peñalosa eugene :D

1. Family
Planning

2. What is Family
planningFamily planning is the planning of when to
have children (the moms‘ age of their first
birth and the interval between the
children)
•Use of birth control and other techniques
to implement the planning of when to have
children.
•Other techniques commonly used include
sexuality education, prevention and
management of sexually transmitted
infections, pre-conception counseling and
management, and infertility management
•Family Planning does not mean stopping to
have children.

3. Family planning
Family planning is sometimes used as a
synonym for the use of birth control. It
is most usually applied to a female-
male couple who wish to limit the number
of children they have and/or to control
the timing of pregnancy (also known
as spacing children).
Family planning may encompass
sterilization, as well as abortion.

4. Family planning
Family planning services are
defined as
"educational, comprehensive
medical or social activities which
enable individuals, including
minors, to determine freely the
number and spacing of their
children and to select the means
by which this may be achieved".

5. SOCIOLOGY OF
FAMILY PLANNING
• Basic social cell.
• Sociologists and economists believed that
living standards of the people cannot be
improved while population growth unchecked.
• Attitude surveys have shown that awareness
of family planning is very widespread and
over 60 per cent people have favorable to
restricting or spacing births.
• Studies have shown that the population
problem complicated by deep-rooted
religious and other believes.
• Attitudes and practices favoring larger
families.

6. • Preference for male children.
• Most of these beliefs stem from
ignorance and lack of
communication.
• The experience of all countries
which a successful population
control shows that the best
motivation is economic, a desire
to improve standard of living.
• The solution to the problem is
one of mass education and
communication.

7. Purposes of Family Planning
• Raising a child requires significant
amounts of resources:
– time,
– social,
– financial, and
– environmental.
• Planning can help assure that resources
are available.
• The purpose of family planning is to
make sure that any couple, man, or
woman who has the desire to have a
child has the resources that are needed
in order to complete this goal.

8. • With these resources a
couple, man or women can
explore the options of natural
birth, surrogacy, artificial
insemination, or adoption.
• In the other case, if the
person does not wish to have a
child at the specific time, they
can investigate the resources
that are needed to prevent
pregnancy, such as birth
control, contraceptives, or
physical protection and

9. History of Family Planning
– 1900
• Distributing information and counseling
patients about contraception and
contraception devices was illegal under
federal and state laws
– 1912
• The modern birth-control movement
began
• Margaret Sanger an American born
activist, founded the American Birth
Control League and was instrumental in
opening the way to access birth control

10. – 1916
• Margaret Sanger challenged the laws
that suppressed the distribution of
family planning information by opening
the first family planning clinic in
Brooklyn, New York.
• The police closed her clinic, but the
court challenges that followed
established a legal precedent that
allowed physicians to provide advice on
contraception for health reasons.
- 1930’s- a few state health departments
and public hospitals had begun to provide
family planning services

11. – 1960- the era of of modern contraception
began – birth control pill and Intrauterine
device became available
– 1965- Pill became the most popular method
followed by the condom and contraceptive
sterilization
– 1965 Supreme Court (Griswold vs
Connecticut) struck down stat laws
prohibiting contraceptive use by married
couples
– The United Nations Conference on Human
Rights at Teheran in 1968 recognized
family planning as a basic human right.
– 1973 -Supreme Court (Roe vs Wade)
legalizes abortion.
– 1973 - First National Survey of Family
Growth conducted

12. – The Bucharest Conference on the World
Population held in August 1974 endorsed the
same view.
'Plan of Action' that
"all couples and individuals have the
basic human right to decide freely and
responsibly the number and spacing of their
children and to have the information, education,
and means to do so".
– The World Conference of the International
Women's Year in 1975 also declared
―The right of women to decide
freely and responsibly on the number and
spacing of their children and to have access to
the information and means to enable them to
exercise that right‖.
– 1976: Marie Stopes International was
established to provide accessible family
planning services globally.

13. World Contraception Day
• September 26 is designated as
World Contraception
Day, devoted to raising
awareness of contraception and
improving education about sexual
and reproductive health, with a
vision of "a world where every
pregnancy is wanted".

14. Family Planning in other Country
• China's one-child policy
• the policy was instated to control the
rapid population growth that was
occurring in the nation at that time.
• With the rapid change in
population, China was facing many
impacts of the rapid population
growth including poverty and
homelessness.
• As a developing nation, the Chinese
government was concerned that a
continuation of the rapid population
growth that had been occurring would

15. • In Hong Kong and Vietnam
the ‖Two is Enough‖ campaign
encouraged people to have 2 or
fewer children in each family. It
contributed to the reduced birth
rate in the following decades.

