Subject:- Community

Health Nursing

Topic:- Methods of Contraceptive

PRESENTED BY,
MR. KAILASH NAGAR
ASSIST. PROF.
DEPT. OF COMMUNITY HEALTH NSG.
DINSHA PATEL COLLEGE OF NURSING, NADIAD
FAMILY PLANNING
 FAMILY PLANNING

Family planning is the ability for a

woman or couple to determine when
and how many children they are going
to have by practicing safe sexual
practices.
 OBJECTIVES FAMILY PLANNING

( WHO ) “the use of a range of methods of a fertility

regulation to help individuals or couples attain
certain objectives:
avoid unwanted birth.
bring about wanted birth.
Produce a change in the no. of children born.
Regulate the intervals between pregnancies.
Control time at which birth occur.”
 DEFINITION OF TARGET COUPLE

The term target couples are applied who have

2-3 living children, and family planning was largely
directed to such couples.
 DEFINITION OF SMALL FAMILY NORM
it is composed of mother , father and few children.

Slogan for SMN

•Hum Do, Hamara Ek 
•Hum Do, Hamara do (1970)
•A Small Family is a happy Family.
• Small family-small conflicts
• Small family-small demands
• two child complete the family
• Chota Parivar Ghar Sansar.
HEALTH ASPECT OF FAMILY PLANNING
ADVANTAGES TO MOTHER
 Reasonable gap between two children will give the
mother sufficient time to replenish her body
nutrients depleted due to the earlier pregnancy.
 Loss of fear about unwanted pregnancy.
 More time and energy to give proper attention
and love to her children.
 More time to participate in other fruitful activities
like education, vocational training, community
projects etc.
Can avail of better job opportunities when not
tied down by small children..
 HEALTH ASPECT OF FAMILY
PLANNING
ADVANTAGES TO FATHER

Can provide sound economic base for the family.

Can provide children with better education,
comfort, food, clothing, recreation etc.
Can be more relaxed and enjoy good
health.
Improved living standards, better health,
more productive labour force
HEALTH ASPECT OF FAMILY PLANNING
ADVANTAGES TO CHILD
Less chances of foetal death, birth
defects, mortality during infancy and
childhood.
 Conducive atmosphere for proper
physical and psychological growth of
the child.
Get proper nutrition, education,
parental care and love.
HEALTH ASPECT OF FAMILY PLANNING

ADVANTAGES TO COMMUNITY AND COUNTRY

-Conversation of natural resources and savings.
-Enough schools, hospitals and other basic services.
-More employment
-Planned families would gradually bring happiness,
peace, harmony, prosperity.
 CONCEPTION

It is the fertilization of a
female ovum by a male
sperm. Every 28 days, in an
adult female, one ovum
leaves the ovary and is
directedinto fallopian tube
by the fimbriated end,
which passes along with
the tube.
• Human fertiliz
ation is the
union of a
human egg
and sperm,
usually
occurring in
the ampulla of
the fallopian
tube.
 CONTRACEPTION
it is the voluntary prevention of pregnancy, a
process with individual and social implications.

Contraception (birth control) prevents pregnancy

by interfering with the normal process of ovulation,
fertilization, and implantation. There are different
kinds of birth control that act at different points in
the process.
 Emergency contraception

Emergency contraception refers to back up

method for contraceptive emergencies which
woman can use within the first few days after
unprotected intercourse to prevent an unwanted
pregnancy. Emergency contraceptive is not
suitable for regular use.
(WHO, 2005)
 INDICATIONS OF
EMERGENCY
CONTRACEPTIVES
•After voluntary sexual act without contraceptive protection.
•Incorrect or inconsistent use of regular contraceptive
methods. Failure to take oral contraceptive for more than
three days.
•In case of contraceptive failure or mishap, miscalculation of
infertile period, expulsion of an intrauterine device and
failed coitus interruptus or in case of leakage of condom.
•In the case of sexual assault.
•Emergency contraception should not be used as regular
birth control. Other birth control methods are much better
at keeping women from becoming pregnant.
 METHODS OF EMERGENCY CONTRACEPTION
Emergency contraceptive pills (ECPs) emergency
contraceptive pills; ECPs
Medication containing synthetic hormones for preventing
pregnancy after unprotected vaginal intercourse.
All the hormonal oral contraceptive pills (combined as well
as single) in varying doses and IUD can be used for EC. The
method currently used in india are :
High dose of progesterone only pill containing
levonorgestrel (LNG).
high doses of combined oral contraceptive containing
ethylestradiol and levonorgestrol (yuzpe regimen).
 Cont…..
•Copper releasing intrauterine devices (IUCD) such
as CuT 380A.

