Family Planning/Contraception Methods

Family planning concept is based on the ability of individuals and couples to anticipate and attain their desired number of children and the spacing and timing of their birth. The eligible couples consists of married couples where the wife is in the reproductive age group (15-49) years of age. This term was previously used as target couple. Eligible couple register is maintained by ANM at the sub-center. There are few terms used for family planning, these are:

• Couple Protection Rate- It is the percentage of eligible couples protected against childbirth by one or other approved family planning methods. It is a good indicator of prevalence of the contraceptive practice in the community.

Couple protection Rate= No. of couples using the contraceptive method/Total no. Of eligible couples multiply by 100

• Effective Couple Protection Rate- It is the percentage of eligible couples effectively protected against childbirth by one or other approved family planning methods.

Also Read: National TB Elimination Programme (NTEP)

Family planning methods under National Family Welfare Program ( NFWP)

1. Condoms: Male condoms are provided( Nirodh)
2. Mala-N
3. IUD
4. Antara
5. Chaya
6. Sterilization

Also Read: Intrauterine Device: Types, Uses, Function, Procedure, Advantages, Risks and Complications

Contaceptive Efficacy

It can detect the  number of unwanted pregnancies occuring in a specific period or use of contraceptives.

• Evaluation of Contraceptive efficacy:
  • Pearl Index- It is defined as No. of accidental pregnancies/ Total months of exposure multiply by 1200.
  • Life Table analysis - It is considered as a better method than Pearl Index. It calculates the cummulative failure rates over a specified time frame.

Also Read: Epidemiology: Ideas, Models, Definitions, Morality, Morbidity Rate, Analytical and Descriptive

Methods of contraception

1. Spacing methods - Spacing between two pregnancies ( atleast of 3 years) and It is a temporary method. It constitutes of:

• Barrier methods : Physical methods, chemical methods 
• Intrauterine devices
• Hormonal methods
• Post conceptional methods

Barrier methods: Condoms- It comes for both males and females. 

1. Male condoms- It is made up of latex and the most famous brand name is NIRODH. It is freely available under NFWP. It is provided under a social marketing scheme and failure rate is 2-14/HWY. It is non-reusable.
2. Female condoms- It is identified by presence of two rings(Inner ring covers cervix and outer ring lies outside vagina). It is sold under brand name FEMIDOM. It is made up of Polyurethane or Nitrile. It is not provided under NFWP but provided freely under NACP. It is reusable.

Diaphragm

1. It is inserted into vagina and pushed to place over the cervix but requires expertise.
2. It should be fitted properly and not damaged.
3. Cervical cap, Vault cap are its some other variations.

Vaginal sponge

1. It must be wet under water till thoroughly wet before insertion and should be gently pushed towards the cervix.
2. The chemical used is Nonoxynol-9.

Spermicides

1. It includes Foams, Pastes , Jellies and Suppositories.
2. These are best used along with condoms.
3. These are surface active agents that binds to sperms and inhibits oxygen uptake by sperms which kills them

Intrauterine Devices

It is a temporary method of contraception and is essential in spacing pregnancies. There is a great importance of the tail of IUD because it gives reassurance that IUD is in place. The types are:

• 1^st generation- Includes Lipples Loop, Grafenberg containing ring
• 2^nd generation- includes Copper containing devices like CuT380A, Nova-T and Multiload.
• 3^rd generation-  includes Hormone containing devices like MIRENA ( LNG-20) and Progestasert.

Also Read: Accessibility, Functions, Obligations, Compensation, Benefits And Facilitators of Asha

The ideal time for insertion of an IUD is during menses or first 5 days of menstruation. Most preferred timing is Immediate Postpartum or Late postpartum that is within 48 hours of delivery upto 1 week.

