FAMILY PLANNING

AND
CONTRACEPTION

Family Planning
The conscious process by which a couple
decides on the number and spacing of children
and the timing of births
The totality of human efforts to achieve stability,
health, happiness and welfare

Objectives of Family Planning

Avoiding unwanted pregnancies
Regulating intervals between pregnancies
Deciding on the number of children in the family
Controlling the time at which birth occur
Preventing pregnancy for women with serious illness
Providing the option for women who are carriers of
genetic disease

Contraception

The voluntary prevention of pregnancy

Characteristics of an
ideal contraceptive method
Safe
100% effective
Free of undesirable side effects
Easily obtainable
Acceptable to the user and sexual partner
Free of effects on future pregnancies

Contraceptive Methods
A. Natural methods
1. Abstinence
2. Calendar method
3. Basal body temperature (BBT) method
4. Cervical mucus method
5. Coitus interruptus

Contraceptive Methods
Artificial Methods:
A. Spermicides
B. Barrier methods
1. Female condom (vaginal pouch)
2. Male condom
3. Cervical cap
4. Diaphragm
C. Intrauterine device (IUD)

Contraceptive Methods
D. Pharmacologic methods
1. Oral contraceptives
2. Subdermal implants
3. Injection
E. Sterilization
1. Vasectomy
2. Tubal ligation

A. Natural or fertility awareness methods

1. Abstinence
- most effective (0% failure rate)

A. Natural or fertility awareness methods

2. Calendar method
- abstinence from intercourse during fertile periods
- typical user, pregnancy rate is about 13%
Advantages:
- inexpensive and convenient
- no side effects
- encourages communication
- ethically and morally noncontroversial
- appropriate for sexual education programs
Disadvantages:
- requires long periods of abstinence and
correct calculations
- effectiveness is unreliable and depends on

self-control,
many variables

Cycle Record
First Day of Period

Number of Days in
Cycle

Jan. 20
Feb. 18
Mar. 18
Apr. 16
May 12

29
29
28
29
26

June 9

28

July 9
Aug. 5

30
27

Predicting first and last fertile day

A. Natural or fertility awareness methods

3. Basal body temperature (BBT) method
- a rise in BBT predicts ovulation and to begin abstinence
- pregnancy rate is about 20%
Advantages:
- inexpensive
- no side effects
- encourages communication
Disadvantages:
- not as effective as other methods
- temperature may result from other conditions
- requires regular and accurate record keeping
- intercourse only in the postovulatory period

A. Natural or fertility awareness methods

4. Cervical mucus method
- uses the appearance, characteristics, and amount of cervical mucus to identity ovulation
- Ovulatory period: clear, slippery, more abundant
- Preovulatory and postovulatory periods: yellowish, less
sperm motility
- pregnancy rate is about 20%.
Advantages:
- inexpensive
- no side effects
- noncontroversial
Disadvantage:
- not as effective as other methods

abundant, thereby inhibits

B. Coitus interruptus
- requires withdrawal of the penis from the vagina before
ejaculation
- highly ineffective because sperm exist in preejaculatory fluid
- pregnancy rate is about 19%.
Advantages:
- inexpensive and medically safe
Disadvantages:
- unreliable
- interrupts sexual excitation or plateau
- diminishes satisfaction
- does not eliminate the risk of STDs.

C. Spermicides
- interfere with sperm viability and prevent sperm from
entering the cervix
- vaginal jelly, cream, suppository, Nonoxynol-9
- pregnancy rate ranges from 5% to 50%

C. Spermicides
Advantages:
- available without prescription
- useful when other methods are
inappropriate or
contraindicated
- few or no side effects
- provide moderate protection against
some STDs
Disadvantages:
- lower effectiveness than other
methods
- may irritate tissues
- esthetically unpleasant
- one dose is effective for one hour

D. Barrier methods
1. Female condom (vaginal pouch)
- long polyurethane sheath inserted manually into the vagina
- inserted up to 8 hours
- 80% effective
Advantages:
- Protects against STDs and conception
Disadvantages:
- may cause sensitivity to sheath material

Female condom (vaginal pouch)

D. Barrier methods
2. Male condom
- rubber sheath that fits over the erect penis and prevents sperm from entering the vagina
- about 86%effective
Advantages:
- prevent conception and transmission of STDs
- available OTC
- no side effects
- maintain erections longer
- prevents premature ejaculation
- easily carried
Disadvantages:
- decrease spontaneity and sensation
- cannot be used if with latex allergy

Male condom

D. Barrier methods
3. Cervical cap
- small rubber or plastic dome that fits over the cervix
- Effectiveness depends on parity
(Parous: 60%; Nulliparous: 80%)
Advantages:
- Provides continuous protection for 48 hours
Disadvantages:
- may dislodge
- must be fitted individually by a health care provider
Side effects:
- trauma to the cervix or vagina
- pelvic infection, cervicitis
- odor problems

D. Barrier methods
4. Diaphragm
- flexible ring covered with a dome-shaped rubber cap inserted in to the
vagina and covers the cervix
- applied no more than 2 hours before intercourse, and is
left in
place for 6 hours after coitus
- about 80% effective
Advantages:
- reusable and inexpensive
Disadvantages:
- must be fitted individually, refitted after childbirth or after a weight
loss of 15 lbs more.

