UNIT 12

Family Planning

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Concept of family planning

• The concept of families throughout their own

design can plan when, how often, and at
what intervals they wish to have children is
family planning at the highest level of
responsibility.
• Family planning is the term given for pre-
pregnancy planning and action to delay,
prevent or actualize a pregnancy.

2
 Definition

• Family planning is a way of thinking and living

that is adopted voluntarily, upon the basis of
knowledge, attitude and responsible decision by
individuals and couples, in order to promote the
health and welfare of family group and thus
contribute effectively to the social development
of the country.
WHO expert committee, 1971

3
• It is the conscious effort of couples to
regulate the number and spacing of births
through artificial and / or natural methods of
contraception.

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Objectives of family planning
• The use of a range of methods of a fertility regulation to
help individuals or couples attain certain objectives:
 avoid unwanted birth.
 bring about wanted birth.
 determine the number of children in the family
 Regulate the intervals between pregnancies.
 Control time at which birth occur in relation to the ages
of parents
Improve and promote the health status of mothers ,
children as well as whole family

5
 National FP programme
• Family Planning is one of the priority programs of Government of
Nepal, Ministry of Health. 
• It is also considered as a component of reproductive health
package and essential health care services of Nepal Health Sector
Program II (2010-2015), National Family Planning Costed
Implementation Plan 2015-2021, Nepal Health Sector Strategy
2015-2020 (NHSS) and the Government of Nepal’s commitments
to FP 2020.
• In Nepal, FP information and services are being provided through
government, social marketing, non-governmental organizations
and private sectors.

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• In government health system, currently, short acting reversible
contraceptive methods (SARCs: male condoms, oral pills and
injectable) are provided on a regular basis through primary health
care centers (PHCC), health posts (HP) and primary health care
outreach clinics (PHC/ORC).
• Female Community Health Volunteers (FCHVs) provide information
and education to community people, and distribute condom and
resupply of oral contraceptive pills.
• Long acting reversible contraceptive (LARC) services such as IUCD
and implants are available only at limited number of hospitals,
PHCCs and HPs where trained health care providers are available.

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• Access to LARC services is provided in remote areas
through satellite clinics and mobile camp.
• Permanent FP method are provided at static sites or
through scheduled seasonal and mobile outreach
clinics.
• Almost all district FP MCH clinics are providing all
types of temporary FP methods regularly.

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 Major activities in 2074/75
• Provision of regular comprehensive FP service
• Provision of long acting reversible services (LARCs)
• FP strengthening program through the use of decision making tool
(DMT) and WHO medical eligibility for contraceptive (MEC) wheel
• Micro planning for addressing unmet need of FP in low modern
CPR district
• Permanent FP Methods or Voluntary Surgical Contraception (VSC)
• Implementation of PPP program at high population district

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• Development of institutionalized family planning service
center as a training center
• Integration of FP and immunization service
• Satellite clinic services for long acting reversible
contraceptives
• Orientation on family planning services for
Obstetrician/Gynecologist & Concerned key players
• Micro planning to address unmet need of FP in targeted
communities with low CPR District/ Council & follow up

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• Interaction program on FP in marginalized
communities
• Initiation of school health nurse programme in
selected school of some Provinces

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Family planning services in Nepal
• Family planning was first initiated in Nepal with the
involvement of the Nepal Medical Association
(NMA) in 1959.
• The FPAN was formed with the active involvement
of Nepal Medical Association with the support of
International Planned Parenthood Federation (IPPF).

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• In 1965 Family planning policy was developed with the
technical assistance of US government and FP was
integrated with MCH project and form FP/MCH project
under the department of health.

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• Subsequent technical assistance for family planning
activities started with the support of the USAID as
long ago as 1966. This took the form of support to
MCH section of the Department of Health in
starting some health facilities in the three districts
Kathmandu, Lalitpur and Bhaktapur.

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• In 1968, the FP & MCH project with 4 regional
offices was established to implement activity
ordered by government.
• In 1990, the FP/MCH project was converted into a
division under the Ministry of Health.

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• A lot of importance was given in the initial stages on
the permanent methods. The use of contraceptives
was taken up as one of the strategies.
• Improvements in availability and accessibility of
contraceptives occurred between 1976 and 1986.

