SRI MANAKULA VINAYAGAR NURSING COLLEGE

KALITHEERTHALKUPPAM

COMMUNITY HEALTH NURSING

SEMINAR

ON

METHODS OF FAMILY LIMITING AND SPACING METHODS

SUBMITTED TO: SUBMITTED BY:

MRS.KOSALAI, P.DEEPA

ASST.PROF.IN COMMUNITY HEALTH NURSING, M.SC.,NURSING 1ST YR,

SMVNC. SMVNC.

SUBMITTED ON:

INTRODUCTION:
FAMILY :

 It refers two or more individuals who depend on one other for emotional, physical,
and financial support.

FAMILY PLANNING:

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

DEFINITION OF FAMILY PLANNING:

 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.

BIRTH SPACING:

DEFINITION OF BIRTH SPACING:

 Birth Spacing is the practice of waiting between pregnancies. A woman’s body needs
to rest following pregnancy. After having a baby, it is a good idea to wait at least 18
months before getting pregnant again to maintain the best health for her body and her
children. The 18-month rest period is called “birth spacing.” When the time between
pregnancies is less than 18 months, her body may not be ready to have a healthy baby

OBJECTIVES:

 Family Planning refers to practices that help individual or couples to attain certain
objectives:
 To avoid unwanted pregnancies
 To bring about wanted births
 To regulate the interval between pregnancies
 To control the time at which births occur in relation to ages of the parent
 To determine the number of children in the family
PURPOSES:

 Raising a child requires significant amounts of resources: time, social , financial and
environmental. Planning can help assure that resources are available.
 To improve the health of the mother and child.
 Helping to prevent HIV/AIDS.

CONTRACEPTIVE METHODS:

DEFINITION:

 Contraceptive methods defined , it is preventive methods to help women avoid

unwanted pregnancies. They include all temporary and permanent measures to
prevent pregnancy resulting from coitus.

 CRITERIA FOR IDEAL CONTRACEPTIVE:

 It should be safe for use means free from any kind of side effects.
 It should be reliable.
 It should be cost effective.

 It should be easy to administer and convenient. 

 It should be culturally feasible and acceptable.

METHODS OF CONTRACEPTIVE:

 The contraceptive methods may be broadly grouped into two classes ;

 Spacing methods:
1. Barrier methods
a. Physical methods
b. Chemical methods
c. Combined methods
2. Intra-uterine devices
3. Hormonal methods
4. Post- conceptional methods
5. Miscellaneous
  Terminal methods:
1. Male sterilization [Vasectomy]
2. Females sterilization[Tubectomy]

BARRIER METHODS:

 A variety of barrier or ‘occlusive’ methods, suitable for both men and women are
available.
 The aim of these methods is to prevent live sperm from meeting the ovum.
 Its is classified into three types:
 Physical methods
 Chemical methods
 Combined methods

PHYSICAL METHODS:

 It involves three methods:

 Condoms
 Diaphragm
 Vaginal sponge

CONDOMS:

 Condom is 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.
 Condom is receiving new attention today as an effective, simple ‘spacing’ methods of
contraception, without side effects.
 In addition to preventing pregnancy, condom protects both men and women from
sexually transmitted diseases.
 The condom is fitted on the erect penis before intercourse. The air must be expelled
from the teat end to make room for ejaculate.
 The condom must be held carefully when withdrawing it from the vagina to avoid
spelling seminal fluid into vagina after intercourse.
  A new condom should used for each sexual act. Condom prevents the semen from
being deposited in vagina.
 The effectiveness condom may increased by using it conjunction with spermicidal
jelly inserted into the vagina before intercourse. The spermicide serves an additional
protection in unlikely event that condom should slip off or tear.
 Condoms can be a highly effective method of contraception, if they used correctly at
the coitus.

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 remains
outside the vagina.
 It is prelubricated with the silicone and a spermicide need not to be used. It is an
effective barrier to sexually transmitted diseases infection.
 However , high cost and acceptability are major problems.

