What is Family planning

Family planning is the planning of when to have children (the moms age of their first birth and
the interval between the children)
Use of birth control and other techniques to implement the planning of when to have children.
Other techniques commonly used include sexuality education, prevention and management of
sexually transmitted infections, pre-conception counseling and management, and infertility
management
Family Planning does not mean stopping to have children.

Family planning is sometimes used as a synonym for the use of birth control. It is most
usually applied to a female- male couple who wish to limit the number of children they have
and/or to control the timing of pregnancy (also known as spacing children). Family planning may
encompass sterilization, as well as abortion.

Family planning services are defined as "educational, comprehensive medical or social
activities which enable individuals, including minors, to determine freely the number and
spacing of their children and to select the means by which this may be achieved".

SOCIOLOGY OF FAMILY PLANNING
Basic social cell.
Sociologists and economists believed that living standards of the people cannot be improved
while population growth unchecked.
Attitude surveys have shown that awareness of family planning is very widespread and over 60
per cent people have favorable to restricting or spacing births.
Studies have shown that the population problem complicated by deep-rooted religious and
other believes.
Attitudes and practices favoring larger families.
Preference for male children.
Most of these beliefs stem from ignorance and lack of communication.
The experience of all countries which a successful population control shows that the best
motivation is economic, a desire to improve standard of living.
The solution to the problem is one of mass education and communication.

Purposes of Family Planning
Raising a child requires significant amounts of resources:
time,
social,
financial, and
environmental.
Planning can help assure that resources are available.
The purpose of family planning is to make sure that any couple, man, or woman who has the
desire to have a child has the resources that are needed in order to complete this goal.
With these resources a couple, man or women can explore the options of natural birth,
surrogacy, artificial insemination, or adoption.
In the other case, if the person does not wish to have a child at the specific time, they can
investigate the resources that are needed to prevent pregnancy, such as birth control,
contraceptives, or physical protection and


History of Family Planning
1900 Distributing information and counseling patients about contraception and contraception
devices was illegal under federal and state laws
1912 The modern birth-control movement began
Margaret Sanger an American born activist, founded the American Birth Control League and
was instrumental in opening the way to access birth control

1916 Margaret Sanger challenged the laws that suppressed the distribution of family
planning information by opening the first family planning clinic in Brooklyn, New York.
The police closed her clinic, but the court challenges that followed established a legal precedent
that allowed physicians to provide advice on contraception for health reasons.

- 1930s- a few state health departments and public hospitals had begun to provide family
planning services
1960- the era of of modern contraception began birth control pill and Intrauterine device
became available

1965- Pill became the most popular method followed by the condom and contraceptive
sterilization

1965 Supreme Court (Griswold vs Connecticut) struck down state laws prohibiting contraceptive
use by married couples

The United Nations Conference on Human Rights at Teheran in 1968 recognized family
planning as a basic human right.

1973 -Supreme Court (Roe vs Wade) legalizes abortion.
1973 - First National Survey of Family Growth conducted

The Bucharest Conference on the World Population held in August 1974 endorsed
the same view. 'Plan of Action' that
"all couples and individuals have the basic human right to decide freely and responsibly
the number and spacing of their children and to have the information, education, and
means to do so".
The World Conference of the International Women's Year in 1975 also declared
"The right of women to decide freely and responsibly on the number and spacing of their
children and to have access to the information and means to enable them to exercise that
right".

1976: Marie Stopes International was established to provide accessible family planning services
globally.

World Contraception Day
September 26 is designated as World Contraception Day, devoted to raising awareness of
contraception and improving education about sexual and reproductive health, with a vision of "a
world where every pregnancy is wanted".

Family Planning in other Country
China's one-child policy
the policy was instated to control the rapid population growth that was occurring in the nation
at that time.
With the rapid change in population, China was facing many impacts of the rapid population
growth including poverty and homelessness.
As a developing nation, the Chinese government was concerned that a continuation of the rapid
population growth that had been occurring woul.