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• In 1988 with the concept of having a different
approach, sterilization was no longer emphasized.
More stress was laid on the other temporary methods
to prevent early pregnancy and better spacing.

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• In the effort to popularize FP, the Nepal
Contraceptive Retail Sales (CRS) company was
established in 1978. The CRS organizes the sale of
pills, condoms on a subsidized basis through many
outlets all over the country.

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• The main thrust of National Health Policy (1991) in
relation to the National Family planning programme
is to expand and sustain adequate quality family
planning services to communities through all health
facilities like hospitals, primary health care (PHC)
centers, health posts (HP), sub health posts (SHP),
PHC outreach clinics and mobile voluntary surgical
contraception ( VSC) camps.

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• The policy also aims to encourage NGOs, social
marketing organizations, as well as private
practioners to complement and supplement
government efforts. FCHVs are to be mobilized for
condom distribution and supply of oral pills.

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• Awareness on FP is to be increased through various
IEC/BCC intervention as well as active involvement
of FCHVs and mothers group as envisaged by the
revised National strategy for FCHVs programme.

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Governmental services for FP services

• MCH clinics of DPHO

• Primary health centre
• Health post
• Sub health post
• Female Community Health Volunteers (FCHVs) also
conduct community based programs for family
planning

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• PHC outreach clinic
• Paropakar obstetric & Gynaecological Hospital,
Thapathali
• Kanti children hospital
• Tribhuvan university teaching hospital

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International and bilateral assistance in FP

1. UNFPA (United Nations Population Fund)

2. USAID (United States Agency for International
Development)
3. KfW (Kredistanstalt FUR Wiederaufbau)
4. NFHP (Nepal Family Health Programme)
5. Marie Stopes International (MSI)/ Sunaulo Parivar
Nepal (SPN)
6. IPAS

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Non governmental agencies for FP

• FPAN
• Medical college
• UMN supported community Hospital
( Okhaldhunga, Amp pipal hospital, tansen hospital)

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Objectives of family planning
• The use of a range of methods of a fertility regulation to
help individuals or couples attain certain objectives:
 avoid unwanted birth.
 bring about wanted birth.
 determine the number of children in the family
 Regulate the intervals between pregnancies.
 Control time at which birth occur in relation to the ages
of parents
Improve and promote the health status of mothers ,
children as well as whole family

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Family planning counseling and
Use of ABHIBADAN for family
planning counseling

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 Counselling

Counselling is a type of talk

therapy that allows a person to
talk about their problems and
feelings in a confidential and
controlled environment.

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Family Planning Counselling

• Family Planning counselling is a process of

communication, where the counselors give accurate
and complete information to a client or clients and
assists them to make informed and voluntary decision
about their fertility and contraceptive options.
• Counselling provides balanced and complete
information to help the client come to a decision based
on their reproductive goals.

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Purpose
Helps clients to :
Arrive at an informed choice of reproductive options
Select a family planning method with which they are
satisfied
Use the chosen method safely and effectively
Initiate and continue family planning
Learn objective, unbiased information about
available methods of family planning.

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Benefit of family planning counselling

Increased acceptance
• Correct information and ‘open’ discussion between
client and service providers through listening,
talking and non-verbal communication helps clients
to accept family planning.
Appropriate method choice
• Counselling helps to choose the methods that is
best for the individual health needs and social well-
being.

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 Benefit of family planning
counselling…
Effective method use
• Effective counselling is necessary for clients to learn how to
use methods correctly.
Longer continuation
• A client is more likely to continue using a contraceptive
method and be a satisfied client if she/he participates in
choosing the method, understand how it works, knows how
to deal with possible side effects and feel comfortable in
contracting and talking with service provider.

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Benefit of family planning
counselling…
Counter rumors and misconceptions
• Counselling offers the opportunity to identify,
correct misinformation about family planning
methods that a client may have.
• This will increase method acceptance, use and
continuation for the client as well as in the wider
community.

