E. Tutor Online loksewa prepration class.

Kathmandu
Family Planning ( kl/jf/ lgof]hg )
 Away of thinking and living that is adopted  To Determine Number of Child.-aRrfsf] ;+Vof lgwf/0f
voluntarily, upon the basis of knowledge, Attitude, ug'{._ & Improve MCH cfdf / aRrfsf] jf bDkltsf] :jf:Yo
Responsible decisions by individual and couple in l:ylt k|j4{g ug'{._
order to promote the health and welfare of family  To control the time at which Birth occurs in relation
group thus contribute effectively to the social to the age of Parents
development of a country .
WHO 1971 Main Objective :-
 s'g} klg kl/jf/nfO{ ;fgf], ;'vL / Jojl:yt ug]{ ul/g] planning nfO{  Equitable access to voluntary for services [ ;dfg d'Ns
lat/0f]
Family planning elgG5 .
 Based on informed choice
 Symbol of Family Planning is Inverted Red Triangle
 Particulatory to the poor, Vulnerable [hf]lvddf /x]sf] ] &
 Family planning is preventive service & Family
health and welfare program Marginalized [ l;dfGt/lsd Aolt]
Important Date Related to Family planning Policy [lglt] & Striates [ /0lglt] of f.P
S.N Related points Date  Enabling Environment [ ;xh jftfa/0f agfpg s;l/ k|rf/
1. Family Planning from India 1952 k|;f/ ug]{
2. Family planning Start in Nepal 1959 ( BS  Demand generation [ dfFUf a9fpg' / cfaZoStf fell u/fpg ]
from Non Gov. sector by FPAN 2016 )  Services delivery [ ;]af lbg]]
3. MCH Was established under 1963  Capacity building [ Human health man power lasfz
MoH ug{ ]
4. Government of Nepal Supported 1968 AD  Research and Innovation [ Gof vf]lhlglt ug]} ]
FP Program
5. Family planning policy 1965
Modern concept of Family Planning
6. Family Planning Strategy 2068 BS  Family planning is not Synonymous of Birth control
7. CRS [Contraceptive Retail Sales] 1978 only, A WHO export committee [1970] recommends
established that family planning includes in its preview
8. EPI-ORC + Family planning 2012 A. Proper Spacing & limitation of Birth
integration from Kalikot B. Advice on Sterility & Education for parenthood
C. Sex education , Genetic counseling & Marriage
SDG Targets and Indicators in Family planning counselling
S.N Indicators 2030 D. Carrying out of pregnancy tests
1 Proportion of women of 80 % E. Preparation of arrival 1st child & Providing
reproductive age who have adoption services
their need for family planning F. Premarital consultation & Examination
satisfied with modern method G. Providing services for unmarried mothers
2 CPR 60 % H. Screening for pathological condition related to
3 TFR 2.1 % productive system Eg :- Cervical cancer
 World family planning Day celebrate :- Sep 18 2014/ Terminology
2071 Ashoj 2
 Conception :- Ovum + Sperm ldng x'g' [Fertilization]
 Family planning cervices are start from CRS
Company  Contraception :- Sperm and ovum sf] ldng x'g glbg'
o CRS Company Established:- 1978  Contraceptive :- Contraception sf] nflu k|of]u ul/g] ;fwg
o First services start from Condom & Pills -kl/jf/ lgof]hgsf] ;fwg ._
 Best /Main indicator of family planning is CPR [  New user :- klxnf] k6s kl/jf/ lgof]hg ;fwgsf] k|of]ustf{
contraceptive prevalence rate]  Current user :- lg/Gt/ ?kdf k|of]u ul//x]sf] F.P. sf] k|of]ustf{
Aim / pb]zo /Objective of family planning Cafeteria Choice/ Informed Choice
 To Avoid Unwonted Birth [ aRrf hGdfpgjf6 /f]lsg'_  Individuals can choose according to Needs & Wishes
 To bring about Wanted birth [ rflxPsf] ;Dfodf aRRff after offering all method
kfpg]  Main right of Client of family planning
 To Regulate the birth Spacing -ue{x? ljrsf] ;do plrt  Governments has focus on it.
