"Family Planning "

.It is time for us to think seriously about Family planning

The way the population of the world is increasing it is likely that one day either we would have
major scarcity of food and shelter or if we follow the process of constantly clearing jungles
and provide food for the people in the world, we would over exhaust nature and that would
lead to a grave natural disaster that might kill thousands of people. It has become a concern
for the whole world now as to how to save the world from destruction and devastation that
would be the consequence of over population. Individually all the countries in the world are
taking up measures to limit and control the population of their country but then in most of the
countries the rules are not rigid and the counter actions are not stern therefore the measures
either have not been implemented well or in some cases have not been followed in a proper
manner. Family planning has been the key word in the run for development which the third
world have been suggested time and gain but then their lack of infrastructure to spread the
awareness in these countries have let condition deteriorate. Here we would discuss about
family planning and its role in world development

Family Planning : Definition

Family planning implies that a couple discuss when and how many children they can have so
that they can give the utmost care to the child, financially, psychologically and socially. In
general usage we commonly associate terms like contraception and birth control with Family
Planning but theoretically family planning is much more than that. Family planning methods
would include every measure that can be taken so as to give a couple their required freedom
to determine when they want to have their children and what the time gap should be if
planning more than one child. Let us look at the methods

Methods and Types of Family Planning

There are two types of family planning one of them refers to the usage of artificial methods
and the other is called natural Family planning in which a woman’s natural infertile phases are
.emphasized upon

With this discussion we come to the next step of methods used in family planning. There are
:various methods that are used and here are some of the following

Oral Contraceptives for women --- Progestin ---

Contraceptive Injections --- Vasectomy ---

Female Sterilization --- Tubectomy ---

Intrauterine Devices --- Norplant Implants ---

Vaginal Methods --- Condoms ---

Family Planning: Importance
Family Planning is not only to avoid the impending disaster of over population but also for the
well being of mothers since it avoids unnecessary abortions and also reduces the number of
times a woman gives birth. With every pregnancy the risk towards maternal health increases
so it is better to avoid unnecessary pregnancy at the first place. Family Planning would also
lead to an enhancement in the health of the baby that is born since a healthy mother would
definitely give birth to a healthy child. So it is high time we implement this in our lives and get
!!some fruitful results
" Family Planning "
? What is Family Planning (FP)
Family Planning involves planning the number, frequency and timing of pregnancy. In other words it is
a program to regulate the number and spacing of children in a family through the practice of
.contraception or other methods of birth control

? What are the various methods of FP

There are several contraceptive choices available to a couple. FP methods can be broadly classified into
.Reversible (Temporary) methods and Irreversible (Permanent) methods

? What are Reversible FP methods

Also known as Spacing methods, these are temporary in nature, hence do not have any permanent
.contraceptive effect

Reversible (Temporary Methods)

 

Natural                         Barrier                     Intra Uterine                   Non Hormonal                 Hormonal 

Methods                    Methods                     Devices                         Contraceptives                Contraceptives

? What are Irreversible FP methods

Also known as Sterilization, these are permanent methods. They need to be carefully thought about and opted for. This
.FP method is best for people who have already completed their family

Irreversible (Permanent)

Vasectomy (Men)                                                 Tubectomy (Women)  

 
 REVERSIBLE / SPACING (TEMPORARY METHODS)

? What are natural methods of family planning

Periodic abstinence: A group of methods that are based on avoiding sexual intercourse during the fertile
time (time when a woman can conceive.) A woman's fertile time is identified through observing, recording
and interpreting natural signs and symptoms associated with the menstrual cycle. These methods include
the standard days method, calendar (rhythm) method, cervical mucus (or ovulation) method, and basal
.body temperature method

Withdrawal (coitus interruptus): A method where sexual intercourse is interrupted and the penis is
.withdrawn from the vagina before ejaculation

Lactational Amenorrhea (LAM: LAM is a temporary method of contraception based upon breast-
feeding. Sucking during breast-feeding releases natural hormones which prevents ovulation acting as a
.protection against pregnancy

