1.

Definition
Immunization is a way to boost immunity someone is actively against an antigen, so when it
comes to it exposed to similar antigens, no disease. (Ranuh, 2008)
Immunization comes from the word immune, immune, resistant. Immunization
meanschildren are given immunity to a particular disease. Child immuneagainst a disease but not
immune to other diseases.(Notoatmodjo, 2003)
Immunization is an attempt to give immunity to infants andchildren by entering the vaccine
into the body. In order for the body to make substancesanti to stimulate the formation of anti-
inserted substances intobody by injection (eg BCG vaccine, DPT and measles) and by mouth (eg
polio vaccine). (Hidayat, 2008)
Immunization is a deliberate programinsert a weak antigen to stimulate the antibody out sothe
body can be resistant to certain diseases. The body's immune systemhas a memory system, when
the vaccine entersinto the body, then the antibodies will be formed to fight the vaccineand the
memory system will store it as aexperience. If the body will be exposed two or three times bythe
same antigen with the vaccine then the antibodies will be created morestronger than previously
experienced vaccines (Atikah, 2010, p.8).
Immunization is an attempt to generate oractively boosts a person's immunity against a
disease. (Atikah, 2010)
2. The purpose of immunization
The purpose of immunization is to prevent the occurrence of diseasecertain in a person and
eliminating certain diseases ona group of people (population) or even eliminate acertain diseases
of the world. (Ranuh, 2008)
The immunization program aims to reduce morbidityand death from diseases that can be
prevented by immunization. OnAt present, these diseases are diphtheria, tetanus, whooping
cough(pertussis), measles, polio and tuberculosis. (Notoatmodjo, 2003)
The immunization program aims to provide immunity toinfants to prevent the disease and
death of infants and children whocaused by an often contagious disease.
In general the purpose of immunization, among others: (Atikah, 2010, p5)
1. Through immunization, the body is not susceptible to infectious diseases
2. Immunization is very effective in preventing infectious diseases
3. Immunization decreases the number of mordibities and mortality in infants
3. Benefits of immunization
a. For children: preventing suffering caused by illness, andpossibility of disability or death.
b. For families: eliminating anxiety and psychological treatment when the child is sick. Encourage
family formation if parents convinced that his son would undergo a comfortable childhood.
c. For the country: improve the health level, create the nationstrong and sensible to continue the
country's development.
4. Types of immunization
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 Immunizations have been prepared in such a way as to not causeadverse effects. Immunization
there are 2 kinds, namely:
a. Immunization active
It is a gift of a disease that has been weakened(vaccine) so that the immune system will
respond specific andgive a memory to this antigen, so whenexposure to the body can recognize
and respond to it. Example; Active immunization is the immunization of polio and measles. In
immunization active, there are several elements of the vaccine, namely:
1. The vaccine can be an organism as a whole turned off, detoxified exotoxins only, or
endotoxins which are bound to carrier proteins such as polysaccharides, and vaccines can
also be derived from the extracts of organism components of an antigen. Basically the
antigen must bepart of the organism that is used as a vaccine.
2. Preservatives, stabilizers or antibiotics. It is a substance used to keep the vaccine in a weak
state or stabilize antigen and prevent microbial growth. Materials used such as mercury and
ordinary antibiotics used.
3. The solvent liquid may be either sterile water or also a liquid culture tissue used as a growing
medium antigen, for example egg antigens, serum proteins, and cell culture materials.
4. Adjuvant, consisting of a functioning aluminum saltincrease the immune system of the
antigen. When the antigen is exposed with antibodies of the body, the antigen can do
resistance as well,in this case the higher the resistance the higherincrease in body antibodies.
b. Passive immunization
Is a process of boosting immunityby way of giving immunoglobulin substances, ie
substances produced through a process of infection that can originate from human plasma (the
immunity a baby acquires from the mother through the placenta) or animals (can snake) used
to overcome the microbes already enter in the infected body. An example of passive
immunization isinjecting ATS (Anti Tetanus Serum) in a person who has experienced injury
accident. Another example is that of a new babyborn where the baby is receiving various types
of antibodies from mother through placenta blood during the gynecological period, for example
antibodies against measles.
5. Various kinds of basic immunization
1. Bacillus Celmette-Guerin Immunization (BCG)
a. Function
BCG immunization serves to prevent transmission Tuberculosis (TB) of tuberculosis
is caused by a group bacterium called Mycobacterium tuberculosis complex. On humans,
tuberculosis mainly attacks the respiratory system (pulmonary TB), although other organs
may also be stricken (spread or extrapulmonary tuberculosis). Mycobacterium tuberculosis
is usually transmitted through a person's cough. Someone usually gets infected if they are
suffered from lung pain and there was bacteria sustained. Condition a dark and humid
environment also supports the occurrenc transmission. Transmission of TB disease to a child
can occurs due to inhalation of airborne splashes containing bacteria tuberculosis. These
bacteria can attack various organs of the body, such as the lungs (most commonly), lymph
nodes, bones, joints, kidneys, liver, or membranes of the lining of the brain (the
heaviest).Primary infection occurs when a person contracts TB bacteria for the first time.
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 These bacteria are so small that they can be through the bronchial mucosilier defense system,
and on developing.
Complications on TB suffering, often occur inpatients with advanced stage. Here are
some complications that canexperienced:
1. Severe hemomtasis ( bleeding from the lower airway )can result in death from
hypofolemic shock orobstruction of the airway.
2. Lobes that do not work due to bronchial retraction.
3. Bronchiectasis (local bronchial dilation) and fibrosis (the formation of connective tissue)
in the process of recovery or retractionin the lungs.
4. Spontaneous pneumotorak (presence of air in the pleural cavity): spontaneous collapse
due to pulmonary tissue damage.
5. The spread of infection to other organs such as brain, bone, joints, kidney and so on.
6. Cardio pulmonary insufficiency.
BCG immunization does not prevent TB infection but reduces the risk of severe TB such
as TB meningitisor billion TB. Factors that affect the effectiveness of BCGto TB is BCG
vaccine difference, environment, factorgenetic, nutritional status and other factors such
as exposure to ultraviolet light against the vaccine.
b. How to administer and dose
BCG vaccine is a bacillus tuberculosis bacteriumhas been attenuated. How to
administer it by injection. Before injected, BCG vaccine should be dissolved first. Dose
0.05cc for infants and 0.1 cc for children and adults. Immunization BCG is performed in
infants aged 0-2 months, but usually given to infants aged 2 or 3 months. Can be given to
children and adults if already through tuberculin test with results negative.
BCG immunization is injected intracutaneously in the arm regiontop right. Injected
