2013 resent advances

1. FAMILY PLANNING
by
DR.VENU

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‖.

3. 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.

4. 1. The United Nations Conference on Human Rights
at Teheran in 1968 recognized family planning as
a basic human right.
2. 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".

5. 3.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‖.

6. SCOPE OF FAMILY PLANNING
SERVICES
(1)The proper spacing and limitation of births.
(2) Advice on sterility,
(3)Education for parenthood.
(4) Sex education,
(5) Screening for pathological conditions related
reproductive system,
(6)Genetic counseling,

7. (7) Premarital consultation and examination,
(8) Carrying out pregnancy tests,
(9) Marriage counseling,
(10) The preparation of couples for the arrival of their
child,
(11) Providing services for unmarried mothers,
(12) Teaching home economics and nutrition,
(13) Providing adoption services

8. HEALTH ASPECTS OF
FAMILY PLANNING
1.WOMEN'S HEALTH
Maternal mortality, morbidity of women
of child bearing age, nutritional status (weight
changes,haemoglobin level, etc.) preventable
complications of pregnancy and abortion.
2. FOETAL HEALTH
Foetal mortality (early and late
foetal death);abnormal development.

9. 3.INFANT AND CHILD HEALTH
- Neonatal, infant and
pre- school mortality ,
- Health of the infant at birth
(birth weight),
- Vulnerability to diseases.

10. THE WELFARE CONCEPT
Family planning is associated with numerous
misconceptions - one of them is its strong
association in minds of people with sterilization.
The recognition of its welfare concept came only
a decade and half after its inception, when it was
named Family Welfare Programme.
The concept of welfare is very comprehensive
and basically related to quality of life.

11. SMALL - FAMILY NORM
The objective of the Family Welfare Programme
in India is that people should adopt the "small
family norm" to stabilize the country's population
at the level of some 1,533million by the year 2050
AD.
 SYMBOLISED
 In the 1970s, - do ya teen bas.
 In the 1980s - 2 - child norm.

12. The current emphasis is on three themes:
"Sons or Daughters – two will do";
"Second child after 3 years", and
universal immunization”.
Small differences in the family size will make big
differences in the birth rate.
A significant achievement of the Family welfare
Programme in India has been the decline in the
fertility from 6.4 in 1950s to 2.6 in 2010.
The national target to achieve a Net Reproduction
Rate of 1 by the gear 2006 which is equivalent to
attaining approximately the 2-child norm.

13. ELIGIBLE COUPLES
A currently married couple wherein the wife is in
the reproductive age, which is generally assumed
to lie between the ages of 15 - 45.
There will be at least 150 to 180 such couples per
1000 population in India.
20 % of eligible couples - age group 15- 24 yrs
 On an average 2.5 million couples are joining
the reproductive age group every year.
The "Eligible Couple Register" is a basic
document for organizing family planning work.

14. TARGET COUPLES
Couples who have had 2-3 living children, and
family planning was largely directed to such
couples.
The definition of a target couple has been
gradually enlarged to include families with one
child or even newly married couples with a view
to develop acceptance of the idea of family
planning from the earliest possible stage.
In effect, the term target couple has lost its
original meaning.

15. Target group
for spacing
method Unsterilized
couples =112.2
million
(estimated)
Unsterilized
couples exposed
to higher order
of birth (3&
above) = 50.3
million
(estimated)
Target group
For
Sterilization
Couple
sterilized
= 45.4 million
TOTAL ECs = 197.4 million
As on march 2010

16. COUPLE PROTECTION RATE
(CPR)
An indicator of the prevalence of
contraceptive practice in the community.
It is defined as ―the per cent of eligible
couples effectively protected against childbirth
by one or the other approved methods of
family planning‖.
Demographers are of the view that the
demographic goal of NRR : 1 can be achieved
only if the CPR exceeds 60 per cent.