16. Religious View
• Many Christians began to consider sex
as a gift from God and a positive force
that could strengthen the institution of
marriage if couples did not feel
threatened by the possibility of having
children they could not support. The
majority of Protestant denominations,
theologians, and churches allow
contraception and may even promote
family planning as an important moral
good. As with all issues of Christian
morality, it stresses that members use
birth control as dictated by their
consciences.

17. Health and Benefits
• Family welfare – a state of well
– being of the family as a whole
and the individual. Means a level
of satisfaction of the basic
needs of family (adequate
food, water, shelter, employmen
t, health and education).

18. • Responsible Parenthood – the
essence of family planning.
Pregnancy is planned and a child
us desired and is assured of
parent's love, protection, etc.

19. For the Mother
• Help mother to fully recover
from physical strain of child
bearing. Those more than 4
children – considered high risk.
Help reduce number of maternal
death due to abortion.

20. • For the Father
Family Planning helps the
father shoulder his responsibility
and enables him to give his
children equal attention. It also
lightens his load because he will
not be obliged to provide for and
support too many children.

21. For the Children:
• Through Family Planning, the
children are better taken care
of. The parent could meet the
basic needs of the children
Benefits to Whole Family Health
• help the family enjoy the better
kind of life.

22. For the Community, the Country and
the World:
Family Planning can provide a
peaceful, orderly, and self-
sustaining community with fewer
problems, like juvenile delinquency.
For the World , overcrowding
can be minimized, and governments
can focus their economic efforts
on production rather than
consumption.

23. World population

24. Philippine‘s population

25. About one half of all pregnancies
in the Philippines are unplanned.
Most women can become
pregnant from the time they are
in their early teens until they
are in their late 40s. Birth
control can help couples postpone
having a baby until the time is
right for them—if ever.

26. Basic conditions of pregnancy
First, health of the woman.
The woman must have attained
puberty and she better be under
about 35 years of age and must not
have reached menopause stage. Her
monthly periods must be regular and
her ovaries must be producing eggs
systematically. She should not have
any other present or past health
problems that can affect her physical
and mental condition - her natural
biological functions of becoming a
mother.

27. Second, health of the man:
The man must have crossed
puberty, must have a well developed
sex organ that has proper erectile
function, must produce enough count
of sperms that have mobility in his
semen. He should not have any other
present or past health problems that
can affect his physical and mental
condition - his manliness or the
capacity of healthy sperm production.

28. Timing
• A woman have a normal 28-day
menstrual cycle which ovulation takes
place approximately at the mid period -
about 14 days before the next
menstrual discharge. The egg produced
in one of the 2 ovaries reaches a
woman's uterus via fallopian tubes. It
waits for the arrival of male sperm for
the next 24 hours.
• Taking averages and probabilities into
consideration in a normal menstrual
cycle, if a hassle-free intercourse takes
place between the 12th day to 16th day
after previous last day menstrual
discharge, there is a good possibility for
the woman to get pregnant.

29. The Act
The physical intercourse has to take place
without much of tension in a normal and
natural way in the above mentioned
conducive period. Ideally, the man and
woman should keep their organs clean
before intercourse.
The ejaculation should take place fully
inside, deep in the vaginal passage;
Ideally, the woman's posture must be such
(facing upwards) that it receives the
discharge without allowing it to flow out and
it is conducive for the sperms to find their
way into the uterus though the cervix
passage.

30. • It is recommended that the
woman keeps lying in the bed for
about 15 to twenty minutes
after intercourse, facing
upwards, thighs together but
relaxed, knees raised up with
toes touching the rear of the
theighs. This is to facilitate the
ejaculated semen to reach the
cervix and travel down into the
uterus. The woman should not
wash her vaginal passage
immediately after intercourse.

32. Contraceptive methods
How many kinds of contraception
methods do you know?
(From film or books)

33. CONTRACEPTIVE
METHODS
• Preventive methods to help women avoid
unwanted pregnancies.
IDEAL CONTRACEPTIVE
• Safe Effective
• Acceptable Inexpensive
• Reversible Simple to administer
• Independent of coitus
• Long lasting to avoid frequent
administration
• Requiring little or no medical supervision

34. • The present approach in family
planning programs is to provide a
"cafeteria choice" that is to offer all
methods from which an individual can
choose according to his needs and
wishes and to promote family planning
as a way of life.
• The term ―conventional
contraceptives‖ is used to denote
those methods that require action at
the time of sexual intercourse, e.g.,
condoms, spermicides, etc.

