Outlines:

1. Introduction.
2. Definition of family planning.
3. The importance of family planning.
4. Natural methods:
_Basal body temperature charting, Calendar calculation, Cervical
mucus monitoring, Lactational amenorrhea, Symptothermal method.
_Advantages, disadvantages.
5. Chemical methods:
_Use, types, mechanism of action, advantages, disadvantages.
6. Barrier methods:
_condoms, contraceptive Sponge, diaphragm, cervical caps and
spermicide.
_Advantages, disadvantage.
7. Hormonal methods:
_oral pills, injectable contraceptives, vaginal rings, subdermal
implants.
_Advantages, disadvantages.
8. Mechanical methods:
_IUD.
_Advantages, disadvantages.
_contraindications.
9. Surgical methods:
_Female and male sterilization.
10. Family Planning counseling.
11. References.
Introduction:
_A program to regulate the number and spacing of children in a family through the
practice of contraception or other methods of birth control.

_The regulation, as by birth control methods, of the number, etc. of children that a
family will have.

_There are many birth control methods and techniques available today. It is important
to think about what method will be best for family.

_Family Planning services support people’s decisions about when, or if, they would
like to have children by offering education, counseling and birth control methods.

_Planned pregnancies spaced two or more years apart result in healthier babies and
fewer medical problems for the woman. Planning for a child will help you avoid the
social, health, and financial problems you face if an unplanned pregnancy happens.

_Contraception also reduces the need for unsafe abortion and reduces HIV
transmissions.

_According to WHO, in 2017 estimates, 214 million women of reproductive age in

developing regions have an unmet need for contraception. Reasons for this include:

limited access to contraception, limited choice of methods, fear or experience of side-

effects, and cultural or religious opposition.

Definition:
▪️ Family planning is defined as a program to take steps to control when you conceive
children and how many children you conceive.

▪️ Family planning services are defined as comprehensive educational, medical, or

social activities that enable individuals and minors to freely determine the number of
their children and the spacing of births and to choose the means that enable them to
achieve this.
The importance of family planning:
Family planning provides many benefits to mother, children, father, and the family:

I. Mother

 Enables her to regain her health after delivery.

 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 an illness, gives
enough time for treatment and
recovery.

II. Children

 Healthy mothers produce healthy

children.
 Will get all the attention, security, love, and care they deserve.

III. Father

 Lightens the burden and responsibility in supporting his family.

 Enables him to give his children their basic needs (food, shelter, education, and
better future).
 Gives him time for his family and own personal advancement.
 When suffering from an illness, gives enough time for treatment and recovery.

IV. Community

 High level of socioeconomic development.

 Less drain on resources.
The natural method of family planning:
o Basal body temperature charting:
Identifies the luteal phase of the menstrual cycle by postovulatory increase in
basal body temperature; all other days are considered fertile.
o Calendar calculation:
Predicts the fertile period by menstrual darting.
o Cervical mucus monitoring:
Identifies beginning and end
of the fertile period from
cervical secretions.
o Lactational amenorrhea:
Maximizes suppression of
ovulation during
breastfeeding; effectiveness
limited to 6 months
postpartum.
o Symptothermal method:
Based on cervical mucus monitoring; calendar calculations or basal body
temperature charting monitoring.
Advantages
 No Side Effects: Most forms of contraception come with a lot of physical side
effects, but natural family planning has none.
 Reversible: When you’re no longer interested in preventing pregnancy, you can
use the same system to get pregnant. Knowing your most fertile days of the
month.
 Acceptable for Religious Individuals: For those with religious restrictions when
it comes to birth control, natural family planning may also be the way to go.
 Raising awareness: Monitoring your fertility signals can bring about a new
awareness of your own reproductive system. This knowledge will help you and
you will be no longer need to a health professional.
 Budget Friendly: This method is inexpensive to start.
 Partner Inclusive: With natural family planning, your partner can also be
engaged in t.

Disadvantages

 No Protection From sexually transmitted infections (STIs): While using fertility

awareness as your main form of birth control, you will not have any protection
from STIs.
 Requires Partner Cooperation: This method will also require cooperation from
your sexual partner.
 Time Commitment: The learning curve on this one is a little steep. Following
and tracking all of your fertility signs can be more challenging than popping a
pill once a day. You will have to commit to learning about your body and
keeping accurate records.
 It May Be Unreliable: Your fertility signs can be disrupted by many
environmental factors. Stress, illness, travel and even using the emergency
contraceptive pill will change the accuracy of your signals. You’ll need to wait
for two menstrual cycles before you can rely on natural family planning again.
 Every Woman Is Different: For some women, the fertility signs may differ from
the normal.
The chemical methods

Usage:

o Spermicides can be used alone or

with other barrier methods except the
sponge, which already contains a
spermicide.

o When used alone, spermicides should be inserted into the vagina close to the
cervix. They take 10-15 minutes after insertion to become effective, last only 1
hour and shouldn't be removed for at least 6-8 hours after insertion to ensure the
proper death of sperms.
o Spermicides must be reinserted for each act of sex.

