III.

REPRODUCTIVE LIFE PLANNING

At the end of this module, the students will be able to:
[Link] the Family Planning Methods according to its benefits or advantages and
disadvantages
[Link] the important role of a nurse in educating clients on their of family planning
method.

Definition
These are forms are forms of birth control that place a chemical or latex barrier between
the cervix and the advancing sperm so sperm cannot reach and fertilize the ovumtrol that place a
chemical or latex barrier between the cervix and the advancing sperm so sperm cannot reach and
fertilize the ovum.

RATIONALE:
1. To prevent passage of sperm or ovum that may lead to fertilization.
2. To keep the woman safe from getting impregnated

Family Planning: Having the right number of children born with

proper spacing
• Family Planning is helping couples and individuals achieve their desired family size in
the context of responsible parenthood
• Family Planning is spacing pregnancies (2-3 years between pregnancies) to ensure
the health of mother and child
• Family Planning is a health intervention program of the Dept of Health to promote
the overall health of women and children; significantly contributes to the reduction
of maternal and infant deaths in the country
Health Benefits of Family Planning:
Health of the Mother

1. The importance of Family Planning to mother’s health to enable her to:

* Regain her strength lost in last pregnancy (women need at least 2 years
to completely recover their health from the physical stress of pregnancy)
* Avoid unplanned, high-risk pregnancies for mothers who are:
- Too young (less than 18 years old) or too old (more than 34years old)
- Having more than 4 pregnancies
- Having closely spaced pregnancies (less than 2 years interval between
pregnancies)
- Getting pregnant while sick with chronic diseases like TB, Malaria or
with iron deficiency anemia
* Practice her reproductive right – millions of women want to stop giving
birth altogether; millions want to space their pregnancies
* Devote more and quality time to herself, her husband or her
community.
2. Family planning will significantly contribute to the reduction of illegal abortions that
may lead to complications or even death of the mother.

Health Benefits of
Family Planning:
Health of the child
1. Proper child care/ rearing

* Importance of breast-feeding, immunization, proper nutrition, mental

feeding, dental care

2. Reduction in infant/ child deaths in the Philippines through Family

Planning

* Children can be given the proper care, love and attention to ensure
health and survival below the age of 5

Nursing Consideration
1. Contraception’s effectiveness depends on motivation, which is a result of
education, culture, religion and personal situation.
2. It is best to include both partners in any contraception decision and secure the
signed consent of both partners.
3. Emphasize that the permanent methods (Bilateral Tubal Ligation for females
and Vasectomy for males) are recommended to couples who have already
reached/ achieved their desired family size and no longer with to have another
child.
4. Nurses should be familiar with contraceptive methods and educate patients with
moral judgment.
5. Warn clients who uses condoms, diaphragms and cervical caps that latex
sensitivity may be a problem. Watch out for itching, swelling and generalized
reactions.
6. Hand hygiene, gloving and perineal washing are a must before insertion of
contraceptive devices.

The Pill – Oral contraceptive pills contain two hormones similar in a woman’s body – estrogen
and progestin/ progesterone
Method Oral Contraceptive Pill
How it works ▪ The pill inhibits ovulation (release of the mature egg from the
ovary)
▪ Thickens the cervical mucus, making it difficult for the sperm to
pass through
▪ Does not disrupt pregnancy
How effective ▪ Very safe and effective especially when taken everyday

Who should use it ▪ Safe for almost all women of any age

Method Oral Contraceptive Pill

Advantages • Very convenient; no need to do anything at time of sexual

intercourse
• Regulates menstruation and helps prevent menstrual cramps
• Can be used for as long as a woman does not want to get
pregnant; but can be stopped anytime a woman is ready to get
pregnant; fertility returns soon after stopping
• Can help prevent certain cancers, anemia (low iron) and
menstrual cramps and irregular bleeding and other medical
conditions

Method Oral Contraceptive Pill

Disadvantages ▪ Women who smoke or who are 35 years old or

older and are hypertensive, diabetic are not
advised to take the pill unless they are under
the care of a doctor.

