Demography, family planning Flashcards
Annual growth rate
Malthusian model
AGR=(crude birth rate-crude death rate)/10
0.5-1% is moderately growing
India 1.2%
1% ➡️ doubling time 70 years
Malthusian model
Dependency ratio
(No of dependent population)/(No of independent population)*100
Demographic trap
Demographic trap is difficulty to decline the birth rate because of decline rate (and increase in birth rate)
It is seen in stage II
Sex ratio
Female deficit syndrome
Sex ratio =(no of females)/1000 males
Female deficit syndrome:
Decrease in no of female population
It leads to ecological imbalance
Effective literacy rate
(People who can read and write age >7 yr)/(total population of age >7 yr)*100
General fertility rate
Live birth/WRA*1000
Women in reproductive age group
Total fertility rate
(No of live birth ASFR)/WRA*1000
Women is reproductive age group
Assuming age specific fertility pattern
Age specific fertility rate
(No of children in a specific age group)/(total no female in that age group)*1000
Gross reproduction rate
(Total no of daughters ASFR)/ WRA * 1000
Net reproduction rate
(No of daughters ASFR and ASMR) / WRA * 1000
The most refined/sensitive/best epidemiological indicator
Best indicator for growth of population
Best indicator for family planning implementation services
Crude birth/death rate
(No of births or deaths in an area in a year)/ mid year population of same year *1000
Child women ratio
(No of children of 0-4 years)/WRA * 1000
Survey systems
- Civil registration systems
- Sample registration system
- National family health survey
- District level household survey
- Census
Planned family
- 1st child is after 20 years of the mother’s age
- Minimum of 3 years between 2 children
- Limited size of collagen (2 or 3)
Requirements of stable population
- CPR of 60%
- TFR of 2.1
- NRR of 1
Male condoms
Latex
Failure rate: 2 or 3 to 40 HWY (hundred women years)
M/C side of failure: incorrect usage
Female condoms
Polyurethane
Prelubricated with silicone
Failure rate: 4 or 5 to 20 HWY
Less effective in preventing pregnancies and STDs compared to male condoms
Diaphragm
Dutch cap
Not recommended under the National family planning program
Used before intercourse and left for 6 hours post coital ➡️ chance of toxic shock syndrome
Failure rate: 6-12 HWY
IUDs
1. 1st generation: Lippes loop, Graffenberg’s ring 2. 2nd generation: CuT-220, CuT-380, CuT-380 Nova T Multiload device- •CuT 375 •CuT 250 3. 3rd generation: hormonal LNG-20, Progestasert
3rd generation IUDs
1. Mirena (LNG-20) For 7-10 years Levonorgestrel 20 mcg progesterone/day Lowest failure rate 2. Progestasert: For 1 year Natural progesterone Loading dose 38 mg ➡️ 65 mcg/day Lowest expulsion rate
Second generation IUD
- CuT-220, CuT-380- used nowadays
- CuT-380 applicable for 10 years
- Nova T ➡️ for 5 years
- Multiload device-
•CuT 375
•CuT 250 for 3-5 years
Mechanism of action of IUD
Inhibits fertilization
Highly effective: 0.5-1.5 failure rate
1. Askers biochemical environment of cervical mucus
2. Thickens cervical mucus
3. Foreign body reaction ➡️ implantation 🔽
Absolute contraindications of IUD
- 🤰
- Undiagnosed vagina bleeding
- PID
- Cervical cancer
- Carcinoma of genital tract
- Previous ectopic pregnancies
Relative contraindications of IUD
- Previous history of PID
- Congenital malformations
- Cervical discharge
- Anemia
- Menorrhagia
- Unmotivated females
Adverse effects of IUD
- Pain
- Bleeding
- PID
- Ectopic pregnancy
- Perforation
- Expulsion
- 🤰 with IUD in situ ➡️ abortion, if not:
• thread visible ➡️ pull out
• thread not visible ➡️ sepsis ➡️ evacuate the uterus
Chemical classification of hormonal contraceptives
1. Pregnane: Medroxy progesterone acetate Megestrol 2. Estrane: Norethisterone Lynestrenol Ethynodiol diacetate 3. Gonane: levonorgestrel
Physical classification of hormonal contraceptives
1. Oral pills: Combined oral Progesterone only Post coital Long acting Male 💊 2. Depot formulations: Injectable Implants
Combined oral pills
Examples and composition
Mala N: National program (free) 21 tablets Mala D: social marketing scheme 21 + 7 (ferrous fumarate 60 mg) 21 ➡️ levonorgestrel 0.15 mg and ethinyl estradiol 0.03 mg
Combined oral pills
Mechanism and effectiveness
Mechanism: 1. Disrupts hypothalamus-pituitary axis 2. Stoppage of OCP after 21 days leads to withdrawal bleed (less amount of bleeding) ➡️ less chance of anemia Effectiveness: More effective than IUD
Adverse effects of OCPs
1. Metabolic: Obesity, hypertension, dyslipidemia 2. Cardiovascular: Atherosclerosis 3. Carcinogenic: Cervical, breast, HCC 4. Liver diseases, slight inhibition of lactation 5. Ectopic 🤰 in progesterone only pills
