U5.

Family planning
Prepared by: Roha W/tensay ( Bsc in PH, MPH
Family planning
 Family Planning Refers to the use of various
methods of fertility control that will help
individuals (men and women) or couples to have
◦ the number of children they want and
◦ when they want them.
◦ Reduce the risk of sexually transmitted
infection(especially condom), and
◦ Improve the health of women and children
by spacing birth.
 simply means preventing unwanted pregnancies
by safe methods of prevention.
Family planning cont…
 WHO defines “Family planning ”as:
“The ability of individuals and couples to anticipate
and attain their desired number of children and the
spacing and timing of their births.”
 It is achieved through:
1. use of contraceptive methods and the treatment
of involuntary infertility.
Family planning cont…
2. A wide range of contraceptives and
counseling for well informed choice.
3. Screening and follow up Integrated services
like prevention and treatment of STIs
Rationale for Family Planning Programs
in Developing Countries

1. The demographic rationale:-

 Reducing high fertility and slowing population growth provided
the dominant rationale for FP programs in the 1960s and 1970s.

2. The Health Rationale:-

 During the 1980s, the public health consequences of high
fertility for mothers and children are set of concerns.
 High rates of infant, child, and maternal mortality as well as
abortion and its health consequences, were pressing health
problems.
Rationale for Family Planning Programs
in Developing Countries Cont…
3. Human Rights Rationale
 This rationale became preeminent in the
1990s.
 It rests on the belief that individuals and
couples have a fundamental right to control
reproductive decisions, including family size
and the timing of births.
Family planning benefits to women’s
health
 we can reduce maternal deaths by as much as
one-third by providing contraceptives through:-
◦ Avoiding pregnancy at the extremes of maternal age
◦ Decreasing risks by decreasing parity
◦ Preventing high-risk pregnancies: decrease maternal
deaths by quarter
◦ Prevention of unwanted pregnancy: reduces
unnecessary risks of pregnancy, childbirth and risks
of induced abortion
◦ Improving health through non-contraceptive
benefits including prevention of STIs and
reproductive cancers.
Family planning benefits women and
their societies
 When women control their reproductive live they can
take advantage of education, employment, and civic
opportunities.
 Population number decreases so future demands on
natural resources such as water and fertile soil will
be less.
 Everyone will have a better opportunity for a better
quality of life.
Family planning benefits children’s
health
 Family planning indirectly contributes to children’s
health, development and survival by:-
◦ reducing the risk of maternal mortality and morbidity.
◦ Spacing births at least 2 years apart has to do with their
survival:

◦ avoiding sharing limited resources such as food

 women who are very young or very old are more

likely to have an infant or child death.
Family Planning methods
 The commonly used family planning methods are
classified as natural and artificial methods:
1. Natural methods include:-
i. Breast feeding(Lactational Amenorrhea Method) Can be
effective for up to 6 months after childbirth, as long as
monthly bleeding has not returned and the woman is
fully or nearly fully breastfeeding.
ii. Abstinence
iii. Withdrawal (Coitus interrupts)
iv. Calendar methods(Calendar Rhythm Method)
v. Cervical mucus (Billing’s Method)
vi. Sympathothermal (Basal Body Temperature (BBT)
Method+ cervical secretions + other fertility signs)
Basal Body Temperature (BBT)
Method)
 Take body temperature daily( before getting
out of bed and before meal)
 watches for temperature to rise slightly—0.2°

to 0.5°C (0.4° to 1.0°F)— just after ovulation

 Avoid sex or use another method until 3 days

after the temperature rise.

 The couple can have unprotected sex on the

4th day and until her next monthly bleeding

begins.
Calendar Rhythm Method
 Keep track of the days of the menstrual
cycle(6x) .The first day of monthly bleeding is
always counted as day 1.
 subtracts 18 from the length of her shortest

recorded cycle. This tells the estimated

restart day of her fertile time. subtracts 11
days from the length of her longest recorded
cycle. This tells the estimated last day of her
fertile time.
 Avoid unprotected sex during fertile time
Cervical mucus
 At the Time of Ovulation the production of
cervical mucus will be at its highest and the
consistency and color of the mucus will be
similar to egg whites. So avoid unprotected
sex.
Family Planning methods
2. Artificial methods:-
i. Barrier methods
◦ Diaphragm
◦ Condom
◦ Cervical cap
ii. Chemical methods:- spermicides
iii. Intra-uterine device (IUD)
iv. Hormonal
◦ - Pills
◦ - Implants
◦ - Injectables:-most commonly used (23% ) by married and 35% of
sexualy active unmarried women in Ethiopia
v. Surgical methods (Permanent)
◦ - Tubal ligation (ligating the oviduct).
◦ - Vasectomy (ligating the sperm duct).
Pills
1. Combined oral contraceptives (COCs) Pills
that contain low doses of 2 hormones—a
progestin and an estrogen. 

 Combined oral contraceptives (COCs) are also

called “the Pill,” low-dose combined pills,
OCPs, and OCs. 

 Work primarily by preventing the release of

eggs from the ovaries (ovulation). 
2.Progestin-Only Pills “minipills”
 Pills that contain very low doses of a progestin
 Take one pill every day.

