FAMILY PLANNING

NAME : DESI NOVIANTI SUKARDI

CLASS : 12 SCIENCE 4

[Link] JAYA NO.17 PARUNG-BOGOR

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Definition
Family planning is an attempt to measure the number and spacing of
children wanted. In order to achieve this then be made several ways or
alternatives to prevent or delay pregnancy. These methods include
contraception or pregnancy prevention and family planning. Based on
research, there are 3.6 million unplanned pregnancies each year in the
United States, half of these unplanned pregnancies occur because couples
did not use a pessary, and half were using contraception but not how to
use them correctly.

Basic method of contraception works by preventing sperm from reaching

the male and female egg (fertilization) or preventing the fertilized egg to
implant (attached) and grow in the uterus. Contraception can be
reversible (back) or permanent (fixed). Reversible contraception is a
method of contraception that can be terminated at any time without effect
in restoring fertility in a long time or ability to have children again.
Methods of permanent contraception or sterilization is what we call a
method of contraception can not restore fertility due to involve surgery.

Contraceptive methods can also be classified based on how it works is the

method of barrier (barrier), for example, condom prevents sperm;
mechanical methods such as IUDs, or hormonal methods like the pill.
Natural contraceptive method does not use these tools based on the
physiological and hormonal but a woman in order to prevent fertilization
(conception).

Factors that influence the choice of contraception is the effectiveness,

safety, frequency of use and side effects, as well as the willingness and
ability to perform contraception regularly and correctly. In addition to this,
consideration is also based on the cost of contraception and the role of
religion and culture of the contraceptive. Another factor is the frequency
of intercourse, easy to re-conceive again, side effects to the lactation, and
the effect of contraception in the future. Unfortunately, no method of
contraception, except abstinensia (not sex), which is 100% effective in
preventing pregnancy.
 Figure 1. Method of Contraception

The various methods of contraception

A woman can still become pregnant if:

* Perform coitus interuptus

* Breastfeeding
* The first time you have sex
* If the woman does not orgasm
* Using douches (insert chemical liquids or spermicide into the vagina)
* The position whatsoever in having sex

Contraception for older women

Increasingly there is a change from the age of the menstrual period. When
menstrual blood eventually stopped, then a woman enters menopause.
However, contraception should be used until the woman did not get a
period or menstrual blood for 2 years if aged less than 50 years or 1 year
if more than 50 years of age.
Contraceptive method consists of:
1. Hormonal Contraception
2. Oral contraceptive progestin combination oral contraceptives
Contraceptive injections Contraceptive injections of estrogen-progestin
progesterone progestin implants Contraception Contraceptive Patch
barrier (barrier)

o Condoms (male and female)

o The diaphragm and cervical cap

3. Spermicides
4. IUD (spiral)
5. Natural Family Planning
6. Withdrawal of the penis before ejaculation
7. Lactation amenorrhoea method
8. Emergency Contraception

o Emergency Hormonal Contraception

o Emergency Contraception IUD

9. Sterilization

o Vasectomy
o tubal ligation

Hormonal Contraception
Contraceptives are available in the form of oral, injectable, and
mechanics. Oral contraceptives are a combination of the hormones
estrogen and progestin or progestin-only mini pill. Contraceptive injections
and implants (mechanical) containing progestin alone or a combination of
progestin and estrogen.

* Combined oral contraceptives (the pill) -> preparations

containing synthetic estrogen and progestin that prevents pregnancy by
inhibiting ovulation (release of eggs by the ovaries) via suppression of LH
and FSH, thicken cervical mucus mucosa (cervical), and blocking growth of
the endometrial lining. There are combination pills have lower doses of
estrogen and estrogen-containing existing high doses. High-dose estrogen
is usually given to women who take certain medications (especially
epilepsy drug).

In addition to contraception, oral combination can be used to treat

dysmenorrhoea (painful menstruation), menorrhagia, and metroragia. Oral
combination is not recommended for breastfeeding women, until at least
6 months after delivery. Combination pills taken by breastfeeding mothers
can reduce the amount of breast milk and fatty substances and protein
content in milk. Hormones from the pills found in breast milk so it can get
to the baby. Due to nursing mothers should be given a tablet that contains
only progestin, which does not affect the formation of milk.

