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 Chapter 7
Responsible Parenthood
Family Planning
Pre-Pregnancy Services
Lawrence Ryan A. Daug, RN, MPM
CHN 1 - Instructor
Learning Objectives:

1. Identify different legislative documents that regulate maternal, child,

newborn, and adolescent healthcare

2. Describe the role of the public health nurse in implementing

government programs.
TOPICS:

• Responsible Parenthood

• Family Planning

• Pre-Pregnancy Services
Responsible Parenthood

Refers to the will and ability of a parent to respond to the needs and
aspirations of the family and children. It is likewise a shared responsibility
between parents to determine and achieve the desired number of children,
spacing and timing of their children according to their own family life
aspirations, taking into account psychological preparedness, health status,
sociocultural and economic concerns consistent with their religious
convictions (Congress ofthe Philippines, 2012)
13 Sexual Reproductive
Rights
1. The Right to Life

• This means, among other things, that no woman’s life should be put at risk by
reason of pregnancy, gender or lack of access to health information and services.
This also includes the right to be safe and satisfying sex life.

2. The Right to Liberty and Security of the Person

• This recognizes that no woman should be subjected to forced pregnancy, forced

sterilization or forced abortion.

3. The Right to Equality, and to be free from all Forms of Discrimination

• This includes, among other things, freedom from discrimination because of one’s
sexuality and reproductive life choices.
4. The Right to Privacy
•This means that all sexual and reproductive health care services should be confidential in
terms of physical set-up, information given or shared by the clients, and access to records or
reports.

5. The Right to Freedom of Thought

•This means that all sexual and reproductive health care services should be confidential in
terms of physical set-up, information given or shared by the clients, and access to records or
reports.

6. The Right to Information and Education

•This includes access to full information on the benefits, risks and effectiveness of all methods
of fertility regulation, in order that all decisions taken are made on the basis of full, free and
informed consent.
7. The Right to Choose Whether or Not to Marry and to Found and Plan a Family
• This includes the right of persons to protection against a requirement to marry
without his/her consent. It also includes the right of individuals to choose to remain
single without discrimination and coercion.

8. The Right to Decide Whether or When to Have Children

• This includes the right of persons to decide freely and responsibly the number and
spacing of their children and to have access to related information and education.

9. The Right to Health Care and Health Protection

• This includes the right of clients to the highest possible quality of health care, and the
right to be free from harmful traditional health practices.
10. The Right to the Benefits of Scientific Progress

• This includes the right of sexual and reproductive health service of clients
to avail of the new reproductive health technologies that are safe,
effective, and acceptable.

11. The Right to Freedom of Assembly and Political Participation

• This includes the right of all persons to seek to influence communities

and governments to prioritize sexual and reproductive health and rights.
12. The Right to be Free from Torture and Ill-Treatment

• This includes the rights of all women, men and young people to protection from

violence, sexual exploitation and abuse.

13. The Right to Development

• This includes the right of all individuals to access development opportunities

and benefits, especially in decision-making processes that affect his/her life.

The Responsible Parenthood
and Reproductive Health Act
of 2012 (RA 10354)
The State recognizes and guarantees the human rights of all persons

including their right to equality and nondiscrimination of these rights, the

right to sustainable human development, the right to health which includes

reproductive health, the right to education and information, and the right to

choose and make decisions for themselves in accordance with their religious

convictions, ethics, cultural beliefs, and the demands of responsible

parenthood.
• to protect and strengthen the family as a basic autonomous social institution and
equally protect the life of the mother and the life of the unborn from conception.

• protect and promote the right to health of women especially mothers in

particular and of the people in general and instill health consciousness among
them.

• protect and advance the right of families in particular and the people in general
to a balanced and healthful environment in accord with the rhythm and harmony
of nature.

