REPORT ON FAMILY PLANNING

SUBMITTED TO: Dr. Mukta SUBMITTED BY:

Department of Community Ayush Paudyal
Medicine Roll no. : 50
Dhulikhel Hospital MBBS 16th Batch
KUSMS
• Family planning
WHO defines family planning as “ability of individuals and couples to anticipate and attain their
desired number of children and spacing and timing of their births.” It is achieved through use of contraceptive
methods and treatment of involuntary infertility. A woman’s ability to space and limit her pregnancies has a
direct impact on her health and well being as well as an outcome of each pregnancy.

In Nepal, family planning services are provided using a cafeteria approach; which means different
methods of contraception are made available to most of health institutions and a client is to choose the method
that suits his or her objectives. It is expected that this approach will not only increase prevalence of
contraceptive use but also reduce fertility. This approach is also based on client’srights and opinion
• AGE SPECIFIC FERTILITY RATE IN NEPAL

The ratio of children born to a specific age group of women to the number of women in
the
risk of bearing children is age specific fertility rates (ASFRs). International comparisons of asfrs can easily be made.
There is an inverted u-shaped relationship between fertility and the age of women. In other words, during early part of
reproductive life fertility is low. It increases to a maximum value during the twenties and then declines when women
get older.
• DEMAND FOR CONTRACEPTION IN NEPAL

• Unmet need for family planning has been defined as proportion of women who want no more children or want
children only after 2 years but are not using any form of contraception.
• Current users of family planning methods are categorized as having a met need for family planning.
• Total demand = met need + unmet need
• CURRENT USE OF CONTRACEPTION IN NEPAL

Also called as CONTRACEPTIVE PREVALENCE RATE (CPR) is percentage of currently

married women who report using a method at time of interview.
• METHODS OF FAMILY PLANNING
• TEMPORARY METHODS/ BIRTH-SPACING METHODS
1. BARRIERMETHODS
TYPES:
PHYSICAL BARRIER

• Condom: they are made of polyurethane or latex mechanism of action: it is fitted in erect
penis before intercourse and thus prevent semen from being deposited in vagina.
Indication: as a interim form of contraception during pill use, following vasectomy
operation and during treatment of trichomonas vaginitis infection
Advantages: cheaper and easily available with no side effects easy to carry and simple to
use, prevent from STDs like aids, gonorrhea
Disadvantages:may accidentally break and slip during coitus and inadequate sexual
pleasure
• Femidom:it is the pouch made up of polyurethane which lines vagina.It acts as physical
barrier preventing the entry of sperm to cervix
Advantages: prevents from STDs like HIV, gonorrhoea
Disadvantages: high cost and less acceptability in females
• Diaphragm: it is the intra vaginal device made up of rubber with flexible metal or spring ring at the margin acting
as vaginal barrier.
Timing of insertion: before sexual act and is kept at least for 6 hours after the act
Advantages: cheap, reduces the risk of pelvic inflammatory diseases ,can be used for long time
Disadvantages: a)requires the help of physician for measuring the size and demonstrating technique
b)increases risk of UTI and vaginal irritation

•Vaginal sponge: it is made up of synthetic polyurethane impregnated with nonoxynol-9 as spermicide

