Family planning in India Ms Navya Lecturer Yenepoya

Family planning in India • Ms. Navya • Lecturer • Yenepoya College of Nursing • • Peer reviewed by: Mr. Anand Assist Professor Community Health Nursing

Objective • At the end if the class student will be able to • List down the classification of family planning • Explain regarding IUCD

CLASSIFICATION Spacing method: • Barrier method • Intrauterine method • Hormonal method • Post coital method Terminal method

BARRIER METHOD • • • Condoms (male and female) �Spermicidal �Sponge �Diaphragm �Cervical cap

Male condoms: • These are made up of polyurethane or latex. • Silicon used now a days to produce semi dry Prelubricated forms. • In India one particularly brand is widely marketed as ‘Nirodh’. • Spermicidal – coated with nonoxynol on inner and outer surfaces.

ADVANTAGES: �Simple spacing method �No side effects �Easily available, safe & inexpensive �Protects against STDs DISADVANTAGES �Chances of slip off and tear off �Allergic reaction to latex �Failure rate: 16%

Female condoms • It is a pouch made up of polyurethane which lines the vagina and also external genitalia. • It is 17 cm in length with one flexible polyurethane ring at each end. ADVANTAGES: • Prevents STDs including HIV/AIDS • Not damaged by oils and other chemical

DISADVANTAGES: • High motivation • Only women who can use diaphragms can use female condom • Slippage occurs • Expensive • Failure rate 21% with typical use and 5% with correct and consistent use.

Diaphragm • Most common and easiest to fit and use. • Thin, nearly hemispherical dome made of rubber or latex material, with circular, covered metal spring at periphery (flat type and coil type) • External diameter of rim is size of diaphragm – 45 mm • diameter rising in steps of 5 mm to 105 mm (most common 60, 65, 70, 75, 80).

CONT. . • The device is introduced up to 3 hrs. before • intercourse and is to be kept for at least 6 hrs after • intercourse. ADVANTAGES: • �cheap • �No gross medical side effects • �Control of pregnancy in hands of woman • �Reasonably safe when properly used • �Prevent spread of STDs though less effective than • condom

DISADVANTAGES • • • Requires help of doctor to measure the size required. Need high motivation Allergic reaction to rubber Erosion UTI’s

SPERMICIDES • Available as vaginal foams , gels , creams , tablets and suppositories. • Contain surfactant like nonoxynol 9, benzalkonium chloride. • Alter the sperm surface membrane permeability • Resulting in killing of sperm.

ADVANTAGES: • • �No instructions by doctors or nurses �Easily available and easy to use �No gross medical side effects DISADVANTAGES �Failure rate high when used alone �Can increase spread of HIV infection by irritating vaginal and cervical mucosa �Failure rate – 21% with typical use and 6%

Vaginal contraceptive sponge • The sponge is a doughnut-shaped device made of soft foam coated with spermicide. • Made up of polyurethane with 1 gm of nonoxynol-9 as a spermicide. • It releases spermicide during coitus, absorbs ejaculate and blocks the entrance of cervical canal. • To use the sponge, it must be moistened with water. • Once inserted in the vagina, it covers the cervix and blocks sperm from entering the uterus

DISADVANTAGES • • May get broken Difficult to removal High pregnancy rate Allergic reactions Vaginal dryness, soreness May damage vaginal epithelium Increase risk of HIV transmission

INTRAUTERINE DEVICES • Intrauterine Device The IUD is a small, Tshaped, • plastic device that is inserted and left inside the uterus • to prevent pregnancy.

CLASSIFICATION OF IUDs • Intra Uterine Device v. Non medicated: First generation v. Medicated : Second generation Third generation

First generation • Non-medicated made up of polyethylene. • Different shapes and sizes • LIPPE’S LOOP • Double ‘s’ shaped device , made up of polyethylene material. • Non- toxic, non-tissue reactive and extremely durable. • Small amount of barium sulphate is also added for radiological examination • Available in 4 sizes A, B, C, D

Second generation • Made up of metal Cu • Earlier devices Cu-7 , Cu-T 200 • Newer devices T copper 220 C , T copper 380 C , nova T • multiload devices: • ML-Cu 250 • ML-Cu 375

Third generation • Hormones releasing IUD • PROGESTASTERT : • Most commonly used T shaped device filled with 38 mg • progesterone • Effective for 1 year • LNG- mirena • Mirena (levonorgestrel-releasing intrauterine device) is a • form of birth control that is indicated for intrauterine • contraception for up to 5 years and Releases 20 μg of • levonorgestrol. • Effective for 5 years.

SIDE EFFECTS �Amenorrhea �Intermenstrual bleeding and spotting �Abdominal/pelvic pain �Ovarian cysts �Headache/migraine �Acne �depressed/altered mood.

ADVANTAGES OF IUD • Safe • effective , Reversible • Long action , Inexpensive DISADVANTAGES • Heavy bleeding and pain • Pelvic inflammatory diseases • Ectopic pregnancy • May come out accidently if not properly inserted.

CONTRAINDICATION �History of PID �Abnormal shaped uterus �Ectopic pregnancy �Menorrhagia

HORMONAL CONTRACEPTIVES Oral : • Combined Prep • Single Prep Parenteral : • Injectables • Implants

HORMONAL CONTRACEPTIVES With hormonal birth control , a women takes hormones similar to those her body makes naturally. �Hormonal contraceptives are mostly for female sex steroids.

Oral contraceptives • Combined oral contraceptive pills • Commonly used progestin are either levonorgestrol or Norethisterone and estrogens are ethiyl estradiol or menstranol. • COMMERCIAL NAMES NO. OF TABLETS • Mala–N 21+7 iron tab. • Mala –D 21+7 iron tab. • Loette (desogestrel 0. 15) 21 tab.

Contraindications • • ABSOLUTE: Circulatory diseases Severe HTN Angina, ischemic heart dis. Liver disease Tumors Pregnancy breast cancer, breast feeding.

benefits �contraceptive benefits: �Protection against unwanted pregnancy �Convenient to use. �Non-contraceptives benefits: �Regulation of menstrual cycle �Reduction of dysmenorrhea �Protection against PID, fibroids, ovarian cysts, chances • of cancer. • •

Recapitualization • What are all the type of contraceptive?

Reference • • K. Park Community Health Nursing Neelam Kumari Community Health Nursing N. J Singh Community Health Nursing Thressiamma Community Health Nursing