into the skin layer with absorption slowly. In giving intracutan injection, in order todone
exactly, must use a short need levery smooth (10 mm, size 26). Cooperation between mother
with the immunization officer is expected, in order for the vaccine to run appropriately.
c. Contra indication
BCG immunization should not be given under the following conditions:
1. A child suffering from a severe or chronic skin disease, such as eczema, furunculosis, and
so on.
2. Immunization should not be given to a person or childis suffering from tuberculosis.
d. Side effects
After being given BCG immunization, the reactions that arise are notas in immunization
with other vaccines. BCG immunization is not causing a fever. After 1-2 weeks of
immunization, willinduration and redness occur at the injection site changes became a
pastula, then broke into a wound. Injuries are not necessary special treatment, because this
wound will heal by it self spontaneously. Sometimes regional enlargement of the glands
occurs or neck. Enlargement of this gland feels solid, how ever not cause fever.
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2. Immunization of DPT (Diphtheria, Pertussis, and Tetanus)
a. Function
DPT immunization aims to prevent 3 diseasesat once, namely diphtheria, pertussis,
tetanus. Diphtheria is a disease which is caused by Coryne bacterium diphtheria bacteria.
Diphtheri amalignant, infectious and particularly attacking channel supper breath.
Transmission can be due to direct contact with the patient through sneezing or coughing or
indirect contact because of the food contaminated with diphtheria bacteria. Patients will
experience some symptoms such as more feverless 380 C, nausea, vomiting, painful
swallowing and presencegrayish white pseudomembranes in the pharynx, larynx and tonsils,
noeasy to get off and easy to bleed, neck swell like neck cattle are caused due to swollen
neck glands and tightnessbreath accompanied by sound (stridor). On examination of swabs
of the throator the nose is a diphtheria germ. In the next infection process, Diphtheria
bacteria will spread the toxins into the body, sothe patient may experience low blood
pressure, resulting in an effectlong-term cardiomyopathy and peripheral myopathy will
occur. Cutaneus from diphtheria bacteria causes secondary infection inskin of the patient.
Diphtheria is caused by bacteria found in the mouth, throat and nose. Diphtheria causes
the membranes to growaround the inside of the throat. Such membranes maycausing trouble
swallowing, breathing, and even can resulting in suffocation. Bacteria produce toxins that
canspread throughout the body and cause various complicationsweight such as paralysis and
heart failure. About 10 percent diphtheria sufferers will die from this disease. Diphtheria
can transmitted through coughing and sneezing of people affected by this disease.
Pertussis, is a disease caused by germ Bordetella Perussis. These germs secrete the toxin
causing the threshold of coughing stimuli to be low so when there is little stimulation of a
great cough and For a long time, a cough will occur and at the end of the cough breathe long
sounds typical "hup" (whoop), usually accompanied gag. Coughing can reach 1-3 months,
there fore pertussis also called "cough hundred days". Transmission of this disease can
through droplet sufferer. In the early stages are called the cataral stage lasting 1-2 weeks,
the symptoms are unclear.Patients show symptoms of fever, runny nose, a longer cough
harder. At the next stage is called paroxysmal stage, new symptoms arise typical of the old
cough or great, preceded with a deep breath accompanied by the sound "Whoops".
StadiumThis paroxismal lasts 4-8 weeks. In non-typical cough babies, "Whoops" are absent
but often accompanied by a cessation of breath so the baby becomes blue (Muamalah, 2006).
Tetanus is a disease caused by infection Clostridium tetani germs. This germ is
anaerobic, socan live in an environment with no acid (oxygen). Tetanus can attack babies,
children and even adults. In infants the transmission is caused by cutting the rope withouta
sterile tool or in the traditional way in which the cutting toolssprinkled with traditional
ingredients contaminated with germ sporestetanus. In children or adults can get infected
because ofdirty wounds or contaminated wounds of tetanus bacteria spores, these germs are
most prevalent in spore-shaped horse intestineswhich is widespread on the ground.
Tetanus is caused by bacteria that are in the soil, dustand animal feces. These bacteria
can enter the body through the wound as small as a needle puncture. Tetanus can not be
transmitted from one personto others. Tetanus is a disease that attacks the systemnerves and
often cause death. Tetanus causes Muscle spasms are initially felt in the muscles of the neck
and jaw. Tetanus can cause difficulty breathing, convulsions that hurt, and an abnormal
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 heartbeat. Becauseeffective immunization, tetanus disease is now rarely found in Australia,
but the disease still occurs in adult shave not been immunized against the disease or have
not been injected (injected with booster dose vaccine).
b. How to administer and dose
How to give DPT immunization is through injection intramuscularly. Injection given to
the outer middle thigh orsubcutaneously in a dose of 0.5 cc.
How to give this vaccine, as follows:
1. Put the baby in a sloping position on the lap of the mother with all bare feet
2. Parents should hold the baby's feet
3. Hold your thigh with your thumb and index finger
4. Insert the needle with a 90 degree angle
5. Press the entire needle directly down through the skin so that it isinto the muscle. To
reduce pain, inject slowly.
DPT vaccine is administered three times from infant age2 months to 11 months with 4
weeks interval. This immunizationgiven 3 times due to the first administration of antibodies
in the bodystill very low, the second gradually began to rise and the third is obtained
sufficient antibodies. Protection of vaccinesdiphtheria is good enough at 80-90 %, vaccine
protection power tetanus 90-95 % but the power of protection pertussis vaccine stilllow ie
50-60 %, there fore, children still areis likely to be infected with a hundred days cough or
pertussis, but lighter.
c. Side effects
DPT immunization provides mild side effects and severe, mild effects such as swelling
and pain onplace of injections and fever, while the effect of infant weight crying great
because of pain for about four hours, decreased consciousness, seizures, encephalopathy,
and shock.
3. Immunization of measles
a. Function
Measles immunization is intended to provide immunityactive against measles. Measles,
measles or rublesis an acute viral disease caused by measles virus. The disease is highly
infectious, infectious from the beginning of the prodromal period until approximately 4 days
after the appearance of the rash. Infectionair borne.
Measles virus is transmitted through droplet infection throug hair, attaches and breeds on
the massive epithelial. Three days after inflation, replication and colonization continues on
the glans regional lymph nodes and the first occurrence of vitemia. Virus spreadin all
reticuloendothelial system and following second viremia after 5-7 days of initial infection.
The existence of giant cells and processes inflammati on is the pathological basis of rash
and infiltrateslung peribronchial. There are also udema, dams and bleeding which is spread
over the brain. Colonization and spread on the epithelium and skin causes cough, runny
nose, red eyes (3C = coryza, coughand conjuctivitis) and an increasingly high fever.

