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Family Planning I Methods of FP I Dr.Singh
Family Planning: A Key to Health, Development and Empowerment Family planning is a vital component of public health and social development, enabling individuals and couples to anticipate and attain their desired number of children and the spacing and timing of their births. It is achieved through the use of contraceptive methods and the treatment of involuntary infertility. The World Health Organization defines family planning as a way of thinking and living that is voluntarily adopted, based on knowledge, attitude, and responsible decisions, to promote the health and welfare of the family and the community at large. The primary objectives of family planning include improving maternal and child health, reducing unintended pregnancies, controlling population growth, and enhancing the quality of life. It also plays a significant role in achieving gender equality and empowering women by giving them greater control over their reproductive choices. Effective family planning contributes to reducing maternal mortality by preventing high-risk pregnancies and enabling women to recover between births. Family planning methods are broadly classified into temporary (spacing) methods and permanent (limiting) methods. Temporary methods include barrier methods (condoms), hormonal methods (oral pills, injectables, implants), intrauterine devices (IUDs), natural methods (calendar, withdrawal), and newer technological approaches such as fertility awareness apps and long-acting reversible contraceptives (LARCs). Permanent methods involve sterilization procedures like vasectomy for males and tubectomy for females. In India, the government plays a pivotal role through its National Family Welfare Programme. Initiated in 1952, it was the first countrywide population control effort in the world. The program focuses on increasing awareness, accessibility, and availability of contraceptive services, especially in rural and underserved populations. The National Population Policy (2000) further reinforced the commitment to population stabilization and reproductive health. Eligible couples – those where the wife is in the reproductive age group (15–49 years) – are the primary target group for family planning services. The Couple Protection Rate (CPR) is a key indicator used to assess the effectiveness of family planning programs, reflecting the percentage of eligible couples using any method of contraception. The scope of family planning extends beyond contraception. It includes counseling, education, pre-marital advice, safe abortion services, infertility management, and reproductive health services. It promotes informed choices, respect for rights, and integration with other health services like maternal and child health, HIV prevention, and adolescent health. Despite progress, challenges remain. Myths, misconceptions, cultural resistance, gender norms, and inadequate access to services hinder optimal family planning coverage.
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- 2. 2 Contents • Introduction &Definition • Scope and Benefits of Family Planning • National Population Policy & Initiatives • Classification of Contraceptive Methods • Newer Methods in Family Planning • Post-Conceptional Methods (MTP) • Newer Initiatives in Family Planning • Conclusion
- 3. 3 Definition • A wayof thinking and living adopted voluntarily, upon the basis of knowledge, attitudes and responsible decisions by individuals and couples, in order to promote the health and welfare of the family group and thus contribute effectively to the social development of a country.
- 4. 4 Scope of FamilyPlanning 1. Proper Spacing and limitations of birth 2. Advice on sterility 3. Education for parenthood 4. Sex Education 5. Screening – Reproductive system 6. Genetic Counselling 7. Premarital Consultation and examination 8. Preparation of couples for 1st child 9. Services for unmarried mothers 10. Teaching home economics and nutrition 11. Adoption services
- 5. 5 Benefits of Familyplanning A. Women's Health • Reduces maternal mortality & morbidity • Prevents unwanted pregnancies • Ensures optimal birth spacing • Reduces pregnancy risks <20 & >35 years • Prevents anaemia, uterine rupture, and complications B. Foetal Health • Reduces foetal mortality & congenital anomalies • Helps time pregnancies to minimize genetic risks C. Child Health • Reduces neonatal, infant, and child mortality • Promotes growth, nutrition, and disease resistance • Prevents malnutrition and infection in large families
- 6. 6 Small Family Norm •Goal: Stabilize population at 1.53 billion by 2050 • Promotes 2-child norm (Do ya Teen Bas → “Two will do”) • Impacts population growth significantly • Supported by slogans • “Sons or daughters, two will do” • “Second child after 3 years” • “Universal Immunization”
- 7. 7 NATIONAL POPULATION POLICY (NPP)2000 Focus Areas • Women’s education and empowerment • Reproductive health services • Adolescent health and education • Male involvement • Urban poor, tribal, slum populations • NGO collaboration
- 8. 8 Population (Stabilization) Bill,2017 • Suggested raising minimum marriage age for women to 21 years. • Encourages: • Two-child norm. • Proper spacing between children. • Incentives for adoption. • Recreational centers in villages. • Minimum criteria before starting a family.
