Family planning

Under supervision :-
*Dr/Abeer mostafa .
*Dr/Omnia Ibrahim
 ❖Prepared by :-
1.Aya hosny
2. Aya shaban
3.Aya sayed daif
4.Aya Mohamed Ali
5.Aya Mohamed naguib
6.Aya alam fargal
7.Khadega ahmed
8.Samah ahmed
9.Khloud adel
10.Khloud taraq
11.Haya Mohamed
12.Gehad labib
13.Jackleen kairy
14.Aya abd el hamed
15.Habiba Ibrahim
16.Doaa ragab
17.Doaa ahmed zaki
❖Out line:-
1. Introduction.
2. Definition .
3. Important .
4. Natural methods .
(calendar method, basal body temperature ,cervical
mucus examination, withdrawal methods ,lactation
infertility)
5. Chemical methods.
(spermicide)
6. Barrier methods .
(spermicide .condom ,sponge, diaphragm, cervical
cap)
7. Hormonal methods .
(pills ,injection, vaginal ring)
8. Mechanical methods.
(IUD)
9. Surgical methods.
(female sterilization )
10. Family plan counseling
 ❖Introduction about family planning:-
Family planning is "the ability of individuals and couples to anticipate
and attain their desired number of children and the spacing and timing
of their births. It is achieved through use of contraceptive methods and
the treatment of involuntary infertility.Family planning may involve
consideration of the number of children a woman wishes to have,
including the choice to have no children and the age at which she
wishes to have them. These matters are influenced by external factors
such as marital situation, career considerations, financial position, and
any disabilities that may affect their ability to have children and raise
them. If sexually active, family planning may involve the use of
contraception and other techniques to control the timing of
reproduction.

❖ Definition:-
the ability of individuals and couples to anticipate and attain their
desired number of children and the spacing and timing of their birth

❖Benefits of family planning:

A.For women:
1. Decrease maternal mortality and morbidity by reduceing high risk
pregnancies (maintain good health stander).
2. Improve health and the quality of the life.-
3. Avodiance of hazard and complication of high parity: •Nutrition
deficiency(anemia) .
4. Obstatric risk (disproportion,mal presentation, rupture of
uterus,ante partum, post partum hemorrhage, toxemia of
pregnancy, indused abortion for unwanted pregnancy).
5. Medical disorder complicating pregnancy(hypertension,renal
disorder, diabetes). G
6. ynecology problems resulting from repeat pregnancies and
deliveries (prolapse, perineal tear, urinary incontinence)
7. Supporting woman's right and opportunities for education,
employment,and full participation of society.
 B/For children:
1. Decrease child mortality.
2. Improve intellectual development.
3. Prevent genetic disease and improve genetic potential.
4. Prevent communicable disease .
5. Improve the nutrition status and prevent nutritional disease.
6. Provide better opportunities for education, recreation and
interaction with other family members.

C/For the family:

1. Improve the financial status.
2. Improve the education opportunities for children.
3. Improve work opportunities especially women.
4. Improve nutrition and quality of life.
D/For the community:
1. Less drain on resources.
2. High level of socioeconomic development.
3. Fighting HIV/AIDS through providing information.
Protecting the environment by stabilizing population growth

