FAMILY PLANNING

DEFINITION:

A way of thinking and living that is adopted voluntarily, upon the basis of knowledge, attitude and
responsible decisions by individuals and couple, in order to promote the health and welfare of the
family group and thus contribute effectively to the social development of the
country. (WHO)

Family planning refers to practices that help individuals or couples to attain certain objectives:-

1. To avoid unwanted births.

2 To bring about wanted births.

3. To regulate the intervals between pregnancies.

4. To control the time at which births occur in relation to the ages of the parents.

5. To determine the number of children in the family.

Scope of family planning

1. The proper spacing and limitation of births.

2. Advice on sterility.
3. Education for parenthood.
4. Sex education.
5. Screening for pathological conditions related to the reproductive system
6. Genetic counseling
7. Premarital consultation and examination
8. Carrying out the pregnancy tests.
9. Marriage counseling
10. The preparation of couples for the arrival of their first child.
11. Providing services for unmarried mothers
12. Teaching home economics and nutrition
13. Providing adoption services.

CONTRACEPTIVE: Contraceptive are preventive methods to help women avoid unwanted

pregnancies. They include all temporary and permanent measure to prevent pregnancy resulting
from coitus.

OR

FAMILY PLANNING METHODS

The conception can be prevented by using any of the family planning methods which are also called
as contraceptive methods.
Criteria of An ideal Contraceptive

An ideal contraceptive has the following criteria:

(i) Safe: It means that the contraceptive is free from any kind of side effects complications.
(ii) Reliable: It means that the contraceptive is cent percent effective.
(iii) Easy and convenient to administer method: Its means that contraceptives are easy to
understand and use, also require least medical supervision.
(iv) Cost effective: It means the contraceptive is not only of low cost but also safe and
reliable.
(v) Culturally feasible and acceptable:
(vi) Acceptable, inexpensive and reversible

Family Planning Methods

The contraceptive methods broadly grouped into two classes:

I. Spacing methods
II. Terminal methods

S.no. Category Methods

SPACING
METHODS
1. Natural • Coitus
interruptus
• Safe Period
• Abstinence
• Others
2. Barrier methods
• Physical Condom
barrier Diaphragm with
method spermicide
Vaginal sponge

• Chemical
barrier Chemical
method spermicides in the
form of :
• Foam tablets
• Cream, jelly
and paste
• Suppositories
• Soluble film

3. Intrauterine Lippes loop

devices Copper T
 4. Hormonal Oral pills
methods • Combined
pill
• Progesterone
only pill
• Once a
month pill
Depot formulations
• Injectable
• Implants
• Vaginal rings
5. Post Menstrual regulation
conceptional Menstrual induction
methods Abortion
TERMINAL Female sterilization
METHODS OR Male sterilization
TERMINAL
STERILIZATION

SPACING METHODS

There are various contraceptive methods available which help in the prevention of pregnancy as
long as they are used. These methods can help in timing and spacing of pregnancies, preventing
unwanted children and having wanted children. These methods are temporary methods.

1. Natural Methods

Natural Methods do not involve the use of any of the man made devices. These methods are quite
useful for timing and spacing of pregnancies.

These include:

(i) Coitus interruptus

(ii) Safe period
(iii) Abstinence
(iv) Others

(i) Coitus interruptus

This method is also called as withdrawal method. In this method the penis (male organ) is withdrawn
from the vagina before ejaculation (discharge).

In this way the semen is prevented from entering the uterine cavity and pregnancy does not take
place.

Since the penis is withdrawn and ejaculation takes place out side the vagina, this method is called as
coitus interruptus or the withdrawal method.

The merits of this method :

(i) It involves no cost

(ii) It does not require any other device
 (iii) With self control and discipline it can be fairly effective.

The demerits of this method-

(i) It requires a great deal of self control and the slightest delay in withdrawal of penis may
cause failure because even a drop of semen which may escape is sufficient to cause
pregnancy
(ii) the pre-ejaculatory fluid which may find way into the uterine cavity contains sufficient
sperms-to cause pregnancy
(iii) the semen deposited out side the vagina has the risk of entering in the genital tract
(iv) failure rate is as high as 25 percent
(v) couples are often dissatisfied.