 No breaks between packs. Safe for breastfeeding

women and their babies. Progestin-only pills do

not affect milk production.
Works by:-
 Thickening cervical mucus (this blocks sperm

from meeting an egg)

 Disrupting the menstrual cycle, including

preventing the release of eggs from the ovaries

(ovulation)
Spermicides
Female condom
Diaphragm
Emergency contraception

 Emergency contraception, or post-coital

contraception, refers to methods of contraception
that can be used to prevent pregnancy in the first 5
days after sexual intercourse.

 It is intended for use following unprotected

intercourse, contraceptive failure or misuse (such
as forgotten pills, or breakage or slippage of
condoms), rape or coerced unprotected sex.
Methods of emergency contraception

 There are 3 methods of emergency contraception:

1. emergency contraception pills (ECPs)
◦ Levonorgestrel taken as a single dose (1.5 mg) Or ,
◦ levonorgestrel taken in 2 doses (0.75 mg each, 12 hours apart).
◦ Ulipristal acetate, taken as a single dose at 30 mg.
2. combined oral contraceptive pills or the Yuzpe method:-
◦ The first dose should be taken as soon as possible after unprotected
intercourse and the second dose should be taken 12 hours later
3. copper-bearing intrauterine devices (IUDs).
◦ should be inserted within 5 days of unprotected intercourse.
◦ This method is particularly appropriate for a woman who would
like to start using a highly effective, long-acting and reversible
contraceptive method.
The major activities to be carried out
in family planning service are:
1. Review of all available methods in a simple and
understandable manner.
2. Understanding and respecting the clients’ right.
3. Follow the acronym GATHER- greet, ask, tell,
help, explain, and return
GATHER steps

 G- Greet clients in an open, respectful manner

 Assure the client of confidentiality.
 Give as much time listening as talking.
 A -Ask clients about themselves.
◦ Help client talk about their family planning practices,
intentions, concerns, and wishes.
 T -Tell clients about choices
◦ Focus on methods that interest the client.
 H -Help clients make an informed choice.
◦ Help the client think about the options
◦ Check for medical eligibility
GATHER steps cont,
 E -Explain fully how to use the chosen
method
◦ Give condoms to any one at risk for sexually
transmitted diseases (STD's) and encourage to use
them along with any other family planning method.
 R -Return visits should be welcomed:
◦ Discuss and agree when the client will return for
follow-up or
◦ When in need of more supplies.
◦ Always invite the client to return any time for any
reason.
Men’s Attitude towards FP
 In nearly all surveyed Sub-Saharan countries ,
most men know and approve of contraception.

 Most married men say that they want to have

more children, however, and on average, they
want more children than married women do.
Counseling in Family Planning
 The main goal of family planning
◦ is to improve the quality of life and reproductive
health by empowering individuals and couples to
exercise their right to safe sexuality, and
◦ to decide whether and when to have children and
◦ how many to have.
Context of Counseling in FP
A. Bridge Knowledge Gap:-
 Brief anatomy and physiology of reproductive

health to clients
 Explain about the contraceptive technology –

the benefits, risks, effectiveness and mode of

action for all available family planning
methods.
 Myths and belief should be told.
Context of Counseling in FP cont,
B. Help Clients Make Informed Choice
 Consider that women may be unprepared to

make their own choice. So, Encourage clients

to take responsibility for decision- making.
 Give complete information about the method

chosen by the client.

C. Provide Services
 Record should be kept for a client
 Give the service
 Appoint for next visit
Six topics discussed on methods
i. Effectiveness
ii. Advantages and disadvantages
iii. Side effects and complications
iv. How to use
v. STI prevention
vi. When to return
Adolescent Counseling on Family
Planning
 family life education and counseling are
important to adolescents in order to tackle
the potential problems in relation to their
sexual and Reproductive Health.

 Consistent and correct use of condom is

highly effective in preventing pregnancy and
STI (dual protection).
Problems of adolescent RH
 Consequences of unwanted pregnancy.
 Unsafe abortion.
 High risks of early child bearing.
 Diminished opportunities for education
especially females.
 High risk of STD's.
Family Planning Delivery Strategies
 The most common service delivery sites
include
◦ clinics,
◦ community-based distribution programs,
◦ commercial retail sales,
◦ workplace programs,
◦ postpartum programs, and
◦ private physicians.
common service delivery sites
 Clinics:-
◦ provide methods that are
◦ more medically complex, such as IUDs, implants,
Injectable and sterilization.

 Community-Based Distribution (CBD):-CBD workers,

usually village women are trained to educate their
neighbors about family planning and to distribute
certain contraceptives
◦ A midwife, family planning nurse, program coordinator, or
other staff member is usually responsible for supervising the
CBD workers’ activities and managing any problems that
occur.
common service delivery sites cont,
 Commercial Retail Sales:- OCPs and condoms
are sold at reduced, subsidized prices in
pharmacies, stores, shops, bars, beauty
salons, etc.
The Main Reasons for Not Intending
to Use FP methods are:
 Currently pregnant or want to have more
children.

 Concerns with contraceptive side effects

 Religious or other opposition to family

planning.
Major Reasons in Ethiopia (EDHS)
 Fertility-related reasons (40 %) mainly desire
for more children

 Opposition to use (23.6 %)

 Lack of knowledge (11.2%),

 Method-related reasons (13.6%)

Thanks !
End of the slides