Lecturer: Hamdi Hersi

Definition
A program to control the number and spacing of
children in a family through the practice of
contraception or other methods of birth control.
Family planning allows individuals and couples
to attain their desired number of children and
the spacing and timing of their births.
 Cont….
• WHO defines family planning as :
“A way of thinking and living that is adopted
voluntarily upon the basis of knowledge,
attitude and responsible decisions by
individuals and couples, in order to promote
the health and welfare of the family group and
thus contribute effectively to the social
development of a community”.
 Cont….
Family planning programs provide services that
help people achieve:
 The number of children they desire
 Reduce the number of unwanted pregnancies
 Reduce the risk of sexually transmitted infection
(especially condom),
 Improve the health of women and children by
spacing birth.
 Purpose of Family Planning
The purpose of Family Planning is to help
women and their partners protect themselves
from unwanted pregnancies and identify
conditions that may affect reproductive health,
such as sexually transmitted diseases and breast
Planning for a pregnancy ensures that the parent
or parents are best prepared mentally,
physically, and emotionally to care for a child.
 Importance of Family Planning
Maternal health refers to the health of women
during pregnancy, childbirth and after delivery.
While motherhood is often a positive and
fulfilling experience, for too many women it is
associated with suffering, ill-health and even
death. A woman's ability to space and limit her
pregnancies has a direct impact on her health and
well-being, as well as on the outcome of each
pregnancy.
Health Aspects of Family Planning
• The principal health outcomes given by WHO
are: Women’s Health: Maternal morbidity,
morbidity of women of child bearing age
group, nutritional status, preventable
complications of pregnancy and abortion.
• Fetal Health: Fetal mortality, abnormal
development Infant and Child health:
Neonatal, infant and preschool mortality,
health of infant at birth, vulnerability of
disease.
 Cont….
• Eligible couples An “eligible couple” refers to a currently
married couple where in the wife is in the reproductive
age, which is generally assumed to lie between the ages of
15 and 45 years. These couples are in need of family
planning services. On an average 2.5 million couples are
joining the reproductive group every year.
• Target couples are the couples who have two to three
living children, and family planning was largely directed to
such couples. The definition of target couples has been
gradually enlarged to include families with one child or
even newly married couples with a view to develop
acceptance of the idea of family planning from the earliest
possible stage.
 Family Planning methods
There are different methods of contraception
including:
1. Long-acting reversible contraception, such
as an implant, or an intra uterine device
2. Hormonal contraception such as
contraceptive pills –“the pill”,  the injection
and vaginal rings
 Cont…
3. Barriers : such as condoms and diaphragm.
5. Permanent Contraception: such as vasectomy
and tubal ligation.
6. Natural methods such as Breast feeding and
abstinence.
7. Emergency Contraceptive such levonorgestrel
or a copper IUD.
 Long-acting Reversible Contraception
Long-acting reversible contraception (LARC) is
a contraceptive that lasts for a long time. You
don’t need to remember it every day or even
every month.
There are two types of LARC :
• An intrauterine device (IUD) that lasts five or
more years
• An implant under the skin that lasts either
three Or five years.
 Hormonal Contraceptive
The Pill" is one of the most popular
contraceptive methods The Pill pire comes in
two forms:
• Combined oral contraceptive pill
• Progestogen only contraceptive pill.
 Cont….
Both are taken daily and are over 99% effective
at preventing pregnancy when taken
correctly. 
The Depo Provera injection and the
vaginal ring are other forms of hormonal
contraception. The injection lasts three months
and the vaginal ring is changed every month.
 Barrier Methods
Barrier methods stop sperm from entering the
vagina. There are three main barrier methods of
contraception:
• Male condoms
• Female condoms
• Diaphragms.
• Spermicide
 Permanent Contraceptive
Permanent contraception is sterilization that
permanently prevents pregnancy. The procedure
for men is a vasectomy and for women it is tubal
ligation.
 Natural Methods
Natural methods of birth control do not involve
medications or devices to prevent pregnancy
But rather rely on behavioral practices and/or
making observations about a woman’s body and
menstrual cycle.
 Natural Method
The commonly used Natural methods are:
1) Breast feeding
2) Abstinence
3) Withdrawal (Coitus interruptus)
4) Fertility awareness
 Emergency Contraceptive
• There are two options for emergency contraception:
the levonorgestrel or a copper IUD.
• ECP can be taken up to three days after unprotected
sex. If you are an average weight, the ECP is 98%
effective. If you weigh more than 70kg, the ECP is less
effective and a copper IUD is recommended. If you
weigh more than 70kg and you choose to take ECP.
• The copper IUD can be inserted up to five days after
unprotected sex, and is more than 99% effective at
preventing pregnancy.
 Steps in Family Planning Counseling