How do natural methods of family planning work? (mechanism of action)

They prevent sperm from uniting with an egg by avoiding intercourse around the time of ovulation or by
withdrawing the penis from the vagina before ejaculation. In this method a woman should be aware of
.her fertility

?For whom are natural methods of family planning appropriate

Couples willing and motivated to learn how to observe, record and interpret the woman's fertility signs

Couples who accept the potential for unintended pregnancy

Couples with no/little access to modern contraceptive methods

Couples with religious/philosophical reasons not to use other methods

Women with regular menstrual cycles

Women unable to use other contraceptive methods

Men willing to practice withdrawal

What are the advantages and disadvantages of Natural Methods of Family
? Planning
Advantages

Have no medical side effects

Immediate return to fertility

Free and readily available

Use increases knowledge of female reproductive physiology

Use may improve communication between partners

Disadvantages
High failure rate

Require high motivation and ability to follow instructions

Require partner's cooperation

Couple practicing periodic abstinence must abstain from intercourse for a significant period of time
every month

No protection from STIs/HIV

May be difficult to detect a woman's fertile period (close to menarche, close to menopause, during
breastfeeding, or in women with irregular cycles)

? What is meant by Barrier method

This method stops the sperm from uniting with the egg and acts as a barrier. Different barrier methods
.are male condom or female condom, Foam tablets or Spermicidal jellies

? What is a Male Condom

A condom is a contraceptive choice available to men and women. It acts as a barrier to the passage of
seminal fluid into the vagina. Condoms also protect from RTI/STI. A Condom is made of a thin latex
sheath, which is rolled over the erect penis of the male partner before sexual intercourse. It prevents the
.sperms from entering into vagina and coming in contact with the female egg

Male When should a

? Condom be used
.A Condom should be used at the beginning of each act of intercourse by unrolling on the erected penis

.A Condom should not be re-used

? How should a Male Condom be used

The Condom should be rolled over the erect penis before the penis is in the vagina. The rim of the
condom should be rolled all the way to the base of the penis, leaving half inch of an empty space at
the top by pinching the tip of the condom as it is rolled over the penis. No air should be left in the tip
.of the condom

After intercourse, the condom should be held at the rim as the penis is being withdrawn so that no
.semen is split anywhere near the opening of the vagina

The penis should be withdrawn soon after ejaculation because once the penis returns to its flaccid
.state, the condom may slip off and pregnancy may result

.If using spermicide, it should be applied to the outside of the condom

The condom should be checked before being thrown away to see whether it is torn or not. If torn, the
woman should use a spermicidal tablet or cream immediately, otherwise an emergency contraceptive
.pill within 2 days or an IUCD within 5 days should be used

Oils or petroleum jelly should not be used as lubricants, because they can cause deterioration of the
.condom

? What is a Female Condom

Female condoms are made of very thin polyurethane plastic pouch about 17cm(6.5”) in length. That is
sturdier than male latex condoms and is a soft, loose fitting sheath with flexible rings at each end. One
ring is at the closed end of the sheath and serves as an insertion mechanism and anchor inside the vagina.
The outer ring forms the external edge of the device and remains outside the vagina after insertion.  It
lines the entire vagina thereby preventing seminal fluid containing sperms from entering the uterine
cavity and preventing pregnancy. Also, this design may reduce the potential for transfer of infectious
.organisms between sex partners, particularly genital ulcer diseases

The Female condom is a highly effective barrier method in preventing pregnancy, provided it is used
.correctly and consistently

This barrier method may be especially useful for women at risk of STDs who have difficulty convincing “
”male partners to use latex condoms
  

? How should a Female Condom be used

The female condom must be properly positioned before any contact occurs between the penis and
.vagina or rectum. The female condom may be used for both vaginal and rectal sexual intercourse

Squeeze the smaller ring and insert into the vagina. The large end should be placed over the vaginal
.opening to protect outer genitalia infection

Be sure that the penis goes directly into the large ring to preclude unprotected sexual contact between
.the penis and the vagina or rectum