E. Intrauterine device (IUD)

- small, plastic, T-shaped device with

a string attached to the end

E. Intrauterine device (IUD)

- flexible device inserted into the uterine cavity
- alters tubal and uterine transport of the sperm
- 93% to 97% effective
Advantages:
- inexpensive for long-term use
- reversible
- may be used in breast-feeding women
- requires no attention other than checking that it is in place

E. Intrauterine device (IUD)

Disadvantages:
- available only through a health care provider
- cannot be used if the woman has pelvic infection, postpartum
infection, endometrial hyperplasia or carcinoma, or uterine
abnormalities
- should not be used by women who have an increase risk of STDs
and women with multiple sexual partners
Side effects:
- dysmenorrhea, increased menstrual flow, spotting between periods,
uterine infection, and ectopic pregnancy

E. Intrauterine device (IUD)

Copper IUD
- Releases copper to prevent
pregnancy
- Approved to remain in place
for 10 years

E. Intrauterine device (IUD)

Hormonal IUD
(Levonorgestrel-releasing IUD
or Mirena)
- Progestin thickens cervical
mucus
- Approved to remain in place
for 5 years

F. Pharmacologic methods
1. Oral contraceptives
- combined estrogen and progesterone
preparation
- stops ovulation
- prevents ovaries from releasing eggs
- thickens cervical mucus
- 97% effective

F. Pharmacologic methods
1. Oral contraceptives
Advantages:
- convenient to use
- periods may be lighter or more regular
- does not harm future fertility
- does not interrupt sex play
- may protect against uterine and ovarian
cancers
- may reduce acne
- can be used for emergency contraception

F. Pharmacologic methods
1. Oral contraceptives
Disadvantages:
- does not protect against STIs
- must be taken every day
- increased risk of heart attack and stroke

F. Pharmacologic methods
1. Oral contraceptives
Cautions:
- women who are over 35 and smoke
- history of heart attack
- blood clots
- known or suspected pregnancy

F. Pharmacologic methods
1. Oral contraceptives
Danger signs:
- Abdominal pains (severe)
- Chest pain
- Headaches (severe)
- Eye problems (blurred vision)
- Severe leg pain

F. Pharmacologic methods
3. Subdermal implants
- Six, soft, silastic rods filled with
synthetic progesterone are
implanted into the womans arm
- Norplant
- 0.04% failure; 99% effective within 24 hours

F. Pharmacologic methods
3. Subdermal implants
Advantages:
- long-acting (5 years)
- not coitus dependent
- reversible
- inexpensive
Disadvantages:
- requires surgical insertion

F. Pharmacologic methods
4. Injection
- Medroxyprogesterone
(DMPA or Depo-provera), an IM
injection given every 3 months

F. Pharmacologic methods
4. Injection
Advantages:
- highly effective
- may be used by breast-feeding
women

F. Pharmacologic methods
4. Injection
Side effects:
- likely to cause amenorrhea
particularly after the first year

G. Sterilization
1. Vasectomy
- Performed by cutting and
sealing the tubes that carry
sperm

Vasectomy

G. Sterilization
1. Vasectomy
-

Procedure takes about 15-20 mins

Rest for 48 hours
No strenuous activity for 1 week
Semen samples should be
analyzed

G. Sterilization
1. Vasectomy
Advantages:
- 99.85% effective
- Recovery time is short
- Sexual function is not affected
- Cost-effective and convenient

G. Sterilization
1. Vasectomy
Disadvantage:
- Method is permanent

G. Sterilization
2. Tubal ligation
- Fallopian tubes are accessed
through two small incisions into
the abdomen and visualized using
a laparoscope, then cut, tied,
cauterized, or banded to block the
passage of sperm and prevent
the ovum from becoming fertilized
- 99.2-96.3% effective

G. Sterilization
2. Tubal ligation
- Procedure takes approximately
30 mins
- Avoid strenuous activity for 1
week

G. Sterilization
2. Tubal ligation
Advantages:
- Permanent and effective in
preventing pregnancy
- May be performed at any time
- Sexual function are not affected

G. Sterilization
2. Tubal ligation
Disadvantages:
- Procedure requires outpatient
surgery
- Reversal of procedure may not be
possible