RIZALINA S.

BARRAMEDA,RM,MSPH
City Health Midwife III
 WHO’S Definition Of
Family Planning

“Family planning allows individuals and couples to anticipate and attain their
desired number of children and the spacing and timing of their births. It is achieved
through the use of contraceptive methods and the treatment of involuntary infertility.
A woman’s ability to space and limit her pregnancies has a direct impact on her health and
well-being as well as on the outcome of each pregnancy”.

In other words, family planning is voluntary, and available methods of contraception

(previously referred to as birth control) can be customized to individual needs with a range
of methods that are acceptable to all, effective and easy to use. Unmet need for family
planning applies only to married women and indicates those women who say they prefer to
avoid a pregnancy but are not using any method of contraception. That number is a stunning
215 million women globally.
Family planning prevent, about one-third of pregnancy-related deaths, as well as 44% of
neonatal deaths. This is because timing and spacing of pregnancies- at least 2 years between
births-is needed to prevent adverse pregnancy outcomes, including high rates of prematurity
and malnutrition, and stunting in children. Spacing of pregnancies for optimal outcomes applies
globally, not only in poor settings. The ability to determine whether or not to become
pregnant and how many children to have has long been recognized as a human right.
If you’re already parents, family planning takes on new meaning. Having another child will change
your family’s lives. Are you and your partner ready to take care of a newborn again? How
will your other child or children react to sharing your attention with a new baby?
The timing of your pregnancies is important, too. While you and your partner might have
preferences about how close in age, you’d like your children to be, some research shows that how
you space your pregnancies can affect mother and baby.
What Is Fertility Awareness?
• Fertility awareness is recognizing the signs of fertility in your
menstrual cycle. It can be used to:
o understand your own menstrual cycle
o plan a pregnancy
o avoid a pregnancy.

• How reliable is it for preventing pregnancy?

o The method can be 97% effective if you can easily recognize
the fertile phase and use the method correctly. This
effectiveness means three out of 100 people using fertility
awareness will get pregnant each year.
Methods of Contraception

• long-acting reversible contraception - the implant or intra

uterine device (IUD)

• hormonal contraception - the pill or the Depo Provera injection.

• barrier methods - condoms.

• emergency contraception.

• fertility awareness.

• permanent contraception - vasectomy and tubal ligation.

 What Is Long-acting Reversible Contraception?

• Long-acting reversible contraceptives are methods of birth control that provide

effective contraception for an extended period without requiring user action.
• They include injections, intrauterine devices, and subdermal contraceptive
implants.
• There are two types of LARC.
 the intra uterine device, which lasts for three, five or ten years
 the implant, which lasts for five years.
• Once you have a LARC put in, you don’t need to remember to take contraception every
day or every month.
• LARCs are the most effective types of contraception. They are more than 99%
effective at preventing pregnancy.
What Are Hormonal Contraceptives?