Remove the condom immediately after sexual intercourse and before standing up. To avoid semen
.leakage twist the large outer ring  and carefully pull the condom out and dispose it

? What are the basic things to remember about Condom

.Condoms should not be kept in places with extreme temperatures either hot or cold

.Use a new condom for each act of sexual intercourse

.Do not use a male condom and female condom at the same time

.Do not throw used condoms into the toilet as they can clog pipes

? What are Foam Tablets or Spermicidal Jellies

Spermicides are barrier birth control methods that are bought over the counter. Once inserted, these
contraceptives kill sperm. Vaginal spermicides are available in several forms: spermicidal jelly, cream,
foam tablets, suppositories, sponge and film. Most use the chemical nonoxynol-9 against sperm.
Spermicides provide lubrication and can be used with other methods of birth control.  They are most
effective when used consistently and correctly with a barrier method of birth control, like a condom.
Spermicides are 71-82% effective as birth control. Used alone, spermicide does not protect against
.HIV/AIDS

 
? What is an Intra Uterine Contraceptive Device
 

It is a device made of polyethylene/ plastic, which is inserted in the uterus for prevention of pregnancy.
The different types of IUD’s are –Copper T, CuT-380A, ML-375, Nova T, Progestasert and LNG 20. The
most common IUCD available is Copper T (CuT) in which a thin copper wire is coiled around the
vertical stem of T. It causes changes in the uterus lining and hence prevents the implantation of the
fertilized egg. It also decreases sperm motility, thereby preventing fertilization in the fallopian tube. A
complete examination by the doctor is essential before an IUCD is inserted. It can be left in the uterus for
.3 years after which it has to be removed and reinserted, if required

Facts about IUD

 

IUCD is effective immediately after insertion. The string should be checked frequently atleast after
.the menstrual period every month

Possibility that the first and probably the second periods may be earlier than the scheduled date but
.there is nothing to panic.It is normal

.Check pads and toilet during menstruation as expulsion could occur during this time

? When should IUD be inserted

 

Preferably on the 5th day of the menstrual cycle as bleeding associated with the insertion is likely to
.cause less anxiety

Anytime convenient except during pregnancy

.Immediately after a first trimester spontaneous or legally induced abortion, with antibiotic cover

During lactation

.Immediately post-partum within 72 hours or at six weks post natal checkup visit

? What are Non – Hormonal Contraceptives

Non Hormonal Oral Contraceptives like Saheli are non-steroidal. The have weak estrogenic with potent
anti-estrogenic properties. They inhibit preparation of uterine cavity for implantation of fertilized ovum
and accelerate ovum transport. A pill is taken twice a week for three months and is followed by once a
.week dose, on the same day each week

 
                   ? What are OCPs
OCP’s or Oral Contraceptive Pills are an efficient and reversible contraceptive choice available to
women. It is the best birth spacing method that is available to women. OCP’s are a combination of
female sex hormones, which are normally present in a woman’s body. PSS product - ECROZ

? What role does Hormone play in Pregnancy

During a woman's monthly cycle, hormones produced by a gland in the brain cause the ovaries (small
organs where the egg cells are produced and stored) to release the hormones oestrogen and progesterone.
Oestrogen and progesterone cause the ovaries to release an egg (ovulation), which travels through the
.fallopian tube - where it can be fertilised by sperm - and the egg then travels on to the womb

Oestrogen and progesterone also thicken the lining of the womb (the endometrium) and increase its
blood supply, preparing it for pregnancy. If the egg is fertilised it can implant in the lining, where it
develops during pregnancy. If pregnancy doesn't occur, the levels of oestrogen and progesterone drop.
The lining of the womb and the egg are shed, coming out of the vagina as a period (menstruation). It is
.this drop in oestrogen that makes the cycle to start again
The combined contraceptive pill contains artificial (synthetic) versions of hormones. They mimic the
action of oestrogen and progesterone on the body. When taken correctly, the pill interferes with the
.normal cycle to prevent pregnancy