(2) Safe period

This method is based on the process of ovulation and menstruation cycle which helps in
determination of the safe period when coitus can be done and unsafe period when coitus should be
avoided to prevent pregnancy.

The ovum is normally not released from the ovary during first nine to ten days from the start of
menstrual period. This period which includes three to four days of menses is safe for coitus. From
the 10th day of the start of the period upto the 19th day is unsafe period because ovulation takes
place between 13—17 days after the start of menses (or between 12—16 days before the start of
next period).

The ovum is viable for fertilization for 24-72 hours after ovulation. Two to three days on either side
(before and after) of ovulation are considered as unsafe that is why unsafe period is from 10-19th
day after the start of menses.

This method is also called as rhythm method because there is periodicity of safe and unsafe period.

This is also called as calendar method because it is based on the monthly calendar.

The merits of safe period method are

(i) It does not require any manmade device

(ii) This method is accepted by Roman Catholic Church.

The demerits of safe period method are

(i) the practice of this method requires a great deal of self control because there is a period
of compulsory avoidance of coitus
(ii) This method is unsuitable for women who have irregular periods
(iii) This method is possible for those couples who are educated, can maintain a record of
their calendar and follow the safe and unsafe period
(iv) It requires a great deal of will power and motivation.
(v) The failure rate is high
(vi) This method is not applicable during changes in monthly cycle e.g. during postnatal
period, menopausal period.

3. Abstinence

This implies complete avoidance of sexual cohabit.

Complete abstinence during this period which will help in birth control may not be practicable
because it may manifest various psychosocial problems due to suppression of sexual desire. Hence
this method can not be considered as a method for family planning.

4. Other methods of periodic abstinence

There are three methods which are based on the physiological changes associated with ovulation
and which help in identification of fertile period ie. unsafe period for coitus. The methods are:

(a) Basal body temperature (B.B.T.) method

(b) Cervical mucus method
(c) Symptothermic method

BARRIER METHOD

Also known as occlusive method, or conventional methods available for both men and women with
the aim to prevent live sperm from meeting the ovum. These includes:

a) PHYSICAL METHODS

1. CONDOM:- Condom is a most widely known and used barrier device by the males around the
world.

In India it is better known by its trade name NIRODH, meaning prevention.

Condom is receiving new attention today as an effective, simple “spacing” method of contraception
without side effects.

In addition to preventing pregnancy, condom protects both men and women from sexually
transmitted diseases.

A new condom should be used for each sexual act.

Available free of cost at rural and urban centre’s

ADVANTAGES OF CONDOM:

1. They are easily available

2. Safe and inexpensive
3. Easy to use, do not require medical supervision
4. No side effects
5. Light compact and disposable
6. Provides protection not only against pregnancy but also against STD including HIV and
Hepatitis B infections.

DEMERITS/ DISADVANTAGES OF CONDOM:

• It may slip off or tear during coitus due to incorrect use
• The main limitation of condom is that many men do not use them regularly or
carefully, even when the risk of unwanted pregnancy or sexually transmitted
disease is high.
• In rare cases the person may have allergy to rubber or latex

FEMALE CONDOM:
The female condom is a pouch made of polyurethane, which lines the vagina. An internal ring in the
close end of the pouch covers the cervix and an external ring remains outside the vagina.

It is pre lubricated with silicon, and a spermicide need not to be used.

It is an effective barrier to STD infection. However high cost and acceptability are major problems.

DIAPHRAGM:

The diaphragm is a vaginal barrier. It was invented by German physician in1882.

Also known as “Dutch cap”, the diaphragm is a shallow cup made of synthetic rubber or plastic
material. It has a flexible rim made of spring or metal. It is important that a women be fitted with a
diaphragm of the proper size in front of the cervix.

ADVANTAGES OF DIAPHRAGM

• Diaphragm along with spermicide is very effective.

• There is no risks or any kind of contraindications.

