Population explossion and family planning

SREERAJ.V.T Jr. Health Inspector

FAMILY PLANNING

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Some Facts…..World population 711 Crore Indian Population 1,251,695,584 (July

2015 est.)Second most populous country Will become the first by 2022Occupies 17.5% of world population

and 2.4% of land area.Population growth rate is 1.25%Birth rate is 20.22Death rate is 7.4

S.No. Census Year Population  % Change 

1 1951 361,088,000 -----

2 1961 439,235,000 21.6

3 1971 548,160,000 24.8

4 1981 683,329,000 24.7

5 1991 846,387,888 23.9

6 2001 1,028,737,436 21.5

7 2011 1,210,726,932 17.7

Historical Background1952- National Family Planning

Programme1977- National Family Welfare Programme1985- Universal Immunization Programme1992- Child Survival And Safe Motherhood

Programme1997- RCH (Phase-1)2000 National Population Policy2005- RCH (Phase-11)

The National Family Welfare Programme was launched in 1952 as National Family Planning Program. India was the first one to do so.

It is 100% centrally sponsored program.

The ministry of health and family welfare is responsible for this program.

EARLY DEVELOPMENT : - The second 5 year plan (1956 to

1961) the “clinic approach” was adopted . Large no of family planning clinic were opened .

In 1960 the NFWP entered a New

technological era with introduction of the Lippi's loop later replaced by copper T .

Later Development:- Target free approach

IUD insertion at the rate of 20/1000 urban and 10/1000 rural.

Integration with maternal and child welfare , immunization , nutrition and non formal education.

Medical termination of Pregnancy Act

PNDT Act.

AIMS & OBJECTIVES OF FAMILY PLANNING -To bring down population

growth.

- To reduce the maternal & child mortality rate.

- To control the unwanted birth.

- To prevent from Unsafe abortion.

- To bring out wanted birth.

- To bring interval between pregnancies.

1. Operational goals 2. Demographic goals

1. Operational Goals :- - To promote the voluntary acceptance of small

family norms .Family planning has two main goals :- - To promote the people to use of spacing between

children & Child survival. - Poverty eradication & socio – economic growth.

GOALS OF FAMILY PLANNING

DEMOGRAPHIC GOALS -:

- Stabilizing the population by the year 2045.

- Reduce the infant mortality rate to level below 30/1000 live childbirth.

- Reduce the maternal mortality rate to the level below of 100/100,000 live child birth.

- sssss

RCH Programme

The reproductive and child health program was formally launched by Gov. of India on 15th Oct 1997. As

per recommendation of International Conference on

Population and development held in Cairo in 1994.

COMPONENTS OF RCHEffective maternal and child health care

Increased access to contraceptive care 

Safe management of unwanted pregnancies

Nutritional services to vulnerable groups

Prevention and treatment of RTI/ STD

Reproductive health services for adolescents

Prevention and treatment of gynecological problems

Screening and treatment of cancers, especially that of uterine cervix and breast

RCH Phase I‐Aim• To bring down the birth rate below 21 per 1000

population,• To reduce the infant mortality rate below 60 per

1000 live birth and• Tobring down the maternal mortality

rate<400/1,00,000.

• 80% institutional delivery, 100%antenatalcare and 100% immunization of children

were other targeted aims of the RCH programme.

RCH Programme- II (2005-2009) To reduce Infant Mortality Rate (IMR), Maternal Mortality Rate (MMR) Total Fertility Rate (TFR) To increase Couple Protection Rate

(CPR) Immunization coverage, specially in

rural areas. The ultimate objective is population

stabilization , through responsible reproductive behavior.

Vertical Programmes Integrated Service Delivery

Camp Oriented Client Oriented

Target Oriented Goal Oriented

Quantity Oriented Quality Oriented

FAMILY PLANNING METHODS

METHODSTEMPORAR

Y

NATURAL

MECHANICAL

HORMONAL

PERMANENT

SURGICAL

NATURAL METHODS

a. Calendar Methodb. Basal Body Temperature

c. Cervical Mucosa

d. Sympto thermal Method

e. Ovulation awareness

f. Withdrawal Method

MECHANICAL

METTHODS

• Female condom

• Male Condom • Diaphragm• Spermicidal Creams

• Intra uterine devices

CONDOMSADVANTAGES :-Cheaper & easy to carry. No side effect .Protection against STD & AIDS.Reduce the incidence of tubal fertility & Ectopic pregnancy .

DISADVANTAGES :-Inadequate sexual pleasure .To discard after one coital act.

An IUD is known as Coil is a small plastic and copper device .Usually shaped like ‘T’ which is fitted into uterus by a doctor using a simple procedure and provide protection against pregnancy .In IUD can stay in place 5 to 10 year .

COPPER T :Copper reduces the fertility of woman so that it is used for contraceptive. Advantages :--Inexpensive , easy to use and can be inserted in minimal time.-Effective contraceptive.-Fertility can be restored removal of copper T.-Can be used up to 10 years.-Disadvantages-Pain and bleeding.-Ectopic pregnancy.