ADVANTAGES:

 They are easily available .

 It is safe and expensive
 It is easy to use, do not require any medical supervision.
 There is no side effects.
 Its is light , compact, and disposable.
 It provides protection not only against pregnancy but also against sexually
transmitted disease.

DISADVANTAGES:

 It may be slip off or tear during coitus due to incorrect use.

 It interferes with sex sensation locally about which some complains while others get
used to it#

LIMITATION:
  The main limitation of condoms is that many men do not use them regularly or
carefully even when the risk do unwanted pregnancy or sexually transmitted disease is
high.

DIAPHRAGM:

 The diaphragm is a vaginal barrier. 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 materials.
 It ranges in diameter from 5-10 cm(2-4 inches). It has flexible rim made of spring or
metal. It is important that a women be fitted with a diaphragm of the proper size.
 It is held in position partly by the spring tension and partly by the vaginal muscle
tone.
 The diaphragm is inserted before the sexual intercourse and must remain in place for
not less than 6 hours after intercourse.
 A spermicidal jelly is always used along with the diaphragm. The diaphragm holds
the spermicide over the cervix.
 Side effects are practically ill.

ADVANTAGES:

 Diaphragm is almost total absence of risk and medical condition.

DISADVANAGES:

 Initially a physician or other trained person will be needed to demonstrate the

technique of inserting the diaphragm into the vagina and to ensure a proper fit.
 After delivery , it can be used only after involution of the uterus is completed.
Practice at insertion, privacy for this to be carried and facilities for washing and
storing the diaphragm precludes it use in most Indian families particularly in rural
area.
 If the diaphragm is left in the vagina for an extended period , there is a remote
possibility of a toxic shock syndrome, which is the state of peripheral shock
requiring resuscitation.

VARIATION:
  Variations of the diaphragm include the
 Cervical cap
 Vault cap
 Vimule cap
 These devices are not recommended the National Family Welfare Programme.

VAGINAL SPONGE:

 Another barrier device employed for hundred of years is the sponge soaked in vinegar
or olive oil, but it is only recently one has been commercially marketed in USA under
the trade name ‘TODAY’ for the sole purpose of preventing contraception.
 Its is small polyurethane foam sponge measuring 5cm*25cm, saturated with the
spermicide , nonoxynol-9.
 The sponge is far less effective than the diaphragm, but its better than nothing.

CHEMICAL METHODS:

 In the 1960s , before the advent of IUD and oral contraceptives , spermicide (vaginal,
chemical contraceptives) were used widely.
 They comprise for categories:
 Foams: Foam tablets. Foams aerosols
 Cream, Jellies, and Pastes: Squeezed from the tube.
 Suppositories: Inserted manually.
 Soluble films: C-film inserted manually.
 The commonly used spermicide are ‘surface–active agents’ which attaches
themselves to spermatozoa and inhibit oxygen uptake and kill sperms

DRAWBACKS:

 They have a high failure rate.

 They must be used almost immediately before intercourse and repeated before each
sex act.
 They must be introduced in those regions of the vagina where sperms are likely to be
deposited.
 They may cause mild burning or irritation , besides messiness.
  There should be free from potential systemic toxicity . It should not have an
inflammatory or carcinogenic effect on the vaginal skin or toxicity.
 Spermicides are not recommended by professional advisers

INTRA-UTERIENE DEVICES:

TYPES OF IUD:

 There are two basic types of IUD:

 Non medicated
 Medicated
 Both are usually made of polyethylene or other polymers in addition , the medicated
or bio active IUDs release either metal ions (copper) or hormones(progesterone).
 The non medicated or inert IUDs are often referred to as first generation IUDs.
 The copper IUDs comprise the second generation IUDs and the hormone releasing
IUDs the third generation IUDs.
 The medicated IUDs were developed to reduce incidence of side effects and to
increase the contraceptive effectiveness.
 In India , under the National Family Welfare Programme, Cu-T-200 B is being used.
From the year 2002, Cu-T-380 A has been introduced in the programme.

