FAMILY

PLANNING
PROGRAM
-There are about 3-4 million women
getting pregnant every year

NATIONAL DEMOGRAPHIC AND

HEALTH SURVEY OF 2003

44% got pregnant with their 1st

child at the age of 20-24
6.1% at the age of 15-19
35-39 age group has the highest
percentage who uses contraceptives
15-19 years old- has the lowest percentage

48.8%- use any form of contaceptives

51.1%- do not use any form of
contaceptives

33.4%- uses modern contraceptives

15.5%- uses traditional method
Philippine Family Planning Program
(PFPP)
 National Family Planning Policy (A.O. 50-A, s. 2001) asserts
that family planning as a health intervention shall be made
available to all men and women of reproductive age (15 to 44
years old)
 FP is a means to prevent high-risk pregnancies brought about
by the following conditions:
1. Being too young (less than 18 years old) or too old (over 34 years
old);
2. Having had too many (4 or more) pregnancies;
3. Having closely spaced (too close) pregnancies (less than 36
months); and
4. Being too ill or unhealthy/too sickly or having an existing
disease or disorder like iron deficiency anemia (DOH, 2001).
Philippine Family Planning Program
(PFPP) (continued)

 A.O. 132, s. 2004: DOH Natural Family

Planning (NFP) Program
◦ recognition of modern NFP methods
 A.O. 2012-0009: National strategy towards
reducing unmet need for modern family
planning as a means to achieving MDGs
◦ emphasized the implementation of the FP program
integrated and synchronized with other public health
programs such as the MNCH and Garantisadong Pambata
in the broader context of the Kalusugan Pangkalahatan
Execution Plan
Four Pillars of the PFPP
1) Responsible parenthood.
◦ Will and ability to respond to the needs and
aspirations of the family.
2) Respect for life.
◦ The 1987 Constitution protects the life of the unborn from the
moment of conception
◦ Prevent abortions, thereby saving lives of both women and children
3) Birth spacing.
◦ Proper spacing of 3 to 5 years from a recent
pregnancy
4) Informed choice.
◦ Couples and individuals are fully informed on the different modern
FP methods
Client Counseling and Assessment
 Family planning counseling is a client-centered, face-to-face,
interactive communication process between the health service
provider and the client that helps the latter to make free and
informed choices regarding his/her fertility intention or plan
 Essential content of the nurse-client interaction regarding the
chosen method (DOH, 2006b):
1. Effectiveness;
2. Advantages and disadvantages;
3. Possible side effects, complications, and signs that require an
immediate visit to the health facility;
4. How to use the chosen method; and
5. Prevention of sexually transmitted infections; and
6. When to return to the health facility.
Benefits of Family Planning
 Benefits to mothers
◦ 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
 Benefits to children
◦ Healthy mothers produce healthy children
◦ Will get all the attention, security, love, and care they deserve
 Benefits to fathers
◦ 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
OBJECTIVES:
 Help couples and individuals achieve
their desired family size, be a
responsible parenthood and improve
their reproductive health to attain
sustainable development.
 Ensure that quality Family Planning

services are available in DOH retained

hospitals, LGU managed health
facilities, NGO’s and private sector.
Goals:
1. Safe Pregnancy
- Right age to be pregnant: 20 to 35
y/o; not less than 20 & not more than
35 (high risk).
- Right interval of pregnancy: once
in 2 or 3 years
-Supportive of Safe Pregnancy,
done in Home Setting:
a. Benedict’s Test
- Test for sugar in the urine; test for diabetes
- (+) test – diabetic
- Adverse Effect of Diabetes: Macrosomia (too large
baby) – teratogenic
- Heat test tube with 5 cc of Benedict’s Sol’n (blue) in
the burner the add 3-5 gtts of urine (amber yellow)
then heat again. Observe for the change in color.
*Blue: (-) sugar in urine (-)
*Green: trace of sugar in urine +1 +
*Yellow: Traces of sugar +2 ++
*Orange: More traces of sugar +3 +++
*Brick Red: Surely diabetic +4 ++++
*Advice mother to take sugar in moderate (not totally
prohibited)
b. Acetic Acid Test – test for albumin (CHON
substance) in urine
Albuminuria or Proteinuria – toxemia in
pregnancy  PIH
2 Categories of PIH (Pregnancy Induced
Hypertension)
a. Pre-Eclampsia: HEP (HPN, Edema, Proteinuria)
b. Eclampsia
** Collect urine in test tube. Heat it in burner then
add 3-5 gtts of acetic acid sol’n (clear white in color).
Observe solution.
*if it remains clear (-) CHON or albumin in urine
*if it turns cloudy ((+) protein – proteinuria