• Hormonal contraceptives include the Pill and the

Depo Provera injection.
Hormonal Contraception
• There are two types of pill:
- A type of birth control that uses
 combined oral contraceptive pill hormones to prevent
 progestogen-only contraceptive pill pregnancy. Hormonal
• You take one pill each day. If you take the pill contraceptives contain estrogen
and progesterone, or
correctly, it is more than 99% effective at
progesterone only.
preventing pregnancy.
- They prevent pregnancy by
• The Depo Provera injection is an injection you blocking the release of eggs from
get every three months. If you get your the ovaries, thinning the lining of
injections on time, Depo Provera is more than the uterus, or thickening the
99% effective. mucus in the cervix to help keep
sperm from reaching the egg.
 What Are Barrier Methods?
• Barrier methods stop sperm from entering the
External Condom Internal Condom
vagina.
• worn on the penis, • worn inside the
only once it is erect • The two barrier methods are: vagina & can be
• majority are made  condoms initiated by the
from latex; some  internal condoms female/receptive
people may be allergic partner
• must be removed
• Condoms protect against sexually transmissible • latex-free, made from
immediately after
infections (STIs) and from unintended pregnancy. hypoallergenic nitrile
ejaculation • You can buy internal condoms from our website and • can be inserted prior
from some pharmacies. to sexual activity for
• You can get a prescription for condoms from Family interruption-free
Planning or your doctor, or you can buy them from intimacy
this website, pharmacies, supermarkets, and other • can be worn even
shops. after ejaculation,
increasing duration of
intimacy
 What Is Emergency Contraception?
• Emergency contraception refers to methods • Emergency contraception can be used to
of contraception that can be used to prevent prevent pregnancy if:
pregnancy after sexual intercourse. o you haven't used protection
• There are two options for emergency o your normal contraception fails e.g. condom
contraception: the emergency splits
contraceptive pill (ECP) or a copper IUD. o you have missed more than one
• ECP can be taken up to three days after contraceptive pill
unprotected sex. If you are an average o you have been vomiting or had diarrhea
weight, the ECP is 98% effective. If you weigh while on the pill
more than 70kg, the ECP is less effective and a o you have missed your injection
copper IUD is recommended. If you weigh more o you have been forced to have sex without
than 70kg and you choose to take ECP, you
contraception.
should ask if taking a double dose is the right
option for you. • It is not a good idea to use ECP as your
regular method of contraception - it is less
• The copper IUD can be inserted up to five
effective than if you were using a LARC or
days after unprotected sex, and is more than hormonal method.
99% effective at preventing pregnancy.
• However, typically the pregnancy rate is closer to 25 out of 100.
This is because:
• people have not been taught correctly
• people do not understand how to use the method
• people have sexual intercourse during the fertile time
• it is difficult to recognize the signs of fertility.

• What do I need to learn?

• We strongly recommend you consult an experienced teacher before
using fertility awareness as a method of contraception.
• You need to know how to:
• understand your menstrual cycle
• check your cervical mucus
• take your temperature
• recognize other signs of your fertile phase
• use this information to plan or avoid a pregnancy.
Natural Family Planning
• Natural family planning (NFP) is a term used to
describe methods of planning or preventing pregnancy based
on observation of naturally occurring signs and symptoms
of the fertile and infertile phases of the menstrual cycle.
• The natural family planning methods do not include any
chemical or foreign body introduction into the human
body. Most people who are very conscious of their religious
beliefs are more inclined to use the natural way of birth control.
Some want to use natural methods because it is more cost
effective.

Abstinence
 This natural method involves abstaining from sexual
intercourse (simply, not having sex) and is the most effective
natural birth control method with ideally 0% fail rate.
 It is also the most effective way to avoid STIs.
 However, most people find it difficult to comply with abstinence,
so only a few of them use this method.
The Calendar Method

• Also called as the rhythm method, this natural

method of family planning involves refraining
from coitus during the days that the woman is
fertile.
• According to the menstrual cycle, 3 or 4 days
before and 3 or 4 days after ovulation, the woman
is likely to conceive.
• The process in calculating for the woman’s safe
days is achieved when the woman records her
menstrual cycle for six months.
• She subtracts 18 from the shortest cycle and the
difference is the first fertile day.
• She also subtracts 11 from the longest cycle, and
this becomes the last fertile day.
• Starting from the first fertile day until the last
day, the woman should avoid coitus to avoid
conception.
• It has an ideal fail rate of 5%, but when used it
has a typical fail rate of 25%.
Basal Body Temperature

 The basal body temperature is the woman’s temperature at rest.

 BBT falls at 0.5⁰F before the day of ovulation and during ovulation , it
rises to a full degree because of progesterone and maintains its level
throughout the menstrual cycle, and this is the basis for the method.
 The woman must take her temperature early every morning before any
activity, and if she notices that there is a slight decrease and then an
increase in her temperature, this is a sign that she has ovulated.
 The woman must abstain from coitus for the next 3 days.
 The BBT method has an ideal fail rate of 9% and has a typical use fail rate of
25%.
 Cervical Mucus Method

 The basis of this method is the changes in the

cervical mucus during ovulation.
 To check if the woman is ovulating, the
cervical mucus must be copious, thin, and
watery.
 The cervical mucus must exhibit the property
of spinnbarkeit, wherein it can be stretched up
until at least 1 inch and feels slippery.
 The fertile days of a woman according to this
Spinnbarkeit mucus is the stringy, stretchy quality method is as long as the cervical mucus is
of cervical mucus found especially around the copious and watery and a day after it.
time of ovulation. Usually a result of high estrogen
Therefore, she must avoid coitus during these
levels, spinnbarkeit mucus refers to the egg white
quality of cervical mucus that is easier for sperm days.
to penetrate.  When used typically, it has a fail rate of 25%.
Symptothermal Method

 The symptothermal method is simply a combination of the BBT

method and the cervical mucus method.
 The woman takes her temperature every morning before getting
up and also takes note of any changes in her cervical mucus every
day.
 She abstains from coitus 3 days after a rise in her temperature or
on the fourth day after the peak of a mucus change.
• Symptothermal method has an ideal failure rate of 2%.

