as a component of fertility
awareness

69.  .
 Example of a basal
body temperature
chart. Menstruation
begins on day 1. The
rise in temperature
between days 14 and
18 are the indication
of ovulation.
Temperature was
taken orally with a
regular fever
thermometer.

70. Cervical mucus method
 The cervical mucus method, also
called the ovulation method and
the Billings ovulation method,
 is a type of natural family
planning also known as fertility
awareness-based methods.
 cervical mucus changes in
viscosity throughout a woman's
cycle.

71.  When an egg develops in the ovary,
estrogen is released, making the
mucus thinner and slippery. This
enables sperm to swim to the egg
more easily
 After the egg is released, a spike in
progesterone causes mucus to thicken
and act as a barrier to other sperm.
 Thus, tracking the state of this
cervical mucus gives insight into a
woman's fertility.

73. Symptothermal method [combined
method]
 a natural method of family planning th
at
incorporates the ovulation and basal
body temperature methods of family p
lannin
 It is more
effective than either method
used
alone and requires fewer days of abs
tinence from sexual intercourse

74.  Sometimes called LAM
(Lactational Amenorrhea
Method)
 A natural way to
prevent pregnancy after
giving birth
 Effective, safe,
convenient, and free
 Lasts for up to six
months after giving
birth

75. Birth control vaccine
 Depo-Provera is a birth control
method for women. It is made up of a
hormone similar to progesterone and
is given as an injection by a doctor
into the woman's arm or buttocks.
 Each shot provides protection against
pregnancy for up to 12 to 14 weeks,
but the shot must be received once
every 12 weeks to provide full
protection.

76. POST CONCEPTIONAL METHODS
(termination of pregnancy)
 Menstrual regulation :
 Aspiration of uterine content (6 to 14
days)
 Cervical dilation (only in nallipara)
 Much complicate (uterine perforation)
 Menstrual induction:
 Disturbing menstrual cycle
 Intrauterine application (1 to 5 mg
prostaglandin)

77. ABORTION
 Definition: Termination of pregnancy before
the fetus becomes viable (capable of living
independently) i.e. before 12 weeks (3
months)
Types of abortion
 Spontaneous
 Induced – legal, illegal
 Medical termination of pregnancy:
 Indian parliament has passed an act in 1971
regarding medical termination of pregnancy.
 Came into force on April 1972
 Rules and regulations were revised on 1975.

78. MTP ACT IN 1971 Lays down
 The conditions under which a pregnancy can
be terminated.
 The person or persons who can perform such
termination
 The place where such terminations can be
performed.
1- Condition criteria for terminate
 Medical
 Eugenic
 Humanitarian
 Socioeconomic
 Failure of contraceptive devices

79. 2-The person or persons
 Registered medical practitioners
 Do not exceeds 12 weeks
3- Where (the place for abortion)
 Govt hospital
 Strict confidence
RULES FOR MTP-1975
 Approval by bored
 Certificate can be taken from chief
medical officer

80.  Qualification
 RMP( 2-5 conduct MTP under approved
institution)
 6 month houseman ship in obstetrics and
gynecology
 A PG in OBG
 3 years practice in OBG
 Place for conduct of MTP
 Non govt institute (license from chief medical
officer)

81. TERMINAL METHODS
(STERLISATION)
 One of the methods of family planning where
the male and female will sterilized for
conception.
 Compare to female sterilization, the male
sterilization is safe simple,
 only 85 % female sterilization
 10 to 15% male sterilization.

82. Guidelines for sterilization
 Free of charge in govt institution
 Age of husband not less than 25 yrs nor
should be 50
 Age of wife not less than 20 yrs or more than
45 yrs
 The motivated couples must have 2 living
children
 Acceptor declares (consent) from spouse
 Clear information about surgery

83. MALE STERILISATION:
 Vasectomy: were the vas difference will be cut
at least 1 cm after clamping, fold it back &
suture. If so there is no chance of
recanalisation.
 Acceptors are not immediately sterile
 At least 30 ejaculation have to take
 Other contraceptive should be used (condom)
 100% effective
 Sperm & hormone production is not effected
 Sperms will be destroyed only
 Simple faster & less expensive

85. Complication
 Operative: chance of pain, scrotal hematoma,
local infection
 Sperm granules: pain, swelling
 Spontaneous reconualisation: chance of
reconnection – follow up for 3 years
 Psychological: feeling of impotence reduction
sexual flessure

86. Post operative advice
 Explain the person that he is not sterile
immediately after operation
 To use of contraceptive until aspermia.
 Avoid both for 24 hour after operate
 Wear T bandage or scrotal support for
15 days
 Avoid cycling heavy lifting for 15 days
 Stitches are remove 5th day
No scalpel vasectomy (NSV)
 It is a new technique that is safe
convenient & acceptable to males
 Medical personnel all over the country
to be trained.

88.  The No-Scalpel
vasectomy is a
technique used to do
the vasectomy
through one single
puncture.
 The puncture is made
in the scrotum and
requires no suturing
or stitches.
 This procedure is
done with the aid of a
local anesthetic called
‘Xylocaine’ (similar to
‘Novocaine’)

89. Female sterilization
which can be done as an
internal procedure,
postpartum or at the time of
abortion . Namely
 Laparoscopy
 Mini laparoscopy

90.  Laparoscopy :
 Technique of the female sterilization
through abdominal approach with a
specialized instrument called
laparoscope
 Were abdomen in inflated with gas
 Introduction of instrument into
abdominal cavity & visualization tube
 Clips or rings are applied.

91. Criteria for selection
 After 6 week of delivery
 After MTP
 Hb Not less than 8 gm%
 No medical disorder (heart
disease reparatory disease

93. Mini laparoscopy (abdominal
tubectomy)
 Small abdominal incision
 Under local anesthesia
 Cutting of the tube and
legating
 Postpartum tubal sterilization

94. Role of nurse in family well fare
programme
 Communication is one of imp factor in
the family planning program were she
has to convey the correct information
idea meaning to people where she
needs knowledge skills in utilization or
representation of Av aids.
 Normally couple will be having doubts
are fear associated with surgical
method and or the interference

95.  Regarding tubectomy
,laparoscopy & vasectomy.
Especially in India there all the
matters are not discussed in
public which .
 so the CHN is having a good
opportunity to give motivate the
people for adopt of family
planning method for effective
communication better use local
language & clear information or
doubts.

96. 1 Understanding
 Understand own feelings
 Attitude towards sex & family
planning.
2 Knowledge about family planning
 Population problem
 Nature of family planning
 Method of family planning
 Resources available
 Govt policies

97. 3] Knowledge about the person
 Individual needs and awareness
 Culture beliefs
 Customs and practice
4] Communication and health
education
 Be a good listener
 Individual counseling
 Health education

98. 5] Clinics
 Assisting the Dr in conducting the
clinics
 Assisting IUCD insertion
 Assist in postnatal clinic
6]Follow up
 Through home visits
 Clinic visits
 Maintains of record
7]Referral units
 Referring to various agency
 Consultation from their agency

99. 8]Records
 Proper mantainence of record
 Attitude date of acceptance
9]Research
 Participate in research projects
Role of nurse in family welfare
program
 Administrative role
 Supervising role
 Functional role
 Educational role
 Role in research
 Role in evaluation

100. Thank
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