DISADVANTAGES OF DIAPHRAGM:

• Initially a physician or other trained person will be needed to demonstrate the technique of
inserting the diaphragm into the vagina and to ensure a proper fit.
• After delivery, it can be used only after involution of the uterus is completed.
• If the diaphragm is left in the vagina for an extended period, there is a remote possibility of
the toxic shock syndrome, which is a state of peripheral shock requiring resuscitation.
• It requires periodical check up
• This method is found inconvenient to use rural areas

3. VAGINAL SPONGE:

It is a small polyurethane foam sponge, saturated with the spermicide, nonoxynol-9. The
sponge is far less effective than the diaphragm, but it is better than nothing.

It can be fitted onto the cervix and has a loop on its outer surface which can be used for pulling
out the sponge after use

It provides protection for 24 hours but should be inserted before coitus

It should remain for atleast 6 hours after coitus

Sperms are trapped into the sponge and are destroyed by spermicide

CHEMICAL BARRIER METHODS:

Also known as vaginal chemical contraceptives and it comprises four categories:

1. Foams: Foam tablets, foam aerosols.

2. Creams, jellies and pastes.
3. Suppositories inserted manually.
4. Soluble films- C- film inserted manually.
The spermicides contain a base into which a spermicide is incorporated. The commonly used
modern spermicide are “surface-active agents” which attach themselves to spermatozoa and inhibit
oxygen uptake and kill sperms.

Merits of Chemical contraceptives are:

1. They are easy to administer

2. Available free in healthcenters
3. Not expensive

The main drawbacks or Demerits of spermicides are:

• They have a high failure rate

• They must be used almost immediately before a intercourse and repeated before each sex
• They must be introduced into those regions of the vagina where sperms are likely to be
deposited
• They may cause mild burning or irritation, besides messiness.

No spermicide which is safe to use has yet been found to be really effective in preventing
pregnancy when used alone. Therefore spermicides are not recommended by professional
advisers.

INTRA- UTERINE DEVICES

The IUD is one of the most effective reversible contraceptive methods.

There are two basic types of IUD:

• Non medicated
• Medicated

Both are usually made of polyethylene or other polymers, the medicated or bioactive IUDs release
either metal ions (copper) or hormones (progestogens).

And the non medicated or inert IUDs are often referred to as first generation IUDs.

GENERATIONS OF IUDS

• First generation: Made of polyethylene and are non medicated e.g. Lippes loop
• Second generation: Made of polyethylene but copper is added into these. Copper enhances
the contraceptive effect. e.g. copper 7 and copper T-200 ( replaced after 3 years); TCu –
220C and TCu – 380 A (effective can stay upto 5 years); multiload Cu-250, Cu 375 can stay for
5years
• Third generation : It contain hormones which are released slowly in the uterus. E.g.
Progestasert contains progesterone and Levonorgestrel device contains Levonorgestrel a
synthetic device.

ADVANTAGES OF IUDs

• Simplicity i.e., no complex procedures are involved in insertion.

• No hospitalization is required
 • Insertion takes only a few minutes
• Once inserted IUD stays in place as long as required
• Inexpensive
• Contraceptive effect is reversible by removal of IUD
• Virtually free of systemic metabolic side-effects associated with hormonal pills
• Highest continuation rate
• There is no need for the continual motivation required to take a pill daily or to use a barrier
method consistently, only a single act of motivation is required.
• Does not interfere with coitus
• Less failure rate ( 1 to 3 % ) only

CONTRAINDICATIONS FOR IUD INSERTION

• Suspected pregnancy
• Pelvic inflammatory disease
• Vaginal bleeding of undiagnosed etiology
• Cancer of the cervix, uterus or adnexia and other pelvic tumors
• Previous ectopic pregnancy
• Anemia
• Menorrhagia
• Purulent cervical discharge
• Distortions of the uterine cavity due to congenital malformations, fibroids.
• Unmotivated person.

SIDE EFFECTS AND COMPLICATIONS OF IUDs:

• Bleeding
• Pain
• Pelvic infection
• Uterine perforation
• Pregnancy
• Expulsion

HORMONAL CONTRACEPTIVES:

Hormonal contraceptive when properly used are the most effective spacing methods of
contraception.