FIRST GENERATION IUDs:

 The first generation IUDs comprise the inert or non medicated devices, usually made
of polyethylene or other polymers.
 They appeared in different shapes and sizes:
 Loops
 Spirals
 Coils
 Rings
 Bows
 Of all the models, the Lippes Loops is the best known and commonly used in devices
in developing countries.

LIPPES LOOPS:
  Lippes loops is double shaped device made of polyethylene, a plastic materials that is
non toxic, non tissue reactive and extremely durable.
 It contains a small amount of barium sulphate to allow X – ray observation .The loops
has attached threads or ‘tail’ made of fine nylon, which projects into the vagina after
insertion.
 The tail can be easily felt and is reassurance to user that the loop is in its place. The
tail also makes it easy to remove the loop when desired.
 The Lippes Loops exists in four sizes A,B,C, and, D the latter being the largest. The
larger Loops C and D are most suitable for multiparous women.

SECOND GENERATION IUDs:

 I occurred to a number of research workers that the ideal IUD can never be developed
simply as a result of obtaining changes in the usual shape or size. A new approach
war tried in the 1970’s by adding copper to the IUD.
 It was found that metallic copper had a strong anti-fertility effects. The addition of
copper has made it possible to develop smaller devices which are easier to fit , even
in the nulliparous women.
 A number copper bearing devices are now commercially available:
 Earlier devices:
 Copper-7
 Copper T-200
 Newer devices:
 Variants of the T devices
i. Cu-T-220C
ii. Cu-T-380A or Ag
 Nova T
 Multiload devices
i. ML-Cu-250
ii. ML-Cu-375
 Nova T and Cu-T-380Ag are distinguished by a silver core over which thhhhhhhe
copper wire is wrapped.
 The newer copper devices are significantly more effective in preventing pregnancy
than the earlier copper ones or inert IUDS.
ADVANTAGES OF IUD:

 Low expulsion rate

 Lower incidence of side effects . Example: pain and bleeding
 Easier to fit even in nulliparous women
 Better tolerated by nullipara
 Increases contraceptive effectiveness
 Effective as post – coital contraceptives , if inserted within 3-5 days of unprotected
intercourse.

THIRD GENERATION IUDs:

 A third generation of IUDs bases on the principle that is release of hormone and have
become available on a limited scale.
 The most widely used hormonal device is progestasert , which is a T shaped device
filled with 38 mg of progesterone, the natural hormone.
 The hormone is released slowly in the uterus at the rate of 65mcg daily. It has directly
local effects on the uterine lining, on the cervical mucus and on possible on the
sperms.
 Another hormonal device LNG-20 (Mirena) is a T –shaped IUD releasing 20 mcg
levonorgestrel it has a low pregnancy rate and less number of ectopic pregnancies.

CHANGES OF IUD:

 The Cu-T-380A is approved for use for 10 years.

 However, the Cu-T-380A has been demonstrated to maintain to maintain its efficacy
over at least 12 years of use.
 The Cu-T-200 is approved for 4 years and the Nova T for 5 years. The progesterone
releasing IUD must be replaced by every year because the reservoir of progesterone is
depleted in 12-18 months.
 The levonorgesterel IUD can be used for at least 7 years.

ADVANTAGES:

 Simplicity that is no complex procedures are involved in insertion, no hospitalization

is required.
  Insertion takes only few minutes
 Once inserted IUD stays in place as long as required.
 Inexpensive
 Contraceptive effect is reversible by removal of IUCD.
 Virtually free of free from systemic metabolic side effects associated with hormonal
pills
 Highest continuation rate.
 There is no need for continual motivation required to take pill daily.

