Family planning is a way of thinking and living that is adopted voluntarily, upon the basis of knowledge, attitudes and responsible decisions by individuals and couples. In order to promote health and welfare of the family group and thus contribute effectively on the social development of a country.
Objectives of Family Planning:
- To avoid unwanted births
- To bring about wanted births
- To regulate the intervals between pregnancies.
- To control the time at which births occur in relation to the ages of parent
- To determine the number of the children in the family
Case Scenarios:
- A 35 years old woman comes to Basic Health Care Facility for her postnatal Checkup. She complains of severe fatigue and weakness. She has 2 sons and 1 daughter. She wants to know about different methods of child spacing:
- How will you give health education to this woman regarding family planning methods?
- What is the preferred contraceptive method in this case?
- Is there any specific investigation you will do regarding her present complaint?
- A married woman was living alone. Her husband came by as a surprise from England. Next morning she comes to OPD for suggestion regarding emergency contraception.
- How will you counsel her regarding emergency?
- A 30 years old woman has 1 and half year old son. She has no history of pelvic disease and has normal menstrual period. She wants to have child spacing for about 3 years:
- What is the ideal contraceptive method for this woman?
- A couple is newly married and wants to have child spacing for 1 year. They want to have intrauterine contraceptive device inserted.
- How will you counsel this couple regarding IUCD?
- What is the preferred method of contraception in this case?
- A married couple having 2 children comes to you for advice on contraception. They want long term contraception for 1-5 years. The man is reluctant to use male’s contraceptive method. Wife (35 years) is a known hypertensive for 10 years.
- What type of contraception would you advise?
- How will you counsel the couple regarding that contraception?
- What is the mode of action of that contraception?
- A young woman works in NGO. Recently she got married but want child spacing for about 1 year till her NGO project ends. Her husband is reluctant to use any male contraception method. She is herself afraid of having any contraceptive method that will affect her fertility.
- What is the preferred method of contraception in this case?
- How will you counsel her regarding that specific contraceptive method?
- A married couple comes to RHC family OPD. They have 2 daughters (one 5 years old and second 4 years old). 2 months back husband was diagnosed with sexually transmitted disease (hepatitis B). Now they want to plan for a male child. Their concern are regarding disease transmission.
- How are you going to counsel them regarding another pregnancy?
- What contraceptive method will you suggest them?
- What will you advise the husband regarding the disease?
- 26 years old married woman is on Oral contraceptive pill since last 2 months. One day show forgot to rake OCPs. Next day she comes to OPD and wanted to know what is she suppose to do now?
- What advise will you give her regarding her missed OCP dose?
Learning Objectives:
- Know the definition and basic objectives of family planning
- Be able to outline different methods of contraception and their indications, effectiveness, benefits, side effect and contraindications.
Tasks:
- Identify different contraceptives and shall know their time and mode of delivery
- Explain mode of actions of different contraception methods
- Effectively communicate with couples regarding family planning
Case scenario 1:
a) First a detailed history will be taken including her medical and gynecological history. Then we will the duration of spacing being desired and whether she wants to have more children. According to her need and requirement we will explain about different methods available along with their advantages and disadvantages and which method is best.
b) If contraception is needed for a short period then barrier methods may be used (physical methods e.g. condom, chemical methods e.g. spermicides or combined methods). If contraception is required for longer period, then formulatious injections or sub dermal implants may be used.
c) A complete blood picture is done to check for anemia.
Case Scenario 2:
A post coital contraception is needed within 72 hours of unprotected intercourse or an IUCD may be inserted within 5 days. COC is preferred e.g. Levonorgestrel 0.75mg tab and tab after 12 hours of 1st dose or Mifepristone 10mg once within 72 hours or Ethyl estradiol 2 pills within 72 hours and same done after 12 hours.
Case Scenario 3:
The woman is candidate for IUCD. A medicated (2nd generation e.g. copper containing or 3rd generation e.g. hormone releasing) or non-medicated (1st generation e.g. Lippies loop) devise may be used.
Case Scenario 4:
a) We will counsel that IUCD is not preferable choice for her since she is nulliparous and desires contraception for her short period. Also she might suffer from pain, menorrhagia and pelvic inflammatory disease.
b) Preferred method would be combined and contraception pills which are almost 100% effective is used correctly.
Case Scenario 5:
a) Since she is hypertensive patient, COCs are contraindicating. IUCD is preferred for long term protection.
b) Copper or hormonal IUCD can be used. They are inserted during menstruation or within 10 days of beginning of period. Advantages are that it is simple, effective, inexpensive, reversible, easy insertion and free of systemic metabolic effects. Disadvantages include bleeding, pain, pelvic infection and expulsions. Follow up is needed.
c) Copper enhances cellular response in the endometrium and effects enzymes and composition of cervical mucus. Hormonal IUCD increases cervical mucus viscosity and prevent sperm entry. They cause a foreign body reaction.
Case Scenario 6:
a) Oral contraceptives are preferred as they don’t affect long term fertility.
b) One pill daily is taken per 21 days followed by a pill free interval of 7 days. Each pack is started on the fifth day of the period. If a pill is missed take 2 pills as soon as possible. Advise her of danger signs and adverse effects of pills (cardiovascular effects like MI and DVT, cervical cancer risk, breast tenderness, headache, bleeding disturbances and weight gain).
Case Scenario 7:
a) Since there is risk of transmission of STD to the child, the couple is advised to refrain from having a child now.
b) They should practice abstinence or use barrier method. Barrier methods may be physical (condom, diaphragm, vaginal sponge) or chemical. They provide protection against STDs but are less effective and require motivator.
c) He is advised to visit a doctor and get treatment for this disease and use barrier methods.
Case Scenario 8:
If one pill is missed, she should take it as soon as she remembers and should take the next pill at the usual time. If 2 are missed take them together and take the next pill at usual time. If more than 3 pills are missed then chock the pack. If less than 7 tablets are left then take recent one and continue.
Methods of Contraception
- Barrier methods
- Intra uterine contraceptive devices
- Hormonal methods
- Post conceptional methods
- Natural methods
- Terminal methods
Barrier methods
Physical (Physically block the sperm to reach the egg)
Condom
- Male condom
- Female condom
- Chemical (Attach themselves to sperm & block oxygenation)
Foams
- Tablets
- Aerosols
Creams
- Jellies
- Pastes
Suppositories
Soluble films
Combined (Physical methods + chemical methods)
Intra uterine contraceptive devices
Control of conception by introduction of foreign body into the uterus
Non medicated
1st generation
- Made up of polyethylene or other polymers
- e.g Lipples loops
Medicated
2nd generation
- e.g Copper T multiload
3rd generation (Hormone releasing)
- Progestasent (65mg/day)
- Levonorgestrolated (20mg/day)
Hormonal methods
Oral pills
- Combined pills
- Progesterone only pills
- Post coital pills
- Once a month pill
- Male pill
Depot formulation
- Injectables
- Subcutaneous implants
- Vaginal rings
Post conceptional methods
Within 48hrs of unprotected conception
- An IUCD can be inserted within 7 days e.g Cu T
- COC in double dose
Preferred 2 pills immediately followed by 2 more after 12 hrs e.g Postinor Enfit
Natural methods
- Abstinence
- Coitus interrupts
- Safe period (calendar method)
Other methods
- Basal body temperature
- Cervical mucus method
- Breast feeding
- Birth control vaccine
- New method, Persona
Terminal methods
Male sterilization
Vasectomy
Female sterilization
Tubal ligation
- Minilap operation
- Laproscopy
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