? How does OCP work

preventing the ovaries from releasing an egg

thickening the mucus at the cervix (neck between the vagina and womb) making it more difficult for
sperm to enter the womb and fertilise the egg

making the lining of the womb unsuitable for a fertilised egg to implant on to

? What are the different type of OCPs

.Combined – Contain fixed doses of estrogen and progestogen

Progestogen only Pill – Not available in India, contains only progestogen

.Phasic – The doses of the hormones vary during different phases of the menstrual cycle
? Who can take the pill
Young, newly wedded or unmarried women who can fulfill medical, eligibility checklist can take OCP

? When can one take OCP’s

Pills can be taken after unplanned, unprotectedcoitus as emergency contraceptive after consulting the
. doctor

A  dose of 4 tablets of a low dose pill within 72 hours of un protected intercourse followed by 4 more  
.tablets 12 hours later

.OCP’s can be taken as post Abortal, immediately after an abortion

? What are the benefits of having Oral Pills

Contraceptive benefits

Ideal Spacing method

Useful in nulliparas (A woman who has never given birth)

Useful immediately after abortion / MTP

.May be used as a post-coital contraceptive or for postponing periods

Wait-in period before terminal method

Menstrual benefits

Regular cycles

Pain-free cycles

Lighter bleeding during cycles

Non-contraceptive benefits

Decreased anemia

Decreased risk of ectopic pregnancy, pelvic inflammatory disease, benign breast disease, ovarian
cysts, carcinoma of ovary and endomentrium

  Improvement in Rheumatoid Arthritis

Improvement of acne in some women

? What might be the side effects of having Oral Pills

Side effects are rare with low doses. Some may report nausea, break-through bleeding and sore breasts.
.But these are temporary limited to 2-3 days

Please Remember – Pills do not provide protection against STI/ STI Infections. Use Condoms for
.protection
? What is Injectable Contraceptive (IC)
Injectable Contraceptive is a method that provides protection from pregnancy when women receive
injections at regular intervals. These injections contain Progestin, a liquid similar to the natural hormone
.Progesterone that a woman’s body produces

– There are 3 different varieties of IC available today, which are as follows

.Monthly Injectable – Cyclofem/ Cycloprovera and Mesigyna/ Norigynon ]1

Bi-monthly Injectable – Noristerat and Norethindrone Enanthate – NET-EN ]2

Quarterly Injectable – DMPA (Depo medroxy progesterone acetate) ]3

.Out of all these DMPA and NET-EN are the officially registered products in our country

? What is DMPA
It is an Injectable progesterone (long lasting steroidal preparetion which gives protection from
pregnancy for three months. It contains 150 mg of Depo medroxy progesterone acetate in an aqueous
.microcrystalline suspension in 1 ml solution

? How does DMPA act

.It prevents ovulation

.It prevents implantation by altering the endomentrium, which ultimately becomes atrophic

.It thickens the cervical mucus and so prevents the sperms from entering the uterine cavity

It alters tubal motility and either hastens or delays transports of fertilized ovum and prevents
nidation (the development of the epithelial membrane lining the inner surface of the uterus following
menstruation)

? How is IC administered
DMPA is an acqueous suspension and is given by deep Intra Muscular Injection

.A single injection will prevent pregnancy for 3 months

.It should be given within 7 days of the start of menstrual period

May also be administered after an induced or spontaneous 1or 2 trimester abortions and after 6
.weeks post-partum

To continue protection against pregnancy, it must be given every 3 months

The re might be some delay in return to fertility averaging between 6- 9 months after the last DMPA
injection. It is therefore advised that DMPA be discontinued atleast 6-9 months before the wish to
.conceive

 
? Who can take DMPA
Any woman in good health may take DMPA provided she is

Not pregnant

Between age group of 18 – 45 years

Not have history of abnormal vaginal bleeding

Not have history of heart attacks or strokes

Not suffering from jaundice/ liver disease within 6 months prior to the Ist dose of DMPA