- 9. 9 Mission Parivar Vikas(MPV) • Launched in 2016. • Targets 146 high fertility districts in 7 states: • Bihar, Uttar Pradesh, Rajasthan, Madhya Pradesh, Chhattisgarh, Jharkhand, Assam. • Goal: Increase access to contraceptive & family planning services. • Focus on high TFR (≥ 3) areas • Affects 40% of India’s population
- 10. 10 Strategic Action • DeliveringAssured Services • Promotional Schemes • Ensuring Commodity Security • Capacity Building • Enabling Environment
- 11. 11 CONTRACEPTIVE METHODS • Contraceptivemethods are preventive measures used to avoid unwanted pregnancies. • They include both temporary (spacing) and permanent (terminal) methods to prevent conception following coitus.
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- 13. 13 BARRIER METHODS • MOA- Prevent sperm from reaching the ovum • Contraceptive Benefits : No hormonal side effects • Non-contraceptive benefits: • Protects against STDs & HIV • Reduces pelvic inflammatory disease • May lower cervical cancer risk
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- 15. 15 Male Condom (NIRODH) •Latex sheath worn over erect penis before coitus • Prevents semen from entering the vagina • May be used with spermicidal jelly for added protection Advantages • Easily available, inexpensive • No prescription or supervision • Protects against pregnancy & STDs • No systemic side effects • Effectiveness: 2–14 pregnancies/100 women-years (user-dependent) Disadvantages • May slip/tear • Can reduce sexual pleasure • Inconsistent usage by men is common
- 16. 16 Female Condom (Femidom) •Polyurethane pouch with: • Inner ring (covers cervix) • Outer ring (remains outside) • Pre-lubricated with silicone • Does not need spermicide Disadvantages • High cost • Lower acceptability • Effectiveness: 5–21 pregnancies/100 women-years
- 17. 17 Diaphragm ("Dutch Cap") •Rubber/plastic cup-shaped barrier • Inserted into vagina to cover cervix • Used with spermicide • Insert before intercourse, keep 6+ hours after Advantages • Minimal side effects • No hormonal involvement Disadvantages • Needs proper fitting by trained personnel • Not practical for rural/low-resource settings • Rarely used in India
- 18. 18 Vaginal Sponge • Polyurethanefoam soaked with nonoxynol-9 spermicide • Inserted vaginally before sex • No STD protection • Effectiveness: • 9–20 per 100 WY (nulliparous) • 20–40 per 100 WY (parous)
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- 20. 20 Mechanism of Action •Contain surface-active agents • Immobilize or kill sperm • Must be inserted before every sex act Limitations • High failure rate if used alone • Require precise application • May cause irritation/messiness • Not ideal for sole contraception
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- 22. 22 Generations of IUDs GenerationType MOA 1st Inert (Lippes Loop) Foreign body reaction → Endometrial changes 2nd Copper IUDs Affects sperm motility/capacitation Biochemical endometrial alterations 3rd Hormonal IUDs Cervical mucus thickening Endometrium becomes unfavourable to implantation
- 23. 23 First Generation IUDs •Inert/Non-medicated: Polyethylene loops, spirals, coils, rings • Example: Lippes Loop • Double “S” shape • Sizes A–D (C/D for multiparous women) • Tail for checking placement • X-ray visible (barium sulphate) • Still used in developing countries
- 24. 24 Second Generation IUDs– Copper-based • Introduced in 1970s; copper enhances anti-fertility action • Earlier devices: Copper-7, Copper-T 200 • Newer devices: • Cu-T 220C, Cu-T 380A/Ag, Nova-T • Multiload devices: ML-Cu-250, ML-Cu-375 • Copper surface area (in sq. mm) determines efficacy
- 25. 25 Third Generation IUDs– Hormonal • Release progesterone or levonorgestrel (LNG) • Progestasert: • 38 mg progesterone; replaced annually • LNG-20 (Mirena): • 20 mcg/day of levonorgestrel • Effective for up to 10 years • Reduces menstrual bleeding and anaemia risk
- 26. 26 IUD Type Lifespan Cu-T380A 10–12 years Nova T 5 years LNG-20 7–10 years Progestasert 1 year Lippes Loop Long-term use OK