17.  National Population Policy was to attain a CPR
of 42 per cent by 1990 , and 60 per cent by the
year 2000.
 During 2010-2011, the total number of family
planning acceptors by different methods .
 Sterilization- 5 million
 Vasectomy- 0.219 million
 Tubectomy- 4.78 million
 IUD insertion- 5.6 million
 Condom users- 16 million
 Oral pill users- 8.3 million

18. However about 60 per cent eligible couples
are still unprotected against conception.
STATE-WISE BREAK-UP
Punjab, Gujarat, Maharashtra, Karnataka,
Haryana and Tamil Nadu etc – ahead
Bihar, Uttar Pradesh, Assam, Rajasthan, West
Bengal, Jammu and Kashmir etc - low

19. NATIONAL POPULATION
POLICY 2OOO
National population policies intended to
decrease the birth rate or growth rate.
In April 1976 India formed its first
National Population Policy.
Legal minimum age of marriage was
increased from 15 to 18 for girls and from
18 to 21 for boys

20. IMMEDIATE OBJECTIVE :
– To address the unmet needs for contraception,
– Health care infrastructure and health personnel and
– To provide integrated service delivery for basic reproductive
and child health care.
 MEDIUM TERM OBJECTIVE:
– To bring the TFR to replacement level by 2010 through
vigorous implementation of inter sectoral operational
strategies.
 LONG TERM OBJECTIVE:
– Achieve a stable population by 2045 at a level consistent with
requirement of sustainable economic growth, social
development and environmental protection.

21. NATIONAL SOCIO -
DEMOGRAPHIC GOALS FOR 2010
1. Address the unmet needs for basic RCH services, supplies and infrastructure.
2. Make school education up to age 14 years free and compulsory, and reduce drop
outs rate from primary and secondary school levels to below 20 percent for both
boys and girls.
3. Reduce IMR to 30/1000 live births.
4. Reduce maternal mortality ratio (MMR) to less than 100 per 1000 live births.
5. Achieve universal immunization of children against all Vaccine Preventable
Disease (VPD).
6. Promote delayed marriage for girls, at age not less than 18,and preferable after 20
years.
7. Achieve 80% institutional delivery and 100% by trained personnels

22. 8. Achieve universal access to information/ counseling services for fertility
regulation and contraceptive with wide basket of choices.
9. Achieve 100% registration of births, deaths, marriage, and pregnancy.
10. Containment of AIDS, and greater integration between the management
of AIDS and STD.
11. Prevention and control of communicable diseases.
12. Integration of Indian system of medicine in provision of RCH services,
and in reaching out to households.
13. Promote small family norm to achieve replacement level of Total
Fertility Rate 2.1.
14. Bring about convergence in implementation of related social sector
programmes so that family welfare become people centered programme.

23. 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

24.  The present approach in family planning
programmes 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.

25. 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

26. 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.
 In India, dry condoms are
manufactured and supplied
free of cost by the
government under brand
name ‗Nirodh‘
 ADVANTAGE:
 Simple spacing method
 No side effects
 Easily available, safe &
inexpensive
 Protects against STDs
 DISADVANTAGE:
 Chances of slip off and tear off
Failure rate: 2-3/HWY

27. 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

28. 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)
Coil spring type (ortho diaphragm mostly

29. CERVICAL CAP OR CHECK PESSARY
Small dome shaped rubber appliances designed to cover the
cervix
Remain in place by suction
Cap must be tailored to fit cervix
Loosely fit caps may be displaced during intercourse
Not suitable if cervix lacerated or irregular in shape
3 or 4 sizes between 22 and 31 mm

30. VAULT CAP
Hemispherical, dome shaped rubber or plastic cap
that fits into vaginal vault covering the cervix
Rim is thick but does not contain metal spring
External diameter of rim is size of vault cap, ranging
from 50 to 75 mm in 5mm steps
Correct size – smallest that fits evenly in vaginal vault
VINULE CAP
Type of cervical cap made of rubber, fairly rigid
String attached for easy removal
Useful in cystocele or mild prolapse where diaphragm
not retained
External diameter of rim is size – 45 to 51 mm in
3mm steps