/ lgoldt /fVg' _  Motivation should not be used in counselling of F.P
 To limit birth after willingness of child. -;+tfgsf] /x/ Indicator of Family Planning
k'lu;s]kl5 aRrf gkfpg' _  Common indicators of Family planning are
1. Contraceptive Prevalence Rate ( CPR ) ( Main )

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 2. Total Fertility Rate ( TFR )  It is used to identify the failure rate of Any
3. Year of Protection ( CYP ) contraception
4. Unmet need  It is used to Identify Effectiveness of Contraception
5. Eligible couple  Pearl index lgsfNg] ;'q =
6. Target couple
7. Peal Index ( CFR ) Number of Accidental pregnancy in a year x 100%
Total nom of using Modern Method
CPR (Contraceptive Prevalence Rate)
 s'g} lglzlrt ;dodf s'n k|hGfg pd]/sf dflg;x? dWo] slt
Life table Analysis
k|ltztn] F.P sf] ;fWfg k|of]u ul//x]sf 5g eGg] a'lemG5 f  It is also Percentage of failure rate of Modern Family
Planning Method in a Month
 kl/jf/ lgof]hgsf] d'Vo ;'rs CPR xf] .
 CPR :-  It is Effective than Pearl Index
 NDHS :- 2011 :- 43 % Good / Ideal quality of Contraceptive
 NDHS :- 2016 :- 53% ( All method )  Common characteristics features of contraceptives are
 But Modern Method ( 2016 ) :- 43.2% 1. Easily available [ ;lhn} kfpg] ]
 NDHS 2022 :- 57 % ( All method ) 2. Inexpensive [ ::tf] ] & Safe [ ;'/l1t]
3. Simple to use [ k|of]u ug{ ;lhnf]]
 NDHS 2022 :- 43 % ( Modern Method )
4. Effectiveness [ k|efasfl/tf ]
CPR lgsfNg] ;'Q :-
Current user of Modern family planning service x 100 % Method of Family planning
Women Of Reproductive age Artificial/ Modern Natural/ Traditional
TFR (Total Fertility Rate -s'n k|hgg b/_
Temporary Permanent Abstinence , BBT, LAM
 Pp6f dlxnfn] cfkmgf] k|hgg calwdf ;/b/ slt aRrf hGdfpl5g
Tof] g} TFR xf] Natural Method
o NDHS 2011 :- 2.6 / Woman  Natural method also called Traditional method
o NDHS :- 2016 - 2.3/ Women  Natural method includes
o NDHS 2022 :- 2.1 / Women 1. Abstinence ( Most effective 100% )
CYP (Couple Year of Protection) 2. Basal body temperature
 kl/jf/ lgof]hgsf] ;fwg k|of]u u/]/ ue{atL x'gaf6 hf]lug] aif{ 3. Coitus interrupted method ( Oldest method )
 Pp6f bDkltnfO{ ue{jlt jf6 protect ug{sf] nflu lgsflng] b/ xf] 4. Safe method
 of] Ps aif{df ul/G5 / s'g ;fwg slt lbg] s'/fsf] ;'rs xf] 5. LAM ( Least effective )
S.N Contraceptives CYP 6. Cervical mucous method
1. 4 Vial/Dose Depo 1 CYP 7. Vaginal douching
2. 13 Cycle Pills 1 CYP Some notes of Natural method
3. 150 /144 Piss. Condom 1 CYP  Abstinence /Avoid sex -j|xdrfl/ ljwL_ is Only
4. 1 Set Implant 3.5 CYP completely method 100% effective
5. Norplant 5 CYP  Coitus interrupts /Withdraw method means
6. 1set IUCD 8 CYP Withdraw of penis before ejaculation, Its Oldest
7. 1 Vasectomy 13 CYP method of Family planning.
 2 types of couple  B.B.T (Basal Body Temperature method)
1. Eligible couple [ECs] :- Newly married couple o During Ovulation raised Body Temperature about
where in wife is in Reproductive age & are not 0.3.c to 0.5.c/ 1f due Progesterone hormone
planning for baby Couple with wife of age is 15-45 o Temperature Measurement Before getting out of
years / 15-49 years Bed in Morning time [Preferably]
2. Target couple :- Target couple refers to the o Precaution :- Abstinence, Post ovulatory
Couple have 2-3 living child [ ;Gtfgsf] /x/ k'lu;s]sf] Restricted sex
dlxnf ]  Safe Period/Calendar/Rhythm method)
Unmet Need o Unsafe period / Danger period :- 14 ± 5 day of
 cfaZostf 5 t/ ;]jf lng gkfPsf] ;]afu|flx Ovulation [9-19th days Danger period x'G5 .