Not have reproductive tract or breast malignancy

Having Blood Pressure below 180/110 mm of HG

? What are the Non – Contraceptive Benefits of DMPA

Decreased menstrual flow

Decreased menstrual cramps

May protect against PID

Protects against endometrial and ovarian cancer

Prevents development of Uterine fibroid

? What is Emergency Contraceptive (EC)

Emergency contraceptive pill is taken following an act of un protected sex to prevent pregnancy. It is
most often called the “Morning after Pill” EC is a post coital contraceptive based on the fact that even
.one act of un protected sex can result in pregnancy

? When to use EC
.Non-use or in consistent use of any contraceptive method during sexual intercourse

Condom breakage/slippage

Missed two or more Oral contraceptive Pills

Expulsion or displacement of IUD

Slippage of diaphragm or surgical cap

Failure of withdrawal technique

Miscalculation of safe period

Missed regular contraceptive injection

Sexual assault /rape

.EC is to be used within 72 hours

  

IRREVERSIBLE/ PERMANENT METHODS

? What is Sterilization
Sterilization is an irreversible and permanent family planning method. It is a contraceptive choice for
men and women who do not want to have more children or couples who have already completed their
.family

? What is Vasectomy ? How Male Sterilization is done

.Sterilization in males is known as vasectomy

Sperms are produced in the two testicles lying in the loose fold of skin called scrotum behind the penis.
The tube called vas deferens starts from the testes and passing through abdomen it collects secretion
from prostate and other glands before it passes through the penis and opens outside at the urethra. Urine
.is carried through the same tube

Semen is made up of sperms (30%) and secretion of prostate and seminal vesicles (70%). Vasectomy
involves the sealing of the tubes through which the sperms pass before ejaculation. This blocking does
.not interfere with attaining orgasm

During Vasectomy, a 1 cm incision is made either at the central part or on either side of scrotum after
applying local anesthesia, which numbs the area.  Then the tubes which carry the sperms are located and
blocked.. A dressing is then applied at the site of the incision. It is a simple procedure done under local
anesthesia. It takes only 5-10 minutes and the person can return home after resting for an hour. Also
.Vasectomy does not interfere with the man’s masculinity or sexual activity

? What is No-Scalpel Vasectomy (NSV)

This is the puncture technique of during male Sterilization without use of any knife. It is an effective
method with less discomfort and very few complications. In this there are no incisions or stitches,
.therefore both the procedure and recovery is much faster

? How does the new operation of NSV differ from the old vasectomy
In the old method two cuts were made in the scrotum to bring out the vas deferens, which is then tied off.
At the end of the procedure, these cuts have to be stitched. In the new NSV procedure, the vas are
brought out through a tiny puncture which does not require any stitches. The procedure is nearly
.painless, less invasive and faster
? Are there any complications doctor
No surgery is without complications. But NSV has very few complications as compared to the old
.method, and is very safe

? Are there any chances of failure

Very few, more when one does not follow the doctor’s advice about the precautions. One is protected
.from failure when you observe the precautions

? What precautions one must take to prevent failure

It is important to use some form of contraception up to 10-14 weeks or 20 ejaculations whichever is
earlier, after Vasectomy. The reason is that the vas empties itself of all the sperms that remain in it after
the operation. A semen test is necessary to confirm the absence of sperms in the semen and the success of
.the vasectomy

? What other precautions must I take

You must take adequate rest and resume normal work 48 hours after surgery. You should also not wet
the operation area for the same period. You can resume all activities including cycling by one week
following surgery. Take the medicines as prescribed. Since these will prevent any infection/pus discharge
.from wound. In case you feel a lot of pain or swelling you must immediately report to a doctor

? What are the effects on sex after this operation

No charge will occur from whatever it is for you now. In some cases people find it better because the fear
of pregnancy is gone. Fears of lowering of sexual pleasure are founded. The nerves that regulate sexual
pleasure are within the abdomen and we operate outside the abdomen. Your body will continue to
produce male hormones and same amount of semen but the sperms will not be transmitted to your
.partner during the sex