In Hong Kong and Vietnam the "Two is Enough" campaign encouraged people to have 2
or fewer children in each family. It contributed to the reduced birth rate in the following decades.

Religious View
Many Christians began to consider sex as a gift from God and a positive force that could
strengthen the institution of marriage if couples did not feel threatened by the possibility of
having children they could not support. The majority of Protestant denominations, theologians,
and churches allow contraception and may even promote family planning as an important moral
good. As with all issues of Christian morality, it stresses that members use birth control as
dictated by their consciences.

Health and Benefits
Family welfare
a state of well being of the family as a whole and the individual. Means a level of satisfaction
of the basic needs of family (adequate food, water, shelter, employment, health and education).
Responsible Parenthood
the essence of family planning. Pregnancy is planned and a child us desired and is assured of
parent's love, protection, etc.
For the Mother
Help mother to fully recover from physical strain of child bearing. Those more than 4 children
considered high risk. Help reduce number of maternal death due to abortion.
For the Father
Family Planning helps the father shoulder his responsibility and enables him to give his children
equal attention. It also lightens his load because he will not be obliged to provide for and support
too many children.
For the Children:
Through Family Planning, the children are better taken care of. The parent could meet the basic
needs of the children Benefits to Whole Family Health
help the family enjoy the better kind of life.
For the Community, the Country and the World:
Family Planning can provide a peaceful, orderly, and self- sustaining community with fewer
problems, like juvenile delinquency. For the World , overcrowding can be minimized, and
governments can focus their economic efforts on production rather than consumption.



World population (picture)



Philippines population (picture)

About one half of all pregnancies in the Philippines are unplanned. Most women can become
pregnant from the time they are in their early teens until they are in their late 40s. Birth control
can help couples postpone having a baby until the time is right for themif ever.

Basic conditions of pregnancy
First, health of the woman. The woman must have attained puberty and she better be under
about 35 years of age and must not have reached menopause stage. Her monthly periods must be
regular and her ovaries must be producing eggs systematically. She should not have any other
present or past health problems that can affect her physical and mental condition - her natural
biological functions of becoming a mother.

Second, health of the man: The man must have crossed puberty, must have a well developed
sex organ that has proper erectile function, must produce enough count of sperms that have
mobility in his semen. He should not have any other present or past health problems that can
affect his physical and mental condition - his manliness or the capacity of healthy sperm
production.

Timing
A woman have a normal 28-day menstrual cycle which ovulation takes place approximately at
the mid period - about 14 days before the next menstrual discharge. The egg produced in one of
the 2 ovaries reaches a woman's uterus via fallopian tubes. It waits for the arrival of male sperm
for the next 24 hours.
Taking averages and probabilities into consideration in a normal menstrual cycle, if a hassle-
free intercourse takes place between the 12th day to 16th day after previous last day menstrual
discharge, there is a good possibility for the woman to get pregnant.

The Act
-The physical intercourse has to take place without much of tension in a normal and natural way
in the above mentioned conducive period. Ideally, the man and woman should keep their organs
clean before intercourse.
-The ejaculation should take place fully inside, deep in the vaginal passage; Ideally, the woman's
posture must be such (facing upwards) that it receives the discharge without allowing it to flow
out and it is conducive for the sperms to find their way into the uterus though the cervix passage.
It is recommended that the woman keeps lying in the bed for about 15 to twenty minutes
after intercourse, facing upwards, thighs together but relaxed, knees raised up with toes touching
the rear of the theighs. This is to facilitate the ejaculated semen to reach the cervix and travel
down into the uterus. The woman should not wash her vaginal passage immediately after
intercourse.

