Family Planning

Family planning
and Responsible Parenthood

What is Family Planning?
… is achieving desired family size and proper
birth spacing.
• Desired family size is having only

the number of children that a
couple wants to have
• Optimal birth spacing is having
children born at least 3-5 years
apart.
Key facts
 An estimated 200 million couples in developing countries would

like to delay or stop childbearing but are not using any method of
contraception.
 Some family planning methods help prevent the transmission of
HIV and other sexually transmitted infections.
 Family planning reduces the need for unsafe abortion.
 Family planning reinforces people’s rights to determine the
number and spacing of their children.
Benefits of family planning
 Preventing pregnancy-related health risks in women

 A woman’s ability to space and limit her pregnancies has a direct
impact on her health and well-being.
 Family planning allows spacing of pregnancies and can delay
pregnancies in young women at increased risk of health problems
and death from early childbearing. This reduces maternal mortality.
 Reducing infant mortality

 Family planning can prevent closely spaced and ill-timed
pregnancies and births, which contribute to some of the world’s
highest infant mortality rates.
 Infants of mothers who die as a result of giving birth also have a
greater risk of death and poor health.
 Helping to prevent HIV/AIDS

 Family planning reduces the risk of unintended pregnancies
among women living with HIV, resulting in fewer infected
babies and orphans.
 In addition, male and female condoms provide dual protection
against unintended pregnancies and against STIs including HIV.
 Reducing the need for unsafe abortion

 By reducing rates of unintended pregnancies, family planning
reduces the need for unsafe abortion, which accounts for 13%
of global maternal mortality.
 Empowering people
 Family planning enables people to make informed choices about
their sexual and reproductive health.
 Reducing adolescent pregnancies

 Pregnant adolescents are more likely to have preterm or low
birth-weight babies.
 Babies born to adolescents have higher rates of neonatal
mortality.
 Many adolescent girls who become pregnant have to leave
school. This has long-term implications for them as individuals,
their families and communities.
 Slowing population growth

 Family planning is key to slowing unsustainable population
growth and the resulting negative impacts on the economy,
environment, and national and regional development efforts.
Responsible parenthood
➢ Is the will and ability of parents to respond to the needs and
aspirations of the family and children.
➢ It is a shared responsibility of the husband and the wife to

determine and achieve the desired number, spacing and
timing of their children according to their own family life
aspirations, taking into account psychological preparedness,
health status, socio-cultural and economic concerns.
The Family Planning
Methods
Classification of Modern FP Methods
I. Temporary Methods
• Fertility Awareness Based Methods
• Hormonal Contraceptives
• Intra-Uterine Device (IUD)
• Condom
II. Permanent Methods
• Bilateral Tubal Ligation (BTL)
- Minilap Under Local Anesthesia
• Vasectomy
- No Scalpel Vasectomy (NSV)
Summary of Contraceptive Methods
• Hormonal Methods • Natural Family Planning

▫ Oral contraceptives ▫ Periodic abstinence
▫ DMPA ▫ Calendar Method
• Barrier Methods ▫ Withdrawal Method
▫ Spermicides ▫ Lactational Amenorrhea
▫ Condoms
▫ Diaphragm, cervical cap • Surgical Methods
▫ Intrauterine device (IUD) ▫ Female sterilization
Fertility Awareness-Based Methods ▫ Male sterilization
▫ Calendar method
▫ Cervical mucus
▫ Basal Body temperature
Modern Family Planning Methods
SAFE AND
EFFECTIVE
DO NOT DISRUPT
PREGNANCY
Temporary (Spacing) Methods
Fertility Awareness Based Methods
• Basal Body Temperature