2. Safe Motherhood – pre-natal, post-natal

3. Healthy Reproductive Life
OVER ALL GOAL:
Reduce infant deaths
Neonatal deaths
Under five deaths
Maternal deaths
STRATEGIES TO ACHIEVE GOALS AND
OBJECTIVES:
Focus service delivery to urban and
rural poor
Reestablish the FP outreach ptogram
Strenghten FP provision with high

unmet needs
Promote frontline participation of

hospitals
Mainstream modern natural family

planning
 Policies in FP:
1. Non-coercive (give freedom of choice); you
are just a facilitator, never force/command/
dictate the couple what contraceptive method
to use.

2. Integration of Family Planning in all

Curricular Program – LOI 47 DECS
- DECS is supportive of the program.
- Memo from DECS. LOI 47 DECS stated that
Family Planning is to be integrated/offered in all
school curricular programs, either
baccalaureates. It should be enrolled separated
as I unit.
3. Multisectoral Approach
- establish relationship with other agencies which can
either be;
a. Intrasectoral
b. Intersectoral: 1. Local or 2. International – WHO,
UNICEF, USAID, Japhiego
-deals primarily on Family Planning

4. Unacceptability of Abortion
Abortion – is the termination of pregnancy before
reaching the age of viability.
- “E” contraceptives – used for legal cases such as rape.
May give OC pills (special pills with increase amount of
progesterone & estrogen): 1 pack then after 12 hours
another pack.
Function of the Health
Professional in Family Planning
To counsel, reassure, give
information and allow an
individual/couple to decide
his/her/their course of action
according to what he/she think
is appropriate for them and in
accordance to their own
personal, societal, religious
beliefs & values
 TYPES OF FAMILY PLANNING
 TEMPORARY

 PREVENTATION OF OVULATION
 I. PILLS- contains estrogen and progesteron,

yaken daily to prevent contraceptions

- may reduce effectiveness when taken
with certain drugs (rifampicin and
some anti convulsant)
 Types of Pills
Combination pills – contain both
progesterone & estrogen; taken from day 5
to day 25 of the menstrual cycle
Sequential
2 types of pills are taken:
1. Contains estrogen alone – taken from
day 5-19
2. Contains progestin-taken from day 20-
25
All-progestin (minipill) – taken everyday
Does not necessarily inhibit ovulation;
prevents implantation of the zygote
Client Instructions on taking CPs
Before starting CP, the woman must
undergo physical examination, pelvic
exam and Pap smear to rule out
contraindications. CP should be
prescribed by a physician.
Must be taken on a Sunday following
menses and abortion or the first Sunday
2 weeks after delivery.She is to use
condom on the first 7 days of pill taking.
They should be taken at the same time
everyday.
If she is taking 28 day pills, there is no rest
day or interval. If she is taking a 21 day pill,
she ends on a Saturday and begin a new pack
on the next Sunday. Bleeding will occur
around 4 days after stopping pills. If she
expected bleeding did not come, she should
consult the doctor before starting a new
packet of pill.
If a woman forgets one pill, take one now
and then the next on the regular schedule of
pill taking. If two pills, take two pills now
and two pills tomorrow and use back-up
method for the next 7 days. If 3 pills, discard
the remaining pack and start a new pack, use
back-up method for the next 7 days.
Folic acid deficiency is
common in long term user
so that it is advisable to
take folic acid supplement
If used by adolescent, they
should have a regular
menstruation for at least
two years before beginning
OC use.
ADVANTAGES:
 Safe
 Convenient and easy to use
 Regular menstruation
 Reduce painful menses and endometriosis
 Reduce cases of ovarian and endometrial
cancer
 Reversible
 Does not interfere with sexual intercourse
DISADVANTAGES:
o Often not use correctly and
ineffectively
o Nausea, dizziness and breast