Contraceptive methods
How many kinds of contraception methods do you know? (From film or books)

CONTRACEPTIVE METHODS
Preventive methods to help women avoid unwanted pregnancies.
IDEAL CONTRACEPTIVE
Safe Effective
Acceptable Inexpensive
Reversible Simple to administer
Independent of coitus
Long lasting to avoid frequent administration
Requiring little or no medical supervision
The present approach in family planning programs is to provide a "cafeteria choice" that is to
offer all methods from which an individual can choose according to his needs and wishes and to
promote family planning as a way of life.
The term (conventional contraceptives) is used to denote those methods that require action at
the time of sexual intercourse, e.g., condoms, spermicidal, etc.
Inhibiting the development and release of the egg
To prevent sperm and egg from uniting
Imposing a mechanical, chemical, or temporal barrier between sperm and egg
Altering the ability of the fertilized egg to implant and grow



Barrier methods
These include male condoms, the female condom, diaphragms and caps.
They prevent sperm entering the uterus.
You can use male and female condoms as soon as you feel ready to have sex.
MALE CONDOMS
Mostly made of fine latex rubber.
Silicon used nowdays to produce semi- dry, pre-lubricated forms.
Spermicidal coated with nonoxynol 9 on inner and outer surfaces.
ADVANTAGE:
Simple spacing method
No side effects
Easily available, safe & inexpensive
Protects against STDs
DISADVANTAGE:
Chances of slip off and tear off
Penis must be withdrawn immediately after ejaculation
Failure rate: 16%

FEMALE CONDOM
Advantages
Woman controlled method
Prevents STDs including HIV/AIDS
Not damaged by oils and other chemicals



Disadvantages
High motivation
Only women who can use diaphragms can use female condom
Slippage occurs
Expensive
Failure rate 21% with typical use and 5% with correct and consistent use.

VAGINAL DIAPHRAGM
Most common and easiest to fit and use
Thin, nearly hemispherical dome made of rubber or latex material, with circular, covered metal
spring at periphery (flat type and coil type)
External diameter of rim is size of diaphragm
45 mm diameter rising in steps of 5 mm to 105mm (most common 60, 65, 70, 75, 80)
Advantages
No gross medical side effects
Control of pregnancy in hands of woman
Reasonably safe when properly used
Prevent spread of STDs though less effective than condom
Disadvantages
Use of spermicidal unacceptable and messy for some
Suitable for intelligent, highly motivated women of middle or high socioeconomic groups
Allergy to rubber
Infection may occur if used for long time
Erosion
Urinary tract infection
Occlusive caps do not prevent spread of AIDS
Rarely, toxic shock syndrome

VAGINAL SPONGE
Introduced in 1980s
Today most popular
Soft, disposable foam sponge made of polyurethane.
Round shaped with depression at centre of upper surface to fit over cervix Saturated with
spermicide nonoxynol 9
Attached nylon loop for removal
Moistened with water, squeezed gently to remove excess water and inserted high up in vagina
to cover cervix
Acts for 24 hrs
Failure rate 9 27 per 100 women years Must be removed and thrown away after 8- 24 hrs
but not before 6 hrs of last act

Drawbacks:
May get broken
difficult removal
High pregnancy rate
Toxic shock syndrome
Allergic reactions
Vaginal dryness, soreness
May damage vaginal epithelium
increase risk of HIV transmission

SPERMICIDES
Non ionic surfactants which alter sperm surface membrane permeability, resulting in killing of
sperms
Advantages
No instructions by doctors or nurses
Easily available and easy to use
No gross medical side effects
Disadvantages
Messy to use
Failure rate high when used alone
Can increase spread of HIV infection by irritating vaginal and cervical mucosa
Failure rate
21% with typical use and 6%


First generation iud
They are inert or Nonmedicated devices made up of polyethylene
Different shapes and sizes
LIPPES LOOP:
Double S shaped device
Made up polyethylene material
Non toxic, non tissue reactive & extremely durable
Small amount of Barium Sulphate is also added for radiological examination
Available in 4 sizes A,B,C &D

