6/7/2016

FAMILY PLANNING
By
Tiyas K

Background

Human Rights declaration pasal 25:

Everyone has the right to a standard
of living adequate for the health and
wellbeing of himself and of his family,
including food, clothing, housing, and
medical care and necessary social
services , and the right to security in
the event of unemployment, sickness,
disability , widowhood, old age or
other lack of live-hood in
circumstances beyond his control

Airlangga University-Faculty of
Nursing-2012

METHODS

Background

Airlangga University-Faculty of
Nursing-2012

International
Conference
on
Population and Development(ICPD)
th 1994, Kairo:

Reproductive health is a state of complete

physical, mental and social well-being in all
matters relating to the reproductive system,
and to its function and processes......
Indonesian Population Growth 2008= 1.175%
Population Growth # Economic Growth
Unwanted pregnancy rate

Ammenhorea Lactation Method (ALM)

Fertility Awareness-based Methods (FAB)

Barrier Methode

Intra Uterine Device

Intra Uterine Systems

Hormonal Methode

Tubal Ligation & Vasectomy

Others

Airlangga University-Faculty of
Nursing-2012

Airlangga University-Faculty of
Nursing-2012

FAB

ALM

Available for women with baby under 6 month

Prolactin >> GnRh release <<

LH <<
no folicel

stimulation
no ovulation
ammenorhea

Conditions: intensive breastfeeding

5,2% failure of ALM

working women

CI: mother with HIV, Hepatitis B without vaccine on

baby, active Tb, breast Ca on theraphy

ovum hold for 24hr, sperm stays on uterine 72hr, ovulation

hapen in the middle of sicle.
physical n psychology condition base
failure rate >>

Basal Body Temperature (BBT)

-

Airlangga University-Faculty of
Nursing-2012

Calendar
- track lenght of last 6 cycles

assumtion body temperature decrease

1224 hr pre-ovulation and increase
couple days after
morning measure same place
physical n psychology condition base
Airlangga University-Faculty of
Nursing-2012

1
6/7/2016

METODE BARIER

Billing
mucous

Method/cervical

recognise spinnbarkeit mucous

some
women
producing
more
mucous

Men Condom
Women Condom

Diafragm

combine with spermicidal

Sympto-thermal method
billing method + cervix consistency
examination & sign of ovulation (lower
abdomen pain, hardnes in breast,
emotional changes, etc)

Airlangga University-Faculty of
Nursing-2012

Airlangga University-Faculty of
Nursing-2012

Female Condom
Plastic sheath
with ring

at both ends

Outer ring

Inner ring
Grasping female condom

Airlangga University-Faculty of
Nursing-2012

AirlanggaforUniversityinsertion-Faculty of
Nursing-2012

Insertion

Airlangga University-Faculty of
Nursing-2012

Airlangga University-Faculty of
Nursing-2012

6/7/2016

Diapraghm

Inserted up to 18 hours before

intercourse and can be left in for a
total of 24 hours

Condom
Combining condoms with
spermicides raises effectiveness
levels to 99%

Airlangga University-Faculty of
Nursing-2012

Airlangga University-Faculty of
Nursing-2012

Drawbacks

IUDs

condom:
Interruption of coitus
Decreased

sensation

Efectiveness 510 years

Insertion when menstruation
time

IUS (Intra Uterine System)

plus Mirena
(levonorgestrel)

Airlangga University-Faculty of
Nursing-2012

Mechanism of Action

An IUD prevents sperm from

meeting an egg.
An IUD may stop a fertilized
egg from growing inside the
uterus.

Prevents fertilization by creating a

hostile environment (a sterile

inflammatory reaction) for sperm and

for a fertilized ovum
Airlangga University-Faculty of
Nursing-2012

20g/day

Airlangga University-Faculty of
Nursing-2012

Timing of
Insertion of
Intrauterine
Contraception
Timing

Pros

With menses

Ensures patient
not pregnant

Cons
Scheduling;
interim
pregnancy

Midcycle anytime

Convenience;
low rate of
expulsion

Must rule out

pregnancy

Emergency
contraception
(copper IUD)

Convenience;
pregnancy
prevention

Pregnancy

Alvarez PJ. Ginecol Obstet Mex. 1994.

OHanley K, et al. Contraception. 1992.
Airlangga University-Faculty of
Nursing-2012

3
6/7/2016

The IUS: Mirena

Mirena releases 20 mcg levonorgestrel/day

Failure rate very low: only 0.3% over 5 yrs
Ectopic rate very low : 0.02%
5 years (as effective as CuT380 at 7 years)
Not for EC
STI protection relative, not for sex workers
Good for women with heavy periods
Expulsion rate as other framed devices

Airlangga University-Faculty of

Nursing-2012

Airlangga University-Faculty of
Nursing-2012

Side Effect

Advantages of the IUD

Provides long-term birth control.