31. Failure rate:
 DIAPHRAGM: 18-28% with
typical use and 6% with correct
and consistent use
 CAPS: parous women – 30-40%
with typical use 20-26% with
correct and consistent use
 nulliparous – 16-20% with
typical use 9% with correct and
consistent use

32. 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

33. 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

34. 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

35. SPERMICIDES
 Non ionic surfactants which alter sperm surface
membrane permeability, resulting in killing of
sperms
 Developed in late 19th century
 Use decreasing due to high failure rate
 Types and distribution: spermicidal agents
contain nonoxynol 9. few products contain
octoxynol 9 and menfegol
 Chemical suppositories:
 Cheapest but least effective
 Melt at body temperature
 Manual insertion high in vagina 10-15 min before
sexual act

36. 2. Contraceptive creams and jellies
liquefy at lower temperature than most creams so more suitable for women with
dry vagina
3. Foam tablets
effervesce on contact with vaginal moisture
placed deep in vagina close to cervix
more effective than pessaries
Tablets have to be used about 10 min before act and action lasts for 1 hour
Failure rate – 0.3-5 per 100 women years
‗Today‘ tablets
4. Aerosols or foams
foaming chemical contraceptive creams with butane propellant stored under
pressure that may be released by pressing valve
slightly more effective but more messy
5. C-film
5cm squares of water soluble , semitransparent plastic impregnated with
nonoxynol9
either placed over glans penis before coitus or high in vagina 3-5 min before
coitus
active for 2 hrs

37. 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% with correct and consistent use.

38. classification
IUD
Medicated
Third
Generation
Eg. Hormonal IUD
Second
Generation
Eg. Copper IUD
Non medicated
First
Generation
Eg. Lippe’s loop
8/6/2013 38

39. 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
Failure rate: 3-5 / HWY 39

40. 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 Failure rate: 0.8/HWY
 ML-Cu250
 ML-Cu375 40

41. Third generation iud
Hormone releasing IUD
Progestastert
Most commonly used
T shaped device
filled with 38mg of progesterone
Releasing rate 65µg/day.
Effective for 1 yr Failure rate: 0.2 / HWY
LNG-20 (Minera)
Releases 20µg of levonorgesterol.
Effective for 5 yrs
Effective rate 99%
8/6/2013 41

42. 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
8/6/2013 42

43. 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.
8/6/2013 43

44. 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
8/6/2013 44

45. 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
Subdermal Implants
Vaginal Rings8/6/2013 45

46. Combined pills
Composition:
In early 1960s –
Oestrogen - 100-200µg and
Progesterone - 10mg
Greater side effects
Nowadays
Oestrogen - 30-35µg and
Progesterone - 0.05-0.15mg.
Taken from 5th to 25th day of menstrual cycle, followed by
a break of 7 days (withdrawal bleeding).
FAILURE RATE: 0.1/HWY

47. Main type
A) MALA-D: (Levonorgestrol 0.15mg + EE 0.03mg)
Packet of 28 tabs. 21 are white and 7 are brown
coloured containing Ferrous Fumarate.(Rs – 3/-)
B) MALA-N : (Levonorgestrol 0.15mg + EE0.03mg)
Packet of 28 tabs.
Govt Supply.
Mechanism of action:
A) Prevents ovulation
B) Prevents implantation
C) Makes cervical secretions thick
Effectiveness
100% effective if taken correctly.