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 Rights of client
In serving clients, it is important to remember that
they have:
The right to decide whether or not to practice family
planning
The freedom to choose method to use
The rights to privacy and confidentiality
The right to complete and accurate information
The right to form/express their own options
The right to refuse any type of examination

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Types of Family Planning Counseling

1. Method-specific Counseling
2. Return/Follow up counseling
3. Individual counseling
4. Group counseling
5. Couple counseling

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Counselling process and ABHIBADAN
approach

• Counselling is an ongoing process integrated into all

aspects of family planning and is not just
information presented and discussion at one point
in the provision of services.
• Counselling techniques should be applied and
appropriate technical information provided and
discussed in an interactive and culturally
appropriate manner throughout the clients visit.

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ABHIBADAN approach

• The ABHIBADAN approach to counselling is a

systemic counselling approach based on clients’
reproductive needs.

• Referred to as the “ GATHER” approach in English

and ABHIBADAN in Nepali.

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G- gather clients in friendly way
A- ask clients about their FP
T- tell clients about available methods
H- help clients decide what method they want
E- explain how to use the method chosen
R- return visits should be planned

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“A” abhibadan garne i.e. to greet

Greet
Welcoming and friendly
Treat with respect
Arrange for privacy

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“BHI” Bhinna nathani awashyakta patta lagauna sodh
puch garne (i.e. asking question without discrimination to
identify the needs)
• Ask the client about his/her needs without any discrimination
against his/her education, social and economic status.
• Listen attentively to what the client says encouraging him/her to
speak up about anxieties, curiosities and doubts concerning family
planning
• Ask about his/her age, marital status, number of children, number
of pregnancies, number of living children and their ages and about
previous or present use of family planning methods in detail.

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 “BA” Badha hatauna soochana uplabdha garaune
(i.e. provide information for solving problems)

• Provided detailed information about the

advantages, disadvantages of the method where it is
advisable, how to obtain it, how to combat side
effects etc.

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“DA” Datta chitta bhai sahayog garne (i.e. Help
whole heartedly)

• Comparative information on available methods

should be given to clients enabling them to select
methods suited to their needs.
• After selection the counselor should test the client’s
knowledge of the method.
• Detailed information as to where and when the
method is available, what sort of physical
examination the clients must under go if before
using it and where the client should go if side-
effects occur should be provided to clients.

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“Na” Namaskar gardai pheri auna aunrodh garne (i.e.
Bidding good bye and asking clients to come again)

• Having provided information per the needs of the

client, he/she should be direct to the place where
the family planning method is available upon
obtaining the methods; the client should be
reminded to come for a follow up visit.
• During follow-up visit, the client should be asked
about the method being used and any side-effect.

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Factors affecting method of choice

Reproductive goals of woman or couple (spacing or

birth timing)
Personal factors including time, travel costs, pain or
discomfort likely to be experienced
Accessibility and availability of other products that
are necessary to use methods.

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Factors affecting method of choice…

Advantages and disadvantages of the method

Reversibility
Long and short term effects

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FP methods

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Types of family planning

Temporary Methods

Permanent Methods

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 Temporary methods(spacing)

Barrier methods
Intrauterine
Hormonal
Fertility awareness
Miscellaneous ( LAM, withdrawl)

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 Barrier methods
Physical
• male condom
• Female condom
• Diaphragm
Chemical (Spermicidal ) foam tablet, jelly, paste and cream
• Kamal chakki
Combined
• Physical + chemical

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Physical method

1. Condom:
It is most widely practiced method used by the
male. Available free of cost from
government and non government family
planning clinics.

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Mechanism of action:
• It blocks the sperm from entering the vagina
• Prevent STI
• Effectiveness: In perfect users 98% effective

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Advantage:
• Effective immediately
• Protect against STI, HIV/AIDS
• Easy to use
• Do not require medical supervision
• No side effects

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Disadvantage:
• Must available before intercourse.
• It may slip off or tear during coitus due to
incorrect use.
• Problems of disposal after use
• Sometimes allergy may occur.(very rare)

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2. Female condom (femidom):
A thin polyurethane sheath placed inside the
vagina to stop sperm from entering.

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3. Diaphragms/Cervical cap:
A diaphragm or cap is dome of rubber
which is fitted on the woman over her
cervix before sex.
It is used 2 hours before sex. It must be
placed for 6 hrs after sex. It is not available
in Nepal.

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Mechanism of action:
• Prevent sperm passing into the upper
reproductive tract and serve as a holder of
spermicide that inactivates the sperm.