- 27. 27 Advantages: • Simple, long-acting,reversible, no systemic side effects • High continuation rate • No daily effort required Contraindications: Absolute Contraindications: • Pregnancy, PID, unexplained bleeding, genital cancers, ectopic pregnancy Relative Contraindications: • Anaemia, menorrhagia, uterine anomalies, poor motivation
- 28. 28 Copper 7 Cu-T200 B Cu-T-380 A Cu-T-220C
- 29. 29 Nova T Multiload375 Progestase rt Levonorgestr el
- 30. 30 Lippes loop Lippes loopin situ
- 31. 31 Complications • Bleeding • Pain •Pelvic Infections (PID) • Uterine Perforation • Pregnancy with IUD in situ • Ectopic Pregnancy • Expulsion • Mortality
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- 33. 33 Hormonal Contraceptives • Amongthe most effective spacing methods of contraception. • Combined oral contraceptives (COCs) are nearly 100% effective when used correctly. • Globally, ~65 million women use oral contraceptives. • In India, approximately 9.52 million women use the pill.
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- 35. 35 Combined Oral Contraceptive(COC) • Initial (1960s) pills: 100–200 mcg estrogen + 10 mg progestogen • Now: 30–35 mcg estrogen + 0.5–1 mg progestogen • Administered: 21 days starting from Day 5 of cycle + 7-day break • Withdrawal bleeding during the break MOA - Suppress gonadotropin → inhibit ovulation. • Thicken cervical mucus • Inhibit tubal motility and sperm/egg transport
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- 37. 37 Government-Supplied COCs • Mala-N(free supply) & Mala-D • Both contain: • Levonorgestrel 0.15 mg • Ethinylestradiol 0.03 mg • Mala-D includes 7 iron tablets (ferrous fumarate 60 mg)
- 38. 38 Progestogen-Only Pills (POPs) •Also known as minipills or micropills • Contain only progestogen: e.g., norethisterone, levonorgestrel • Advantages: • Safer for women at cardiovascular risk • Option for older or high-risk women • Drawbacks: • Irregular bleeding • Higher failure rates than COCs
- 39. 39 Post-Coital Contraception (Emergency) •Effective within 72 hours of unprotected intercourse • Options: • Copper IUD within 5 days • Levonorgestrel 0.75 mg × 2 doses (12 hours apart) • High-dose COCs • Mifepristone 10 mg once • Indications: rape, condom failure, missed pills
- 40. 40 Once-a-Month Pill • Combinesquinestrol (long-acting estrogen) + short-acting progestogen • High failure rate and irregular bleeding • Not acceptable for routine use
- 41. 41 Male Pill –Research Insights • Focus on: • Suppressing spermatogenesis • Blocking sperm transport • Altering seminal fluid • Gossypol (cottonseed oil derivative): causes azoospermia • Risk of permanent infertility (10%) • Toxicity concerns limit clinical use
- 42. 42 Effectiveness • COCs: ~99%effective with correct use • Real-world use: Slightly lower due to missed pills • POPs: • Near-equal efficacy in clinical trials • Lower effectiveness in population settings • Some drug interactions reduce efficacy (e.g., rifampicin, phenobarbital)
- 43. 43 Adverse Effects • CardiovascularEffects • Carcinogenesis • Metabolic Effects Symptom Cause Breast tenderness/fullness Estrogen/Progestogen Weight gain Water retention Headache/Migraine Estrogen Breakthrough bleeding Hormonal imbalance • Other Adverse Effects Liver disorders Lactation Fertility Ectopic pregnancy Foetal development
- 44. 44 Contraindications Absolute Contraindications • Breast/genitalcancer • Active liver disease • Thromboembolic disorders • Cardiac disease • Hyperlipidemia • Unexplained uterine bleeding Relative (Require Monitoring) • Age > 40 or smoker > 35 • Hypertension • Diabetes • Renal disease • Migraine • Gall bladder disease • Lactating mothers (<6 months)
- 45. 45 Depot Formulations • Depotformulations are long-acting, reversible, estrogen-free contraceptives designed for spacing pregnancies with a single administration lasting months or years. Categories • Injectable contraceptives • Subdermal implants • Vaginal rings
- 46. 46 Injectable Contraceptives Types • Progestogen-onlyinjectables • DMPA (Depot-medroxyprogesterone acetate) • NET-EN (Norethisterone enantate) • DMPA-SC (Subcutaneous formulation) • Combined injectables (monthly) – newer category