Second generation Iud
Made up of metal copper.
EARLIER DEVICES
Copper - 7
Copper - T 200
NEWER DEVICES
Variants of T device
T copper 220C
T copper 380A
Nova T
Multi load devices
ML-Cu250
ML-Cu375 47
Third generation iud
Hormone releasing IUD
Progestastert
Most commonly used
T shaped device
filled with 38mg of progesterone
Effective for 1 yr
LNG-20 (Minera)
Releases 20g of levonorgesterol.
Effective for 5 yrs
Effective rate 99%

ADVANTAGES OF IUDs:
Safe, Effective, Reversible
Inexpensive
High continuation rate

DISADVANTAGES OF IUDs:
Heavy bleeding and pain
Pelvic Inflammatory diseases
Ectopic pregnancy
May come out accidently if not properly inserted

TIMING OF INSERTION:
Inserted with a plunger
Any time during womens reproductive period Except in pregnancy
Most ideal time is during or within 10 days of the beginning of menstruation the diameter of
cervical cavity is greatest at this time.

IDEAL IUD CANDIDATE:
Who has borne at least 1 child
Has no history of PID
Has normal menstrual periods
Is willing to check IUD tail
Has an access to follow up and treatment of potential problems
Is in monogamous relationship



What kinds of hormone has been used in hormone contraception?
How does the hormone work in the contraception?

Hormonal contraception are COMMONLY for female sex steroids
Synthetic estrogen and a synthetic progesterone (progestin), or a progestin only

Mechanism of Hormonal Contraception
Estrogen:
1) prevents the recruitment of the dominant follicle by suppressing FSH
2) allows for reduction of progesterone dose by recruitment of progesterone receptors,
3) minimizes side effect of break through bleeding by stabilizing the endometrium

Progesterone:
1) prevents ovulation by suppression of LH surge
2) thickened cervical mucus impedes sperm penetration into the upper genital tract.
3) produces an atrophic endometrium that is less receptive to implantation.
4) impairs secretion and peristalsis within fallopian tubes

Short-acting contraceptives Combined oral contraceptive pill (COCP)
often just called 'the pill'.
It contains estrogen and progestogen
stopping egg production (ovulation).
started from 21 days after the birth.
not recommended if you are breast-feeding, aS it can affect your milk supply.

Some advantages - it is very effective. Side-effects are uncommon. It helps to ease painful
and heavy periods. It reduces the chance of some cancers. When you stop taking it, you quickly
become fertile again.
Some disadvantages - there is a small risk of serious problems (eg blood clots). Some women
have side- effects. You must remember to take it. It can't be used by women with certain medical
conditions, such as uncontrolled high blood pressure .

Progestogen-only pill (POP)
used to be called the 'mini-pill'.
It contains just a progestogen hormone.
It is commonly taken if the COCP is not suitable,.
causing a plug of mucus in the neck of the womb (cervix) that blocks sperm.
One type stops ovulation.
The POP can be started from 21 days after the birth. You need to remember to take it at the
same time every day because, if you take a pill more than three hours later than usual you lose
protection.

Some advantages - less risk of serious problems than the COCP. When you stop taking it,
you quickly become fertile again.
Some disadvantages - periods often become irregular. Some women have side-effects. Most
types are not quite as reliable as the COCP.

Contraceptive patch
This contains the same hormones as the COCP
in patch form.
It is as effective as the COCP at preventing pregnancy.
The contraceptive patch can be started from 21 days after the birth. not recommended if you
are breast- feeding, as it can affect your milk supply.

Some advantages - it is very effective and easy to use. You do not have to remember to take
a pill every day. Your periods are often lighter, less painful and more regular. If you have
vomiting or diarrhoea, the contraceptive patch is still effective. When you stop using it, you will
quickly become fertile again.
Some disadvantages - some women have skin irritation. Despite its discreet design, some
women still feel that the contraceptive patch can be seen.

Long-acting contraceptives
These are more suitable for women who do not want to get pregnant again or for a few years.