CONTRAINDICATION:

ABSOLUTE:

 Suspected pregnancy
 Pelvic inflammatory disease
 Vaginal bleeding
 Cancer of the cervix and uterus
 Previous ectopic pregnancy

RELATIVE:

 Anemia
 Menorrhagia
 History of pelvic inflammatory disease.
 Purulent cervical discharge
 Distortions of the uterine cavity due to congenital malformations.
 Unmotivated person

TIMING OF INSERTION:

 The time of loop insertion is during menstruation or within 10 days of the beginning
of a menstrual period.
 During this period, insertion is technically easy because the diameter of the cervical
canal is greater at this time during secretory phase.
 The IUD insertion can also be taken up during the first week after delivery before the
women leaves he hospital.
  The convenient time for loop insertion is 6-8 weeks after the delivery.

FOLLOW UP:

 The objective of follow up examination is:

 To provide motivation and emotional support for the women
 To confirm the presence of IUD
 Diagnose and treat any side effects or complication

SIDE EFFECTS:

 The side effects of IUD is:

 Bleeding
 Pain
 Pelvic infection
 Uterine infection
 Pregnancy
 Expulsion
 Fertility after removal
 Cancer and teratogenesis
 Mortality

HORMONAL CONTRACEPTIVES:

 Hormonal contraceptives may be classified as follows:

 Oral pills
1. Combined pill
2. Progesterone only pill
3. Post-coital pill
4. Once- a-month pill
5. Male pill
 Depot (slow release) formulations#
1. Injectables
2. Sub cutaneous implants
3. Vaginal rings

ORAL PILLS:
  The combined pills is one of the major spacing methods of contraception. In 1960,it
contains 100-200mcg of oestrogen and 10 mg of a progestogen.
 At present combined pill contains no more than 30-35mcg of synthetic oestrogen and
0.5 to 1.0 mg of a progesterone.
 The pill is given orally for 21 consecutive days beginning on the 5 th day of the
menstrual cycle, followed by a break of 7 days during which period of menstruation
occurs.

TYPES OF PILLS:

 The Department of Family Welfare , in the Ministry of Health and Family Welfare,
Government of India has made available 2 types of low dose oral pills under the
brand names of MALA-N and MALA-D.
 It contains Levonorgestrel 0.15mg and Ethinyl Estradiol 0.03mg
 MALA-D in package of 28 pills(21 of oral contraceptive pills and 7 brown film
coated 60 mg ferrous fumarate tablets) is made available to consumer under social
marketing at a price of Rs.3 per packet.
 MALA-N is supplied free of cost through all the PHCs urban family welfare centre.

PROGESTERONE – ONLY PILLS:

 This pill is commonly referred to as ‘mini pill’ or ‘micro pill’. It contain only
progesterone , which is given in small doses throughout cycle.#
 This is commonly used progesterone are norethisterone and levonorgestrel.

POST-COITAL CONTRACEPTION:

 Post – coital or morning after contraception is recommended within 72 hours of an

unprotected intercourse.
 Two methods are available:
 Intra – uterine devices:
 The simplest technique is to insert an IUD, if acceptable, especially a
copper device within 5 days.
 Hormonal :
 In India Levonorgestrel 0.75mg tablet is approved for emergency
contraception. Its used as one tablet of 0.75 mg tablet is approved for
 emergency contraception. It is used as one tablet of 0.75mg within 72
hours of unprotected sex and 2nd tablet after 12 hours of 1st dose.
 Two oral contraceptive pill containing 50 mcg of ethinyl estradiol
within 72 hours after the intercourse, and the same dose after 12
hours.
 Four oral contraceptive pills containing 30 or 35 mcg of ethinyl
estradiol within 72 hours and 4 tablets after 12 hours.
 Mifepristone 10 mcg once within 72 hours.

ONCE-A-MONTH(LONG ACTING) PILLS:

 Experiment with once a month oral pills in which quinestrol , long acting oestrogen is
given in combination with short acting progesterone have been disappointing. In this
method pregnancy rate is too high to be acceptable.