- 47. 47 DMPA (Depot-medroxyprogesterone acetate) • Dose:150 mg IM every 3 months • Effectiveness: ~99% • Mechanism: • Suppresses ovulation • Alters endometrium and fallopian tubes • Thickens cervical mucus Advantages: • Long-acting, low motivation required • Safe during lactation • Suitable for multiparous women >35 years Side Effects • Weight gain • Irregular/prolonged bleeding • Delayed fertility return (~5.5 months)
- 48. 48 NET-EN (Norethisterone enantate) •Dose: 200 mg IM every 60 days • Mechanism: Similar to DMPA – inhibits ovulation, alters cervical mucus • Failure rate: Slightly higher than DMPA (~0.4%) Injection Guidelines: • First dose: Day 1–5 of menstrual cycle • IM injection into gluteus maximus • Avoid massaging site post-injection • May be given ±14 days from schedule
- 49. 49 DMPA-SC (Depo-subQ Provera104) • Dose: 104 mg subcutaneous injection every 3 months • Sites: Upper thigh or abdomen • Equal efficacy and similar side effect profile to DMPA-IM • Should not be interchanged with IM formulation
- 50. 50 Side Effects Advantages •Irregular bleeding • Amenorrhoea • Weight gain • Delayed fertility return • Highly effective and long-lasting • Minimal compliance required • Useful in postpartum contraception • Checklists allow auxiliary health workers to screen and follow-up users without physician intervention
- 51. 51 Combined Injectable Contraceptives (CICs) Composition: •Contain both progestogen and oestrogen Schedule: • Administered monthly (±3 days) Mechanism of Action: • Suppress ovulation • Thicken cervical mucus → blocks sperm entry • Alter endometrium → prevents implantation
- 52. 52 Injectable Components FailureRate (12-month) Cyclofem / Cycloprovera Medroxyprogesterone acetate + Estradiol cypionate ≤ 0.2% Mesigyna Norethisterone enantate + Estradiol valerate ~0.4%
- 53. 53 Advantages • High efficacy •Fewer menstrual disturbances compared to progestogen-only injectables Limitations • Limited data on return to fertility • Not suitable for fully breastfeeding women <6 months postpartum • Less suitable for women with oestrogen-related risk factors
- 54. 54 Contraindications • Confirmed orsuspected pregnancy • Thromboembolic disorders (past or present) • Stroke or heart disease • Focal migraine • Breast cancer • Diabetes with vascular complications
- 55. 55 Subdermal Implants Example: Norplant •Developed by Population Council, New York • Contains Levonorgestrel 35 mg in 6 silastic capsules • Newer version: Norplant-2 with 2 small rods → Easier insertion/removal Mechanism: • Slow release of progestogen → prevents ovulation Duration: • Effective for >5 years • Reversible upon removal
- 56. 56 Effectiveness: • 3-year pregnancyrate: ~0.7% Disadvantages: • Requires minor surgical procedure • Irregular menstrual bleeding common
- 57. 57 Vaginal Rings • Containlevonorgestrel • Inserted into the vagina • Worn for 3 weeks, removed for 1 week Mechanism: • Slow hormone release through vaginal mucosa • Bypasses liver → lower systemic dose Advantages: • User-controlled • High compliance and convenience
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- 59. 59 Centchroman (Chhaya) • Alsoknown as the weekly pill • Contains Ormeloxifene (a selective estrogen receptor modulator) Schedule: • First 3 months: 2 pills/week (3 days apart) • From 4th month: 1 pill/week (same day every week)
- 60. 60 Initiation Timing: • Day1 of period • Day of abortion • Within 4 weeks postpartum (regardless of breastfeeding) Advantages: • Non-hormonal, no impact on lactation • Minimal side effects • Long-term reversible contraception
- 61. 61 Miscellaneous Methods ofFamily Planning
- 62. 62 Miscellaneous Methods ofFamily Planning i. Safe Period/ Rhythm Method • Start of Ovulation till 48 hours (fertilization period) – Avoid Intercourse during this time. ii. Withdrawal Method (Coitus Interruptus) • Withdrawal of penis before ejaculation. • High Failure rate – i. Pre Ejaculatory Emission ii. Fail to withdraw on time
- 63. 63 • Lactational Ammenorrhoea– After delivery there is ammenorrhoea (due to high estrogen and progesterone) due to intense lactation. • Useful only upto 6 months.