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 b. Clinical symptoms
1. Heat increases and peaks on 4-5 days,at rash ou
2. Coryza is difficult to distinguish from common cold weight. It improves quickly when
the heat falls.
3. Conjunctivitis is characterized by red eyes on conjunctiva accompanied by inflammation
accompanied by a photo phobic complaint.
4. Cough is a result of inflammation of the respiratory epithelium, peak at the time of
eruption and disappear after several weeks.
5. The appearance of clothed spots (koplik's spot) is generally around 2 days before the onset
of rash (day 3-4) and fastdisappears after a few hours or days. Koplik's spot isa set of
white nodes on the red buccal epithelial region, is a pathognomonic clinical sign for
measles.
6. The original maculopapular rash is reddish. This rashappears first on the area of the hair
and forehead, as well as behind the ears, spreads in the direction of the periphery to the
feet. Rashes are generally embroidered so on the face and chest become confluent. This
rash distinguishes it from the rubella rash discreta and no desquamation. Palm and feet
do not experience desquamation.
c. How to administer and dose
Giving measles vaccine is given only once, can performed at the age of 9-11 months,
with a dose of 0.5 CC. Before injected, measles vaccine first dissolved with solvent sterile
that has been available which is 5 ml of dilution of the solvent fluid. Then injections given
to the upper left arm subcutaneously.
d. Side effects
Up to 15% of patients may experience mild fever and rednessfor 3 days which can occur
8-12 days after vaccination.
e. Contraindications
Immunization should not be given to people whoex periencing an immunodeficiency or
an individual suspected of suffering impaired immune response due to leukemia, and
lymphoma.
4. Polio immunization
a. Function
Is an immunization that aims to prevent disease poliomyelitis. Provision of polio vaccine
can be combined with DPT vaccine. There are two kinds of polio vaccine:
1. Inactivated Polio Vaccine (IPV = Vaccine Salk), containsa polio virus that has been
switched off and administered by injection.
2. Oral Polio Vaccine (OPV = Sabin Vaccine), contains vaccines life that has been
attenuated and given in pill form orfluid.
b. How to administer and dose
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 Basic immunization of polio is given 4 times (polio I, II, III and IV) at intervals of not
less than 4 weeks. Repeat immunization given 1 year after IV polio immunization, then at
the moment enter primary school (5-6 years) and at the time of leaving primary school (12
years). In Indonesia generally given Sabin vaccine. This vaccine is givenas much as 2 drops
(0.1 ml) directly to child's mouth or with orusing a spoon containing sugar water.
c. Side effects
In general there are no side effects. Side effects include paralysis caused by vaccine is rare.
d. Contra indication
Polio immunization should not be done on a person who suffer from immune deficiency.
There are no harmful effectsarise from polio in sick children. However, if there is any doubt,
for example is suffering from diarrhea, then dose can be given after recovery.
5. Hepatitis B immunization
a. Function
Hepatitis B immunization, intended to give the body acquainted with hepatitis B disease,
caused by a virush as affected the liver organ. This virus will stay forever in the body. Infants
infected with hepatitis virus risk of liver cancer or liver damage. Hepatitis virus B is found
in the body fluid of an infected person includin gblood, saliva and semen.
b. transmission
Hepatitis B virus is usually spread by contact with body fluids (blood, saliva, semen)
sufferers of this disease, or from mother to child during child birth.

