COLLEGE OF NURSING

DHAMTARI C.G.
health education
SUBJECT- MATERNAL NURSING
TOPIC – FAMILY PLANNING METHOD

SUBMITTED TO – SUBMITTED BY –
MRS. S.R. NATH AKASH DAN
CLINICAL INSTRUTOR POST BASIC BSC NURSING 1ST YEAR
SCHOOL AND COLLEGE OF NURSING DHAMTARI (C.G.) SCHOOL AND COLLEGE OF NURSING DHAMTARI (C.G.)
General objectives: At the end of health education, people would be able to gain knowledge regarding family planning method.

Specific objectives: At the end of health educationpeople would be able to—

 Introduce the topic

 Define the term family planning
 List down the purpose of family planning.
 List down the criteria for ideal contraceptives.
 Enlist the method of contraceptives.
 Explain the different type of spacing method.
 Explain the termination method of family planning.
 Enumerate the responsibilities of nurse or health workers.
Subject: Community Health Nursing
Topic: Health Education on “ Family planning Method”
Name of the supervisor:

Name of the student:

Group: people of community
Teaching Method: Lecture, Discussion
AV Aids: chart, flip card, flash card
Duration: 20 minutes
Language: Hindi
Date:
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1 ½ min Introduce SELF INTRODUCTION Lecturing Listening - It helps to make
self Myself Akash dan post basic BSc. 1nd year, student, college of nursing a good rappo
Dhamtari. with student.

2 5 min Introduce TOPIC INTRODUCTION

the topic Family planning means having only the number of children you want and Discussion Answering Chart What do you
only when you want to have them. These can be used by newly married know about
couples who want to delay having children for two to three years. There family
are number of birth control methods available to protect unwanted planning?
pregnancies. Birth control measures eliminate the unnecessary need for
abortions.
There are number of family planning methods such as
mechanical methods, chemical methods, biological methods, hormonal
methods, emergency contraceptive methods and surgical methods.

3 2 min Define the DEFINITION

term family Lecturing Listening Chart What do you
planning According to the World Health Organization (WHO) mean by family
“family planning is defined as the ability of individuals and planning?
couples to anticipate and attain their desired number of children and the
spacing and timing of their births.”
Or
“Family planning is the planning of whento have children, and the use of
birthcontrol and other techniques toimplement such plans”

4 2½ List down the PURPOSE OF FAMILY PLANNING Lecturing Listening Chart What are the
min purpose purpose of
1. Raising a child requires significant amounts of resources: time,
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 Of family social, financial, and environmental. Planning can helpassure that Family
planning. resources are available planning?
2. To improve the health of the mother and child.
3. Helping to prevent HIV/AIDS

5 1 min List down the CRITERIA FOR IDEAL CONTRACEPTIVE Lecturing Listening Chart What are the
criteria for criteria for ideal
1. It should be safe for use means free from any kind ofside effects.
ideal contraceptive?
2. It should be reliable.
contracepti-
3. It should be easy to administer and convenient.
ve.
4. It should be cost effective.
5. It should be culturally feasible and acceptable.

6 1 min Enlist the METHOD OF CONTRACEPTIVE

method of Lecturing Listening Chart How many
contracepti- 1. Spacing methods: methods of
ve. a.) Natural methods contraceptive?
b.) Barrier method :- physical barrier methods
- chemical barrier methods
- intra-uterine devices
- hormonal methods
- post conceptional methods

2. Terminal methods

7 10 min Explain the SPACING METHOD Lecturing Listening Flash What are the
different  Help in prevention of pregnancy as long as they are used. card types of spacing
type of  These methods can help in timing and spacing ofpregnancies, methods?
preventing unwanted children.
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 spacing  Thesemethods are temporary methods
method.
A. NATURAL METHOD
 Natural methods do not involve the use of any of the man
madedevices.
 These methods are useful for timing and spacingof pregnancies.

1. Coitus interruptus/ withdrawal method

In this method the penis is withdrawn from the vagina before
ejaculation. In this way semen is prevented from entering the
uterine cavity and pregnancy does not take place. Since the penis
is withdrawn and ejaculation takes place outside the vagina, this
method is called coitus interruptus or withdrawal method.
Merits

 Involves no cost.
 it does not require any other device.
 With self control and discipline it can be fairly effective.

Demerits

 Require a great deal of self control

 slightest delay inwithdrawal can leads to pregnancy
 pre-ejaculatoryfluid containsenough quantity of semen that leads
to pregnancy
 Thus failure rate is very high

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2. Safe period
 Based upon the process of ovulation and menstrual cycle which
helps in determination of the safe period when coitus can be done
and unsafe period when coitus can be avoided to prevent
pregnancy.