Oral contraceptive of the combined type are almost 100% effective in preventing pregnancy. They
provide the best means of ensuring spacing between one childbirth and another.

CLASSIFICATION OF HORMONAL CONTRACEPTIVES:

A. Oral pills
I. Combined pill
II. Progestogen only pill(POP)
III. Post coital pill
IV. Once a month pill(long acting)
B. Depot (slow release) formulations:
 I. Injectables
II. Subcutaneous implants
III. Vaginal rings

A. ORAL PILLS

1) COMBINED PILL: It is one of the major spacing method of contraception.

The pill composed of 2 hormones that is synthetic oestrogen and synthetic Progestogen in very small
doses.

The oral pills are available free of cost is Mala D, Mala N and Chaya .

The pill should be taken every day at fixed time, preferably before going to bed at night. The first
course should be started strictly on the fifth day of menstrual period, as any deviation in this respect
may not prevent pregnancy. If the user forgets to take a pill, she should take a pill as soon as she
remembers, and that she should take the next day’s pill at the usual time. Example MALA-D and
MALA-N.,chaya

2) Progestogen only pill(POP):

This pill commonly referred to as “minipill” or “micropill”. It-contains only progestogen, which is
given in small doses throughout the cycle. The commonly used progestogens are norethisteron and
levonorgestrel.

Disadvantage of the progestogen only pill is that it never gained widespread use because of poor
cycle control and an increased pregnancy rate.

They could be prescribed to older Women for whom the combined pill is contraindicated because
of cardiovascular risks.

3) POST-COITAL CONTRACEPTION:— Emergency contraception

Post-coital or morning after contraception is recommended within 72 hours of an unprotected

intercourse. It is an emergency method for example after unprotected intercourse, rape or
contraceptive failure.

Two methods are available:

a) IUD :The simplest technique is to insert an IUD, if acceptable, especially a copper

device within 5 days.
b) Hormonal :More often a hormonal method may be preferable.
Or
Two oral contraceptive pills within 72 hours after intercourse, and the same
dose after 12 hours.
Or
Four oral contraceptive pills within 72 hours and 4 tablets after 12 hours.
Or
Mifepristone 10mg once within 72 hours.

4) ONCE A MONTH(LONG ACTING) PILL:

In once a month oral pill in which quinestrol, a long acting oestrogen is given in combination with a
short-acting progestogen, have been disappointing. The pregnancy rate is too high to be acceptable
and menstruation tends to be irregular.

MODE OF ACTION OF ORAL PILLS:

The mechanism of action of the combined oral pill is to prevent the release of the ovum from the
ovary. This is achieved by blocking the pituitary secretion of gonadotropin that is necessary for
ovulation to occur. Progestogen only preparations render the cervical mucus thick and scanty and
thereby inhibit sperm penetration. Progestogens also inhibit tubal motility and delay the transport
of the sperm and the ovum to the uterine cavity.

EFFECTIVENESS OF ORAL PILLS/ ADVANTAGES

Oral contraceptive of the combined type are almost 100% effective in preventing pregnancy. Some
women do not take the pill regularly, so the actual rate is lower. The effectiveness may also be
affected by certain drugs such as rifampicin, phenobarbital and ampicillin.

DEPOT FORMULATIONS:

The need for depot formulations which are highly effective, reversible, long acting and oestrogen-
free for spacing pregnancies in which a single administration suffices for several months or years
cannot be stressed, the followings are under depot formulations category:

1) INJECTABLE CONTRACEPTIVE: There are 2 types of injectable contraceptives: progestogen

only injectable and the newer once-a-month combined injectables.

PROGESTOGEN-ONLY INJECTABLES : They offer more reliable protection against unwanted

pregnancies than the older barrier techniques. These are:-
• DMPA (Depot- medroxyprogesterone acetate)
• NET-EN( Norethisterone enantate)

SUBDERMAL IMPLANTS: New York has developed a subdermal implant known as

NORPLANT for long term contraception. It consists of 6 silastic (silicon rubber)
capsules containing 35 mg (each) of levonorgestrel(85). NORPLANT (R)-2,which are
comparatively easier to insert and remove. The silastic capsules or rods are
implanted beneath the skin of the (forearm or upper arm.
Effective contraception is provided for over 5 years.