▪ Does not protect against Sexually Transmitted

Diseases (STDs)

Side effects ▪ Especially in the first few months, some

women experience nausea or vomiting,
bleeding between periods or “spotting” weight
gain, mild headache or moodiness. None of
these side effects are dangerous and generally
become less or disappear in a few months.
DMPA Injectable Contraceptive – (Depot-Medroxyprogesterone Acetate) An injectable
contraceptive that is given every 3 months. It contains progestin, similar to the natural
hormone a woman’s body makes. The progesterone is slowly released into the woman’s
bloodstream.
Method DMPA Injectable Contraceptive

How it works ▪ Inhibits/prevents ovulation

▪ Thickens the cervical mucus, making it difficult for sperm
to pass through the vagina to the uterus
▪ Does not work by disrupting existing pregnancy

How Effective ▪ Very effective especially when injections are given

regularly every 3 months apart

Who should use it ▪ Generally all women of any age, even those who smoke
▪ Breastfeeding mothers
▪ Fat or thin
▪ Women who may currently have some diseases or
hypertensive

Advantages ▪ Very effective, Reversible

▪ Very convenient: One injection prevents pregnancy for at
least 3 months, no daily pill taking
▪ No estrogen side effects
▪ Does not interfere with sex and increases sexual
enjoyment because there is no need to worry about
pregnancy
▪ Helps prevent certain cancers and iron-deficiency anemia
▪ Lessens seizures in women with epilepsy

Disadvantages ▪ Delayed return of fertility

▪ Requires regular (3 month intervals) visits to the health
center
▪ Does not protect against STDs including HIV/AIDS

Side effects ▪ Moodiness, nausea

▪ Light spotting to heavy bleeding to amenorrhea, are
normal especially in the 1st year
▪ Weight gain
▪ Headaches, breast tenderness
▪ None of these side effects are dangerous

Instructing Insertion Of Barrier Methods of Contraception

Equipment
Prescribed contraceptive device:

 condom

 diaphragm

 cervical cap

 IUD (intrauterine device)

 Spermicide

 gloves

 examining table w/ stirrups

 sterile drapes and gloves/towel (for IUD insertion)

 hand soap/detergent

Planning and Implementation

ACTION RATIONALE

Male Condom - it is a latex, rubber or

synthetic sheath that is placed over the exact
penis before coitus to trap semen from
entering the cervix

1. Check condom for tear or hole To ensure safety

2. Place condom over the erect penis To facilitate insertion of condom

3. Leave dead space at the tip of the condom

To allow room or space for ejaculated semen
(from which air has been expelled)

4. Apply spermicide on exterior portion of the

To add protection from the live sperm
condom

5. After coitus, the condom must be To prevent sperm from leaking the now
withdrawn before it begins to become flaccid loosely fitting sheath into the vagina
after ejaculation.

6. Grasp ring around condom at withdrawal To avoid leaving condom in the vagina

7. Knot tightly the upper portion of the

To prevent leakage of the semen that can be
condom and place it securely at the non-
a source of spread of infection
biodegradable waste receptacle.

8. Wash hand after discarding the used To prevent the spread of microorganism that
condom might be contaminated by infected semen.

Female Condom - are sheaths made of

latex or polyurethane, pre-lubricated
with a spermicide, similarly to male
condom

[Link] hand To prevent spread of infection.

2. Check for the expiration date To ensure safety

3. Open the pack at the arrow with

To facilitate ease of opening of the pack
mark “open”

4. Spread out the condom to open and

To ensure safe use
check for any hole or breakage

5. Hold the soft inner ring with the

To follow the correct technique of inserting the
non-dominant fingers and the our ring
vaginal condom
with the dominant fingers

6. Pinch the outer ring and hold it like

a pencil
7. Insert it to the vagina until it
reaches for the cervix

8. The inner ring will open at the cervix

9. After intercourse, twist it out and

knot the condom, wrap with a piece of To prevent the spread of contaminated
paper or tissue and dispose of microorganism
properly in a non-biodegradable waste
receptacle

The Condom- a sheath or covering made to fit over a man’s erect penis. Most
condoms are made of thin latex rubber and some are coated with lubricants or
spermicides.