• recognizes and guarantees the promotion and equal protection of the welfare
and rights of children, the youth, and the unborn.
Section 4.04

• Informed Choice and Voluntarism. To ensure adherence to

the principles of the RPRH Act and the delivery of quality

reproductive health care services to voluntary recipients,

the applicable provisions of DOH guidelines on Informed

Choice and Voluntarism shall form part of these Rules

Section 4.05 - Access to Family Planning

• All accredited public health facilities shall provide a full range of modern
family planning methods, which shall also include medical consultations,
supplies and necessary and reasonable procedures for poor and
marginalized couples having infertility issues who desire to have children.

• The LGUs, with assistance of the DOH, shall ensure that all public health
facilities within the Service Delivery Network shall provide full, age,
capacity, and development-appropriate information and services on all
methods of modern family planning to all clients
These services include, but are not limited
to the following:
• Fertility awareness and family planning information and education;

• Infertility services;

• Referral services where necessary; and

• Other family planning information and services as deemed relevant by

the DOH
• Interpersonal communication and counseling (IPCC) services to the

client to allow him or her to make a free and informed choice

regarding his or her intention/plan;

• Provision of modern family planning methods which shall include

dispensing of medically safe, legal, and non-abortifacient health

products and procedures, among others;

Section 4.06 - Access to Family Planning Information and Services

No person shall be denied information and access to family planning

services, whether natural or artificial: Provided, That minors will not be

allowed access to modern methods of family planning without written

consent from their parents or guardian/s except when the minor is

already a parent or has had a miscarriage.

Section 4.07 - Access of Minors to Family Planning Services

Any minor who consults at health care facilities shall be given age-

appropriate counseling on responsible parenthood and reproductive

health. Health care facilities shall dispense health products and perform

procedures for family planning: Provided, That in public health facilities,

any of the following conditions are met:

a) The minor presents written consent from a parent or guardian; or

b) The minor has had a previous pregnancy or is already a parent as proven

by any one of the following circumstances, among others:

• 1. Written documentation from a skilled health professional;

• 2. Documentation through ancillary examinations such as ultrasound;

• 3. Written manifestation from a guardian, local social welfare and

development officer, local government official or local health volunteer; or

• 4. Accompanied personally by a parent, grandparent, or guardian.

• Consent shall not be required in the case of abused or exploited minors,
where the parent or the person exercising parental authority is the
respondent, accused, or convicted perpetrator as certified by the proper
prosecutorial office or the court.

• Provided finally, That in case a minor satisfies any of the above

conditions but is still refused access to information and/or services, the
minor may direct complaints to the designated Reproductive Health
Officer (RHO) of the facility. Complaints shall be acted upon
immediately.
• In the absence of any parent or legal guardian, written consent shall
be obtained only for elective surgical procedures from the
grandparents, and in their default, the oldest brother or sister who is
at least 18 years of age or the relative who has the actual custody of
the child, or authorized representatives of children’s homes,
orphanages, and similar institutions duly accredited by the proper
government agency, among others. In no case shall consent be
required in emergency or serious cases as defined in RA 8344.
Responding to Unmet Needs and/or Gaps for Reproductive Health Care.

With assistance from the DOH, each province-, city-, or municipality-

wide health system shall carry out measures to reduce the unmet need

and/or gaps for reproductive health care

Family Planning
Refers to a program which enables couples and individuals to decide freely and
responsibly the number and spacing of their children and to have the information
and means to do so, and to have access to a full range of safe, affordable, effective,
non-abortifacient modern natural and artificial methods of planning pregnancy
(Congress of the Philippines, 2012). In the Philippines, responsible parenthood and
family planning are enacted and enforced by Republic Act 10354 or the Responsible
Parenthood and Reproductive Health Act of 2012 as a component of the law, 7.40
million women of reproductive age received modern family planning (MFP)
methods in both public and private facilities and clinics in 2018.
This number equates to about 2.60 million unintended pregnancies prevented, 1.60 million
probable abortions avoided, and 1,410 maternal deaths averted. Based from the FHSIS,
modern Contraceptive Prevalence Rate (CPR) increased from 53% to 57% in 2018. However,
this only represents service utilization in the public sector and does not reflect performance
from the private sector target in CPR under the Philippine Development Plan is 65% for married
women of reproductive age. However, while the number of Women of Reproductive Age (WRA)
reached already exceeded the estimated number of women with unmet need for modern
family planning, 230 million women of reproductive age have not yet been served and remains
to have unmet need for modern family planning. This statistic implies that 2.30 million women
of reproductive age were not provided with modern family planning and translates to 835,000
unintended pregnancies which could have been avoided, 492,000 possible abortions
prevented, and 440 maternal deaths that could have been averted.
Four Pillars of Family
Planning
1. Responsible Parenthood

