FAMILY PLANNING METHODS

-[Link], ASST. PROFESSOR

 DEFINITION
• “A way of thinking and living that is
adopted voluntarily, upon the basis of
knowledge, attitudes and responsible
decisions by individuals and couples,
in order to promote the health and
welfare of the family group and thus
contribute effectively to the social
development of a country”

- W.H.O
 SCOPE OF FAMILY PLANNING
• Proper spacing and limitations of birth

• Advise on sterility

• Education for parenthood

• Screening for pathological conditions related to reproductive system

• Pre marital consultation

• Carrying out pregnancy test

• Preparation of couples for the arrival of their first child

 OBJECTIVES
• To avoid unwanted births

• To bring about wanted births

• To regulate the intervals between pregnancies

• To control the time at which births occur in relation to the ages

of the parent

• To determine the number of children in the family

REVIEW OF FERTILIZATION
Male reproductive system
Female reproductive system
fertilization
Family planning methods
Temporary methods
 CONDOM
• A condom is a thin latex or polyurethane sheath. The male
condom is placed around the erect penis.

• A condom must be worn at all times during intercourse to

prevent pregnancy.

• Condoms can be bought in most drug and grocery stores.

Some family planning clinics offer free condoms. You do
not need a prescription to get condoms.
 Female condom

• The female condom is a lubricated polyurethane

sheath, similar in appearance to a male condom. It

is inserted into the vagina. The closed end covers

the cervix. Like the male condom, it is intended

for one-time use and then discarded.

 Cervical cap

• The cervical cap is made of soft rubber and is designed

to fit completely over the cervix. Spermicide is placed

on the outer rim of the cap and in the portion of the cap

facing the vagina. The cervical cap prevents pregnancy

by blocking the sperm from entering the uterus.

• Risks include irritation and allergic reactions to the
diaphragm or spermicide, and increased frequency of
urinary tract infection and vaginal yeast infection.

• In rare cases, toxic shock syndrome may develop in

women who leave the diaphragm in too long.

• A cervical cap may cause an abnormal Pap test.

 diaphragm
• A diaphragm is a flexible rubber cup that is filled with spermicidal cream or
jelly.

• It is placed into the vagina over the cervix before intercourse, to prevent sperm
from reaching the uterus.

• It should be left in place for 6 to 8 hours after intercourse.

• Diaphragms must be prescribed by a woman's health care provider. The

provider will determine the correct type and size of diaphragm for the woman.

• About 5 to 20 pregnancies occur over 1 year in 100 women using this method,
depending on proper use.
insertion
Mode of action
 VAGINAL SPONGE

• Vaginal contraceptive sponges are soft, and

contain a chemical that kills or "disables
"sperm.

• The sponge is moistened and inserted into the

vagina, to cover over the cervix before
intercourse.
Vaginal sponge
 CHEMICAL METHOD
• Foams

• Creams

• Jelly

• Soluble films

– Spermicidal agents attach with spermatozoa and blocks the

oxygen supply and kills the sperm.

 I.U.D
• The IUD is a small plastic or copper device placed inside
the woman's uterus by her health care provider. Some IUDs
release small amounts of progestin. IUDs may be left in
place for 5 to 10 years, depending on the device used.
• IUDs can be placed at almost any time.
• IUDs are safe and work well. Fewer than 1 out of 100
women per year will get pregnant using an IUD.
 I.U.D GENERATIONS

• First generation : Non medicated I.U.D

• Second generation : Medicated I.U.D

(COPPER)

• Third generation: Medicated I.U.D

(HORMONE)
 1. NON MEDICATED I.U.D

• They are made out of polyethylene or other

polymers.

• Eg. Loops, Spirals, Coils and Rings

LIPPES LOOP
• First Generation IUD
• Double “S” shaped
• Non medicated Device
• They are made up of
polyethylene or other
polymers.
• Sizes A,B,C,D
COPPER T
• Second Generation IUD

• 1970 it was introduced in market.

• Copper act as anti fertility effect.

• Copper 380 A is widely available in our India.

• The Copper T IUD is extremely effective and

can last up to 10 years.

• The Copper T IUD prevents pregnancy by

blocking sperm from reaching an egg. It can
also be inserted as emergency contraception to
prevent pregnancy up to 5 days after
unprotected sex.
Copper T
 ADVANTAGES
• This is a highly effective type of birth control.

• The Copper T IUD does not contain hormones or interact with medicines.

• You don’t have to think about birth control every day or every time you

have sex.

• If you decide you want to get pregnant, you can have the IUD easily

removed at any time. The IUD is quickly reversible, which means that its

effects on your body go away as soon as it is removed and your fertility

returns back to normal.

• Because one IUD can be used for so long, it is actually one of the least

expensive methods of birth control.

 DISADVANTAGES
• The Copper T IUD does not protect against sexually transmitted
infections (STIs).
• You must visit your health care provider to have the Copper T IUD
inserted and removed.
• Most women have more bleeding and cramping with their periods
when they first get the Copper T IUD, but this usually lessens over
time.
• It is possible for the IUD to slip out of place, but this is rare. It is
more likely to happen in women who have not had a baby.
HORMONAL CONTRACEPTIVES

1. BIRTH CONTROL PILLS

– COMBINED PILLS
– PROGESTRONE ONLY PILLS
– ONCE IN WEEKLY PILLS
– EMERGENCY PILLS

2. INJECTABLE HORMONES
3. SUB DERMAL IMPLANTS
4. VAGINAL RINGS
 Birth control pills
• Some birth control methods use hormones. They will have either
both an estrogen and a progestin, or a progestin alone. You need a
prescription for most hormonal birth control methods.