Postpartum IUDs (PPIUD)IUD insertion within 48 hrs of

childbirth

Intrauterine device (IUD) with Progestogen

In addition to birth control, hormonal IUD are used for prevention and treatment of:

heavy menstrual periodsEndometriosis and chronic pelvic pain

Adenomyosis and dysmenorrhea

AnemiaIn some cases, use of a hormonal IUD may prevent a need for a hysterectomy

HORMONAL METHOD Hormonal contraceptives are the effective means of maintaining interval between births. It includes :-

1. ORAL PILLS 2. Mixed Pills3. Mini Pills ( Progesterone only pills)4. Post Coital Pills5. Non Steroidal weekly oral pills6. Long acting /Once a month pills7. Emergency Contraceptive pills ( E – Pills )

Oral contraceptives (the pill) are hormonally active pills which are usually taken by women on a daily basis. They contain either two hormones combined (progestogen and estrogen) or a single hormone (progestogen). 

Combined oral contraceptives suppress ovulation. Progestogen-only contraceptives also suppress ovulation in about half of women (they are slightly less effective). Both types cause a thickening of the cervical mucus, blocking sperm penetration.

Oral contraceptives are 92 - 99% effective

Pills are taken daily for 21 days and stopped for 7 days before starting a new package

Possible side effects include nausea, breast tenderness, mild headaches, weight gain or loss.

The pill does NOT protect against sexually transmitted infections (STIs, including HIV).

NON STEROIDAL WEEKLY ORAL PILLS :-

Ormeloxifene (also known as Centchroman)

It is best known as a non-hormonal, non-steroidal oral

contraceptive which is taken once per week

-

LONG ACTING /ONCE A MONTH PILLS :- -Long acting estrogen & short acting Progesterone are

mixed in this tablet.- This pill is taken only once a month.- Its harmful effect only rate of failure is very high .- Advantages :-- Prevents pregencey- Shortness period.- Prevents ovarian and uterine cancer.- Disadvantages :-- Headache- Malaise- Leg cramps- Weight gain.- Sleep disturbance.- Hypertension

EMERGENCY CONTRACEPTIVE PILLS ( ECPs or E – PILLS )ECPs are used to prevent

pregnancy following an unprotected sexual intercourse .If taken within 72 hours ECPs are safe for all women.

Levonorgestrel is a manufactured hormone used in this pill.

The first pills should be taken as soon as possible but certainly before 72 hrs.

Medical Termination of Pregnancy MTP Act 1971Abortions are termed legal only when all the

following conditions are met:Termination done by a medical practitioner

approved by the ActTermination done at a place approved under the ActTermination done for conditions and within the

gestation prescribed by the ActOther requirements of the rules & regulations are

complied with

When can pregnancies be terminated?

Up to 20 weeks gestation

With the consent of the women. If the women is below 18 years or is mentally ill, then with consent of a guardian

With the opinion of a registered medical practitioner, formed in good faith, under certain circumstances

Opinion of two RMPs required for termination of pregnancy between 12 and 20 weeks

MTP Act: Indications Continuation of pregnancy constitutes risk to the life or

grave injury to the physical or mental health of woman

Substantial risk of physical or mental abnormalities in the fetus as to render it seriously handicapped

Pregnancy caused by rape (presumed grave injury to mental health)

Contraceptive failure in married couple

SURGICAL METHOD :-

VESECTOMY :-It is simple operation performed under local

anesthesia .In this method both of the vas-difference are

cut 1cm each & clamped or their heads are tied in a manner that they can not unite again .

These days more attention in being paid to Non Scalpel Vasectomy –NSV- to avoid cuts & stitches.

NO-SCALPEL VASECTOMY

VASECTOMYSmall incision in the scrotum under LA A piece of vas at least 1cm removed after clampingCut ends are ligated & folded upon themselves Sutured so that cut ends face away from each other

oSterility not immediate (at least 30 ejaculations)oSperms are stored in reproductive tract upto 3 monthsoSperms destroyed intra luminally by phagocytosiso2 semen analysis- no sperm –man declared sterile

ADVANTAGES OF NSVNo incision, no stitchMinimal dissection using only 3

instruments Chance of complications reduced from

2% th 0.3%Safer, convenient, acceptable methodCheaper compared to tubectomy

Non Scalpel Vasectomy

Local Anaesthesia is given

Vas deferens fixed by a ring forceps so that only minimal amount of tissue is present in the ring

Skin directly overlying the vas in the ring forceps is punctured

Puncturing hole is enlarged to about twice the diameter of vas deferens

Delivering the vas out of the puncture hole

Ligaturing the ends of vas & excising a small segment

Tied ends are pushed back into scrotum

Opposite vas is also manipulated

POST OPERATIVE CARE Wear a T bandage for 15days Avoid bathing 24hrs after the operation• Keep the site clean & dry Avoid cycling or lifting heavy weights for

15 days Use contraceptives until aspermia has

been established Have stitches removed on 5th day after

operation

COMPLICATIONS OF VASECTOMYLocal pain, skin discolouration, bleeding Infection, trauma to artery ,gangreneAb formation, autoimmune diseaseFailure rateGranuloma formationSpontaneous recanalizationSpermatocele formationHaematoma

DISADVANTAGES OF NSVHaematoma formationSepsisRecanalization

TUBECTOMY :-1. Traditional method This method is known as the

abdominal tubectomy in which under Spinal or General anesthesia.

2. Mini lap :- This is minor from abdominal

tubectomy in which under local anesthesia .

3. Laparoscopy :- In this technique using a laparoscope

through the abdomen .

Local infection. Some women complain of bleeding. Irregulatingr of cycle.

DISADVANTAGES

This method is almost 100% safe against pregencey . Minimal complication . Comparatively less expensive .

ADVANTAGES

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