Cost effective.

Can be removed when a woman

would like to become pregnant.

Spotting, light bleeding,

heavy or longer menstrual
periods are common in the
first 3 6 months of IUD use

Pelvic pain after insertion

Convenient - a woman does

not need to remember it daily
or weekly.
Airlangga University-Faculty of
Nursing-2012
Airlangga University-Faculty of
Nursing-2012

Contraindications

History of PID

Immunocompromised (e.g., HIV, sickle

cell disease)

Known/suspected pregnancy

Small uterus (<6 cm in length)

Airlangga University-Faculty of
Nursing-2012

PID
Uterine perforation
Ectopic pregnancy
Menorrhagia and metrorrhagia
IUD expulsion

Airlangga University-Faculty of
Nursing-2012

4
6/7/2016

Fertility Rates in Parous Women

After
Discontinuation of Contraceptive

HORMONAL

100
Pregnancies(%)

Complications

Multiple sexual partners

80

IUC
OC
Diaphragm
Other methods

60
40

20
00

12
18
24
30
36
Months After Discontinuation

Combination pills (estrogen & progesteron)

Mini pills (progestin)
Monthly injectable (estrogen & progesteron)

Trimester injectable ( DMPA)

progesteron

Implant (etonogestrel)
Transdermal administration (Evra)
Transvaginal administration (vaginal-Nuva ring)

42

Based on data from Vessey MP, et al. Br Med J. 1983.

Airlangga University-Faculty of
Nursing-2012

Norplant Implant

Airlangga University-Faculty of
Nursing-2012

Airlangga University-Faculty of
Nursing-2012

Airlangga University-Faculty of
Nursing-2012

COCs Mechanism of Action:

Ovulation Suppression

Mechanism

Estrogen suppresses follicle-stimulating hormone

(FSH) and therefore prevents follicular emergence.
Progesterone suppresses the midcycle

gonadotropin-releasing
hormone
(GnRH)
surge, which suppresses luteinizing hormone
(LH) and therefore prevents ovulation.
Causes thicker cervical mucus
Causes decreased motility of fallopian tube
Causes endometrial atrophy

Airlangga University-Faculty of
Nursing-2012

Normal Menstrual Cycle

Follicular
development

Cycle Modified by COCs

Follicular
development

ovulation

Pituitary
hormones

FSHFSH

Pituitary
hormones

LHLH

Natural ovarian
hormones

progestinrtin

estrogenestrogen
progesteroneprogesterone

estrogenestrogen

14
days of menstrual cycle

28

1
days of active
pill-taking

14

28
hormone-free
interval

Adapted from: Senanayake and Potts, 1995.

Airlangga University-Faculty of
Nursing-2012

5
6/7/2016

Hormonal SE

Benefits of Oral
Contraceptives

Decreases risk of ovarian cancer by 75%

Decreases risk of endometrial cancer by

50%

Decreases bleeding and dysmenorrhea

Regulates menses

Protects
against
pelvic
inflammatory
disease (PID) (thicker mucus)

Fats deposit>>, increase body weight

higher trombosites
High blood pressure
Amenorrhea
Cloasm
Headache
Nausea

Nonbreastfeeding postpartum women

should wait three weeks before
starting estrogen-containing
contraceptives because of the
increased risk of thromboembolism

Protects
against
fibrocystic
change, ovarian cysts, ectopic
pregnancy, osteoporosis, acne

Airlangga University-Faculty of
Nursing-2012
Airlangga University-Faculty of
Nursing-2012

Return to Fertility
After
Stopping DMPA
Use

Percent of Women Having Conceived

100

80

60

Oral Contraceptives (0=last pill taken)

40

IUD (0=device removed)

DMPA (0=15 weeks after last injection)

20
0

4
8
12
16
20
Months After Stopping Contraceptive

24

Source: Tieng, 1982.

Airlangga University-Faculty of
Nursing-2012

Contraindications of Oral
Contraceptives
Thromboembolism
Cerebrovascular accident (CVA) or coronary artery disease
(CAD)

Breast/endometrial cancer
Cholestatic jaundice
Undiagnosed vaginal bleeding
Hepatic disease
Known/suspected pregnancy
Concomitant anticonvulsant therapy
Some antibiotics