•Under the national family welfare programme, the

drug controller of india has only approved
levonorgestrel (LNG) 0.75mg tablet for use as ECP.
LNG is the specially packaged at the correct doses
for use as ECP.
 MODE OF ACTION OF ECPs
 Inhibition or delay of ovulation.

 Thickening of cervical mucus.

 Direct inhibition of fertilization.

 Alteration in endometrium leading to impaired

endometrium receptivity to implantation of

the fertilized egg..
 MODE OF ACTION OF ECPs
 Alteration in transport of egg, sperm and
embryo.

 Interference with corpus luteum and

luteolysis
 Effectiveness of ECPs

The probability of conception after single act of

intercourse is approximately 8%.
A normally fertile sexually active couple not using
contraception has an average monthly chance of
conceiving of 20-25% (counting on pregnancies that
result in live births.
ECPs taken within 72 hours of unprotected
vaginal intercourse are 85% effective .
ECPs are more effective if used within 12-24 hours
of unprotected intercourse any delay in taking the
pills decrease the efficiency of ECPs.
 ADVANTAGES OF ECPs
Effective if taken correctly as prescribed.
Safe for all woman including those who have
conditions, that are listed as precautions in case of
other hormonal contraceptives.
 Does not affect lactation.
Can be taken at any time during the monthly
cycle.
It is available without a prescription (over the
counter medicine)
Use not associated with foetal malformation or
congenital defects.
 DISADVANTAGES
•Has to be used within 72 hours of the first act of
sexual intercourse as use of ECP beyond this
period increases the risk of pregnancy.
•Effectiveness decreases with frequent use.
•Does not protect from STIs/HIV.
•Side effects: nausea, vomiting, irregular bleeding
per vagina, breast tenderness, headache,
dizziness, fatigue.
 MODE OF INTAKE
ECPs must be taken 72 hours of an unprotected
act of intercourse best to be taken as soon as
possible after the unprotected act and as a single
dose of 2 tabs of 0.75 mg each.
 There is an option of taking 2 doses of 1 tablet
0.75 mg each, 12 hours apart.
However no woman should be denied the pills in
case she comes later than 3 days (maximum 120
hours) but should be counseled regarding the
decreased efficacy).
 EMERGENCY CONTRACEPTION
PILLS
Calculation of 72 hours (three days interval)
Calculation of 72 hours or three days should
start from the first unprotected penetrative
vaginal intercourse the woman has had
during the particular menstrual cycle.
 Side effects of ECPS

 Nausea and vomiting

. Headache,
dizziness,
irregular bleeding,
breast tenderness,
 fatigue
INTRAUTERINE DEVICE (IUD
 INTRAUTERINE DEVICE
(IUD)
•IUD is a small, T-shaped device placed into the
uterus by a doctor within 5 days after having
unprotected sex.
•This prevents implantation.
•The IUD works by keeping the sperm from joining
the egg or keeping a fertilized egg from attaching to
the uterus.
•It can remove the IUD after next period. Or left in
place for up to 10 years
 STERILIZATION

Sterilization refers to surgical procedures intended

to render the person infertile. Most procedure
involve the occlusion of the passageways for the
ova and sperm.
 TYPES OF TERMINAL METHODS
TYPES OF TERMINAL METHOD
FOR MALE
Vasectomy
Non scalpel vasectomy.
FOR FEMALE
Tubectomy
Minilap operation
Laproscopic sterilization
Tubal ligation.
 MALE STERILIZATION - VASECTOMY
Male sterilization or vasectomy being a
comparatively simple and permanent method.
can be performed even in primary health
centres by trained doctors LA.
through a small scrotal incision on an out
patient basis.
When carried out under strict aseptic
conditions,.
 TECHNIQUE OF MALE STERILIZATION
The tubes through which sperm travels from the
testes to the penis are cut and blocked.
So that spermatozoa can no longer enter the
semen that is ejaculated.
It is customary to remove a piece of vas at least 1
cm after clamping.
The ends are ligated and be then folded back on
themselves and sutured into portion so that the cut
ends face away from each other.
 MALE
STERILIZATION
.
 MALE STERILIZATION
The passage of the sperm along with the vas
deferens is blocked,
so that the sperm that is ejaculated does not
contain sperm.
It is important to stress that the acceptor is not
immediately sterile after the operation,
usually until approximately 30 ejaculations have
taken place.
During this intermediate period another method
of contraception must be used.
CONT……
 MINOR COMPLICATION OF
VASECTOMY
Swelling
•Pain
•Blood Clots
•Infection
•Epididimitis
 CARE AFTER
OPERATION
•
Avoid heavy works for at least 3 days.
Avoid cycling for at least 7 days.
Avoid taking bath for at least 24 hours
after the operation.
Use contraceptives until aspermia has
been established
 THE PATIENT NEEDS

Prescribe medicine.
 Adequate diet.
 Dry and clean dressing.
 Scrotal support for one month.
Niroth to be used at least 12 ejeculation
after operation.
 Suture removed after 3 rd day.