 NDHS 2016 :- 24 % o Safe period :- 1 Weeks before and after the
o Wanted Spacing :- 8 % Menstruation ( 28 ±7th days)
o Wanted Stopping :- 16 % o It is not useful in postnatal period
 NDHS 2022 :- 21 % o Only suitable for Educated & High motivational
o Programmed Sex :- Abstinence Required for ½
Pearl index lgsfNg] ;'q month

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 o Fertile period :- Shortest cycle minus 18 days &  According to Safe period method couple need 72
Longest cycle minus 10 days condom
8. Breast feeding Method / LAM (Locational  Length of Condom 15-20cm
Amenorrhea method)  Diameter :- 3-5 cm& Thickness :– 0.01 – 0.22
 A good method for Natural contraception under  2 Types of Condom are available in Nepal
Exclusive Breast Feeding for 6 month Male Condom Female Condom
 Effective LAM Method :– 98% Made by Latex Made by Polyurethane
 Criteria features for LAM Rubber Rubber
 Baby age Under 6 Month It contain 1 Ring It contain 2 Ring, Re-usable
 Not return Mensuration Free Gov. supply Not Free gov. supply
 Complete breast feeding ( 10-12 times ) Prevent Pregnancy & Prevent Pregnancy& STD
STD
 Which Hormone is Responsible in LAM Method Erect is necessary Erect is not necessary
:- Prolactin Effectiveness – 98.5 % Effectiveness – 96%
 Cervical mucous Method Also called Billing
Notes :-
method /Ovulation method
 Precaution of Condom :- Allergy, Breakup, Slip of
 of] Method df Ovulation kl5 Cervical discharge afSnf] /
the penis [ leq c8lsg' ]
sd u/fp5
 During ovulation :- Watery, Clear, Smooth , slippery,  Condom also called Temporary/Alternative / Back
Profuse discharge as like egg white up method .
 Symptothermic Method :- Combine of Safe method  Advantage of Condom :-
o Easily available,
+ BBT + Cervical method
o Easy to use,
Artificial Method o Provide dual protection
 Artificial method Classification in to 2 types o No side effect usually
A. Temporary / Spacing method Condom is Choice for
B. Permanent / Limiting method
 Accidental & Emergency contraceptive
Temporary / Spacing Method  Multiple partner sex [ Prostitution ] & Removal time
 Temporary method classification in to following of Implant & IUCD
a. Barrier method ( Condom, Foam tab )  Pills vfg 3 lbg 5'6]df / 14 lbg eGbf al9 Depo lnf l9nf] ePdf
b. Hormonal method ( Dipo, Pills, Implant )
c. Mechanical method ( IUCD )  Couple having STD
d. Post coitus method ( Mini pills, COC, IUCD ) Diaphragm
Barrier Method  Also called Vaginal barrier/ Cervical cap/ Dutch
 Barrier method includes :- cap / Cervical barrier method
A. Physical Barrier :- Male Condom, Female  Diaphragm is Dome Shaped & 5-10 cm length
condom , Diaphragm, Vaginal sponge  Made by Plastic Synthetic rubber & Inserted in to
B. Chemical Method :- Creams , Jelly , Foam Tab vagina before Sex
[ sdn rSls ]
C. Combine Method :- Both Physical & Chemical  of] o}fg ;Dks{ x'g' eGbf cufl8 /flvG5 / of}g ;Dks{ ePsf] slDtdf
[ Vaginal Sponge] 6 hour leq lemSg' x'bf}g / 24 306f eGbf al9 /fVg' x'bf}g f
 Used along with Spermicidal jelly.
Barrier Method of F. P  Diaphragm sf] semen c8lsg] 7fpFnfO{ Dome of
[Condom/9fn ]
diaphragm elgG5 h;df 5 ml htL semen c6fFp5 .
 Barrier method is also called Occlusive method/
Conventional Method, Dual method  Prevent PID, Human papilloma virus, & STD
 Condom have only dual action ( Prevent Conception &  @$ 3G6f eGbf a9L Diaphragm vagina df /x] g/fd|]f k|ltc;/
Prevent STD ) b]vf kb{5 , h;nfO{ TSS ( Toxic shock syndrome) elgG5 .
 Oldest Name of Condom is Dhal [bfn]  Failure rate :- /fd|/L k|of]u gu/]df 6-12 % x'G5 .
