Sunday, 8 September 2024

Family planning
Family planning refers to the practice of controlling the number and spacing of
children through the use of contraception and other methods. It is essential for
improving maternal and child health, reducing poverty, and empowering individuals.
1. Goals of Family Planning:
• Prevent unintended pregnancies.
• Promote healthy spacing between children.
• Improve maternal and child health.
• Empower individuals and couples to plan their families.
• Control population growth.
2. Methods of Contraception:
• Barrier Methods: Condoms, diaphragms, and cervical caps that prevent
sperm from reaching the egg.
• Hormonal Methods: Birth control pills, patches, injections, implants, and
hormonal IUDs that regulate or prevent ovulation.
• Intrauterine Devices (IUDs): T-shaped devices placed in the uterus that
prevent fertilization or implantation.
• Permanent Methods:
• Male sterilization (vasectomy): Blocking or cutting the vas deferens to prevent
sperm from mixing with semen.
• Female sterilization (tubal ligation): Cutting or sealing the fallopian tubes to
prevent eggs from reaching the uterus.
• Natural Methods: Fertility awareness and withdrawal method.
• Emergency Contraception: Pills or copper IUD used after unprotected
intercourse to prevent pregnancy.
3. Bene ts of Family Planning:
• Health Bene ts:
• Reduces maternal and infant mortality by preventing high-risk pregnancies.
• Helps women avoid unintended pregnancies and unsafe abortions.
• Economic Bene ts:
• Enables families to plan their nancial resources and improves quality of life.
• Empowers women to pursue education and career opportunities.
• Social Bene ts:
• Improves gender equality by giving women more control over their
reproductive health.
4. Challenges to Family Planning:
• Cultural and Religious Beliefs: Some communities may oppose contraception
due to cultural or religious reasons.
• Lack of Access: Limited access to family planning services, especially in rural
and low-income areas.
• Myths and Misconceptions: Misinformation about contraceptive methods
may prevent individuals from using them.
5. Global Initiatives:
• Organizations like WHO, UNFPA, and national governments promote family
planning programs to ensure access to reproductive health services.

1
fi
fi
fi
fi
fi
• Sustainable Development Goal (SDG) 3: Focuses on ensuring universal
access to sexual and reproductive health services, including family planning.

Family planning plays a vital role in improving individual health and societal well-
being by empowering people to make informed decisions about their reproductive
health.

Contraceptive methods
A contraceptive method is the one which helps the woman to avoid unwanted
pregnancy. There are many methods of contraception. Each has got its own merits
and demerits.
An ideal contraceptive method is the one, which is safe, effective, acceptable,
inexpensive, reliable, reversible, simple, long lasting, independent of coitus and
requires less medical supervision.
A method suitable for one group may not be suitable for another group.

Broadly the contraceptive methods have been classi ed into two groups

Temporary (Nonterminal Methods; Spacing Methods)

subclassi ed into ve groups:
• Barrier methods
• Intrauterine devices
• Hormonal methods
• Postconceptional methods
• Miscellaneous methods.

Terminal (Permanent Methods;Sterilization Methods)

• Vasectomy
• Tubectomy.

TEMPORARY METHODS
Temporary (Non-terminal/Spacing) Contraceptive Methods

Temporary contraceptive methods, also known as spacing methods, are non-

permanent ways to prevent pregnancy. These methods allow couples to plan their
families by spacing out births or delaying pregnancies. These methods are
reversible, meaning fertility can be restored once they are discontinued. They are
broadly classi ed into ve groups:

1. Barrier Methods

Barrier methods work by physically or chemically preventing sperm from reaching

the egg.

