Family welfare:

Introduction:

Definition: According to WHO “family welfare means married couple follows one of the family
planning methods on their own by following the family planning method, they improve their
own health, thereby improving national health”.

Human development can be viewed as the process of achieving an optimum level of health and
well-being. It includes physical, biological, mental, emotional, social, educational, economic,
and cultural components.

There is an improvement in the overall health of workers automatically raises the national
output. According to World Development Report (1993), “improved health contributes to
economic growth in four ways: it reduces production losses caused by worker illness, it permits
the use of natural resources that had been totally or nearly inaccessible because of disease, it
increases the enrolment of children in schools and makes them better able to learn, and it frees
for alternative uses resources that would otherwise have to be spent on treating illness. The
economic gains are relatively greater for poor people, who are typically most handicapped by ill
health and who stand to gain the most from the development of underutilised natural resources”.

The main focus of this paper is on ‘health’ that is very critically linked with family welfare.
Both of these are important components of the Human Development Index (HDI) that was first
introduced by the United Nations Development Programme (UNDP) In 1990, and ever since
then it has been enlarged and refined in terms of the changing world scenario in all the spheres
that matter in the given context. Many new indices like, Gender-Related Development Index
(GDI), Gender Empowerment Measure (GEM), and Human Poverty Index (HPI) have been
formulated.

The criteria that have been used to evolve the concept of Human Development Index are very
well described below:

1.  It includes many more human choices (relating to long and healthy life, acquisition of
knowledge, quality of life, pollution-free environment, gainful employment, peaceful community
life, and so on) than only income (as in the case of Gross National Product);

2.  It is simple and manageable in terms of the limited number of variables and proxy variables
used in its computation;
3. It is based on a composite index rather than many indices. (This initially posed the problem of
a common denominator, which was sorted out by introducing a scale between 0 and 1, indicating
the actual progress in each indicator as relative distance from a desirable goal);

4.  It covers both economic and social choices (on the basis that both move hand in hand) by
incorporating appropriate indicators.
 
In terms of the HDI, India is one of the lowest countries in the whole world. But in recent years,
there appears to be a marginal improvement in HDI in the context of India.

But, reality comes to the forefront when we look at the widespread deprivation and hardship,
starvation deaths in the midst of plenty, unsafe environment, deteriorating public culture, limited
and ineffective health facilities, poor infrastructure, deteriorating performances on a number of
critical social indices like, the infant mortality rates, and safety hazards. The reason is that our
political process has largely failed to deliver the basic social needs. We have, therefore, to shed
our complacency, and we have to recognise the current euphoria about economic liberalisation.
Market forces, no matter how efficiently they work, cannot alone tackle the issues involved. The
State has to perform its basic role in the areas of social and human development.

Health and Family Welfare are assessed in terms of the number of registered medical
practitioners, and the availability of hospital beds per 10,000 of population, the data for which
are available for limited years. It is seen that over the years the medical facilities have steadily
improved both in terms of the availability of medical practitioners and hospital beds. As
compared to 1950-51, the number of registered medical practitioners per 10,000 of population
has increased, though marginally, over the years. The same is the case with hospital beds per
10,000 of population.

Although the availability of these facilities shows an upward trend, yet these facilities,
considered in absolute sense, are extremely meager and even negligible in a country with a
massive population. An important point to remember is that illness care is not much of the
responsibility of the State in India. A large proportion of people pay directly for the curative
services which are delivered to them either by private sector physicians of western medicine, or
by a large number of practitioners of indigenous and other systems. The provision of preventive
and promotive health care services (which also include, to some extent, suitable housing,
sanitation, safe drinking water etc.) is, however, the responsibility of the State. Some of the well-
meaning health programmes the Government has launched so far is briefly mentioned below:
 
 An extensive net work of Primary Health Centers and Sub-Centers opened under the
Minimum Needs Programme;
 Community Health Worker Scheme ( later called Village Health Guide) of the Seventies;
  The policy measures to integrate practitioners of traditional medicine into primary health
care as contained in the National Health Policy of 1982;
 The Programme of Urban Basic Services (UBS) of the urban slums introduced in the
early eighties;
 Signing of Alma Ata Declaration on ‘Health for All’ by the year 2000 which led to the
National Health Policy Statement of 1982;
 Launching of a number of disease-specific programmes to contribute to the health and
productivity of the poor;
 Establishment of a National Illness Assistance Fund to achieve the objective of ‘ Health
for Under Privileged’;
 Launching of the National Surveillance Programme for Communicable Diseases;
 Launching of the Mental Health Programme;
 Development of rural health infrastructure under the Minimum Needs Programme;
 Launching of The Central Government Health Scheme (CGHS);
 The Major National Health Programmes aimed at prevention, control and eradication of
communicable and non- communicable diseases should be made more effective.
 National Surveillance Programme for Communicable Diseases;

There is no end to such schemes, but the final effects of these schemes never reach the people for
whom these are meant. There is a complete absence of the percolating effect. All this is due to
poor governance and lack of complete bureaucratic control.

Besides the schemes that have been mentioned above, the Government should also look at the
following:
 Provision of compulsory medical insurance supported fully by the Government,
especially for the poor and low income classes;
 Extension of medical hospitals all over;
 Reducing the prices of life-saving medicines.

Tackling the major nutritional problems in India are Protein Energy Malnutrition (PEM), Iodine
Deficiency Disorders (IDD), Vitamin A Deficiency (VAD) and Anemia.

We must remember that good health is the ultimate objective in life. Once there is good health,
other things being given, it leads to the overall well-being of the family/household/ and also of
the society.

The welfare concepts:

The welfare concept of welfare is vary comprehensive and is basically related to quality of life.
The family welfare programme aims at achieving a higher end-that is, to improve the quality of
life of the people.

Small-family norm:

Small family small differences in the family size will make big differences in the birth rate. The
difference of only one child per family over a decade will has a tremendous impact on the
population growth.

The objective of the family welfare programme in India is that people should adopt the
“small family norms” to stabilize the country’s population at the level of some 1533 million by
the year 2050 AD. Symbolized by the inverted red triangle the programme initially adopted the
model of the 3-child family. In the 1970’s the slogan was the famous DO YA Teen Bas. In view
of the seriousness of the situation, the 1980’s campaigning as advocated the 2-child norms. The
current emphasis is on three themes: “sons or daughters-two will do”; “second child after 3
years”, and “universal Immunization”.

A significant achievement of the family welfare programme in India has been the decline in the
fertility rate from 6.4 in the 1950s to 2.8 in 2006. The national target was to achieve a net
reproduction rate of 1 by the year 2006, which is equivalent to attaining approximately the 2-
child norm. All efforts are being made through mass communication that the concept of small
family norm is accepted, adopted and woven into lifestyle of the people.

Eligible Couples:

An eligible couple refers to a currently married couple where in the wife is in the reproduction
age. There will be at least 150 to 180 eligible couples per 1000 population in India.

Target Couples:

Target couples are the couples who have 2-3 living children and have not adopted any family
planning method. The definition has gradually enlarged to include families with one child and
even newly married couples.

Couple Protection Rate (CPR):

CPR is an indicator of the prevalence of family planning practice in a community. It is defined as

the percentage of eligible couples effectively protected against childbirth by one or the other
approved methods of family planning.
India was the first country in the world to implement family welfare programme on national
wide basis by the Government itself. However, it was only during third five year plan that family
welfare programme received more priority in the health schemes of the country. According to
Indian Constitution, Family welfare programme is a 'State Subject' but for proper coordination it
is a centrally sponsored item.

Health aspects of family planning:

Family planning and health have a two-way relationship. The principle health outcome of family
planning were listed and discussed by a WHO scientific group on the health aspects of family
planning.