❖ Natural methods :-
Natural methods are a type of birth control that relies on
observations about the woman's body and menstrual cycle.
Types of natural methods of birth control include:-
calendar method,
basal body temperature method,
cervical mucus examination
Basal body temperature method.
1/Calendar method:-
The calendar method to avoid pregnancy relies upon calculating a
woman's fertile period on the calendar. Based upon her 12 previous
menstrual cycles, a woman subtracts l8 days from her shortest
menstrual cycle to determine her first fertile day, and 11 days from her
longest menstrual cycle to determine her last fertile day. She can then
calculate the total number of days during which she may ovulate. If a
woman's menstrual cycles are quite irregular from month to month,
there will be a greater number of days during which she might become
pregnant.
The calendar method is only about 80% effective in preventing
pregnancy.
2/Basal body temperature method
The basal body temperature (BBT) method is based upon the fact that a
woman's temperature drops 12 to 24 hours before an egg is released
from her ovary and then increases again once the egg has been
released. Unfortunately, this temperature difference is not very large. It
is about a half-degree C when the body is at rest.
3/Mucus inspection method
The mucus inspection method depends on the presence of a particular
type of cervical mucus that a woman produces in response to estrogen.
A woman will generate larger amounts of more watery mucus than
usual (like raw egg white) just before release of an egg from her ovary.
This so-called egg-white cervical mucus.
4/Withdrawal method
Using the withdrawal method, the man withdraws his penis from a
woman's vagina before he ejaculates so that the sperm released from
his penis does not enter her vagina.
5/Lactational infertility
Lactational infertility is based upon the idea that a woman cannot
become pregnant as long as she is breastfeeding her baby. It is true that
a woman may not ovulate quite as soon after giving birth as she would
if she were not breastfeeding. Women who are breastfeeding usually
start ovulating again between 10-12 weeks after delivery.However, the
method is not considered appropriate
❖ Advantages of natural methods include
1/cost savings,
2/lack of health-care visits,
3/avoidance of medications
❖ Disadvantages of natural methods,
1/they can be difficult to use correctly
2/ sexual intercourse must be avoided at certain times of the month.

❖Chemical methods :-( spermicide)

Spermicides contain chemicals to stop sperm from getting to an
egg. They come in several different forms: cream, gel, foam, film,
and suppositories. Put it in your vagina to prevent pregnancy.
 ❖ How does spermicide work?
▪ Spermicide is a chemical that you put deep into your vagina
right before sex. It prevents pregnancy two ways: blocking
the entrance to the cervix so sperm can’t get to your egg, and
stopping sperm from moving well enough to swim to your
egg
▪ Spermicide can be used by itself, or combined with other
birth control methods. Using spermicide plus a condom gives
you extra protection from pregnancy .
❖ Disadvantage:-
1-do not provide protection from sexually transmitted infections
(STIs);
2-are not considered an effective form of contraception when used
alone.
3-may produce side effects such as vaginal or penile irritation.
4-may increase the risk of developing urinary tract infections
(UTIs)
5-must be applied at the correct time, and reapplied with
subsequent sex acts
6-must remain in place for 6-8 hours after ejaculation to make
sure all sperm are killed.
❖ Advantage:-
1-It's available over the counter and don’t require a prescription
2-It's easy to use
3-It's inexpensive .
.4-do not affect the menstrual cycle; and
5-increase lubrication during sex.
❖ Contraindications:-
1-Sensitivity.
2-vaginal irritation
3-sexual disease
 ❖Barrier methods :-
A barrier method is any type of birth control that puts, well, a barrier
between the penis and vagina to block sperm from reaching an egg. No
sperm to egg contact = no pregnancy .

1- condom :
A condom acts as a physical barrier that prevents sperm from entering
the uterus and reaching an egg .
Two types are available :
External condoms (male condom ) : is a thin sheath made of latex
(rubber), polyurethane (plastic), that is worn over the erect penis during
sexual intercourse. Latex and polyurethane condoms provide the best
protection against many STIs, including HIV.
Internal condoms ( female condom):-
is a thin plastic pouch that lines the vagina. It is held in place by a
closed inner ring at the cervix and an outer ring at the opening of the
vagina. It provides some protection against STIs.
 ❖ Advantage:

Male ▸Helps protect against STIS - Easily accessible and inexpensive -

Do not need prescription - No hormonal changes - May help to avoid
premature ejaculation

Female ▸ Available without a prescription , Prevents STDs: chlamydia,

gonorrhea, herpes, HPV, and HIV

❖ Disadvantage
Male ▸ May slip or break during intercourse , those with latex allergies
cannot use them .

Female ▸ Can break or leak , More expensive then the male condom .

