LESSON

3 FAMILY PLANNING
LEARNING CONTENTS

Let’s start…

Motivate use of family planning

methods – the success of the family
planning program depends to a great
extent on the motivation of both
husband and wife.
1. Physiological methods – the oral contraceptives.
a. Action: Suppresses the pituitary gland, thus inhibiting ovulation.
b. Types:
1. Combined – estrogen and progesterone in the same dosage each
day for 20 days, starting on the fifth day of the menstrual cycle,
after which it is discontinued and then resumed on the fifth day of
the next menstrual period.
2. Sequential – estrogen alone for 15 days, then estrogen and
progesterone for 5 days.
3. Mini-pill – taken continuously
c. Side effects – same complaints of pregnant women because of estrogen
and progesterone:
 Nausea and vomiting
 Headache and weight gain – both due to fluid retention
because of progesterone
 Breast tenderness
 Dizziness
 Breakthrough bleeding/spotting between periods
 Chloasma
d. Contraindications:
 Breastfeeding
 Certain diseases
  Thromboembolism – because there is
increased tendency towards clotting in the presence of
estrogen
 Diabetes mellitus and liver disease – because estrogen
tends to interfere with carbohydrate metabolism
 Migraine; epilepsy; varicosities
 Cancer; renal disease; recent hepatitis
 Women who smoke more than 2 packs of cigarettes per
day
 Strong family history of heart attack
2. Mechanical methods
a. Intrauterine device (IUD)
 Specific action: Prevents implantation by
setting up a nonspecific cell inflammatory
reaction to the device
 Inserted during a menstruation to ensure that
the woman is not pregnant; septic abortion can
result if she is pregnant.
 Side effects:
 Increased menstrual flow
 Spotting or uterine cramps during the first 2
weeks after insertion
 Increased risk of infection
 When pregnancy occurs with the device in place, it need
not be removed since it stays outside the membranes, and,
therefore, will not in any way harm the fetus
b. Diaphragm
 Specific action: A circular rubber disc that fits
over the cervix and forma a barrier against the
entrance of sperms
 Is initially inserted by a doctor who determines
the depth of the vagina
 May be coated with a spermicidal jelly or
cream for double protection
 Maybe washed with soap and water after use
 Sperms remain viable in the vagina for 6
hours, so the device should be kept in place
during such time, but should not stay for more
than 24 hours because stasis of semen can
lead to infection.
c. Condom
 Specific action: Sperms are deposited in the
tip of the rubber sheath placed over an erect
 penis prior to coitus. Has the added potential of lessening the change of contacting
sexually-transmitted disease (STDs)
 Most common complaint of users: it interrupts the sexual
act to apply
3. Chemical methods – are spermicidals (kill sperms). E.g., jellies,
creams, foaming tablets, suppositories

4.

Biological method – Rhythm/Calental/Ogino-Knause Formula

a. Specific action: the couple abstains on days that the woman
is fertile
b. Procedure
 The woman charts her menstrual cycles for 12
continuous months in order to determine the shortest and
the longest cycles
 The first fertile day is determined by subtracting “18” from
the shortest menstrual cycle; the last fertile day is
determined by subtracting “11” from the longest
menstrual cycle.
 E.g., if a woman’s shortest menstrual cycle is 26 days
and her longest is 32 days,

26 32
- 18 - 11
8 21
her fertile period would be from the 8th to the 21st day of her cycle,
i.e., she should not have sexual intercourse during these
days

5. Natural Family Planning (NFF) – periods abstinence:

a. Cervical mucus/Billing method
  Basis: the flow of mucus from the cervix of the uterus
 Method: a woman can discern her fertile and infertile days
based on her sensory and visual observations of the
cervical mucus (when it becomes thin and watery –
spinnbarkeit), intercourse is avoided 4 days prior to and 3
days after the spinnbarkeit

b. Basal Body Temperature (BBT)

 Method: involves observing the temperature of the woman at
rest, free from any factor that may cause it to fluctuate
(immediately upon waking up, before doing anything else). As
soon as the temperature drops slightly and then increases (which
means ovulation has taken place), she counts 3-4 days, after
which sexual intercourse may be resumed.
c. Sympto-Thermal method – fertile and infertile days are determined
after having established an accurate record of the six immediately
preceding menstrual cycles and then watching out for BBT
fluctuations.

6. Surgical methods
1. Tubal ligation – the Fallopian tubes are ligated in order to
prevent passage of sperms. Menstruation and ovulation
continue
2. Vasectomy – small incision made into each side of the scrotum
and the vas deferens is and cut and tied, blocking passage of
sperms. Sperm production continues, only passage into the
exterior is prevented. (Sperms in the vas deferens at the time of
surgery may remain viable for as long as 6 months. Implication:
couple should still observe a form of contraception during this
time to ensure protection against a subsequent pregnancy.)

7. Social methods
a. Abstinence
b. Withdrawal or coitus interruptus