Effects of Family Planning

Practices on Productivity at
the Workplace

Cesar C. Ubaldo, MD, FPOGS, FPCS

Outline
 Overview of Family Planning
 Benefits of Family Planning
 General Facts
 Risks
 Economic Costs
 Family Planning Methods
OVERVIEW OF FAMILY PLANNING
Family Planning is a concerted effort of the husband
and children in the family.
The decision of when or even whether to have
children is a basic human right.
With this right can come benefits or risks.
Through the practice of family planning, individuals
and their families and their society are more
likely to enjoy the benefits that result from
procreation.
BENEFITS TO THE MOTHER
 Family planning gives more time to the mother to
 Provide love and attention to the husband and children,
 Enable her to regain health after the last delivery, it usually
takes 2-3 years interval to fully recover mother’s health
 Recover and be treated from illnesses like tuberculosis, heart
disease, anemia, infection and others
 Practice her profession or work to help the husband earn a
living
 Pursue further education if not able to finish her planned career
 Participate in religious, civic and social activities of the
community.
BENEFITS TO THE MOTHER
 Family planning also prevents
 Young mothers below 18 and old mothers (above 35
yrs.) from getting pregnant, as pregnancy during this
age groaup is associated with high risks,
 Other mothers considered at high risk from becoming
pregnant as pregnancy might aggravate existing
disease, problems and etc.,
 Women from resorting to illegal abortion, of
unwanted pregnancy, as illegal abortion is considered
as one of the number one causes of maternal deaths
in developing countries.
BENEFITS TO THE CHILDREN.
 Family planning in general influence the survival,
health and development of children. The practice
of family planning will make the children
 Happier, for the mother and the father, and the rest
the family can give more love and attention
 Healthier, for healthy mother can produce healthy
children
 More security for few children in the family have
better opportunities for adequate food, clothing, good
education and other needs.
BENEFITS TO THE FATHER.
 Lighten his burden and responsibility in supporting the family
especially with few children
 Enable him to give the family a happy and contented life
 Enable him to give his children good shelter, good education
and better future,
 Enable him to give more attention, more love to his to his wife
 Give him more time for self-improvement time 5 have extra
resources and enough time to actively participate in community
activities
 Give him a feeling of fulfillment and pride in the family for
being a good provider.
BENEFITS TO THE COUPLE
 More relaxed in sexual relations knowing that the sexual
intercourse will not lead to unwanted pregnancy
 More intimate relations and further discovery of each
other
 Increase their sense of self-respect by being able to
improve their love to each other
 Good example to their children in taking care of their
reproductive health
BENEFITS TO THE FAMILY
 With all the advantages each member can derive
from the practice of family planning, the family
will be happier, healthier and more secured.
BENEFITS TO THE ECONOMIC
SYSTEM AND SOCIETY

 The impact of family planning to the society may

be its contributions in preventing or reducing the
impending problems of overpopulation like
overcrowding, contaminated water, air pollution,
energy crisis, deforestation and floods,
malnutrition and poverty.
General Facts
Birth control coverage:
Productivity vs. Reproductivity
Kathleen O'Connor
 Here are some facts about contraception, maternity and the
bottom line:
 More than 50 percent of all pregnancies are unintended, i.e.,
not wanted at that specific time.
 A normal pregnancy (no Cesarean, no complications) costs
about $5,000 to $6,000.
 Contraceptive coverage costs about $1.50 to $2 per
employee/month, or $18 per employee/year ($20 maximum).
 It would take 300 women on contraceptives at $20 per
woman/year to equal the cost of one pregnancy.
 · If you're an employer with 45 employees, and 30 percent
(14) are women, about seven of these women could become
pregnant at a cost of $6,000 each, or roughly $42,000. Annual
contraceptive costs for all 45 employees is $900.
 · All 45 employees would have to be on contraceptives for 6.6
years to equal the cost of one pregnancy.
Risk of Death in Childbearing
 Every pregnancy entails risk, especially where health care is
poor.
 Each year more than 500,000 women worldwide die from
pregnancy or childbirth-related causes, almost all from
developing countries.
 Most maternal deaths could be prevented with inexpensive
measures. (WHO - $US 3.00 per capita per year to provide
mother & baby care for women in low-income countries
 2000 – 98% (3.43M) adult deaths from causes related to poor
reproductive health in developing countries
 Every year nearly 80 million unintended pregnancies occur
worldwide.
 Total cost of saving the life of a mother or infant is approx. $ 230
Economic Cost
 Women account for 70% of the 1.3
billion people who live in absolute
poverty.
 In India, study found that disability
reduced the the productivity of the
female labor force by 20%
Maternity Leave Benefits – WHO 2000
Country Length of %of wages Provider of
maternity paid in coverage
Leave covered
period
Phils 90 days 100% SSS