Methods Condom

How it works  Condoms help prevent pregnancy and sexually

transmitted diseases (STDs) by keeping the sperm
and any disease organisms in the semen out of
the vagina
 Condoms also prevent any disease organisms in
the vagina from entering the penis

How Effective  Must be used correctly every time to be highly

effective in preventing pregnancy
• Helps prevent STDs including HIV/AIDS,
gonorrhea, syphilis, chlamydia and trichomoniasis

Methods Condom

Who  Sexually active men of all ages

should use
it

Advantage • Prevents pregnancies and STDs

s • Very convenient, easy to keep and
obtain
• May be used without seeing a health
provider first
• Men can stop using it any time
• No hormonal side effects
• Will not interfere with any other
medicine
• May be used with other Family Planning
methods for STD/HIV prevention and
extra protection from pregnancy
• Helps prevent premature ejaculation
(helps men last longer during sex)

Methods Condom

Disadvantage • Latex rubber and lubricant may cause

s allergy to some
• May decrease sensation
• Couple must take time to put the
condom on the erect penis before sex
• Condoms may weaken if stored too long
or in too much heat; may break during
use

Side Effects None

Diaphragm - it is a
circular rubber disk that
is placed over the cervix
before intercourse to
mechanically halt the
passage of sperm; a cap
shaped like dome with a
flexible rim

1. Check for holes To ensure safety

2. Place spermicide
To weaken or kill the sperm to provide
inside the dome and the
further safety
rim

3. The diaphragm is
To facilitate accurate insertion of the
pinched between the
device
fingers and the thumb

4. The folded
diaphragm is then
inserted to the vagina
and pushed backwards
as far as it would go

5. To check for proper To ascertain that the cervix is

positioning, the woman should completely by the dome-
feel the cervix shaped of the diaphragm.

To consider the lifespan o th

6. Leave in place for at least 6
sperm that may leak into the
hours after intercourse
cervix.

7. To remove diaphragm, the

To provide further protection
finger is hooked under the
from the semen to enter the
forward rim and the diaphragm
cervix
is pulled down and out

8. Wash hands with soap and

water, including the device then To preserve integrity of the
dry and store them in a safe rubber
place
Cervical Cap - is made of
soft rubber shaped like
thimble, which fits snugly
over the uterine cervix

To prevent spread of
1. Wash hands
microorganism

2. Apply spermicide inside To provide further protection from

and rim of the cap sperm to enter the cervix

3. Place cervical cap over To prevent the entry of semen in

cervical opening the cervical opening

4. After intercourse, keep To provide further protection from

cap in place for 48hrs sperm to enter.

5. Clean with soap and To prevent spread of infection and

water, dry and store in a to maintain the functional
safe place. integrity of the device
Intrauterine Device - a small device
made of plastic with exposed copper or
progesterone-release system to inhibit
uterine wall implantation. It is usually a
small, flexible plastic T-shaped device
with copper wire. It is inserted in to a
woman’s uterus through her vagina.

To facilitate the
1. Prepare the equipments needed for
insertion smoothly and
IUD insertion
avoid wasting of time

To ensure sterility of
2. Health care provider must wash
the procedure and
hands and wear sterile gloves
prevent infection

To clearly visualise the

3. Place the client in a lithotomy
internal female
position.
genitalia
To reduce
4. Perform perineal washing microorganisms
present on the genitalia

To maintain sterility of
5. Apply sterile drape and expose only
the procedure and
the genitalia
provide privacy

To ensure that device is

inserted properly and
6. Insert device slowly and usually at the for correct placement
time of menses and to prevent trauma
to the mucous
membrane

Equipments should be
7. Do after care of the equipments,
ready for use for the
wash and keep them in proper place.
next client

8. Instruct client to check IUD string

regularly at least once a month or after
every intercourse

To provide instructions
9. Instruct client for possible risks or
thus preventing the
complications and to see the health
severity of side effects
care provider for any unusualities noted
and any complications
Method Intra Uterine Device

How it works ▪ Works by preventing the sperm

and egg from meeting. The IUD
makes it hard for the sperm to
move through the woman’s
reproductive tract and reduces
the ability of the sperm to
fertilize an egg.