• Mucus (Cervical Mucus) Method
• Symptothermal Method
• Standard Days Method (SDM)
• Lactational Amenorrhea Method
Fertility Awareness Based Methods
Nature
• utilizes the signs and symptoms of female
fertility to avoid or achieve pregnancy
Mechanism of Action
• prevents fertilization by abstinence during
fertile periods of the woman
The Cervical Mucus Method
1.) Check the cervical secretions daily
2.) Avoid sex or use a barrier method or withdrawal if slippery
secretions are present , or can be stretched . Avoid sex until 4
days after the peak day
Basal Body Temperature Method
To identify the end of the fertile time
1. Woman takes her body temp either orally, rectally or
vaginally each morning
2. One must know how to read a thermometer
3. A woman’s temperature rises 0.2°C to 0.5 °C (0.4
to 1 °F) around the time of ovulation (about midway
through the menstrual cycle for many women.
Basal Body Temperature
 The couple avoids sex, uses a barrier method or uses
withdrawal from the 1st day of menstrual bleeding until
the woman’s temperature has risen above her regular
temperature and stayed up for 3 full days. This means
that ovulation has occurred and passed.
 After this, the couple can have unprotected sex (over the
next 10 to 12 days) until the next menstrual bleeding
period begins.
Cervical Secretions + Basal Body Temperature To
Identify the Start and End of the Fertile Time
1. The couple starts avoiding unprotected sex when the
woman senses cervical secretions
2. The couple keeps avoiding unprotected intercourse until
BOTH the fourth day after peak cervical secretions AND
the third full day after the rise in temperature (BBT)
3. If one of these events happens before without the other, the
couple waits for the other event before having unprotected
sex
4. Other signs and symptoms of ovulation are abdominal pain,
cervical changes, breast tenderness
The Calendar (Rhythm) Method to Identify the
Start and End of the Fertile Period
1. Before using this method, the woman must record the
number of days in each menstrual cycle for at least 6
months. The first day of the menstrual bleeding is always
counted as 1.
2. The woman subtracts 18 from the length of her shortest
recorded cycle. This tells her estimated first day of her
fertile time .
3. Then she subtracts 11 days from the length of her longest
recorded cycle. This tells her the last day of her fertile time.
4. The couple avoids sex, uses barrier method, or uses
withdrawal during the fertile time.
Example:
If her recorded cycle vary from 26 to 32 days,
26 – 18 = 8 → Start avoiding unprotected sex
on day 8
32 – 11 = 21→ Okay to have unprotected sex
again AFTER day 21
She must avoid unprotected sex from day 8 to through day 21 of
her cycle. (14 days of avoiding unprotected sex)
 The calendar method may require 16 days or more in a row of
avoiding sex or using withdrawal or a barrier method in each
cycle, especially for women with irregular menstrual cycles.
 For this reason, the BBT method or barrier methods during the
fertile days are often recommended along with the calendar
methods
Standard Days Method
• new method of Natural Family Planning

• only women with 26-32 day cycles can use it
• utilizes “necklace” or cycle beads
• Simply no sex or use other method of contraception
on days 8-19 of the menstrual cycle
Lactational Amenorrhea Method
(LAM)
 Uses breastfeeding as a temporary family planning
method
 Woman is protected from pregnancy if:
 Her baby gets at least 85% of his or her feedings as breast milk
 Her menstrual periods had not yet returned
 Her baby is less than 6 months old
 Protection can extend to 9-12 months if she regularly breast
feeds
 Makes sure that the baby gets the needed nutrients on
the early stages of life
Effectiveness of the LAM
 Effective as commonly used
 2 pregnancies per 100 women in the first 6 months after child
birth (1 in every 50)
 Very effective when used correctly and consistently - 0.5
pregnancies per 100 women in the first 6 months after child
birth ( 1 in ever 200)
Can a Woman use LAM?
1.) Have your menstrual periods returned?
2.) Are you regularly giving the baby much other food besides
breast milk or allowing long periods of NOT breastfeeding?
3.) Is your baby more than 6 months old?
If the answer is YES to any one of the above→ increased chance of

pregnancy to occur
If the answer to ALL is NO→ she can use LAM
When Using LAM
 Breast feed often
 Breast feed properly
 Start other foods when the baby is 6 months old
 Start another FP method if menses have resumed
 (bleeding in the first 56 days or 8 weeks after childbirth is not NOT
considered menstrual bleeding)
 If she stops fully or nearly fully BF
 Her baby is 6 months old (about the time the baby starts sitting up)
 She no longer wants to rely on LAM for family planning
Lactational Amenorrhea Method (LAM)
Nature
• Physiological
infertility
experienced by
breastfeeding
women
Mechanism of Action
• Inhibits ovulation
Conditions for LAM
 fully or nearly fully breastfeeding
 no menses yet
 baby is less than 6 months old

