FAMILY

PLANNING
is the term given for pre-pregnancy planning
and action to delay, prevent or actualize a
pregnancy
( WHO ) “the use of a range of methods of a
fertility regulation to help individuals or
couples attain certain objectives:

 avoid unwanted birth.

 bring about wanted birth.
 Produce a change in the no. of children
born.
 Regulate the intervals between pregnancies.
 Control time at which birth occur.”
BENEFITS TO MOTHER

 Reduce the health risk

 Below 20y, And above 35 y. At risk of

developing complications during pregnancy.

physical strain of child bearing.

 reduce number of maternal death.

 reduce the risk of ovarian cysts.

HEALTH BENEFITS TO CHILDREN:

 Ensures better chance of survival at birth.

 Promote better childhood nutrition.

 Promote physical growth and development.

 Prevent birth defects.

TYPES OF FAMILY PLANNING

 NATURAL METHOD

 HORMONAL METHOD

 SURGICAL / PERMANENT METHOD

 ABSTINENCE
 or refraining from sexual relations, has a theoretical
0% failure rate and is also the most effective way to
prevent STIs.

 Due to natural human sexual drive, patient may find it

difficult to adhere to abstinence because they may
deny the possibility of sexual activity and fail to plan
for pregnancy and STI prevention.

 Because it is difficult for many couples to adhere to

abstinence, the method has a high failure rate
 LACTATION AMENORRHEA METHOD
(LAM)
 When a woman is breastfeeding, there is a
natural suppression of both ovulation and
menses
 Lactation amenorrhea method (LAM) is a safe

birth control method

 (a failure rate about 1% to 5%) if:

 *Under 6 months of age

 *Being totally breastfed at least every 4 hours
during the day
 and every 6 hours at night
 *Receives no supplementary feedings, and
 *Menses has not returned
CALENDAR (RHYTHM) METHOD
 The calendar method requires a couple to
abstain from coitus on the days of a
menstrual cycle when the woman is most
likely to conceive.

 To plan for this, the woman keeps a diary of

about six menstrual cycle.

 This method may be used by women whose

menstrual cycles are always between 26 and
32 days in length .
TO CALCULATE:

-18 from shortest cycle documented

-11 from longest cycle
= represents her last fertile day.

 Example: If she has 6 menstrual cycles

ranging from 25 to 29 days, fertile period
would be from 7 th day (25-18) to the 18 th
day (29-11). To avoid pregnancy, avoid
coitus/use contraceptive during those days.
STANDARD DAYS METHOD:
CYCLEBEADS
 This method is designed for women who have
menstrual cycles between 26 and 32 days
 The first beads on the ring is red and marks the

first day of her menstrual flow;

 followed by six brown beads which indicate

“safe” days.
 Twelve glow in the dark white beads, which mark

fertile days (during which she needs to abstain

from coitus).
 and 13 additional brown “safe” days follow.

 If she reaches a dark brown bead (appears on the

27th day) before she begins her next menses,

her cycle is too short for the method to reliable.
BASAL BODY TEMPERATURE
METHOD
 Just before the days of ovulation, a woman’s
basal body temperature, or the temperature of
her body at rest, falls about 0.5⁰F.
 At the time of ovulation, her BBT rises a full
Fahrenheit degree (0.2⁰C)
 To use this method, the woman takes her
temperature, either orally or with tympanic
thermometer, each morning immediately after
waking before she rises from bed or undertakes
any activity;
 As soon as a woman notices a slight dip in
temperature followed by an increase, she knows
she has ovulated. Refrain coitus (sexual
relations) for the next 3 to 5 days.
TWO-DAY METHOD
 a woman assess for vaginal secretions daily.
If she feels secretions for 2 days in a row, she
avoids coitus that day and the day following
as the presence of secretions suggests
fertility.
COITUS INTERRUPTUS (WITHDRAWAL)
 The couple proceeds with coitus until the
moment of ejaculation. Then, the man
withdraws and sperm are emitted outside the
vagina.
 Furthermore, because there may be a few

sperm present in pre-ejaculation fluid,

fertilization may occur even if withdrawal
seems controlled.
 only about 82% effective,
BARRIER METHODS
 forms of birth control that place a chemical
or latex barrier between the cervix and
advancing sperm so sperm cannot reach and
fertilize an ovum

 Condoms (male and female)

 Spermicidal

 Sponge

 Diaphragm

 Cervical cap
SPERMICIDES
 A spermicide is an agent that causes the
death of spermatozoa before they can enter
the cervix.
MALE CONDOM
 a latex rubber or synthetic sheath that is
placed over the erect penis before coitus to
trap sperm.
 To be effective, a condom must be applied

before any penile-vulvar contact as even pre-

ejaculation fluid may contain some sperm.
 The condom should be positioned so it is

loose enough at the penis tip to collect the

ejaculated without placing undue pressure on
the condom.
FEMALE CONDOM
 It is the sheaths made of latex or
polyurethane, pre-lubricated with spermicide
 similarly to male condoms, they offer

protection against conception as well as STIs,

including HIV.
DIAPHRAGM
 It is a circular rubber disk that is placed over
the cervix before intercourse to mechanically
halt the passage of sperm.
 A diaphragm is prescribed and fitted initially

by a healthcare provider to ensure a correct

fit.
 Diaphragms should remain in place for at

least 6 hours after coitus

 they may be left in place for as long as 24

hours.
 A diaphragm will last for 2 years, after which

it should be replaced.
CERVICAL CAPS
 A cervical cap is made of soft rubber shaped
like thimble, which
 fits snugly over the uterine cervix.