? Can I work as hard as before

Surely you can. This operation has absolutely no relationship with physical strength as that depends on
.your nourishment and exercise

? What happens to the sperm after the vasectomy

Sperms continue to be produced, as before but since they do not come out of the body after the operation
they get absorbed into the body. This is a normal process, which occurs, even in non-vasectomised men
.who do not have sex for sometime

? What is Tubectomy ? How Female Sterilization is done

Sterilization in women is called Tubectomy. Also referred to, as Tubal Sterilization is a surgical
procedure done on women as a permanent method of contraception. Gynaecologists, general surgeons
.and laparoscopic surgeons perform Tubectomy
The Fallopian Tubes are two in number and are attached on either side of the uterus at one end and the other end
is open in the abdomen. The length of each Fallopian tube is about 10cm.When the ovum or egg is released from
the ovary, it is picked up by Fallopian tube through which it moves into the uterus. If sperms are present in the
Fallopian tubes, the ovum is fertilized and the resulting embryo is transmitted to the uterus where it is embedded.
In short, we can say that Fallopian tubes are channels through which the eggs from the ovaries travel to the uterus.
In Tubectomy the tubes are blocked or divided to prevent the eggs from entering the uterus. This prevents any
.future pregnancies to occur after the surgical procedure
 
  

.Tubectomy can be performed in two ways (1) Laparoscopic method and (2) Minilap technique

? What is Minilap technique

Mini-laparotomy or Mini lap is the conventional method of Tubectomy. It involves opening the abdomen
through a small incision and both the fallopian tubes are tied and cut under vision. Local anesthesia is
given by injection. The mini-lap method needs hospitalization for two days. It is useful for post-childbirth
tubectomy, when the womb is still high in the abdomen and easy to

? What is Laparascopic method

Currently, Laparoscopy is the most popular method of female sterilization in non-pregnant women. It is
performed under General Anesthesia. The actual procedure is done in an operating room, either in a
.hospital or a surgical center. The surgery takes about half an hour

In the Laparoscopy procedure, the abdomen is filled with carbon dioxide gas by introducing a needle .1
.so that the abdominal wall balloons away from the uterus and tubes

The surgeon makes a small cut just below the navel and inserts a laparoscope, a small telescope-like .2
.instrument

A second incision is made just above the pubic hairline to allow the entrance of another small .3
.instrument that can help with closure of the fallopian tubes

Usually Falope/ Silastic rings or Filshie clips are placed on the fallopian tubes to block the tubes. .4
Sometimes the tubes are cut and clipped

The skin incision is then closed with one stitch or a tape. The patient may feel well enough to go home .5
.from the outpatient surgery center in a few hours
 

?What is the best time to have a tubectomy done

Tubectomy should be done best within a week after menstruation. Post partum sterilization is performed
.within 72 hrs of completion of a vaginal delivery

?Are there any precautions to be followed before a tubectomy

Refrain from sexual intercourse for at least 4 days before tubectomy. If having sexual intercourse, use a
.condom
?Why are these precautions essential before undergoing Tubectomy surgery
The sperms of semen are alive for 48-72 hours. If the women had sex about 2 days before operation, these
sperms would be available in the Fallopian tubes and may fertilize the ova or egg. This fertilised ovum
maybe implanted inside the uterus
.and she may become pregnant even after tubectomy

There is another aspect of presence of viable sperms in the Fallopian tubes. These sperms may remain
trapped at the far end of the Fallopian tubes and fertilize an ovum, even after Tubectomy. This fertilized
ovum will not be able to pass into the uterus and hence will impregnate the thin Fallopian Tube resulting
in ectopic pregnancy. This is a dangerous condition because ectopic pregnancy may result in rupture of
.Fallopian tube, severe hemorrhage and sometimes even death if not detected early enough

?Will tubectomy protect against sexually transmitted diseases (STDs)

It's important to know that sterilization won't protect you against sexually transmitted diseases
 

Always use a condom during each sexual activity to prevent STDs .)STDs(