family planning content with recent advances ..family planning is for everyone ...content can be used for educational purposes ....by sharanjit kaur jhajj

1. Presented by : Sharanjit jhajj
Silver oaks CON Mohali

2. INTRODUCTION
Family planning is the term given for pre-pregnancy planning
and action to delay, prevent or actualize a pregnancy.
 According to the Minnesota Department of Health, family
planning is a fundamental aspect of enhancing the health
outcomes of women and children. There are many family
planning options ranging from contraception and birth control
to abstinence and other natural methods to the latest medical
technology .

3. DEFINITION
( WHO ) “the use of a range of methods of a fertility
regulation to help individuals or couples attain certain
objectives:
 avoid unwanted birth.
 bring about wanted birth.
 Produce a change in the no. of children born.
 Regulate the intervals between pregnancies.
 Control time at which birth occur.”

4. No. of
pregnanci
es
Proper
timing
Proper
spacing
Elements of family planning
3 important elements in family planning:

5. Benefits
Benefits to Mother
 Reduce the health risk
 Below 20y.o. And above 35 y.o. At risk of developing
complications during pregnancy.
physical strain of child bearing.
 reduce number of maternal death.
 reduce the risk of ovarian cysts.

6. Health Benefits to Children:
Ensures better chance of survival at birth.
 Promote better childhood nutrition.
 Promote physical growth and development.
 Prevent birth defects.

7. Health Benefits to Father
 Allows father to keep a constant balance between
their physical, mental, social well –being.
Increase father sense of respect because he is able to
provide the type of education and home environment.

8. Benefits to Whole Family
Health
 Benefits to Whole Family Health - help the family
enjoy the better kind of life.

9. TYPES OF FAMILY PLANNING
Natural family planning
Barrier family planning
Permanent/surgical family
planning

10. INTRODUCTION OF NATURAL
FAMILY PLANNING
 No introduction of chemical of foreign material into
the body.
 Practice may be due to religious belief, “natural” way
is best for them.
 Effectiveness varies greatly, depends on couples ability
to refrain from having intercourse on fertile days.
 Failure Rates: about 25% Poses no risk to fetus

11. NATURAL FAMILY PLANNING
Rhythm (Calendar) method
Basal Body Temperature (BBT)
Ovulation or Cervical Mucus Method
Symptothermal method
Coitus Interruptus
Lactation amennorhea

12.  The rhythm method, also called the fertility
awareness method, is a form of pregnancy
prevention where couples calculate a woman's fertile
time using a calendar .
 Abstaining from coitus on the days of menstrual cycle
when a woman is most likely to conceive (3 or 4 days
before until 3 or 4 days after ovulation). Woman keeps
a diary of 6 menstrual cycles.
RHYTHM (Calendar) METHOD

13.  This method may be used by women whose menstrual
cycles are always between 26 and 32 days in length .
 To calculate:
 18 from shortest cycle documented –11 from
longest cycle = represents her last fertile day.
 Example: If she has 6 menstrual cycles ranging from
25 to 29 days, fertile period would be from 7 th day (25-
18) to the 18 th day (29-11). To avoid pregnancy, avoid
coitus/use contraceptive during those days.

14. Disadvantages
Lifespan
of Sperm
Reliability
Failure of
method

15. . Basal Body Temperature (BBT)
 Identifying fertile and infertile period of a woman’s
cycle by daily taking and recording of the rise in body
temperature during and after ovulation.
 Just before ovulation, a woman’s BBT falls about 0.5ºF
At time of ovulation, her BBT rises a full degree
(influence of progesterone). This higher level is
maintained the rest of menstrual cycle.

16. DISADVATAGES
 NOT reliable method: of birth control, especially for
women with irregular cycles. Plus, outside
factors, such as a lack of sleep, can cause a woman’s
temperature to vary.

17.  Cervical mucus is a fluid produced by small glands
near the cervix
 This fluid changes throughout her cycle, from
scant and sticky, to cloudy and thick, to slick and
stringy.
 Each of these types of mucus is related to the
hormonal shifts that naturally occur during
the menstrual cycle as her body prepares for and
achieves ovulation.
CervicalMucus/Ovulation

18. Right before ovulation, the mucus from the cervix
changes from being cloudy and scanty to being clear
and slippery.
The consistency of ovulation mucus is like that of an
egg white and it can be stretched between the fingers.
It is the peak of her fertility.
 After the ovulation, the mucus tends to dry up again.
These are also safe days.
Ideal Failure rate: 3%

19. DISADVANTAGES
 It is not a particularly reliable method of birth
control, especially for women with irregular cycles .
 Remember that cervical mucus does not let you know
when you will soon be ovulating, but sperm can live up
to seven days inside the vagina. Any sperm deposited
ahead of time can still impregnate the woman.