 The failure rate is estimated to be as high as

23% (ideal) to 35% (typical use) because

caps tend to
 dislodge more readily than diaphragms

during coitus.
 Caps can be kept in place longer (up to 48

hours) because they do not put pressure on

the vaginal walls or urethra.
HORMONAL METHODS
 Estrogen Progesterone Subdermal Patch
 Vaginal Estrogen/Progestin Rings (NuvaRing)

 Combination Oral Contraceptives

 Intramuscular Injections

 Intrauterine Devices

 Subdermal Hormone Implant

ESTROGEN/PROGESTERONE
TRANSDERMAL PATCH
 patches that slowly but continuously release
a combination of estrogen progesterone.
 Patches are applied each week for 3 weeks.

 The efficiency of transdermal patches is equal

to COCs,
 Patches may be applied to one of four areas:

upper outer arm, upper torso (front or back,

excluding the breasts), abdomen, or buttocks.
 If a patch does come loose, the woman

should remove it and immediately replace it

with a new
patch.
VAGINAL ESTROGEN/PROGESTIN
RINGS (NUVARING)
 A flexible silicone vaginal ring that, when placed
in the vagina,continually releases a combination
of estrogen and progesterone.
 The ring is inserted vaginally by the woman and
left in place for 3 weeks and then removed for 1
week with menstrual bleeding occurring during
the ring-free week
 Some women may experience vaginal discomfort
or infection, both of which would make the ring
an undesirable method of contraception.
 if they should take out the ring for more than 4
hours for any purpose, they should replace it with
a new ring and use a form of barrier or protection
for the next 7 days.
COMBINATION ORAL
CONTRACEPTIVES
 COCs must be prescribed by a healthcare
provider after screening for eligibility.

 When used correctly,COCs are 99.9%

effective.

 Because women occasionally forget to take

them, however, and because of individual
physiologic differences, the typical failure
rate is closer to 5%
Women can set a start date for a cycle of pills in
one of four ways:

● Sunday start: Take the first pill on the first

Sunday after the beginning of a menstrual flow.
● Quick start: Begin pills as soon as they are
prescribed.
Beginning pills immediately after a prescription is
filled may increase compliance, reducing
unintended pregnancies.
● First day start: Begin pills on the first day of
menses.
● After childbirth, a woman should start the
contraceptive on a day (or Sunday) closest to 2
weeks after birth; after an elective termination of
pregnancy, she could begin on a chosen day or the
first Sunday after the procedure.
INTRAMUSCULAR INJECTIONS
 A single intramuscular injection of depot
medroxyprogesterone acetate or DMPA
(Depo-Provera),
 a progesterone given every 12 weeks,

inhibits ovulation, alters the endometrium,

and thickens the cervical mucus so sperm
progress is difficult.
 effectiveness rate of this method is almost

100%,
 The injection is made deep into a major

muscle (buttocks, deltoid, or thigh) before

the fifth day after the beginning of a
menstrual flow.
SUBDERMAL HORMONE IMPLANT
 A progestin-filled miniature rod no bigger
than a matchstick,
 can be embedded just under the skin on the

inside of the upper arm

 slowly release progestin over a period of 3

years.
 Inserted during menses or no later than day

7 of menstrual cycle to be certain a woman is

not pregnant at the time of insertion
 the failure rate is less than 1%, comparable

to oral contraception
INTRAUTERINE DEVICES
 IUD is a small plastic device that is inserted
into the uterus through vagina.

 usually inserted before a woman has had

coitus after menstrual flow,

 T shaped plastic device wound with copper. It

is effective for 10 years
SURGICAL METHODS
VASECTOMY
 Made on the scrotum, the vas deferens on each
side are then pulled forward, cut and tied,
cauterized, or plugged, blocking the passage of
spermatozoa.
 Although the procedure is about 99.9% effective,

spermatozoa, which were present in the vas

deferens at the time of surgery, can remain
viable for as long as 6months.
 although the man can resume sexual intercourse

within 1 week, an additional birth control method

should be used until two negative sperm reports
at about 6 and 10 weeks have been obtained
TUBAL LIGATION
 where the fallopian tubes are occluded by
cautery, crushed, clamped, or blocked.

 A fim- briectomy, or removal of the fimbria at

the distal end of the tubes, is another
possible but little used technique.

 has a 99.5% effectiveness rate