Women who do not breastfeed have to wait at least 3 months after

delivery before starting the combined oral because of the increased risk of
blood clots in the leg. If one missed pill, two pills must be taken as soon as
possible after the recall, and the pack should be spent as usual. When two
or more pills are missed, then it must still be spent pack of pills and other
contraceptive methods should be used, such as condoms to prevent
pregnancy.

If the last menstrual period occurred in less than 12 weeks after childbirth,
the birth control pills can be directly used. If the last menstrual period
occurred within 12-28 weeks, then had to wait a week before starting the
Pill is used, whereas if the last menstrual period occurred in more than 28
weeks, had to wait 2 weeks before starting to use birth control pills.

Birth control pills have no effect on other drugs, but other medications
(especially sleeping pills and antibiotics) can decrease the effectiveness of
birth control pills. Anti-seizure drugs (phenytoin and phenobarbital) may
cause abnormal bleeding in women increases Pill users.

Some conditions where COCs should not be diigunakan in women

with:

* Breastfeeding or less than 6 weeks after giving birth

* Age> 35 years and smoked 15 cigarettes a day

* Multiple risk factors for heart disease (older age, smoking, diabetes,
hypertension)

* Systolic blood pressure 160 or diastolic BP 100 mmHg

 * A history of deep venous thrombosis or pulmonary embolism

* Major surgery with a long rest in bed

* A history of ischemic heart disease

* Stroke

* Valvular heart disease complications

* Migraine with focal neurological symptoms (with aura)

* Migraine without focal neurological symptoms and age = 35 years

* A history of breast cancer

* Diabetes with nephropathy, retinopathy, neuropathy, vascular

disease, or diabetes> 20 years

* Severe cirrhosis

* Liver cancer

1. Effectiveness: pregnancy occurs in 0.1 to 5 per 100 women at 1 year

of use the first
2. Advantages: very effective, preventing ovarian cancer and
endometrial cancer, menstrual irregularities and reduce anemia
associated with menstruation, smoothing the skin with acne were
3. Disadvantages: not recommended for breast-feeding, does not
protect from Sexually Transmitted Diseases (STDs), must be taken every
day, requiring a doctor's prescription
4. Local side effects: nausea, breast tenderness, headache

Side effects: irregular bleeding (usually disappeared after 3 months of

usage), increased blood pressure (can return to normal when oral
combination discontinued), blood clots in leg veins (3-4 times on high-
dose birth control pills), increases heart disease risk factors , the risk of
stroke (in women aged> 35 years)

5. Return of fertility: when it is stopped then it will return to normal

fertility. Fertility varies, within 3-12 months after you stop then there is no
difference in fertility among women using oral contraceptives and who do
not
 * Progestin oral contraceptives (the pill) -> prevents pregnancy by
inhibiting ovulation (release of eggs by the ovaries), thicken cervical
mucus mucosa, disrupting the movement of the cilia of the fallopian
tubes, and inhibit the growth of the endometrial lining. Effectiveness is
reduced when the pill is not taken at the same time each day.
Contraception is given to women who want oral contraception but can not
use because of the influence of combined oral estrogen may be harmful,
for example in women who are breastfeeding.

1. Effectiveness: pregnancy occurs in 0.5 to 5 per 100 women at 1 year

of use the first
2. Advantages: at work fast (24 hours after the consumption of pills),
reduced the incidence of menorrhagia and anemia. Can be used in
lactating women. Prevent the occurrence of endometrial cancer, have no
side effects associated with estrogen (blood clot in leg veins)
3. Disadvantages: must be taken at the same time every day, is less
effective than combined oral, require a doctor's prescription
4. Side effects: weight gain, acne, anxiety, the incidence of irregular
bleeding high
5. Rapid reversal when the pill is stopped

* Contraceptive injections of progestin -> prevents pregnancy by the

same mechanism as the progestin contraceptive pill but this use of
intramuscular injections (intramuscular atas> <bokong or arm).
Frequently used are medroxyprogesterone acetate (Depo-Provera), 150
mg given every 3 months.