Ovulation Detection

 The ovulation detection method is an over-the-counter kit that can

predict ovulation through the surge of luteinizing hormone that
happens 12 to 24 hours before ovulation.
 The kit requires the urine specimen of the woman to detect the
LH.
 The kit is 98% to 99% accurate and is fast becoming the method
of choice by women.
Lactation Amenorrhea Method

 Through exclusive breastfeeding of the infant, the woman is able to

suppress ovulation through the method of lactation amenorrhea
method.
 However, if the infant is not exclusively breastfed, this method would
not be an effective birth control method.
 It is also best to advise the woman that after 3 months of exclusive
breastfeeding, she must make plans of choosing another method of
contraception.

Coitus Interruptus

 This is one of the oldest methods of contraception.

 The couple still proceeds with the coitus, but the man withdraws the
moment he ejaculates to emit the spermatozoa outside of the vagina.
 The disadvantage of this method is the pre-ejaculation fluid that
contains a few spermatozoa that may cause fertilization.
• Coitus interruptus is only 75% effective because of this
Modern/Artificial Family Planning Methods

Hormonal Contraception
These hormonal contraceptives are effective through manipulation of the
hormones that directly affect the normal menstrual cycle so that
ovulation would not occur.

1.Oral Contraceptives
 Also known as the pill, oral contraceptives contain
synthetic estrogen and progesterone.
 Estrogen suppresses the FSH and LH to suppress ovulation, while
progesterone decreases the permeability of the cervical mucus to
limit the sperm’s access to the ova.
 To use the pill, it is recommended that the woman takes the first pill
on the first Sunday after the beginning of a menstrual flow, or the
woman may choose to start the pill as soon as it is prescribed.
 Advise the woman that the first 7 days of taking the pill would still not have an effect,
so the couple must use another contraceptive method on the initial 7 days.
 If the woman has skipped one day of taking the pill, she must take it the moment she
remembers it, than still follow the regular use of the contraceptive.
 If the woman has missed taking the pill for more than one day, she and her partner
must consider an alternative contraception to avoid ovulation.
 Side effects for OCs are nausea, weight gain, headache, breast tenderness,
breakthrough bleeding, vaginal infections, mild hypertension, and depression.
 Contraindications to OCs are breastfeeding, age of 35 years and above, cardiovascular
diseases, hypertension, smoking, diabetes, and cirrhosis.
Transdermal Patch

 The transdermal patch has a combination of both estrogen and progesterone in a form of a
patch.
 For three weeks, the woman should apply one patch every week on the following areas:
upper outer arm, upper torso, abdomen, or buttocks.
 At the fourth week, no patch is applied because the menstrual flow would then occur.
 The area where the patch is applied should be clean, dry, free from any applications. And
without any redness or irritation.
 Patches can be worn while bathing or swimming, but when the woman notices that the patch
is loose, she should immediately replace the patch.
 If the patch has been loose for less than 24 hours, the woman need not use an alternative
form of contraceptive, but if she is not sure of how long the patch has been loose, she should
replace it and start with a new week cycle and also use an additional contraceptive method.
Vaginal Ring

 The vaginal ring releases a combination of estrogen and progesterone and

surrounds the cervix.
 This silicon ring is inserted vaginally and remains there for 3 weeks, then removed
on the fourth week as menstrual flow would occur.
 The woman becomes fertile as soon as the ring is removed.
 The vaginal ring has the same effectivity rate as the oral contraceptives.
Subdermal Implants

 The subdermal implants are two rod-like implants embedded under the skin of the
woman during her menses or on the 7th day of her menstruation to make sure that
she is not pregnant.
 It contains etonogestrel, desogestrel, and progestin.
 It is effective for 3 to 5 years.
 Subdermal implants have a fail rate of 1%.
Hormonal Injections