Merits: Does not require any man made device.

Demerits
 Require self control by the partners during the highly unsafe
period.
 Not suitable for the women who does not have regular periods.
 require great deal of will power and motivation
 Failure rate is high.
 Not applicable during changes in menstrual cycle.

3. Abstinence
This involves complete avoidance of sexual cohabit. Abstinence is not
having any kind of sex i.e. oral, anal or vaginal and not engaging in any
activity that puts you or your partner in contact with either of your bodily
fluids such as semen, vaginal fluids, and blood. This method is useful as
there are no medical or hormonal side effects and it doesn’t cost
anything.

B. BARRIER METHODS
Barrier methods are those methods which prevent meeting of sperms
with the ovum.
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 Physical barrier method:- There are three types-
1. Nirodh: (condom)
 It is a thin rubber sheath which is used by men. It is rolled over
the erect penis before having sex.This rubber sheath prevents the
entry of semen into the vagina. The condom must be held
carefully when taking out the penis from the vagina to prevent
spilling of semen into the vagina. It is available free of cost from
urban or rural family welfare centres.
Types of nirodh
a. Dry nirodh, for a price of rs 25 paisa per packet of 3 pieces.
b. Deluxe nirodh for a price of rs 1.50 per packet of 5 pieces,
these are lubricated nirodh
c. Super deluxe nirodh for a price of rs 3 per packet of four
pieces, these are very thin sheeth , lubricated and coloured

Merits
 easy to use
 It is most simple and effective method
 Disposable
 no medical supervision is required.
 protects fromsexually transmitted disease
Demerits
 if not used correctly it may slip or get tear of and the semen gets
spilled into vagina
 in somerare cases the person may have allergic to rubber.
 some people may not enjoy sex because of interference with the
sensation.

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 2. Diaphragm
The diaphragm is used by women in her vagina to form a barrier in front
of the cervix. The diaphragm is dome shaped and is like a shallow cap. It
is made of soft synthetic rubber or plastic with a stiff but flexible rim
around the edge. It is also known as DUTCH CAP. Diaphragm is
available in different ranging from 5-10 cm. The size of diaphragm will
vary with each women. It is held in position partly because of the tension
created by the spring and partly because of the muscle tone of vagina. It
is very important to observe the vaginal muscle tone otherwise the
diaphragm may not remain in position.

Merits
 A diaphragm along with spermicidal is very effective.
 The failure rate is low. There is no risk or any kind of
contraindication.
Demerits
 It requires the assistance of doctor and any other health personnel.
 it requires periodical check-up
 It requires privacy and time to place it in the vagina.
 it requires facilities for its proper care and storage.

3. Vaginal sponge
It is small polyurethane foam sponge, diffused with spermicide. The
sponge is shaped in a way that it can be fitted on to the cervix and has a
loop on its outer surface which can be used to pull out thesponge after
use.Should be inserted before the coitus.It providesprotection for 24
hours. It should remain be there for at least 6 hours aftercoitus. Sperms
are trapped on in the sponge and are destroyed by spermicide. It is better
than not to use any method.
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  Chemical barrier method
These methods usually kill the sperms and this waychemical
contraceptives help in preventing the pregnancy. The chemical
contraceptives whichare in use are:
 Foam Tablet Arosols
 Cream Jelly And Pastes
 Suppositories
 Soluble Films
Merits
 They are easy to administer
 available free in health centers
 not very expansive
 increases vaginal lubrication
Demerits
 Must be inserted deep down and in all such points where sperms
are likely to reach
 must be applied each time before sex
 may cause irritation and burning.

 Intrauterine device
These are the devices which are placed in the uterine cavity. Earlier these
devices were made up of silk worm gut, silk and gold. The three different
types of IUD’s generations are:
1. First generation IUDS
 These devices were made of polyethylene and are non-medicated.
These are available in different sizes and shapes such as coils,
spirals, loops. The lippes loop is the most popular and commonly
used device.
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  It is made of polyethylene and contains barium sulphate which
makes it possible to be located when required by x-ray. The loop
is double s shaped and has an attached tail made of fine nylon
threads.

2. Second generation IUDS

 These are also made of polyethylene but copper is added into
these. The copper enhances the contraceptive effect. Variety of
copper devices are:
o Copper-7 and copper t-200
o Variants of T devices: TCU 220C and TCU: 380A .
o Multi load devices: ML-CU: 250, ML-CU: 375.
o Nova T: TCU-380
 All cu devices are more effective and less chances of side effects
i.e pain and bleeding
 Can be fitted easily in nulliparous women and can be tolerated
by them.