A. Women’s health:
Pregnancy can mean serious problems for many women’s. It may damage the mother
health or even endanger her life. in mother risk of dying as a result of pregnancy is 10-20
times. The risk increases as the mother grows older and after she has had 3 or 4 children.
Family planning by intervening in the reproductive cycle of women helps them to control
the number, interval and timing of pregnancies and births and there by reduces maternal
mortality and morbidity and improves health.
I. Unwanted pregnancies:
The essential aim of family planning is to prevent the unwanted pregnancies. An
unwanted pregnancy may lead to an induced abortion. From the point of view health,
abortion outside the medical setting (criminal abortion) is one of the most dangers
consequences of unwanted pregnancies.
II. Limiting the number of births and proper spacing:
Repeated pregnancies increase the risk of maternal mortality and morbidity.
These risks rise with each pregnancy beyond the third, and increase significantly
with each pregnancy beyond the fifth. The incidence of rupture of the uterus and
uterine atony increases with parity as does the incidence of toxemia, eclampsia
and placenta previa.
III. Timing of births:
Generally mothers face the greater risk of dying below the age of 20 and above,
the age of 30-35.
B. Fetal health:
The number of congenital anomalies ( e.g. down syndrome) are associated with
advancing maternal age. Such congenital anomalies can be avoided by timing the births
in relation to the mother’s age. Fathers, the “qulitity”of population can be improved only
by avoiding completely unwanted births. In the parent state of our knowledge, it is very
difficult to wait the overall genetic effect of family planning.
C. Children health:
 I. Child mortality: it is well known that child mortality increases when pregnancies
occur in succession. A birth interval of 2-3 is considered desirable to reduce child
mortality.
II. Child growth, development and nutrition: birth spacing and family size are
important factors in Child growth and development. The child should receive his
full share of love and care, including nutrition needs, when the family size is
small and births properly spaced.
III. Infectious diseases: children living in large-sized families have an increases
infection, especially infectious gastroenteritis, respiratory and skin infections.

The National Family Welfare Programme has four components,

(1) Administration and Organization which includes recruitment of staff, getting

equipment and supplies.
(2) Training-Medical, paramedical- and social workers in this field.
(3) Social and Health Education.
(4) Supplies and Services.

ADMINISTRATION FAMILY WELFARE PROGRAMME IN INDIA:

Centre provides 100% assistance to State Governments for service and educational purposes
towards family planning schemes. The central government controls the planning and financial
management of the programme, training, research and evaluation. A Population Advisory
Council headed by the Union Minister of Health and members of parliament and persons
related to the field of population was set up in 1982. During the second plan period, family
planning bureaus were established in every state at its headquarters with an Additional Director
of Health Services and Family Planning to direct the programme. One Family Welfare
Cell is set up for each state as a link between the State and Central Government. At the District
level, since 1963, there are District Family Planning bureaus under the Charge of District Family
Welfare Officers with facilities for publicity services, sterilization and for the Intra
Uterine Contraceptive application.
The District Family Welfare staff consists of:

District Family Welfare Officer 1

Medical Officers 2

Extension educator 2

Information Officer 1

Statistician 1

Administrative Officer 1

Clerk/Ancillary staff 1

Urban family welfare centers are being reorganized and have been established according to the
population. The urban areas have been categorized into 4 types of Health Posts. At present there
are 1499 urban family welfare centers in the country. In rural areas, family planning programme
has been integrated along with maternal and child health service programme of the existing
health care infrastructure i.e. primary health centre. As mentioned in the earlier chapter,
additional staff has been added to carry on family planning work in primary health centers.
 CENTRAL

CENTRAL MINISTER OF HEALTH AND FAMILY WELFARE

SECRETARY OF HEALTH AND FAMILY WELFARE

DEPARTMENT OF FAMILY WELFARE SPECIAL SECRETARY

SECRETAREAL WING TECHNICAL WING

JOINT SECRETARY COMMISSIONER

Additional Add. Add Add.Sec. Field Add, Sec Add. Sec... Add. Add.

Secretary Sec. Sec. Organized MCH Mass Supply& Sec. Sec.

Policy Aided Plan Operational Media and IntelligenceEvaluation&Research

DivisionProgram Budget media and Transport Education Extension

Division Sector Commu- Division Division

Nication
 STATE LEVEL

STATE MINISTRY OF HEALTH AND FAMILY WELFARE

ADDITIONAL DIRECTOR OF HEALTH AND FAMILY PLANNING

STATE FAMILY WELFARE BUREAU

JOINT DIRECTOR

Deputy Deputy Deputy Deputy Deputy Deputy

Director Director Director Director Director Director

Programme Media Wing MCH Wing Demographic & Training Administrative

Wing Evaluation Wing Wing

Wing

The organization for the operation of family planning programmes at the Centre, State and
District level
 DISTRICT LEVEL

DISTRICT COLLECTOR

DISTRICT FAMILY WELFARE BUREAU

Administrative Mass Education and Evaluation Division

Division Media Division Statistical Officer

District Family District Mass

Welfare Officer Education and

Media Officer

The Christian Medical Association of India has a very intensive family planning programme
operated through various mission hospitals in the country. This family planning project of
CM.A.I. Assists mission hospitals in the training of the health personnel, e.g. organizing periodic
workshops on family planning. Also it helps in supplying the units with necessary financial aid
to conduct vasectomies, puerperal and non-puerperal sterilization's, administering oral pills etc.

It is relevant to mention now about the recent introduction of postpartum programme in India in
1970, through medical institutions. The aim of this programme is to intensify or initiate family
planning activity in large hospitals, on women from the time they book themselves for delivery
in that hospital. During this time efforts are made to educate and motivate the mother and at the
time of 4-6 weeks after delivery to give postnatal check up. At this time, the mothers are
persuaded to adopt either one of the suitable birth control methods to avoid another pregnancy.

Family Welfare Programmes:

 
India, the largest democratic republic in the world, possesses 2.4% of the world’s land area and
supports 16% of the world population. It is the second most populous country after China. Every
year it adds about 16 million people to its large base of population.
 
Massive implication of rapid population growth had already diluted much of benefits of our
substantial economic growth since independence which made it obligatory to adopt a policy of
Family Planning. India is the first developing country in the world to have a Family Planning
Programme.
 
Family Welfare Activities 2002-03 to 2006-07:
 
 
  Method 2002-03 2003-04 2004-05 2005-06 2006-07
  Vasectomy 16 21 17 19 24
Tubectomy 12273 12524 11915 10194 10459
I.U.D 4075 3737 3150 3628 3506
Oral Pills 1356 1758 1584 1871 1743
C.C (Condoms) 8066 10526 10379 9934 10575
M.T.P 1486 1322 1683 1996 1726
Institutional Deliveries 27290 28286 27978 26170 *46864
Home Deliveries 447 308 185 85 116
Reduction in fertility, mortality and population growth rates is major objectives of the 10th Plan.
The focus will be on improving accesses to services to meet the health care needs of the women
in reproductive age group and of children below the age of 5 years and also to provide
contraceptives and spacing services to the desired people. The main objective is reducing the
birth rate to the extent necessary to stabilize the population at a level consistent with the needs of
National development.
 
Crude Birth Rate Crude Death Rate Infant Mortality Rate
Year
All India Pondicherry All India Pondicherry All India Pondicherry
2001 25.4 17.9 8.4 7.0 66.0 22.0
2002 25.0 17.9 8.1 6.7 63.0 22.0
2003 24.8 17.5 8.0 6.3 60.0 24.0
2004 24.1 17.0 7.5 8.0 58.0 24.0
2005 23.8 16.2 7.6 7.1 58.0 28.0
Pre-Natal Diagnostic Techniques (PNDT):
 
With a view to improve the declining sex ratio (Number of females per thousand males) and for
containing the menace of female feoticide the Government has brought into force the Pre-natal
Diagnostic Techniques (Regulation and prevention of Misuse) Act, 1994 (PNDT Act) with effect
from 1.1.1996. PNDT Act is being implemented in the U.T. with the direction of the Supreme
Court. Under the Act, 36 Genetic clinics are functioning in the U.T. with the approval of
Appropriate Authority/ Director of Health and Family Welfare Services. The Deputy Director
(FW&MCH) is the Nodal officer for the implementation of this Act in the U.T.
 
Under the PNDT Act, a Central Supervisory Board has been constituted under the Chairmanship
of Minister of Health and Family Welfare. Appropriate Authorities and Advisory Committees
have been constituted in all States and Union Territories for implementation of PNDT Act.

Family planning:
Definition:
An expert committee (1971) of the WHO defined family planning “as a way of thinking and
living that is adopted voluntarily, up on the basis of knowledge, attitudes and responsible
decisions by individuals, couples, in order to promote the health and welfare of the family group
and thus contribute effectively to the social development of a country”.