Types:

 They are available in foaming tablets, melting or foaming suppositories, melting

film, jelly and cream.
 Jellies, creams and foam from cans can be used on their own, with a diaphragm,
or with condoms.
 Films, suppositories, foaming tablets or
foaming suppositories can be used on
their own or with condoms.

Mechanism of action:

✔️Spermicides commonly contain chemicals that alter the integrity of sperm cells,
killing them or slowing their movement.

Advantages:
  Spermicides are safe.
 Cheaper than most methods.
 No need for prescription.
 They can increase vaginal lubrication.
 Can be stopped at any time.
 No hormonal side effects.

Disadvantages:

 Spermicides are one of the least effective family planning methods on their own
(70% effectiveness).
 Generally needs to be used with other methods.
 Can cause vaginal burning and irritation.
 Some women may be allergic to spermicides.
 Spermicides do not protect against STIs.

The barrier method of family planning:

_Barrier methods of birth control prevent pregnancy by blocking sperm, this stops the
sperm from reaching an egg.

_Barrier methods are not effective at preventing pregnancy as other birth control
methods, such as intrauterine device (IUD).

_Types of barrier methods include: condoms, contraceptive Sponge, diaphragm,

cervical caps and spermicide.

o Condoms:
 _A condom is a thin, fitted tube worn over the penis before intercourse (male
condoms) or inserted into the vagina before intercourse (female condoms). They
create a barrier that keeps semen and other body fluids out of the vagina.

o Diaphragm:
_Is a small, dome-shaped device made of
silicone or latex that fits inside the vagina and
covers the cervix. It must be used with
spermicide.
o Cervical caps:
_Is a reusable, deep silicone cup that is inserted
into the vagina and fits tightly over the cervix. It
is effective at preventing pregnancy only when
used with spermicide.
o Contraceptive sponge:
_Is a small, round sponge made from soft,
squishy plastic. You put it deep inside your
vagina before intercourse. The sponge covers
your cervix and contains spermicide to help
prevent pregnancy.
o Spermicide:
_A chemical that you put deep into your vagina right before sex to kill sperms.
_You can buy it as jelly, foam, cream and suppository, and most common
spermicide is called Nonoxynol-9.
 _It prevents pregnancy two ways: blocking the entrance to the cervix so sperm
can’t get to your egg , and stopping sperm from moving well enough to swim to
your egg.
_It can be used by itself, or combined with other birth control methods.
_And you need to use spermicide with diaphragms and cervical caps in order
for them to work.

Advantage
 Condoms protect against pregnancy. They also are the only method that may
protect against STIs such as HIV/AIDS.
 Barrier methods are safe to use while breastfeeding.
 Barrier methods cost less than hormonal types of birth control.
 These methods do not affect a woman’s menstrual cycle.
 You do not need a doctor’s prescription for condoms, the contraceptive sponge,
or spermicides.
Disadvantages
 Diaphragm , cervical cap and Sponge don’t protect against STI, and can cause
vaginal irritation which increases risk of STI.
 Diaphragm, cervical cap and sponge don’t work well without spermicide.
 These methods do not prevent pregnancy as well as IUDs or hormonal forms of
birth control.
 Barrier methods prevent pregnancy only if you use them every time before
intercourse.
 A woman needs a doctor's prescription to get a diaphragm or cervical cap.
 The cervical cap and contraceptive sponge do not work as well as the other
barrier methods for women who have delivered a child through the vagina.