2





fi
fi
fi
fi
fi
• Physical Barriers:
• Condoms: Thin sheaths made of latex or polyurethane worn over the
penis (male condom) or inserted into the vagina (female condom). They prevent
sperm from entering the uterus. Condoms also protect against sexually transmitted
infections (STIs).
• Diaphragm: A dome-shaped cup inserted into the vagina before
intercourse. It covers the cervix and blocks sperm from reaching the uterus. It must
be used with spermicide for increased effectiveness.
• Cervical Cap: Similar to the diaphragm but smaller, the cervical cap ts
tightly over the cervix to block sperm.
• Vault Cap and Vimule Cap: These caps are designed to t over the cervix
and create a barrier between sperm and the uterus.
• Chemical Barriers:
• Foams, Creams, Suppositories, Soluble Films: These are spermicidal
agents that kill or immobilize sperm. They are inserted into the vagina before
intercourse. Although not highly effective on their own, they can be combined with
physical barrier methods for better protection.
• Combined Barriers:
• Condom and Cream: Using a condom along with a spermicide cream
increases the effectiveness of contraception by providing both a physical and
chemical barrier.
• Diaphragm and Jelly: A diaphragm used with spermicidal jelly further
enhances protection by killing sperm that may bypass the physical barrier.

2. Intrauterine Devices (IUDs)

IUDs are small, T-shaped devices inserted into the uterus by a healthcare provider.
They prevent pregnancy by affecting the way sperm move, preventing them from
fertilizing an egg. There are two types of IUDs:

• Copper IUD: The copper in the IUD creates a toxic environment for sperm,
preventing fertilization.
• Hormonal IUD: Releases progestin, which thickens cervical mucus and
inhibits sperm from reaching the egg. It also prevents ovulation in some women.

IUDs are long-acting and can be effective for 3 to 10 years depending on the type.

3. Hormonal Methods

Hormonal methods regulate a woman’s hormone levels to prevent ovulation and

create other barriers to fertilization.

• Combined Oral Contraceptive Pills: These pills contain synthetic versions

of estrogen and progestin, which prevent ovulation. They also thicken cervical
mucus, making it harder for sperm to reach the egg, and thin the uterine lining,
making it less likely for a fertilized egg to implant.

4. Post-conceptional Methods

3
fi
fi
These methods are used after conception to prevent or terminate early pregnancy.

• Menstrual Regulation: A procedure that involves clearing the uterine lining

to prevent pregnancy shortly after a missed period.
• Menstrual Induction: This involves using medications to induce bleeding
and expel the uterine contents if a pregnancy is suspected but not con rmed.
• Induction of Absorption: A method to stimulate the natural absorption of an
early pregnancy.

5. Miscellaneous Methods

These include natural methods and non-hormonal alternatives for birth control.

• Abstinence: Complete avoidance of sexual activity. It is the only 100%

effective method of preventing pregnancy.
• Coitus Interruptus (Withdrawal): The male partner withdraws the penis
before ejaculation to prevent sperm from entering the vagina. It has a high failure
rate due to pre-ejaculate containing sperm.
• Fertility Awareness-Based Methods: These involve tracking a woman’s
menstrual cycle to avoid intercourse during fertile days. Methods include the
calendar method, basal body temperature monitoring, and cervical mucus
observation.
• Non-hormonal Long-acting Oral Pills: These pills contain no hormones but
work by affecting the uterine environment, making it less conducive to fertilization or
implantation.
• Birth Control Vaccines: These are experimental vaccines designed to
produce antibodies that interfere with fertility. They are not widely available but hold
potential for the future of contraception.

Each method has different advantages, disadvantages, and effectiveness levels,

allowing couples to choose what best suits their health, lifestyle, and family planning
goals.

TERMINAL METHODS
These are the permanent methods. They are also called as
'Sterilization methods.
There are two methods-Vasectomy and Tubectomy.

4
fi
Tubectomy
This is also known as 'Voluntary surgical contraception; 'Tubal ligation, and 'Minilap!
It is a simple, safe, very effective, cheap, convenient and permanent method of
contraception for women, who do not want any more children. It consists of blocking
both the fallopian tubes. The procedure is permanent and probably cannot be
reversed

There are two approaches:

Minilaparotomy
Laparoscopy.

Minilaparotomy
Minilaparotomy is a surgical procedure used primarily for tubal ligation (female
sterilization). It involves making a small incision in the lower abdomen to access the
fallopian tubes and is often performed under local or general anaesthesia.