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 b. CHEMICAL METHODS

In the 1960s, before the advent of IUDs, spermicides

(vaginal chemical contraceptives) were used widely. They
comprise these categories.
a) Foams : foam tablets, foam aerosols
b) Creams, jellies and pastes - squeezed from a tube
c) Suppositories - inserted manually kamal chakki

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 Spermicide action

Modern spermicides are "surface-active agents" which

attach themselves spermatozoa and inhibit oxygen
uptake and kill sperms.

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 Drawbacks of spermicides

(a) they have a high failure rate

(b) they must be used almost immediately before
intercourse and repeated before each sex act
(c) they must be introduced into those regions of the
vagina where sperms are likely to be deposited,
(d) they may cause burning or irritation..
(e) It have an inflammatory or carcinogenic effect on the
wag skin or cervix.

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Intrauterine

• IUCD

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IUD:
IUD’s are medicated or non-medicated
devices which exerts it’s contraceptive
action in the uterine cavity continuously for
a prolonged period of time

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Classification:
• Non- medicated IUCDs: Lippes loop
• Medicated copper containing IUCDs : Cu T-380
A, Multiload – 375, Cu T-200, Multiload – 250
• Hormone containing IUCDs : Levonorgestrel
intrauterine system (LNG – IUS), progestasert

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Mechanism of action:
• An IUD prevents sperm from meeting an egg.
• An IUD may stop a fertilized egg from growing
inside the uterus
• Copper seems to enhance the cellular response in
the endometrium. It also affect the enzymes in the
uterus by altering the biochemical composition of
cervical mucus, copper ions may affect sperm
motility capacitating and survival.

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Effectiveness: Effectiveness of IUD is 99.2% and its
effectiveness is immediately.
Advantages:
• Provides long-term birth control.
• Cost effective.
• Can be removed when a woman would like to become
pregnant.
• Convenient - a woman does not need to remember it
daily or weekly.

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Disadvantages
• Between 2 and 10% fall out, most commonly in
the first year of use.
• In rare cases, the IUD may attach to or perforate
the wall of the uterus.
• With the copper IUD, a woman may experience
heavier bleeding and cramping with periods.

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Advice the client:
• Should regularly check the thread tail if she could
not feel the tail she must consult the health
worker
• If she misses a period she must consult the
health worker
• Client with PID, vaginal bleeding can’t use this
method.

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Hormonal

• Oral pills
• Depo provera ( DMPA)
• Sub dermal implant

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 Hormonal method
1. Oral pills:
a) Combined pills:
• Content: contains estrogen and progesterone
• Mode of action: inhibit ovulation of ovum by blocking
the gonadotrophin from pituitary gland. The
progesterone alters the cervical mucosa which prevents
entry of sperm into genital canal makes the uterine inner
lining unsuitable for implantation of fertilized egg.

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• For example: Nilocan, Gulaf etc
When to start:
within 5 days of mens
Within 6 weeks of postpartum(non breastfeeding)
Within 4 months of postpartum(breastfeeding)
Within first 7 days of post abortion or immediately.

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Contraindication: • Breast cancer,
• Circulatory disease. • breast feeding
• Severe HTN,
• angina,
• ischemic heart
disease,
• liver disease,
• pregnancy,
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Effectiveness:
• With perfect use: less than one women out
of 100 will become pregnant
• With typical use: five women out of 100 will
become pregnant

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Advantages:
• Convenient to use.
• Decrease the risk of ovarian and uterine cancer
• Decrease the risk of PID
• Easily available for free of cost at health facilities.

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Disadvantage:
• It cannot be use in women older than 35yrs.
It increased the cardiovascular risk.
• Failure rate is high if not taken regularly.
• May increase the risk of cervical cancer.
• Quality of breast milk may be decreased.

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Side effect:
• Dizziness, Nausea
• Patches in skin
• Weight gain
• Headache
• Breast tenderness

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b) Progesterone only pills( mini pills) POP
• Content: contains only progesterone
• Mode of action: the progesterone alters the
cervical mucosa which prevents entry of sperms
into genital canal makes the uterine inner lining
unsuitable for implantation of fertilized egg.

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Advantage:
• Can be used in older women with
cardiovascular risks
• Can be taken by those women who had side
effect using estrogen containing pills.
• Client who are on breast feeding.