Family planning refers to practice that help individual or couples to attain certain

objectives:

a) To avoid unwanted baths

b) To bring about unwanted births
c) To regulate the intervals between pregnancies
d) To control the at which births occur in relation to the age of parent’, and
e) To determine the number of children in the family.

Scope of family planning services:

1. The proper spacing and limitation of births,

2. Advice on sterility,
3. Education for parenthood,
4. Sex education,
5. Screening for pathological condition related to the reproductive system (e.g. cervical
cancer),
6. Genetic counseling
7. Premarital consultation and examinination
8. Carrying out pregnancy test
9. Marriage council ling
10. The preparation of couples for the arrival of their first child
 11. Providing services for un married mothers,
12. Teaching home economics and nutrition, and
13. Providing adoption services

Family planning methods:

CONTRACEPTIVE MOTHODS:

Contraceptive methods are by definition, preventive methods to help women avoid unwanted
pregnancies. They include all temporary and permanent measures to prevent pregnancy resulting
from coitus.

The last few year have witnessed a contraceptive revolution, that is, man trying to interfere with
the ovulation cycle.

The contraceptive methods may be broadly grouped into two classes- spacing methods and
terminal methods, as shown below
 1. SPACING METHODS

I. Barrier methods

(a) Physical methods

(b) Chemical methods

(c) Combined methods

II. Intra-uterine devices

III. Hormonal methods

IV. Post-conceptional methods

V. Miscellaneous

2. TERMINAL METHODS

1. Male sterilization

2. Female sterilization

Barrier methods:

A variety of barrier or occlusive methods, suitable for both men and women are available.

The aim is: to prevent live sperm from meeting the aim ovum.

Advantages include protection from

 sexually transmitted diseases,

 a reduce in the incidence of pelvic inflammatory diseases

 protection from the risk of cervical cancer

These methods require a high degree of motivation on the part of the user.

a. PHYSICAL METHODS:

CONDOM:

Condoms are made of thin strong rubber and are meant to be used by men. If utilized properly it
is fairly reliable. It is very inexpensive. Condoms are freely available in India through
Government Agency. Condoms are about 95% effective. Condoms are manufactured in India
and this prevents conception by avoiding the deposition of semen in the vagina. Condoms should
be free from any tear or leak. It can be used only once. Whether physiological and psychological
satisfaction is reached by the couples who use condoms is still a major question?

FEMALE CONDOM:

It is a pouch made of polyurethane, which lines in vagina. An internal ring in the close end of the
pouch covers the cervix and an external ring remains outside the vagina.

I. DIAPHRAM:

Diaphragms are a soft latex rubber cup shaped object that is inserted into the vagina so that they
fit over the cervix. Diaphragms stop sperm from getting into the cervix. The diaphragm needs to
be sized and fitted by a doctor. It is recommended that the diaphragm is used with spermicide but
studies have shown using spermcide does not significantly increase effectiveness.

Advantages are:

 Can be inserted in advance

 reusable
 can be used during period
 controlled by woman
 95% effective if used correctly
 Does not interfere with body’s natural hormonal system.

Disadvantages:

 the diaphragm can move about during sex which means sperm can enter cervix
 need to get used to inserting it
 leaving diaphragm in for too long (over 24 hours) can increase risk of infection
 have to be fitted by doctor
 does not protect against STD's

II. VAGINAL SPONGE:

 Another barrier device employed for hundreds of years is the sponge. The purpose
of preventing contraception. It is a polyurethane foam sponge measuring 5cm x
2.5cm. Saturated with the sperimicide, nonxynol-9. It is less effective than the
diaphragm. The failure rate is in parous women-20 to 40/100 women-years, in
nulliparous women about 9-20/100 women-years.

b. CHEMICAL METHODS:

In the 1960s, before the advent of IUDs and oral contraceptives, spermicidal (vaginal
chemical contraceptives) were used widely. They comprise four categories

a) Foams: form tablets, foam aerosols

b) Creams, jellies and pastes – squeezed from a tube

c) Suppositories – inserted manually

d) Soluble films – C – film inserted manually

The main drawbacks of spermicides are: (a) they have a high failure rate (b) they must be
used almost immediately before intercourse and repeated before each sex act (c) they must be
introduced into those regions or the vagina where sperms are likely to be deposited, and (d) they
may cause mild burning or irritation, besides messiness. They are best used in conjunction with
barrier methods.

INTRA-UTERINE DEVICES

TYPES OF IUD:

There are two basic types of IUD: non-medicated and medicated. Both are usually made of
polyethylene or other polymers; in addition, the medicated or bioactive IUDS release either
metal ions (copper) or hormones (progestogens)

The non – medicated or inert IUDs are often referred to as first generation IUDs. The copper
IUDs comprise the second and the hormone-releasing IUDs the third generation IUDs. The
medicated IUDs were developed to reduce the incidence of side-effects and to increase the
contraceptive effectiveness. However, they are more expensive and must be changed after a
certain time to maintain their effectiveness.

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, and bows. Of all the models, the lippes loop is the best known and commonly used device
in the developing countries.

Lippes loop:

Lippes loop is double-S shaped device made of polyethylene, a plastics material that is non-
toxic, non-tissue reactive and extremely durable. It contains a small amount of barium sulphate
to allow X-ray observation. The loop has attached threads or “tail made of fine nylon, which
project into the vagina after insertion. The tail can be easily felt and is a reassurance to the user
that the loop is in its place. The tail also makes it easy to remove the loop when desired. Side-
effects such as pain and bleeding. The larger loops (C and D) are more suitable for multiparous
women.

SECOND GENERATION IUDs:

It 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. It was found that metallic copper had a
strong anti-fertility effect. The addition of copper has made it possible to develop smaller devices
which are easier to fit, even in nulliparous women. A number of copper bearing devices are now
commercially available:

Advantages of copper devices

- Low expulsion rate

- Lower incidence of side-effects, e.g., pain and bleeding

- Easier to fit even in nulliparous women

- Better tolerated by nullipara

- Increased contraceptive effectiveness

- Effective as post-coital contraceptives, if inserted within 3-5 days of unprotected-

intercourse.

The copper bearing devices introduced recently are -

(i) TCU -220 C

(ii) TCU380 A or 4g
(iii) Nova T
(iv) Multi load devices
Copper devices have become very popular in India accounting for 99.7 percent of the
total IUD insertions.

An I.U.D. can be changed anywhere from 18 months to 24 months and also, depending on the
women's side effects and their convenience.

Process of application:

1. The IUD and the inserter to be sterilized.

2. To be done by physician nurse or Multipurpose Health Worker.
3. Can be inserted at any time during the menstrual cycle. Usually insertion is done 3rd to 7th day
of the cycle or 6th week after delivery.
4. In some cases 10 days after delivery or prior to leaving the hospital.
ADVANTAGES OF IUD:

 Simplicity, i.e., no complex procedures are involved in insertion; no

hospitalization is required.

 Insertion takes only a few minutes.

 Once inserted IUD stays in place as long as required.

 Inexpensive.

 Contraceptive effect is reversible by removal of IUD

 Virtually free of systemic metabolic side-effects associated with hormonal pills

 Highest continuation rate, and

 There is no need for the continual motivation required to take a pill daily or to use
a barrier method consistently

CONTRAINCATIONS:

ABSOLUTE:

 Suspected pregnancy

 Pelvic inflammatory disease

 Vaginal bleeding un diagnosed

 Etiology
  Cancer of the cervix, uterus or adnexia and other pelvic tumors

 Revise ectopic pregnancy

RELATIVE:

 ANEAMIA

 Menorrhagia

 History of PID since last pregnancy

 Petulant cervical discharge

 Distortion of the uterine cavity due to congenital malformations, fibroids.

 Unmotivated person

Timing of insertion:

The most propitious time for loop insertion is during menstruation or within 10 days of begin of
a menstrual period. The IUD insertion can also be taken up during the 1st week after delivery
before the women leaves the hospital. Special care is required with insertions during the 1st week
after delivery because of the greater risk of preparation during this time. Further immediate post-
partum insertion in associated with a high explosion rate. But IUD insertion immediately after a
second trimester abortion is not recommended since there is a risk of an infection.