1. Effectiveness: pregnancy occurs in 0.3 per 100 women at 1 year of

use the first
2. Advantages: first, fast and very effective job, working in a long time,
does not interfere with breastfeeding, can be used immediately after a
miscarriage or after the puerperium,
3. Disadvantages: injections must be performed by health workers on a
regular basis, does not protect from STDs,
4. Local side effects: weight gain, hair loss

Side effects: the bones become porous, lipid metabolism disorders,

menstrual irregularities including menometroragi (generally the first few
months) and amenorrhoea (1st year), if use of injectible discontinued,
regular menstrual cycle will re-occur within 6 months-1 year

5. Return of fertility after stopping the injections 5-7 months

Side effects: the bones become porous, lipid metabolism disorders,

menstrual irregularities including menometroragi (generally the first few
months) and amenorrhoea (1st year), if use of injectible discontinued,
regular menstrual cycle will re-occur within 6 months-1 year

- Contraceptive injections of estrogen-progesterone -> is

given by intramuscular injection every month, containing 25 mg of depot
medroxyprogesterone acetate and 5 mg estradiol cypionat. Mechanism of
action, side effects, criteria, and the same security as combined oral
contraceptives. More stable menstrual cycle occurs every month. Return
of fertility is not for contraceptive progestin injections.

Figure 2. Contraceptive injections and pills

- Implants progestin -> plastic capsule, a thin, flexible,

containing 36mg of levonorgestrel that is inserted into the skin of a
woman's arm. After being given anesthesia, an incision is made and with
the help of a needle inserted implant capsule. No need to do sewing.

This capsule releasing progestin into the bloodstream slowly and are
usually installed for 5 years. Prevent pregnancy by inhibiting ovulation
(release of eggs by the ovaries), thicken cervical mucus mucosa,
disrupting the movement of the fallopian tubes, and hinder the growth of
the endometrial lining. This effective contraception within 48 hours after
the implanted and effective for 5-7 years.

a. Effectiveness: pregnancy occurred at 0.05 per 100 women at 1 year of

use the first
b. Advantages: very effective, works for a long time
c. Disadvantages: requires minor surgery procedures for the use and
release, does not protect from STDs
d. Local side effects: headache, breast becomes hard, weight gain, hair
loss, acne, mood changes
Side effects: lipid metabolism disorders, hirsutism, menstrual disorders
(elongated, irregular)
e. Fertility returned 1 month after the capsule is taken

* Contraceptive Patch -> The patch is designed to release 20g

ethinyl estradiol and 150 microg norelgestromin. Prevent pregnancy the
same way as oral contraceptives (the pill). Used for 3 weeks, and a patch-
free week for the menstrual cycle.

Figure 3. Contraceptive Patch

1. Barrier contraception (barrier)

* Condoms (male and female) method of collecting semen and

sperm in the bag of condoms and prevent it from entering the female
reproductive tract. Male condom should be worn after erection and before
the male genitalia of penetration into the vagina that covers half of the
erect penis. Should not be too tight (no space at the tip to collect semen).
Condoms should be removed after ejaculation.

How to use condoms:

* Use a condom seiap time you have sexual

* Open the condom gently to avoid damage (do not use teeth or sharp
objects)
* Put the condom in a state of penile erection and before contact with a
partner
* Make sure no air is trapped at the tip of the condom
* Ensure use enough lubricant (can use extra lubricant)
* Use only water-based lubricant with the material when using a
condom (with oil-based lubricants can weaken latex)

* Hold the condom carefully after ejaculation, and to prevent the escape
of condoms, remove the condom from the vagina in a state of penile
erection
a. Efktivitas: pregnancy occurs in 3-14 per 100 women at 1 year of use the
first
b. Advantages: can be used during breastfeeding, the only contraceptive
that prevents STDs, GO infection, chlamydia
c. Disadvantages: high failure if not used properly, latex allergy in
sensitive people

* The diaphragm and cervical cap -> barrier contraceptive that is

inserted into the vagina and prevent sperm into the reproductive tract.
The diaphragm is made of latex or rubber with a flexible ring. The
diaphragm is placed posteriorly from the symphysis pubis so that the
cervix (cervical) covered everything. The diaphragm must be placed at
least 6 hours after intercourse. Cervical cap (cervical cap) is a header that
is placed round the neck of the uterus covered by adhesions in the fornix.
Made of rubber and must remain in place more than 48 hours.