- 64. 64 Birth Control Vaccines(Experimental) • Immunological method under research • Target: hCG (β sub-unit) to block pregnancy maintenance • Antibodies develop in 4–6 weeks, peak at 5 months • Immunity lasts 6–11 months; can be boosted • Currently in trials; not yet available • Uncertainty remains
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- 66. 66 Terminal Methods (Sterilization) Overview •Permanent method for couples who have completed their family. • In India: ~85% female sterilizations, ~10–15% male. • Male sterilization is simpler, safer, cheaper than female. Advantages • One-time method, highly effective. • No need for ongoing motivation. • Very low failure rate. • Cost-effective (prevents 1.5–2.5 births per woman).
- 67. 67 Eligibility Guidelines (Govt.of India) • Husband: 25–50 years; Wife: 20–45 years. • Minimum 2 living children (flexibility if ≥3). • Voluntary consent, no coercion. • Declaration of spousal consent and irreversibility.
- 68. 68 Male Sterilization (Vasectomy) •Minor surgery under local anaesthesia; can be done at PHC level. • Vas is cut, ends ligated, folded back. • Not immediately effective: ~30 ejaculations required for sterility. • Sperm production and hormones remain unaffected. • Much cheaper and faster than tubectomy.
- 69. 69 Complications • Minor: Pain,scrotal haematoma, wound infection (~3%). • Sperm granuloma: Painful swelling; may cause recanalization. • Spontaneous recanalization: 0–6% risk; follow-up important. • Autoimmune response: Sperm antibodies—may reduce fertility post reversal. • Psychological: May occur if done under pressure.
- 70. 70 No-Scalpel Vasectomy • Minimallyinvasive, safe, and more acceptable. • Promoted under national programme with UNFPA support. • Aim: Increase male participation in family planning.
- 71. 71 Female Sterilization (a) Laparoscopy •Performed via abdominal route using a laparoscope. • Abdomen inflated with CO , N O or air ₂ ₂ to visualize fallopian tubes. • Falope rings or clips applied to occlude tubes. • Requires specialist Ob-Gyn. • Benefits: • Short operating time • Minimal scar • Shorter hospital stay
- 72. 72 Minilaparotomy (Minilap) • Modifiedabdominal tubectomy. • Requires only 2.5–3 cm incision. • Done under local anaesthesia. • Uses Pomeroy technique. • Simple, safe, and efficient. • Suitable for PHC-level services and mass campaigns. • Preferred method for postpartum sterilization.