20. Symptothermal Method
 Combines the cervical mucus and BBT methods
Watches temp. daily and analyzes cervical mucus daily.
 Watch for midcycle abdominal pain Couple must
abstain from intercourse until 3 days after rise in temp.
or 4 th day after peak of mucus change.
 More effective than BBT or CM method alone Ideal
Failure rate: 2%

21. COITUS INTERRUPTUS
 One of oldest known methods of contraception
Couple proceeds with coitus until the moment of
ejaculation which Offers little protection.

22. LACTATION AMENNORRHEA
The lactational amenorrhea method (LAM) is a
natural birth control technique based on the fact that
lactation (breastmilk production) causes amenorrhea
(lack of menstruation).

23. How it works:
Breastfeeding interferes with the release of the
hormones needed to trigger ovulation.
ADVANTAGES:
Breastfeeding on demand improves health for mother
and baby.
Nothing to buy or use.

24. DISADVANTAGES
 an use this method only for the first six months after
birth or until the first menstrual period.
 LAM does not provide protection against SEXUALLY
TRANSMITTED INFECTIONS.

25. CLASSIFICATION OF
CONTRACEPTIVE METHOD
CLASSIFICATION
SPACING
METHOD
BARRIER
METHOD
INTRAUTERINE
METHOD
HORMONAL
METHOD
POST COITAL
METHOD
TERMINAL
METHOD

26. BARRIER METHODS
Condoms (male and female)
Spermicidal
 Sponge
 Diaphragm
Cervical cap

27. Male condoms:
 These are made up of polyurethane or latex.
 Silicon used now a days to produce semi dry pre-
lubricated forms.
 In India one particularly brand is widely marketed as
‘Nirodh’.
 Spermicidal – coated with nonoxynol on inner and
outer surfaces.

28. ADVANTAGES:
 Simple spacing method
 No side effects
 Easily available, safe & inexpensive
 Protects against STDs
 DISADVANTAGES
Chances of slip off and tear off
Allergic reaction to latex
Failure rate: 16%

29. Female condoms:
 It is a pouch made up of polyurethane which lines the
vagina and also external genitalia.
 It is 17 cm in length with one flexible polyurethane
ring at each end.
ADVANTAGES:
Prevents STDs including HIV/AIDS
Not damaged by oils and other chemicals

30.  DISADVANTAGES:
 High motivation
 Only women who can use diaphragms can use female
condom
Slippage occurs
Expensive
 Failure rate 21% with typical use and 5% with correct
and consistent use.

31. diaphragm
 Most common and easiest to fit and use .
 Thin, nearly hemispherical dome made of rubber or
latex material, with circular, covered metal spring at
periphery (flat type and coil type)

 External diameter of rim is size of diaphragm – 45 mm
diameter rising in steps of 5 mm to 105mm (most
common 60,65,70,75,80)

32.  The device is introduced up to 3 hrs. before
intercourse and is to be kept for at least 6 hrs after
intercourse.
ADVANTAGES:
cheap
No gross medical side effects
 Control of pregnancy in hands of woman
Reasonably safe when properly used
 Prevent spread of STDs though less effective than
condom

33. DISADVANTAGES:
 Requires help of doctor to measure the size required.
 Need high motivation
 Allergic reaction to rubber
 Erosion
 UTI’s

34. SPERMICIDES
 Available as vaginal foams ,gels ,creams ,tablets and
suppositories.
 contain surfactant like nonoxynol-9,benzalkonium
chloride.
 Alter the sperm surface membrane permeability
resulting in killing of sperm.

35. ADVANTAGES:
 No instructions by doctors or nurses
 Easily available and easy to use
 No gross medical side effects
DISADVANTAGES
 Failure rate high when used alone
 Can increase spread of HIV infection by irritating
vaginal and cervical mucosa
Failure rate – 21% with typical use and 6%

36. Vaginal contraceptive sponge
(TODAY)
The sponge is a doughnut-shaped device made of soft
foam coated with spermicide.
Made up of polyurethane with 1gm of nonoxynol-9 as
a spermicide.
It releases spermicide during coitus, absorbs ejaculate
and blocks the entrance of cervical canal.
To use the sponge, it must be moistened with water.
Once inserted in the vagina, it covers the cervix and
blocks sperm from entering the uterus.