SIDE EFFECTS AND COMPLICATIONS OF IUDs:

 Bleeding

 Pain

 Pelvic infection

 Uterine perforation

 Pregnancy

 Ectopic pregnancy

 Expulsion

 Fertility after removal

 Cancer and teratogenesis

  Mortality

Hormonal contraception:

Hormonal contraception is widely classified as

1. Oral pills

 Combined pill

 Progesterone only pill

 Post-coital pill

 Once-a-month pill

 Male pill

Action:

(1) To prevent the release of a ripe egg, i.e., to prevent ovulation.

(2) Acts on cervical mucosa and makes it strong there by it is impossible for the sperm to
penetrate it. Hence sperm cannot pass into the womb and tubes for fertilization.
(3) They produce changes in endometrium that tend to prevent implantation, so that
endometrium is not adequately prepared to receive a fertilized ovum.

Method of use;

One pill a day should be taken. The pill should be taken from the 5 th day, counting from the day
of menstruation and continued till the 21st day. This procedure has to be followed regularly.

A doctor's prescription is needed for the pills for various reasons as there are contraindications
like:

(a) Disease of the liver.

(b) Cancer of the breast or reproductive organs.

(c) Varicose veins.

(d) Asthma, eczema.

So the pill has to be taken only after medical check-up.

The pill may have side effects like, Nausea, headache, swelling of breasts etc.

Other functions of pill;

(1) Many infertile women have become pregnant soon after discontinuing birth control tablets.
(2) Women who had repeated miscarriages were able to carry their babies through pregnancy
when put on oral pill.
(3) Those whose menstrual cycle was irregular became regular when given synthetic hormones.

This oral pill is more suitable for educated women and those who have enough income to
purchase pills.

2. Depot formulations

 Injectables like DMPA, NET-EN, DMPA-SC

 Injectables contraceptives are of two types. Progestogen only Injectables and

combined injectables.Two hormonal contraceptive based on progestogen are used
that are DMPA (Depot-medroxy progesterone acetate) and Net-EN (norethisterm
emanate), that primarily exert effects by pressing ovulation. Both DMPAand
NET-EN give by deep intramuscular injection into the gluteus maximum in a dose
150 mg every three month 200 mg every 60 days respectively. The initial
injection of both should be given during the first five days of menstrual
cycle.DMPA is more effective in preventing unwanted pregnency.DMPA is
effective for three months in 99% women however the adverse effect is that it
may reduce fertility among women.

 Combined inject able contraceptive are given at monthly interval plus or minus
three days. They contain a progestogen and estrogen.
 Sub dermal Implants:

The population council New York has developed a sub dermal implant called
Norplant for long term contraception. 6 silastic (Silicon rubber) capsules which
contain progesterone are implanted sub dermally. The hormone is slowly released
in very small amounts. Each capsule contains 35 mgm of levonorgestrel. A more
 recent device consists of 2 small rods inserted in the fore arm. It provides
effective contraception for over 5 years.

 Vaginal rings :

This is another device that is being studied. In this new approach the vaginal rings
contain norgestrel which releases slowly the estrogen in vagina that observed
vaginal mucousa which facilitates in the prevention of conception by acting on the
sperms. With simple education a women can introduce this device by her and
remove it. This is still under investigation but in a few years' time it will be
available for the public.

The Indian Council of Medical Research is conducting clinical trials on a post

coital non steroidal oral pill namely CENTCHROMAIMS. This drug is
manufactured in Luck now, U.P. at Central Drug Research Institute. The dosage is
60 mg post coitus or 120 mg given once a week.

POST CONCEPTIONAL METHODS:

MENSTRUAL REGULATION:

Loosely called very early abortion is a simple procedure done before the pregnancy test can even
determine pregnancy at 6 to 14 days of a missed period where contents of uterine are aspirated.
Complications can be uterine perforation, menstrual disorder & infertility.

Women who missed their regular menstrual period and who strongly suspect that they are
pregnant but cannot or do not want to wait for the results of a pregnancy test can ask a
gynecologist for a simple procedure called variously menstrual regulation (MR), menstrual
aspiration, or menstrual extraction. Since there may not be an actual pregnancy to terminate,
this procedure is available even in some countries that prohibit abortions. It is mostly designed to
till the gap between "foresight contraception" and "hindsight abortion." The procedure is similar
to the one used for inserting intra-uterine devices (lUDs). Just as in the case of an IUD insertion,
the doctor inserts a small tube through the cervix into the uterus. However, instead of depositing
the IUD through the tube, he applies a vacuum at one of its ends, thus pulling out (i.e.,
"aspirating" or "extracting") the lining of the uterus which would normally be shed in
menstruation. The procedure takes only a few minutes and can easily be performed in a doctor's
office.

Menstrual induction: Prostaglandin F2 is applied intrauterinaly to disturb the normal

progesterone -prostaglandin balance that causes contraction of uterus, bleeding starts and
remains continuous for 7 to 8 days.

ABORTION:

Abortion or Termination of pregnancy:

Abortion: is another method of birth control and to terminate pregnancy Abortion can be
spontaneous or of Induced type. Abortion is generally considered termination of pregnancy at 28
weeks of gestation when the fetus normally weighs 1000 g .Studies show that the optimal time of
termination of pregnancy is 7th and 8th week of gestation.

This is another recent addition to the birth control measures in India. It is a method where some
steps are taken after pregnancy occurs; whereas in other methods, measures are undertaken
before conception takes place. Abortion is defined as termination of pregnancy before the lapse
of 28 weeks after conceiving. When adopted as a population control measure, it is confined to
the first 12 weeks of pregnancy. Abortions are either spontaneous or induced. In India, induced
abortions are commonly carried out with the help of indigenous dais illegally; nearly 6.5 million
abortions take place annually, out of which 3.9 million are induced. Studies at Khanna, Punjab
have showed that the abortions rate is about 10% of the confirmed pregnancies. An eight year
study at Lady Harding Medical College, New Delhi indicates that in 1962 there were 318
abortions per 1000 pregnancies. Therefore in view of these conditions the need for legalizing
abortions has risen in India. In Hungary, the legal abortions exceed live births. Many countries
have adopted this method widely and have reduced their birth rates. In Japan, the birth rate was
30 per 1000 live births in 1947 and by 1957 it came down to 17 per 1000 mostly due to abortion
procedure and partly with other methods. It is estimated that worldwide the abortion ratio is 260-
450 per 1000 live births. In India it is computed that about 6 million abortions occur every year
of which 4 million are induced.
The ‘Medical Termination of pregnancy Bill was passed by the Indian Parliament in 1971 and
has come into force from April 1972. This seeks to advocate abortions under the following
circumstances.

THE MEDICAL TERMINATION OF PREGNANCY ACT 1971:

An Act to provide for the termination of certain pregnancies by registered medical practitioners
and for matters connected therewith or incidental thereto.

Be it enacted by Parliament in the Twenty-second Year of the Republic of India as follows: -

STATEMENT OF OBJECYTS AND REASONS

(1) The provisions regarding the Indian Penal Code which were enacted about a century age
were drawn up in keeping of with the than British Law on the subject. Abortion was made a
crime for which the mother as well as the abortionist could be punished except where it had to be
induced in order to save the life of the mother .It has been stated that this very strict law has been
observed in the breach in a very large number of cases all over the conceal their pregnancy.

(2) In recent years, when health services have expanded and hospitals are availed of the fullest
extent by all classes of society, doctors have often been expanded and hospitals are availed of to
the fullest extent by all classes of society, doctors have offer been confronted with gravely ill or
dying pregnant women whose pregnant uterus has been tampered with a view to causing an a
abortion and consequently suffered very severely.