35. • Inhibiting the development and
release of the egg
• To prevent sperm and egg from
uniting
– Imposing a mechanical, chemical, or
temporal barrier between sperm and egg
• Altering the ability of the fertilized
egg to implant and grow

36. I. SPACING METHODS
Barrier
Methods
Intrauterine
Devices
Hormonal
Methods
Post
Conceptional
Methods
Classification of contraceptive methods
II. TERMINAL METHODS
Male
sterilization
Female
sterilization

37. Barrier methods
• These include male condoms, the
female condom, diaphragms and
caps.
• They prevent sperm entering the
uterus.
• You can use male and female
condoms as soon as you feel
ready to have sex.

38. MALE CONDOMS
– Mostly made of fine latex rubber.
– Silicon used nowdays to produce semi-
dry, pre-lubricated forms.
– Spermicidal – coated with nonoxynol 9 on
inner and outer surfaces.
• ADVANTAGE:
• Simple spacing method
• No side effects
• Easily available, safe & inexpensive
• Protects against STDs
• DISADVANTAGE:
• Chances of slip off and tear off
• Penis must be withdrawn immediately after
ejaculation
• Failure rate: 16%

39. FEMALE CONDOM
• Advantages
– Woman controlled method
– Prevents STDs including HIV/AIDS
– Not damaged by oils and other
chemicals
• 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.

40. VAGINAL 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)

41. • Advantages
– 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
• Disadvantages
– Use of spermicidal unacceptable and messy for some
– Suitable for intelligent, highly motivated women of
middle or high socioeconomic groups
– Allergy to rubber
– Infection may occur if used for long time
– Erosion
– Urinary tract infection
– Occlusive caps do not prevent spread of AIDS
– Rarely, toxic shock syndrome

42. VAGINAL SPONGE
• Introduced in 1980s
• ‗Today‘ most popular
• Soft, disposable foam sponge made of
polyurethane.
• Round shaped with depression at centre of
upper surface to fit over cervix
• Saturated with spermicide nonoxynol 9
• Attached nylon loop for removal
• Moistened with water, squeezed gently to
remove excess water and inserted high up
in vagina to cover cervix
• Acts for 24 hrs
• Failure rate – 9 – 27 per 100 women years
• Must be removed and thrown away after 8-
24 hrs but not before 6 hrs of last act

43. • Drawbacks:
– May get broken – difficult removal
– High pregnancy rate
– Toxic shock syndrome
– Allergic reactions
– Vaginal dryness, soreness
– May damage vaginal epithelium – increase
risk of HIV transmission

44. SPERMICIDES
• Non ionic surfactants which alter
sperm surface membrane
permeability, resulting in killing of
sperms
• Advantages
– No instructions by doctors or nurses
– Easily available and easy to use
– No gross medical side effects
• Disadvantages
– Messy to use
– 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%

45. IUD
Medicated
Third
Generation
Eg. Hormonal IUD
Second
Generation
Eg. Copper IUD
Non medicated
First
Generation
Eg. Lippe‘s loop
Classification of
Intrauterine Devices (IUD)

46. First generation iud
They are inert or Nonmedicated devices
made up of polyethylene
Different shapes and sizes
LIPPE’S LOOP:
 Double ‘S’ shaped device
 Made up polyethylene material
 Non toxic, non tissue reactive &
extremely durable
 Small amount of Barium Sulphate is also
added for radiological examination
 Available in 4 sizes A,B,C &D

47. Second generation Iud
Made up of metal – copper.
EARLIER DEVICES
Copper - 7
Copper - T 200
NEWER DEVICES
Variants of T device
 T copper 220C
 T copper 380A
Nova T
Multi load devices
ML-Cu250
ML-Cu375
47

48. Third generation iud
Hormone releasing IUD
Progestastert
Most commonly used
T shaped device
filled with 38mg of progesterone
Effective for 1 yr
 LNG-20 (Minera)
Releases 20µg of levonorgesterol.
Effective for 5 yrs
Effective rate 99%