37. DISADVANTAGES
 May get broken
 difficult removal
 High pregnancy rate
 Allergic reactions
 Vaginal dryness, soreness
 May damage vaginal epithelium
 increase risk of HIV transmission

38. INTRAUTERINE DEVICES
 Intrauterine Device The IUD is a small, T-shaped,
plastic device that is inserted and left inside the uterus
to prevent pregnancy.

39. CLASSIFICATION OF
IUDs
INTRAUTERINE
DEVICE
NON-
MEDICATED
FIRST
GENERATION
MEDICATED
SECOND
GENERATION
THIRD
GENERATION

40. First generation
 Non-medicated made up of polyethylene.
 Different shapes and sizes
 LIPPE’S LOOP
 Double ‘s’ shaped device , made up of polyethylene
material.
 Non- toxic, non-tissue reactive and extremely durable.
 Small amount of barium sulphate is also added for
radiological examination
 Available in 4 sizes A,B,C,D

41. Second generation
 Made up of metal Cu
 Earlier devices Cu-7 , Cu-T 200
 Newer devices T copper 220 C ,T copper 380 C ,nova T
 multiload devices:
 ML-Cu 250
 ML-Cu 375

42. Third generation
 Hormones releasing IUD
 PROGESTASTERT :
 Most commonly used T shaped device filled with 38 mg
progesterone
 Effective for 1 year
 LNG- mirena
 Mirena (levonorgestrel-releasing intrauterine device) is a
form of birth control that is indicated for intrauterine
contraception for up to 5 years and Releases 20 µg of
levonorgestrol.
 Effective for 5 years.

43. SIDE EFFECTS
Amenorrhea
 Intermenstrual bleeding and spotting
Abdominal/pelvic pain
 Ovarian cysts
 Headache/migraine
 Acne
 depressed/altered mood.

44. ADVANTAGES OF IUD
 Safe
 effective , Reversible
 Long action ,Inexpensive
 DISADVANTAGES
 Heavy bleeding and pain
 Pelvic inflammatory diseases
 Ectopic pregnancy
 May come out accidently if not properly inserted.

45. CONTRAINDICATION
History of PID
Abnormal shaped uterus
Ectopic pregnancy
Menorrhagia

46. CLASSIFICATION OF HORMONAL
CONTRACEPTIVES
HORMONAL
CONTRACEPTIVES
ORAL
COMBINED
PREP.
SINGLE
PREP.
PARENTERAL
INJECTABLES
IMPLANTS

47. HORMONAL CONTRACEPTIVES
 With hormonal birth control , a women takes
hormones similar to those her body makes naturally .
 Hormonal contraceptives are mostly for female sex
steroids.

48. Mechanism of hormonal
contraceptives
 hypothalamus has a main role in the mechanism of
the ovulation .
 Releases gonadotrophin releasing hormone which
stimulate the follicle stimulating
hormone, FSH and luteinizing hormone, LH .
 Which will act on the corpus luteum then it will
secrete the estrogen and progesterone.
 Function of the FSH that is necessary to initiate
follicle development and selection of a dominant
follicle. LH surge that is necessary to trigger
ovulation.

49. Mechanism of hormonal
contraceptives
 The primary mechanism of action of hormonal
contraceptives is that they suppress the secretion
of gonadotropins(follicle stimulating
hormone, FSH and luteinizing hormone, LH)
 Estrogen – acts on FSH and LH thus suppresses ovulation
 progesterone promotes secretion of thick cervical
mucus, which acts as a barrier, and inhibits sperm
movement past the cervix.
 Hormonal contraceptives reduce endometrial growth, so it
is theoretically possible that they may also block
conception by interfering with implantation.

50. Oral contraceptives
 Combined oral contraceptive pills
 Commonly used progestin are either levonorgestrol or
norethisterone and estrogens are ethiyl estradiol or
menstranol
 COMMERCIAL NAMES NO. OF TABLETS
 Mala–N 21+7 iron tab.
 Mala –D 21+7 iron tab.
 Loette(desogestrel 0.15) 21 tab.

51. TYPES
Monophasic biphasic triphasic
Monophasic:
 fixed doses of both estrogen and progesterone
throughout 21 day cycle.

52. Biphasic:
 constant amount of estrogen throughout cycle BUT
increased amount of progestin during the last 11 days .
 Triphasic:
 Varies level of estrogen and progesterone. Closely
mimic natural cycle, reducing breakthrough bleeding
(bleeding outside the normal menstrual flow)

53. contraindications
ABSOLUTE:
Circulatory diseases
Severe HTN
Angina,ischemic heart dis.
Liver disease
Tumors
Pregnancy
breast cancer,breast feeding.