Low Dose Combined Oral
Contraceptives
Nature
• contains
hormones
(estrogen and
progestin) in
low doses
Mechanism of Action
• inhibits ovulation (release of eggs from
the ovaries)
• thickens the cervical mucus
Advantages
• very effective (99.9%)

• monthly periods are regular, lighter, with
fewer days of bleeding
• can be used as long as woman wants to
prevent pregnancy
• does not interrupt sex
• prevents anemia
• prevents uterine and ovarian cancer
Disadvantages
• clients must take a pill as long as she does not
want to be pregnant
• not recommended for breastfeeding or
hypertensive women
• does not protect against sexually transmitted
infection
Possible Side Effects

• Nausea
• Headache
Progestin Only Oral Contraceptives
Nature
• contains very small amount
of only 1 hormone
(progestin)
• does not contain estrogen
Mechanism of Action
• inhibits ovulation (release of eggs from the
ovaries)
Advantages
• can be used by breastfeeding women six

weeks after childbirth
• very effective when used correctly
• reversible method
• prevents benign breast disease and cancer of
the uterus and ovary
Disadvantages
• requires daily pill intake

• should be taken at about the same time
each day (delay of at least 3 hours
increases risk for pregnancy)
• does not protect against sexually-
transmitted infections
• changes in menstrual bleeding including

irregular periods, spotting or bleeding
between periods
• few women have heavy or prolonged
menstrual periods
• less common side effects include
headache and breast pain
Injectable Contraceptives
Types
• DMPA (Depo-Provera,
DepoTrust, Lyndavel)
• Norethindrone
enanthate (Noristerat,
NET-EN)
Nature
• long acting contraceptives that provide
protection for 2 or 3 months per injection
• contains only progestin
Mechanisms of Action
• inhibits ovulation
Advantages/Benefits
• can be used by breastfeeding women six weeks

after childbirth
• highly effective when regularly spaced three
months apart
• long term pregnancy prevention
• no daily pill-taking
• offers privacy to user
• helps prevent uterine and ovarian cancers
Disadvantages
• delay in return of fertility

• requires another injection after two or three
months
• offers no protection against STIs, including
HIV infection
• changes in menstrual bleeding including

spotting and amenorrhea
• long return to fertility
Contraceptive Patch
A thin transdermal patch that contains hormones

(estrogen and progestin)
Mechanism of Action
• Inhibits ovulation
• Put a new patch on
every week for 3 weeks
• Very effective: 99.0%
• Convenient & simple
• No daily pill intake
Disadvantages
• Less effective in women weighing > 90 kg.
• Affects breast milk
• Does not protect against STI/HIV
Side Effects
• Headache
• Menstrual bleeding irregularities

Condom
Nature
• thin sheath
made of latex
rubber that fit
over the erect
penis
Mechanism of Action
• keeps sperm out of the vagina
Advantages
• effective when used correctly and

consistently
• can be bought in drugstores and other
commercial outlets
• encourages male participation
• only method that protects against STI
including HIV/AIDS
• helps prevent premature ejaculation
Disadvantages
• condom can weaken if stored too long

• man’s cooperation is needed
Intra-Uterine Device (IUD)
Nature
• a small device in the shape of a “T” introduced
into uterus to prevent pregnancy
Mechanism of Action
• Prevents the sperm and egg from meeting
Advantages
• Very effective: 99.2-99.4%
• Long acting: 10 years
• Does not interrupt sex
• Does not affect breast milk