The main disadvantages, however, appear to be irregularities of menstrual bleeding

and surgical procedures necessary to insert and remove implants.

2) VAGINAL RINGS:- Vaginal rings containing levonorgestrel have been found to be effective.
The hormone is slowly absorbed through the vaginal mucosa, permitting most of it to bypass
the digestive system and liver and allowing a potentially lower dose. The ring is worn in the
vagina for 3 weeks of the cycle and removed for the fourth.
Disadvantages

• Needs medical professionals to insert

• Costly
• Irregular menstruation

POST CONCEPTIONAL METHOD:

i. MENSTRUAL REGULATION- It is a simple method of birth control and it consists
of aspiration of the uterine contents 6 to 14 days of a missed period, but before
most pregnancy tests can accurately determine whether or not a women is
pregnant.

Disadvantages

1) The immediate complication are uterine perforation and trauma.

2) Late complications (after 6 weeks)include a tendency to abortion or premature
labor, infertility, menstrual disorders, increase in ectopic pregnancies and RH-
immunization.
3) Some regard menstrual regulation as very early abortion others view it as a
treatment for delayed periods. menstrual regulation differs from abortion in
three respects:
. Lack of certainty if pregnancy is being terminated The lack of legal restrictions
© The increase safety of the early procedure.

MENSTRUAL INDUCTION:- ( Dilatation and curettage)

This is based on disturbing the normal progesterone prostaglandin balance by
intrauterine application of 1-5 mg solution of prostaglandin f2. Within a few
minutes of the prostaglandin implant, performed under sedation, the uterus
responds with the sustained contractions lasting about 7 mins, followed by
cyclic contractions continuing for 3-4 hours. The bleeding starts and continue for
7-8 days.

ABORTION: Abortion is defined as termination of pregnancy before the foetus

becomes viable(capable of living independently)

Abortion is sought by women for a variety of reasons including birth control.

Abortion can categorized as spontaneous and induced.
Spontaneous abortion can occur once in every 15 pregnancies. They may be
considered the natures method of birth control.
Induced abortions are deliberately induced they may be legal or illegal. Illegal
abortions are hazardous. They are usually the 1st resort of women determined to
end their pregnancies at the risk of their own life.

COMPLICATIONS OF ABORTION:
Early complication includes:
• Hemorrhage
• Shock
• Sepsis
• uterine perforation
 • Cervical injury
• Thromboembolism
• Anesthetic and psychiatric complications.

The late complications include

• Infertility
• ectopic gestation
• Increased risk of spontaneous abortion
• and reduced birth weight.

THE MEDICAL TERMINATION OF PREGNANCY ACT 1971:

This act lays down-

a) The conditions under which the pregnancy can be terminated

b) The person or persons who can perform such terminations
c) The place where such terminations can be performed.

The condition under which a pregnancy can be terminated under the MTP act:

1. Medical condition where continuation of pregnancy might endanger

the mothers life or cause grave injury to her physical and mental
health.
2. Eugenic - where there is substantial risk of the child being born with
serious handicaps due to physical and mental abnormalities.
3. Humanitarian- where pregnancy is a result of rape.
4. Socio economic-when actual or reasonably foreseeable
environment( whether social or economic)could lead to risk of injury
to the health of the mother.
5. Failure of contraceptive devices-the anguish caused by an unwanted
pregnancy resulting from failure of any contraceptive device or
method can be Presumed to constitute a grave mental injury to the
health of the mother.

According to the Act, the MTP can be performed only by authorised Registered Medical Practitioner
having prescribed experience in OBG.

The pregnancy should be terminated in Government . hospital or any other governmental

institution or a place recognised by the Government for the purpose.

If the period of pregnancy is below 12 weeks the abortion is done by a doctor without consulting
any other doctor. But if it is above 12 weeks then two doctors together must decide on the need for
termination. The termination can be done by any one of the doctors.

