Family planning

Family planning methods

Family planning (WHO definition)

Involves cognitive decisions and behavioral practices that help individuals or couples avoid unwanted births, bring about wanted births, regulate the intervals between pregnancies, and determine the number of children in the family.

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Aims of the FPM to promote health to:

1. The mother give chance for more care and decreased her weight and protect from any diseases such as anemia.

2. The child give chance for more care and breastfeeding.

3. Family and community, socioeconomic aspects, decreases infant and maternal morbidity and mortality rate.

Any pregnancy must be planned before 3 months from the occurrence of the pregnancy. Our job as a counselors and educators, provide proper assessment discuss with the couples the benefits and side effect for each method and give family the chance to choice the suitable method.

Family planning & JordanAccording to 2007 JPFHS:

-Fertility rate is 3.7

-Contraceptive Prevalence rate for married women in the 2007 JPFHS is 57%: 42% using modern methods, 15% using traditional methods.

-All over married women in Jordan know at least one method of family planning.

-Among modern methods the pills 38% and IUD 47% are the best known.

-The least recognized methods were emergency contraception & female condom (one percent or less)

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Methods of the family planning

Natural methods

Breastfeeding: increased blood prolactin level lead to decreased estrogen and progesterone levels( suppression of the ovulation).

Breastfeeding (LAM, lactation amenorrhea method), highly effective first 6 months after delivery if breastfeeding regular and frequently and infant age less than 6 months and 1st mens after delivery occur after 56 days.

Exclusive breastfeeding.

Coitus interrupts: withdrawal of the penis prior to ejaculation.

Uncontrolled method leakage of the seminal fluids, high failure rate).

Abstinence: avoiding sexual intercourse around the time of ovulation. Ovulation associated with watery vaginal discharge and increase body tempreture0.3-0.5 c.

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Vaginal douching: douching after intercourse, not safe method because sperm can reach the internal cervical os with 90 sec of ejaculation.

Calendar or rhythm method: used to calculate the period during which intercourse is most likely to result in pregnancy, 2 days before and 2 days after the time of ovulation.

Barrier methods

Male condom: cover the penis with condom to prevent the sperm from entering the vagina, failure rate 3%, decreased to 2% if used with spermicidal with the condoms.

Male may not accept it because it is decrease enjoyment.

Not safe may rupture and leakage the sperm.Other method not usable in our MCHC:Female condom( 8 hrs before sexual

intercourse)

Diaphragm ( for 6 hrs after sexual intercourse) and not more than 24 hrs.

Failure rate is 6%.Cervical cap: can remain in place for 24-

48hrs.Vaginal supp and vaginal foam.All these methods high failure rate

around 25%.

Intrauterine device IUDT shape inserted into the uterine cavity through the

cervix to prevent the pregnancy, failure rate less 1%.Can insert within 10 mints after delivery of the placenta

or 5 days of the mens cycle.Copper for 7 years, mirena for 5 days.Complication:Perforation of the uterus.Not recommended for woman who have cardiac

disorder, DM, salpingitis.Adverse reaction: dysmenorrhea, infection, PID,

irregular mens, expulsion 10%, increase incidence of spontaneous abortion, and premature labor.

Contraindication: liver disease, copper allergy, uterine abnormality, pelvic infections, breast cancer mirena.

Hormonal therapy

Injectable type( Depo-Provera): long acting injection, single injection is given every 3 month.

Progestin: it alter the cervical mucus and impair ovulation and implantation.

Adverse effect: menstrual spotting, headache, wt gain.Advice the woman to take additional ca++ and exercise

to minimize the risk of osteoporosis.The injection site should not be massage to avoid

altering absorption rate.The effect of the injection may last up 1 year after

injection.

Implant contraceptive ( nor plant): Norplant progestin implant consist of 6 subdermal hormonal implants effective for 5 yrs.

Act by suppressing ovulation.Increase thickness of the cervical mucus

which inhibit sperm penetration.

Oral contraceptive: Prevent pregnancy by suppressing ovulation

and increase thickness of the cervical mucus and alter the lining layer of the uterus to prevent implantation. Effectiveness rate 99%.

Two types:1. Minipill progesterone only used for lactated

woman.2. Combination estrogen and progesterone, more

effectives (suppression ovulation), use for non lactated women.

It is important to take the pill at the same time daily to keep the hormone levels stable. If one or two pills is missed take it as soon as her remember it.

If more than 2 used another method such as male condom.

Adverse effect: thrombosis, pulmonary embolism, MI, stroke, HTN, headache, infection, cervical cancer.

OC can be started after pp 4 weeks to decrease thromboemblic risk

Surgical methods

For female (tubal ligation) cutting or clipping the fallopian tube ( both side).

For male (vasectomy): small incision 3 cm cut of vas deferens on each side of the scrotum.

Instruct the couples to use other method for 3 months to clear the remaining sperm from the vas deference ( 36 ejaculation).

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