FAMILY PLANNING

‘a way of thinking and living that is adopted voluntarily, upon the basis of knowledge, attitude and responsible decision by individual 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 1971

FAMILY PLANNINGOBJECTIVES::To avoid unwanted birth

To bring about wanted birth

To regulate the interval between pregnancy

To control the time at which the birth occur in relation to the ages of the parents

To determine the number of children in the family

ELIGIBLE COUPLE:CURRENTLY MARRIED COUPLE WHEREIN THE WIFE IN THE REPRODUCTIVE AGE(15-45)

TARGET COUPLE::COUPLES WHO HAVE HAD 2-3 LIVING CHILDREN. FP WAS LARGELY DIRECTED TO SUCH COUPLLES.

TWO CHILD FAMILY NORMNRR=1COUPLE PROTECTION RATE=60%

Physician obligations are:

First do no harm.

(primum non nocere, Hippocrates )400 B.C

Assessing the balance between risk and benefit

Temporary methodsTemporary methodsPermanent methodsPermanent methods

1.Natural Methods Periodic abstinence

Withdrawal Lactational Amenorrhea Method

2.Barrier methods3.Hormonal contraception

4.Intra uterine contraceptive devices

5.Emergency (Post coital ) contraception

Temporary methodsTemporary methods

Pearl index

• Method used for determination of pregnancy failure rate:

Pregnancy rate = no. of pregnancies x100women/12 months of use

BARRIER METHODS

• Condom male

female

• Diaphragm

• Sponge

• Spermicides

PHYSICAL METHOD

CHEMICAL METHOD

CondomsCondoms

BenefitsBenefits

No medical side-effects

Inexpensive, easily accessed

Protecting against STDs ( Latex )HPV that can cause genital warts HSV that can cause genital herpes

Hepatitis-B virus

Lower risk for cervical dysplasia and cancer

CondomsCondoms

Disadvantages

Can interrupt sexual activity

May sometimes tear or leak

Failure rate 2-3----14 HWY

Can cause an allergic reaction

INTRAUTERINE DEVICES (IUD)

1) Non medicated(inert) or first generation IUD:: lippes loop

Large size Good anti-fertility effect but higher removal rate due to pain and bleeding.

2) Copper IUD::( Second generation IUD) T Cu 380 A(2002 NFPP) no. SA(sq.mm) of Nova T, T Cu 380 Ag Cu on the device. ML-Cu-250, ML-Cu-375 Low side effect---low expulsion rate---great

efficacy—better tolerated by nullipara-----------but still bleeding be the commonest S/E.

INTRAUTERINE DEVICES (IUD)

3) Hormone releasing IUD::

Progestasert 38 mg of progesteronerelease @ 65mcg daily.

LNG-20 (MIRENA) release @ 20 mcg of levonorgestrel daily.

Low side effect---low expulsion rate---great efficacy—better tolerated by nullipara-----------and bleeding much less occurred than copper devices.

Mechanism of Action

Foreign body reaction altering cellular and biochemical changes in the endometrium impair the viability of gamete.

Cervical mucus is changed to obstruct passage of sperm through the cervix.

Prevent chances of fertilization rather than implantation

endometrial thinning which inhibits implantation of embryos

Inhibition of ovulation.(Probably)

T-CU 380 A PROGESTASERT MIRENA

FAILURE RATE 0.5-0.8 1.3-1.6 0.2

CHANGE AFTER (YRS)

10 1 7

Timing of insertion::::

During menstruation or within 10 days of beginning of menstrual period.

Immediate postpartum insertion1st wk after delivery chances of perforation

Post puerperal insertion6-8 wks after delivery.

ADVANTAGES

Long-term contraceptionVirtually free of systemic S/EWomen with contraindications to COC Emergency contraceptive.

DISADVANTAGES

BLEEDING

PELVIC INFECTION

UTERINE PERFORATION

ECTOPIC PREGNANCY

EXPULSION

Absolute Contraindications-Pregnancy. Post partum puerperal sepsis Immediately post-septic abortion

-Undiagnosed abnormal vaginal bleeding.

-Suspected gynecological malignancy.

(Cervical cancer, Endometrial cancer)

-Current STDs.

-Current PID.

Relative Contraindications

-Anaemia

-Menorrhagia

-H/O PID in last pregnancy

-Purulent cervical discharge

-Anatomical abnormalities

The ideal IUD candidateWHO HAS AT LEAST ONE CHILD

HAS NO H/O PELVIC DISEASE

HAS NORMAL MENSTRUAL PERIOD

IS WILLLING TO CHECK IUD TAIL

HAS ACCESS TO FOLLOW UP AND TREATMENT

IS IN A MONOGAMOUS RELATIONSHIP

THANK U