 Condom used in Nepal from 2017 BS Chemical / Spermicidal method
 Easily available on Every place A. Foam Tab -sdn rSsL_ :-
 National condom Day celebrate every First Saturday  10 min before sexual contact .
of Dashain/ Purnima  It's Contains Menfigol or Non Oxynol 9 (
 Main causes of condom failure is In-correct use Spermicidal agent ) , o;n] Sperm df O2 sf] sld Nofp5
 1 CYP condom equal 150 Condoms requirement  Used in Vagina
B. Jelly cream

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C. Vaginal sponge  Iron contain Ferrous fumarate 75 mg
 It's made up of Polyurethrene form , Size 5x25 cm  Colour :- Gray color
 Must left at least 6 Hours after ejaculation but Not Side effect
more than 24 Hours  Side effect of pills seen Mainly due to Estrogen
 Failure rate :- 9-20 % Hormone
 TODAY Is brand name in USA  Common side effect are :-
Hormonal method o Dizziness , Nausea, Headache & Hypertension (
Dizziness :- Commonest )
 Hormonal method contain :-
o Amenorrhea
o Pills ( Most effective Hormonal Method ) o Intermenstrual Bleeding / Spotting -l56 k'6 /ut b]vf
o Depo kg'{_ ( Common during First 3 Month )
o Implant ( Jadelle ) o Weight Gain or Loss
o Indoplant o Breast tenderness
Pills ( vfg] rSls )  Other S/E :- Acne, Chlasma, Mood change or
 dlxnfx? n] k|of]u ug]{ Hormonal ;fwg xf] Depression
 Most popular temporary hormonal method in World Contra-indication
is pills
 Suspected Pregnancy
 1 Packet pills contain 28 tab
 Lactating mother up to 6 Month of Delivery
o 21 White [Hormonal Tab]
o 7 Brown [Iron]  Epilepsy , TB, Liver disease ,
 7 Iron contain in Pills also called Placebo pills  Sever Headache, Thromboembolism
 Effectiveness about 99.99 % ( 99.97 % ) (Highly  Hypertension , Heart disease , Hyperlipidemia , DM
effective/ Almost 100% ) ;'gf}nf] u'nfkm/ lgsf]ng jfO6 /  Breast cancer -:tgdf uf7f u7L_,
s+rg gfd af6 ahf/df pknAw 5 f  Isoniazid & Rifampicin vfO{/x]sL cfdf ,
 Failure rate :- 0.3 % ( 3 per thousand Pregnancy )  Heavy smoker (>15 Cigarette /day & > 35 year age)
Pills sf] 2 j6f form x'G5  Undiagnosed Vaginal Bleeding
1. COC :- Combine Oral Contraceptive [ Estrogen & Method of Pills using
Progesterone]  5th day of menstruation
2. POP :- Progesterone Only pills [ Only progesterone]  5-7th day of Abortion
 POP Also called Mini pills / Micro pills /  6 month of Post partum ( Complete B. Feeding )
Progesterone only pills  6 Weeks of Post partum ( Incomplete B. Feeding )
 g]kfn ;/sf/n] supply ug]{ Pills s'g xf] :- COC (Combined  Immediate after delivery ( Not B. Feeding )
oral contraceptive pills] xf] f
 OCP also prevent Ovarian cancer & increase chance Mechanism of Action of Pills (M.O.A)
of Breast cancer  Prevent/ Suppress Ovulation ( Ovulation x'g glbP/ )
 Return fertility after pills is 3 month  Inhibits the tubal mobility to slow sperm and ovum
Composition of pills  Cervical Mucus nfO{ jfSnf] / yf]/} jgfpF5 h;n] ubf{ Sperm
1. COC [Combined oral Contraceptive pills) Kff7]3/ leq hfg kfpb}g f
 Also called Monophasic pills .  kf7]3/sf] Endometrium nfO{ kftnf] agfOlbG5 h;n] ubf{ ue{
 It contains :- /xg kfpb}g f
o Estrogen :- Ethinyl estradiol :- 0.03 mg or 30 Pills is Choice for
mcg  Newly marred -1st
o Progesterone :- Levenorgestrel :- 0.15 mg or  Post Abortion Case -2nd,
150 mcg /x]sf] x'G5 .  < 35 years female
2. POP [ Progesterone Only Pills]  Ovary cancer
 Also called Mini pills /Micro pills  Dysmenorrhea, PID & Ectopic pregnancy
 Mini pills contain Low dose of Progesterone  Anemic mother
o Norgestrol ( 0.075mg) Notes of Pills :-
OR  Almost 100% effectiveness
o Levenorgesterel ( 0.75 mg )  Popular method in World
