Family planning methods and welfare services

1. Family Planning methods and family
welfareservices
Mrs.Jagadeeswari.J
m.Sc nursing

2. 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”. --WHO

3. DEFINITION
Family planning is action taken by
an family or couples to regulate
the number and spacing their
children in accordance with their
personal preference
--Dictionary

4. 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 ; and
 To determine the number of children in the
family.

5. Classification of contraceptive methods
I. SPACING
METHODS
Barrier
Methods
Physical
Methods
Chemical
Methods
Combined
Methods
Intrauterine
Devices
Hormonal
Methods
Post
Conceptional
Methods
.
Miscellaneous
II. TERMINAL METHODS
Male
sterilization
Female
sterilization
Natural
method

6. Natural family planning methods
Natural methods avoid pregnancy
by abstain from sexual intercourse
during fertile phase ,coitus
interruptus,rhythm method etc.
 Basal body temperature
 Cervical mucus method
 Calendar method

7. Miscellaneous methods
1. Abstinence
2. Coitus Interruptus
3. Safe period method
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8. Barrier method
Barrier methods are those methods which
prevent meeting of sperm with ovum .
There are three types…
1. Physical barrier methods
2. Chemical barrier methods
3. Combined methods

9. physical barrier method
MALE CONDOMS
It is a thin rubber sheath which is used
by men. Its is rolled over the erect penis
before having sex.This rubber sheath
prevents the entry of semen into the
vagina.
 In India, dry condoms are manufactured
and supplied free of cost by the
government under brand name ‘Nirodh’

10. Condom cont…
 ADVANTAGE:
 Simple spacing method
 No side effects
 Easily available, safe & inexpensive
 Protects against STDs
 No medical supervision
 DISADVANTAGE:
 Chances of slip off and tear off
 Rare cases allergic to rubber

11. DIAPHRAGM
The diaphragm is used by women in her vagina to
from a barrier in front of the cervix .
The diaphragm is dome shaped and Is like
shallow cap
It made of soft synthetic rubber or plastic with a
stiff or flexible rim around the edge .its also
known as Dutch cap
It is held in position partly because of tension
created by the spring and partly by the muscle

12. Diaphragm cont…
 Advantages
 Effective with spermicidal
 Failure rate is low
 Prevents STDs including HIV/AIDS
 No risk /contraindications
 Disadvantages
 Requires assistance by health personal
 Requires periodical check up
 Requires privacy to place
 Requires facilities for storage

13. VAGINAL SPONGE
 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
 Must be removed and thrown away after
8-24 hrs but not before 6 hrs of last act

14. 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

15. CHEMICAL BARRIER METHODS
Foam tablets
Cream jelly and pastes -
spermicides
Suppositories
Soluble films

16. MERITS
 Cheapest but least effective
 Melt at body temperature
 Manual insertion high in vagina 10-15
minutes before sexual act
 Available in all health centers
 Easy to administer
 Increases vaginal lubrication

17. DEMERITS
 Must be inserted deep down where
sperm is likely to reach
 Must be applied each time before
coitus
 May cause irritation and burning

18. Intra uterine devices
The control of conception by introducing a
foreign body into the uterine cavity .
There are three types of IUD’S
 First generation IUD’S
 Second generation IUD’S
 Third generation IUD’S

19. classification
IUD
Medicated
Third
Generation
Eg. Hormonal IUD
Second
Generation
Eg. Copper IUD
Non medicated
First
Generation
Eg. Lippe’s loop
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20. First generation iud
20
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
Easy detected by x ray

21. Second generation Iud
21
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

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

23. ADVANTAGES OF IUDs:
 Safe, Effective, Reversible
 Inexpensive
 High continuation rate
 Does require hospitalisation
DISADVANTAGES OF IUDs:
 Heavy bleeding and pain
 Pelvic Inflammatory diseases
 Ectopic pregnancy
 May come out accidently if not properly
inserted9/30/2018 23

24. 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.9/30/2018 24

25. 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
9/30/2018 25

26. Classification of hormonal contraceptives
Hormonal
contraceptives
Oral Pills
Combined pills
Progesterone
only pills (POP)
Once – a –
month (long
acting) pills
Male pill
Post coital pill
Depot
Preparations
Injectables
Sub dermal
Implants
Vaginal Rings9/30/2018 26

27. Combined pills
Composition
Oestrogen - 100-200µg and
Progesterone - 10mg
Greater side effects
Taken from 5th to 25th day of menstrual cycle,
followed by a break of 7 days (withdrawal
bleeding).