(3) There is thus avoidable wastage of the mother’s health, strength and , sometimes, life. The
proposed measure which seeks to liberalize certain existing provisions relating to termination of
pregnancy has been received (I) as a health measure-when there is danger to the life or risk to
physical or mental health of the woman; (2) on humanitarian grounds- such as when pregnancy
arises from a sex crime health of the woman; etc., and (3) eugenic grounds- where there is
substantial risk that the child, if born, would suffer from deformities and diseases.- Gazette of
India, Pt. II, Section 2, Extra, dated November 7, 1969, p 880

2. Definitions.

In this Act, unless the context otherwise requires, -

(a) "Guardian" means a person having the care of the person of a minor or a lunatic;

(b) "Lunatic" has the meaning assigned to it in Section 3 of the Indian Lunacy Act, 1912 (4 of
1912);

(c) "Minor" means a person who, under the provisions of the Indian Majority Act, 1875 (9 of
1875), is to be deemed not to have attained his majority;
(d) "Registered medical practitioner" means a medical practitioner who possesses any recognized
medical qualification as defined in clause (h) of Section 2 of the Indian Medical Council Act,
1956 (102 of 1956), whose name has been entered in a State Medical Register and who has such
experience or training in gynecology and obstetrics as may be prescribed by rules made under
this Act.

3. When pregnancies may be terminated by registered medical practitioners.

(1) Notwithstanding anything contained in the Indian Penal Code (45 of 1860), a registered
medical practitioner shall not be guilty of any offence under that Code or under any other law for
the time being in force, if he terminates any pregnancy in accordance with the provisions of this
Act.

(2) Subject to the provisions of sub-section (4), a pregnancy may be terminated by a registered
medical practitioner, -

(a) Where the length of the pregnancy does not exceed twelve weeks, if such medical practitioner
is, or

(b) Where the length of the pregnancy exceeds twelve weeks but does not exceed twenty weeks,
if not less than two registered medical practitioners are, of opinion, formed in good faith, that-

(i) The continuance of the pregnancy would involve a risk to the life of the pregnant woman or of
grave injury to her physical or mental health; or

(ii) There is a substantial risk that if the child were born, it would suffer from such physical or
mental abnormalities as to be seriously handicapped.

Explanation I-Where any pregnancy is alleged by the pregnant woman to have been Caused by
rape, the anguish caused by such pregnancy shall be presumed to constitute a grave injury to the
mental health of the pregnant woman.

Explanation II. -Where any pregnancy, occurs; as a result of failure of any device or method used
by any married woman or her husband for the purpose of limiting the number of children, the
anguish caused by such unwanted pregnancy may be presumed to constitute a grave injury to the
mental health of the pregnant woman.

(3) In determining whether the continuance of a pregnancy would involve such risk of injury to
the health as is mentioned in sub-section (2), account may be taken of the pregnant woman's
actual or reasonably' foreseeable environment.

(4)

(a) No pregnancy of a 'woman, who has not attained the age of eighteen years, or, who, having
attained the age of eighteen years, is a lunatic, shall be terminated except with the consent in
writing of her guardian.
(b) Save as otherwise provided in clause (a), no pregnancy shall be terminated except with the
consent of the pregnant woman.

4. Place where pregnancy may be terminated.

No termination of pregnancy shall be made in accordance with this Act at any place other than-

(a) A hospital established or maintained by Government, or

(b) A place for the time being approved for the purpose of this Act by Government.

5. Sections 3 and 4 when not to apply.

(1) The provisions of Section 4, and so much of the provisions of sub-section (2) of Section 3 as
relate to the length of the pregnancy and the opinion of not less than two registered medical
practitioners, shall not apply to the termination of a pregnancy by a registered medical
practitioner in a case where he is of opinion, formed in good faith, that the termination of such
pregnancy is immediately necessary to save the life of the pregnant woman.

(2) Notwithstanding anything contained in the Indian Penal Code (45 of 1860), the termination
of a pregnancy by a person who is not a registered medical practitioner shall, be an offence
punishable under that Code, and that Code shall, to this extent, stand modified.

Explanation. - For the purposes of this section so much of the provisions of clause (d) of Section
2 as relate to the possession, by a registered medical practitioner, of experience or training in
gynecology and obstetrics shall not apply.

6. Power to make rules.

(1) The Central Government may, by notification in the Official Gazette, make rules to carry out
the provisions of this Act.

(2) In particular, and without prejudice to the generality of the foregoing power, such rules may
provide for all or any of the following matters, namely-

(a) The experience or training, or both, which. a registered medical practitioner shall have if he
intends to terminate any pregnancy under this Act; and

(b) Such other matters as are required to be or may be, provided by rules made under this Act.

(3) Every rule made by the Central Government under this Act shall be laid, as soon as may be
aft6r it is made, before each House of Parliament while it is in session for a total period of thirty
days which may be comprised in one session or in two successive sessions, and if, before the
expiry of the session in which it is so laid or the session immediately following, both Houses
agree in making any modification in the rule or both Houses agree that the rule should not be
made, the rule shall thereafter have effect only in such modified form or be of no effect, as the
case may be; so, however, that any such modification or annulment shall be without prejudice to
the validity of anything previously done under that rule.

7. Power to make regulations.

(1) The State Government may, by regulations, -

(a) Require any such opinion as is referred to in sub-section (2) of Section 3 to be certified by a
registered medical practitioner or practitioners concerned, in such form and at such time as may
be specified in such regulations, and the preservation or disposal of such certificates; require any
registered medical practitioner, who terminates a pregnancy, to give intimation of such
termination and such other information relating to the termination as may be specified in such
regulations;

(c) Prohibit the disclosure, except to such persons and for such purposes as may be specified in
such regulations, of intimations given or information furnished in pursuance of such regulations.

(2) The intimation given and the information furnished in pursuance of regulations made by
virtue of clause (b) of sub-section (1) shall be given or furnished, as the case may be, to the Chief
Medical Officer of the State.

(3) Any person who willfully contravenes or willfully fails to comply with the requirements of
any regulation made under sub-section (1) shall be liable to be punished with the fine which may
extend to one thousand rupees.

8. Protection of action taken in good faith.

No suit or other legal proceeding shall he against any registered medical practitioner for any
damage caused or likely to be caused by anything, which is in good faith done or intended to be
done under this Act.

MISCELLANEOUS:

1. Complete Abstinence’s

Not practicable. Psychological disturbance may result in both partners, leading to behaviour
patterns that no civilized society would accept.

2. Coitus Interrupts:

It is an ancient practice. This consists of the man withdrawing the organ before ejaculation. This
prevents sperm entering the womb and is about 60-70% effective. But this results in physical and
mental dissatisfaction.
3. Rhythm Method/SAFE period:

Approved by Catholic Churches particularly in women who have regular menstrual cycle and
who can keep a record of it can practice this effectively. This method is based on scientific fact.
Once a month only one ripe ovum is released and this can stay active and alive for 12-24 hours,
during which time it can be fertilized by a sperm. If fertilization does not take place, the egg
breaks apart and disappears. A sperm has an active life of 48 hours during which time there is
chance to fertilize the egg. Normally a woman produces a ripe egg about 14 days before the
onset of menstruation. But this may vary from 12th - 16th day. So it is said that 12 days before
menstruation and 11 days after is said to be fertile period. It is effective for women whose
periods are regular. It is a reliable method for the educated couple and those with proper
understanding.

4. Natural family planning methods:

 Basal body temperature:

A woman's body temperature varies throughout her menstrual cycle.  This temperature variation
is mediated by the hormone progesterone and, to a minor extent, the hormone LH.  You can use
this information to predict ovulation. 

Using a special thermometer, called a basal body thermometer, you must take your temperature
every morning BEFORE getting out of bed and record this on a chart (such as the one below). 
Your temperature rises between 0.4°F and 0.8°F on the day of ovulation.  (Your temperature will
begin to rise on Day 13 of a 28 day cycle and continue to rise until approximately day 15 - these
are the three days you are COMPLETELY UNSAFE.)  From the day after ovulation until a few
days before your period, it will remain elevated.  Your temperature will begin to drop a few days
before your period.  You should refrain from intercourse seven days before the temperature rise
until four days after.
Just because temperature changes are very accurate in predicting the day of ovulation, they do
not predict it before it happens.  To be completely safe, you should consider unsafe days from
the first day of your period until the fourth day after the temperature rise.  Don't forget, sperm
can live up to seven days after intercourse.

 Cervical mucus method

Cervical Mucus has regular, cyclic pattern changes.  The cycle starts with the beginning of a
period and ends at the beginning of the next period.  Normally cloudy and tacky, it becomes
clear and slippery (similar to egg whites) before ovulation.  It will also be stretchy between your
fingers (spinnbarkeit).  To use these changes for birth control, you must be religious in observing
YOUR pattern changes. 