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- 74. 74 Definition: • Aspiration ofuterine contents 6–14 days after a missed period, before confirmation of pregnancy via test. Procedure: • Minimal or no cervical dilation (except in nullipara or apprehensive subjects) • Typically no aftercare required 1. Menstrual Regulation
- 75. 75 2. Menstrual Induction Mechanism: •Uses Prostaglandin F2 (1–5 mg solution or 2.5–5 mg pellet) • Intrauterine application under sedation Effects: • Sustained uterine contraction → initiates menstruation • Bleeding starts within minutes and may last 7–8 days
- 76. 76 3. Oral Abortifacient:Mifepristone + Misoprostol (Medical Abortion) Mechanism: • Disrupts progesterone support to pregnancy • Induces uterine contractions Indication: • Effective up to 9 weeks of gestation • Success rate ~95%
- 77. 77 Standard Regimen (MTPKit): • Day 1: Mifepristone 200 mg orally • 6–8 hours later (or same day): Misoprostol 800 mcg vaginally (4 x 200 mcg tablets) Alternative Regimen: • Day 1: Mifepristone 600 mg orally • Day 3: Misoprostol 400 mcg orally
- 78. 78 Abortion Definition • Termination ofpregnancy before fetal viability, defined administratively as before 28 weeks (approx. 1000 g). • Used for various reasons, including birth control. Type Description Spontaneous Occurs naturally in ~1 out of 15 pregnancies ("Nature's method of birth control") Induced Deliberate termination—legal or illegal
- 79. 79 Complications Early • Hemorrhage, shock,sepsis • Uterine perforation • Cervical injury, thromboembolism • Anaesthetic & psychiatric complications Late • Infertility, ectopic pregnancy • Increased spontaneous abortion • Low birth weight
- 80. 80 Legalization of Abortionin India The MTPAct, 1971 (amended 2020) A health measure to reduce illegal abortions and promote maternal health. Key Provisions: 1.Conditions for Termination: 1. Medical: Threat to mother's life or health 2. Eugenic: Risk of fetal abnormalities 3. Humanitarian: Pregnancy due to rape 4. Socioeconomic: Adverse living conditions 5. Failure of Contraception: Unique to Indian law
- 81. 81 1.Who can perform: 1.RMPs (Registered Medical Practitioners) with training in OBG 2. 1 RMP up to 12 weeks; 2 RMPs from 12–20 weeks 3. Now up to 24 weeks in special cases (2020 Amendment) 2.Where: 1. Only at government hospitals or approved facilities 2. Abortion records are strictly confidential
- 82. 82 MTP Rules (1975,amended) Changes: • Certification simplified: CMO can approve doctors/facilities • RMPs eligible if they: • Assisted in 25 MTPs • OR have PG qualification / house job / OBG experience Private Sector Inclusion: • Private clinics can perform MTP after district-level approval
- 83. 83 Impact and CommunityStrategy Challenges: • Despite legal framework: • Illegal abortions: 13.5/1000 pregnancies • Legal abortions: 6.1/1000 pregnancies → 2/3 abortions still occur outside legal services
- 84. 84 Post-2003 Amendments Decentralization ofMTP centre approvals to districts Community Strategy: • Promote awareness of safe abortion • Train ASHA/ANM/AWWs for counselling • Promote post-abortion care with confidentiality Facility Strategy: • Provide Manual Vacuum Aspiration at CHCs, 50% PHCs • Ensure high-quality MTP at all FRUs • Involve NGOs/private sector
- 85. 85 Supreme Court Ruling,Oct 2022 • Rule 3B now applies not just to married women • Unmarried women can seek abortion between 20–24 weeks if there is a change in relationship status (e.g., breakup, desertion, death)
- 86. 86 Newer Initiatives inFamily Planning
- 87. 87 Newer contraceptive • Antara-Injectablehormonal contraceptive – DMPA • Chhaya-OCP-Centchroman • ASHA-all contraceptive under government of India are given a brand name ASHA
- 88. 88 Fixed day staticapproach • Sterilization services • Twice a week - District hospital • Weekly-Sub-district hospital • Fortnightly-CHC • Monthly-PHC
- 89. 89 Social marketing • Seeksto influence social behaviour not to benefit the marketers but to benefit the target audience & general society • Examples of social marketing-installation of condom vending machines (CDM's) at petrol pumps, parks, public toilets, bus/railway stations, bars, restaurants etc.
- 90. 90 Pregnancy testing kit •Nishchay kit - At Subcentre or through ASHA • Nishchay Home delivery of contraception (by ASHA) • Rs. 1 (3 condom per pack) • Rs. 1 (1 OCP per cycle) • Rs. 2 (1 tab of emergency contraceptive pill)
- 91. 91 Ensuring spacing atbirth • Introduction of post partum IUD insertion • Use of Short term IUD- Cu T 375 - (5 years) ASHA gets • Rs. 500 for delaying 1st child birth by 2 years after marriage • Rs. 500-for ensuring spacing of 3 year after the birth of 1st child • Rs. 1000-if couple opts for sterilisation upto 2 children
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- 93. 93 • Family Planningis a vital public health tool to promote the health of mothers, children, and families while supporting population stabilization and socioeconomic development. • It includes a broad scope: spacing and limiting births, preventing unintended pregnancies, promoting maternal and child health, and enhancing quality of life. Contraceptive methods are classified into: • Temporary methods – Barrier methods, Intrauterine devices (IUDs), Hormonal methods (oral pills, injectables, implants), Emergency contraception, Natural methods. • Permanent methods – Male and female sterilization. • The choice of method depends on individual needs, health status, reproductive goals, and access. • Government initiatives like the National Population Policy (2000) and Mission Parivar Vikas focus on increasing access, promoting small family norms, and ensuring informed choices. • Family planning empowers couples, especially women, to make informed decisions, thus contributing to improved health outcomes and national development.