Relative
contraindications:
hypertension (HTN), lactation

Migraines,

Airlangga University-Faculty of
Nursing-2012

Taking the Pill

Once a day at the same time everyday

Use condoms for first month
Use condoms when on antibiotics

Use condoms for 1 week if miss a pill or take

one late
The pill offers no protection from STDs

Sterilization

Tubal Ligation ( Tubectomy )

pengikatan
pemotongan
-

Airlangga University-Faculty of
Nursing-2012

Vasectomy
note:
use
ejaculation

Essure
nickel titanium
insertion on each tubal by
histeroscopy

condom

until

15

Airlangga University-Faculty of
Nursing-2012

6/7/2016

LAPAROSCOPY-BAND-AID
STERILIZATION

Airlangga University-Faculty of
Nursing-2012

Airlangga University-Faculty of
Nursing-2012

Airlangga University-Faculty of
Nursing-2012

Airlangga University-Faculty of
Nursing-2012

Airlangga University-Faculty of
Nursing-2012

Airlangga University-Faculty of
Nursing-2012

VASECTOMY

6/7/201
6
:
P
e
l
v
i
c

Airlangga University-Faculty of

Nursing-2012

C
o
m
p
l
i
c
a
t
i
o
n

P
o
s
t
s
t
e
r
i
l
i
t
y
s
y
n
d
r
o
m
e

p
a
i
n
/
d
y
s
m
e
n
o
r
r
h
e
a
,
m
e
n
o
r
r
h
a
g
i
a
,
o
v
a
r
i
a
n
c
y
s
t

F
s
u
a
f
r
m
a
i
n
U
e
o
p
e
i
o
n
e
a

fi
t
l
s
c
n
o
c
r
e
p
e
i
l
i
t

e
pr
oc
ed
ur
e
is
pe
rf
or
m
ed
on
th
e
fal
lo
pi
an
tu
be
s
<
2
to
3
c
m
fr
o
m
th
e
ut
er
us
.

A
i
r

O
T
H
E
R

M
E
T
H
O
D
S

C
o
i
t
u
s
i
n
t
e
r
u
p
t
u
s

i
s
i
d
e
s

/
w
i
t
h
d
r
a
w
l

g
e
l

S
p
e
r
m

Airlangga University-Faculty of
Nursing-2012

P
O
Delivery 3 weeks
All women

Condoms/spermicides

IUD

Diaphragm/cervical
cap

Female sterilization

B
r
L
a

Progestin-only methods/Natural Family

Planning Combined
estrogen-progestin

N
o
P
r

Combin
ed
estroge
nprogest
in
method
s/Natur
al
Family
Plannin
g

M
a
l
e

s
t
e
r
i
l
i
z
a

V
a
g
i
n
a
l
d
o
u
c
h
e

S
R
e
v
i
e
w
c
o
n
t
r
a
c
e
p
t
i
v
e
o
p
t
i
o
n
s
w
i
t
h
p
a
t
i
e
n
t
s
A
ll
o
w
p
a
t
i
e
n
t
s
t
o
h
o
l
d
c
o
n

8
S
c

r
Allo
w
tim
e
for
que
stio
ns
Pro
vid
e
writ
ten
ma
teri
als
in
the
app
rop
riat
e
lan
gua
ge
and
lite
rac
y
lev
el

Airlangga University-Faculty of

Nursing-2012

6
/
7
/
2
0
1
6

C
o
n
s
i
d
e
r
a
ti
o
n
s
i
n
C
h
o
i
c
e
o
f
C
o
n
t
r
a
c
e
p
ti
v
e
M
e
t
h
o

d
s

Effectiveness
Side effects

Convenience

Duration of
action
and

childbearing plans

n
o
t
e

T
h
e
n
e
w
M
ir
e
n
a
I
n
s
e
rt
e
r

w
h
e
n
h
a
n
d
l
i
n
g
w
i
t
h
t
h
e
n
e
w
i
n
s
e
r
t
e
r

Airlangga University-Faculty of
Nursing-2012

I
m
p
o
r
t
a
n
t
t
o

mly
with
your
forefin
ger or
thumb
when
pulling
on the
system
into
the
tube

T
ub
e
be
nd
s
ea
sil
y
aft
er
4t
h
m
ar
k
(cm
sca
le)
if
forc
ed
too
mu
ch

In
se
rt
o
n
Te
ch
ni
q
u
e

O
pe
n
pa
ck
ag
e
ca
re
fu
lly

Airlangga University-Faculty of
Nursing-2012

En
su
re
th
e
sli
de
r
is
fur
th
es
t
a
w
ay
fro
m
fit
te
r

pri
or
to
loa
din
g
P
r
a
c
t
i
c
a
l
t
i
p
T
o
m
a
k
e
s
u
r
e
a
r
m
s
a
r
e
h
o
r
i
z
o
n
t
a
l
,
a
l
i
g
n

f
a
c
e
w
h
i
l
s
t
m
a
i
n
t
a
i
n
i
n
g
m
o
d
e
r
a
t
e
p
r
e
s
s
u
r
e
A
i
r
l
a
n
g
g
a