MALE PILLS:

 There are four main lines of approach:

 Preventing spernmatogenises
 Interfere with sperm storage and maturation.
 Preventing sperm transport in the vas
 Affecting constituents of the seminal fluid
 The ideal male contraceptive would decrease sperm count while living testosterone at
normal levels. A male pill made up of gossypol-a derivative of cotton seed oil but
now a days it is not widely used as male contraceptive.

ADVERSE EFFECTS:

1. Cardiovascular effects
2. Carcinogenesis
3. Metabolic effects
4. Other adverse effects
 Liver disorder
 Lactation
 Subsequent fertility
  Ectopic pregnancies
 Foetal development

5. common unwanted pregnancies

 Breast tenderness
 Weight gain
 Headache and migraine
 Bleeding disturbances

CONTRAINDICATION:

ABSOLUTE:

 Cancer of the breast and genitalia

 Liver disease
 History of thromboembolism
 Abnormal uterine bleeding

SPECIAL PROBLEMS REQURING MEDICAL SURVEILLENCE:

 Age over 40 years

 Smoking and age over 35 years
 Mild hypertension
 Chronic renal disease
 Epilepsy
 Migraine
 Lactating mothers
 Diabetes mellitus
 Bladder disease

DURATION OF USE:

 It should used primarily for spacing pregnancies in younger women.

 Those over 35 years should go for other form of contraceptives.

MEDICAL SUPERVISION:
  An examination before prescribing oral pills is required:
 To identify those with contraindications
 Those with special problems that require medical intervention or supervision.

DEPOT FORMULATION:

INJECTABLE CONTRACEPTIVES:

 They are two types of injectable contraceptives:

 Progesterone-only Injectables
 Combined Injectables

PROGESTERONE-ONLY INJECTABLES:

 Progesterone only Injectables are:

 DMPA(Depot – medroxyprogesterone acetate)
 NET-EN(Norethisterone enantate)
 DMPA-SC

DMPA(DEPOT – MEDROXYPROGESTERONE ACETATE):

 DMPA is an intra muscular injection of 150mg every 3months. It exerts its

contraception effect primarily by suppression of ovulation.
 It has been safe, effective, and acceptable contraceptive
 This contraceptive should find good use among multiparae of age over 35 years

ADVANTAGES:

 It does not affect lactating mothers

SIDE EFFECTS:

 Increases a weight
 Irregular menstrual bleeding
 Prolonged infertility after its use.

NET-EN:

 Norethisterone enanate is given intramuscularly in a dose of 200mg ever 60 days.

  Contraceptive action appears to include inhibition of ovulation and progestogenic
effects on cervical mucus.

ADMINISTRATION:

 It should be given during the first 5 days of the menstrual periods.

 Both are given in deep intra muscular injection into the gluteus maximus. The
injection site should never be massaged following injectioms.

DMPA-SC-104MG:

 DMPA-SC-104mg (depo-subQ provera 104MG) is injected under the skin rather than
muscle. Its given at 3 months intervals.
 Injections of DMPA-SC are given in the upper thigh or abdomen. It should not be
given in intra muscularly and subcutaneously.

CONTRAINDIATIONS:

 Breast cancer
 Genital cancer
 Abnormal uterine bleeding
 Blood vessels
 Stroke
 Heart attack
 Deep vein thrombosis
 Lactating mothers

COMBINED INJECTABLES:

 These Injectables contain a progesterone and an oestrogen. They are given at monthly
intervals, plus or minus three days.
 It act mainly by suppression of ovulation. The cervical mucus is affected mainly by
progesterone and becomes an obstacle to sperm penetration.
 Cyclofen/cycloprovera and Mesigyna have been found highly effective with failures
CONTRINDICATION:

 Suspected pregnancies
 Past or present evidence of thromboembolic disorders
 Coronary artery and cardiovascular disease
 Focal migraine
 Malignancy of breast
 Lactating mothers

SUBDERMAL IMPLANTS:

 The population council ,New York has developed subdermal implants known as
Norplant for long term contraception.
 It consists of 6 silastic (silicone rubber) capsules containing 35mg of levonorgestrel.
 Most recent devices comprise fabrication of levonorgestrel into 2 small rods ,
Norplant-2 which comparatively easier to insert and remove.
 The silastic capsules or rods are implanted beneath the skin of the forearm or upper
arm.
 The main disadvantages is irregularities of menstrual bleeding and surgical
procedures necessary to insert and remove implants.