48. Eg. MALA-D
MALA-N

49. Contraindications to OCP Use
Absolute Contraindications
Cancer of breast and Genitals
H/O venous thrombo-
embolism
Vascular disease- CAD or
CVD
Liver disease ( i.e. Viral
hepatitis, cirrhosis)
Pregnancy
Congenital hyper lipidaemia
Age above 40 yrs.
Smoking and age above 35
yrs
HTN with SBP>160, DBP>99
Chronic renal diseases
Epilepsy , Migraine
Hyper lipidaemia LDL>160
DM with secondary
complications
Infrequent bleeding,
Amenorrhea.
49

50. Progesterone only pills
 Minipill or Micropill.
Composition:
Low dosage of progesterone, mainly
Norethisterone (or) Levonorgestrel.
Dosage:
One tab daily throughout the
menstrual cycle
It is mainly given in older women in
whom combined pills are C/I as in
CVDs
Efficacy 96-98%
Failure rate:0.5/HWY

51. Mechanism of action:
 Makes cervical mucosa thick – action starts in 2-4 hrs last
for 24hrs.
 Decreases the motility of Fallopian tubes.
 Prevent pregnancy without preventing ovulation, as
ovulation occurs in 20-30% women.
Suitable for
Lactating women
Smokers above 35 yrs old
Estrogen sensitive women
Disadvantages:
 Higher risk of neoplasia in women taking POP than in
women on Combined Pills
 Poor control of cycle.

52. POST-COITAL COTRACEPTIVE
(a) IUD : WITH IN 5 DAYS
(b) HORMONAL : More often a hormonal
method may be preferable. In India
Levonorgestrel 0.75 mg tablet is approved .(
1Tab-with in 72 hrs)
(or)
2 tab-50mcg of EE with in 72 hrs after
intercourse & same dose after 12 hrs.
(or)
4 tab-30-35 mcg of EE with in 72 hrs& 4 tab-
after 12 hrs (or) mifepristone 10 mg in 72 hrs

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 & HIV
 1 % failure rate

54. Male pills
The hormones which reduce
sperm count tend to reduce
testosterone levels hence they
affect potency and libido
Gossypol:
Cotton seed derivative
Causes azoospermia and severe
oligospermia
Toxic
Use for 6 months leads to
complete sterility
8/6/2013 54

55. 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.
8/6/2013 55

56. Injectable contraceptives
Injectable
contraceptives.
Progesterone only
injectables
DMPA
(depot- medroxy
progesterone
acetate)
NET-EN
( Norethisrerone
Enanthate)
DMPA-SCCombined
injectables
CLASSIFICATION
8/6/2013 56

57. 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. 57

58. New formulation of DMPA (Uniject)
Prefilled, single use syringe
could be particularly
They contain a special
formulation of DMPA, called
DMPA-SC (104 mg).
Short needle meant for
subcutaneous injection
Useful to provide DMPA in
the community.
Injections by appropriately
trained community health
workers is safe, effective,
and acceptable. 58

59. Side effects:
Disruption of normal menses
Amenorrhoea
Contraindications:
Breast cancer
Genital cancer
Undiagnosed uterine bleeding
Suspected malignancy
Lactating women
FAILURE RATE: 0.3/HWY
8/6/2013 59

60. Combined injectables
 Containing long-acting progesterone with short action estrogen
25 mg DMPA + 15 mg estradiol cypionate (Cyclofem) and
 50 mg NET-EN + 5 mg estrdiol valerate (Mesigyna)
 Given once a month and produce a menstruation like pattern.
The trials are currently taking place in India.
 MOA:
 Suppression of ovulation
 Alteration of cervical and endometrial secretions.
 C/I:
 Pregnancy Thrombo embolytic disorders
 Cerebrovascular disease Coronary artery disease
 Migraine Breast cancer
 DM 60

61. NORPLANT
Sub dermal implants
A flexible plastic single
flexible rod 4cm long x
2mm diameter
Contains 35mg
LEVONOGESTREL
3 years pregnancy rate 0.7
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62. Benefits
 Reliable long term
contraception
 Improvement in menorrhagia
and dysmenorrhoea
 Beneficial effect on acne in
59%
 No adverse effects on bone
mass
 No significant effect on
lipids, haemostasis or liver
function
Adverse side effects
 Bleeding pattern altered:
Amenorrhoea 20%
 Weight gain of >10% in 21%
 Hormonal ‗nuisance‘ effect
eg breast pain, headache, libido
decrease, dizziness, nausea
 Other (<2.5%) alopecia,
depression, change in libido
8/6/2013 62