U
n
i
v
e
r
s
i
t
y
F
a
c
u
l
t
y

o
f
Nurs

o
n
a
f
l
a
t
,
s
t
e
r
i
l
e
s
u
r

K
n
o
b
s
a
t
t
h
e
e
n

s
m
a
ll
g
a
p
i
n
b
e
t
w
e
e
n
t
h
e
k
n
o
b
s

o
f
a
r
m
s
c
l
o
s
e

a
n
d

f
o
r
m

r
o
u
n
d
e
d

A
i
r
l
a
n
g
g
a

U
n
i
v
e
r
s
i
t
y
F
a
c
u
l
t
y

e
n
d

w
it
h

o
f
Nurs

n
i
q
u
e
I
n
s
e
rt
io
n
T
e
c
h

Pul
l
o
n
t
h
r
e
a
d
s
t
o
p
l
a
c
e
I
U
S
i
n

ins
erti
on
tub
e
Fix
thre
ads
in
cleft
at
the
end
of
s
h
a
f
t

S
e
t
u
p
p
e
r
e
d
g
e
o
f
f
l
a
n
g
e
a
t
t
h
e
u
t
e
r
i
n
e
s
o
u
n
d
m
e
a
s
u
r
e
P
r
a
ct
ic
a
l
ti
p
T
h
e
m
e
as
ur
e
m
e
nt
o
bt
ai
n
e
d
fr
o
m
s
o

u
n
d
i
n
g
t
h
e
u
t
e
r
u
s
s
h
o
u
l
d
c
o
r
r
e
s
p
o
n
d
t
o
t
h
e
d
i
s
t
a
n
c
e
f
r
o
m
t
h
e
e
n
d
o
f
t
h
e
l
o
a
d
e
d
i
n
s
e
r
t
e
r
t
o
t
h
e
e
d
g
e
o

6
/
7
/
2
0
1
6

f
t
h
e
f
l
a
n
g
e
n
e
a
r
e
s
t
t
o
t
h
e
c
e
r
v
i
x
Ai
rl
an
g
ga
U
ni
ve
rs
it
yFa
cu
lt
y
of
Nursing-2012

In
se
rti
on
Te
ch
ni
q
ue

M
i
r
e
n
a
i
s
n
o
w
r
e
a
d
y
t
o
b
e
i
n
s
e
r
t
e
d

H
o
l
d
t
h
e
s
li
d
e
r
f
i
r
m
l

y
wit
h
the
fore
fing
er/
thu
mb
in
furt
her
mo
st
pos
itio
n

G
i
v
e
s
s
u
f
f
i
c
i
e
n
t
s
p
a
c
e

Mo
ve
ins
ert
er
gen
tly
into
ute
rus
unti
l
flan
ge
is
abo
ut
1.5
-2
cm
fro
m
cer
vix.

f
o
r
a
r
m
s
t
o
o
p
e
n

Airla
Nurs

h
n
i
q
u
e
N
e
w
I
n
s
e
r
t
i
o
n
T
e
c

Ho
ng
ins
ter
ste
dy,
rele
se
arm
by
pul
ng
slid
r
bac
to
the
ma
P
u
s
h
in
s
e
rt
e
r
g
e
nt
ly
in
w
ar
d
s

Mirena should n

position

Practical tip
To ensure IUS is in fundal p
to advance insertion tube un
met at fundus. The flange m
tube by the cervix. Since the
in absence of strong force, th
risk of perforation

N
e
w
I
n
s
e
r
t
i
o
n
T
e
c
h
n
i
q
u
e

Re
ase
the
IU
by
pu
ng
the
slid
r
ba
k
do
na
the

Re
ov
the
ins
rte
fro
m
the
ute
us

C
u
t
t
h
e
t
h
r
e
a
d
s
t
o
l
e
a
v
e
a
b
o
u
t
2
c
m
v
i

i
b
l
e
o
u
t
s
i
d
e
t
h
e
c
e
r
v
i
x
Pr
ac
tic
al
ti
p
W
h
e
n
r
e
m
o
v
i
n
g
i
n
s
e
r
t
e
r
,
m
a
k
e
s
u
r
e
t
h
e
t
h
r
e
a
d
s
r
u
n
f
r
e
e
l
y
t

h
r
o
u
g
h
t
h
e
t
u
b
e
a
n
d
d
o
n
o
t
d
r
a
w
t
h
e
s
y
s
t
e
m
f
r
o
m
i
t
s
f
u
n
d
a
l
p
o
s
i
t
i
o
n

A
ir
la
n
g
g
a
U
ni
v
e
r
si
t
y
F
a
c
ul
t
y
o
f
Nurs

Cu
al.
W

S
y
l
v
i
a
K
.
R
o
s
e
v
e
a
r(
2
0
0
2
)
H
a
n
d
b
o
o
k
o
f
g
y
n
a
e
c
o
l
o
g
y
m
a
n
a
g
e
m
e
n
t

Airlangga University-Faculty of
Nursing-2012

10

6/7/2016

Airlangga University-Faculty of
Nursing-2012

11