Dr.

Fatima Aiman,
MBBS, MCPS FM,
Sr. Lecturer, CHS Dept.
OBJECTIVES:

• To promote the health of mother and child , to ensure safe

motherhood and child survival.

• To avoid unwanted pregnancies.

• To regulate interval between pregnancies.

• To determine the number of children in family.

SCOPE OF FAMILY PLANNING
• The modern concept of family planning does not merely mean birth control
and child spacing , it is an overall effort to cover all aspects of reproductive
health .

• It includes following ;
• the proper spacing and limitation of births,
• advice on sterility
• education for parenthood
• sex education
• screening for pathological conditions related to the reproductive system
(e.g., CA cervix, STDs)
• Genetic counselling

• Premarital consultation and examination

• Carrying out pregnancy tests

• Marriage counselling

• The preparation of couples for the arrival of their first child

• Providing services for unmarried mothers

• Teaching home economics and nutrition

• Providing adoption services

• CAFETERIA CHOICE :

the approach in family planning programs is to offer all contraceptive methods

from which a couple can choose, according to needs and wishes to promote
family planning as a way of life.
Couples counselling is done to achieve this.

Acronym : “g a t h e r”
• Greet the client.

• Ask the client their needs.

• Tell about different contraceptive methods.

• Help to make decision.

• Explain proper usage of methods.

• Return & follow up of client.

CONTRACEPTIVE METHODS
I. Spacing methods
1. Barrier methods
2. Intra-uterine devices
3. Hormonal methods
4. Post-conceptional methods
5. Miscellaneous.

II. Terminal methods

1. Male sterilization
2. Female sterilization.
Scenario 1:

• 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 concerns are regarding
disease transmission.
• a. What contraceptive method will you suggest them? How it
works?

• b. What are the advantages and disadvantages of the suggested

method?
Task 1

• Barrier Method
• Physical; Condoms, diaphragm, vaginal sponge
• Chemical; foams, creams, pastes,
• Combined.

• MOA: prevent live sperm from meeting ovum.

Task 2
• Advantages:
• Protection from sexually transmitted disease.
• Absence of side effects d/t pills and IUD.
• Protection from PID, cervical cancer.

• Disadvantages:
• require high dose of motivation
• Less effective than either the pill or IUDs.
Scenario 2:

• A married couple having 2 children comes to you for advice on

contraception. They want long term contraception for 4-5 years. The
man is reluctant to use male’s contraceptive method. Wife (35 years
old) has been known Hypertensive for 10 years
Tasks :
• How will you counsel the couple regarding IUD? What are its
different types?

• What is the mode of action of IUD? Enumerate its

contraindications?

• Counsel her by enumerating merits and demerits of the chosen

method.
Task 1
• Counsel her by
• Greet the client in a friendly ,helpful and responsible manner
• Ask the client about family planning needs
• Tell about different contraceptive methods
• Help client to make decision about contraceptive choice
• Explain to client how to chose method
• Return and follow up of client is done
• Types
• Non medicated, first generation, Lippes loop ; S shaped, non toxic, contains
small amount of barium sulphate for Xray detection, attached with it is
thread that project into vagina
• Medicated , 2nd generation, Cu containing , (copper T and multiload)
• Hormone releasing , 3rd generation, MIRENA
Task 2
• MOA:
• IUD causes a foreign body reaction in the uterus causing cellular reaction
and biochemical changes in endometrium and uterine fluids. These changes
impair viability of gamete and reduce chances of fertilization.
• Cu ions affect sperm motility ,capacitation and survival by altering
biochemical changes.
• Hormone releasing IUD, increase viscosity of cervical mucus and thereby
prevent sperm from entering cervix.
• Instructions to IUD wearer:
• she should check thread /tail regularly
• she should visit clinic if she experiences side effects.
• If she misses period she must consult doctor.
Contraindications:

ABSOLUTE RELATIVE

Suspected pregnancy Anemia

pelvic inflammatory disease Menorrhagia

vaginal bleeding of undiagnosed etiology History of PID

cancer of cervix, uterus or pelvic tumour purulent cervical discharge

previous ectopic pregnancy distortion of uterine cavity

unmotivated persons
Task 3
• Advantages of IUCD:
• Simplicity,
• Insertion takes only few minutes,
• Provides long term contraception,
• Inexpensive,
• Reversible,
• Free of systemic metabolic effects,
• No need of continual motivation.
• Side effects/Complications
• Bleeding (commonest; reason for removal of IUD in 10-20%)
• Pain (second major, reason for removal of IUD in 15-40%)
• Pelvic infection
• Uterine perforation(depends on time of insertion,
technique/operator’s expertise, design of IUD)
• Pregnancy (failure rate is approx. 3%)
• Ectopic pregnancy
• Expulsion
• Mortality (extremely rare)
THE END