c. Symptoms
Flu-like symptoms, namely loss of appetite, nausea, vomiting, tastetired, yellow eyes and
vomiting and fever, urine becomes yellow and abdominal pain.
d. How to administer and dose
Immunization is given three times at the age of 0-11 months through intramuscular
injection. The vaccine content is HBsAg inliquid form. There is a Prefill Injection Device
(B-PID) vaccine given shortly after birth, may be given at the age of 0-7 days.The B-PID
vaccine is injected with 1 HB PID.
e. Side effects
Local reactions such as pain, red ness and swelling aroundinjection site. The reaction is
mild and usually lost after 2 days.
7. Weakness
1. Not guaranteed to work or provide 100% protection
2. Possible side effects
3. Cost to the NHS to the individual

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 4. Can be unpleasant or painful
5. Booster injection can be inconvenient
8. Procedure immunization
a. Interview Patient.
The patient should bring the records mentioned above. Perform the following steps as part
of the immunization procedures.

1. Refer to the Immunization Record or Certificate to determine what immunizations are

needed. (This could include a physician’s order or a requirement to go overseas.)

2. Determine whether known allergies exist. A history of reactions to previous immunizations

is of great importance to alert you to possible reactions and allow you to take precautions as
necessary. Allergies to eggs or fowl are important when immunization agents prepared in
eggs are used, such as influenza or yellow fever.

3. Determine whether the patient is pregnant, if appropriate. Follow local policy concerning
questioning women as to whether they are pregnant or suspect they may be pregnant.

(a) Tact and discretion must be used to avoid unnecessary embarrassment.

(b) Determining pregnancy is important because of the possible effect of certain immunizing
agents on the unborn child.

(c) Most immunizing clinics will not administer an immunizing agent to a pregnant woman
without written authorization from her obstetrician.

b. Have Emergency Tray Available.

An emergency tray should be present and readily accessible. An emergency tray contains
materials for immediate treatment of serious reactions, including a constricting band and
syringe containing a 1:1000 aqueous solution of epinephrine. A tracheostomy set should be
available since the majority of fatalities reported involve asphyxiation due to laryngeal edema
or swelling.

c. Perform Handwash.
Perform patient care handwash.

d. Obtain Immunizing Agent.

Vaccines are kept in a refrigerator or other designated storage area. The proper storage
temperature of different vaccines is found on their labels and must be adhered to in order to
keep them safe for administration. Some vaccines contain live organisms and must remain
frozen.

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 Since a considerable amount of variation exists between storage temperatures and potency
periods for these vaccines, it is essential to review the instructions on the labels for each vaccine.
Check the clinic SOP regarding proper storage of preconstituted and reconstituted vaccines. All
other equipment for administering immunizations will be available in a specific location within
the clinic.

e. Check Label for Expiration Date.

