Family planning for community Health
workers
by
Dr. Wilson Imongan
Outline
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Family Planning
population issues,
Relevance of family planning,
Family Planning Methods
Family planning commodities
Introduction
Contraception is deliberate prevention of
pregnancy using any of the several methods.
 Birth control prevents a female sx cell (egg) from
being fertilized by a male sx cell (sperm) and/or
implanting in the uterus
 A variety of methods to choose from, although
most options are or women
 selecting a method is a personal decision that
involves consideration of many factors including
convenience, reliability, side effects etc
Classification
Broadly classified as a, Temporary, b, permanent
Temporary: are reversible – natural fp, coitus
interrupts, barrier methods, IUCD, &
hormonals. (most contracetives are reversible.
They do not affect a perso’s ability to be
pregnant once it is halted)
Permanent: vasctomy and tubal ligation.
Temporary Methods
A, Barrier Methods
 physically block sperm from entering the
uterus to unite with an egg,
Must be used with each sexual intercourse.
Easy to use but may not be convenient.
Barrier methods include male and female
condom, cervical caps and spermicides.
Emergency Contraception
• Methods used by women after unprotected
intercourse to prevent fertilization or
implantation of the fertilized egg.
• Two methods –
• Emergency oral contraceptive pills (taken the morning
after in 2 doses 12 hours apart. Effective if taken within 72 hours.)
Major SE – Nausea
– Call health care provider if severe – may prescribe antiemetics
• Next period should begin within 2 – 3 weeks
2 Emergency insertion of iucd.
Human Population Growth
The term population is
defined as the
number of persons
living in a
geographical location
at a particular time.
The world’s population is now over 7.1 billion people.
World population has risen sharply
• Global human population was <1 billion in 1800.
• Population has doubled just since 1963.
• We add 2.5 people every second (79 million/year).
Figure 7.2
Is population growth really a problem?
Some say YES:
Some say NO:
• People can find or
manufacture additional
resources to keep pace
with population growth.
• Nations become stronger
as their populations
grow.
• Not all resources can be
replaced.
• Even if they could,
quality of life suffers.
• Nations do not become
stronger as their
populations grow.
Population growth leads to resource depletion, which can
result in declining food production, industrial output, and
population.
Factors affecting population growth rates
Population growth depends on rates of birth, death,
immigration, and emigration.
(birth rate + immigration rate)
– (death rate + emigration rate)
= population growth rate
Natural rate of population change: Change due to
birth and death rates alone, excluding migration
Fertility rates affect population growth rates
Total fertility rate (TFR) = average number of
children born per woman during her lifetime.
Replacement fertility = the TFR that keeps
population size stable
For humans, replacement fertility is about 2.1.
The Nigerian Total Fertility Rate is 5.7
Family planning can lower TFR
Source: Nigeria 2008 demographic and health survey: key findings.
Population and the Quality of Life
in Nigeria
Population Growth in Nigeria
What does high fertility mean for the health
of families & the individual?
How does population growth affect
Nigeria’s development?
Strategies for managing population growth
Population Growth
in Nigeria
Photo: Population Service International (PSI)
Nigeria is in the second stage of the
demographic transition
Stage I: High birth rate; High death rate
Stage II: High birth rate, low death rate
Stage III: Low birth rate; low death rate
The effect of high fertility after
Four Generations
Projected population of Nigeria,
2000- 2025
225 million
250
118 million
150
100
50
0
20
00
20
02
20
04
20
06
20
08
20
10
20
12
20
14
20
16
20
18
20
20
20
22
20
24
Millions
200
The “footprint” will
grow larger with
economic and
population growth but
Nigeria’s Land Mass
remains the same!!!
How can Nigeria bring down
its fertility rate?
Delayed Marriage
Increased birth Spacing
Prolonged Breastfeeding
Delayed commencement of
Sexual Activity
Increased use of modern
Contraception
Invest in fp
• To prevent “demographic fatigue,” where
government is unable to meet the social,
economic, and environmental challenges
imposed by rapid population growth.
• Human population is rising by 79 million
people annually.
Why Invest in fp
World wide Every minute:
380 women become pregnant. (190 of these
did not plan to be pregnant)
110 women experience pregnancy related
complications,
40womenhave unsafe abortion
1woman dies from pregnancy related cause.
FMOH CLMS Training manual 2003
Family Planning
What is family planning?
• The practice of controlling the number of children one
has and the intervals between their births, particularly
by means of contraception or voluntary sterilization.
"family-planning clinics“
• 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 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.
Importance of family Planning
• Reinforces people’s rights to determine the number
and spacing of their children.
• Reducing rates of unintended pregnancies, and
hence reduces the need for unsafe abortion
• Secures the well-being and autonomy of women,
• Supports the health and development of
communities
• Condoms provide dual protection against unintended
pregnancies and against STIs including HIV.