Hormonal methods
 Hormonal contraceptives refer to birth control methods that act on the endocrine
systems.
 Action varies from one type to another.
 Uses synthetic progesterone and estrogen.
I. Oral pills
1. Combined pills.
2. Progesterone only pills.
3. Post coital pill.
4. Once a month pill.
5. Male pill.
1. Combined pills (combined injectable)
Content: Contains estrogen and progesterone.
Mode of action:
 Inhibits ovulation of ovum by blocking the
gonadotropin from pituitary gland.
 The progestogen alters the cervical mucosa which prevents entry of sperms into
genital canal makes the uterine inner lining unsuitable for implantation of
fertilized egg.
Duration: 21 or 28 days.
Taken for 21 consecutive days beginning from 5th day of menstruation.
2. Progesterone only pills (Minipill/ micro pill)
Content: Contains only progesterone.
Mode of action:
 The progestogen alters the cervical mucosa which prevents entry of sperms into
genital canal makes the uterine inner lining unsuitable for implantation of
fertilized egg.
Duration: throughout the menstrual cycle.
Disadvantage: Increased pregnancy rate and poor cycle control.
Advantage: can be used in older women with cardiovascular risks.
3. Post coital pill
Post coital method is advocated as an emergency method e.g., Contraceptives failure,
rape, unprotected sex.
Duration: To be taken within 72 hours of unprotected intercourse.
Content: Contains hormone progesterone.
Mode of action:
  It prevents ovary from releasing egg or prevents fertilization or implantation.
One tablet within 24 hours and the 2nd tablet after 12 hours of 1st dose.
Advantage: Failure rate less than 1 %.
Side effects: nausea, mild stomach upset, spotting, headache and tiredness.
4. Once a month pill
o It’s a long-acting pill.
o Combination of long-acting estrogen with short acting progesterone.
Disadvantages:
 High pregnancy rate.
 Irregular menstrual cycle.
5. Male pill
o An ideal male contraceptive pill should decrease sperm count but does not
affect testosterone levels.
Produces: oligospermia or azoospermia.
o 10% of men because permanently azoospermia after taking it for 6 months
o Not on practice.
II. Injectable contraceptives
Types:
1. Progesterone only injectable.
2. Combined injectable contraceptives.
1. Progesterone only injectable
 Is a long-acting, reversible contraceptive.
 A synthetic progesterone, or progestogen,
is slowly released into the systemic
circulation following intramuscular (IM) or
subcutaneous (SC) injection.
Its main mechanism of action: is to suppress ovulation.
Duration: give protection against unwanted pregnancy for a period of 2 or 3 months.
Advantages:
  Do not contain estrogen, and so can be used throughout breastfeeding, starting 6
weeks after giving birth, and by women who cannot use methods with estrogen.
2. Combined injectable
Content: Contains progesterone and estrogen.
Duration: Given at monthly intervals.
Mode of action: Action mainly ovulation suppression.
Ex: Cyclo provera.
III. Vaginal rings
 Is a small soft, plastic ring that you
place inside vagina.
 It releases a continuous dose of the
hormone's estrogens and progestogen
into the bloodstream to prevent
pregnancy.
 Hormone is slowly absorbed through
vaginal mucosa.
 Rings is worn 3weeks of the cycle and
removed.
IV. Subdermal implants
 Plastic capsules the size of paper
matchsticks inserted under the skin in the
arm.
Administration:
1) Implants are placed in the body filled
with hormone that prevents pregnancy.
2) Physically inserted in simple 15-minute
outpatient procedures
Effectiveness: 99.95% effectiveness rate.
NORPLANT 1:
 Six capsules.
 Five years effectiveness.
NORPLANT 2:
  Two capsules.
 Three years.
Advantages of hormonal methods of contraception
 No interruption of foreplay or intercourse.
 Reduced bleeding and cramping with periods, which lowers the risk of anemia.
 Fewer or no periods.
 Reduced pain during ovulation, reduced risk of pelvic inflammatory disease
(PID), reduced breast changes, and reduced risk of ectopic pregnancy.
 May reduce acne, reduce ovarian cysts, and reduce symptoms of endometriosis.
 May protect against ovarian and endometrial cancer.
 Can be used after an abortion.
Disadvantages of hormonal methods of contraception
 Does not protect against sexually transmitted infections or HIV.
 Causes more irregular periods or spotting between period.
 May not be as effective when taken with certain medicines.
 Makes diabetes more likely if women have had gestational diabetes during
pregnancy.
 Pills must be taken at the same time each day.
 Implant may cause headaches.
 Causes slight weight gain.
 May decrease levels of HDL ("good") cholesterol.