49. ADVANTAGES OF IUDs:
• Safe, Effective, Reversible
• Inexpensive
• High continuation rate
DISADVANTAGES OF IUDs:
• Heavy bleeding and pain
• Pelvic Inflammatory diseases
• Ectopic pregnancy
• May come out accidently if not
properly inserted

50. TIMING OF INSERTION:
• Inserted with a plunger
• Any time during women‘s reproductive period
Except in pregnancy
• Most ideal time is during or within 10 days
of the beginning of menstruation the
diameter of cervical cavity is greatest at
this time.
IDEAL IUD CANDIDATE:
• Who has borne at least 1 child
• Has no history of PID
• Has normal menstrual periods
• Is willing to check IUD tail
• Has an access to follow up and treatment
of potential problems
• Is in monogamous relationship

51. Hormonal
contraceptives
Oral Pills
Combined pills
Progesterone only
pills (POP)
Once – a – month
(long acting) pills
Male pill
Post coital pill
Depot Preparations
Injectables
Subdermal Implants
Vaginal Rings
Classification of hormonal
contraceptives

52. • What kinds of hormone has been
used in hormone contraception?
• How does the hormone work in
the contraception?

53. • Hormonal contraception are
COMMONLY for female sex
steroids
• Synthetic estrogen and a
synthetic progesterone
(progestin), or a progestin only

54. Mechanism of Hormonal
Contraception
Estrogen:
1) prevents the recruitment of the
dominant follicle by suppressing FSH
2) allows for reduction of progesterone
dose by recruitment of progesterone
receptors,
3) minimizes side effect of break
through bleeding by stabilizing the
endometrium

55. Progesterone:
1) prevents ovulation by
suppression of LH surge
2) thickened cervical mucus
impedes sperm penetration into
the upper genital tract.
3) produces an atrophic
endometrium that is less
receptive to implantation.
4) impairs secretion and peristalsis
within fallopian tubes

56. Short-acting contraceptives
Combined oral contraceptive pill
(COCP)
• often just called 'the pill'.
• It contains estrogen and
progestogen
• stopping egg production
(ovulation).
• started from 21 days after the
birth.
• not recommended if you are
breast-feeding, aS it can affect
your milk supply.

57. • Some advantages - it is very
effective. Side-effects are
uncommon. It helps to ease painful
and heavy periods. It reduces the
chance of some cancers. When you
stop taking it, you quickly become
fertile again.
• Some disadvantages - there is a
small risk of serious problems (eg
blood clots). Some women have side-
effects. You must remember to take
it. It can't be used by women with
certain medical conditions, such as
uncontrolled high blood pressure .

58. Progestogen-only pill (POP)
• used to be called the 'mini-pill'.
• It contains just a progestogen hormone.
• It is commonly taken if the COCP is not
suitable,.
• causing a plug of mucus in the neck of the
womb (cervix) that blocks sperm.
• One type stops ovulation.
• The POP can be started from 21 days after
the birth. You need to remember to take it
at the same time every day because, if you
take a pill more than three hours later than
usual you lose protection.

59. • Some advantages - less risk of
serious problems than the COCP.
When you stop taking it, you
quickly become fertile again.
• Some disadvantages - periods
often become irregular. Some
women have side-effects. Most
types are not quite as reliable
as the COCP.

60. Contraceptive patch
• This contains the same hormones as
the COCP
• in patch form.
• It is as effective as the COCP at
preventing pregnancy.
• The contraceptive patch can be
started from 21 days after the birth.
• not recommended if you are breast-
feeding, as it can affect your milk
supply.

61. • Some advantages - it is very
effective and easy to use. You do not
have to remember to take a pill
every day. Your periods are often
lighter, less painful and more regular.
If you have vomiting or
diarrhoea, the contraceptive patch is
still effective. When you stop using
it, you will quickly become fertile
again.
• Some disadvantages - some women
have skin irritation. Despite its
discreet design, some women still feel
that the contraceptive patch can be
seen.

62. Long-acting contraceptives
These are more suitable for women
who do not want to get pregnant again
or for a few years.
Contraceptive injection (such as Depo-
Provera® and Noristerat®)
• This contains a progestogen hormone.
• It works by preventing ovulation
• similar actions as the POP.
• An injection is needed every 8-12
weeks.
• It is usually recommended that you wait
until six weeks after the birth to start
the contraceptive injection because you
may get heavy and irregular bleeding.