28. Main type
A)MALA-D
B)MALA-N
Mechanism of action:
A)Prevents ovulation
B)Prevents implantation
C)Makes cervical secretions thick

29. E.g.. MALA-D
MALA-N

30. Merits
 100% effective if taken regularly
 Easy to use
 Reduces risk of anemia
 Reduces risk of pelvic inflammation
disease

31. Demerits
 Failure rate increases if irregularly taken
 Minor side effects are like
dizziness,nausea,vomiting,headache,breast
tenderness and weight gain
 Increase risk of heart problems
 Increases risk of gall bladder disease and
cervical cancer.
 Decrease the quantity of breast milk.

32. Progesterone only pills
 Minipill or Micropill.
Composition:
Low dosage of progesterone, mainly
Norethisterone (or) Levonorgestrel.
Dosage:
One tab daily throughout the menstrual cycle
Efficacy 96-98%
High failure rate
Not widely used

33. Once a month (long acting) pill
 In this method a long acting
oestrogen (Quinestrol) + short acting
progesterone is given.
 But the results are highly
disappointing.
High pregnancy rate
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34. Injectable contraceptives
Injectable
contracepti
ves.
Progesterone
only
injectables
DMPA
(depot-
medroxy
progesterone
acetate)
NET-EN
(
Norethisreron
e Enanthate)
DMPA-SCCombined
injectables
9/30/2018 34
CLASSIFICATION

35. Progesterone only injectables
DMPA:
 Dose: 150mg IM every 3 months.
 MOA: suppresses ovulation
 Advantage: doesn’t affect lactation, useful in postpartum
period. Can be used in the multiparae of age >35yr
NET-EN:
 Dose: 200mg IM every 2 months
 Both DMPA & NET-EN are given in 1st 5 days
of menstrual cycle.
They are given deep IM in gluteus muscle. 35

36. Combined injectables
 Containing long-acting progesterone with short action estrogen
 Given once a month and produce a menstruation like pattern.
The trials are currently taking place in India.
 Mode of acion:
 Suppression of ovulation
 Alteration of cervical and endometrial secretions.
 Contraindications
 Pregnancy Thrombo embolytic disorders
 Cerebrovascular disease Coronary artery disease
 Migraine Breast cancer
 DM
36

37. NORPLANT
Sub dermal implants
A flexible plastic single
flexible rod 4cm long
x 2mm diameter
Contains 35mg
LEVONOGESTREL
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38. Vaginal ring (Nuvaring)
 Contains small amount of oestrogen
 Use for three weeks with a withdrawal week
 Inhibits ovulation
 Cycle control good
 Non-latex
 Implanted intra vaginally
 The progesterone is absorbed slowly through the vaginal
mucosa.
 Store 2-8 degrees; if room temperature, up to 4-12
Effectiveness: Overall perfect use
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38

39. Post conceptional methods Classification
Post
conceptional
methods
Menstrual
Regulation
Menstrual
Induction
Oral
Abortifacient
Abortion9/30/2018 39

40. Menstrual regulation
 No legal restriction
 Aspiration of uterine content
 Within 6-14 days of missed period
 Cervical dilatation needed in nullipara
 Early complications : Bleeding, Uterine
perforation and trauma.
 Late complications : Tendency to abortion or
premature births, infertility, menstrual disorders,
ectopic pregnancy & Rh isoimmunization40

41. Menstrual induction
 Based on disturbing the normal progesterone-
prostaglandin balance by IU application of 1.5mg
solution or 2.5-5mg pellet of prostaglandin F 2.
 Causes sustained uterine contraction for 7 min.
followed by cyclical contraction for 3- 4 hrs.
 Bleeding starts and continues for 7-8 days.
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42. Oral Abortifacient
 Mifepristone + Misoprostol – 95%
successful in terminating pregnancies upto
9 weeks.
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43. abortion
Definition:
 Termination of pregnancy before the foetus
becomes viable .
 LEGALISATION
 Medical termination of pregnancy act
1971
1) Conditions under which abortion is done
 Medical
 Eugenic
 Humanitarian
 Socio-economic
 In failure of contraceptive device
9/30/2018 43

