FAMILY PLANNING

 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 .

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 about wanted birth.
 Produce a change in the no. of children born.
 Regulate the intervals between pregnancies.
 Control time at which birth occur.”
 No. of pregnancy Proper timing Proper spacing

Benefits

Benefits to Mother

Reduce the health risk Below 20y, And above 35 y. At risk of developing complications during
pregnancy. physical strain of child bearing. reduce number of maternal death. reduce the risk of
ovarian cysts.

Health Benefits to Children

Ensures better chance of survival at birth. Promote better childhood nutrition. Promote
physical growth and development. Prevent birth defects.

Health Benefits to Father

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.

Benefits to Whole Family Health :Benefits to Whole Family Health - help the family enjoy the
better kind of life.
CLASSIFICATION OF CONTRACEPTIVE METHOD

 Natural Method
 Barrier Method
 Intrauterine Method
 Hormonal Method
 Post Coital Method
 Permanent/Surgical Family Planning

 NATURAL FAMILY PLANNING

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

 Rhythm (Calendar) method

 Basal Body Temperature (BBT)
 Ovulation or Cervical Mucus Method
 Symptothermal method
 Coitus Interruptus
 Lactation amennorhea

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.
Disadvantages: Lifespan of Sperm Reliability Failure of method

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 BBT falls 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.

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 to vary.

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,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%
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.

Symptothermal Method : Combines the cervical mucus and BBT methods Watches temp. daily
and analyzes cervical mucus daily. Watch for midcycle abdominal 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 BBT or CM method alone Ideal Failure rate: 2%

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

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).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.

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.

 BARRIER METHODS

 Condoms (male and female)

 Spermicidal
 Sponge
 Diaphragm
 Cervical cap

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.

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%

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

 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 consistent use.

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) 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

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

SPERMICIDES  Available as vaginal foams ,gels ,creams ,tablets and suppositories.  contain
surfactant like nonoxynol-9,benzalkonium chloride.  Alter the sperm surface membrane
permeability resulting in killing of sperm.

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 cervical mucosa Failure rate – 21% with typical use and 6%

Vaginal contraceptive sponge (TODAY) The sponge is a doughnut-shaped device made of soft
foam coated with spermicide. 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.

DISADVANTAGES  May get broken  difficult removal  High pregnancy rate  Allergic
reactions  Vaginal dryness, soreness  May damage vaginal epithelium  increase risk of HIV
transmission

 INTRAUTERINE DEVICES

Intrauterine Device The IUD is a small, T-shaped, plastic device that is inserted and left inside the
uterus to prevent pregnancy.

CLASSIFICATION OF IUDs INTRAUTERINE DEVICE

  NON- MEDICATED FIRST GENERATION
 MEDICATED SECOND GENERATION THIRD GENERATION

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 sizes A,B,C,D

Second generation  Made up of metal Cu  Earlier devices Cu-7 , Cu-T 200  Newer devices T
copper 220 C ,T copper 380 C ,nova T  multiload devices:  ML-Cu 250  ML-Cu 375

Third generation  Hormones releasing IUD  PROGESTASTERT :  Most commonly used T

shaped device filled with 38 mg progesterone  Effective for 1 year  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
5 years.

SIDE EFFECTS Amenorrhea  Intermenstrual bleeding and spotting Abdominal/pelvic pain 

Ovarian cysts  Headache/migraine  Acne  depressed/altered mood.

ADVANTAGES OF IUD  Safe  effective , Reversible  Long action ,Inexpensive 

DISADVANTAGES  Heavy bleeding and pain  Pelvic inflammatory diseases  Ectopic
pregnancy  May come out accidently if not properly inserted.

CLASSIFICATION OF HORMONAL CONTRACEPTIVES

 ORAL COMBINED PREP

 SINGLE PREP
 PARENTERAL INJECTABLES IMPLANTS

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.

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

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

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

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

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 75 µg

Advantages  No side effect on breast feeding or lactation  May be prescribed in patient

having diabetes, HTN , smoking etc.  Reduce risk of PID  DISADVANTAGES  Acne, mastalgia,
headache. Long acting contraceptives  These are more suitable for women who do not want to
pregnant again or for few years. THESE ARE:  CONTRACEPTIVE INJECTIONS  IMPLANTS 
PATCHES

CONTRACEPTIVE INJECTIONS ( DEPOPROVERA & NORISTERET)  Contain progesterone hormone

.  Prevents ovulation.  Commonly used as Depomedroxyl progesterone acetate (DMPA)
administered on deltoid muscle within 5 days of cycle.  DOSE: 150 mg  Provide protection for
3 months .

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

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

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

HORMONES: MORNING AFTER PILLS: It preventing conception in case of accidental

intercourse. drugs used ethinyl oestradiol 2.5mg, premarin(conjugated oestrogen) 15 mg.
Drug is taken orally twice daily for 5 days.

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

 PERMANENT STERLISATION
  VASECTOMY
 TUBECTOMY

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 .

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 .

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

ABDOMINAL CONVENTIONAL MINILAPROTOMY 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 .

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