3. Third generation IUDS

These contains hormones which is released slowly in the uterus. The
hormone affects the lining of uterus and cervical mucus. It mayaffect the
sperm.
There are two types of hormone IUD:
a. Progestasert: It is T shaped device and contains progesterone
which is a natural hormone. Progesterone is in more use than the
other hormone devices.
b. Levonorgestrel Device: This is also a T shaped device which has
levonorgestrel a synthetic steroid. It is found to be more effective.
It needs to be changed after five years.
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 Merits:
 Can be used for longer period.
 Can be easily removed when couple wants to have child.do not
interfere with coitus.
 Very effective and failure rate if less.
 Inexpensive does not require hospitalization.

Demerits: Bleeding, pain, PID, perforation of uterus, expulsion,

pregnancy

 Hormonal methods
Hormonal methods of contraceptives are found to be the most effective
method to prevent unwanted pregnancies. It is of two main types:

1. Oral Pills
There are verity of oral contraceptive pills. They are :

a. Combined Pills:
The pill is composed of two hormones i.e synthetic oestrogen and
progesteogen in very small doses. Its action is toinhibit ovulation
of ovum by blocking the secretion of gonadotropin from pituitary
gland. Progestogen also thickens the mucosa of the cervix which
prevents the entry of sperm into the genital cannal. There are two
types of pills available with the name of: MALA-D, MALA-N:
i. Mala- D: D-Norgestrol - 1.0mg , Ethynilestadiol – 0.03mg
ii. Mala-N: Norethisterion - 0.50 mg , Ethynilestradiol -0.04 mg

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Merits
 It is 100% effective if taken regularly easy to use and does not
 interfere with coitus.
 reduces the risk of anemia because menstrual bleeding is less
 Reduces the risk of pelvic inflammatory disease, ovarian cyst and
uterine cancer.
Demerits
 failuare rate increases if taken irregularly
 minor side effects like dizziness, nausea, vomiting, headache,
tenderness of breast, weight gain
 increases the risk of heart problems if women is already at risk.
 may increases the risk of gall bladder disease and cervical cancer.
 decreases the quantity of breast milk and its early cessation

2. Progesterone Only Pill

This pill is also known as mini pill. It contains only progest -eogen and it
thickens the cervical mucus which prevents the entry of sperms into the
uterine cavity. Mini pills are taken throughout the menstrual cycle and
these are not used widely because of its high failure rate.
3. Once A Month Pill
It is modified combined pill. It contains long acting oestrogen and short
acting pregesteogen. These pills are not in use because experimental
results revealed high pregnancy rate and irregularity in the menstrual
cycle
4. Depot Formulation
These are long acting hormonal contraceptive contains only synthetic
progesteogen. These are available in three forms:

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 a. Injectable contraceptive
It is again of two types:

i. Pregestagen Only Injectable: There are two preprations which

are available
ii. DMPA: (Depot-medroxypregestron acetate) and NET-EN.

Merits
It is easy to administer, highly effective and irreversible, do not
interfere with lactation and does not cause any effect on infant.

Contraindication: Abnormal uterine bleeding, any malignancy of the

genital tract, suspected malignant growth and cancer
breast.

b. Combined Injectable Contraceptive

 These contain progestogen and oestogen. Contraceptive action is
similar to that of progestagen only injectable.
 The injection is given once in a month three days early or three
days late.
 It is contraindicated in pregnancy, women having any other
problem like diabetes with complications, vascular disorder,
suspected malignancy, migrane.

c. Subdermal Implants
 There are two varieties. The earlier one is known as Norplant and
latest one is Norplant R-2.
 The norplant has six small silicon rubber tubes. Each of these

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 tubes contains 30mg of progestogen(Levonorgestrel)
 The norplant-R-2 has two small rods.
 Both of these devices are placed under the skin of the arm. The
tubes or the rods allow steady diffusion of steroids into the blood
stream for a period of five years to give effective contraceptive
effects.

d. Vaginal Ring
This method is not much in use. It consists of ring which contains small
amount of pregestogen. The ring is fitted into the vagina for three weeks
of menstruation cycle, after which it is removed for a week and then
reworn after menstruation cycle. The steroid is directly absorbed by the
mucus lining of the vagina.