Counseling new clients about family planning

needs a step-by-step process. The process
includes learning, making choices, making
decisions and . It consists of six steps which can
be remembered with the acronyms GATHER.
 The GATHER Steps
G - Greet clients in an open, respectful manner. Assure
the client of confidentiality. Give as much time
listening.
A - Ask clients about themselves. Help client talk about
their family planning practices, intentions, concerns,
and wishes.
T - Tell clients about choices. Depending on the clients
need, tell the client what reproductive health choices
she/he might take. Focus on methods that interest
the client. Also explain other services that the client
may want.
 Cont….
H - Help clients make an informed choice. Help the client think
about the options. Encourage the client to express opinions and
ask questions. Consider medical eligibility criteria for the Family
planning method that interest the client. In the end, make sure
that the client has made Clear decision.
E - Explain fully how to use the chosen method: after a client
chooses a family planning method, give her or him the supplies if
appropriate. Encourage questions, and answer them openly and
fully. Check that the clients understand how to use their method.
R - Return visits should be welcome: Discuss and agree when the
client will return for follow up or more supplies if needed. Always
invite the client to return any time for any reason.
 Advantage of Family Planning
Reduced Risk of Pregnancy
 Family planning decreases the number of pregnancies
for teens and for people who can't afford to care for a
baby
Birth Control Health Benefits for Women and
Men
 the use of male and female condoms lowers the risk
of contracting sexually transmitted diseases.
Intervals Between Pregnancies
 Family planning makes it easier for couples to create
desired intervals between pregnancies.
 Disadvantage of Family Planning
The side effects of hormonal birth control may
stand out as a disadvantage for some women.
While many women regularly use contraception
without experiencing side effects, complications
can occur. The most common side effects
associated with hormonal contraception include
weight gain, headaches, dizziness and nausea. Less
common but more serious side effects include
stroke, blood clots and ectopic pregnancy.
HORMONAL CONTRACEPTIVE

Lecturer: Dr Jibril Mohamed

 Hormonal Contraceptive
• Hormonal contraceptives: all contain a small
amount of man-made estrogen and progestin
hormones. These hormones work to inhibit
the body's natural cyclical hormones to
prevent pregnancy.
 Hormonal Contraceptives in
current use
• Combination oral contraceptive pills:
containing a combination of
estrogen+progestins in varying amounts or in
phased regimens (monophasic, biphasic,
triphasic)
• Minipills (progestin only pills)
Containing progesterone preparation alone
• Postcoital (morning after)pills or emergency
contraceptive pills.
 Mechanism of action of OC pills
• Suppression of ovulation by
inhibiting the release of FSH
and LH (mainly estrogenic
effect)
• Disruption of proliferative and
secretory phases of
endometrium, reducing the
chances of implantation of ovum.
• Progestogenic effects increase
the viscocity of cervical mucus.
 Oral contraceptives
• Most popular and effective method with
99-
99.5 % success rate.
Estrogen Progestin Name

Ethinyl estradiol(30 µg) Norgestrel(300 µg) MALA D

Ethinyl estradiol(30 µg) Levonorgestrel(150 µg) OVRAL L

Ethinyl estradiol(30 µg) Desogestrel(150 µg) Desogen®
 Monophasic combination pills
• No phasic increase or decrease in the
estrogen/progestin content during 21 days of
pill administration.
• The first pill is taken on the 5th day after the
start
of menses.
• Thereafter, one pill is to be taken each
day consecutively for 21 days.
• Then , next 7 days are pill free period and
the next course starts again after the 5th day
of menses.
 Biphasic pills

• Fixed dose of estrogen for 21 days but with

increasing doses of progesterone during two
successive phases, i.e., from the day 1-10
and 11-21.