63. The Patch (OrthoEvra)
Is a thin & plastic patch
 That sticks to the skin.
The sticky part of the patch contains
the hormones: norelgestromin (progestin)
and ethinyl estradiol (estrogen).
Weekly for 3wks then patch free 1 week.
These hormones are absorbed
continuously through the skin and into
the bloodstream.
8/6/2013 63

64. 64
Vaginal ring (Nuvaring)
 Etonorgestrel 120mcg +Ethinylestradiol 15mcg daily
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 failure rate
0.3%, typical use failure rate 8%
64
8/6/2013

65. Post conceptional methods Classification
Post
conceptional
methods
Menstrual
Regulation
Menstrual
Induction
Oral Abortifacient
Abortion
8/6/2013 65

66. 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 isoimmunization
66

67. Menstrual induction
Based on disturbing the normal progesteron-
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.
8/6/2013 67

68. Oral Abortifacient
Mifepristone + Misoprostol – 95% successful in
terminating pregnancies upto 9 weeks.
Commonly used regimen
Mifepristone 200mg oral on day 1 followed by
 Misoprostol 800mcg vaginally immediately or
6 -8 hrs later.
Other regimen is
Mifepristone 600mg oral on day 1 followed by
Misoprostol 400mcg orally on day 3
Follow up visit is must within 14 days for clinical
and/or USG examination
8/6/2013 68

69. 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
8/6/2013 69

70. 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.
8/6/2013 70

71. Miscellaneous methods
1. Abstinence
2. Coitus Interruptus: failure rate 25/HWY
3. Safe period/rhythm period/ calendar method
Basis: ovulation from 12th - 16th day before onset of menses
Calculation: 1st day of fertile period = shortest cycle-18days
Last day of fertile period = longest cycle-10days
8/6/2013 71

72. Drawbacks:
Irregular cycle so difficult to predict
Only for educated and responsible couples
 Programmed Sex
High Failure rate 9/ HWY
Complication:
Embryonic Abnormalities, Ectopic
Pregnancy
8/6/2013 72

73. 4) Natural family planning method:
Basis: same as calendar method but here the women
employs self recognition of certain signs and
symptoms associated with ovulation.
a) Basal Body temperature method
b) Cervical mucous method
c) Symptothermic : It is based on the observation
of changes in different body signs: cervical
secretions, basal body temperature and the
position of the opening of the cervix.
5) Lactation
8/6/2013 73

74. Terminal methods
Terminal
methods
Male
sterilization
Vasectomy
No scalpel vas
occlusion
Female
sterilization
Tubectomy
Laparoscopic
occlusion
Tubal inserts
(no incision)8/6/2013

75. vasectomy
8/6/2013 75

76. Failure Rate: 0.15/HWY (due to
mistaken identification of vas)
COMPLICATIONS:
Operative
Sperm granules
Spontaneous recanalisation
Autoimmune response
Psychological response
8/6/2013 76

77. No scalpel vas occlusion
METHODS
Elastomer plugs: Gets hardened and
plugs the vas
SHUG: preformed silicon rubber plug is
inserted.
RISUG: Reversible Inhibition of Sperm
Under Guidance8/6/2013 77

78. Tubectomy
Failure rate: 0.5/HWY 78

79. Approaches to the fallopian tubes, surgical procedures, timing of
procedure,and related occlusion techniques
8/6/2013 79

80. Evaluation of contraceptive methods
Contraceptive efficiency:
It is the measurement of unplanned pregnancies even after
the use of contraceptive measures.
1) Pearl Index: no. Of failures/100 woman-yr of exposure
Failure rate/HWY= Total accidental pregnancies × 1200
total months of exposure
2)Life-table analysis - calculates a failure rate of each
month of use.
8/6/2013 80