- 94. 94 Modern advancements infamily planning offer safer, longer-acting, and more user-friendly contraceptive options: • Injectable Contraceptives like DMPA, NET-EN, and DMPA-SC provide 3-month protection with high efficacy and minimal user effort. • Subdermal Implants (Norplant, Norplant-2) release progestogens over years, ensuring reversible, long-term contraception. • Vaginal Rings offer self-administered hormonal delivery with a monthly cycle— convenient and discreet. • Centchroman (Chhaya) – a non-hormonal, weekly oral pill unique to India; minimal side effects, safe for lactating women. • Male Pills and Birth Control Vaccines are still in trial phases, focusing on targeting sperm production or early pregnancy maintenance hormones.
Editor's Notes
- #3 Objectives Avoid unwanted births. Ensure wanted births. Regulate intervals between pregnancies. Control timing of births in relation to parents’ ages. Determine the number of children in a family
- #4 Potential Partner, couples, infertile couple,
- #7 Immediate: Address unmet needs for contraception and health infrastructure gaps. Medium-term: Achieve replacement-level TFR (2.1) by 2010. Long-term: Achieve a stable population by 2045 in line with economic and social development.
- #10 Strategic Action 1 – Delivering Assured Services Use of injectable contraceptives (ANTARA Program) Training of doctors, nurses, ANMs IEC activities Incentives: ₹150 to ASHA, ₹300 to acceptors Condom boxes at health facilities Strategic Action 2 – Promotional Schemes Nayi Pahel: FP kit for newlyweds Saas Bahu Sammelan: Community discussions on FP & reproductive health Saarthi – Awareness on Wheels Strategic Action 3 – Ensuring Commodity Security Monitoring supply and consumption of FP commodities Appointment of FP Logistic Managers in all 7 focus states Strategic Action 4 – Capacity Building Training doctors & nurses Focus: Injectable contraceptives and PPIUCD Strategic Action 5 – Enabling Environment Advocacy for population stabilization Inter-sectoral convergence for TFR reduction Promoting health of mother and child
- #11 Ideal criteria: Safe, effective, acceptable Inexpensive, reversible Simple to use, coitus-independent Long-acting, low medical supervision Suitability varies by culture, religion, and socio-economic status.
