Family planning is having children by choice and not by chance. It helps couples to have a desired number of children by appropriately spacing and limiting pregnancies and thereby enrich family life. Having a child by choice and nurturing the child with love and care will help the child to grow well and be a happy member of the family.
What are the objectives of family planning?
- Help couples to postpone the first pregnancy
- Help couples to space pregnancies
- Help couples to limit their families
MODERN FAMILY PLANNING METHODS
Modern family planning methods refers to the correct use of contraceptives. Contraceptives are devices or drugs that are effectively used to prevent pregnancy, while allowing sexual intercourse. Contraceptive counselling and services could be obtained from Public Health Midwives, Medical Officers of Health, General Practitioners and Specialists.
What are the modern family planning (FP) methods available for couples?
Modern FP methods are classified into Temporary and Permanent methods.
Temporary methods are;
a) Hormonal contraceptives
I. Combined oral contraceptive
pills (COC)
II. Injectables (DMPA)
III. Subdermal implants
b) Non hormonal contraceptives
I. Intra uterine contraceptive
devices (IUD)
II. Condoms (Barrier method)
Permanent methods are;
I. Female sterilizations
II. Male sterilizations
In addition to these, Emergency Contraception or Post Coital Contraception is also available for those who have had unprotected sexual intercourse.
Temporary methods
a.) Hormonal contraceptives
Definition: A preparation of synthetic steroidal female hormones (progesterone combined with oestrogen or progesterone alone) administered systemically.
Types
I. Oral contraceptive pills (e.g. Combined oral contraceptive)
II. Injectables (e.g. DMPA-Depot Medroxy Progesterone Acetate)
III. Subdermal implants (e.g. Jadelle)
I. Combined Oral Contraceptive (COC) Pill
The COC is one of the commonly used hormonal contraceptives used in the national family planning programme. It consists of synthetic hormones that are similar to those that occur naturally in a woman.
Each packet contains 21 pills of low dose oestrogen and progesterone in constant amounts and 7 placebo pills containing iron.
The COC is suitable for:
1. Newlyweds (e.g. teenagers- to postpone the birth of the first child)
2. Spacing between pregnancies
3. Limiting family size when other
methods are not acceptable
4. Unmarried sexuallyactive women
Effectiveness- 92%
Return to fertility-No delay in return to fertility
There should be no break in taking pills between packets if effective contraception is to be achieved.
II. Injectables-Depo Medroxy Progesterone Acetate (DMPA)
DMPA is a long acting progesterone preparation of 150mg, given deep intramuscularly in a single dose. DMPA has a contraceptive action for 90 days and does not have the undesirable oestrogen related side effects.
The DMPA is suitable for:
1. Spacing between pregnancies
2. Limiting family size
3. Lactating women after 6 weeks post partum
4. Those awaiting sterilization
Effectiveness- 97% (If 100 women use this method for one year, it will prevent pregnancy in 97 women)
Return to fertility- 7-12 months after the last injection.
III. Subdermal implant –Jadelle
Jadelle is a long acting reversible progesterone only contraceptive delivered by means of two rods, placed under the skin in the inner aspect of the upper arm. Implants provide contraceptive cover for 5 years.
Jadelle is suitable for:
1. Postponing pregnancies
2. Limiting family size
3. Those awaiting sterilization
4. Those who cannot use IUDs, COCs or Injectables
5. Those who cannot use contraceptivemethods containing Oestrogen.
Effectiveness- more than 99%
Return to fertility- Immediate after removal.
b) Non–hormonal contraceptives
I. Intra Uterine contraceptive Device (IUD)
The IUD is a small flexible device, made of plastic and copper that has a contraceptive action for 10 years. The IUD is placed easily in the womb by trained medical personnel with no pain to the woman. The IUD used in Sri Lanka is the Copper T 380 A (TCu-380A).
Secondarily it prevents implantation by producing an inflammatory reaction in the endometrium.
Effectiveness- more than 99%
If 100 women use this method for one year, it will prevent pregnancy in more than 99 women)
Return to fertility- Immediately after removal of the IUD. This method is ideal for spacing and limiting pregnancies.
II. The male condom
The condom is a thin rubber sheath made to fit the erect penis. Condoms are lubricated, rolled, individually packed in foil and ready to use.
Mode of action
Prevents sperms from entering the vagina.
The condom is suitable for the following:
1. When other reversible methods
are contraindicated.
2. Couples practising infrequent intercourse.
3. As a backup method with other modern contraceptive methods or traditional methods.
4. Following vasectomy.
5. When protection is needed against
STI/AIDS.
Effectiveness 85%
Return to fertility- Fertility is not affected.
PERMANENT METHODS
The permanent methods of family planning are female and male sterilization. These are surgical procedures, which are effective, safe and economical and are carried out in both developed and developing countries.
I Female sterilizations
Sterilization in a woman involves a minor surgical procedure that results in occlusion of both fallopian tubes and prevents the union of the sperm and ovum.
Effectiveness- more than 99%
It is suitable for:
1. Those who have completed their families.
2. Certain high risk groups such as:
Women with a history of serious obstetric and medical complications; Those who have undergone repeated caesarean sections; Women who are at risk of producing congenitally abnormal children. E.g. Thalassaemia major
Women who are willing to undergo sterilization should be well counselled.
Female sterilizations are performed by Gynaecologists and Trained Medical Officers.
II. Male sterilizations (Vasectomy)
Vasectomy is a simple operation that blocks the two small ducts, which carry the sperms produced in the testes, and prevents the sperms from mixing with seminal fluid.
Effectiveness- 97%
(The writer is a Consultant Community Physician attached to the Family Health Bureau,
Ministry of Health)
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