81. RECENT
ADVANCES

82. 1.New Male Pill
The pill contains desogestrel as well as
testosterone.
 Blocks the production of sperm while
maintaining male characteristics and sex drive.
It must be taken daily.
100% effective and completely reversible in
preliminary clinical trials .
In clinical trials, all of the participants‘ sperm
counts dropped to zero, which means that the male
pill would be more effective than the condom and
even the female pill. 82

83. 2. CatSper Blocker
Sperm rely on calcium ions in sperm-
tail for mobility and fertilization.
 Humans -ion-channel gene -CatSper.
 Blocking CatSper action - effective form of birth
control.
 Men or women could take this potential CatSper
―blocker‖ because it could be made to act ‖wherever
sperm are present.‖

84. 3. Spray On -Contraceptive
Australian biotech company Acrux has come up
with a world‘s first — a contraceptive spray for women.
Metered Dose Transdermal System (MDTS) to administer a
pre-set dose of the Nestorone to the skin (forearm) every 14
days.
The fast-drying spray gradually absorbed into the bloodstream.
Suitable for
Breastfeeding mothers
Who cannot tolerate contraceptive pills with oestrogens.
Leaves no visible residue & less irritation than patches.
Because it does not have to be taken at the same time every
day, it will suit women who often forget to take the Pill.

85. 4. Adjudin “the male patch”
Adjudin (2,4-dichlorobenzyl-
1H-indazole-3-carbohydrazide)
is non-hormonal male contraceptive
drug, which acts by blocking the
maturation of sperm in the testes,
but without affecting testosterone
production.
Normal spermatogenesis returned in 95% within 210 days
after the drug had been discontinued.
The oral dose effective for contraception is so high that
there have been side effects in the muscles and liver,
therefore the drug is being manufactured as implant or patch
for males.

86. 5. contraction inhibitor pill “dry orgasm”
2 different types of smooth muscle in vasa deferentia
 Longitudinal muscle fibers and circular muscle fibers.
When segments of vasa deferentia were exposed to
phenoxybenzamine or thioridazine , the longitudinal smooth
muscle fibers did not contract.
The circular smooth muscles did, causes, clamping the vas
shut.
 Thioridizine‘s side effects were so extreme(hives,
difficult breathing;,swelling of face) that the
manufacturer discontinued it in 2005, the common side
effects of phenoxybenzamine are dizziness , fast
heartbeat & stuffy nose.
8/6/2013 86

87. 6. Anti-Fertility Vaccines
Contraceptive vaccine either target
Gamete production ( FSH and LH)
Gamete function
Gamete outcome (hCG).
CVs targeting gamete function are better choices but
induce oophoritis affecting sex steroids.
 Antisperm antibody-mediated immunoinfertility
provides a naturally occurring model to indicate how
an antisperm vaccine will work in humans.
The hCG vaccine is the first vaccine to undergo
clinical trials in humans. Both the efficacy and the
lack of immunotoxicity have been reasonably well

88. 7. R.I.S.U.G
Reversible Inhibition of Sperm Under Guidance
(RISUG), developed at IIT Kharagpur in India by Dr.
Sujoy K Guha.
It is currently undergoing clinical trials in India.
RISUG is a non-hormonal injectable contraceptive
composed of SMA (styrene maleic anhydride) mixed with
DMSO (solvent dimethylsulfoxide).
Partially blocks the vasa deferentia and destructs the sperm
The differential charge from the gel ruptures the sperm‘s
cell membrane, stopping the sperm before they can even
start their journey to the egg.
Reversals by multiple injection of dimethyl sulfoxide or
sodium bicarbonate – and several months to reverse.