The couple has the right to determine the number of children they want to have

provided they can support the needs and provide better life to their children

2. Child Spacing

A birth interval of 3 to 5 years is encouraged to prepare the mother's uterus for a

new pregnancy and more time for the couple and other children to establish a

strong relationship or bond

3. Respect for Life

Abortion is considered illegal based on Philippine Law and culture. It is mandated that
preservation of life of the fetus be observed regardless if the his or her condition. The
1987 Constitution protects the life of the unborn from the moment of conception

4. Informed Choice

The couple has the right to determine the kind of family planning method/s based on
their religious beliefs, culture, ethical values subject to conformity with the universally
recognized international human rights. It is the responsibility of the nurse to discuss
full details of pros and cons
 Benefits of Family
Planning
Appropriate family planning has several benefits not only to the mother,
but also to the children and the spouse. These benefits include the
following:
1. Benefits to the mother

• Enables to regain her health after delivery

• Prevents pregnancy-related health risks

• Gives enough time and opportunity to love and provide attention to

her husband and children

• Gives more time for her family and own personal advancement

• When suffering from illness, gives enough time for treatment and
recovery
2. Benefits to children

• Reduces infant mortality

• Healthy mothers produce healthy children

• Will get the attention, security, love and care they deserve

3. Benefits to the father

• Lightens the burden and responsibility in supporting his family

• Enables him to give his children their basic needs

Methods of Family Planning

It is important that family planning methods are widely available and easily
accessible through midwives and other trained health workers to anyone
who is sexually active, including adolescents. Clinicians, nurses, midwives,
community health workers, and other trained health workers are in the
position to promote family planning among sexually-active individuals by
promoting the use of culturally acceptable birth control or contraceptive
methods (WHO, 2018).
In most developing countries, like the Philippines,
several women of reproductive age who wishes to
avoid pregnancy do not use modern approaches
because of the following reasons:
(I) limited choice of methods

(2) limited access to contraception, particularly among young people, poorer

segments of populations, or unmarried people

(3) fear or experience of side-effects

(4) cultural or religious opposition

(5) poor quality of available services

(6) users and providers bias

(7) gender-based barriers

 Effectiveness: Effectiveness:
pregnancies per 100 pregnancies per 100
Method How it works
women per year with women per year as
consistent and correct use commonly used

Modern Method
Combined oral
  0.3
contraceptives (COCs) or 7
Prevents the release of eggs  
“the pill”
from the ovaries (ovulation)

Thickens cervical mucous to

Progestogen-only pills block sperm and egg from
0.3 7
(POPs) or "the minipill" meeting and prevents
ovulation

Thickens cervical mucous to

blocks sperm and egg from
Implants 0.1 0.1
meeting and prevents
ovulation
 Effectiveness:
Effectiveness:
pregnancies per 100
pregnancies per 100
Method How it works women per year with
women per year as
consistent and correct
commonly used
use

Thickens cervical
Progestogen only mucous to block sperm 0.2
4
injectable and egg from meeting  
and prevents ovulation