▪ Helps in thickening of the

cervical mucus thus blocking the
passage of the sperm from the
vagina to the fallopian tubes.

How Effective ▪ Very safe and effective with

efficacy lasting up to 10 years

▪ Safe for almost most women of

any age, even for those who
smoke, are currently taking
Who should use it
antibiotics or anti-convulsants,
fat or thin and are breast
feeding, hypertensive
Permanent Method: Vasectomy- cutting and tying of the vas
deferens; a procedure for men

Method Vasectomy

How it works A simple surgical method of Family Planning for

men performed by trained health providers. It
requires a small incision on the scrotum for the
vas deferens to be cut and tied. This keeps sperm
out of a man’s semen. The man still have erection
and ejaculate semen, but his semen can no longer
get a woman pregnant because it has no sperm.

How effective Very effective

Who should For men who have reached their desired family
use it size and are sure that they will not want more
children

Advantages ▪ The procedure can be done in a clinic or an

office in less than an hour
▪ Permanent. A single, quick procedure leads
to lifelong, safe and very effective Family
Planning
▪ No interference with sex
▪ Very convenient
▪ Does not affect a man’s ability to have sex
▪ Increased sexual enjoyment because there is
no need to worry about pregnancy
▪ Will not affect man’s ability to perform
regular activities
▪ No supplies to get, no repeated visits
required

Disadvantage ▪ May require the use of condom or

s abstinence for the first 20 ejaculations or the
first 3 months, whichever comes first after
surgery
▪ Feeling of discomfort in the scrotum after
the procedure, usually 2 to 3 days
▪ Requires minor surgery by a specially trained
provider
▪ Does not protect against STDs.

Side Effect ▪ None

Permanent Method : Tubal Ligation- Cutting and tying of the
Fallopian Tubes; a procedure for women

Method Tubal Ligation

How it works • A safe, simple, surgical method of Family

Planning for women performed by
trained health providers.
• It requires a small incision in the
woman’s abdomen for the fallopian
tubes to be cut and tied.
• These tubes carry the mature eggs from
the ovaries to the uterus.
• With the tubes blocked, the woman’s
egg can not meet the man’s sperm.
• The woman continues to have her
menstrual periods.

Who should • For women who have reached their

use it desired family size and are sure that they
will not want more children
• For women who have just given birth but
decided to have permanent Family
Planning
• Breastfeeding mothers

How effective • Very effective

Method Tubal Ligation

Advantages ▪ Permanent. A single, quick procedure leads
to lifelong, safe and very effective Family
Planning
▪ No interference with sex
▪ Does not affect a woman’s ability to have sex
▪ Increased sexual enjoyment because there is
no need to worry about pregnancy
▪ No supplies to get
▪ No effect on breast milk
▪ Helps protect against ovarian cancer
▪ Will not affect woman’s ability to perform
regular activities

Disadvantages ▪ Usually painful at first but pain goes away

after a day or two
▪ Feeling of discomfort in first two days
▪ Requires minor surgery by a specially trained
provider
▪ Does not protect against STDs

Side Effect ▪ None

Natural Family Planning – refers to methods for planning and
child-spacing by observing the fertile and infertile phases of the
menstrual cycle with abstinence from sexual intercourse if
pregnancy is to be avoided.
Method Use of Cycle Beads or Cervical Mucus
Standard Days (Necklace)

How it Woman marks with a Woman observes her mucus

works rubber ring the color-coded secretions. Couple avoids sex on
beads (in a strand) that the woman’s “wet days” or when
signify different phases and the mucus is slippery wet and can
days of the menstrual cycle be stretched. Couple can engage
in sex on the woman’s “dry days”
or when the woman has no
secretions.