Estrogen Progesterone

Ethinyl estradiol (35 µg) Norethindrone (500 µg) From day 1-10

Ethinyl estradiol (35 µg) Norethindrone (1000 µg) From day 11-21.
 Triphasic pills

• Higher dose of estrogen near midcycle but

increasing doses of progesterone for three
successive phases i.e., for days 1-6, 7-11,
12- 21 days.

Ethinyl estradiol (30 µg) Norgestrel (50 µg) From day 1-6
Ethinyl estradiol (40 µg) Norgestrel (70 µg) From day 7-11
Ethinyl estradiol (30 µg) Norgestrel (125µg) From day 12-21
 OC pills
• Most branded preparations provide packet
of
21 tablets only.

• Others provide a packet of 21+7 extra

pills, which contain either lactose or some
iron preparation.
• If the woman misses one pill some day, she
should take 2 pills next day and continue
one pill a day as usual.
• If the pills have been missed for 2-3 days,
then the course should be stopped,
mechanical barriers like condoms, diaphragm
or jelly should be used and the next course
should start from 5th day of menses as usual.
 Side effects of OC pills
• Mild (no need to withdraw
OC)
Estrogenic effects Progestogenic effects
Nausea Increase in apetite
Migraine Weight gain
Breast tenderness Acne
Mild oedema Hirsutism (mild)
Withdrawal bleeding which Decrease in libido
at times fail to occur
Increase in
body
temperature
 Side effects of OC pills
• Moderate (may warrant discontinuation
of
Estrogenic
OC) Progestogenic
Vertigo Breakthrough
bleeding(spotting)
Leg cramps Monilial vaginitis(urethral
dilatation and bacteriuria)
Uterine cramps Amenorrhoea (even
after stopping OC)
Precipitation of diabetes
 Side effects of OC pills
• Severe(needs stoppage of
OC)
Estrogenic Progestogenic
Thromboembolism Myocardial infarction
Cholestatic jaundice Cerebrothrombosis
Gall stones
Hepatic adenoma
 Contraindications of OC pills(absolute)
• Thromboembolic, coronary and cerebrovascular
disease or a history of it.
• Moderate to severe hypertension;
hyperlipidemia.
• Active liver disease, hepatoma or
h/o jaundice
during past pregnancy.
• Suspected/overt malignancy of
genitals/breast.
• Impending major surgery- to avoid postoperative
thromboembolism.
Contraindications of OC pills(relative)
• Diabetes
• Obesity
• Smoking
• Undiagnosed vaginal bleeding
• Age above 35 years
• Migraine
 If pregnancy occurs during the use of
OC pills
• It should be terminated by suction-
evacuation,because there is risk of
• Malformations,
• Genital carcinoma of female
offspring
• Undescended testes in male
offspring
 Post coital contraception
• High dose estrogen and/or high dose
progestin.
• Two tablets of progestin levonorgestrel (750
µg each)[NORLEVO]. The first tablet must be
taken as soon as possible (within 48 hrs of
the coitus) and the second tablet taken after
12 hrs.
 Post coital contraception
• Ethinyl estradiol (50 µg each tablet) +
Levonorgestrel (250 µg each tablet)[OVRAL].
Two such tablets are to be taken within 72
hrs of unprotected coitus and next 2 tablets
after 12 hrs.
Post coital contraception
• Mifepristone (antiprogestine) 600 mg
single dose taken within 72 hrs of
unprotected intercourse.