Monthly injectable or Prevents the release of

combined injectable eggs from the ovaries 0.05 3
contraceptives (CIC) (ovulation)
Combined
7 (for patch)
contraceptive patch Prevents the release of 0.3 (for patch)
 
and combined eggs from the ovaries  
7 (for contraceptive
contraceptive vaginal (ovulation) 0.3 (for vaginal ring)
vaginal ring)
ring (CVR)
 Effectiveness:
Effectiveness:
pregnancies per 100
pregnancies per 100
Method How it works women per year with
women per year as
consistent and correct
commonly used
use
Copper component
Intrauterine device
damages sperm and
(IUD): copper 0.6 0.8
prevents it from meeting
containing
the egg
Thickens cervical
Intrauterine device
mucous to block sperm 0.5 0.7
(IUD) levonorgestrel
and egg from meeting

Forms a barrier to
Male condoms prevent sperm and egg 2 13
from meeting

Forms a barrier to
5
Female condoms prevent sperm and egg 21
 
from meeting
 Effectiveness:
Effectiveness:
pregnancies per 100
pregnancies per 100
Method How it works women per year with
women per year as
consistent and correct
commonly used
use

Male sterilization Keeps sperm out of

0.1 0.15
(Vasectomy) ejaculated semen

Female sterilization Eggs are blocked from

0.5 0.5
(tubal ligation) meeting sperm

Prevents the release of

Lactational amenorrhea
eggs from the ovaries 0.9 (in six months) 2 (in six months)
method (LAM)
(ovulation)

Prevents pregnancy by
Standard Days Method avoiding unprotected
5 12
or SDM vaginal sex during most
fertile days.
 Effectiveness:
Effectiveness:
pregnancies per 100
pregnancies per 100
Method How it works women per year with
women per year as
consistent and correct
commonly used
use

Prevents pregnancy by
Basal Body Reliable effectiveness
avoiding unprotected
Temperature (BBT) rates are not available  
vaginal sex during fertile
Method  
days

Prevents pregnancy by
avoiding unprotected 4
Two Day Method 14
vaginal sex during most  
fertile days,

Prevents pregnancy by
Sympto-thermal avoiding unprotected
<1 2
Method vaginal sex during most
fertile
 Effectiveness:
Effectiveness:
pregnancies per 100
pregnancies per 100
Method How it works women per year with
women per year as
consistent and correct
commonly used
use

 
Natural Method
 
The couple prevents
 
pregnancy by avoiding Reliable effectiveness
Calendar method or 15
unprotected vaginal sex rates are not available
rhythm method
during the 1st and last
estimated fertile days, by
abstaining or using a
condom.

Tries to keep sperm out

Withdrawal (coitus 4
of the woman's body, 20
interruptus)  
preventing fertilization
Pre-Pregnancy services
Include provision of iron and folate supplementation, counselling and provision of
Family Planning (FP) methods, and prevention and management of infection and
lifestyle-related diseases. Commodities for these services are provided by both the
DOH and Local Government Units (LGUs).

Pre-pregnancy services highlight the provision of modern FP methods to reduce

unplanned pregnancies and unmet needs of women and adolescents that can expose
them to unnecessary risks from pregnancy and childbirth. Unplanned pregnancies
are also associated with poorer health outcomes for both mother and newborn
(Yazdkhasti, Pourreza, Pirak, & Abdi, 2015). Effective provision of FP services can
potentially reduce maternal mortality by around 44% (Ahmed, Li, Liu, & Tsui, 2012).
1. Micronutrient supplementation

2. Iron and Folate: 60 mg elemental iron with 400 micrograms folic acid tablet
daily for 3-6 months

3. Iodized oil capsule with 200 mg iodine I capsule for I year (women ages 15-45)

4. Promotion of the use of iodized salt

5. Nutrition counselling

6. Promotion of healthy lifestyle including advice relative to smoking cessation,

healthy diet, regular exercise and moderation alcohol intake (DOH, 2009)
1. Advice on family planning and provision of family planning services

2. Prevention and management of lifestyle related diseases like diabetes and

cardiovascular diseases

3. Counselling, prevention, and management of infection including Sexually

Transmitted Infections (STI) and HIV/AIDS

4. Adolescent health services

5. Deworming women of reproductive age to reduce other causes of iron

deficiency anemia

6. Provision of oral health services