 Effective for not tolerance of Estrogen .  Honeymoon Contraceptive is Pills
 Useful in Breast feeding after 6 weeks  Pills not use more than 2 year
3. Iron :-

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 Pills reduce the chance of Ovary cancer & increase  Implant Rod is made by Silicon rubber
the chance of Breast cancer  About Length 43 mm & Diameter 2.5 mm
 Most effective pills :- COC  It contains
 1 CYP Contain :- 13 Cycle pills o Rod :- 2 Rod
If missed to take for o Hormone :- Levenorgestrol 75 mg / Rod ( Total-
 1 day :- 2 tab next day when remembered 150mg )
 2 day :- 2 tab / day for 2 day o Site :- flexor surface of left Arm ( V shape )
 3 day :- Use another or Avoid sex for 7 days o Route :- Sub dermal( 1st option ), Sub cutaneous
Depo provera o Instrument :- Trocher instrument
 Also called DMPA / Sangini ;'O{ jf # dlxg] ;'O{  One Rod of Implant work about 3 year
 Injectable method of Family planning  80 kg eGbf alb jhg ePsf]nfO{ $ jif{df lemSg' k5{ f
 Most acceptable contraceptive by Female in Nepal  Effectiveness :- 99.95 %
 DMPA (Depot Medroxy Progesterone Acetate) first k|of]u ug]{ ;do
use in World 1960 & Nepal 1994  dlxgfjf/L ePsf] 7 lbg leq
 Dose of Depo :- DMPA -150mg x 1 ml / 3 months  ;'Ts]/L ePsf] ^ xKtfdf jf ^ xKtf kl5
 Only one injectable Temporary method & Effective  Abortion ePsf] 7 lbg leq .
99.7%  Work start within 24-48 Hour of Insertion
 Site :- Left Upper arm ( Deltoid muscle) Choice of Method :-
 ;a} eGbf l5tf] sfd ug]{ ;f3g Depo Provera [ <24hr &  2 - 3 j6f jRrf kfO{;s]ls dlxnf
Work about 3 month ]  Lactating mother
 Fertility return time in Depo :- Side effect
o Become pregnant after 7-8 month 1st Option.  Irregular bleeding/ Amenorrhea -1st ,
o 10- 12 months 2nd Option from last injection  Weight gain, Dizziness,
up to 18 month  Rod expulsion , Infection
 g]kfndf nf]slk|o / e/kbf]{ c:yfO{ ;fwg xf] Contraindication & Precaution
Side effects of Depo  Same as Depo
 Irregular /Spotting menstruation – 1st
 Jaundice , Heart disease , Vaginal bleeding ,
 Weight gain -2nd
 Asthma , Breast cancer,
 Amenorrhea -3rd
 Taking drug for Epilepsy & TB
 Breast tenderness
 D M , Hypertension - >160/100 mm of Hg
 Cloasma & Hirsutism ( Rare )
 Suspected pregnancy , Liver disease ,
Choice of Method Danger sign of Implant:- [HEDMPA]
 Breast feeding / Lactating mother after 6 month
 H-Heavy bleeding
 Mother who not Suitable of pills .
 E- Expulsion of an implant
 Ectopic pregnancy & Ovary cancer Client
 D- Delayed menstruation period
Contra indication & Precaution  M- Migraine /headache
 Suspected pregnancy  P- Pus or bleeding of the insertion site
 Within 6 weeks of Delivery  A -Arm pain
 Cancer of Breast & Genital cancer , Liver disease IUCD [Intra Uterine Contraceptive Device]
 Heavy Smoker, HTN, DM., Heart Disease
 It is the Mechanical method , Also called IUD (Intra-
 Undiagnosed vaginal bleeding uterine device)
Implant / Norplant  3 Types of IUCD
Types of Implant :- o First generation
 Jadelle :- 5 years (2 Rod each rod contain 75 mg o Second generation
Levenorgesterel ) [ Nepal df k|of]u x'g] ] o Third generation
 Implanone / Endoplant :- 3 years (1Rod 68 mg A. 1st Generation
Etonorgestrel )  Non Hormonal / Non Metallic
 Norplant - 7 years (6 Rod each Rod contain  Non medicated IUCD / lipes loops made by
Levenorgestrel 36mg. total 216 mg) plastic/polymer
Implant/ jadelle  1st IUCD is Lipes loop in Prepared 1965 [ Non
 In Nepal useable form of Implant is Jadelle Medicated]

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B. 2nd Generation  2nd bleeding