tenderness
o Health risk for some women
o No protection against STI
o Some may suppress lactation
o Requires regular intake
II. DMPA (Depo Medroxy Progesterone
Acetate) / INJECTABLES – supressess
ovulation, thickens cervical mucus, making it
difficult for sperm to pass through.
ADVANTAGES:
• Reversible
• No need for daily intake
• Does not interfere with sexual
intercourse
• Acceptable by some women
• No estrogen related side effects (nauses
and dizziness)
• Does not affect breast feeding
• 3 months effective
DISADVANTAGES:

oPain
oSome may experience
weight gain
oAmmenorrhea
III. Implant (Norplant)
6 tiny biodegradble silicone rubber capsules
or 2 rods containing progestin
(evonorgestiel), surgically implanted under
the skin of the upper arm; removed surgically
in about 5 years or when the woman wishes
to discontinue the method.
slowly release the hormone to suppress
ovulation
The contraceptive is implanted under
anesthesia during menses or within 7 days
of menses, 6 weeks after delivery or
immediately after abortion.
Advantages:
•Long term reversible
contraception
•Do not interfere with coitus
•Has no estrogen related side-
effects
•Can be used during breastfeeding
•Can be used by adolescents
•Rapid return of fertility w/c occurs
3 months after removal
Disadvantages:
•Expensive
•Scarring at insertion site

Contraindications:
•Pregnancy
•Desire to get pregnant within 2
years
•Undiagnosed vaginal bleeding
PREVENTION OF IMPLANTATION

IV. IUD (Intra Uterine Device)

An object made of plastic or non-reactive
metal (nickel-chromium alloy) that fits inside
the uterine cavity
Manufactured in several shapes (loop, coil,
spiral)
Causes a chronic inflammatory response in
the endometrium, discouraging implantation
of a fertilized ovum
Usually inserted during the menstrual phase
 Contraindications of IUD

•Any inflammatory condition or

infection of the reproductive tract or
PID
•Abnormalities of the uterus
•Severe dysmenorrhea
•Uterine bleeding of unknown origin
•Suspected pregnancy
Complications / Adverse reactions
oIncreased risk of PID w/c may result in
Sterility or infertility
oMedical-surgical intervention for
complications such as twisted ovary,
bowel obstruction, unilateral tubo-
ovarial abscess
oPerforation of the uterus
oDysmenorrhea
oIncreased blood loss (anemia)
oEctopic pregnancy
oexpulsion
 IUD Danger Signs
P – period late or skipped period
A – abdominal pain
I – increased temperature (fever)
N- noticeable vaginal discharge;
foul-smelling
S – spotting, heavy periods,
bleeding
LOCAL BARRIER METHODS:
V. CONDOM
-A thin stretchable rubber sheath worn
over the penis by the man during
intercourse.
Pregnancy rate is 7-28%
Added potential of preventing STD’s
ADVANTAGES:
 Safe and no hormonal effect
 Prevents STD
 Encourage male participation in family

planning
 Easily accessible
 Used in managing premature

ejaculation
DISADVATAGES:
Some allergy to latex
Less sensation
Interrupts sexual act
Requires man’s cooperation
Self-lubricated type breaks easily