❖ Mechanism of action:-
Prevent sperm from gaining access to female reproductive tract .
Prevent micro organism (Sexual Transmitted Disease) from passing
from one partner to another (latex & vinyl condom only)
2)What is the cervical cap?
A cervical cap is a barrier contraception method. It’s a soft rubber
cap with a round rim that fits snugly around the cervix. The only
cervical cap available in the United States is the FemCap, a non-
hormonal, latex-free device made of silicone, a no allergenic,
easy-to-clean material.
 How is it Used?
➢ The cap is placed inside the vagina to cover the cervix. It stays
in place by suction and has a strap to assist its removal. Adding
spermicide to the cap’s rim increases its effectiveness.
➢ The cervical cap blocks the entrance to the uterus; the
spermicide kills and immobilizes the sperm, preventing it from
fertilizing the egg. As with a diaphragm, you have to reapply new
spermicide to the cap each time you have sex.
➢ The cervical cap must be left in place for at least six hours after
last intercourse before removing.
❖ Advantages
1. Can be inserted many hours before sex
2. Comfortable
3. Does not alter the menstrual cycle
4. Does not affect future fertility.
❖ Disadvantages
1. Does not protect against HIV/AIDS
2. Requires a fitting in a clinic
3. Can be difficult to insert or remove
4. Can be dislodged during intercourse

3)What is the sponge and how do I use it?

The sponge is a round device made of soft foam that contains
spermicide. It is inserted into the vagina to cover the cervix and
keeps sperm from entering the uterus. The spermicide also
inactivates sperm. The sponge does not protect against STIs,
including HIV.
The sponge can be put in up to 24 hours before sex and should be
left in place for at least 6 hours after sex. The sponge should be
worn for no longer than 30 hours total. If you have sex again in
this time frame, you do not have to replace the sponge. Throw the
sponge away after use.
The sponge is less effective in women who have given birth. If
you want to use the sponge after having a baby, you should wait 6
weeks after giving birth until the uterus and cervix return to their
normal size.
 ❖ Advantages:
1. Women do not need to get a prescription to use. Available,
safe, cheap. They do not need the husband's cooperation.
2. It can be delivered just before intercourse, or no later than 24
hours.
3. Daily or continuous use does not cause any hormone
disturbance in Madame
❖ Disadvantages:
1. Is not a guaranteed method of contraception, preferably as an
adjuvant, as well as using one of the other contraceptives.
2. It does not protect against sexually transmitted diseases.
3. May cause allergy, and can cause vaginal cataracts.
4) The diaphragm:-
is a reusable rubber or silicone cup that covers the cervix. The
diaphragm is inserted into the vagina with spermicide before sexual
intercourse to prevent pregnancy. The diaphragm is a method of
contraception (fertilization) that prevents sperm from entering the
uterus
❖ Types of diaphragms:
1. Arching spring diaphragm ( Poor vaginal muscle tone
2. Coil spring diaphragm (Average vaginal muscle tone)
3. Flat spring diaphragm (stronge vaginal muscle tone)
4. Wide seal rim diaphragm ( Useful women who are allergic )
❖ Advantage :
1. It has no effect on a woman’s natural hormone
2. It does not affect milk supply if you are breastfeeding.
3. They cost less to use than other birth control methods
4. is not usually felt by either partner
5. gives a woman control on pregnant
 ❖ Disadvantage:-
1.increase the risk of urinary tract infection.
2.cause vaginal burning and irritation from the spermicide.
3.To avoid an increased risk of infection should not be used during
your menstrual period
4.difficulty with insertion
5.the possibility of the diaphragm moving, due to penis size, sexual
position, or heavy thrusting
6.it needs to be inserted before every act of vaginal intercourse