Laparoscopy Procedure
Laparoscopy is a minimally invasive surgical procedure used for both diagnostic and
therapeutic purposes. It involves using a laparoscope (a thin, exible tube with a
camera and light) to view the internal organs and perform surgery through small
incisions in the abdomen.

Instructions after Surgery

Rest for 2 to 3 days and avoid strenuous work for one week.
Keep the wound clean and dry.
Not to have sex for at least one week or until all pain is gone.
To report at once if she develops, fever, bleeding or pus in the wound.

Effectiveness
Failure rate is about 0.5 pregnancies per 100 women years.
Postpartum tubal ligation is one of the most effective female sterilization techniques.
In the rst year after the procedure 0.05 pregnancies per 100 women years.

Merits
It is simple, safe, very effective, permanent, lifelong method of family planning.
Nothing to remember (like using condoms unlike in vasectomy).
No interference with sex; so prolonged sexual pleasure.
No effect on breast milk.
No long-term side effects.
Helps to protect against ovarian cancer.

Demerits
Usually painful for several days after surgery.
Postoperative infection or bleeding.
In rare cases when pregnancy occurs, it is more likely to be ectopic.
Compared to vasectomy, it is slightly more risky and expensive.
Reversal surgery is probably not possible.

5
fi
fl
Does not protect against STDs including HIV /AIDS.

Vasectomy
It is a simple, safe, very effective, cheap, convenient, permanent and quick, surgical
method of family planning for men, who decide that they do not want an more
children. It is not castration, it does not affect the testes and it does not affect sexual
ability.

Procedure
A small incision is made in the scrotum on either side above the testes under local
anesthesia, under aseptic precautions, vas-deferens tubes are lifted, cut and tied
with thread or clamped and the incisions are closed with stitches. Then bandage is
put (Fig. 24.16).

No Scalpel Vasectomy
This is a newer procedure, only one small puncture is made instead of incisions. At
the end, it is not sutured, just a bandage is suf cient. It is of shorter duration, less
painful and bruising and shorter recovery time.
Both no-scalpel technique and conventional procedures are quick, safe and
effective.

Instructions after Surgery

• Rest for two days. He should not do any heavy work or vigorous exercise for a few
days.
• The wound should be kept clean and dry.
• If possible put ice on the scrotum for four hours to lessen swelling.
• He should wear snug underwear or pants for two to three davs to help.
• He can have sex within 2 or 3 days after the procedure if it is not uncomfortable,
but he should use condoms or another effective family planning method for his next
20 ejaculations or three months after the procedure, whichever comes rst,
because the sperms which are present beyond the site of cut end can result in
pregnancy.
It requires about 20 ejaculations or about three months for him to become
aspermic.
Effectiveness
Vasectomy is highly effective and permanent method.
Failure rate is about 0.15 pregnancies per 100 men in the rst year after the
procedure. It can still be reduced if he uses condom or any other effective method
consistently for the rst 20 ejaculations or for three months after the procedure,
whichever comes rst.

Merits
It is simple, safe, highly effective, life-long permanent method of family planning.
Nothing to remember except to use condoms till he becomes aspermic.
.
Prolonged sexual pleasure, because no need to worry about pregnancy.

6
fi
fi
fi
fi
fi
Compared to tubectomy, vasectomy is easy to perform, more effective, less
expensive and able to be tested for effectiveness at any time.
The surgery can be done even in the clinic.
Does not require hospitalization.

Demerits
Common short-term surgical complications are:
Pain in the scrotum, swelling and bruising
Uncomfortable for 2 to 3 davs
Feeling of faintness after the procedure.
Uncommon complications are:
Bleeding or infection of the wound
Blood clots in the scrotum
Not immediately effective
It will be effective only when he becomes aspermic.

Constraints
Since it is relatively a new surgical techniques, skilled providers are not available at
the PHC level.
Acceptance of this method by men is still very low. So training of the doctors in this
skill is limited.
'Thus, there is a lack of both providers and acceptors.
Awareness and knowledge of this method is still limited among acceptors and
providers.

7
8