Beginning with your period, the days you are having your period are considered unsafe because
the blood can disguise changes in the mucus pattern.  After your period, you may have a few
days when there is no mucus.  These are called dry days and are safe.  The amount of mucus
then begins to increase once the egg starts to ripen.  Mucus will be cloudy, sticky and white to
yellowish in color.  These are also safe days.  Then the mucus changes to the slippery, clear
pattern a few days before ovulation.  This is the beginning of an unsafe (THE MOST UNSAFE)
time.  The amount of mucus becomes the greatest just before ovulation.  The mucus may
suddenly become cloudy and sticky again.  It also may completely disappear just before your
period.  From the beginning of the change in your mucus pattern until it disappears or changes
(four days after the greatest volume) are the days you must not have intercourse.  Once you are
familiar with the mucus changes, you then only need to watch for changes until you are sure that
you have ovulated. 
 Breast feeding

 Birth control vaccine

Terminal methods (sterilization):

Sterilization or Terminal method

It's a good contraceptive procedure for those couples who want no more children. Both men and
women get sterilizations. The number of women getting sterilized is more than male
sterlizations.But the fact is male sterilization is a simpler, safer and cheaper process. Also, the
risks of complications are smaller. Male sterilization or vasectomy is performed under local
anesthetics. Vasectomies are 100% safe, if care is taken performing the operation.

Male sterilization: First of all vas is identified in the spermatic cord. Once it has been identified,
it’s removed at least 6cm after clamping. The ends are legated, folded back and sutured so that
the cut ends may not reanalyze in the future. The stitches are removed on the 5th day of
operation. There are between 0-6% chances of recanalization of vas cut ends, a follow up for
three years is a good choice to minimize the possibility of re-fertility.

Complications: They are very few such as pain, scrotal hematoma, spontaneous recanalization of
vas after operation. Another complication is appearance of sperm granules at 10-14days after
operation. Sperm granules are hard masses approx. 7mm in size, caused by accumulation of
sperm.

How to take care after vasectomy?

The male becomes sterile after 30 ejaculations have occurred after the vasectomy not as soon as
the operation is over. All vasectomy acceptors must avoid bath for 24hrs after operation. A
vasectomy acceptor doesn't need bed rest after the operation but must avoid cycling or lifting
heavy weight for the first 15days of operation and wear a T-bandage or scrotal support in this
period. Keep the site clean and dry for 15days.

Female sterilization: is less cost effective, it generally costs 5times more than vasectomy. There
are two well known techniques to carry out female sterilization namely laparoscopy and minilap
operation. Laparoscopy: It’s a short time operation where the patient is required to stay for a
minimum 48hrs stay in hospital after operation. Patient is selected before the operation, if
suitable for laparoscopy. During the operation an instrument called laparoscope is inserted into
the abdominal cavity and the abdomen is inflated with air to see the fallopian tubes. The tubes
are occluded with the help of fallopian rings or clips. Minilap operation: is a safe and simple
procedure and is suitable for post partum patients. The operation is a modification of abdominal
tubectomy.A small abdominal incision 2.5-3cm is given under local anesthesia.

Complications: Complications are usually uncommon, but they might be of serious nature if
occur like puncture of large blood vessels.
PERMANENT STERILIZATION PROCEDURES:
Laparoscopic sterilization — Laparoscopic sterilization is a surgical procedure that is done in
an operating room at a time other than after childbirth. General or regional (e.g., spinal)
anesthesia is usually recommended. During the procedure, a small incision is made near the belly
button and in the lower abdomen and a telescope-like device (a laparoscope) is used to view the
fallopian tubes. The physician uses rings or clips to close the fallopian tubes; alternately, the
physician seals the tubes shut using electro coagulation (the fallopian tubes are burned and
become permanently sealed).

Minilaparotomy — A minilaparotomy is a surgical procedure done one to two days after

childbirth. It is done in an operating room using general, regional, or local anesthesia. The
physician makes a small incision (one to three inches) in the abdomen, and then removes a
section of the fallopian tubes on each side. In the postpartum period, the procedure does not
lengthen the hospital stay.

One advantage of minilaparotomy is that a tissue specimen is removed to ensure that the
fallopian tubes have been completely cut. Disadvantages of minilaparotomy include a greater
need for pain medication, a slightly longer recovery time, and a larger surgical incision than with
a laparoscopic procedure.
Hysteroscopic sterilization — Hysteroscopic sterilization is a procedure that may be done in the
office or operating room using local anesthesia. The Ensure permanent birth control procedure
uses a tiny coil mechanism, which is inserted through the cervix and uterus into the fallopian
tubes.

After the coil is placed, scar tissue develops, causing the tubes to become sealed shut. The
woman must use another form of birth control for three months after the coil is placed. At this
time, a procedure called hysterosalpingogram is performed to confirm that the tubes are blocked.
If the tubes are not completely blocked, the procedure may be repeated.

Hysteroscopic sterilization is best done seven to ten days after the start of a woman's menstrual
period. In some cases, the provider will recommended an injectable birth control treatment
(medroxyprogesterone acetate/Depo Prover) two to three weeks before the procedure to make it
easier to place the coils (and eliminate the risk of pregnancy before/after the procedure).

The advantages of hysteroscopy sterilization are that no sedation or general anesthesia are
required (e.g., the woman is not sleepy and may drive herself home), and there are no incisions.
Compared to other forms of surgical sterilization, hysteroscopy sterilization costs less, allows the
woman to spend less time in the hospital, is well tolerated, and causes less severe post-operative
pain.

The disadvantages of hysteroscopy sterilization include the need for an alternate form of birth
control for three months after the coil is placed and the potential need to repeat the procedure. In
one study, approximately 15 percent of women did not have complete blockage of one or both
tubes after three months.

PERMANENT STERILIZATION OUTCOMES:

Complications — Complications of laparoscopic and minilaparotomy procedures occur in
approximately 1 of every 1000 procedures. The most common complications include infection,
bowel or bladder injury, internal bleeding, and problems related to anesthesia.

The complication rate with hysteroscopy sterilization is approximately 0.02 per 1000 procedures.
The most common complication is perforation of the uterus (when an instrument creates a small
tear through the uterine wall). This does not usually require treatment and does not have any
long-term consequences.

Menstrual periods — there is no evidence that bleeding or uterine cramping increases after

sterilization. In fact, women who undergo sterilization are more likely to have fewer days of
bleeding during menstruation, a lower amount of blood loss, and less menstrual pain. However,
sterilized women have described more cycle irregularity than women who were not sterilized.

Sexual desire — Sterilization does not affect sexual desire or performance.

Pregnancy — it is uncommon for sterilization to fail, allowing a woman to become pregnant. In

one study of women who had laparoscopic or minilaparotomy sterilization and were followed for
8 to 14 years, approximately 1 percent of women became pregnant. The risk of pregnancy was
highest among women who underwent sterilization at a young age (under age 30) and among
women who had clips placed on the tubes.

The failure rate for hysteroscopy sterilization is also quite low, estimated to be less than 1
percent. Between 1997 and 2005, approximately 50,000 procedures were performed and 64
pregnancies were reported to the manufacturer. Most pregnancies occurred in women who did
not have appropriate follow-up (e.g., testing to confirm that the tubes were blocked).

When pregnancy occurs after a sterilization procedure, it is more likely to be an ectopic

pregnancy. For this reason, any woman who has had undergone sterilization and then misses or
is late for a menstrual period should consult her healthcare provider for advice about the need for
a pregnancy test.

AFTER PERMANENT STERILIZATION SURGERY:

Laparoscopy and minilaparotomy — A few hours after laparoscopic or minilaparotomy
sterilization, most women are able to go home. Someone should be available to drive and help as
needed. There will be some discomfort at the incision site and menstrual-type cramping; this can
be treated with pain medication such acetaminophen (Tylenol®) or ibuprofen (Advil®,
Motrin®). Some women will have a sore throat (from a tube placed to help with breathing during
general anesthesia), neck or shoulder pain, vaginal discharge, or light bleeding.