54.  RELATIVE:
 Age>40 yrs.
 Smoker, history of jaundice
 Diabetes

55. benefits
 contraceptive benefits:
 Protection against unwanted pregnancy
 Convenient to use.
 Non-contraceptives benefits:
 Regulation of menstrual cycle
 Reduction of dysmenorrhea
 Protection against PID, fibroids, ovarian cysts, chances
of cancer.

56. Side effects
 Dizziness
 Nausea
 Weight gain
 Headache
 Breast tenderness
 vaginal infection
 Mild HPN
 Depression
 increase blood clotting

57. Progesterone only pills
 Also known as “Minipill”.
 Contains just progesterone or progesterone hormone.
 Causing plug of mucus in the neck of cervix
block the entry of the sperm.
Example: levonorgesrol 75 µg, desogestrel 75 µg

58. advantages
 No side effect on breast feeding or lactation
 May be prescribed in patient having diabetes, HTN
, smoking etc.
 Reduce risk of PID
 DISADVANTAGES
 Acne, mastalgia, headache

59. Long acting contraceptives
 These are more suitable for women who do not want
to pregnant again or for few years.
THESE ARE:
 CONTRACEPTIVE INJECTIONS
 IMPLANTS
 PATCHES

60. CONTRACEPTIVE INJECTIONS
( DEPOPROVERA & NORISTERET)
 Contain progesterone hormone .
 Prevents ovulation.
 Commonly used as Depomedroxyl progesterone
acetate (DMPA) administered on deltoid muscle
within 5 days of cycle.
 DOSE: 150 mg
 Provide protection for 3 months .

61. Contraceptive implants
 It is a small device placed under the skin
 Contains progesterone hormone .
 Works in a similar way to injection
 Contains 3 ketodesogestrel
 Releases hormone about 60 mcg, gradually reduced to
30 mcg per day over year.
 Inhibts ovulation.
 Lasts for 3 years.
 NORPLANT – II

62.  NORPLANT- II
 Two rods of 4cm long. Each rod containing 75 mg of
levonorgestrel releases 50 mcg per day.


63. Emergency contraceptives
 Used whithin 72 hrs ,ovulation is either prevented or
delayed. It may be in form of :
hormones, IUD, antiprogesterone
 INDICATIONS
 Unprotected intercourse
 Condom rupture
 Sexual assault

64. HORMONES:
MORNING AFTER PILLS:
It preventing conception in case of accidental
intercourse.
drugs used ethinyl oestradiol
2.5mg, premarin(conjugated oestrogen) 15 mg.
Drug is taken orally twice daily for 5 days.

65. Emergency contraceptives
Levonorgesterel 0.75 mg stat and after 12 hrs.
Ethinyl oestradiol 50 µg + norgesterel
0.25 mg
2 tab stat and 2 after 12 hours
Conjugated oestrogen 15 mg BD 5 days
Thinyl oestradiol 2.5 mg BD 5 days
Mifepristone 10 mg single dose
Copper IUDs Insertion within 5 days
DRUG DOSE

66. PERMANENT STERLISATION
ÖVASECTOMY
Ö TUBECTOMY

67. STERILIZATION
It is most effective method its failure rate is 1/2000 so in
this there is permanent termination .
VASECTOMY :
Small incision made on each side of scrotum vas
deferens is then cut and tied , cauterized or plugged .
Blocking the passage of spermatozoa.
Does not interfere with production of sperms but does
not pass beyond vas deferens .

68. Very effective after 3 months of procedure
Permanent and safe
No apparent long term risks .
 DISADVANTAGES:
Slightly uncomfortable due slightly pain and swelling
after 2-3 days of the of the procedure .
Bleeding may result in the hematoma in scrotum .

69. TUBECTOMY :
It is one of the operative procedure where resection of
a both segment of both fallopian tubes is done to
achieve permanent sterilization
The approach may be :
Abdominally
Vaginally

70.  ABDOMINAL
Ω CONVENTIONAL MINILAPROTOMY
Ω CONVENTIONAL:
In which a loop is made by holding the tube by Allis forceps in
such a way that the major part of loop consists mainly of isthmus
and ampullary part of tube . the loop is ligated with catgut and is
cut .

71. MINILAPROTOMY:
When the tubectomy is done through small
abdominal incision along with some device .
VAGINAL LIGATION :
Tubectomy through vaginal route may be done along
with vaginal plastic operation or on isolation .

72. COMPLICATION :
Ectopic pregnancy
Menstrual irregularities
Loss of libido
Infection