Disadvantages
• Must be inserted and removed by a trained

health worker
• Does not protect against STI/HIV
Side Effects
• Mild abdominal pain
• Longer and heavier menstrual periods
Permanent Family
Planning Methods
Bilateral Tubal Ligation (BTL)
Nature
• A surgical technique
of contraception
where both fallopian
tubes of the woman
are tied and cut
Mechanism of Action
• Prevents sperm and
egg from uniting by
blocking the fallopian
tubes
Advantages of BTL
 very effective (99.9%)
 simple, out-patient, minor procedure
 permanent (one-time procedure leads to lifelong, safe,

and very effective family planning)
 does not affect female hormonal balance
 does not lessen couple’s sexual desire and enjoyment

Disadvantages of BTL
 Needs a trained surgeon to do the procedure

 Reversal is difficult, expensive, and success is
not guaranteed
 Does not protect against STIs including HIV/AIDS
Possible Side Effect

 Minor pain or swelling at operative site
No-Scalpel Vasectomy (NSV)
Nature
• a minor surgical
operation wherein
the vas deferens of
the man are tied and
cut
Mechanism of Action
• prevents the passage
of the sperm into the
female reproductive
organ during
intercourse
Advantages of Vasectomy
 very effective (99.85%)
 safe, simple, and easy to perform
 does not affect man’s ability to have sex
 does not lessen couple’s sexual desire and enjoyment
 no known side effects or health risks
 compared to BTL, vasectomy is:
- slightly more effective
- safer
- easier to perform
- less expensive
- able to be tested for effectiveness at any time

Disadvantages of Vasectomy
 Can be performed only by trained provider

 Not immediately effective; the couple should
use another method until the sperm count is
negative
 Reversal procedure is more difficult, expensive,
and not available in many places
 Does not protect against STI/HIV
Possible Side Effect

 Minor pain or swelling at operative site

Family Planning

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Family planning

and Responsible Parenthood

… is achieving desired family size and proper

• Desired family size is having only

 An estimated 200 million couples in developing countries would

 Preventing pregnancy-related health risks in women

 Reducing infant mortality

 Helping to prevent HIV/AIDS

 Reducing the need for unsafe abortion

 Reducing adolescent pregnancies

 Slowing population growth

➢ It is a shared responsibility of the husband and the wife to

• Hormonal Methods • Natural Family Planning

Fertility Awareness Based Methods

• Basal Body Temperature

• new method of Natural Family Planning

If the answer is YES to any one of the above→ increased chance of

 fully or nearly fully breastfeeding

 baby is less than 6 months old

• very effective (99.9%)

Possible Side Effects

• can be used by breastfeeding women six

• requires daily pill intake

• changes in menstrual bleeding including

• can be used by breastfeeding women six weeks

• delay in return of fertility

• changes in menstrual bleeding including

A thin transdermal patch that contains hormones

• Less effective in women weighing > 90 kg.

• Affects breast milk

• Does not protect against STI/HIV

• Menstrual bleeding irregularities

• effective when used correctly and

• condom can weaken if stored too long

• Prevents the sperm and egg from meeting

• Very effective: 99.2-99.4%

• Long acting: 10 years

• Does not interrupt sex

• Does not affect breast milk

• Must be inserted and removed by a trained

 very effective (99.9%)

 simple, out-patient, minor procedure

 permanent (one-time procedure leads to lifelong, safe,

 does not affect female hormonal balance

 does not lessen couple’s sexual desire and enjoyment

 Needs a trained surgeon to do the procedure

Possible Side Effect

 very effective (99.85%)

 safe, simple, and easy to perform

 does not affect man’s ability to have sex

 does not lessen couple’s sexual desire and enjoyment

 no known side effects or health risks

 compared to BTL, vasectomy is:

- slightly more effective

- able to be tested for effectiveness at any time

 Can be performed only by trained provider

Possible Side Effect

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