UNIT : VI

Family Planning

Acknowledgment
Misbah Khan
( Lecturer, DION&M)

Year 3 ,Semester V

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 Objectives
At the end of this unit, learners will be able to:

1. Describe the consequences of population growth in Pakistan.

2. Identify Family Planning (FP) services available in Pakistan.

3. Identify social, economic, political and religious aspects of FP in Pakistan.

4. Discuss the responsibilities / role of a nurse for Family Planning.

5. Describe the indications, contraindications, advantages and side effects of

different contraceptive methods.

6. Discuss the importance and steps of counseling skills

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Family Planning
• Family planning is a way of thinking and living that it is adopted voluntarily,
upon the basis of knowledge, attitude and responsible decision by
individuals and couples in order to promote the health and welfare of
family group and thus contribute effectively to social development of a
country”( WHO, 1971)

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Family Planning
• Family planning allows people to attain their desired number
of children, if any, and to determine the spacing of their
pregnancies.
• It is achieved through use of contraceptive methods and the
treatment of infertility.

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Objectives of Family Planning
• Family planning refers to practice that help individuals or
couples to attain certain objectives( WHO 1971) given below:
i. To avoid unwanted births.
ii. To bring about wanted births.
iii. To regulate the intervals between pregnancies.
iv. To control the time at which birth occur in relation to the age of the
parents.
v. To determine the number of children in the family.

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 Consequences of Population Growth In
Pakistan
• Pakistan’s total population is 177.1 million, up from 173.5
million the previous year, according to the Pakistan Economic
Survey 2010-11. Pakistan ranks sixth among the world’s most
populous countries, with a population growth rate of 2.1
percent.

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 Consequences of Population Growth In
Pakistan
The major effects and explosion of population in Pakistan are:
– Low standard of living, in spite of five year plans.

– Shortage of food is one of the cause of malnutrition.

– Old persons have a work beyond the age of retirement.

– Young person work at the cost of education.

– Unemployment, housing and law and order problems.

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 Family Planning (FP) Services Available In
Pakistan
• Family planning services can help address these and other public health challenges by

providing education, counseling, and medical services . Family planning services

include the following:

– The proper spacing and limitation of birth.

– Education for parenthood.

– Screening for pathological condition related to the reproductive system.

– Genetic counseling.

– Premarital consultation and examination.

– Carrying out pregnancy test.

– The preparation of couples for arrival of first child.

– Teaching home economics and nutrition.

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 Role of Nurse in Family Planning
• The community health nurse can educate the family and the eligible couples on
advantages of a planned family.
• The role of nurses in family welfare program will include in:
 Administrative Role: nurses participate in the organization of family welfare
program at national, regional or community level and in development of nursing
activities within the framework of these programs.
 Supervisory Role :Community health nurse should encourage their staff to watch
carefully for indication that mother or couples would accept advice on how to space
their children and so on.
 Functional Role: finding eligible couples and making referral to adopt suitable
family planning method, and also help the client to choose one of the simple and
suitable method of contraception.
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Role of Nurse in Family Planning
 Educational Role : All nurse have an education role to fulfill with their
patient and the community.
 Role of Research: Nurse are essential members of multidisciplinary
research team and then nursing as a science or practice provides valuable
data upon which research may be based.
 Role of Evaluation : Evaluation is an important part of planning of
nursing services including those related to regulation of fertility and should
be build into the plan as it is being formulated.

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Contraceptive Method
• Contraception is defined as the intentional prevention of
conception through the use of various devices, sexual practices,
chemicals, drugs, or surgical procedures.
• The contraceptive method can be divided as :
– Temporary method(spacing )

– Permanent method (terminal)

Note: No single method of birth control is the “best” one. Each has its
own advantages and disadvantages. Abstinence is the only 100% effective
way to prevent pregnancy and STD’s

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 Methods of Family Planning

Natural Methods Modern Methods

LAM Terminal method

Abstinence Spacing method
SDM

Tubal Ligation Vasectomy

Hormonal
Non-Hormonal

Pills Implants Barrier IUCD

Injectable
Lactational Amenorrhea Method (LAM)
• For breastfeeding mothers
• Works primarily by preventing the release of eggs from the
ovaries (ovulation).
• No monthly bleeding since baby was born.
• You only breastfeed your baby, day and night. No other
food or liquids are given.
• Baby is less than 6 months old
Standard Days Method
• Natural method with no side- effects
 Keep track of the days of the menstrual cycle
 Day 8–19 of the cycle is considered to be the fertile days

• Prevent pregnancy using condoms or not having sex on days

women can get pregnant

• May require to use memory aids

Abstinence

• Abstinence prevents pregnancy by keeping sperm out of the

vagina.
• Continuous Abstinence is the only 100% effective in
preventing pregnancy.
• There are no side effects.