During emergency situation if the pregnancy is at 20 weeks or above, the MTP , can be done by a
single doctor without consulting the second doctor even in an unrecognised clinic or hospital.

It is very important to take written consent of the woman. If the woman is minor or in a state of
shock or insane then written consent of guardian must be taken.
Abortion under the MPT Act 1971, is considered as a personal matter and therefore strict
confidentiality is to be maintained by the service providers. Identity of the woman is to be kept
confidential .

The doctor is protected from any legal action for any kind of problem caused or any problem which
is likely to occur because of termination, provided the doctor has taken all the precautions and
proper care. But if any of the rules are violated, then the doctor is liable for punishment which may
include a fine upto Rs. 1000.

Termination of pregnancy on medical and eugenic basis is good for both mother and child.

Repeated abortions are harmful to mother’s health and lead to high morbidity and mortality.

The MTP Act 1971 was amended in 1975. The following amendments were done:

• The Chief District Medical Officer was empowered to certify the necessary qualification for a
doctor to perform abortions. Earlier it was done by certification board.
• Qualification required for performance of abortion:
(i) If RMP has assisted in the performance of 25 MTPs,
(ii) if the doctor has 6 months of housemanship in OBG
(iii) if he has postgraduate qualification in OBG
(iv) if a doctor who graduated before the 1971 Act was enacted, has 3 year of
experience in OBG
(v) those who graduated after the Act were enacted, have 1 year of experience in OBG.
• The Non Governmental Organisation (NGO) could also under take the abortion
services after taking licence from the Chief District Medical Officer.

Despite the MTP Act 1971 (amendment 1975) , a large number of illegal , abortions are still
performed in rural areas, remote hilly and tribal areas and even in urban areas, by persons who are
neither skilled nor authorised under the Act.

The major factors responsible for this are:

(i) Lack of access to safe abortion clinics

(ii) Lack of financial resources to reach the clinics in urban areas.
(iii) Lack of information about availability of safe abortion services
(iv) Lack of privacy and impersonal atmosphere in Government run hospitals.
(v) Reluctance of unmarried and widowed women to go to clinics.

MTP Act Amendments in 2021:

The Rajya Sabha has approved the Medical Termination of Pregnancy (Amendment) Bill, 2021
to amend the Medical Termination of Pregnancy Act, 1971 on 16th March 2021. The Bill was
approved in Lok Sabha on 17th March 2020.
Salient features of amendments:
 • Enhancing the upper gestation limit from 20 to 24 weeks for special categories of women
which will be defined in the amendments to the MTP Rules and would include survivors of
rape, victims of incest and other vulnerable women (like differently-abled women, minors)
etc.
• Opinion of only one provider will be required up to 20 weeks of gestation and of two providers
for termination of pregnancy of 20-24 weeks of gestation.
• Upper gestation limit not to apply in cases of substantial foetal abnormalities diagnosed by
Medical Board. The composition, functions and other details of Medical Board to be
prescribed subsequently in Rules under the Act.
• Name and other particulars of a woman whose pregnancy has been terminated shall not be
revealed except to a person authorised in any law for the time being in force.
• The ground of failure of contraceptive has been extended to women and her partner.

The Medical Termination of Pregnancy (Amendment) Bill, 2021 is for expanding access of
women to safe and legal abortion services on therapeutic, eugenic, humanitarian or social
grounds.
The amendments include substitution of certain sub-sections, insertion of certain new clauses
under some sections in the existing Medical Termination of Pregnancy Act, 1971, with a view
to increase upper gestation limit for termination of pregnancy under certain conditions and to
strengthen access to comprehensive abortion care, under strict conditions, without
compromising service and quality of safe abortion.
It is a step towards safety and well-being of the women and many women will be benefitted by
this.

The amendments will increase the ambit and access of women to safe abortion services and will
ensure dignity, autonomy, confidentiality and justice for women who need to terminate
pregnancy.

Terminal Methods (Sterilization)

Temporary protection from conception is to delay the first child and have suitable gap for the
second child and prevent the next child.