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Disadvantage:
• Menstrual irregularities is most common
problem
• Irregular bleeding and spotting can observe.
• Increases the risk of ectopic pregnancy

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Advice to client:
• If you miss taking a pill on one day, should
take it as soon as you remember. Take the
next pill at the regular time.
• If you miss taking a pill on 2 or more days in a
row, take a pill as soon as you remember and
continue pill until you finish the packet and
can use condoms for backup.

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• If you continually forget to take pills, should
start another method of family planning.
• Blood pressure measurement is desirable
before starting a hormonal method
• Medication interference with pill
effectiveness eg anti seizure, anti convulsion,
rifampicin

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2. Depo-Provera:

• The only injectable contraceptive available in

Nepal is depot- medroxy progesterone
acetate or DMPA. It contains Progesterone
only.
• Sangini

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Mechanism of action:
• It suppress ovulation
• Reduce sperms transport in upper genital
tract(fallopian tube)
• Changes endometrium making implantation less
likely.
• Thicken cervical mucus (preventing sperm
penetration)

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Types:
• DMPA(Depot-medroxyprogestrone acetate)-
150mg IM every 3 months
• NET-EN (norethisterone enantate) - it has been
less extensively used than DMPA. It is given
intramuscularly in a dose of 200 mg every 60 days.

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• DMPA-SC 104 mg or DMPA-SC-is injected
under the skin rather than in the muscle. It
contains 104 mg of DMPA rather than the
150 mg in the intramuscular formulation. Like
the intramuscular formulation, DMPA-SC is
given at 3-month intervals.

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• Effectiveness: Depo-Provera is 97%  effective.
This means 3 out of 100 women will get
pregnant each year. If you have your injections
on time (every 12 weeks) it can be more than
99% effective.

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Advantage:
• Can provide long term protection
• Do not adversely affect breast feeding
• Rapid effectiveness.
• Can use over 40 yrs also
• Easy to use.
• The risk of endometrial cancer is reduced by 80%. 

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Disadvantage:
• Do not protect against STI
• Causes menstrual changes on most users
• Weight gain
• Can lead to very irregular periods.

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Side effect
• Breast tenderness
• Headache
• Bleeding or spotting between periods.

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Advice to client:
• If heavy vaginal bleeding, lower abdominal pain,
severe headache and depression return to clinic.
• Women who have had breast cancer can’t use
this method.

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• Some women put on weight, some lose
weight, most do not change weight
• Explain about possible side effects and their
management.

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3. Implant (jadelle):

• This device contain the progestin

levonorgestrel 75 mg in each of 2 silicon
rubber capsule and are surgically inserted
under the skin of the women’s upper arm by
a trained medical practitioner.

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Mechanism of action:
• By blocking ovulation
• Causing thick cervical mucus
• Thin atrophic endometrium

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• Effectiveness: It is one of the most effective
reversible contraceptive methods. The
average annual pregnancy rate for implant is
less than 1%. 
• 99.7% effective

92
Advantage:
• Immediately effective within 24 hours of
injection
• Long term protection for 5 yrs.
• It does not interfere with the lactating and blood
pressure
• Protect against uterine cancer.
• Does not interfere breast feeding

93
Disadvantage:
• Need small surgical procedure and medical
person
• Causes menstrual irregularities.
• Weight gain or loss may occur.

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Side effect:
• irregular menstrual bleeding patterns
• lack of menstruation
• spotting
• headache
• stomach cramps
• nausea

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Advice to client:
• The implant is inserted like an injection
• Irregular bleeding can occur, but this can
often be managed with medication to help it
settle down
• Periods may stop, but this is nothing to worry
about
• It requires a simple procedure to remove it.

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• If sign of inflammation , pain at site and fever return
to clinic
• Follow up after 7 days of insertion site

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 Fertility awareness

• Fertility awareness means that a women learns how

to predict when the fertile time of her menstrual
cycle starts and end.
• Couple voluntarily avoid sexual intercourse during
the fertile phase of the women’s cycle.