89. 8. Hydrothermal Male Control
 Methods used include
Hot water applied to the scrotum
Heat generated by ultrasound
Artificial cryptorchidism (holding the testicles inside the
abdomen) using specialized briefs.
 Raising the body temperature above 42 degrees Celsius initiates
certain processes, resulting in cells disability. It is called Heat Shock
Factor (HSF).It disable sperm cells.
 Hot water bath (about 46.7 degrees Celsius)for 45 minutes daily for
3 weeks - simple wet heating - ensure up to 6 months of male
infertility.
 ultrasound method - the testicles are heated with the help of
ultrasound - only two procedures 48 hours - temporary infertility for
up to 10 months.

90. 10. SILCS Diaphragm
The SILCS diaphragm is a silicone barrier
contraceptive device .
Its dome is filled with BufferGel that acts both as a
spermicide and microbicide that not only immobilizes
the sperms but also kills them and fights infections.
It avoids the need for many sizes and a pelvic exam
for a correct fit; it is designed as a ―one size fits most‖
device.
The new device is being evaluated for comfort and
ease-of-use in studies, underway in the Dominican
Republic, South Africa, Thailand, and the United
States.

91. 11. Injectable silicone plugs
Often used by men in China as a potential alternative
to vasectomy.
There are two tested types of injected plugs:
Medical-grade polyurethane (MPU)
Medical-grade silicone rubber (MSR).
The polymer (special ingredient) is injected directly
into the vasa differentia, Once injected, the polymer
solidifies in place, forming a flexible plug.
The procedure takes less than 30 minutes under local
anesthesia.
It is easier to reverse. It takes 2 to 4 years after the
reversal procedure.

92. 12.Essure
The Essure procedure involves placing a
small & flexible device called a Micro-
insert into each fallopian tubes.
The Micro- inserts are made from materials
that have been well studied and used
successfully in the heart and other parts of
the human body for many years.
Once the Micro-inserts are in place, body
tissue grows into the Micro- inserts, blocking
the fallopian tubes.

93. SOCIOLOGY OF FAMILY
PLANNING
Basic social cell.
Sociologists and economists believed that
living standards of the people can not 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.

94. Studies have shown that the population problem
complicated by deep-rooted religious and other
believes.
Attitudes and practices favoring larger families.
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 show 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.

95. UNMET NEED
Women have an unmet need if they
are sexually active
do not want to have a child soon or at all
are not using any contraceptive method
are able to conceive
 In 1960s – “KAP – gap”
In 1977 - Unmet Need

96. Who has unmet need?
Fifteen percent of married women in
developing countries:
24% in Sub-Saharan Africa
11% in South and Southeast Asia
10% in North Africa and West Asia
12% in Latin America and the
Caribbean

97. More than 100 million married women have an
unmet need for contraception
South & Southeast Asia
Central Asia
Latin America & Caribbean
North Africa & West Asia
Sub-Saharan Africa
Number (in millions) and % distribution of married women with unmet need
60 (56%)
29 (27%)
7 (7%)
9 (8%)
3 (3%)

98. Reasons for nonuse can be grouped into a few
broad categories
Opposition to family planning
Lack of knowledge
Access and cost
Health concerns and side effects of methods
Misconceptions about pregnancy risk

99. CONTRACEPTION AND
ADOLESCENCE
10 and 20 per cent of all pregnancies- developing
countries - USA.
"At Risk―-Many are undesired, and occur in
unmarried adolescents who then resort to legal or
illegal abortion, performed under unsatisfactory
medical conditions.
PREVENTION-Through educational programmes
dealing with responsible sexual behavior.
 Adolescents are ambivalent about family planning
to request contraception is to reveal one's sexuality.

100. For this reason, adolescent girls sometimes
choose the risk of an undesired pregnancy and
of an abortion.
BARRIER METHODS
HORMONAL CONTRACEPTION;
Hormonal methods are perfectly suitable for
adolescents, who generally do not suffer from
such problems as cardiovascular
contraindications.
The demographic future of the world will
depend on them, on how well informed they
are, and on their sense of responsibilities.

