What is family planning?
The practice of controlling the number of children one has and the intervals between their births, particularly by means of contraception or voluntary sterilization.
Goal of Family planning:
- Allows people to attain their desired number of children
- And determine the spacing of pregnancies.
- It is achieved through use of contraceptive methods
Benefits of family planning / contraception:
Preventing pregnancy-related health risks in women
- Allows spacing of pregnancies
- Can delay pregnancies in young women at increased risk of health problems and death from early childbearing.
- Prevents unplanned pregnancies, including those of older women who face increased risks related to pregnancy.
- Family planning enables women who wish to limit the size of their families to do so.
Broader Benefits of FP/ contraception:
Reducing infant mortality
By preventing closely spaced and ill-timed pregnancies and births.
Helping to prevent HIV/AIDS
Condoms provide dual protection against unintended pregnancies and against STIs including HIV.
Empowering people and enhancing education
A smaller family allows parents to invest more in each child.
Opportunity for women to pursue additional education and participate in public life
Reducing adolescent pregnancies
Pregnant adolescents are more likely to have preterm or low birth-weight babies.
Babies born to adolescents mothers have higher rates of neonatal mortality.
Slowing population growth
Family planning is key to slowing unsustainable population growth
Factors which influence Population Growth
Unmet need of Family Planning: Total unmet need of Family Planning is 12.9% (NFHS-IV) in our country.
Total unmet need of Family Planning is 14.2% (NFHS-IV) in our country.
Age at Marriage and first childbirth: In India 22.1%of the girls get married below the age of 18 years and out of the total deliveries 6.1% are among teenagers i.e. 15-19 years.
Types of contraception available in health institutions as well as front line workers:
Spacing methods:
- OCP (Mala-N)
- Condom (Nirodh)
- IUCD (380A and 375)
- Inject able DMPA (Antara)
- Emergency Contraceptive Pill (Ezy Pill)
Limiting/Permanent methods:
- Vasectomy (Conventional and NSV: male)
- Tubectomy (Minilap and Laparoscopy: Female)
Reasons for Unmet Need:
- Limited choice of methods
- limited access to contraception, particularly among young people, poorer segments of populations, or unmarried people;
- fear or experience of side-effects;
- cultural or religious opposition;
- poor quality of available services;
- users and providers bias
- Gender-based barriers.
- Strong advocacy is required for acceptance of family planning methods by beneficiaries
1. Emergency Contraceptive Pills (ECPs)
Emergency Contraception:
Method of Contraception that is used within 72 Hrs of unprotected intercourse to prevent pregnancy also called "Morning after" or post-coital contraception.
Reasons for Using Emergency Contraception
A Woman who had an unprotected sex, and she wants to prevent pregnancy. For example:
- She did not expect to have sex and was not using any contraception.
- Sex was forced.
- A condom broke or slipped.
- She ran out of contraceptives, started a new packet of pills several days late, or missed three or more active pills in a row, and she did not use condoms or spermicidal.
- She is late for contraceptive injection-more than 2 weeks late for DMPA, more than 2 week for Norethindrome enanthate.
GOI Guidelines
The Government of India guidelines for Emergency Contraception recommend use of Levonorgestrel (progestogen only) NG 0.75 mg as a "dedicated product" for effective emergency contraception. The Drug Controller of India has approved only Levonorgestrel for use as ECP.
How do ECP Work
Probable mechanisms are:
- Inhibition or delay of ovulation.
- Thickening of cervical mucous.
- Direct inhibition of fertilisation
- Histological and biochemical alteration in endometrium leading to impaired endometrial receptivity to implantation of the fertilized egg.
- Alteration in transport egg, sperm and embryo.
- Interference with corpuluteum function and luteolysis.
Medical Eligibility Criteria for Emergency Oral Contraception.
Any Woman can use emergency oral contraception if she is not already pregnant.
When Should ECPs be taken?
The ECPs should be taken as soon as possible after unprotected intercourse. Only one tab of 1.5 mg or two tabs of 0.75 mg stat should be taken within 72 hours after intercourse.
2. In Tra Uterine Devices(IUDs) Copper-bearing IUDs
Mechanism of action
Prevent sperms and egg from meeting.
Perhaps makes movement of sperm difficult, reduces the ability of sperm to fertilize egg.
Possibly prevents egg from being emplaned in wall of uterus.
Advantages
- A single decision leads to effective long-term prevention of pregnancy.
- Long-lasting .Cut-380 A, lasts at least 10 years. Inert IUDs never need replacement.
- Little to remember for clients.
- No interference with sex.
- Increased sexual enjoyment, no need to worry about pregnancy.
- No hormonal side-effects of copper-bearing or inert IUDs.
- Immediately reversible.
- No effect on quality or quantity of breast milk.