 A hormonal injection consists of medroxyprogesterone, a progesterone, and given

once every 12 weeks intramuscularly.
 The injection inhibits ovulation and causes changes in the endometrium and the
cervical mucus.
 After administration the site should not be massaged so it could absorb slowly.
 It has an effectiveness of almost 100%, making it one of the most popular choices
for birth control.
 Advise the woman to ingest an adequate amount of calcium in her diet as there is a
risk for decreased of bone mineral density and to engage in weight-bearing
exercises.
Intrauterine Device

 An IUD is a small, T-shaped object that is inserted into the uterus via the vagina.
 It prevents fertilization by creating a local sterile inflammatory condition to prevent
implantation.
 The IUD is fitted only by the physician and inserted after the woman’s menstrual
flow to be sure that she is not pregnant.
 The device contains progesterone and is effective for 5 to 7 years.
 A woman with IUD is advised to check the flow of her menstruation every month
and the IUD string, and also to have a pelvic examination yearly.
Chemical Barriers

 Chemical barriers such as spermicides, vaginal gels and creams, and

glycerin films are also used to cause the death of sperms before they
can enter the cervix and also lower the pH level of the vagina so it will
not become conducive for the sperm.
 These chemical barriers cannot prevent sexually transmitted
infections; however, they can be bought without any prescription.
 The ideal fail rate of chemical barriers is 80%.
Diaphragm
 A diaphragm works by inhibiting the entrance of the sperm into the
vagina.
 It is a circular, rubber disk that fits the cervix and should be placed
before coitus.
 If a spermicide is combined with the use of a diaphragm, there is a
failure rate of 6% ideally and 16% typically.
 The diaphragm should be fitted only by the physician, and should
remain in place for 6 hours after coitus.
 It can be left in place for not more than 24 hours to avoid
inflammation or irritation.
Cervical Cap
 The cervical cap is another barrier method that is made of soft rubber and fitted on the rim
of the cervix.
 It is shaped like a thimble with a thin rim, and could stay in place for not more than 48
hours.

Male Condoms
 The male condom is a latex or synthetic rubber sheath that is placed on the erect penis
before vaginal penetration to trap the sperm during ejaculation.
 It can prevent STIs and can be bought over-the-counter without any fitting needed.
 Male condoms have an ideal fail rate of 2% and a typical fail rate of 15% due to a break in
the sheath’s integrity or spilling.
After sexual intercourse, the condom is removed to be disposed
Female Condoms

 These are also latex rubber sheaths that are specially designed
for females and prelubricated with spermicide.
 It has an inner ring that covers the cervix and an outer, open
ring that is placed against the vaginal opening.
 These are disposable and require no prescription.
 The fail rate of female condoms is 12% to 22%.

Surgical Methods

• One of the most effective birth control methods is the surgical

method. The two kinds of surgical methods are used by either
the male or the female, and would ensure that conception is
inhibited after the surgery for as long as the client lives.
Vasectomy

• Males undergo vasectomy, which is executed through a small incision made on each side
of the scrotum

 The vas deferens is then tied, cauterized, cut, or plugged to block the passage of the
sperm.
 This procedure is done with local anesthesia, so advise the patient that mild
local pain can be felt after the procedure.
 Advise the patient to use a back-up contraceptive method until two negative sperm
count results are performed because the sperm could remain viable in the vas deferens
for 6 months.
 There is a 99.5% accuracy rate for vasectomy and has a few complications.
Tubal Ligation

 In women, tubal ligation is performed by occluding the fallopian tubes

through cutting, cauterizing, or blocking to inhibit the passage of the
both the sperm and the ova.
 After menstruation and before ovulation, the procedure is done through
a small incision under the woman’s umbilicus.
 A laparoscope is used to visualize the surgery, and the patient is under
local anesthesia.
 The woman may return to her sexual activities after 2 to 3 days of the
operation.
 Educate that menstrual cycle would still occur, and make sure that coitus
before ligation is protected to avoid ectopic pregnancy.
 The effectiveness of this method is at 99.5%.

The reproductive system is our tool as humans to multiply or procreate.

However, the earth would become unlivable if the growth of the population
continues to boom. You have a choice among all these birth control
methods, and these are only a call to be a responsible parent and citizen.
THANK YOU!