Most women are able to return to a normal routine within a couple of days. The woman is
usually instructed not place anything in the vagina (eg, tampons, douches) and to avoid sexual
intercourse sex for approximately two weeks.

Hysteroscopy — hysteroscopy sterilization, most women are able to drive themselves home or
back to work/school. If a sedative was used, the woman should have someone else drive her
home. Most women experience mild cramping, which can be treated with an over-the-counter
pain medication such as acetaminophen (Tylenol®) or ibuprofen (Advil®, Motrin®). A small
amount of vaginal bleeding or discharge may occur for a few days after the procedure; no
treatment is required. Most women are able to return to normal activities the same day.

The woman should be sure to use an additional form of birth control (eg, pills, condoms,
diaphragm) until a test is done, usually three months later, to confirm that both tubes are
completely blocked.

PERMANENT STERILISATION IN WOMEN

This is an abdominal operation in women and could be performed 48 to 72 hours after delivery.
It is done by cutting the fallopian tubes through which eggs pass from the ovaries to the womb
and closing the cut ends of the tubes. This procedure facilitates the ovum to get disintegrated into
the blood as there is no way for it to pass through the tubes to the uterus. The egg is unable to
pass after this surgery but gets disintegrated into the blood. Now recently the method of vaginal
Tubectomy is gaining great importance. This could be done nonpuerperaily only. This is
advantageous for the simple reason that that there will not be any external scar and can be done
at any time. A Tubectomy is done during the present timings as a non puerperal surgery also on
those women who decide to adopt this permanent method. However in such situation it leads to a
laparotomy. Recently Laparoscopic sterilization is performed during 48-72 hours of post-partum
period. This helps to avoid visible scar and minimum hospitalization but it is a sophisticated and
costly procedure.

Mini -laparotmy is a modification of abdominal Tubectomy. The incision is 2.5cm to 3 cm. It is

suitable for postpartum tubal sterilization. It is more safe, efficient and easy in dealing with
complications. Puerperal sterilization is commonly done in India and is becoming popular
gradually.

But one has to remember that this is the terminal method of contraception.

PERMANENT STERILISATION IN MEN:

It consists of cutting and tying the vas passage through which sperm travels from the testicles to
the genital passage (closure of small ductivas). The effect of the operations is the absence of
spermatozoa in the semen; thus pregnancy is prevented. No scalpel vasectomy is a new
technique. It is a safe, convenient and acceptable to males.

There are certain points to remember regarding vasectomy:

1. It does not produce impotence; no gland or organ is removed.

2. It does not cause any mental illness or weakness.
3. After vasectomy some form of contraceptive has to be used for 8-12 weeks as it takes that
long for semen to become completely free from spermatozoa. Each case should be
considered of its own. Both husband and wife should agree for this surgery.
Criteria to be considered in carrying out vasectomy;

1. Even with two children, vasectomy is considered adequate,

2. Male to be healthy,
3. Man should be 35 years of age
4. Mentally balanced,

Important points to remember for puerperal sterilization:

2. It does not involve removal of sex glands.

3. It does not cause any weakness.
4. It is a permanent method, does not interfere with secretions of any hormone.
4. Both husband and wife should give written consent.

The Government of India offers cash incentives to individuals undergoing sterilization operation.

FAMILY WELFARE CAMP:

The responsibilities of the health workers and health assistants are as follows:

BEFORE CAMP:
 Prepare an eligible couple register (ECR) village wise. You can prepare a list of
couples eligible for sterilization, in each village, i.e., those with 2-5 living children.
 Prepare a list of sterilized couples who can help motivate other eligible couples in their
villages.
 Motivate and inform eligible couples about the date, time and venue of the camp.
  Select suitable cases for sterilization. Reject those who have fever, skin eruption, hernia,
hydrocoele or any other infection. Anemic women with hemoglobin less than 70% should
be given iron and folic acid tablets.
 Ask the men to shave the public area and upper part of thighs before they come to the
camp. Advise all the people coming for operation to have bath and change clothes before
coming to the camp. The community health worker can do this task.
 Give each case a referral slip with ECR number on it.
 Transport may be arranged for the cases to reach the camp site. For this you have to
coordinate with the medical officer.

DURING CAMP:
 Assist in registration of cases and check that the other partner has not been already
sterilized. Get their written, signed consent on the register.
 Assist the M.O. in the medical-check-up of cases before operation (female worker).
 Examine urine for sugar and albumin (female worker).
 Assist in preparation of the patient (female worker):

-- shaving of the public area and upper part of thighs in case of vasectomy or of lower
abdomen, public area and upper part of thighs in case of tubal ligation.

-- wash the part with soap and water with cotton swabs.

-- T-bandage or abdominal binder applied to the area.

* give psychological support—allay fears and anxiety by simple explanation of the

operation involved and the duration of operation.

* assist the doctor at operation (health assistants).

 Assist with sterilization of instruments.

AFTER OPERATION
 Check vital signs of patients and record. Inform any abnormalities.
 Advice regarding post-operative care to patients as follows:

VASECTOMY:
Give scrotal support until stitches are to be removed and advice the patient to:

 Keep area dry and clean.

 Have no sexual intercourse for twelve (12) ejaculations and to use Nirodh. Give 12
Nirodh to each such person.
 Stitches to be removed at PHC/SC by doctor or HA on third or fourth day.
  Avoid cycling or heavy manual work for one month.
 Report if there is high fever, bleeding, swelling or pain in the scrotum.
 Report to PHC for semen examination after twelve (12) ejaculations.

TUBAL LIGATION
 Keep area dry and clean.
 Get the stitches removed on sixth or seventh day at PHC or sub- center.
 No heavy manual work or lifting heavy weights for three months.

PHN should:

 Visit sterilized person in the home on second or third day after operation to find out any
problems.
 Remind the vasectomized person or the ligated women to come to PHC/sub-centre on the
third or fourth day and 6th-7th day for removal of stitches respectively.

NATIONAL FAMILY PLANNING PROGRAMME

Sl. Objectives

1 Percentage reduction in unmet need for spacing methods among eligible couples
2 Percentage reduction in unmet need for terminal methods among eligible couples
3 Increase in contraceptive prevalence rate among eligible couples
4
Reduction in percentage of girls marrying below age 18

Increasing the Demand for FP Services

1. By comprehensive media campaign to address the unmet need for family planning services, emphasize
on males as "responsible partners" and to promote NSV.
2. ByorganisingintegrtedRCHcamps.
Integrated RCH camps provide a wide range of services including counseling, antenatal and post-natal
check-ups, TT vaccination and IFA distribution, RTI/STI treatment, immunization of children, IUCD
insertions, oral pills, condoms and sterilization services including NSV. These camps will also provide
complete information on different type of services available. Camps will be conducted in all the 84
blocks as per the norms.

3. Medical Officers, ANMs and Link Workers are being made responsible for spreading the message
among couples in general and counsel them to avail the services.
4. Emergency contraceptives have been made available to all CHCs and PHCs
Family Planning camps:

Family Planning camps are being held at all block level PHC's/CHC's on every Thursday on
rotation and at district hospital on every Tuesday of each month.

THE POPULATION EXPLOSION:

India is noted for its large population, ranking second, next to China, in the world. At present
India's population is equal to that of U.S.A., the then U.S.S.R., and Japan put together. It is found
that 55,000 babies are born every day in India. There are nearly 21 million births and 8 million
deaths occurring annually which results in an addition of 13 million populations each year. At
this rate it was estimated that by 1981, the population of India would exceed 700 million. The
1981 census as of March 1st revealed that the population of India was 683 million (according to
the Central Bureau of Health Intelligence, Health Statistics of India, New Delhi, 1981), where as
the World Population Reference Bureau at Washington in USA mentions that the 1981
population of India was 689 million, However as mentioned earlier the population by now
(1982) would have reached nearly 700 million.

India's population is rapidly growing. The following table will explain how fast the growth rate
has been during the past 80 years.

Population explosion:

1. Population explosion create serious law and order problem because existing agencies
which are responsible for maintain law and order find it impossible to copes with the
problem.

2. It becomes very difficult to provide houses to the ever increasing pollution with the result
that the people begin to live in shums and shanties.

3. When vast majority lives in shanties then the problem of maintain moral character arises.
Moral usually become low and results in many social problems.