(1) The labels of all immunizing agents have an expiration date. The expiration date is the last
date the vaccine may be used.

(2) Vaccines or other immunizing agents must not be used after the date of expiration. Expired
agents must be disposed of in accordance with local policy.

(3) If vaccine is outdated, obtain new vaccine and discard or return outdated vaccine IAW local
policy.

f. Examine Vial and Contents.

(1) Check the agent for unnecessary or unusual particles, clotting, discoloration, evidence of
bacterial growth, or abnormal appearance.

(2) Do not use the agent if anything unusual is observed.

(3) Consult your supervisor or the pharmacy if you find any evidence of the above mentioned
problems with the vaccine.

g. Draw Up Required Amount of Immunizing Agent.

(1) To determine the amount of immunizing agent required, refer to AR 40-562, check the local
clinic SOP, check the supervisor’s directive, or check the doctor’s orders.

(2) If directed to draw the vaccine, have the supervisor check the dosage prior to administration.

(3) Use a different sterile needle and syringe for each individual.

h. Select Site Administration.

Determine appropriate site and route for administration.

i. Expose and Prepare Injection Site.

(1) Ask the patient or assist the patient to remove outer garments to allow complete visualization
of the selected site for injection. The deltoid area may have to be further exposed by pushing
the sleeve of the T-shirt up and over the deltoid area.

(2) Prepare the site by the use of a suitable cleaning agent (either acetone, Betadine, or alcohol)
and allow to dry thoroughly.
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j. Administer Immunization.
(1) Whenever immunizations are given, a military or civilian member of the medical
department/service will be present who is trained and qualified in emergency resuscitative
technique in accordance with local SOP. See AR 40-562 for specific requirements.

(2) As indicated earlier, immunizations can also be administered by jet injection, commonly
referred to as “by injection gun.” Advantages include facilitating mass immunization
procedures, reducing hazards of transmitting serum hepatitis, reducing requirements for
large numbers of sterilized needles and syringes, and eliminating many hours expended in
the care and processing of reusable syringes and needles and preparing individual dosage
from vaccine vials.

k. Observe Patient. Observe for reactions.

(1) The period for observation may be determined by local SOP–usually 30 minutes. The patient
should not leave the inoculation area for at least 10 minutes and should not be more than
five minutes transportation time away from area during the first 30 minutes.

(2) Any dangerous, allergic reaction to any biologic agent or drug, the date, type, and severity
of reaction will be recorded on the patient’s appropriate immunization certificates or
records. A medical warning tag should also be made.

(3) Urticaria (hives) and pruritis (itching) are common reactions. Allergic reactions vary in
nature, severity, and time of onset. Hives and itching are the most common, occurring
approximately 20 minutes after inoculation. Some vaccines after several hours to a day
may produce general systemic reactions consisting of fever, malaise (general aches and
pains), chills, and gastrointestinal upsets as well as a local reaction or swelling, redness,
and tenderness at the site of injection. This type of reaction is not usually severe unless
accompanied by other life-threatening symptoms.

(4) Observe the patient for progressive signs and symptoms of anaphylactic shock. Immediately
treat for anaphylactic shock if signs and symptoms indicate shock.

(a) Anaphylactic shock is an immediate emergency demanding emergency intervention to

prevent a patient’s death.

(b) Anaphylactic shock is a life-threatening allergic reaction following exposure to a

substance to which the patient is allergic. Death may occur within minutes to several
hours due to respiratory failure brought on by edema or constriction of the larynx
and/or spasms of the bronchus, vascular collapse, and circulatory failure, leading to
coma and death.

(5) Observe for undesirable reactions. Whenever local or constitutional reactions of unexpected
severity or frequency, local infections, abscess formation that is not traceable to errors in
techniques of administration, or other significant manifestations occur which may be due
to the use of a biologic product, further administration of the lot will be discontinued. Refer
to your immediate supervisor.
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l. Dispose of Equipment.
Dispose of the needle and syringe in accordance with local SOP. Most areas where
immunizations are administered have special plastic or cardboard devices for storing used
needles and syringes. Place used needle and syringe intact into the designated container.

m. Dispose of or Store Vial.

(1) Dispose of the vaccination vials in accordance with the clinic’s SOP. Containers of all living
vaccines should be handled as infectious wastes. When these items are discarded, they
should be burned, boiled, or autoclaved.

(2) Store unused vaccine in accordance with the manufacturer’s instructions, clinic SOP, or
regulations such as AR 40-562 or TB MED 114. If the vial contains more than one dose,
mark the date and time opened and your initials on the label and place in refrigeration.

n. Perform a Patient Care Handwash.

As always, perform a patient care handwash after treating a patient.

o. Record Immunization.
(1) Record the date, dose, and immunization on the patient’s Public Health Service Form 731.
Recording of this information should be done in accordance with AR 40-562.