• Hormonal contraceptives:
• NUVA Ring- Once a moth self administered use. It has both estrogen and progesterone.
• Depot formulation- It is an injectable and most common is DMPA. It is now available under the name ANTARA.
• NET-EN(Norethisterone Enanthate )- It is highly effective and is an injectable hormone.
• Implants- Contains only progesterone. Most common is Norplant which is a subdermal implant contraceptive.
• Patch- It is a transdermal patch which contains both progesterone and estrogen. It inhibits Ovulation.
• Centchroman (Saheli)-  It is available under the name CHAYA. Mechanism of action is Selective estrogen receptor modulator.
• Oral Contraceptive pills ( OCPs): The typpes of OCPs are 
  • MALA-N - Contains Levonorgesterol 0.15mg and ethinylestradiol 0.03mg.( Free supply under NFWP)
  • MALA-D - Contains Ethinylestradiol 0.03mg and Levonorgesterol 0.15mg. It is Rs. 3 per strip under NFWP. 

• Male only pill (Gossypol): It is dervied from a chinese cotton plant and its adverse effect is permanent sterilization.

2. Terminal methods- This is a permanent method . This includes Male sterilization( vasectomy) and Female sterilization(Tubectomy).

Eligibility criteria of male sterilization:

• <60 years of age
• Married
• Sound minded
• At least one child of more than 1 year of age

Eligibility criteria of female sterilization

• Age 22-49 years
• At  least one child of more than 1 year of age
• Sound minded
• Married

Also Read: Screening of Disease

FAQs

1. What is family planning?
   • Family planning involves methods to control the timing and number of children in a family through contraception and education.
2. What are the main types of contraception?
   • Contraceptive methods include hormonal, barrier, intrauterine devices (IUDs), natural methods, and permanent methods.
3. How do hormonal contraceptives work?
   • Hormonal methods prevent ovulation, thicken cervical mucus, and alter the uterine lining to prevent pregnancy.
4. What are the different hormonal contraceptives available?
   • Options include birth control pills, patches, injections, and implants.
5. What is an IUD, and how does it work?
   • An IUD is a small device inserted into the uterus that prevents fertilization or implantation. It can be hormonal or copper-based.
6. What are barrier methods of contraception?
   • Barrier methods prevent sperm from reaching the egg and include condoms, diaphragms, and cervical caps.
7. What is the effectiveness of condoms?
   • When used correctly, condoms are about 85% effective in preventing pregnancy and also protect against STIs.
8. What are natural family planning methods?
   • Natural methods include tracking fertility signs, like basal body temperature and menstrual cycle, to avoid or achieve pregnancy. Another method that the male partner can practice is coitus interruptus. 
9. How effective are natural family planning methods?
   • Natural family planning methods are not effective as they are very unreliable. They have a high failure rate.
10. What is sterilization?
    • Sterilization is a permanent method of contraception, involving surgical procedures like tubal ligation for women and vasectomy for men.
11. Are there any side effects of hormonal contraceptives?
    • Possible side effects include nausea, weight gain, mood changes, and increased risk of blood clots.
12. What is emergency contraception?
    • Emergency contraception is a method used to prevent pregnancy after unprotected sex, available as pills or a copper IUD.
13. How soon after unprotected intercourse can I use emergency contraception?
    • Emergency contraception pills are most effective within 72 to 120 hours after unprotected sex, depending on the type.
14. What should I consider when choosing a contraceptive method?
    • Consider effectiveness, convenience, health conditions, side effects, and personal lifestyle.
15. Can contraceptive methods protect against STIs?
    • Only condoms provide protection against sexually transmitted infections (STIs).
16. How often do I need to see a doctor for contraceptive care?
    • Regular check-ups are recommended, typically annually, or as needed based on the method used.
17. Can I use contraception while breastfeeding?
    • Many methods are safe during breastfeeding; consult a healthcare provider for recommendations.
18. What if I forget to take my birth control pill?
    • Follow the instructions provided with your pill pack, and consult your healthcare provider for guidance.
19. Are there any contraindications for using hormonal contraceptives?
    • Certain health conditions, like a history of blood clots or certain cancers, may make hormonal contraceptives unsafe.
20. Where can I get more information about family planning?
    • Consult a healthcare provider, family planning clinics, or reputable online resources for personalized guidance and education.

Feel free to ask if you need more details on any specific point!

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