But once the family is complete, it is good to think and adopt method which is terminal and
provides permanent protection. Sterilization is the only method which gives permanent protection
from conception. Either husband or wife can under go sterilization by a simple surgical operation i.e.
vasectomy or tubectomy respectively.

1. Vasectomy

Vasectomy is sterilization of males. It is a very simple and minor operation which takes hardly 15-20
minutes.

The operation can be done in primary health centre under local anaesthesia by a trained doctor. A
strict aseptic technique is to be followed to prevent infection.

The operation involves a small cut on both sides of the scrotum. then a small portion of vas deferens
(about 1 cm) on either side of the scrotum is cut and ligated, folded back and sutured. It does not
affect the maleness or masculine strength.
After the operation the man can return home, resume his normal routine work.

However he should avoid any strenous manual labour or cycling for a week or so.

After operation, it is essential to use NIRODH or any other contraceptives for 3 months after which
the semen should be tested for presence of sperms .

He should give support to scrotum by bandage or Langote.

He should avoid taking bath for 24 hours.

He should get the stitches removed after 5 days.

The merits/ advantages of vasectomy are:

a. Operation is simple and minor.

b. Hundred percent effective.
c. Permanent protection against unwanted pregnancies.
d. No side-effects or complications.
e. In comparison to tubectomy it is cost effective.

The demerits of vasectomy are almost negligible

Complications

• Local pain
• Infection
• Hematoma
• Swelling
• Headache
• Fatigue
• Impotent

Tubectomy :

Tubectomy is sterilization of female. This is done by resecting a small part of fallopian tubes and
ligating the sected ends.

The closing of tubes can also be done by using other alternative methods like closing with bands,
clips, electrocautery.

The operation can be done through abdominal or vaginal approach. The most common abdominal
procedures are laproscopy and minilaparotomy.

Laparoscopy is more popular in India. Minilaparotomy is ‘modification of abdominal tubectomy. It

can be done under local anaesthesia and can be done at health centre and in mass camps.

It is most suitable after delivery. This method is safe, efficient and effective. The tubectomy may be
done after delivery (Post partum), between deliveries (inter partum) and after abortion.

The woman should not have any major illness.

Her haemoglobin should not be less than 8 gms.

She may have to stay in the hospital for 2-3 days and needs to take a few days rest.
Tubectomy does not cause any change in the functioning of reproductive system of woman and sex
life except that it blocks the passage of ovum from ovaries to uterine cavity and prevents its union
with the sperms.

Tubectomy should be done by trained and experienced gynaecologist and in place where proper
medical infrastructure is there .

Some of the complications of laproscopy are:

• Injury of surrounding organs

• Puncture of large blood vessel
• Infection.
• Fever and rapid pulse
• General weakness
• Persistent abdominal pain
• Vomiting
• Pus or tenderness at the site of operation.

It is important that mother should be advised to report any adverse signs and symptoms
immediately.

She should be followed up regularly. Once in 1st fortnight, thereafter once in a month for _ 3-4
months and once again between 12-18 months after the operation.

Guidelines for sterilization

Sterilization, both male and female can be done in of primary health centre in rural, hilly and tribal
areas having facilities for such operations.

Special camps are also organised for sterilization of males and females. The services are given free
of cost.

Some guidelines are provided by the government which need to be followed. These are as under:

(i) The age of the husband and wife. The age of the husband should be between 25-
50 years. The age of the wife should be between 20-45 years.
(ii) Number of living children: The motivated couple should have 2 living children
when undergoing sterilization.
(iii) Relaxation of age: The lower age limits the of the husband or wife may be relaxed
if necessary when the couple has 3 or more living children.
(iv) Motivation and consent: There is no coercion/force/outside pressure. The
accepter is motivated and should declare having obtained the consent of his/her
spouse to undergo sterilization.
(v) Awareness of its implications: The accepter knows that the method is permanent,
that for all practical purposes, the operation is irreversible

Acceptance Level of Contraceptives

The National Family Welfare Programme provides the following contraceptive services:

(i) Sterilization as a terminal method.

(ii) Intra-Uterine Devices for spacing births.
(iii) Daily oral contraceptive pill for spacing births.
(iv) Condoms for spacing births.

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