(2) Record the date, dose, and immunization on the SF 601 in the patient’s health record in
accordance with AR 40-403.

(3) Some vaccinations may require that the patient return and be evaluated by personnel in the
clinic. Such a test is the tuberculosis skin hypersensitivity test (tine test). The results of the
test should be recorded in the patient’s health record but there are no results listed on the
“shot record,” only that the patient received the vaccination.

(4) It is important to remember that entries for yellow fever must be authenticated on the PHS
Form 731 by the Department of the Defense immunization stamp and the actual signature
of the physician or his designated representative. Immunizations other than yellow fever
may be authenticated by initialing.

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 Family Planning Tubectomy
Definition of tubectomy
Tubectomy is an act of cutting or closing the fallopian tubes so that they break the pathways of the
ovum and sperm. Steady contraception (contraception) is an action to limit the offspring in an
unlimited period of time to one of the married couples at the request of the concerned, in a steady and
voluntary manner.
Description of tubectomy
 Everytime during the menstrual cycle if it is believed rationally that the client is not pregnant.
 Day 6 to 13 of the menstrual cycle (proliferation phase).
 Postpartum; Minilapia within 2 days or up to 6 weeks or 12 weeks, laparoscopy is not
appropriate for postpartum clients.
 Post-miscarriage; First quarter (minilap or laparoscopic), second quarter (minilap only).
Function of tubectomy
 To delay pregnancy for couples of childbearing age
 To space pregnancy for couples of childbearing age
 To stop/end pregnancy or fertility
Strength of tubectomy
 Protection of pregnancy is very high
 Does not affect generative libido

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  No Need for a Couple's Life
 Does not affect breast milk
 Safer because the failure rate is very small
 More effective
 There are no changes in generative functions
 There are no long-term side effects
Weakness of tubectomy
 This contraceptive method cannot be restored because it is permanent
 Fertility does not occur
 No subsequent pregnancy will occur So women can regret it
 Short-term pain after medical treatment
 An infection occurs if the surgical procedure is not performed properly
Vasectomic contraception tools
Vasectomy is a mild surgical procedure by binding and cutting sperm channels so that sperm cannot
pass and semen does not contain spermatozoa, thus fertilization does not occur, the operation takes
approximately 15 minutes and the patient does not need to be treated. Operations can be carried out
at the Puskesmas, health services with facilities for surgeons, government and the private sector, and
because vasectomy is cheap and light so it can be done in the field.
Function
1. Controlling the Birth of a Child
2. Treatment of surgery is not difficult
3. Safe to do
4. Opportunities to have children 0 percent
5. Does not affect contraception
6. Does not affect the quality of sexual relations

Advantages
1. Simple small operation techniques can be done at any time.
2. The complications encountered are few and mild
3. Cheap and affordable costs for the community
4. Vasectomy will experience climax in a natural setting
5. Good for men who do not want to have children.
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 6. Vasectomy is cheaper and has fewer complications from tubular sterilization.
7. Men have the opportunity to change contraception with his wife.
8. Does not affect a person's ability to enjoy sexual relations.
Weaknesses
1. Still an operation, the man is still afraid.
2. Some men fear a vasectomy will affect sexual ability or cause erectile problems.
3. There is a little pain and discomfort a few days after surgery, this pain can usually be
relieved by the consumption of soft drugs.
4. Often have to do with an ice pack for 4 hours to reduce swelling, bleeding and discomfort
and must wear pants that can support the scrotum for 2 days.
5. Patients are asked to use a condom first to clean the tube from the remaining sperm. To find
out which are sterile or not, microscopic examination is usually done 20-30 times after
ejaculation.
6. Vasectomy does not provide protection against sexually transmitted infections including
HIV.

Contraceptive Pill
Birth control pills or oral contraceptives pill is a hormonal contraceptive in the form of a drug in the
form of a pill that is taken by mouth (taken by mouth), and contains the hormones estrogen and or
progesterone. Pill or oral contraceptives pill aims to control birth or prevent pregnancy by inhibiting
the release of eggs from the ovary every month. Birth control pills or oral contraceptives pills will be
effective and safe, if used correctly and consistently. Pill or oral contraceptives pill in general do not
fully protect women from sexually transmitted infections. There are several types of birth control pills,
including mini pills (minipil), combination pills or combination oral contraceptive pills or progestin
pills, sequential pills, once a month Pill, and morning after pill.
FUNCTION
• Prevent the ovaries from releasing the egg so that the fertilization process does not occur
• Change the thinckness of the cervical mucus to make it difficult for sperm to move into the
depths of the uterus so that it is not possible for the egg cells in the fruit to be embedded in
the uterus.
Strenght
a. easy to use
b. reduce pain during menstruation
c. prevent anemia
d. reduce the possibility of pelvic infection
e. suitable for delaying the first pregnancy in young EFA