Timing of insertion: before coitus after moistening with water into vagina to cover cervix
Advantages: do not require physician for fitting
Disadvantages: less effective and expensive, causes local allergic reaction
chemical methods: various spermicidal agents are available in the market in forms of cream, jelly, foam,
suppository as vaginal contraceptives.
Mechanism: they produce sperm immobilization and inhibit oxygen uptake resulting destruction of sperm
Advantages: enhances efficacy of condom, diaphragm when combined and easy to use, available
Disadvantages: mild burning and irritation in vagina, high failure rate
• NATURAL METHODS
A) Abstinence: is the practice of restraining oneself from indulging in sex
B)Rhythm method: the method is based on the identification of fertile period of cycle and abstain from sexual
intercourse during that period. It determines the approximate time of ovulation and fertile period by recording of
previous menstrual cycle(calendar rhythm)or noting basal body temperature or noting of excessive mucoid vaginal
discharge(billing method)
Advantages: Disadvantages:
a) no cost a) high failure rate
b) lack of side effects b) not applicable if menstruation is irregular
C) Coitus interruptus: it necessitates withdrawn of penis shortly before ejaculation. It require sufficient self control
by man and oldest and widely accepted method
Advantages : 1: no cost
2: no side effects
Disadvantages: 1: require self control by man,
2:high failure rate as precoital secretion may contain sperm
D) Breast feeding: prolong and intensive breast feeding causes physiological amenorrhoea in female and offer
natural protection against pregnancy.
Mechanism of action: it interferes with release of hormone needed for ovulation
Advantages: 1.Improves health of mother and baby,
2.No cost and side effects
Disadvantages:1.Works only for first 6 months or first menstrual period after delivery
2.No protection from STDs
• INTRAUTERINE CONTRACEPTIVE DEVICES
• There are two types of IUD: non medicated and medicated which are made up of polyethylene or polymer. The non
medicated or inert IUD are called as first generation IUDs. The copper IUDs comprises of second generation IUDs
and hormone releasing IUDs are third generation IUDs.
• The first generation IUDs are inert and found in different shape and size like spiral, loop, coils, rings. Lippes loop is
commonly used IUDs which is non toxic, non reactive, and durable containing BaSo4 for x-ray observation. Its
Mechanism of action: attracts macrophages in uterus cavity and kill sperms
• The second generation IUDs are copper containing device as metallic copper has antifertility effect. Some examples
are copper-7,nova t, multiload 250. It acts by increasing level of PGEs, WBCs in uterus.
• Third generation IUDs is based on principle of release of hormone, commonly used device is progestasert
which contains progesterone slowly in uterus. It act by inhibiting ovulation, decrease tubal motility, and making
cervix and uterus unfavourable for fertilization.
• Advantages of IUDs
1. Prolong contraception
2.Inexpensive and simple procedure
3.Reversible
• Disadvantages of IUDs
1. Heavy menstruation, abnormal
uterine bleeding
2.Chronic pelvic pain, PID 3.Risk
of ectopic pregnancy
4.Acne,ovarian cyst, altered mood
• Timing of insertion: the most appropriate time for insertion is during menstruation or within first 10 days of
beginning menstrual period. During this period, insertion is technically easy as uterus is relaxed and cervix is
dilated. It can also be done during first week of delivery
Contraindication: absolute-suspected pregnancy, PID, cervical cancer, history of ectopic pregnancy
relative-anemia, menorrhagia, history of PID
Complication: perforation, ectopic pregnancy, PID, bleeding, cancer, teratogenicity.
STEROIDAL CONTRACEPTION/HORMONAL METHODS
I.Oral pills: can be combined pills(both estrogen and progesterone), minipill(progesterone only), postcoital pill, male
pills
II. Parenteral forms: injectables and subcutaneous implants
• Mechanism of hormonal methods
1. It decrease FSH and LH by negative feedback to hypothalmo-pituitary axis and inhibit ovulation
2.It makes cervical mucus thick and viscous
3.Makes endometrium unfavourable for implantation
• Advantages:1.Reduce risk of ovarian and endometrium cancer
2. Cheap and easily available
3. Period become regular and reduce dysmenorrhoea
• Disadvantages:1.Less convient as have to take daily
2. Side effects like weight gain,skin pigmentation,headache,breast tenderness
3. Increases risk of thromboembolism and donot protect from stds
• Contraindication:breast cancer,liver disease,renal disease,breast feeding,smoking,hyperlipidemia,hypertension,age
over 40 years
Parenteral routes
A.Progesterone only injectables: depot medroxyprogesterone acetate, norethisterone enantate
B.Subcutaneous implants: norplant (small device placed under skin containing progesterone)
Advantages: 1.Safe,effective,acceptable
2.Donot effect lactation
Disadvantages: irregular menstruation bleeding, weight gain
Contraindication: breast cancer, liver disease, hypertension
• Post conceptional methods:
A. Menstrual regulation: it consists of aspiration of uterine content 6-14 days after missed
period
B. Menstrual induction: application of prostaglandins f2 causing uterine contraction
C.Oral abortifacients: use of mifepristone(progesterone antagonist)and misoprostol to terminate pregnancy
Contraindication: hypersensitivity to drugs, suspect ectopic pregnancy, IUDs in place, renal failure,
bleeding
disoders,porphyria
• PERMANENT METHODS

• These methods are used when desired number of children is present and family is complete

A. Male method(vasectomy): it is permanent method in which segment of vas deferens of both side are
resected and cuts ends are ligated.
Mechanism : it prevent the transfer of sperm from testes to semen but donot interfere with production
Advantages: 1.Operation technique is simple and can be done in mass as outpatient procedure
2.Chances of success of reversal anastomosis operation
Disadvantages: 1.Addition contraception required for 2-3 months until semen is free from stored sperms
2.Impotency and frigidity may occur which is psychological
Complication: 1.Pain and swelling after procedure
2.Bleeding may result hematoma in scrotum
• B. Female method(tubectomy): it is the operative procedure where resection of a both segment of both fallopian
tubes is done to achieve permanent sterilization. They can be approach through abdominally or vaginally.
Advantages: permanent and effective method, can be reversible
Disadvantage: can be costly and requires trained personnel, infections,loss of libido etc
Complication: 1.Ectopic pregnancy, menstrual irregularly
2.Loss of libido, infection
 REFERENCES…
1. Park’s Textbok of Community Medicine
2. National Population Report 2017
3. https://www.who.int/pmnch/media/news/2010/20100322_d_

shaw_oped/en/
4. DC Dutta’s textbook of Gynecology