• Both hormones prevent a woman's ovary from releasing an egg

during her cycle. They do this by affecting the levels of other
hormones the body makes.

• Progestin help prevent sperm from making their way to the egg by
making mucus around a woman's cervix thick and sticky.
 Combine pills
• The pill works in several ways to prevent pregnancy. The pill
suppresses ovulation so that an egg is not released from the ovaries,
and changes the cervical mucus, causing it to become thicker and
making it more difficult for sperm to swim into the womb. The pill
also does not allow the lining of the womb to develop enough to
receive and nurture a fertilized egg.

• This method of birth control offers no protection against sexually-

transmitted diseases.
When to start?
How to take?
When ?
 PROGESTRONE ONLY PILL
• MINI PILL

• CONTAINS ONLY PROGESTRONE

• MENSTRUAL IRREGULARITY WILL BE A

COMMON PROBLEM

• IT BLOCKS OVULATION
 Emergency contraception
• Within 72 hrs

• Unwanted 72

• I pill

• E pill
Mode of action
 HORMONAL INJECTIONS

• Progesterone only injectables

– DMPA(Depot medroxy progesterone acetate) 150 mg/ I.M/
3 Months

– NET – EN (Norethisterone enanate) 200 mg/ IM/ 60 days

– DMPA – SC 104 mg / sc / 3 months

• Combined injectable contraceptives (progesterone

and estrogen / monthly once)
 SUB DERMAL IMPLANTS

• Norplant
• The silastic rods or capsules are implanted
beneath the skin of forearm or upper arm.
• Contraception is provided for over 5 years.
Drawback:
Menstrual irregularity
Surgical procedure
SUB DERMAL IMPLANTS
 VAGINAL RINGS

• It contains levenogestreal
found to be effective.

• The hormone is slowly

absorbed through vaginal
mucosa.

• The ring is worn for 3

weeks.
 POST CONCEPTIONAL METHODS

• MENSTRUAL REGULATION

• MENSTRUAL INDUCTION

• ORAL ABORTIFACIENT

• MTP
 MENSTRUAL REGULATION

• Aspiration of uterus contents 6 to 14 days of a

missed period.

• Pregnancy should be confirmed priorly

 MENSTRUAL INDUCTION

• Disturbing the normal progeterone and prostaglandin

balance by intra uterine application of 1-5 mg of
solution of prostaglandin.

• It should be performed under sedation.

• Bleeding starts and continued for 7-8 days.

 ORAL ABORTIFACIENT

• Mifepristone 200 mg orally

• Misoprostol 800 mcg vaginally

• Follow up
MTP ACT (1972)

CONDITION

PERSON

PLACE
 CONDITIONS

MEDICAL

CONTRACEPTIVE
EUGENIC
FAILURE

SOCIO ECONOMIC HUMANITARIAN

 CRITERIA
• PERSON:
– REGISTERED MEDICAL PRACTITIONER
– EXPERIENCE IN GYNAECOLOGY AND
OBSTETRICS TO PERFORM ABORTION.
– LENGTH OF PREGNANCY DOES NOT
EXCEED 12 WEEKS. (UPTO 20 WEEKS, THE
OPINION OF TWO REGISTERED
PRACTITIONER)
 WHERE TO PERFORM
• GOVERNMENT HOSPITALS AND
GOVERNMENT APPROVED HOSPITALS.
• THE NAME OF THE ABORTION SEEKER IS
KEPT CONFIDENTIAL.
• THE WRITTEN CONSENT OF THE GUARDIAN
IS NECESSARY BEFORE PERFORMING
ABORTION IN WOMEN UNDER 18 YEARS.
 NATURAL METHODS OF FAMILY
PLANNING

• CERVICAL MUCUS METHOD

• BODY TEMPERATURE METHOD

• BREASTFEEDING AMENORRHOEA
Cervical mucus method
• Unsafe days start 2 or 3
days before the first signs
of slippery mucus, and last
for about 3 days after
slippery mucus peaks. The
days during your period are
also unsafe, especially if
you have a short cycle.
 Basal body temperature method:
• The basal body temperature
method helps identify a change
in temperature that occurs
after ovulation and remains
elevated until your next period.
By looking at charting from a
few cycles, your temperatures
can reveal a pattern from
which ovulation can be
anticipated.
 OTHERS

• Abstinence

• Coitus interrupts

• Birth control vaccine

ABSTINENCE
COITUS INTERUPTS

• Withdrawing the penis

before ejaculation

• Failure rate more

Calendar method

Safe period method

Short cycle minus 18 days

Long cycle minus 10 days

PERMANENT METHOD

OF

FAMILY PLANNING
 vasectomy

• A vasectomy is a procedure to cause permanent sterility in a

man by preventing the transport of sperm out of the testes. A

small incision is made in the scrotum and each vas deferens is

tied off and cut apart preventing sperm from being released

within the ejaculate. The small skin incision is stitched closed

and the surgery does not affect a man's sexual function.

No scalpel vasectomy
• No stitches

• No hospitalization

• Pain less

• Free of cost

• performed in phc also

TUBECTOMY
• Laproscopy
• Mini lap

• Post operative advise:

– Avoid heavy lifting
– Nutritious diet