 Medicated , Non Hormonal IUCD/ Cupper T Contra-Indication
made by Cupper- Used in Nepal  Suspected pregnancy [ Because can cause Ectopic
C. 3rd Generation :– pregnancy
 Hormonal releasing cupper T 280 progesterone [  Undiagnosed Vaginal bleeding
Effective 3 Years ]  History of Ectopic pregnancy
 Most common brand of Cupper T Used in Nepal is  Cancer of Uterus & Cervix
Cu T 380 A ( 2nd Generation )  PID & STD
 CU T 380 A Stand for  Uterus prolapse
o Cu :- Cupper Choice of Method
o T :- Shape  ;Gtfgsf] /x/ k'lu;s]s]f / :yfO{ ljlw ckgfpg' grfx]sf]
o 380 :- Surface area  Lactating mother/ purperium mother
o A :- Size ( Small size )
 :yfO{ / c:yfO{ b'a} ;fwgsf] nflu , nfdf] ;do ;Dd ue{cfGt/ /fVg
 Success Rate :– 99.4 % [Within First year of Life] rflxg]
 Total active copper Surface area 32mm x 36mm –  Hormonal method pko'tm gePsf] cfdfsf] nflu
380m m2
 Most long Durable Temporary method & Work about
 As a Emergency contraceptive
12 years Warning sign of IUCD (PAINS))
 Insert in Uterus (fundus )  P-Period late
 Ideal / Suitable contraceptive for Lactating mother -  A- Abdominal pain
IUCD  I- Infection exposure
Time of Insertion :-  N-Not feeling well
 dlxgfjf/L ePsf] 12 lbg leq  S- Streaming missing (wfuf} x/fpg')
 ;'Ts]/L ePsf] 48 306f leq jf 6 xKtf kl5 . Tips of IUCD :-
 Abortion ePsf] 24 306f leq t'?Gt} jf 7 lbg leq  Bleeding disappear in 2 month & pain within 3 month,
 As a Emergency contraceptive within 120 hour / 5 But pain more common in Nulli parous.
days  IUCD increase the Risk of PID 8-10 times,
sfd ug]{ tl/sf:-  Highest expulsion Rate in Lipes loop
 Inhibits Implantation  Most cost effective reversible contraceptive :- IUCD
 Ovum and Spermatozoa sf] Fertilize x'g glbP/ .  Most durable spacing method of contraceptive :-
IUCD
 Sperm nfO{ lg:s|o agfP/ / Motility 36fP/
 Absolute contra indication of IUCD :- PID 1st ,
 sfd ug]{ period - 12 years , Remove period 10 yr , Bleeding 2nd ,
Side effect of IUCD  Most common causes of IUCD Removal :- Pain
1. Uterine Bleeding - 1st  Ectopic pregnancy history sf] Best :- Pills
 Usually disappear by 1-2 month  Ectopic pregnancy & PID u/fpg ;Sg] kl/af/ lgof]hgsf] ;fwg
 Management :- xf] f
 Reassurance, Ferrous sulfate 200mg TDS 1-2  Major problem of IUCD :- Spontaneous expulsion
Month
 Removal IUD [ If heavy /Persistent ]
Permanent Method
2. Pain - 2nd  Also called Terminal / Sterilizing / Limiting /
Permanent Method
 Second major S/E
 It includes 2 method
 Disappear in 3 month a. Male :- Vasectomy
 Pain is First cause of IUD Removal b. Female :- Minilap
 Pain is maximum in Nulli parous  Criteria for permanent
3. P.I.D [ Pelvic Inflammatory disease] – 3rd o Male Age :- 25-50 year
 Increase the chance of PID 8-10 Times o female Age :- 22- 45 year
 If not response with Antibiotic in 24-28 hours then o At least 2 children
remove IUD o Consent of his/ her spouse
4. Ectopic pregnancy Vasectomy
5. Spontaneous expulsion
But During Removal Time – Vasectomy 2 tl/sf jf6 ul/G5 .
1. S.V ( Scalpel Vasectomy )
 1st pain

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  lr/]/ ug]{ k'/fgf] ljlw  c;'/lIft of}g ;Dk{s ePsf] 120 306f jf 5 lbg leq t/ # lbg leqdf
 of] k|rngdf 5}g . alb k|efasfl/ kl/jf/ lgof]hgsf] ;fwg k|of]u u/]/ ue{jtL x'gjf6
2. N.S.V (Non Scalpel Vasectomy) hf]lug] pkfonfO{ g} csfl:ds ue{ lg/f]ws elgG5 .
 Kjfn kf/]/ ug]{ , k|efjsf/L / gof ljlw xf] ,  Emergency contraceptive is also called Post Coital
 Most popular Method Contraceptive/ Interceptive contraceptive
 Most Cost Effective & Cheapest Sterilization  Emergency contraceptive can be used within 5 days of
Method Unsafe sexual contact .