Penis must be withdrawn from the

vagina before it becomes flaccid
Lessen sexual enjoyment by the male
Female Condoms
How to use the female condoms
Open the Female condom package
carefully; tear at the notch on the top
right of the package. Do not use
scissors or a knife to open.
The outer ring covers the area around
the opening of the vagina. The inner
ring is used for insertion and to help
hold the sheath in place during
intercourse
While holding the Female condom at
the closed end, grasp the flexible inner
ring and squeeze it with the thumb and
second or middle finger so it becomes
long and narrow
Choose a position that is
comfortable for insertion – squat,
raise one leg, sit or lie down.
Gently insert the inner ring into the
vagina. Feel the inner ring go up
and move into place.
Place, the index finger on the inside of the
condom, and push the inner ring up as far as it
will go. Be sure the sheath is not twisted. The
outer ring should remain on the outside of the
vagina.
The female condom is now in place
and ready for use with your partner.
When you are ready, gently guide your
partner’s penis into the condom's opening
with your hand to make sure that it enters
properly – be sure that the penis is not
entering on the side, between the sheath and
the vaginal wall.
To remove the Female condom, twist the
outer ring and gently pull the condom
out
Wrap the condom in the package or in
tissue, and throw it in the garbage. Do
not put it into the toilet.
VI. Cervical Cap
Advantages:
Can be inserted many hours
before sex play.
Easy to carry around,
comfortable.
Does not alter the menstrual
cycle.
Does not affect future fertility.
Disadvantages:
Does not protect against
HIV/AIDS.
Requires a fitting in a clinic.
Some women cannot be fitted.
Can be difficult to insert or
remove.
Can be dislodged during
intercourse.
Possible allergic reactions.
 PERMANENT TYPE
I. BILATERAL TUBAL LIGATION
(BTL) / FEMALE STERILIZATION
- Involves tying, cutting or cauterizing
the fallopian tbes
- Usually done immediately after
delivery (within 24-48 hours) when
the incidence of morbidity & failure
are lowest
ADVANTAGES:
Permanent type
Nothing to remember, no

supplies needed, no repeated

clinic visits.
Does not interfere with sex
No effect on breast feeding
DISADVATAGES:
 Infection and bleeding at the infection
site
 When pregnancy occurs, may cause

ectopic pregnancy
 Requires physical examination and

minor surgery
 No protection against STD
 Limit physical activities after surgery.
II. VASECTOMY/MALE STERILIZATION
 Male sterilization is achieved by ligation of the vas
deferens to block the passage of sperm cells.
 A small incision is made on each side of the

scrotum to gain access to the vas deferens.

 Local pain after the procedure can be relieved by

ice and analgesics.

 The man will continue to have erection and semen

ejaculation but without sperm cells.

 Sterility after vasectomy is not immediate unlike

BTL. The client must have two negative sperm

count first in his seminal fluid w/c can be achieved
after 10-20 ejaculations before sterility is achieved.
ADVANTAGES:
Effective3 months after the procedure
Permanent, safe, simple and easy to

perform
Can be performed in a clinic and H.C.
Do not require repeated check ups
Does not affect male hormonal

function, erection and ejaculation

May increase sexual drive and

enjoyment
DISADVANTAGES:
 Slightpain and swelling 2-3
days after the procedure
 Reversibility is difficult and

expensive
 Bleeding may result in

hematoma in scrotum.
-Oldest type of birth control practiced by
man.
-The premature withdrawal of the penis
before ejaculation during sexual
intercourse
-Reliability is low because sperms are
emitted in varying quantities in the
normal lubricating fluid secreted
throughout intercourse
-Psychological disadvantage
-Not accepted by the Catholic Church
Client instructions:

•Completely wipe off any fluid at the tip

of penis before inserting it into the
vagina. Millions of sperms cells maybe
present in the pre-ejaculatory fluid.
•When the man feels that he is about to
ejaculate, he must withdraw his penis
from the vagina.
II. Calendar method
The use of mathematical calculations to predict the probable
time of ovulation. “Ovulation most often takes place 14
days before the onset of the next menstruation.”
Ogino-knaus formula:
1. Determine the shortest and longest cycle
ex. Shortest cycle = 28 days
Longest cycle = 36 days
2. If the cycle is irregular, subtract 18 from the shortest and
11 from the longest
ex. 28-18=10 ex. 25-18=7
36-11=25 29-11=18
3. The difference between the shortest cycle and 18
determines the earliest time when ovulation occur.
4. The difference between the longest cycle and 11
determines the last day when ovulation can occur
5. OVULATION CAN OCCUR ANYTIME IN BETWEEN.
6. In a regular 28 day cycle, abstinence should be observed
from day 9 to day 17. (count 5 days before the earliest
ovulation and 3 days after the last day)
III. Basal Body Temperature
-This relies on slight changes (0.3 to 0.6ºC) in
basal body temp. that may occur just before
ovulation
-Pre-ovulatory temperature is low because of
high estrogen levels
-Post-ovulatory temp. rise is due to high
progesterone
-The temperature is taken every morning at the
same time with the same thermometer just
before arising and after at least 4-6 hours of
continuous sleep.
-3 days of elevation indicate temperature change
is due to ovulation
-Abstinence should be observed 5 days before
and 3 days after temperature rise.
IV. Billings or CERVICAL MUCUS METHOD
o A particular type of cervical
mucus felt by the woman at
the vaginal opening is a signal
of ovulation
o Research shows this type of
mucus appears necessary for
conception. Without the
mucus, sperm transport is
impeded.
Phases of Wetness/Dryness
1.Wet – menstruation
2.Dry – basic infertile pattern
- sequence of dry days (or days of unchanging mucus)
indicating low level of estrogen and present infertility
- duration is invariable, could be days, weeks,months or
zero (if cycle is short)
3.Wet – days of possible fertility
-changing mucus; non-slippery at first later
becoming slippery
-peak: last day of slippery mucus
-days 1-3 after the peak are part of fertile period
4.Dry – infertile days
-day 4 after the peak till the end of the cycle
-ends about 2 weeks after the peak
•Fertile period: As soon as you notice your mucus to
be abundant, slippery, watery, thin and stretchable,
consider yourself fertile.Avoid intercouse.
•Infertile Period: Mucus is thick, scant and yellowish
or absent, sexual intercourse is allowed every other
day.
•Check vagina each time you go to the bathroom.
Insert a finger or dap vaginal entrance with toilet
tissue. Compare mucus changes and degree of
wetness each day. Record observations on a chart.
•Douching, vaginal infections, foams, semen,
diaphragm jelly, lubricants, some medications and
lubrication from sexual arousal can alter mucus
findings.
Wet Dry
Fertile - Abundant - Pasty
- stretchy - Adhesive – not fertile
- Transparent - Whitish
V. Lactational Amenorrhea Method
 LAM is based on scientific evidence that a
woman is not fertile and unlikely to become
pregnant during full lactation or exclusive
breastfeeding. Full lactation describes
breastfeeding when no regular supplemental
feeding of any type is given (not even water)
and the infant is feeding both day and night
with little separation from the mother.
LAM provides maximum protection as long
as:
Menstruation has not resumed and
Bottle feeds or regular food supplements are
not introduced and
Baby is less than 6 months of age.
VI. Symptothermal method
-The Symptothermal Method involves
observing changes in the cervical
secretions, along with changes in the basal
body temperature, and the position and
feel of the opening of the cervix. Other
fertility signs such as mid-cycle pain or
bleeding may accompany ovulation.
-Couples who wish to avoid pregnancy
abstain from intercourse during the fertile
period identified by all of the fertility
indicators.
Advantages:
Safe and has no side-effects
Inexpensive
Acceptable to religious affiliations that
do not accept artificial methods of
contraception
Helpful for planning pregnancy and
avoiding pregnancy
Promotes communication about family
planning and contraception between
couples.
Disadvantages:
Involves long preparation and
intensive recording before it can be used.
There is a need to abstain on certain
days which may be inconvenient for the
couple.
Not ideal to women with irregular
cycles.
Not very reliable because of menstrual
cycle variations that may occur anytime.
Other Family Planning Services
Sex Education
It is a broad term used to describe education about
human sexual anatomy, sexual reproduction,
sexual intercourse, and other aspects of
human sexual behavior. Common avenues for sex
education are parents or caregivers, school
programs, and public health campaigns.
Genetic Counselling
Helping people faced with a diagnosis of genetic
disease to understand both the factual
information about the disease and the effect it
will have on their lives, so that they can reach
their own decisions about the future.
Research