4. It becomes difficult to maintain and even sex ratio which gets disturbed quite frequently,
resulting in many social problems.
 5. The society finds it almost impossible to provide employment opportunities to the
increasing pollution. This results in poverty and unemployment.

6. Nations finds it almost impossible to provide adequate health facilities to the growing
population.

7. It becomes also difficult for the nation to provide schooling and higher educational
facilities to the growing population.

8. When nation cannot provide facilities to the growing population, the result is that for
getting whatever facilities are available, corrupt means used.

Population problem has three dimensions.

It is concerned with,

(1) The number of people versus limited amount of material resources.

(2) People versus cultural resources.
(3) Society's ability to satisfy man's total needs, physical, mental and social.

Over population has the following effect,

(a) Effect on nation

Even if all the resources are tapped to feed the added mouths, this is not at ail sufficient. This
leads to low standard of living, unemployment and overcrowding.

(b) Effect on family

Family income in India is so low that if the number of people in a family to be cared for
increases, the parents will not be able to cope up with additional demands of food, clothing or
education- This leads to less happiness and insecurity in the family.
(c) Effect on mother

Mother's general health gets impaired with increased number of pregnancies. The adverse effects
of repeated pregnancies lead to problems of anemia in a mother and make her more prone to
other infections.

(d) Effect on child

If pregnancies occur too frequently in a family, the child gets very little attention; thereby
problems of malnutrition and maternal deprivation occur.

According to John D. Rockefeller who was the Chairman of Population Council of U.S.A., the
objective of work in family planning is (not the restriction of human life but rather its
enrichment'. Therefore family planning may be defined as planned regulation by a married
couple of the pregnancies which are liable to result from their conjugal union through adoption
of methods selected to avoid unwanted pregnancies. Very often the very word 'Family Planning'
has a wrong connotation in the minds of people; it is equated merely to 'Birth Control'. So it is
very important for nurses to understand this concept clearly.

CAUSES OF OVERPOPULATION:

As nurses it is essential to know the various reasons for such rapid growth of population. In India
several factors including religion and culture influence the size of the population.

The important reasons for a high birth rate in India may be stated as follows

(a) Early age at marriage

The need for every child to be married at an early age. This increases the reproductive
span. The Hindu Marriage Act (1955) provided 15 years of age for females and 18 years
 for males as minimum age of marriage. However, 1961 census showed that 50% of the
girls got married before the age of 15 years, and nearly 20 million married females were
in the age group of 10-19 years. The Child Marriage Restraint Act of 1978 increases the
legal age at marriage from 15 to 18 years for girls and 18 to 21 years for boys. Studies
reveal that in 1991, In many states the mean age at marriage for girls has already moved
to 19 years. In the rural areas of Madhya Pradesh, Rajasthan and Uttar Pradesh, marriages
continue to take place when the girl is around 15 years of age.

(b) Early puberty:

Indian girls attain puberty at the age of 12-14 years, which is fairly early. Girls getting married at
this age are liable to conceive and reproduce. Hence the number of children in a family could be
more leading to over population in the country.

(c) Standard of Living:

Birth rates are high among those where living standards are low as they want more children to
make up for high losses among infancy and early childhood period.

(d) Education:

Educated parents are aware of the responsibilities towards their children. 1961 census showed
only 24% of the population were literate. The literacy rate in the country has improved but there
is a. clear difference between literacy in males and females. According to 1991 census total
literacy above 7 years of age is 52.19 with male literacy of 64.2 and females of 39.19. So, as long
as this remains so low, population problem will continue. The details of the literacy rate in
different states are given in Table 26-2.

(e) Social Customs and Tradition:

In India there is a feeling that everyone should get married. If a boy or a girl is not married, the
parents feel the burden. The community looks down upon the individual and the family if for any
reason the marriage is delayed.
Children are considered; as a gift of God and their birth should not be obstructed.

Also there is a need felt by several communities to have a son to light the funeral pyre of the
father. This practice too adds to more births in a family.

(f) Absence of family planning:

In India people are still not aware of the concept of planning the families.

World population:

World population at mid-2000 was 6.06billion and is growing by 75 million people per year. It
was 1.6billion in 1901. More than 95% of the growth is taking place in developing countries,
according to the UN state of world population 2000. UN –projections are global population, now
on a declining growth trend, will be close to 9 billion in 2050.

Indian population:

 India’s population crossed the one billion mark at the start of the twenty-first century to
become the second largest, after china, and stood at 1027,015,247 on March 1, 2001.

 According to previous results, the growth of Population (annual) in the decade 1991-2001
was 1.9% as against 2.1% in the previous decade, but it was still higher than the
assumptions ranging from 1.6to 1.8%.

 The over 1027 million population comprised 531,277,078 males and 495,738,169
females. The sex ratio of females/1000 males was an improvement over the 1991 figure
of 927.

Literacy:

 In the 1991 the literacy rate is 52.21%

 In the 2001 the literacy rate is 65.38% (75% for males and 54% for females)
  This means that 3/4th of the male population and more than half of the female population
is literate.

 In 1991 the Male-female literacy rate from 28.84

 In 2001 the Male-female literacy rate from 21.70.

National population policy:

 It is built on the experience of half a century in national family welfare programme.

 Government of India has adopted a national population policy in 2000.

 Objective: is to meet the needs for contraception and health care infrastructure and

 To provide integrated service delivery for reproductive and child health care.

 A commission on population has been set up to monitor and directions for the
implementation of the population policy.

National Population Policy by 2010:

Population policy refers to policies which intend to decrease the birth rate. In India the first
population policy was framed in 1976 emphasizing the increase in the legal minimum age at
marriage from 15 to 18 years and 18 to 21 years for males.

The new National Population Policy 2000 deals not only with fertility and mortality rates but
also with women's education; empowering women for improved health and nutrition; child
survival and health; needs for family welfare services , that are yet to be covered; health care for
neglected population, adolescent health; participation of men in planned parenthood and
collaboration with NGOs.

National Socio-Demographic Goals for 2010:

1. Address the unmet needs for basic reproductive and child health services, supplies and
infrastructure.

2. Make school education up to age 14 free and compulsory, and reduce drop outs at
primary and secondary school levels to below 20 percent for both boys and girls.
 3. Reduce infant mortality rate to below 30 per 1000 live births.

4. Reduce maternal mortality ratio to below 100 per 100,000 live births.

5. Achieve universal immunization of children against all vaccine preventable diseases.

6. Promote delayed marriage for girls, not earlier than age 18 and preferably after 20 years
of age.

7. Achieve 80 percent institutional deliveries and 100 percent deliveries by trained persons.

8. Achieve universal access to information/counseling, and services for fertility regulation

and contraception with a wide basket choice.

9. Achieve 100 per cent registration of births, deaths, marriage and pregnancy.

10. Contain the spread of Acquired Immunodeficiency Syndrome (AIDS), and promote
greater integration between the management of reproductive tract infections (RTI) and
sexually transmitted infections (STI) and the National AIDS Control Organization.

11. Prevent and Control communicable diseases.

12. Integrate Indian Systems of Medicines (ISM) in the provision of reproductive and child
health services, and in reaching out to households.

13. Promote vigorously the small family norm to achieve replacement levels of TFR.

14. Bring about convergence in implementation of related social sector programs so that
family welfare becomes a people centered programme.

REFERENCE:

1. K.Park “park text book of preventive and social medicine “bhanot publications, 20th ed,

2009, page no 576-87

 2. Judith Ann All ender “Community Health Nursing Promoting and protecting the public

health”, Lippincott publications, 6th edition, 2005, page no: 789-98

3. Macia Stanhope “Community and public Health Nursing” Mosby publications, 6th

edition, 2000, page no: 782-86.

4. Kasturi sunder rao” An introduction to community health nursing “, B.I.publications, 3rd

edition, 2000, page no:579-604

5. www.docstoc.com/...family welfare

6. Text book of IGNOU “ Conducting family planning programmes” page no. 17-18

Submitted to:

Mrs. T. Vasundara Tulasi

Asst professor
ACON

SENINAR
ON
FAMILY WELFARE AND FAMILY PLANNING

Submitted by:

Ch.Padmalatha

M.sc (N) 1st year

ACON