N.S.V (Non Scalp Vasectomy)  Most effective / Ideal time of Emergency
 Also called Key hole / Modern Vasectomy contraceptive :- Within 72 hours /3 Days
 It is Most cost effective, Cheapest, Not reversible,  Emergency contraceptive Includes :-
Life long protection family planning Method o IUCD
 Removal of Vas deference about 1cm & Stich Number o Combine pills
about 2-3 o Micro pills
 NSV ubf{ k'?ifsf] Vas deference (ef;gln) nfO{ 2 7fpdf afw]/ Uses of Emergency contraceptive
ljrdf sfl6G5 .  Unsafe sex
 NSV ;aeGbf ;'/lIft / k|efasf/L lawL xf] .  Condom rupture
 Vasectomy u/]kl5 slDtdf 30 k6ssf] of}g ;Dk{s ;Dd s08d  Rape case
use ug'{ k{5 jf 3 dlxgf ;Dd s08dsf] k|of]u ug]{ .  Discontinue of pills > 3 days
 NSV ubf{ Scrotum (c08sf]ifsf] y}ln) 5fnfdf Kjfn kf/]/ ul/g] ;fgf]  2 weeks Delay to take Depo
surgical lawL xf] . of] lawL ug{ % ldg]6 nfU5 . Dose of Emergency Contraceptive
 Effectiveness :- 99.8-99.9 % A. Pills :-
 failure Rate :- 0.1-0.4% ( 2-3 Pregnancy/ Thousand)  Dose :- Pills 4 Tab start & 4 Tab after 12 hrs.
 Vasectomy kZrft 3f/df hfbf sl/a 15 days T Shaped from 1st dose
bandage use ug]{  ;fjwflg:- lkN; vfg' eGbf cwf 306f cufl8 Antiemetic
 of] Surgery h'g ;'s} a]nf kgL ug{ ;lsG5 Tf/ k'?ifsf] @-# j6f ;Gtfg lbg]
x'g'k5{ h;df sfG5f] ;Gtfgsf] pd]/ # aif{ k'/f ePsf] x'g 'k5.{ B. IUCD :-
Side Effect :-  c;'/lIft of}g ;Dk{s ePsf ;s];Dd rfF8f] jf % lbg leq k|of]u
 1st :- Hematoma ug]{
 2nd :- Infection  72 306f leq o;sf] k|of]u u/] a9L k|efjsf/L x'G5 of] kf7]3/df
 Superficial bleeding /flvG5 / of] Emergency contraceptive sf] ;aeGbf /fd|]f
 Some times Failure t/Lsf xf] .
After Vasectomy :- Notes :-
 Most effective method of Emergency Contraceptive
 No bath 48 hour
:- IUCD
 Scrotal swelling with T Shaped bandage  Most common method & Hormonal method of
 Use condom 3 month/ 30 Ejaculation Emergency contraceptive :- Pills [ POP]
 Rest for 2 days & Avoid exercise for 1 weeks Gather Method
 No heavy load
 family planning Counselling ubf{ Gather method
 Stich removal generally 5-7 days ckgfOg5 f
Minilap/Laparoscopy o G :- Greet the client
 Also called Female sterilization/ Tubal Ligation/ o A:- Ask the problem
Tubectomy o T :- Tell detail information about contraceptive
 Minilap is Most common method of permanent o H :-Help in decision
sterilization in Nepal o E :- Explain the chosen method
 Timing :- o R :- Return to follow
o Post partum tubal ligation Golden Tip of family Planning
o Within 7 days of Mensuration  g]kfndf kl/jf/ lgof]hgsf] ;]jf ;'? 1959 AD /2016 Bs .
o Pregnancy test Negative  Cafeteria choice is also called informed choice
 o;df fallopian tube sf] isthmus df afw]/ sf6\5g / b'j} 5]p
 ;aeGbf k|efjsf/L :- Abstinence 100 % (1st)
aGb ul/Psf] x'G5 .
 ;aeGbf k|efjsf/L :- Vasectomy (2nd)
 of] dlxnfsf] nfuL ;'/lIft / k|efasf/L ljwL xf] .