63. • Some advantages - it is very
effective. You do not have to
remember to take pills.
• Some disadvantages - periods may
become irregular (but often lighter or
stop all together). After
stopping, there may be a delay in your
return to normal fertility for several
months. Some women have side-
effects. You cannot undo the
injection, so if side-effects occur
they may persist for longer than 8-12
weeks.

64. Contraceptive implant (such as
Nexplanon®)
• An implant is a small device
placed under the skin.
• It contains a progestogen
hormone
• It works in a similar way to the
contraceptive injection.
• It involves a small minor
operation using local anaesthetic.
• Each one lasts three years.

65. • Some advantages - it is very
effective. You do not have to
remember to take pills. You
quickly become fertile again
when the implant is removed.
• Some disadvantages - periods
may become irregular (but often
lighter or stop altogether). Some
women develop side-effects but
these tend to settle after the
first few months

66. Postcoital Contraception Pills
(Emergency Contraception)
• Emergency contraception can be used at any
time if you had sex without using
contraception. Also, if you had sex but
there was a mistake with contraception. For
example, a split condom or if you missed
taking your usual contraceptive pills.
• Emergency contraception pills - are usually
very effective if started within 72 hours of
unprotected sex. They can be bought at
pharmacies or prescribed by a doctor. An
emergency contraception pill works either
by preventing or postponing ovulation or by
preventing the fertilised egg from settling
in the womb.

67. Postcoital Contraception Pills
(Emergency Contraception)
• An IUCD - inserted by a doctor
or nurse, can be used for
emergency contraception up to
five days after unprotected sex.
• You will not need emergency
contraception if you have
unprotected sex within 21 days
of having your baby. You cannot
get pregnant so soon after
childbirth.

68. Coitus interruptus (withdrawal)
• The penis is withdrawn from the
vagina just before ejaculation
occurs
• Failure reasons
– Live sperm leaks form the urethra
before and during coitus
– The withdrawal is delayed so that
part of the semen is discharged
within the vagina

69. Rhythm Method
• Avoiding coitus during the period of
greatest fertility
• Human ovum can be fertilized no later than
24 to 48 hours after ovulation
• Although motile sperm have been recovered
from the uterus and the oviducts as long as
60 hours after coitus, their ability to
fertilize the ovum probably lasts no longer
than 24 to 48 hours
Natural family planning

70. • Ovulation :
– 14 days (12 to 16) before the onset
of menstruation
• Fertile period:
– 4 days before, and for 3 or 4 days
after ovulation
• Safe period:
– on the other days of the cycle

71. • Pregnancy is unlikely to occur if
a couple refrains from fertile
period
• Unprotected intercourse on
safe period should not result in
pregnancy

72. Sterilization
• Called tubal sterilization operation (tubal
ligation)
• Failure rate: 1/2000
• Permanence contraception
• Have the risks of surgery
• Pelvic inflammations
• Skin (section site) inflammation
• Fever (over 37.5 ℃ two times interval 4h
during 24 h)
• Severe disease couldn‘t tolerance operation
• Psychological disease

73. Female Sterilization

74. Tubal clips

75. Male sterilization

76. Complications
• Tubal recanalization
• Pregnancy
• Ectopic pregnancy
• Menstrual irregularity
• Loss of libido
• Infection
• Injury rectum or bladder

77. Family planning methods choice
• Newly wedded couple
– Male condom, female condom,
spermicidal jelly
– No IUD or oral hormonal
contraceptives
• Couple with one child
– IUD, Male condom, oral hormonal
contraceptives, Norplant,
spermicidal jelly

78. • Couple with two or more children
– Sterilization
• Women during breastfeeding
– IUD, condom
– No hormonal contraceptives
• Women in climacteric
– No hormonal contraceptives
• Condom for people with STDs or
HIV

79. Percentage of failure in different
contraception methods
• Spermicides 21%
• Withdrawal 19%
• Periodic abstinence 15%
• Condom female 21%
• Condom male 12%
• Pills 3%
• IUD 2%
• Implant 0.3%
• Patch 5%
• Copper IUD 0.8%
• Female sterilization 0.4%
• Male sterilization 0.15%

80. INTERNATIONAL LEVEL
• ―International Planned Parenthood
Federation‖ is the world's largest
private voluntary organization
supporting family planning services in
developing countries.
• The United Nations Fund for
Population Activities (UNFPA).
• the US Agency for International
Development (USAID)
• Population Council,
• Ford Foundation, The Pathfinder
fund and World Bank besides WHO
and UNICEF.