101. AT CETRE FWP
Central minister
of Health &
family welfare
SECRETARY
SPECIAL
SECRETARY
JIONT
SECRETARY
ADDITIONAL
SECRETARY
SERVICE DELIVERY SYSTEM OF
FAMILY PLANNING

102. The National Institute of Health and Family
Welfare acts as an apex technical institute for
promoting health and family welfare in the country
through education, training services, research and
evaluation.
“Central Family welfare Council” consisting of
all the State Health Ministers to review the
implementation of the programme.
 ―A Population advisory Council‖ headed by the
Union Health Minister, members of Parliament,
and persons from the fields related to population
control was set up in 1982.
This body acts like a ―think tank‖ .

103. State welfare bureau part of
state director of health &
family welfare (25)
Dist. Family welfare bureau
Dist. Family
welfare
officer
Dist. Mass Education and
Media officer
CHCs(4,535) PHCs(147,069) At village level
Urban family
welfare
centers(1,083)10 city family
welfare
bureaus
Statistical officer
1979 family welfare and national malaria
eradication pro.
Regional offices
Family
welfare cell
AT STETE LEVEL

104.  Community Needs Assessment Approach
 Involvement of private sector
 Incentives and Dis-incentives
 Family Welfare linked health insurance
scheme
 Postpartum Programme
 Population education

105. VOLUNTARY ORGANIZATIONS
The Family Planning Association of India,
 The Family Planning Foundation and the
Population Council of India.
The Indian Red Cross,
The Indian Medical Association,
Rotary Clubs,
 Lions Clubs,
Citizens Forum,
 Christian Missionaries and Private Hospitals.

106. 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.

107. NATIONAL FAMILY WELFARE
PROGRAMME
India launched a nation-wide family planning
programme in 1952,first country in the world.
Beginnings the programme were modest with the
establishment of a few clinics and distribution of
educational material, training and research.
Third Five Year Plan (1961-66)- "the very centre of
planned development‖.- the purely ―clinic approach"
to the more vigorous "extension education approach"
for motivating the people for acceptance of the
'small family norm".

108. The introduction of the Lipples Loop in 1965
necessitated the creation of a separate Department
Family Planning in 1966 in the Ministry of Health.
Fourth Five Year Plan (1969-74)- "top priority" to
the programme.
The Programme was made an integral part of MCH
activities of PHCs and their sub-centres.
In 1970- All India Hospital Postpartum Programme
 1972 - Medical Termination of Pregnancy (MTP)
act were introduced.
Fifth Five Year Plan (1975-80)- 1976- National
Population Policy

109. 1977- Ministry of Family Planning was renamed
― Family Welfare‖
The 42nd Amendment of the Constitution has made
"Population control and Family Planning" .
The acceptance of the programme is now purely
on voluntary basis.
The Rural Health Scheme in 1977 and the
involvement of the local people.
1978- the Alma Ata Declaration - The acceptance
of the primary health care approach to the
achievement of HFA/2000 AD led the formulation
of a National Health Policy in 1982.

110. The Sixth and Seventh Five Year Plans were
accordingly set to achieve these goals.
1985 – 86- Universal Immunization
Programme
The oral rehydration therapy
1992 these programmes were integrated under
Child Survival and Safe Motherhood (CSSM)
Programme.
1994- the International Conference on
Population and Development in Cairo-
implementation of Unified Reproductive and

111. Ninth Five Year Plan the RCH Programme
integrates all the related programmes of the Eighth
Five Year Plan.
 The concept of RCH is to provide
 need based,
client oriented,
demand driven,
high quality integrated services.
The investment on family welfare programme
0.65 crores during the first plan,
the Eleventh Plan period-136,147 crores

112. Evaluation of Family Planning
1. Evaluation of need
2. Evaluation of plans
3. Evaluation of performance
a. Services
b. Response
c. Cost analysis
d. Other activities
4. Evaluation of effects
5. Evaluation of impact

113. Thank u