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 Barrier Contraceptives
• Methods that physically or chemically block sperm from
reaching an egg and provide a BARRIER between direct skin to
skin contact
• Act as a physical block between you and your sexual partner
• Physical
 Condoms (male and female)
 Diaphragm
• Chemical
 Spermicidal, creams,
 Vaginal tablets
Male Condoms
• Male condoms are 82 to 98 percent effective at preventing
pregnancy
• Condoms can only be used once
• Do not use oil-based lubricants such as massage oils, baby oil,
lotions, or petroleum jelly.They will weaken the condom, causing
it to tear or break.
• Water-based are the best – can prevent breaking of condom.
Female Condoms
• Female condoms are 79 to 95 percent effective

• Worn by the woman, this method keeps sperm from getting

into her body

• It can be inserted up to eight hours before sexual intercourse

(though not necessary)

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Vaginal Diaphragm
• It is barrier method placed between the vaginal fornix and the
pubic symphysis.
• It should be inserted immediately prior to intercourse and
should be remove no earlier than 6 hours later.

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Hormonal Methods
• NO hormonal methods reduce chances of STD’s!

• Methods that prevent the release of an egg (ovulation)

• Prevents a fertilized egg from implanting in the uterus (prevents

pregnancy).
Hormonal Methods

Mode of Action: Make the endometrium less

suitable for implantation.

Inhibit
Thicken cervical ovulation
mucus
 Combined Hormonal Contraception(CHC)

• CHC contains a combination of two hormones: a

synthetic estrogen and progesterone.
• CHC come in differently forms:
– Pills
– Transdermal patch
– Vaginal ring

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Combined Oral Contraceptives pills (COCP)

• Some contain estrogen, progestin, or mix of other hormones

depending on pill.

• The pill is 91 to 99 percent effective at preventing pregnancy.

• Prescribed by doctor

• COCPs should be taken on 1st day of the cycle, at roughly the

same time each day.

• A pill is taken at the same time each day (once a day for three

weeks, no pill fourth week -will get menstrual period)

Combined Oral Contraceptives pills (COCP)

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Combined Hormone Transdermal Patch

• The regimen is same as for COCP i.e.21 days of application

followed by 7 day hormone free interval.

• The patch is 91 to 99 percent effective at preventing pregnancy

• It releases hormones progestin and estrogen into the bloodstream

• You put on a new patch once a week for three weeks. During the

fourth week, you do not wear a patch, so you can have a

menstrual period
Combined Hormone Transdermal Patch

• Patch application sites:

– Any skin area- lower abdomen, buttocks, arms
• Site contraindication: Breast

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Combined Hormonal Vaginal Ring
• The birth control ring releases the hormones progestin and
estrogen
• It is worn in vagina for 21 days followed by 7 day hormone free
interval.
• It is 91 to 99 percent effective at preventing pregnancy
• Ring goes inside vagina up around your cervix
• You wear the ring for three weeks, take it out for the week you
have your period, and then put in a new ring
• This method does not protect you from HIV or other STDs.
Injectable Contraceptive
• Two types of injectable available :
• DMPA (Depo-Provera: 12 weeks)
• NET-EN (norigest : 8 weeks)
• Contains only progesterone hormones.
• Fertility might be delayed up to a year.
• Mechanism of action : inhibit ovulation
• Injection frequency : 12- 14 weeks
• Bleeding pattern : 50% amenorrhea rates at 1 year.
Injectable Contraceptive
• Highly effective
• Long term contraception
• Disadvantages are:
– Weight gain in first year
– Decrease bone mineral density (BMD)
– Delayed in return of fertility of around 6 months-1 year.

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Subdermal Implants

• It is progesterone containing rods and insert intra-dermally.

• It is inserted subdermal in the non dominant arm.

• Types :

• Nexplanon: single rod, contraception for 3 years

• Uniplant : single rod, contraception for 1 year

• Jedelle: two rods , contraception for 1 year

• Rapid return of Fertility on removal

• Most common side effect is a change in menstrual cycle .