Method Use of Cycle Beads or

Standard Days (Necklace)
How Effective ▪ Effective when used properly

Who Should Use it ▪ All women of any age who want to plan and space
their pregnancies but do not wish to use other
methods for medical religious or personal reasons

Advantages ▪ No physical and hormonal side effects

▪ Very little or no cost
▪ Has no effect on breastfeeding or breast milk
▪ Involves men in planning the family
▪ Educates couples about their fertility

Disadvantages ▪ Usually only somewhat effective

▪ Will not work without continuing cooperation and
commitment of both the woman and the man
▪ Requires woman or couple to keep careful daily
records and pay close attention to body changes
▪ Requires moving the rubber ring guide daily as in
the case of standard Days (necklace) Method
▪ Needs to be taught by a trained provider
▪ Does not protect against STDs

Side Effect ▪ None

Lactational Amenorrhea Method – A contraceptive method
based solely on breastfeeding.
Method Lactational Amenorrhea Method
Cervical Mucus

How it works ▪ Prevents ovulation because breastfeeding

changes the rate of release of natural
hormones

How effective ▪ Effective in the first 6 months after childbirth

provided that:
* The baby gets at least 85% of his feedings as
Breast milk and the mother breastfeeds
often, day and night
* The mother’s menstrual periods have not
returned
* The baby is less than 6 months old

Method Lactational Amenorrhea Method

Cervical Mucus
Who should use it ▪ All women of any age who want to plan and
space their pregnancies but do not wish to
use other methods for medical, religious or
personal reason

Advantages ▪ Effectively prevents pregnancy for at least 6

months
▪ Very little or no cost
▪ Encourages breastfeeding patterns
▪ Can be used immediately after childbirth
▪ No need to do anything at time of sexual
intercourse

Disadvantages ▪ Effectiveness after 6 months is not certain

▪ Frequent breastfeeding may be inconvenient
or difficult for some women especially
working mothers
▪ If the mother is HIV positive there is a chance
that breast milk will pass HIV to the baby
▪ Does not protect against STDs

Side Effect ▪ None

Method Basal Body Temperature

How it • Woman identifies the beginning and end of her

works fertile period by taking her body temperature in the
same way at the same time each morning before
she gets out of bed.
• The couple avoids sex, or uses a barrier method
from the first day of menstruation until the
woman’s temperature has risen above her regular
temperature and stayed up for 3 days.
• This means that ovulation has occurred and passed.
• After this, the couple can have unprotected sex
over the next 10-12 days until her next menstrual
period begins.

Method Sympto Thermal Method

How it works • Woman observes a combination of

changes in her body:
• Mucus secretions, her temperature
and cervical position.
• Couple avoids sex on the woman’s
“wet days”or when the mucus is
slippery, wet and can be stretched ad
her body temperature is somewhat
lower.
• Couple can engage in sex on the
woman’s “dry days”or when the
woman has no secretions and her
temperature is higher.

How effective • Effective when used properly

Who should use it • All women of any age who want to

plan and space their pregnancies but
do not wish to use other methods for
medical, religious or personal reasons

Advantages ▪ No physical and hormonal side

effects
▪ Very little or no cost
▪ Has no effect on breastfeeding or
breast milk
▪ Involves men in planning the family
▪ Educates couples about their
fertility

Disadvantages ▪ Usually only somewhat effective

▪ Will not work without continuing
cooperation and commitment of
both the woman and man
▪ Requires woman or couple to keep
careful daily records and pay close
attention to body changes
▪ Needs to be taught by a trained
provider
▪ Does not protect against STDs

Side Effect ▪ None

EVALUATION AND DOCUMENTATION:

1. Record the information and health instructions about
the use of contraceptive devices.
2. Allow the client to verbalize concerns, reaction about
the use of devices and record.