❖ Hormonal methods :-
1/pills:-
Definition:- Kind of medicine with hormones .
There are two types of pills :-
1_ comined pills "contain estrogen,progesterone" the most
common type.
2_ progesterone only pills.
❖ Combined pills
❖ How combined pills prevent pregnancy:-
* Prevent ovaries releasing ova each month "ovulation" ,
thickening mucus in cervix ,so it is harder for sperm to penetrate
uterus reach to ovum .
❖ Use :-
take pills (1) every day for 21 days then have break for 7days
,during this week your period start to come down , you start taking
pills again after 7 days .
❖ Advantages :-
1/ not promanent method , natural fertility of woman restored
once discontinue use of pill.
2/ reduce risk of cancer of ovaries, uterus .
3/reduce risk of fibroid , ovarian cysts.
❖ Disadvantages :-
1/cause temporary side effects at first such as "headache , nausea ,
breast tenderness " .
2/Doesn't protect against sexually transmitted infections.
 ❖ Progesterone only pills
How progesterone only pills prevent pregnancy:-
* Thickening mucus in cervix to stop sperm reach to ovum .
❖ Use :-
Take pill (1) every day with no break between packs of pills .
❖ Advantages:-
1/ can use it when breastfeeding.
2/ can use it at any age .
❖ Disadvantages:-
1/may not have regular periods.
2/ some medicines such as antibiotics make less effective.

❖ 2/injection :-
A quick piece of information that interests the mother and that we
know about bi- and mono-hormonal injections of pregnancy.

1- the contraceptive injecation will be more than 99% effecative .

2- Information of mother <2- the mother takes the contracepative

injecation within one or three months not given other means .

3- is not effected by other medicine the mother has diabeties and

high blood pressure =hypertension or stomach.

❖ Side effects
1. weight gain
2. headache
3. Changes mood
4. Bleeding irregular
❖ Type of the contracepative
1/ Depo prevera
2/ Mesocept
 ❖ Mesocept
❖ Defination
It is an injection of two hormones, estrogen and progesterone,
taken every 28 days in history.
❖ Action
1-Preventing the release of eggs from the ovary, which occurs on
a monthly basis.
2-Makes cervical secretions thick, making it difficult for sperm to
reach the egg through the cervix.
❖ advantages
1. Long term effect.
2. Suitable for the mother who does not remember to take the
contraceptive pill before intercourse.
3. The ovaries prevent the release of eggs and increase mucus around
the uterus.
4. It can be taken up to six months after birth
5. Helps prevent osteoporosis for women.
❖ disadvantages
1- Do not take it while breastfeeding because it affects
breastfeeding.
2-irregular menstruation.
3- Unusual vaginal bleeding.
4-Changes in sexual desire
❖ contradiction
1-Do not take it if you have a family history of breast cancer.
2-Pregnancy.
3-A mother who suffers from herpes after a previous pregnancy.

❖ Depo prevera

❖ Defination
It contains a single hormone, progesterone, and was taken every
three months.

❖ Acation
Helps regulate ovulation, egg release from the ovary, and the
menstrual cycle.
 ❖ Advantages?
1- It can be taken during breast-feeding and does not affect breast
milk.
2- Suitable for the mother who does not remember to take the
contraceptive pill before intercourse.
3-Helps prevent osteoporosis for women.
4-Protects the mother from uterine cancer.
❖ Disadvantage?
1-Less effective than a monthly injection.
2-It leads to the absence of menstruation.
3-Sometimes it causes an ectopic pregnancy.
4-Delayed pregnancy from six months to two years after stopping.
❖ Contrandication?
1-Undiagnosed vaginal bleeding.
2-pregnancy.
3-aboration.
4-Liver dysfunction and liver tumors.
5-hypersensitivity.
3/Contraceptive implant :
❖ Definition ;
- Are along term birth control option for women, is a small ,
flexible rod about the size of a match stick. That’s put under the
skin of the upper arm. It can stay for up to 3 years.

❖ Mechanism of action ;
- A synthetic progestin is released from the implant rod or rods in
a continuous low-dose fashion into the blood. This causes the
following to happen:-
1/ inhibition of ovulation
- Prevent a woman’s eggs from being released from her ovaries.

2/Action upon cervical mucus

- Thick the mucus in cervix so sperm can’t enter uterus and so
inhibits fertilization on oocyte.
 3/ Action Upon Endometrium
- Very low progesterone levels prevent normal endometrial
maturation, causing it to remain thin and poorly vascularized. This
renders it hostile to implantation, even if fertilization occurs.