Implants
• Implants work in two ways:
• Suppresses hormones responsible for ovulation
• Thickens cervical mucus to block sperm
• Disadvantages Are :
• Irregular or longer than usual periods could occur in the first 6
months
• Insertion and removal has to be done with a minor procedure
• No protection against sexually transmitted diseases
• Slight bruising or pain when first inserted into the arm; there is
a small risk of infection
Subdermal Implants

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 Intrauterine Device
• Intrauterine Device It is placed inside the uterus by a doctor.

• Small, flexible plastic "T" wrapped in copper wire placed in the

womb

• 99% effective at preventing pregnancy

• Copper IUD: Can stay for up to 10 years

• Interferes with sperm, fertilization, and prevents implantation

• Hormonal IUD: Can stay for up to 5 years

• It releases a small amount of hormone each day to keep you from getting

pregnant.
 Emergency Contraception
• Also known as the “morning after pill”and “postcoital contraception”
• It is used after intercourse has taken place and before implantation has
occurred.
• It has two main types:
• Hormonal emergency contraception
• Copper bearing IUDs ( inhibit implantation if fertilization has occured)

• Can be taken up to 3-5days AFTER unprotected sex (depending on brand)

• Effectiveness decreases after 24 hours
• Emergency contraception should only be used after no birth control was used
during sex, or if the birth control method failed, such as if a condom broke
Sterilization
• It is permanent method of contraception that is highly
effective .
• It is ideal for relatively older couples who are sure
that they have completed their families.
• It is of two types:
– Male sterilization : Vasectomy
– Female sterilization : Tubal ligation

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Sterilization
Vasectomy:
• Tubes that carry sperm are cut. This keeps sperm out of
semen.
• Simple surgery that must be performed by a trained doctor
• This operation is done to keep a man’s sperm from going to his
penis, so his ejaculate never has any sperm in it that can
fertilize an egg.
• Operation is more simple than tying a woman’s tubes
Tubectomy Tubal Ligation “Tying Tubes.”
• Permanent method for women and couples who

do not want more children

• A woman can have her fallopian tubes tied (or

closed) to stop eggs from being fertilized .

Family Planning Counseling
• Counseling is one of the most important components of family planning (FP).

• It is the responsibility of service providers at all levels to offer effective

counseling on FP methods
• FP counseling is the process of helping clients to make informed and
voluntary decisions about the choice of contraceptives.
• The role of family planning counseling is to support a woman and her
partner in choosing the method of family planning that best suits them and to
support them in solving any problems that may arise with the selected method
• Counseling focuses on the client's/patient's situation and needs.

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Counseling Skills

• GATHER is an acronym that will help you remember the 6

basic steps for family planning counseling.

 Greet the client respectfully.

 Ask them about their family planning needs.

 Tell them about different contraceptive options and methods.

 Help them to make decisions about choices of methods.

 Explain and demonstrate how to use the methods.

 Return/refer; schedule and carry out a return visit and follow up.
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1. Greet
• Welcome client.

• Register client

• Determine purpose of visit.

• Give clients full attention.

• Assure the client that all information discussed will

be confidential.
2. Ask
• Ask client about her/his needs.
• Assess what the client knows about family planning
methods.
• Ask the client if there is a particular method s/he is
interested in.
• Discuss any client concerns about risks vs. benefits of
modern methods
3. Tell
• Tell the client about the available methods.

• Focus on methods that most interest the client, but briefly

mention other available methods.
• Describe how each method works, the advantages,
benefits, possible side effects, and disadvantages.
• Answer client concerns and questions.
4. Help
• Help the client to choose a method.

• Repeat information if necessary..

• If there is any reason found on examination or while

taking a more detailed history that there are
precautions for the method, help the client choose
another method.
5. Explain
• Explain how to use the method (how, when, where).
• Explain to the client how and when s/he can/should
get resupplies of the method, if necessary.
6. Return
• At the follow-up or return visit ask the client if s/he is still using
the method.
• If the answer is yes, ask her/him if s/he is experiencing any
problems or side effects and answer her/his questions, solve any
problems, if possible.
• If the answer is no, ask why s/he stopped using the method and
counsel her/him to see if s/he would like to try another method
or re-try the same method again.
• Make sure s/he is using the method correctly (ask her/him how
s/he is using it).
References
• Basvanthappa.BT.,(2008).Community Health Nursing. Family
Planning.Jaypee.
• Gavin.L.,Moskosky.S.,(2014). Providing Quality Family
Planning Services. Center Of Disease Control.

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