INTRODUCTION

Family planning services are defined as educational, comprehensive medical or social

activities which enable individual, including minors, to determine the number and spacing of
their children and to select the means by which this may be achieved. Family planning may
involve consideration to the number of children a woman wishes to have, including the
choice to have no children, as well as the age at which she wishes to have them.

The family planning unit in GOVT. Medical college Kozhikode consist of,

o Family planning OP
o Family planning ward
o Family planning operation theatre.

FAMILY PLANNING OUT PATIENT DEPARTMENT

The mother 6 weeks postnatal will be attending family planning OP. The second
category consist of people coming for family planning and service.

SERVICES PROVIDED

 Temporary service
 Permanent services
 Health education on family planning
 Medical termination of pregnancy

Others include

 Copper T insertion
 DMPA injection
 Laparoscopic sterilization
 Mini laparotomy
 MTP
 Non scalpel vasectomy
 Oral pills supplementation
 Condom supply

Registers maintained in the family planning OP

 OP register- record of attending outpatient in the clinic.

 Anomaly register- if any anomalies detected antenatally.
 MTP register
 First trimester MTP consent
 Second trimester MTP consent
 Copper T register
 o Copper T insertion register
o Copper T removal register
o Copper T failure register
 Sterilization failure register

SPACING METHODS
 Oral contraceptive pills
 Injectable contraceptives

One dose DMPA (Depot methoxy progesterone acetate) is 150 mg given

intramuscularly. Repeat DMPA injection after 3 months. A postnatal woman can take first
progesterone injection within 7 days after the starting of menstrual bleeding.

INTRAUTERINE DEVICES

Copper containing IUCD’S are a highly effective method for long term birth spacing.

Two types commonly used are

1. Copper IUCD 380 A (10 years)

2. Copper IUCD 375 (5 years)

FAMILY PLANNING WARD-42

Family planning ward is located in the 3rd floor of IMCH. The patients who are willing for
family planning after the consultation of doctor get admitted.

Patients for legal termination of pregnancy are also being admitted here.

Staff pattern:

 Doctor in charge--1
 Head Nurse-1
 Staff Nurse-4
 Nursing Assistant-4

FAMILY PLANNING OT

OT is situated in the ground floor of IMCH. Permanent method of sterilization are

performing from the family planning OT. These methods may be adopted by any member of
the couple.
FEMALE STERILIZATION

Include 2 techniques.

1. Mini lap: mini laparotomy involves making a small incision on the abdomen. The
fallopian tubes are brought out to the incision and it is to be cut or blocked.
2. Laparoscopic sterilization

The case selection criteria involve

 client should be married.

 Female client with age between 22-49 years.
 Couple should have at least one child with age greater than 1 years.
 Spouses must not have undergone sterilization in the past.
 Client must be in a said state of mind to give consent.
 Mentally ill client must be certified by a psychiatrist and student should be given by
local guardian.

Clinical process

It includes counselling, pre-operative assessment, pre-operative instruction, review of

surgical procedures and post-operative care.

o Inform all clients about all the family planning methods and their criteria.
o They should be made aware of what will happen before, during, and after
surgery. Its side effects and potential complications.

CLINICAL ASSESSMENT AND SCANNING

Demographic information

Medical history includes history of any illness, immunization status of women for tetanus,
current medication using last contraceptive used, menstrual and obstetric history, physical
examination, laboratory examination.

TIMING OF STERILIZATION

1. Interval sterilization: should be performed within 7 days of menstrual period.

2. Post-partum sterilization: should be done after 24 hours up to 7 days of delivery.
3. Sterilization with MTP can be performed concurrently.
4. Sterilization following spontaneous abortion.
INFORMED CONSENT

Consent of the spouse is not required for sterilization

Pre-operative instructions

 Patient preparation
 Antiseptic solution used toclofol or chlorhexidine

Pre medication

 Tab. Alprax .25 to .5 mg.

 Tab Diazepam 5 to 10 mg

Anaesthesia

 Lignocaine without adrenalin .3mg/kg body weight.

 For less than 40 kg and thin patient use pethidine 25 mg
 Phenergan 12.5 mg intramuscularly 30-45 mts prior to surgery.

Post-operative care

 Discharge at least 4 hours of procedure

Follow up instructions

 Return home and rest for the remaining day.

 Resume light work after 48 hours.
 Resume normal diet as soon as possible.
 In case of interval sterilization client can have intercourse one week after surgery.
 Follow up should be made on seventh post-operative day.
 Client must return to the clinic if there is a missed period.

QUALITY ASSURANCE IN FAMILY PLANNING SERVICE

Reports to be send to the state on a annual basis

Quality report on

 Number of persons sterilized per month

 Number of deaths following sterilization
 Major complication post sterilization
 At the state level there is state level quality assurance committee.
 At the District level there is district level quality assurance committee.
 District collector- Chairperson
 Chief medical officer
 District health officer
  One empanelled gynaecologist
 One empanelled vasectomy surgeon
 One anaesthetist
 One representative from nursing group.
 One representative from legal cell.

If sterilization related death occurs, report should be sent within 24 hours.

REGISTERS MAINTAINED IN THE FAMILY PLANNING OT

 Post-partum sterilization book

 Report book
 Histopathologic book
 Taken over book
 Costly medicine book

INDIA VISION FAMILY PLANNING 2020

Provide contraceptive services 48 million users, to drive across, choice and quality of family
planning services to increase the contraceptive usage from 53.1-54.3 and to increase
demand satisfied by modern contraceptive to 74% by 2020.

CONCLUSION

As a part of our first-year community health nursing clinical posting we got posting at IMCH,
family planning unit. From there I can understand about different types of family planning
process, its criteria, preparation, post-operative management, complications, and different
types of registers. This posting was very useful to us.