Family planning

 Definition (WHO)
Family planning refers to the practices that help
individuals or couples to attain certain objectives:
1. to avoid unwanted births
2. to bring about wanted births
3. to regulate intervals between pregnancy
4. to control the time at which births occur in relation
to the ages of the parents
5. to determine the number of children in the family
 Contraceptive methods

 Spacing methods  Terminal methods

1. Barrier methods 1. Male sterilization
2. Intra uterine devices 2. Female sterilization
3. Hormonal methods
4. Post - conceptional
methods
5. Miscellaneous
Terminal Methods of Sterilization
1. Male sterilization – Vasectomy (10-15%)
2. Female sterilization – Tubectomy (85%)

Guidelines for family planning

 Age of the husband should not be less than 25yrs or
more than 50yrs
 Age of the wife should not be less than 20yrs or more
than 45 yrs
 Couple must have 2 living children at the time of
operation
 If more than 3 children then the lower limit of age can
be shortened
 Informed consent required
Advantages of Terminal methods of
Family Planning
 Most effective method

 One time method

 Cost effective

 Does not require motivation

 Male sterilization
(VASECTOMY)
 First used in 1897 (experiments from 1785).
 Permanent sterilization in which the vasa
deferentia of a man are cut and the cut ends are
ligated.
 It is a minor surgical procedure.
 Can be performed by a trained MBBS doctor.
 NORMAL VASECTOMY- typically seals both ends
of the vas deferens with stitches, heat, or both, after
cutting.
 OPEN ENDED VASECTOMY- abdominal end of the
resected vas in coagulated; testicular end is left
open prevents congestive epididymitis.
 PER CUTANEOUS VAS-OCCLUSION (popular in
China) - Polyurethane elastomere is injected into the
vas which solidifies and forms a plug blocking
sperm passage.
 NO SCALPEL VASECTOMY – commonly preferred
technique at present.
 Selection of candidates
 Ideal-Sexually active and psychologically adjusted
husband having the desired number of children.
 Any misconception about the fear of castration, loss
of hormones and impotency are to be removed by
sympathetic conversation.
 Eczema & scabies on the scrotal area is a temporary
contraindication.
 If hydrocele or hernia is present, it is corrected and
then vasectomy is done.
 Requirements
 Informed consent of the person is a must.

 The surgeon should be convinced about the

family structure of the couple.

 Premedication not necessary.

 Procedure
 Identification of vas deferens.
 Infiltration with
1% lignocaine.
 Vertical incision.
 Clamp and remove atleast
1cm of the vas.
 Ends are ligated and
sutured into
position
(cut ends away from
each
other-to reduce
the risk of
recanalisation)
 Complications
 Pain
 Bruising and swelling (scrotal haematoma)
 Infection (wound sepsiscellulitis & abscess)
 Sperm granuloma (5%)
 Post-Vasectomy Pain Syndrome
 Spontaneous Recanalization
 Auto-immune response
 Psychological
 Post operative advice
 At least 30 ejaculations may be necessary for
seminal examination to be negative (sterile)
 Usage of other methods of contraception
until aspermia is established
 T-bandage or scrotal support to be worn for
15days
 Avoid cycling heavy work or lifting heavy
weights
 Stitches removed on 5th day of operation
 Advantages of Vasectomy
 Simplicity of the surgical procedure
 Lower cost
 Effectiveness (early failure rates-below 1%, late
failure is very rare)
 Done under local anaesthesia as opposed to general
anaesthesia usually needed for female sterilization.
 Minimum training required
 Can be done as an outdoor procedure or a mass camp
in remote villages
 Complications – immediate or late are few
 Causes of failure
 Mistaken identifications of the vas
(histological examination is required).

 Spontaneous recanalisation.

 More than one vas on one side.

 Proper post-operative care not taken.

Factors influencing the acceptability of
Vasectomy in Andhra Pradesh
 Socio-economic profile
 Myths and misconceptions about vasectomy
 Knowledge and perceptions of sterilized couple about
family planning methods
 Literacy was not a pre-requisite for undergoing
vasectomy
 No complications and a relatively easy method were
the prime reasons of motivation towards vasectomy
 Majority of the subjects were "self-motivated"
 Social factors determining the
acceptance of vasectomy

 Fear of impotency
 Lack of knowledge or
awareness about
vasectomy
 Apprehension regarding
the surgery
 Acceptors of

vasectomy
 Acceptors of

tubectomy
REVERSAL
 Reversal
 By “Vasovasostomy”
 First performed by Earl
Owen in 1971
 Effective only in 50-70% of
the cases
 Very costly procedure
 Depends on the method
used and the time at which
vasectomy was done (after
2 or more years occlusion
of vas occurs)
 Sperm counts are not
returned to normal
 No scalpel Vasectomy (NSV)
 No-Scalpel Vasectomy is one of the most
effective contraceptive methods available for
males.
 First performed by a Chinese surgeon in 1974.
 It is an improvement on the conventional
vasectomy with practically no side effects or
complications.
 This new method is now being offered on a
voluntary basis under the Family Welfare
programme.
 Instruments used to perform
NSV

1. Ring fixation clamp

2. Sharp curved
dissecting clamp
3. Scissors
 Procedure
 Local anesthesia.
 Vas deferens is fixed in the midline raphe of the
scrotum by a ring forceps.
 A sharp curved dissections clamp is used to puncture
the skin, the puncture hole is enlarged to about twice
the diameter of vas and the vas is delivered out.
 Part of the vas is dissected and ends ligated and then
pushed back into the scrotum.
 Similar procedure done on the opposite side.
 The puncture holes do not require any closure (no
suturing).
 Advantages
 Painless
 Less invasive - no stitches or sutures required
 Less time-taking
 Less discomfort
 Economical
 The person can leave the hospital immediately after
the procedure
 Simpler than tubectomy (requires hospitalization of
the woman)
 No side effects or complications
 Quick recovery
No Scalpel Vasectomy Project
 A two and a half year project being implemented
by the Department of Family Welfare, Ministry of
Health and Family Welfare.
 Medical personnel all over the country are to be
trained.
 Availability at peripheral level will increase the
acceptance of male sterilization all over the
country.
 The project is being funded by UNFPA.
 18 States are being covered by NSV project, of
which Andhra Pradesh is the most successful state.
 Improvement
• At the centre
• At the state level
• At the district level
• At PHC level
• At the village level
• Incentives and dis - incentives
• Family welfare linked health insurance
• Population education
 References
 Standards of Female and Male sterilization
Ministry of Health and Family Welfare, Govt.
of India.

 Text book of Obstetrics, Perinatology and

Contraception- by D.C.Dutta.

 Internet.