VAGINAL RINGS:

 Vaginal rings containing levonorgestrel have been found effective.

 The hormone is slowly absorbed through the vaginal mucosa , permitting most of its
bypass the digestive system of liver and allowing potentially lower dose.
 The ring is worn in the vagina for 3 weeks of the cycle and removed for the fourth.

POST-CONCEPTIONAL METHODS:

MENSTRUAL REGULATION:

 A simple method of birth control is menstrual regulation.

 It consists of aspiration of uterine contents 6 to 14 days of a missed period, but before
the pregnancy test can accurately determine whether the women is pregnant.
  Cervical dilatation is indicated only nullipara.

COMPLICATION:

IMMEDIATE COMPLICATION

 Uterine perforation
 Trauma

LATE COMPLICATION:

 Abortion
 Premature labour
 Infertility
 Menstrual regulation
 Ectopic pregnancy
 Rh-immunization

MENUSTRUAL INDUCTION:

 This is based on disturbing the normal Progesterone –Prostaglandin balance by the

intra uterine application of 1-5 mg solution(2.5-5mg pellet)of prostaglandin.
 Within a few minutes of the prostaglandins impact, performed under sedation , the
uterus responds with the sustained contraction lasting about 7 minutes followed by
cyclic contraction continuing for 3-4 hour.
 The bleeding starts and continues for 7-8 days.#

ORAL ABOSTIFACIENT:

 Mifepristone (RU-486) in combination with misoprostol is successful terminating the

pregnancies of upto 9 weeks duration with minimum complications
 The commonly used regimen is mifepristone 200mg orally on day 1 , followed by
misoprostol 800 mcg vaginally either immediately or within 6-8 hours.#
 MTP kit having combipack tablets of mifepristone 200mg one tablet and misoprostol
200 mcg 4 tablets.
 The other regimen is a dose of mifepristone 600 mg on day one followed by 400 mcg
orally of misoprostol on day three
CONTRAINDICATION:

 History of allergy to mifepristone or misoprostol.

 Suspected ectopic pregnancy
 IUD in place
 Chronic adrenal failure
 Haemorrhagic disorder
 Inherited porphyria.

ABORTION:

DEFINITION:

 Abortion is defined as termination of pregnancy before the foetus becomes viable .

This has been fixed administratively at 28 weeks , when the foetus weighs
approximately 1000g.

EARLY COMPLICATION:

 Haemorrhage
 Shock
 Sepsis
 Uterine perforation
 Cervical injury
 Thromboembolism
 Anesthetic and psychiatric complication#
 The National Termination Of Pregnancy act was introduced in the year of 1971.

MISCELLANEOUS:

ABSTINENCE:  

 This involves complete avoidance of sexual cohabit..

COITUS INTERRUPTS:
  In this method the penis is withdrawn from the vagina before ejaculation.
 In this way semen is prevented from entering the uterine cavity and pregnancy does
not take place.
 Since the penis is withdrawn and ejaculation takes place outside the vagina, this
method is called coitus interruptus or withdrawal methods.
MERITS :
 Involves no cost
 It does not require any other device.
 With self control and discipline it can be fairly effective.
DEMERITS:
 Require a great deal of self control.
 Thus failure rate is very high.
 Slightest delay in withdrawal can lead to pregnancy.
 SAFE PERIOD:

 This is also known as ‘calendar method’. This method is based on fact of ovulation
occurs from 12 to 16 days before the onset of menstruation.
 Safe period Based upon the process of ovulation and menstrual cycle which helps in
determination of the safe period when coitus can be done and unsafe period when
coitus can be avoided to prevent pregnancy.