 NONSCALPEL VASECTOMY
This new method of sterilization is being
actively promoted by the W.H.O.
it was developed in 1974 by Dr. Li Shungiang at
chongging Family Planning Scientific Research
Institute, peoples republic of china.
In contrast to the standard incisional method
of vasectomy, which requires several pieces of
surgical instruments, this new technique needs
only two essential instrument.
 TECHNIQUE OF NON SCALPEL
VASECTOMY
The first is the vas fixation clamp, used to grasp
the vas deferens from outside of the scrotal skin.
The second is the vas dissecting clamp, used to
make a puncture into the skin over lying the fixed
vas . after widening the essential punctured hole
with the vas dissecting clamp, the vas can be seen
and elevated out for any preferred methods of vas
occlusion.
 FEMALE STERILIZATION
Occlusion of the fallopian tubes in some form is
the underlying principle to achieve female
sterilization. It is most popular method of
terminal contraception.

Time of operation
• Immediately after birth (within 24 to
48 hours)
• At the time of abortion.
•An interval procedure (during proliferative
phase of menstrual cycle )
METHOD OF FEMALE
STERILIZATION
 LAPAROSCOPIC STERILIZATION
•This is a technique of female sterilization
through abdominal approach with a specialized
instrument called “laparoscope”. The abdomen is
inflated with gas(carbon dioxide, nitrous oxide or
air).
•Instrument is introduced into the abdominal
cavity to visualize the tubes.
•Once the tubes are accessible, the Falope rings
are applied to occlude the tubes.
LAPAROSCOPIC STERILIZATION
 ADVANTAGES DISADVANTAGES

•It is simple/ small •The instrument is

incision. expensive.
• Easy to perform. •Requires adequate
• Done in the short maintenance.
time. •Requires sufficient
training to use the
•Hospitalization is
instrument
limited.
• Scars will not be
visible.
 MINILAP OPERATION
•Much simpler procedure requiring a smaller
abdominal incision of only 2.5 to 3 cm conducted
under local aneaesthesia.
•Minilap is used for tubal ligtion through the cutting
of the tubes or to application of the band or clip.
 PUERPERAL STERILIZATION
Currently puerperal sterilization is becoming more
popular, an account for 85-90% and male
sterilization for 10-15% only in india. sterlization
services are provided free of charge in
government institution.
 TUBECTOMY
• An operation in which
small piece of a tube on
each side is removed.
The passage of the
sperm into the tube is
blocked, so that sperm
and ovum can not be
meet.
 VAGINAL TUBAL
LIGATION

Tubal ligation through vaginal route is also done.

This approach to the tube is through posterior
colpotomy.

It can be done in the interval period or following

delivery or abortion, provided the uterus is smaller
than 12 weeks size.
VAGINAL TUBAL
LIGATION
 COMPLICATION RELATED
TO STERILIZATION
General complication
•Loss of weight
•Occasional obesity
•Psychological upset.
•Gynaecological complication
•Chronic pelvic pain
•Congestive dysmenorrheal and.menstrual
abnormality such as menorrhagia,
hypomenorrhagia or irregular periods and
alteration in libido.
 Incentives of terminal methods
The acceptor now receive a one time payment of
Rs 800 for vasectomy and 145 for laproscopic
tubectomy and Rs. 20 are given to IUD receptor.
Motivator also received a small amount (Rs 10 for
tubectomy and Rs 40 for vasectomy).
State govt employees, who undergo sterilization
after two or three children are eligible for a special
increments after 2 children and one after 3 children ).
Central Govt employees get one increment after
sterilization.
They get special leave (14 days for woman and 7
days for men). No maternity leave is allowed after 3
children.
In the event of death following sterilization,
recanalisation, or IUD insertion, ex-gratia payment
of Rs. 20,000 has been authorized to be paid to the
surviving spouse, natural heir, etc.
The state Govt has been requested to: issue
Green cards to individual acceptors of terminal
methods after two children as a mark of recognition
and for priority attention in scheme where
preferential treatment was feasible.
 ROLE OF NURSE IN FAMILY
PLANNING
 Administrative role -
 Supervisory role.
 Functional role
 Educational role-
 Role in research
 Role in evaluation
-