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f. Reversible
Weaknessa
a. requires high discipline
b. reducing the production of breast milk
c. increases the risk of chlamydial and fungal infections
d. increase blood pressure and weight
e. return of slow fertility

CONTRACEPTIVE INJECTION
Injection contraception is a way to prevent pregnancy by hormonal injections. This type of injection
contraception hormonal contraception in Indonesia is increasingly used because of its effective work,
practical use, relatively cheap and safe price. Before being injected, maternal health must be examined
first to ensure compatibility. Injections are given when the mother is not pregnant. Generally, users of
family planning injections have the same requirements as pill users, as well as people who should not
use KB injections, including the use of hormonal contraceptives for a maximum of 5 years.
Function Contraceptive Injection
The function of injection contraception is to prevent pregnancy. The hormone progesterone contained
in injection contraception can prevent the release of eggs cells released by a woman's body and
stopping egg cells production. Without the release of an egg cells, a woman will not be able to get
pregnant.
Strenght of Contraceptive Injection
Advantages when using 3-month contraceptive injection:
a. Very effective
b. Prevention of long-term pregnancy
c. Does not affect sexual relations
d. Does not contain estrogen so it does not have a serious impact on heart disease, and blood clotting
disorders
e. Has no influence on breast milk (ASI)
f. A few side effects
g. Clients do not need to store injection drugs
h. Can be used by women over the age of 35 to perimenopause
i. Helps prevent endometrial cancer and ectopic pregnancy
j. Reducing the incidence of benign breast disease
k. Prevent some causes of pelvic inflammatory disease

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l. Reducing the crisis of crescent anemia
Weakness of Contraceptive Injection
a. Menstrual disorders are often found
1. The menstrual cycle is shortened or elongated
2. Low or little bleeding
3. Irregular bleeding or spotting bleeding
4. No menstruation at all
b. Clients are very dependent on health service facilities
c. Cannot be stopped at any time before the next injection
d. Weight problems are the most common side effects
e. Does not guarantee protection against transmission of sexually transmitted infections, hepatitis B,
or infection with the HIV virus
f. Delay in fertility after termination of use
g. Delay in fertility is not due to damage or abnormalities in the genital organs, but because there has
not been an end to the release of injection drugs from the front.
IUD
Definition of an IUD is one of the modern contraceptives that has been designed in such a way (both
the shape, size, material, and active period of its contraceptive function), placed in the uterine cavity
as an attempt at contraception, blocking fertilization, and making it difficult for eggs to implement in
the uterus
Advantage
* According to Saifudin (2010), the advantage of an IUD is:
* As a contraception, the effectiveness is high. Very effective → 0.6 - 0.8 pregnancies / 100
women in the first 1 year (1 failure in 125 - 170 pregnancies).
* The IUD can be effective immediately after installation.
* Long-term method (10 years of protection from CuT-380A and no need to be replaced).
* Very effective because you no longer need to remember e. Does not affect sexual relations.
* Increase sexual comfort because you don't need to be afraid to get pregnant.
* There are no hormonal side effects with Cu IUD (CuT-380).
Loss
* According to Saifudin (2010), IUD losses:
* Possible side effects:
* Change in menstrual cycle (common in the first 3 months and will decrease after 3 months).
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 * Menstruation is longer and more.
* Spotting between menstruation.
* Menstruation is more painful.
* Work mechanism
* The mechanism of the IUD's work up to now has not been known with certainty, some argue
that the IUD is a foreign body that causes local inflammatory reactions, as leukocytes that can
dissolve blastocysts or germ. The mechanism of action of the IUD which is wrapped around
copper wire may be different. Small concentrations of copper released into the uterine cavity
also inhibit the efficacy of carbon hydrase and alkaline phosphatase. The IUD that secretes
hormones also thickens the lenders thereby blocking the passage of sperm
CONDOM MALE
A male condom is a thin sheath placed over the erect penis. When left in place during sexual
intercourse, oral sex or anal sex, male condoms are an effective way to protect yourself and your
partner from sexually transmitted infections (STIs). Male condoms are also an effective way to
prevent pregnancy.
Function
 Make sure to use a new condom in each sexual relationship
 Make sure the penis has an erection and then place the condom at the tip of the penis while
pressing the tip.
 Immediately after ejaculation, hold the base of the condom when removing the penis and
while still erect
 Remove the condom and immediately dispose of it.
Strenght
 Condoms do not reduce the risk of decreasing human papilloma virus (HPV) or
Trichomonas vaginalis
 Syphilis transmission decreases to 29%, and the reduction rate can reach 50-71%
 Transmission of Gonorrhea and Chlamydia decreases by almost 50%
 Transmission of Genital Herpes is reduced by about 40%
 HIV transmission decreases by almost 85%
Weakness

 A male condom can sometimes slip off or split.

 Some people are sensitive to latex condoms, though this is rare.
 When using a male condom, the man has to pull out after he has ejaculated, and before the
penis goes soft, holding the condom firmly in place.