• Reduces the risk of unintended pregnancies among
women living with HIV, resulting in fewer infected
babies and orphans
Importance of fp 2
 Family planning allows spacing of pregnancies and can
delay pregnancies in young women at increased risk of
health problems and death from early childbearing, and
can prevent pregnancies among older women who also
face increased risks
• Reduces risk of maternal mortality.
• Reduces the need for unsafe abortion.
• Improves child spacing, prevents ill-timed pregnancies
and births, thus reducing highest infant mortality rates
• Family planning is key to slowing unsustainable
population growth and the resulting negative impacts on
the economy, environment, and national.
Importance of Family Planning 3
• Family planning allows women to make
choices about their own fertility.
• It also saves lives and reduces suffering by
preventing high risk pregnancies and reducing
a woman’s likelihood of resorting to unsafe
abortions.
• Family planning prevents an estimated
150,000 maternal deaths in the developing
world each year.
CONTRACEPTION
CONTRACEPTION
• prevention of conception is called as contraception.
• Contraception is useful to prevent population
explosion.
• It is also called Birth Control methods or Family
Planning Methods.
• This can be done by the female, male or at coital
stages.
The Ideal Method Should Be:
•
•
•
•
•
•
•
Safe
100% effective
Free of SE
Easily obtainable
Affordable
Acceptable to the user & sexual partner
Free of effects on future pregnancies
Contraception is the prevention of conception.
• There two main types:
– Permanent or Terminal methods:
• Vasectomy or Male sterilization.
• Tubectomy or Female sterilization.
– Temporary or Spacing methods:
• Barriers
• IUCDs
• Other methods.
TERMINAL METHODS
I. VASECTOMY:
– MALE STERILISATION:
– A SIMPLE OUT PATIENT PROCEDURE.
– THE ‘VAS DEFERENS’ IS ISOLATED AND
CUT.
– THE TWO ENDS ARE LIGATED.
VASECTOMY
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TERMINAL METHODS
II. TUBECTOMY:
– FEMALE STERILIZATION:
– PART OF THE FALLOPIAN TUBE IS
REMOVED.
– THE TWO ENDS ARE TIGHTLY LIGATED.
– CAN BE DONE AS:
• POST PARTUM STERILIZATION
• LAPAROSCOPIC STERELIZATION
TUBECTOMY: TYPES
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SPACING methods
•
BARRIER METHODS:
A) PHYSICAL BARRIER:
• CONDOMS
• DIAPHRAGM
• VAGINAL SPONGE
• FEMALE CONDOM.
B) CHEMICAL BARRIER:SPERMICIDAL
• FOAMS
• CREAMS
• SUPPOSITORIES
CONDOMS
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FEMALE CONDOM
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DIAPHRAGM + SPERMICIDE
A diaphragm is a flexible, latex, dome-shaped cup. It is
designed to fit securely in the vagina to cover the cervix.
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A foam sponge inserted into the vagina to prevent pregnancy
VAGINAL SPONGE + SPERMICIDE
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INTRA UTERINE CONTRACEPTIVE
DEVICES (IUCD):
• FUNCTION BY PREVENTING IMPLANTATION.
– I GENERATION:
– NON MEDICATED: LIPPE’S LOOP
– II GENERATION: MEDICATED BIOACTIVE
• COPPER T
– III GENERATION: HORMONE RELEASING
• PROGESTASERT
LIPPE’S LOOP
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IUDs are:
• Safe, effective, convenient, reversible, long
lasting, cost effective, easy to use.
Providers can ensure safety by:
• Careful screening
• Proper follow-up
HORMONAL CONTRACEPTIVES
• ALSO CALLED ORAL PILLS OR ORAL
CONTRACEPTIVES.
• ARE USUALLY HORMONES OR
COMBINATIONS TAKEN BY MOUTH.
• THEY CAUSE THE TEMPORARY CESSATION
OF THE OVARIAN CYCLES.
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ORAL CONTRACEPTIVES
• COMBINED PILLS:
– HAS BOTH ESTROGEN &
PROGESTERONE.
• PROGESTRONE ONLY PILL.
• DEPOT FORMULATIONS
– INJECTABLES: DEPOT PROVERA
OTHER METHODS
• ABSTINENCE: THE BEST
• COITUS INTERRUPTUS:
– HISTORICALLY THE OLDEST IN HUMANS.
– THE SEMEN WAS SPILLED ON THE
GROUND.
• THE MALE PILL:
– GOSSYPOL : COTTON SEED OIL
– KILLS SPERMATIDS.
NATURAL FAMILY
PLANNING METHODS
• SAFE PERIOD METHOD:
– DURING THE FERTILE PERIOD, COITUS
IS AVOIDED.
– THE REST OF THE CYCLE IS ‘SAFE’
• OVULATION TESTS:
– BASAL BODY TEMPERATURE CHARTS
– CERVICAL MUCUS : BILLINGS METHOD
– SYMPTOTHERMIC: ‘SELF RECOGNITION’
SAFE PERIOD METHOD
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Thank you