Contraceptive injection (such as Depo- Provera and Noristerat)
This contains a progestogen hormone.
It works by preventing ovulation
similar actions as the POP.
An injection is needed every 8-12 weeks.
It is usually recommended that you wait until six weeks after the birth to start the contraceptive
injection because you may get heavy and irregular bleeding.

Some advantages - it is very effective. You do not have to remember to take pills.
Some disadvantages - periods may become irregular (but often lighter or stop all together).
After stopping, there may be a delay in your return to normal fertility for several months. Some
women have side- effects. You cannot undo the injection, so if side-effects occur they may
persist for longer than 8-12 weeks.

Contraceptive implant (such as Nexplanon)
An implant is a small device placed under the skin.
It contains a progestogen hormone
It works in a similar way to the contraceptive injection.
It involves a small minor operation using local anaesthetic.
Each one lasts three years.
Some advantages - it is very effective. You do not have to remember to take pills. You
quickly become fertile again when the implant is removed.
Some disadvantages - periods may become irregular (but often lighter or stop altogether).
Some women develop side-effects but these tend to settle after the first few months

Postcoital Contraception Pills (Emergency Contraception)
Emergency contraception can be used at any time if you had sex without using contraception.
Also, if you had sex but there was a mistake with contraception. For example, a split condom or
if you missed taking your usual contraceptive pills.
Emergency contraception pills - are usually very effective if started within 72 hours of
unprotected sex. They can be bought at pharmacies or prescribed by a doctor. An emergency
contraception pill works either by preventing or postponing ovulation or by preventing the
fertilised egg from settling in the womb.

Postcoital Contraception Pills (Emergency Contraception)
An IUCD - inserted by a doctor or nurse, can be used for emergency contraception up to five
days after unprotected sex.
You will not need emergency contraception if you have unprotected sex within 21 days of
having your baby. You cannot get pregnant so soon after childbirth.

Coitus interruptus (withdrawal)
The penis is withdrawn from the vagina just before ejaculation occurs
Failure reasons Live sperm leaks from the urethra before and during coitus The withdrawal
is delayed so that part of the semen is discharged within the vagina

Natural planning
Rhythm Method
Avoiding coitus during the period of greatest fertility
Human ovum can be fertilized no later than 24 to 48 hours after ovulation
Although motile sperm have been recovered from the uterus and the oviducts as long as 60
hours after coitus, their ability to fertilize the ovum probably lasts no longer than 24 to 48 hours
Natural family planning

Ovulation : 14 days (12 to 16) before the onset of menstruation
Fertile period: 4 days before, and for 3 or 4 days after ovulation
Safe period: on the other days of the cycle

Pregnancy is unlikely to occur if a couple refrains from fertile period
Unprotected intercourse on safe period should not result in pregnancy

Sterilization
Called tubal sterilization operation (tubal ligation)
Failure rate: 1/2000
Permanence contraception
Have the risks of surgery
Pelvic inflammations
Skin (section site) inflammation
Fever (over 37.5 two times interval 4h during 24 h)
Severe disease couldnt tolerance operation Psychological disease

Female Sterilization


Tubal clips


Male sterilization


Complications
Tubal recanalization
Pregnancy
Ectopic pregnancy
Menstrual irregularity
Loss of libido
Infection
Injury rectum or bladder

Family planning methods choice
Newly wedded couple
Male condom, female condom, spermicidal jelly
No IUD or oral hormonal contraceptives

Couple with one child
IUD, Male condom, oral hormonal contraceptives, Norplant, spermicidal jelly

Couple with two or more children
Sterilization
Women during breastfeeding
IUD, condom
No hormonal contraceptives
Women in climacteric
No hormonal contraceptives
Condom for people with STDs or HIV



INTERNATIONAL LEVEL
International Planned Parenthood Federation is the world's largest private voluntary
organization supporting family planning services in developing countries.
The United Nations Fund for Population Activities (UNFPA).
the US Agency for International Development (USAID)
Population Council,
Ford Foundation, The Pathfinder fund and World Bank besides WHO and UNICEF.