 Unsafe Period :– 9 -19 days of menstruation
Emergency Contraceptive  Most effective FP for Permanent :- Vasactomy-1st

Mukesh Raj Mahato Family planning 9812145745 7

 Clinical Method :- Pills, Depo, Condom  It focuses its attention on three observable human
 Non Clinical Method :- Implant, IUCD phenomenon
 LARC ( Long Acting Reversible Contraceptive ) :-  Change in population size
IUCD & Implant ( Most popular LARC )  Composition of population
 SARC ( Short Acting Reversible Contraceptive ) :-  Distribution of population in size
Pills & Depo Demographic processes :- 5 process ( 3M- FS)
 Safe Period :– After & before 1 week of mensuration  Fertility k|hGgb/
 Safe and Convenient method :- Minilab  Marriage laafx
 Most Cost Effective method :- Vasectomy  Mortality d'To'b/
 Most cost effective Reversible :- IUCD  Migration a;fO;/fO{
 Most effective & Common reversible method :-  Social mobility
Implant Population
 ATT, Epilepsy, Ampicillin Decrease Effect of pills  s'g} klg lglZrt ef}uf]lns If]qjf6 j;f]af; ul//x]sf] dfG5]x?sf]
 Most cost effective reversible :– IUCD ;+VofnfO{ Population elgG5 .
 Indicator of family planning :- CPR [ Main indicator]  World population Day :- July 11
Other CYP,TFR  Census 12th :- 2078
 Most effective temporary FP :– Pills & Permanent :-  Total population of Nepal :- 29192480
Vasectomy  Female :- 10491169 [ 51.04]
 b'w r';fO{ (Breast feeding) /x]sf] cfdfsf] nflu pio"Qm Best:–  Male :– 104291311 [48.96%]
1st Depo (>6 weeks of puerperium ) , 2nd IUCD  Growth Rate :– 1.35 %
 ;'Ts]/L (Lactating mother) dlxnfsf] nflu ;aeGbf pko"Qm –  1st Population Senses :– 1968 AD (1st hgugf )
IUCD 1st , (<6 weeks of Lactating mother)
 11th population senses :– 2068 Bs ( 2011 AD) .
 ;Gtfg /x/ k'lu;s]sf] bDkltsf] nflu c:yfO{ pko"Qm ;fwg :– IUCD
& Implant  Census first time start from America
 Most Durable Temporary method :– IUCD & Most  Census taken every 10 years interval
durable in Hormonal method :- Implant  China is the most populous country,
 Best method for DM couple :- IUCD  2nd – populous – India
 g]kfnsf] nflu Most popular/common :yfO{ ;fwg – Minilap Colour Codding Notes
& Temporary Method is DIPO Triage
 ljZjsf] nflu Most popular c:yfO{ ;fwg – Pills & Most Colour Code Condition Step
effective Ocp is combine pills, Red Very Serious injury Immediate treat
 Minilab k'Gf{ vf]Ng] Kf|lsofnfO{ Recanalization. Yellow Serious Injuery urgent treat
 Choice for Heart & Diabetes patient Barrier method or Green Minor Injury Late Treat
Sterilization method
Black Death No treat
 Failure Rate of Modern Contraceptive method is
determine by Life Stable Analysis / pearl index CB-IMNCI
 Micro pills [ progesterone only pills] Mainly used Colour Coding Indicator
Emergency contraceptive Yellow At Hospitilization
Commonest side effect F.P Method Pink pre- treat & Reffered
 Pills :- Dizziness Green Normal \ Home remedy treat
 Depo/Implant :– irregular bleeding/ Spotting Biological Waste
types bleeding Colour Coding Disposal Waste item
 IUCD :- Bleeding , Pain Dust bin
 Vasectomy :- Hematoma , infection White colour Sharp instrument [ Blade,
 Minilap :- Infection Niddle]
 Condom :- Allergy
Blue Colour Glass Instrument
Contra indication for family planning Method Red Colour Rubber Item, Plastic , Tube
 Suspected pregnancy
Yellow Colour Anatomical Waste[ placenta, Pus
 Chronic disease Eg. liver diz, Heart diz,
containing, Cytotoxic Dru
 kidney diz
Black Tissue Paper, Kitchen Waste,
 Irregular bleeding
Non infectious waste
DEMOGRAPHY
 It is the Scientific study of Human Population

Mukesh Raj Mahato Family planning 9812145745 8