Family Planning Flashcards
Conventional contraceptives
Require action while sexual intercourse.
Types of conventional contraceptives
Physical methods (barrier)
Chemical (spermicidals)
Emergency contraceptions
Hormonal method
Mechanical method
Medical Termination of pregnancy Act (1972)
Due to incresed maternal mortality and morbidity (illegal abortion- faeticide).
To reduce population explosion.
Modified in 1975.
Considerations
Condition of pregnancy for mtp
Person to perform
Place
Conditions for MTP
Therapeutic (life risk, physical /mental injury)
Eugenic (child to born with severe hysical and mental abnormalities)
Social (economic / social environment not suitable)
Humanitarian (due to rape)
Lunatic mother
Failure of contraception
Person to perform MTP
Registered medical practitioner who has
6 months housemanship in obstetrics and gynaecology.
PG training in obstetrics and gynaecology.
25 MTPs in approved institution.
Place for MTP
Hospital established or maintained by government.
Hospital centre approved by the government for MTP.
Evaluation of contraceptive by
Pearl index
Life table analysis
Pearl index
No. Of accidental pregnancy / no. Of exposure in months (deduct 10 for full term, 4 for an abortion).
Minimum 600 months period required for drawing a conclusion.
Disadvantage
Lengthy exposure (1 yr), fails to accurately compare methods of various duration of exposure.
Life table analysis
Failure rate for each month of use.
Cumulative failure rate can compare the method for any specific legth of exposure.
Reliable + consistent results
Couple protection rate (CPR)
Percent of eligible couples effectively protected against childbirth by methods of family planning (sterilization, IUD, condom, oral pills)
Indicates prevalence of contraceptive practice.
Importance
Exceeds 60% - possible to achieve dographic goal of NRR of 1.
Good -Punjab, gujarat, Maharashtra, Karnataka, haryana, tamil nadu.
Poor - Bihar, UP, Assam , Rajasthan, West Bengal, Jammu Kashmir
Family planning
Planning size of family compatible with physical and socioeconomic resource of parents and conducive to the health + welfare of family members.
WHO
Way of living and thinking, adopted voluntarily on basis of scientific knowledge, attitude and responsible decisions by individuals / couples
Family planning includes
Spacing
Births limitation
Sterility
Education (parenthood)
Sex education
Pathological screening (diseases)
Genetic counseling
Marriage counseling
Premarital consultation and examination.
Pregnancy tests
Preparing couple for 1st child
Services for unmarried mothers
Teaching home economics + nutrition
Adoption services
Unmet need for family planning
Married women not using contraception but don’t want more children/ wait few years
WHO
Gap between women’s reproductive intentions and contraceptive behaviours.
On the basis of women’s response to survey questions.
Reasons
Inconvenient/unsatisfactory services
Lack of adequate information
Fear about side effects
Opposite from husband / relatives
Factors influencing unmet need for family planning.
Residence (higher in rural)
Education (ranges between 10-13% among illiterate.
Religion (higher in muslims)
Socio-economic status(higher in lower)
Age (till 24-spacing, >30-limiting births)
Pearl index of contraceptives
None (80 per HWY)
Calender method -24
Coitus interruptus -18
Male condoms - 2-14
Female condoms - 5-21
Diaphragm - 12
Vaginal sponge
Parous - 20-40
Nulliparous - 9-20
IUD - 0.5-2.0
Oral pills - 0.1-0.5
Centchroman (saheli) - 1.83-2.84
Effectivity of contraceptives
Condom - 50%
IUD - 95%
OCPs - 100%
Sterilization - 100%
Approaches of family planning in India
Targeted approach
Target -free approach (TFA)(1995-96)
Commitee needs assessment approach (CNAA)(1997-98)
Committee needs assessment and monitoring approach (CNAMA)
Social marketing (SM)
New family planning initiative
Home delivery of contraceptives
Mission parivar vikas (MPV)
Ensuring soacing at birth (ESB)
New contraceptives in RCH
Antara (injectable DMPA)
Chhaya (centchroman)
Fixed day static services approach
Pregnancy testing kits (PTKs)
Nishchay
Educational approach in family planning (stages)
Unaware
Aware / Informed (during antenatal, post natal visits, immunization clinics)
Interested (proper counseling)
Evaluates pros and cons
Decision making
Trial change
Adoption of new behaviour
Evaluation of family planning programme
To Improve design and delivery of services.
Types
Evaluation of needs
Evaluation of plans
Evaluation of performance
Services
Responses
Cost analysis
Others
Evaluation of effects
Evaluation of impact
Family size
Additional children desired
Birth interval
Age of mother at 1st and last child
Birth order
No. Of abortions
National socio-demographic goals for 2010 (National population policy 2000)
Address unmet needs RHC , CHC
School free + compulsary for upto 14y
Reduce IMR <30/1000 live births
Reduce MMR<100/1000 live births
Universal immunization of children
Promote delayed female marriage
80% instituional delivery by trained
Access to info /counseling on fertility regulation + contraception.
100% register Birth, Death, Marriage and Pregnancy.
Contain AIDS, integration between RTI, STI and NACO.
Prevent + control communicable diseases.
Integrate Indian system of medicine (in RCH).
Small family norm
Newer contraceptives
Essure (permanent) (occlude fallopian tube)
Trandermal patch (estrogen + progestin) (prevent ovulation)
Combined hormonal contraceptive vaginal ring (prevent ovulation)
Assisted reproductive technology (ART)
Tech for infertility.
Artificial insemination
Cloning
Cryopreservation
Embryo transfer
Hormone treatment
IVF
Intracytoplasmic Sperm Injection
Preimplantation genetic diagnosis
Surrogacy
Testicular sperm extraction
Gamete intrafallopian transfer
Zygote intrafallopian tranfer