[Link]: pregnancy occurs in 6-40 per 100 women at 1 year of use

the first
b. Advantages: can be used during breastfeeding, there is no risk of health
problems, protect from STDs
c. Disadvantages: high failure rate, increased risk of infection, requiring
the evaluation of health personnel, discomfort

Figure 5. Contraceptive Diaphragm and

Cervical Cap

2. Spermicides
Agent that destroys the cell membranes of sperm and decrease motility
(movement of sperm). Type of spermicides include aerosol foams, creams,
vaginal suposituria, jelly, sponge (foam) that is inserted before sexual
intercourse. Mainly containing nonoxynol 9

a. Effectiveness: pregnancy occurs in 6-26 per 100 women at 1 year of

use the first
b. Advantages: does not interfere with the health, functioning as a
lubricant, can prevent bacterial STDs
c. Disadvantages: high failure rate, can increase the transmission of the
HIV virus, is effective only 1-2 hours

3. IUD (spiral)
Flexible, tools made of plastic that is inserted into the uterus and prevents
pregnancy by disrupting the environment of the uterus, which prevents
the occurrence of fertilization and implantation. Copper spiral type T
(copper release) prevents pregnancy by disrupting the movement of
sperm to reach the uterine cavity and can be worn for 10 years.
Progestasert IUD (releasing progesterone) is only effective for one year
and can be used for emergency contraception. An IUD can be fitted at any
time during the menstrual period if the woman is not pregnant. For
women after childbirth, the installation of an IUD immediately (10 minutes
after removal of placenta) can be prevented easily copotnya IUD. IUDs can
also be mounted 4 weeks after giving birth without risk factors for
perforation (tearing of the uterus). For lactating women, IUDs with
progestin should not be used until 6 months after delivery. IUDs can also
be mounted immediately after first trimester spontaneous abortion, but it
is recommended to be delayed until complete involution after second
trimester abortion. After the IUD fitted, a woman should be able to check
the IUD string after every menstrual period. Condition where a woman
should not use IUDs are:

* Pregnancy
* Sepsis
* Abortion postseptik in the near future
* Anatomic abnormalities that interfere with the uterine cavity
* Bleeding that unexplained
* Tropoblastik Malignant Disease
* Cervical cancer, breast cancer, endometrial cancer
* Pelvic inflammatory disease
* PMS (premenstrual syndrome) last 3 months and imunokompromise
(decreased immunity)
* Pelvic tuberculosis

1. Effectiveness: pregnancy occurs in 0.3 to 0.8 per 100 women at 1

year of use the first
2. Advantages: very effective, works quickly once inserted into the
uterus. Work in the long term
3. Disadvantages: risk of pelvic infection, dysmenorrhea (painful
menstruation), menorrhagia in the first months, the increased risk of
perforation (tearing) of the uterus, the risk of ectopic pregnancy, IUDs can
be off by itself
4. Side effects: pain, bleeding, increasing the amount of menstrual blood
5. Rapid reversal once it is released
 Figure 6. Contraceptive IUD (spiral)

4. Method of Rhythmic

Rhythmic method is a method where the couple avoids intercourse on a

woman's fertile cycle. Ovulation (release of eggs from the ovary) occurs
14 days before menstruation. Egg cell that has been released only survive
for 24 hours, but sperm can survive for 3-4 days after sexual intercourse.
Because of that conception could occur due to sexual intercourse carried
out 4 days before ovulation.

1. Rhythmic calendar method is a method where the couple avoids

sexual intercourse during the fertile period of women based on menstrual
cycle length, it is likely time of ovulation, the period can still be fertilized
egg cell, and the ability of sperm to survive in the female reproductive
tract. A woman's fertile period is calculated from: (shortest menstrual
cycle - 18) and (longest menstrual cycle - 11)

Example: when a woman's shortest cycle is 25 days, and the longest cycle
of 29 days, the fertile period is (25-18) and (29-11), which means sexual
hubunan should not be made on day 7 to day 18 after menstruation.

2. Cervical mucus method is a method of observing the quality and

quantity of cervical mucus every day. Fertile period was marked by a clear
mucus, watery, and slippery. Abstinensia (not having sex) is required
during menstruation, every day during the period preovulasi (based on
cervical mucus), and until the time of the fertile mucus appears until three
days after the fertile mucus was stopped.