98
Fertility awareness

Natural:
• Calendar method,
• cervical mucous method,
• basal body temperature method
• Symptothermic method (BBT+ Cervical
method)

99
 Cervical mucus method:
• This is also known as ovulation method.
• This method is based on the observation of
changes in the characteristics of cervical mucus. At
the time of ovulation, cervical mucus becomes
watery, clear resembling raw egg white, smooth,
slippery and profuse.

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• After ovulation due to influence of
progesterone, the mucus thickens and
lessens its quantity. Fertile mucus occurs
approximately at mid cycle. Abstinence is
practiced when fertile mucus is present and
for 3 days afterward.

101
Basal body temperature:
• Before ovulation women’s body
temperature is slightly low in comparison
with the time of ovulation. After ovulation
the body temperature become slightly high
as a result of an increase in the production
of progesterone.

102
• The rise temperature is 0.3 to 0.5° C. The
temperature is measured before getting out of
bed in the morning.
• This method is reliable if intercourse is restricted
to the post ovulatory infertile period, from the
beginning of menstruation until 3 days after the
ovulatory temperature rise.

103
Advantages:
• Can use either to avoid or to achieve pregnancy.
• No physical side effects
• Increase self awareness
• Not needed qualified person
• Economical
• promote involvement of both partners

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 Safe period (Rhythm method, Calendar
method):
• This method also known as calendar method.
• Ovulation takes place 14th days before the next
menstruation. The ovum destroys after 1-2 days
if it is not fertilized. The life of sperm is not
more than 3 days. If these risk days are avoided,
the chances of pregnancy will be reduced.

105
• In this method we use a mathematical
formula to calculate the fertile period. The
women must observe the length of at least
six menstrual cycles and then applies the
formula.

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Calendar method,

• From the number of days in longest cycle , substract

11. This identifies the last fertile day of cycle
• From the number of days in shortest cycle ,
substract 18. This identifies the first fertile day of
cycle
• Abstain during fertile period

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Symptothermal method

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Miscellaneous

• Withdrawl ( coitus interrupts)

• Lactation Amenorrhea method (LAM),

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Coitus interruption (withdrawal method) method
• This refers to removal/withdrawal of the penis
from vagina prior to ejaculation of semen,
ejaculation must occur completely away from the
vagina.

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• Couple who using withdrawal method should
know that the pre-ejaculation fluid from
penis also contain sperms.
• This method is better than no method but is
not a very effective way to prevent
pregnancy.

111
Lactational amenorrhea method (LAM):
• LAM is a method of avoiding pregnancy which is
based on the natural postnatal infertility that
occurs when a women is amenorrhea and fully
breast feeding. If it is not combined with
chemicals or devices, LAM may be considered
natural family planning.

112
Mechanism of Action:
• During breast feeding, stimulation of the nipple by
sucking sends neural signals to the hypothalamus
that affect the secretion of gonadotropin releasing
hormone.
• The irregular secretion of gonadotropin releasing
hormone then interferes with the release of follicle
stimulating hormones and luteinizing hormone
from the pituitary gland resulting in disruption of
follicular development in the ovary.

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• Ovulation remains disrupted or
suppressed. When baby sucks mother’s
nipples it causes a surge in prolactin in the
mother’s blood which inhibits ovulation.
Ovulation remains disrupted or suppressed
as long as the frequency, duration and
intensity of sucking are high.

114
Effectiveness: Women who meet the criteria
listed below, LAM is 98%-99.5% effective
during the first six months postpartum.

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Criteria
• Breast feeding must be the infant’s only source of
nutrition.
• The infant must breastfeed at least every four hours during
the day and at least every six hours at night.
• Feeding is on demand at least 8 times per 24 hours.
• The infant must be less than six months old.
• The mother’s menses has not returned

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Advantages:
• Easy to use
• Protection starts immediately after birth
• Free of cost
• Does not interfere with sexual intercourse
• Close relationship between mother and baby

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Disadvantages:
• Depend upon maternal behavior
• Not an effective method of contraception unless
all criteria are fulfilled
• Limited duration
• No protection against STIs and HIV/AIDs
• May be very difficult for women who work
outside the home.  

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Permanent FP methods

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Permanent method ( Terminal)

• Male sterilization: Vasectomy

• Female sterilization: Tubal ligation (Minilap,
Laparoscopy)

120
Surgical Method

a. Vasectomy
• A safe permanent method of contraception
in which the tubes (vas deferens) through
which sperm travels from the testes to the
penis are cut and blocked so that
spermatozoa can no longer enter the semen
that is ejaculated. It can also done by Non-
scalpel vasectomy.