- #17 Cervical cap, vault cap, vimule cap
- #22 IUD = Small, T-shaped device inserted into the uterus to prevent pregnancy Two main types: Non-medicated (Inert) Medicated (Copper / Hormonal) Material: Polyethylene or polymer; radio-opaque (barium sulphate)
- #24 Advantages: High effectiveness (5–12 years) Post-coital use within 3–5 days Better suited for nulliparous women
- #31 Bleeding Most common reason for removal (10–20%) Types: Heavy/prolonged menses Mid-cycle bleeding Risk: Iron-deficiency anaemia Management: Iron supplements Switch to copper/hormonal IUDs if persistent Remove IUD if bleeding/anemia worsens Pain Affects 15–40% users Types: Post-insertion cramps Menstrual cramps, backache, thigh pain Causes: Improper placement, uterine perforation, infection Management: Analgesics (aspirin/codeine) Replace with smaller/copper IUD if needed Pelvic Infections (PID) Risk 2–8x higher than non-users Caused by bacteria introduced during insertion or ascending via IUD tail Common organisms: Gardnerella, Bacteroides, Actinomyces Symptoms: Discharge, pelvic pain, fever Management: Broad-spectrum antibiotics Remove IUD if no improvement in 24–48 hours Counsel sexually active women about STD risks Uterine Perforation Incidence: 1 in 150 to 1 in 9000 insertions Higher with poor technique, immediate postpartum May be asymptomatic Diagnosis: Pelvic X-ray Management: Removal of IUD mandatory Pregnancy with IUD in situ Failure rate: ~3% first year Risks: 50% chance of spontaneous abortion Premature birth 4x more likely Management: If pregnancy continues: Remove IUD if threads visible If threads not visible, assess for infection Induced abortion is an option Ectopic Pregnancy Rare but serious Symptoms: Abdominal pain, amenorrhoea, scanty bleeding Risk factors: Previous PID, ectopic pregnancy Levonorgestrel IUD reduces ectopic risk due to partial ovulation suppression Expulsion Incidence: 12–20% More common: Postpartum insertions Nulliparous women Diagnosis: Visible IUD stem or missing threads Clinical relevance: Undetected expulsion may lead to pregnancy Mortality Extremely rare: ~1 per 100,000 woman-years Causes: Septic abortion, ectopic pregnancy
- #35 Taken daily at same time, preferably bedtime If missed: Take immediately upon remembering Take next pill at usual time Irregular timing reduces efficacy
- #39 Failure rate <1%, but... If method fails: Some recommend being prepared for abortion No proven teratogenicity, but doubts remain
- #42 Contraceptive Benefit Non-Contraceptive Health Benefits Nearly 100% effective when taken correctly. May offer protection against: Benign breast disease Ovarian cysts Iron-deficiency anaemia Pelvic inflammatory disease Ectopic pregnancy Ovarian cancer
- #43 1. Combined oral contraceptives (COCs) have been associated with increased cardiovascular mortality, particularly: Myocardial infarction Cerebral and venous thrombosis Risk is dose-dependent on estrogen and worsens with increasing age and smoking. Reduction in estrogen and progestogen content in pills has minimized, but not eliminated, vascular risks. 2. Carcinogenesis WHO review: No conclusive link between COC use and most cancers. Some studies indicate a possible increased risk of cervical cancer with long-term use. Requires further investigation. 3. Metabolic Effects Associated with: Raised blood pressure Decreased HDL levels Altered carbohydrate metabolism (↑ blood glucose and insulin) Risks correlate with progestogen dose. May accelerate atherogenesis, increasing MI and stroke risk over time.
- #62 No cost, no devices Male withdraws before ejaculation High failure rate (~25%) due to: Presence of sperm in pre-ejaculate Timing errors Previously overestimated side effects (e.g., anxiety, pelvic congestion) Historically important in reducing birth rates in the 18th–19th centuries Safe Period Based on ovulation: 12–16 days before menstruation Fertile period = Shortest cycle −18 to Longest cycle −10 If cycles range 26–31 days → fertile period = day 8 to 21 Practical advice: Avoid sex from day 8–22 Drawbacks: Irregular cycles make prediction difficult Requires high motivation and education Failure rate ~20% Risk: ectopic pregnancy, embryonic abnormalities Optional visual: Insert Figure showing Safe and Fertile Period (can be redesigned for clarity)
- #63 Prolongs postpartum amenorrhoea Effectiveness: 90–95% during amenorrhoeic period Risk of pregnancy increases once menstruation resumes By 6 months: ~20–50% women menstruate → need contraception
- #64 Abstinence – 100% effective but impractical Coitus Interruptus – Convenient, but high failure rate Safe Period – Based on cycle; unreliable with irregular cycles Natural Methods – Require motivation, training Breastfeeding – Temporary; only during amenorrhoea Vaccines – Promising but experimental
- #71 Timing Can be done: As interval procedure Postpartum At time of abortion (concurrent with MTP)
- #74 Complications Immediate: Uterine perforation, trauma Delayed (after 6 weeks): Infertility Menstrual irregularities Ectopic pregnancy Risk of Rh immunization Premature labour or abortions Advantages Simple and safe when performed early Legally unrestricted in many settings Often viewed as treatment for delayed menstruation
- #79 Mortality rates (unsafe abortion): 30/100,000 in developed nations 220/100,000 in developing regions 520/100,000 in Sub-Saharan Africa