Mechanical methods:
o Intrauterine devices (IUDs) are small contraceptive devices that are inserted into
the uterus (womb) to prevent pregnancy.
o The 2 types available are the copper IUD and the hormonal IUD, Both are
among the most effective methods of contraception and can stay in place for 5
to 10 years, depending on the type.
o Hormonal IUD stay for 5 years and
copper IUD stay for up to 10 years.
o The hormonal IUD is a small, T-shaped,
plastic device, It slowly releases a
hormone (progestogen) into your uterus.
Progestogen is like the hormone
produced by the ovaries.
o The copper IUD is a small, T-shaped,
plastic and copper device. It constantly releases a small amount of copper into
 the uterus. The copper IUD can also be used for emergency contraception
instead of the emergency contraceptive pill (‘morning after pill’).
Advantage of IUD
 It protects against pregnancy for 5 or 10 years, depending on the type.
 Once an IUD is fitted, it
works straight away.
 Most people with a
womb can use it.
 There are no hormonal
side effects, such as
acne, headaches or breast
tenderness.
 It does not interrupt sex.
 It's safe to use an IUD if
you're breastfeeding.
 It's possible to get pregnant as soon as the IUD is removed.
 It's not affected by other medicines.
 There's no evidence that an IUD will affect your weight or increase the risk
of cervical cancer, womb (uterus) cancer or ovarian cancer.
Disadvantage of IUD
 Your periods may become heavier, longer or more painful, though this may
improve after a few months.
 It does not protect against STIs, so you may need to use condoms as well.
 If you get an infection when you have an IUD fitted, it could lead to a pelvic
infection if not treated.
 Most people who stop using an IUD do so because of vaginal bleeding and pain,
although these side effects are uncommon.
Contraindications of hormonal IUD
 Uterine fibroids.
 Breast cancer.
 Carcinoma cancer of the cervix.
 Cancer of the uterus.
 Cancer in the lining of the uterus.
 Diabetes.
 Anemia.
 Increased risk of bleeding due to clotting disorder.
Contraindications of copper IUD
 Pregnant.
 Recent infection called pelvic inflammatory disease (PID).
 Unusual bleeding from your vagina.
 Wilson's disease or you are allergic to copper.
 Have a history of cancer in the uterus or cervix.
 Have a history of ectopic pregnancy.

The surgical method

o Surgical methods considered as permanent methods of contraception are female
sterilization, also called (tubal ligation) and male sterilization, also called
(vasectomy). Both methods involve minor surgery.
o This surgery is very safe and in most cases does not require hospitalization
I. Female sterilization (tubal ligation)
 Female sterilization is a relatively simple surgical procedure.
 A very small incision is made in a woman’s abdomen, and her fallopian tubes
are cut and blocked so that eggs. Cannot move through the tubes to meet the
sperm.
Advantages
 Male, or female do not have to remember to take a pill every day.
 He, or she would usually be asleep (under general anaesthetic) during the
procedure.
 Tubal ligation does not interfere with sex.
 There are no significant long-term side effects.
Disadvantages
 Tubal ligation does not protect against STIs.
 There are possible surgery-related complications.
 Public funding may not be available for everyone who requests tubal ligation.
2. Male sterilization (vasectomy)
 Male sterilization or vasectomy is an even simpler surgical procedure.
 A tiny hole is made in the scrotum (the sac that holds the testicles), and both
tubes (vas deferens) that carry a man’s sperm to his penis are cut and blocked.
This keeps sperm out of the semen.
Advantage
  A vasectomy is more than 99% effective at preventing pregnancy.
 Long-term effects on your health are rare.
 It doesn't affect your hormone levels, sex drive or interfere with sex.
Disadvantages
 A vasectomy can't be easily reversed.
 Possible complications include a collection of blood inside the scrotum
(Haematoma), hard lumps called sperm granulomas (caused by sperm leaking
from the tubes), an infection, or long-term testicle pain (you may need further
surgery).
 The vas deferens tubes can reconnect, but this is very rare.
 Vasectomy doesn't protect against STIs, so you may need to use condoms as
well.

Family Planning counseling

4 STEPS TO COUNSELING FAMILY PLANNING CLIENTS :
Step 1
Welcome and introduce:
 Greet your client.
 Introduce yourself.
 Encourage questions.
Step 2
Ask and assess:
 Ask reason for visit.
 Ask open-ended
questions.
 Assess what your client
knows.
 Assess what your client
needs and wants to learn.
Step 3
Explain and evaluate:
 Discuss your client’s preferred method.
 Cover details about their chosen method.
 How to use it, advantages/disadvantages.
  Side effects, complications/warning signs.
 Assure your client understands using a condom.
 Ask what they learned.
 Ask for a demonstration of a skill. Using this model, show me how to use a
condom.
Step 4
Close:
 Ask open-ended questions about main points.
 Summarize.
 Schedule follow-up phone/appointment.
 Follow-up on referrals, 3 months later.
 Assess correct use of methods.
 Instruct for questions and problems.
 Thank your client for coming.