MERITIS:

 Does not require any man made device

DEMERITIS:

 Require great deal of will power and motivation

 Failure rate is high.

 Not suitable for the women who does not have regular periods.

 Require self control by the partners during the highly unsafe period.
COMPLICATION:

 Ectopic pregnancy
 Embroyonic abnormalities.

NATURAL FAMILY PLANNING METHODS:

BASAL BODY TEMPERTURE METHOD:

 The BBT method depends upon the identification of rise of BBT at the time of
ovulation, as a result of increase in production of progesterone. The rise of
temperature is vary small 0.3 to 0.5 degree C.
 When no ovulation occurs the body temperature does not rise.

CERVICAL MUCUS METHOD:

 This is also known as billing methods or ovulation method.

 This method is based on the observation of changes in the characteristics of cervical
mucus.
 At the time of ovulation, the cervical mucus becomes watery clear resembling raw
egg white, smooth, slippery, and profuse.
 It is recommended that the women uses a tissue paper to wipe inside of vagina to
assess the quantity of and characteristics of mucus.

SYMPTOTHERMIC METHOD:

 This method combines the temperature , cervical mucous and the calendar techniques
for identifying the fertile period.
 If the women cannot clearly interpret one sign , she can ‘double check’ her
interpretation with another. This method is effective than the ‘Billing methods’.

BREAST FEEDING:

 Field and laboratory investigations have confirmed the traditional belief that lactation
prolongs postpartum amenorrhoea and provides some degree of protection against
pregnancy.

BIRTH CONTROL VACCINE:

  Most advanced research involves immunization with vaccine prepared from beta sub
unit of human chorionic gonadotropin , a hormone produced in early pregnancy.
 Immunization of human chorionic gonadotropin would block continuation of
pregnancy.

TERMINAL METHODS:

 Sterilization is only method which gives permanent protection from conception from
conception.
 Either husband and wife can under go sterilization by a simple surgical operation that
is :
 vasectomy

 Tubectomy.

GUIDELINES FOR STERLIZATION:

 The age of the husband should not ordinarily be less than 23 years nor should it be
over 50 years.
 The age of the wife should not be less than 20 years or more than 45 years.
 The motivated couple must have 2 living children at the time of operation.
 If the couple has 3 or more living children , the lower limit of age of the husband or
wife may be relaxed at discretion of the operating surgeon.
 It is sufficient if the acceptor declares having obtained consent of his/her spouse to
undergo sterilization operation.

MALE STERLIZATION(VASECTOMY):

 Vasectomy is sterilization of male.

 It is very simple and minor operation which takes hardly 15-20 min.
 The operation involves a small cut on both sides of scrotum then a small portion of
vas deferens (about 1cm) on either side of the scrotum is cut and ligated, folded back
and sutured.
 The operation is done not affect the sexual characteristics and sex life in any form.
 The sperms are produces but not ejaculated along with semen.

COMPLICATION:
  Sperm granules
 Spontaneous recanulation
 Autoimmune response

POST OPERATIVE ADVICE:

 The patient should be told that he is not sterile immediately after operation at least 30
ejaculation may be necessary before the seminal examination is negative.
 To use contraceptives until aspermia has been established.
 To avoid taking bath for at least 24 hours after the operation.
 To wear a T-bandage or scrotal support for 15 days and to keep the site clean and dry.
 To avoid cycling or lifting heavy weights for 15 days there is, however , no need for
complete bed rest.
 To have the stitches removed on the 5th day after the operation.

NO SCALPEL VASECTOMY:

 No scalpel vasectomy is a new technique that is safe, convenient and acceptable to

males.