44. 2) Who can perform abortion?
If < 12 weeks 1 RMP having
experience in OB-GYN
If > 12 weeks -20 weeks then 2 RMP
opinion
3) Where can abortion be done?
Place approved by Chief medical
officer of district i.e. DM& HO.
9/30/2018 44

45. Drawbacks:
Irregular cycle so difficult to
predict
Only for educated and responsible
couples
 Programmed Sex
Complication:
Embryonic Abnormalities, Ectopic
Pregnancy
9/30/2018 45

46. Terminal methods
Terminal
methods
Male
sterilizat
ion
Vasecto
my
No scalpel
vas
occlusion
Female
sterilizatio
n
Tubecto
my
Laparosco
pic
occlusion
Tubal
inserts (no
incision)
9/30/2018

47. VASECTOMY
 Vasectomy is sterilisation of male
 It is very simple and minor operation which
takes hardly 15-20minutes
 The operation involves a small cut on both
sides of the scrotum then a small portion of vas
deferens about 1cm on either side of the
scrotum is cut and ligated, folded back and
sutured
 Sperms are produced but not ejaculated

48. MERITS
• Permanent cheaper than tubal ligation
• 100% effective
DEMERITS:
• Requires surgery
• Not effective immediately
• May not be reversible

49. COMPLICATIONS:
Operative
Sperm granules
Spontaneous recanalisation
Autoimmune response
Psychological response
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50. Tubectomy
50

51. TUBECTOMY
 Its done by resecting a small part of fallopian
tubes and ligate the sected ends
 The closing of the tubes can be done by using
other methods like closing the tubes with bands,
clips and electrocautery
 This surgery is done through abdominal and
vaginal approach
 Most common is abdominal laparoscopy
 Done after delivery or after abortion

52. POST-COITAL
COTRACEPTIVE
Emergency contraception is a
method of contraception which is
used after intercourse and before the
potential time of implantation
No prescription is needed for
women aged 17 years
This can be used within 72 hours
and should be taken for 5 days after
coitus

53. Mechanism of action:
Hypermotility of fallopian tube
Hypermotility of uterus hence
no implantation and
fertilization
Disadvantages:
Nausea and vomiting.
Next period may start earlier
or later
Do not protect against STI &

54. Family welfare services
DEFINITIONS:
Family welfare includes
not planning of births, but the welfare
of whole family by means of total
family health care.

55. Aims and objectives of family
welfare programmes
 To promote the adoption of small family
size norm on basis of voluntary
acceptance
 To promote the use of spacing methods
 To ensure adequate supply of
contraceptives to all eligible couples
within easy reach
 To arrange for clinical and surgical
services so as to achieve the set targets

56. Cont..
 Participation of voluntary
organization/local leaders/local self
government, in family welfare
programme at various levels
 Using the means of mass
communications and interpersonal to
overcome the social and cultural
hindrance in adopting the programme
or extensive use of public health
education for family planning

57. IMPACT OF FAMILY PLANNING
SERVICE
 Awareness of one or more methods of
contraception
 Increases in contraception use over years
 Increase in use of condoms
 Knowledge of female sterilization
 Increase knowledge about contraceptive pills
 Fertility rate low among educated women
 Fertility rate low among higher income group

58. ROLE OF COMMUNITY HEALTH NURSE IN
FAMILY WELFARE SERVICES
 Survey work
 Collecting demographic facts
 Collecting information about pregnant
mothers, eligible couples, infants and
children below the school going age.

59. Cont..
 Education functions and motivation:
 Explaining the importance and necessity of
family planning to mass
 Using various techniques of teaching and
communication to propagate the message of
family planning to common man
 Motivating the eligible couple to use
contraceptive
 Motivating people for permanent contraception

60. Cont..
 Managerial functions:
 Conducting clinics
 Organizing family planning camps
 Maintaining the records
 Liaison work- soliciting the co-
operation of NGO’s /Voluntary
organization