3. Methods of measuring body temperature based on temperature

changes. Measurements were taken at basal temperature (the
temperature upon awakening before getting out of bed. Basal
temperature will decrease before ovulation and increased slightly (less
than 1 Celsius) after ovulation. Sexual intercourse should not be done
since the first day of menstruation until 3 days after an increase of the
temperature.

1. Effectiveness: pregnancy occurs in 9-25 per 100 women at 1 year of

use the first
2. Advantages: no side effects health problems, economic
3. Disadvantages: high failure rate, does not protect from STDs,
inhibited spontaneous, requiring regular menstrual cycles

5. Withdrawal of the penis before ejaculation

Also called coitus interruptus. In this method, men spend / withdraw his
penis from the vagina before ejaculation (release of sperm when having
an orgasm).
This method is less reliable because sperm can come out before orgasm
also requires a high self-control and determination of the appropriate time.

6. Lactation amenorrhoea method

During breastfeeding, breast milk sucking by the baby which causes

hormonal changes that suppress hypothalamic GnRH release spending
and inhibit ovulation hormone LH. This is an effective method when the
criteria are met: feeding every 4 hours during the day, and every 6 hours
at night. Additional food is given only 5-10% of the total.
Effectiveness: pregnancy occurs in 2 per 100 women at 6 months after
delivery, 6 per 100 women after 6-12 months after delivery
Advantages: the prevention of pregnancy soon after giving birth, do not
harm our health, economy, stimulating a woman to breastfeed
Disadvantages: not fully effective, it must meet the criteria, does not
protect from STDs

7. Emergency Contraception

* Emergency Hormonal Contraception high dose of estrogen or

progestin administered within 72 hours after unprotected intercourse,
with the workings of preventing ovulation and causing changes in the
endometrium. 4 combination pills containing ethinyl estradiol 30-35g,
repeated 12 hours later. 2 combination pills containing 50g
levonorgestrel, repeated 12 hours later. Should not be used in women who
are allergic hormonal contraceptive pill. Should not be used as routine
contraception.

1. Effectiveness: pregnancy occurs in 2 per 100 women in when used

within 72 hours
2. Advantages: very effective for emergency situations
3. Disadvantages: severe nausea and bleeding

* Emergency Contraception IUD inserted 5 days after unprotected

intercourse to interfere with implantation, pregnancy occurred less than 1
per 100 women when inserted within 5 days
8. Sterilization

Vasectomy and tubal sterilization is a permanent method of contraception

and only performed on men and women who have given a description of
this method and willing to permanently prevent pregnancy. There are
several methods of sterilization is reversible depending on the length of
the fallopian tubes, the woman's age, and the time between sterilization
and reversal. Sterilization through vasectomy in men, whereas in women
performed a tubal ligation procedure (binding of the fallopian tubes). Own
vasectomy performed under local anesthesia while tubal ligation using
intraabdominal procedures. Counseling before performing this procedure
is necessary. Not only counseling about the risks or benefits of operations,
but also likely to regret this decision in the future.

* Vasectomy is cutting the vas deferens (the tube that carries sperm
from the testes).
A vasectomy is performed by surgeons urologists and takes about 20
minutes.
Men who undergo vasectomy should not immediately stop the use of
contraception, because fertility is usually still present until about 15-20
times the ejaculation.
After laboratory examinations of the two ejaculations showed no
sperm, then it is said that the men had been barren.
Complications of vasectomy are:
- Bleeding
- Inflammatory response to semen that seeps
- Opening of spontaneous

* Tubal ligation is the cutting and binding, or blockage of the fallopian

tube (oviduct from the ovary to the uterus).
In tubal ligation made an incision in the abdomen and performed
general anesthesia.
Tubal ligation can be performed immediately after childbirth or
scheduled at a later date.

Sterilization in women is often done via laparoscopy. In addition to cutting

and binding, can also be cautery (use of electric current) to close the
fallopian tubes.

Can be used to block the fallopian plastic tape and resilient clips. In tubal
blockage, infertility will be easier again because fewer tissue damage.

Other sterilization techniques are sometimes used in women is

hysterectomy (removal of uterus) and oophorectomy (removal of ovaries /
ovary).