Benefits of OCPs
- Regulation of menstrual cycles
- Contraceptive benefits
- 🔽 benign breast disease, fibroadenoma
- 🔽 Ca ovary, endometrium, ovarian cyst
- 🔽 PIDs
- 🔽 iron deficiency anemia
Absolute contraindications of OCPs
- Ca breast, genital cancers
- 🤰
- Severe liver disease
- Thromboembolism, DVT
- Cardiac abnormalities
- Congenital hyperlipidemia
- Undiagnosed vaginal bleed
Relative contraindications to OCPs
- Age >40
- Smoker 🚬 , age >35
- Diabetes mellitus, gall stone
- Epilepsy migraine
Progesterone only injectables
1. DMPA Depot medroxy progesterone acetate: 150 mg IM, 3 monthly, >35 year old 2. NET-EN norethisterone enatiate: 200 mg, 2 monthly 3. Depo Sub Q Provera 104: DMPA sc. 4. Antara program: MPA 150 mg IM, 3 monthly
Combines injectables
- Cyclo provera
- Cyclofem
- Mesigyna
Contraindications of progesterone only injectables
- Undiagnosed vaginal bleeding
- Genital malignancy of Ca cervix
- 🤰
Implants
Subdermal
Commonly used in India is Norplant
Made of silastic capsules
R2: 2 rods containing 35 mg LNG
Post coital/emergency contraception
1. IUDs Best and most effective Within 5 days 2. LNG 1.5 mg single dose within 72 hours 3. Mifepristone (RU-486) 10 mg within 72 hours
Gossypol
Male contraceptive
Inhibition of spermatogenesis
Natural product - Chinese plant (cotton seed)
S/E: azoospermia
Centchroman
Brand name: Chhaya
Non-hormonal contraceptive
Mechanism:
Selective Estrogen Receptor Modulator SERM
It has 30mg of methoxychroman hydrochloride
Chemical responsible: ormeloxifene
Can be used against dysfunctional uterine bleeding
Centchroman
dose
Twice weekly for 3 months, followed by once weekly till required
If a female misses a dose in more than 2 days, alternate contraception is used, followed by normal schedule
Centchroman contraindications
- PCOD
- Lactation
- Hepatic disease
- Cervical hyperplasia
- Hypersensitivity
Natural method of contraception
- Coitus interruptus
- Calendar 📆 /rhythm method
• cycle of beads
• persona: a digital device
Check hormonal levels in the morning urine - Abstinence
- Basal body temperature
- Cervical mucus thickening (Billing method)
Tubectomy
Can be done as a mini laparoscopic procedure
Incision size: 2.5-3 cm
Done under local anesthesia
Can be done in mass sterilization camps/PHC/ village level
Vasectomy
Most common type: Non-scalpel vasectomy No hematoma 🔽 passion 🔼 user friendly NSV on India is funded by UNFPA (United Nations Fund for Population Activities)
Complications of non-scalpel vasectomy
1. Operative complications: Pain, local infection 2. Hematoma 3. Sperm granules: Appears 10-14 days past operation Reasoned spontaneously 4. Spontaneous recanalisation (0-6% chance) 5. Auto immune response: not harmful 55% antigen antibodies
Vasectomy
failure
Failure rate: 0.15 HWY
M/C reasons:
• Operative
• Non-compliance to post operative advice
People who have undergone vasectomy should use alternate contraception for a period of 8-9 weeks or 30 ejaculations
ESSURE
Permanent method of contraception
A micro filament stent, micro essure is inserted into Fallopian tube
Technique is called Essure technique
Process: a tubal blockage is created
After 6 weeks, hysterosalpingography is done to confirm sterilization
Reasons for MTP
S. Social: unmarried, poor H. Humanitarian: rape victim E. Eugenic: genetic F. Failure of contraception T. Therapeutic: maternal
Who can perform MTP
Where can it be performed
Any MBBS doctor who is a registered medical practitioner and has:
• at least 6 months residency in obg
• at least 25 cases of MTP under supervision
• a degree/diploma in og
Any healthcare centre with facility to do emergency laparotomy or major gynecology surgeries
How to perform MTP
When
<6 weeks:
Ideal MTP
Misoprostol + mifepristone
>6 weeks:
Medical or surgical methods based on doctors opinion
It is usually done within 12 weeks of gestation
>12 weeks to <20 weeks MTP is done only after consultation with 2 doctors
Consent is required
Failure rate of contraception measures
Life table analysis:
Observe the females in reproductive age group to analyze any accidental pregnancies
Pearls index:
=(no of accidental pregnancies) / (total no of women years exposure) *100
Contraception of choice
- Unmarried sexual active 👱🏽♀️: barrier method > OCP
- Married nulliparous 👱🏽♀️ who wants to delay 👶: OCP
- Married 👱🏽♀️, mother of one, wants to delay 2nd 👶: IUD
- ‘3.’ but she is obese, has DM, dose not prefer IUD:
• educated - Chaaya
• uneducated - Antara - Married👱🏽♀️ with 3 children, wants to delay 4th child:
Tubectomy > cheaper vasectomy