 Post Conceptional Method

These are the methods which are used after the missed period and
pregnancy may or may not have occurred. This method is used in
regulating and inducing the menstruation and terminating the pregnancy
or aborting the fetus. These methods are:

a. Menstrual regulation
 It is done within 14 days of missed period when pregnancy is
doubted but it is not confirmed. In this the uterine contents are
evacuated. The procedure is very safe. There is no legal
restriction.
 The complication which can occur are : Local injury perforation
of uterus, injection.
 The complication which may occur later are: infertility,
menstruation disorders, ectopic pregnancy, RH- immunization
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 b. Menstrual induction
This is done within few days of missed period. It is done by application
of prostaglandin F2 under sedation. This induces continuous contraction
of uterus lasting for 7 min. It is then followed by cyclic contraction
which continues for next 3-4 hours. This initiates bleeding which lasts
for a weak or so.
c. Abortion
Abortion refers to the termination of pregnancy before the fetus become
viable i.e before it is able to live outside the womb. This period is fixed
at 28 weeks when the foetus weighs1000 grams. Abortion are either
spontaneous or induced.
8 5 min Explain the Lecturing Listening Flip What are the
TERMINATION METHOD
termination card termination
method of methods of
Sterilization is only method which gives permanent protection from
family family
conception. Either husband and wife can undergo sterilization by a
planning. planning?
simple surgical operation i.e vasectomy or tubectomy.

A. VASECTOMY
Vasectomy is sterilization of male. It is very simple and minor The
operation involves a smalloperation which takes hardly 15-20 min. cut
on both sides of scrotum then a small portion of vasdeferens(about 1cm)
on either side of the scrotum is cut and ligated, folded back and sutured.
The operation does not affect the sexual characteristics and sex life in
anyform. The sperms are produces but not ejaculated along with semen.
B. TUBECTOMY
It is sterilization of females. This is done by resecting a small
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part of fallopian tubes and ligates the sected ends. The closing of the
tubes can also be done by using other methods like closing the tubes with
 bands,clips and electrocautery.The operation can be donethrough
abdominal or vaginal approach. The most common abdominalprocedure
arelaproscopy and minilaprotomy. The tubectomy can be done after
delivery, between delivery and after abortion.

RESPONSIBILITY OF NURSE OR HEALTH WORKER

9 5 min Enumerate  The role of the nurse in family planning has taken on new depth Lecturing Listening - What are the
the in recent years. responsibilities
responsibility  The nurse has become involved in all levels of family planning. of nurse or
-es of nurse  Opportunities to be a case-finder occur in prenatal and health worker?
or health postpartum contact, especially in the family centered nursing
workers. program.
 As initial contact in the family planning clinic the nurse can
encourage a positive attitude toward family planning, evaluate the
patient's knowledge, lead group discussions facilitate
communication and answer questions, prepare the client for
examination, and clarify and instructions for the new patient.
 Of crucial importance is follow-up, including home visits and a
"hot-line" to relieve anxieties of new contraceptive patients.
 Medical or emotional problems in new patients failing to return to
the clinic can be managed through the role of the nurse in follow-
up.
 The nurse must also maintain a professional attitude when her
own religious or social concerns conflict with those of the patient.
 The nurse practitioner has become a new role for nurses in some
countries, and lay workers may assume responsibilities thought to
be the province of all nurse.
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  It was suggested that the nurse be included in all aspects of
program development and evaluation because of her involvement
in and familiarity with the needs of the community.

SUMMARY
So far we discussed about

 Introduction
 Definition
 Purpose
 Criteria for ideal contraceptive.
 Method of contraceptive.
 Different type of spacing method.
 Termination method of family planning.
 Responsibilities of nurse or health workers.
 BIBLIOGRAPHY

1. ‘GHAI SURAJ O.P.’ “A TEXTBOOK OF PEDIATRIC NURSING” ELLEVANTH EDITION, PUBLISHED BY JAYPEE
BROTHERS PVT LTD PP 56-60

2. ‘KUMARI NEELAM’ “ESSENTIAL COMMUNITY HEALTH NURSING” EDITION 2015 S. VIKAS AND COMPANY
INDIA PP 144- 147

3. ‘KUMARI NEELAM, SHIVANI SHARMA AND DR. PREETI’“A TEXT BOOK OF MIDWIFERY AND GYNACOLOGICAL
NURSING” Edition 2011 P 364

4. ‘PARK K.’ “ESSENTIALS OF COMMUNITY HEALTH NURSING” THIRD EDITION 2000, JAYPEE BROTHERS
MEDICAL PUBLISHERS JABALPUR P 194.

5. ‘SWARNKAR KESHAV’ “COMMUNITY HEALTH NURSING” THIRD EDITION 2015N.R. BROTHERS PULISHERS
INDORE PP 799-800