- Can be inserted immediately after childbirth (except hormonal IUDs) or after induced abortion (if no evidence of infection)
Disadvantages
- Menstrual Changes common in early months but lessen after 3 months.
- Longer and heavy menstrual periods.
- Bleeding or spotting between periods.
- More cramps or pain during periods.
- Does not protect against sexually transmitted diseases or HIV/AIDS
Medical Eligibility
Many Women can use Copper-bearing IUDs can be safely used by Women who:
- Smoke
- Have just had an abortion or miscarriage (if no evidence of infection or risk of infection)
- Take antibiotics or anticonvulsants
- Are fat or thin
- Are breastfeeding
Follow–Up
At routine follow-up visit (3 –weeks)
Conduct pelvic examination as appropriate.
Definitely conduct pelvic examination if you suspect:
Pelvic inflammatory disease
Sexually transmitted infection
IUD is out of place.
3. Male Sterilization –Vasectomy
Introduction Vasectomy is:
One of the safest and most effective family planning methods.
One of the few contraceptive options available to men
How does it Work?
A small opening made in the man's scrotum and the Vas deferens on either side are closed off.
This keeps sperms out of his semen. The man can still have erections and ejaculate semen.
His semen, however, no longer makes a woman pregnant because it has no sperms in it.
Advantages
- Very effective
- Permanent. A small, quick procedure leads to lifelong, safe and very effective family planning.
- Nothing to remember except to use condoms or another family planning method for at least 3 months.
- No interference with sex.Does not affects the man's ability to have sex.
- Increased sexual enjoyment because no need to worry about pregnancy.
- No supplies to get, no repeated clinic visits required.
- No apparent long –term health risks.
- Compared with voluntary female sterilization
Vasectomy is:
Probably slightly more effective
Slightly safer
Easier to perform
If there is a charge, often less expensive
Can be tested for effectiveness at any time.
If pregnant occurs in the man's partner, less likely to be ectopic than a pregnancy in a woman who has been sterilized.
Flaccid Interposition
Preliminary results from randomized controlled trials find that use of fiscal interposition with ligationand excision of Vas during Vasectomy leads to more rapid decrease in sperm count than when ligation and excision were used alone.
Female Sterilization
Types of female Sterilization Two broad categories: LAPROSCOPY & LAPROTOMY
- Procedures for reaching the fallopian tubes (Primarily abdominal)
- Minilaparotomy - laparoscopy - laparotomy
- Methods for occluding the fallopian tubes
- Ligation and excision
- Mechanical devices such as clips or rings
- Electro coagulation
Advantages
- Very effective method of contraception.
- Permanent
- Nothing to remember
- No supplies needed
- No repeated clinic visits required
- No interference with sex.
- Increased sexual enjoyment
- No effect on breast feeding
- No known side effects or health risks
- Minilaparotomy can be performed just after a woman gives birth.
- Helps protect against ovarian cancer
Medical Eligibility
Most Women can have Sterilization
Including those Who:
Have just given birth (24 hrs to 7 days)
Are breastfeeding
The Minilaparato my procedure
A small incision (2-5 cm) is made
Uterus raised and turned to bring the 2 fallopian tubes under the incision.
Each tube is tied and cut, or else with clip or ring.
Incision is closed with stitches and covered with adhesive bandages.
The Woman receives instructions on what to do after she leaves the clinic or hospital. She usually can leave in few hours (observed for 4 hours postop.)
The Laparoscopy procedure
Local aesthetics injected under woman's navel.
Abdomen is inflamed with gas or air.
Small incision (about 2 cm) made and laparoscope inserted.
The Laparoscopy Procedure
Each tube is closed with
A clip
A ring
By electrocoaulation
The gas or air islet out of woman's abdomen
Incision is closed and covered with adhesive bandages
The Laparoscopy procedure
The Woman receives instructions on what to do after she leaves the clinic or hospital. She usually can leave in few hours (observed for 4 hours post-op.)
After the procedure, the woman should
- Rest for 2 or 3 days and avoid heavy lifting for a week
- Keep the incision clean and dry for 2-3 days.
- Be careful not to rub or irritate the incision for 1 week
- Take paracetamol or another safe, pain killer as needed. She should not take aspirin or ibuprofen which slow blood clotting.
- Not have sex for at least one week, or until all pain is gone.
Five Common causes of female sterilization failure
- An undetected luteal-phase pregnancy that was present at the time of Sterilization.
- Surgical "Occlusion" of a structure other than the fallopian tube (most often, the round ligament)
- In complete or inadequate occlusion of the fallopian tube.
- Miss placement of the mechanical device. Development of tuboperitonoal fistula.
How to prevent failures of female Sterilization: Two Methods
Schedule procedure should bedone within 7 days following the menstrual period.
Fallopian tubes should be identifying properly by tracing them right up to the finbrial end prior to occlusion.