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 FEMALE CONDOM
A female condom is a device that is used during sexual intercourse as a barrier contraceptive to reduce
the risk of sexually transmitted infection (such as gonorhea, syphilis and HIV, trough its protection
against them is inferior to that by male condoms) and unintended pregnancy. Female condoms can be
used by the receptive partner during anal sex.
FUNCTION
Condoms are one of the contraceptives. Contraception has a general function to prevent
pregnancy in order to plan the right time to have children and the right number of children in a family.
At the present time condoms are also often used to prevent the occurrence of sexually transmitted
infections, especially in commercial sex workers and people with a free sex lifestyle that are very
risky.
As a condom contraceptive, it is considered to be quite effective, with good use of female
condoms that have a probability of failure of around 5%, on average the use of the probability of
failure is around 21%. Female condom failure can be caused by the following: The condom is torn,
either because of the installation process (exposed to the nail) or damaged by an inappropriate
lubricant, or because of intimate relationships; The condom does not open before the penis touches
the vagina; Spilled ejaculate into the vagina during the process of removing the condom.
Weakness of female condom
The disadvantage of a female condom is that effectiveness can be reduce if the installation
are not good, condoms are clearly visible during intercourse, the is no direct touch to the genitals and
friction in the condom can reduce clitoral stimulation so that intimate relationships become less
satisfying.
1. More expensive 4-5 times more than male condoms.
2. The outer ring of a female condom is considered more complicated.
3. Inappropriate use of female condoms can increase the risk of failure by 21 %
4. A little noiser or disturbance during intercourse.
STRENGTH
 If the use is right, it can prevent pregnancy.
 Will not interfere with the health of users and couples.
 Will not interfere with breast milk production so it is safe for those of you who are
breastfeeding.
 No need for a special examination before using it or checking a doctor.
 Excess condom non-contraception.
 Prevent transmission of the virus.
 Encourage husband to have family planning.
 Prevent premature ejaculation.
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  Prevent immune-inferioryty.
 If you don’t need it, you just don’t use it
IMPLANTS
Implant KB, is a small, flexible plastic tube the size of a match, which contains hormones to
prevent pregnancy. This tube (which is often called a implant) will be inserted (or
implanted) into the skin of the upper arm. With the correct use, once a family planning
implant can prevent pregnancy for three years. Types of implants :
1. Norplant. consists of six soft hollow silastic stems with a length of 3.4 cm and a diameter
of 2.4 mm filled with 36 mg of levonorgestrel. five years.
2. Implanon. It consists of one flexible white stem with a length of about 40 mm and a
diameter of 2 mm, which is filled with 68 mg 3-keto-desogestrel and works for three years.
3. Jadena and indoplant. Consists of two sticks containing 75 mg of levonorgestrel with a
three-year working period.
Function
1. Implants are effective in preventing pregnancy
2. Does not interfere with lactation for mothers who are breastfeeding
3. Does not interfere with activities in dealing with husband and wife and has a usage period
of up to 3 years
4 Can be issued at any time and immediately return fertile
Strength
Norplant is a safe and highly effective method of contraception, which requires little effort or
motivation from users and, unlike contraception that can be injected, is rapidly reversible. Because it
is a method that only contains progestin, Norplant can be used by women who have contraindications
for oral contraceptives containing estrogen. Low doses of progestin that are released constantly avoid
high initial doses delivered by injectable ingredients, and prevent daily hormonal explosions
associated with oral contraception. Norplant is not a contraceptive method associated with intercourse.
The effectiveness of Norplant's use is very close to theoretical effectiveness. Norplant is a very good
choice for women who are breastfeeding (there is no effect on breastfeeding) and can be inserted
immediately postpartum.
Weakness
1. Norplant causes disorder in the bleeding pattern of up to 80% of users, especially during the
first year of use, and some women or partners cannot accept this change. Endogenous estrogen
is almost normal, and unlike combination oral contraceptives, progestins are not regularly
disconnected to allow endometrial exfoliation. As a result, endometrial peels occur at
unpredictable intervals.
2. The implant must be inserted (inserted) and removed through a surgical procedure performed
by trained personnel. Women cannot start or stop the method without the help of the clinician.
The incidence of appointment of complications is approximately 5%, an incident that can be
best reduced by good training and experience in inserting Norplant.

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3. Because insertion and removal of Norplant requires a minor surgical procedure, the cost of
starting and stopping will be higher compared to oral contraception or the barrier method
4. Implants can be seen under the skin. "Proof" of contraceptive use may not be accepted by
some women, and by several partners.
5. Norplant is not known to provide protection against sexually transmitted diseases such as
herpes, human papillomavirus, HIV, gonorrhea, or chlamydia. Users who are at risk of
suffering from sexually transmitted diseases should consider adding a barrier method to
prevent infection.

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