Singapore 60 days 100% Employer

Australia 1 year - -

USA 90 days - -
METHODS
 Natural Family Planning method
 Lactational Amenorrhea (LAM)
 Barrier
 Hormonal contraceptions
 IUD
 Spermicide
 Surgical Sterilization
Natural Family Planning Method
 Periodic abstinence
 Symptothermal method
 Billings method
Periodic Abstinence
 life span of egg = 24 hours
 life span of spems = 72 hours
 14 days from ovulation to next
menstruation
SUN MON TUE WED THU FRI SAT
1 2 3 4
5 6 7 8 9 10 11
12 13 14 15 16 17 18
19 20 21 22 23 24 25
26 27 28 29 30 31
COMPUTATIONS
 FIRST DAY = shortest cycle - 18 OR
17
 LAST DAY = longest cycle - 11 OR 10
BILLINGS METHOD
 Stretchability of the cervical mucus
 can reach up to 8 to 20 cms at day of
ovulation
 an estrogenic effect
BASAL BODY TEMPERATURE
 Rise in basal body temperature by 1
degree Fahrenheit
 a progesterone effect
 no ovulation - no progesterone - no
increase in temperature
Natural Family Planning Method
 combination
 use effectiveness: 60 - 90 %
Lactation Amenorrhea Method
 Elevated prolactin - ovulation inhibition
 Requirements:
 exclusive breast feeding x 6 months
 amenorrhea
Hormonal Contraception
 Physiology: Negative feedback
 Elevated Estrogen and Progesterone -
inhibition of GnRH maintained - no FSH, no
LH surge, no ovulation
 COC
 POP
 Injectables
 Implants
 Emergency contraception
Combined Oral Contraceptives
 Ethinyl Estradiol
 Norethindrone, norgestrel,
levonorgestrel
 Low dose: < 50 ug ethinyl estradiol
 third generation: gestodyne,
desogestrel
COC
 1st 5 days of cycle
 7 days interval
 missed pills
Risks
 malignancy ?
 Thromboembolism
COC: contraindications
 hx of thromboembolism, stroke, MI
 undiagnosed vaginal bleeding
 pregnancy
 uncontrolled hypertension and diabetes
 active liver disease
 > 35 years old, smoker
POP
 same mechanism of action as COC
 starts on 1st 5 days of cycle
 continuous
 best for breast feeding mothers
 pseudomenopause state
Injectable Progestins
 DMPA Depoprovera 150 mg IM q 3
months
 rule out pregnancy
 menstrual irregularities
 highly effective
Norplant
 6 rods implanted in the subdermal area
 Upper arm, buttocks, lower arm, thighs
 3-5 year effectivity
 complications associated with insertion
and removal
Emergency contraception
 within 72 hours after unprotected
intercourse
 100 ug ethinyl estradiol
 low dose COC: 2 tablets bid, x 2 days
 98 % effectivity
Condoms
 flavored, studded, spiked
 female condoms: not popular
 latex: not optimum in tropical countries
 plastic condoms
Condoms
 highly effective if used properly
 std/HIV control
IUD
 Mechanism of action: spermicidal
 Perforation secondary to unskilled
provider
 Highly effective, reversible, long
duration
 Timing: any time provided pregnancy
is ruled out
IUD: Infections
 infection associated with insertion only
 multiple sexual partners
Lost IUDs
 uterine sound and hook
 ultrasound or x-ray
 if embedded or outside uterus: explore
Gynefix
 IUD
 fixed in the fundal area
 no expulsion rate
 highly effective
Surgical sterilization
 Bilateral tubal ligation: isthmic portion
 3-4 cms removed
 modified pomeroy technique
 local anesthesia with sedation
Vasectomy
 not popular
 no scalpel vasectomy (NSV)
 15-20 ejaculations
Contraceptive research
 hormones
 vaccines
 condoms, diaphragms, caps
 spermicides
 tubal and vas blockade
Male Methods
 Suppression of spermatogenesis
 Androgens: androgens, GnRH, LH &
FSH, Spermatogenesis, Azoospermia
Androgens
 Testesterone enanthate (TE)
 Intramuscular / week
 70 % azoospermic
 Acne
 decreased HDL
 Testosterone bucyclate
Other male methods
 Androgen/progestin combination
 Levonorgestrel (LNG) 500 ug / day
 TE + desogestrel
 GnRH analogue
 Vas blocking agents
 silicone plugs (VASOC)
 Improved condoms
Immunocontraceptive:
vaccination
 Sperm antibody/ antigens
 Zona pellucida Ag
 FSH
 hCG
Systemic hormone for women
 natural steroid: microspheres
 progestins in polymeric microspheres
 progesterone vaginal rings
Barrier: mechanical
 Lea’s shield
 Femcap
 Easy fit diaphragm
 Tactylon: thermoplastic elastomer
 Reality
Barrier: chemical
 nonoxynol-9 with VCF
 vaginal sponges
Centchroman: non hormonal
contraceptive pill
 CENTRON; SAHELI
 1.25 mg/kg x 1,2,3 postcoital days, 30-
60 mg/week
 Action:
 increase transport of zygote
 increase blastocyst formation
 decrease endometrial proliferation
Guidelines in the use of family
planning methods
 typical use
 skills
 counselling
 informed consent
good day