FEMALE STERLIZATION(TUBECTOMY):

 It is sterilization of female
 This is done by resecting a small part of fallopian tubes and ligate the selected ends. 
 The closing of tubes can also be done by using other methods like closing the tubes
the tubes with bands clips and electrocautery.
 The tubectomy can be done after delivery, between delivery and after abortion.
 The operation can be done through abdominal or vaginal approach.
 The most common abdominal procedure are
 Laproscopy
 Minilaprotomy.

LAPROSCOPY:

 This is technique of female sterilization through the abdominal approach with

specialized instruments is called ‘laproscope’.
  The abdomen is inflated with gas and the instrument is introduced into abdominal
cavity to visualize the tubes.
 Once the tubes is accessible , the falope rings are applied to occlude the tubes.
 Laproscopy is not advisible for postpartum patients for 6 weeks following the
delivery.

COMPLICATION:

 Puncture of large blood vessels.

MINI-LAP OPERATION:

 Minilaparotomy is a modification of abdominal tubectomy.

 It is a much simpler procedure requiring a smaller abdominal incision of only 2.5 to
3 cm conducted under local anesthesia.
 The minilap/Pomeroy technique is consider revolutionary procedure for female
sterilization.
 Minilap operation is suitable for postpartum tubal sterilization.

ADVANTAGES:

 Tubal ligation is considered a permanent method of sterilization and birth control.

 Reduces the Pelvic inflammatory disease (PID)
 Reduces the risks of pregnancy  
 Protection against ovarian cancer.

DISADVANTAGES:

 Death, due to the procedure or anesthesia, is extremely rare.

 Infection or abscess of wound.

ROLE OF NURSE:

 Answering general question regarding contraceptive methods.

 Explaining different methods available and its advantages and disadvantages
 Teaching correct use of contraceptive methods
 Nurses can play part in helping couples to choose and correctly use of contraceptive
methods that enable them to have children that are both wanted and well timed,
CONCLUSION:

 Effective contraception benefits both mothers and children by decreasing morbidity

and mortality, improving the social and economic status of women, and improving the
relationship of the mother with all her children.

JOURNALS:

TOPIC: Knowledge, attitude, and practice of family planning services among healthcare
workers in Kashmir – A cross-sectional study

AUTHOR: Rabbanie Tariq Wani et.al,.

PUBLISHED ON: April 2019.

ABSTRACT:

Background:

Researches have shown highest awareness but low utilization of contraceptives making the
situation a serious challenge. Most of women in reproductive age group know little or have
incorrect information about family planning methods. Even when they know the name of
some of the contraceptives, they do not know where to get them or how to use it. These
women have negative attitude about family planning, whereas some have heard false and
misleading information, the current study aimed in assessing the knowledge, attitude, and
practice of family planning among female healthcare workers in Kashmir valley.

Method:

A self-administered questionnaire was served to the female multipurpose health workers of

District Anantnag and Baramulla at a training conducted in Department of Community
Medicine, Government Medical College, Srinagar, Kashmir.
Result:

All the participants had heard about family planning methods. The major sources of
information were trainers (78.8%). About 90.4% of the study participants gave correct
response regarding the types of family planning. About 80.1% of the respondents had a
favorable attitude toward family planning. Around three-fourths of the study participants
practiced one or other method of family planning.

Conclusion:

Our study lead to the conclusion that the level of knowledge and attitude toward family
planning was relatively low and FP utilization was quite low among the healthcare workers.
In order to imbibe positive attitude among general public, the health workers need to be
trained so as to inculcate the positive attitude in them leading to increased awareness among
general public with regard to family planning.

BIBLIOGRAPHY:

 Neelam kumari , A text book of community health , published by PV books, page

no:.
 A textbook of preventive measures and social medicine , published by Elsevier, in
edition 2013, page no:526-546.

NET REFERENCES:

 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6510098/
 https://www.slideshare.net/Harishanandakp/sterilization-59549504
 https://www.slideshare.net/HariOMMehta2/family-planning-method
 https://www.fphandbook.org/sites/default/files/fffpchapter7.pdf