❖ Advantage:-
1/ it is 99.95% effective.
2/ it lasts for up to 3 years.
3/ your fertility returns to normal as soon as it is taken out.
4/it is a cost-effective type of contraception.
5/ some women have very light bleeding or no bleeding at all
when the implant is in place.
6/ it usually makes periods less painful.
7/ it is safe to use when breastfeeding.
8/ it can be used by most women who cannot use contraception
that has oestrogen in it.

❖ Disadvantage ;
1_ it doesn't protect against sexually transmissible infections
(STIs)
2_ will change your normal monthly period - you may have:
-no bleeding at all
- light bleeding occasionally
- light bleeding often
- heavy bleeding occasionally
- heavy bleeding often
3_ it needs a small procedure to put in and take out
4_ it can cause bruising on your arm when first put in
5_ it can have hormonal side-effects including:
-headache.
-nausea or bloating.
-breast tenderness.
-acne.
-mood changes.
-lowered interest in sex.
 4/Vaginal Ring :-

❖ Definition of vaginal ring :-

▪ is a small soft, plastic ring that you place inside your vagina.It
releases a continuous dose of the hormones oestrogen and
progestogen into the bloodstream to prevent pregnancy.
❖ Action of vaginal ring:-
▪ The ring steadily releases the hormones oestrogen and progestogen
into your bloodstream, which prevents the release of an egg each
month.
▪ It also thickens the cervical mucus, which makes it more difficult
for sperm to move through the cervix, and thins the lining of the
womb so a fertilized egg is less likely to implant itself.

❖ Contraindication:-
1. Sever obesity.
2. blood clot in a vein or artery.
3. Over weight.
4. Over 35 years old.
5. Breast feeding infant less six months.
6. have diabetes or hypertension.
7. History breast cancer ,hepatitis ,vaginal bleeding.
8. Smoking.
❖ Advantages of vaginal ring:-
1. Lower occurrence of ectopic pregnancy
2. lower risk of irregular bleeding
3. lower risk Ovarian cancer and endometrial cancer breast disease
4. Improved Dysmenorrhea
5. reduced The risk of ovarian cysts
❖ disadvantages of vaginal ring:-
1. No protection sexually transmitted infections
2. May have nausea, diarrhea and vomiting.
3. May have vaginal bleeding
4. May have pain breast
5. Increases vaginal secretion.
❖ mechanical method:-
❖ Definition of Hormonal IUD
The hormonal IUD is a small, T-shaped, plastic device, sold as
Mirena™ in Australia. It slowly releases a hormone (progestogen)
into your uterus. Progestogen is like the hormone produced by the
ovaries.
❖ Advantages of the hormonal IUD including
1. Reduce The risk of pelvic infection .
2. Can be removed at any time, followed by a quick return to your
normal fertility .
3. Doesn't require partner participation .
4. Can remain in place for up to five years.
5. Decrease menstrual bleeding .
❖ Disadvantages of Hormonal IUD
1. some users have cramping but usually disappear after a few
days.
2. Sometimes the IUD can come out, This is more common in the
first 3 months of it being inserted.
 3. irregular bleeding, but can improve after six months of use.
4. Some users may experience tender breasts, headaches, skin
changes and mood changes.
❖ Contraindications
1. Breast cancer, or have had it .
2. Uterine or cervical cancer.
3. Liver disease .
4. Uterine abnormalities, such as fibroids, that interfere with the
placement.
5. current inflammatory diseases.