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Advantage:
• Safe and simple
• Reversal is possible
• Minimal invasive
• Can be performed in OPD basis
• Cheaper

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Disadvantage
• Delay effectiveness ( require 3 month or 20
ejaculations)
• Does not protect against STD’s.
• Expensive for reversal

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Contraindication:
• Hydrocele
• Inguinal hernia
• Filariasis 
• Cryptorchism
• Previous scrotal surgery

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Complication

• Swelling and pain

• Blood clots
• Infection
• Epididymitis
• Spontaneous recanalization

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Pre op and post op advice

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b. Tubal Ligation
• It is a permanent method of contraception
in which the fallopian tubes are closed so
that the egg cannot travel through them to
meet the sperm.

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Types:
i. Minilapratomy
 This operation is done under local
anesthesia. 2-3 inch incision is done in the
lower abdomen and the fallopian tube are
tied off and cutting out small piece of tube.

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Advantage:
• Immediately effective
• Does not interfere to sexual intercourse

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Disadvantage:
• Not reversible
• Does not protect from STD’s

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Contraindication:
• Pregnancy • Severe anaemia
• Respiratory problem • Psychiatric
• PID medication
• HTN • Abdominal surgery
• DM

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ii. Laparoscopy:
• After giving local anesthesia about 1 cm
incision is made under the umbilicus and
then the laparoscopy instrument is
inserted to find out the fallopian tubes.
Then the tubes are tied using small rubber
rings.

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Advantages:
• It only takes 15mins
• Immediately effective
• Simple surgery under local anesthesia

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Disadvantage:
• Difficult to operate than minilap
• Does not protect from STD’s

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Contraindication:
• HTN
• Severe anemia
• DM
• Mass in pelvis

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•Pre and post op care

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Emergency Contraception

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Emergency contraception:

• Emergency contraception (EC) is a method of

contraception used as an emergency
procedure before menstruation is missed, to
prevent pregnancy following unprotected
intercourse or expected failure of
contraception. Often called “morning pills”

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• Currently there are two types of emergency
contraception:
 Mechanical: The only mechanical method is
the IUD. When inserted up to 5 days after
unprotected intercourse, copper releasing
IUD’s can prevent a pregnancy.
99.4% effective

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Hormonal:
• COCs:
 Should be taken within 120 hours of unprotected sex
and repeat after 12 hours.
It contains norgestrel (progestin) 0.3mg and ethinyl
estradiol (estrogen)0.03 mg in each pill
Take 4 tablets as soon as possible, up to 120 hours after
an unprotected sex. And 12 hours later take 4 more
tablets. Total= 8 tablets.
98% effective

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• Because of effect of oestrogen, nausea is a common side
effect. If accompanied by vomiting within first 2 hours, the
effectiveness may decreased. Instruct to repeat the dose.
• To minimize nausea and vomiting , advice clients to take
medicine with food. If possible taking the first dose at
bedtime may reduce nausea and vomiting.
• Provide anti emetic 1 tab 1 hour before taking medicine if
needed.

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• Progestin only pills( POPs): postinor
Should be taken within 120 hours of unprotected
intercourse and repeated after 12 hours.
0.75mg levonorgestrel. Take 1 tablet as soon as
possible within 120 hours after unprotected sex.
After 12 hours take 1 more tablet.
97% effective

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Mode of action
• Emergency contraceptive pills prevent
pregnancy by preventing or delaying
ovulation and they do not induce an
abortion. The copper-bearing IUD prevents
fertilization by causing a chemical change in
sperm and egg before they meet. Emergency
contraception cannot interrupt an established
pregnancy or harm a developing embryo.

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Advantages
Emergency contraception offers the following
advantages as a short-term method of
contraception:
• It is safe for almost all women
• Using emergency contraception does not affect long
term fertility

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• It does not cause an abortion
• One can use emergency contraception at any
time in your menstrual cycle
• Emergency contraception is not harmful to
health.

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When to return

• If she has no menses within 3 weeks

• Any concerns.

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THANK YOU

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