❖ What is an IUD?
An intrauterine device (IUD) is a small contraceptive device that is
put into the uterus (womb) to prevent pregnancy. The 2 types
available in Australia are the copper IUD and the hormonal IUD
(MirenaTM). The copper IUD is designed to stay in place for up to
10 years and the hormonal IUD (Mirena) for 5 years. Both can easily
be removed sooner, if needed.
❖ Copper IUD:-
The copper IUD is a small, T-shaped, plastic and copper device. It
constantly releases a small amount of copper into the uterus. The
copper IUD can also be used for emergency contraception within five
days of unprotected sex. instead of the emergency contraceptive pill
(‘morning after pill’).
1. Mechanism of action:-
The copper IUD's primary mechanism of action is to prevent
fertilization.
 Both the progesterone IUD and copper IUD prevent pregnancy in one
of two ways:-
1.The released progesterone or copper creates changes in the cervical
mucus and inside the uterus that kills sperm or makes them
immobile( act as a spermicide).
2. The IUD changes the lining of the uterus, preventing implantation
should fertilization occur. It is important to consider the ethical
implications of this third method.
❖ Advantages of IUDs:
1.They are more than 99% effective in preventing pregnancy.
2.They last for a long time – Mirena can last for 5 years, and the
copper IUD can last for 10 years.
3.They are safe to use if you are breastfeeding.
4.No medications stop them from working.
5.The device can be taken out at any time by an appropriately trained
doctor or nurse.
6.Your chance of getting pregnant will go back to normal as soon as
the copper or hormonal IUD has been taken out.
7.No hormones: Copper IUDs are safe even for people who cannot
use hormonal birth control.
Disadvantages 5.Heavier periods
1.Expulsion 6.Irregular bleeding and
spotting
2.Perforation
7.Pregnancy
3.Infection
8.IUDs do not prevent sexually
4.Cramping transmitted infections (STIs).
 ❖ Contraindications:-
Women should not use a copper IUD if they:
1.May be pregnant.
2.Have certain uterine abnormalities.
3.Have benign or malignant gestational trophoblastic disease.
4.Have or may have an STI.
5.Have or may have had a pelvic infection within the past three
months.
6.Have pelvic tuberculosis.
7.Having a septic pregnancy or abortion.
8.Have a history of cancer in the uterus or cervix.
9.Have unexplained vaginal bleeding.
10.Have pelvic inflammatory disease.
11.Have a history of ectopic pregnancy.
12.Have Gonorrhea or Chlamydia.
❖ Surgical methods:- Tubal ligation ( Female sterilization)
❖ What is it and how it works:-
Tubal ligation is a permanent method of contraception in which the
fallopian tubes are closed so that the ovum can't travel through them
to meet the sperm . The tubes are surgically closed with bands,
clips,electro - cautery or by cutting and tying.
❖ Advantages :-
Highly effective method requires a single procedure and no
subsequent risks .
 ❖ Disadvantages :-
1. complications are rare but sometimes bleeding , infection,
injury to other organs and complications from anaesthesia .
2. Tubal ligation is permanent and difficult to reverse .
3. Tubal ligation doesn't protect against STIs .
❖ Vasectomy :-
It is a permanent surgical method in which the vas deferens which
carries a man's sperm from the scrotum to the urethraduring
ejaculation is cutted . This operation keeps sperm from mixing into
the semen when men ejaculate . After vasectomy, sperm can't move
out of the tests.
❖ Advantages :-
1. Very effective .
2. No interference with sex , doesn't effect a man's ability to have
sex and doesn't effect a hormone levels .
❖ Disadvantages :-
1. a vasectomy can't be easily reversed .
2. Using contraception after the operation until tests show your
semen is free of sperms .
3. Possible complications include a collection of blood inside the
scrotum (haematoma), hard lumps called sperm granulomas
(caused by sperm leaking from the tubes), an infection, or long-
term testicle pain (you may need further surgery ) Vasectomy
doesn't protect against STIs, so you may need to use condoms
as well.
4. Vasectomy doesn't protect against STIs, so you may need to use
condoms as well.
❖ Family planning counselling — (the GATHER
approach):-
(G) Greet the client respectfully.
(A) Ask them about their family planning needs.
(T) Tell them about different contraceptive options and methods.
(H ) Help them to make decisions about choices of methods.
(E) Explain and demonstrate how to use the methods.
(R ) Return/refe:- schedule and carry out a return visit and follow up.