FAMILY PLANNING TEMPORARY METHODS - NURSING ASSIGNMENT

INTRODUCTION

        India launched a national family programme in 1952. Family planning is not only the limitation of family size but 9180 child spacing by contraceptive methods. Contraceptive methods are preventing methods to help women avoid unwanted pregnancies.

FAMILY PLANNING

        A WHO expert committee in 1971 defined and described family planning as follows;

       

        Family planning refers to practices that help individuals and couples to attain objectives.

·        To avoid unwanted births

·        To bring about wanted births

·        To regulate the intervals between pregnancies

·        To control the time at which birth occur in relation to the ages of the parent

·        To determine the number of children in the family.

CONTRACEPTIVE METHODS

Meaning

Contraception means preventing

·        The union of the sperm and the ovum

·        Suppressing ovulation

·        Interfering with the implantation of the fertilized ovum in the uterus.

Types of Contraceptive Methods

        The contraceptive methods can be divided in to two types as

1.   Temporary or spacing methods

2.   Permanent or terminal methods

 Barrier Method

        This method prevents sperm deposition in the vagina or prevents sperm penetration through the cervical canal.

Condom (Nirodh)

        Condom is a thin rubber sheath used by men during sex it is made of polyurethane or latex. Condom user safe and effective method of the birth control.

Method of Application

        The condom is fitted on the erect penis before intercourse. It prevents the deposition of semen in the vagina.

Advantages

·        Easily available

·        Cheaper with no contraindication

·        Easy to use and disposable

·        Protection against sexually transmitted diseases

o       Eg: Gonorrhoea and HIV

·        Protection against pelvic inflammatory disease and cervical cell abnormalities

·        It has no side effects

·        Protects from unwanted pregnancy

·        No medical advice is required

·        Incidence of cervical cancer for the spouse is reduced

Disadvantages

·        It may burst, tear or slip off during use

·        May reduce sexual pleasure

·        A new condom must be used each time

·        Condom may deteriorate in too much heat or light or if stored for more than 3 years

SAFE PERIOD / RHYTHM PERIOD

        A week before and a week after the menser is considered as the safe period. During this period, the women is not fertile because she cannot ovulate this methods is not applicable during  or with irregular cycle.

Advantages

1.   No cost

2.   Lack of side effect

Disadvantages

1.   difficult to calculate the safe period

2.   Compulsory obstinence from sexual act during certain periods

3.   Not, applicable during locational amenorrhoea, or when the periods are irregular

4.   Higher rate of ectopic or congenital abnormalities of the fetus because of chance of the union of the aging sperm and ovum

Eg: If the day of menstruation for a women is Monday, the next Monday will be her first day, the Monday following the most risky day will be the last risk day between risks Monday will be unsafe period.

Coitus Interruptus

        Coitus interrupts (with drawal) is an ancient method of contraception.

Method of Application

        The male withdraws just before ejaculation and there by prevents deposition of semen in the vagina the risk of the pregnancy is very high, this is because of small amount of prejaculatory fluid containing sperms ooze out during intercourse without either partner being aware of it.

Advantages

·        No, appliance is required

·        No, cost

Disadvantages

·        Required sufficient self-control by the man

·        The women may develop anxieties, neurosis, vaginismus

·        Chances of pregnancy is more

o       Pre-ejaculatory may contain sperm

o       Accidental chances of sperm deposition in to the vagina

Intra Uterine Devices

        It is based on the concept that prevents conception by introducing a foreign body in to the uterus

a.    Copper T

b.   Lippies Loop

Copper T

        It is plastic material (polytheleneanes the copper wire is wrapped around the stem of the device).

Eg: Copper T, Copper T-200, Multi Load-375, CVT 380A

Time of Insersion

·        Low risk of STD

·        Low expulsion rate

·        Less pain and bleeding

·        Greater effectiveness

Disadvantages  

·        Severe dysmenorrheal

·        Severe anemia

·        Nullipara

Contra Indications

        IUD cannot be used in the presence of certain gynecological conditions such as

a.    Pregnancy

b.   Cervical or pelvic infections

c.    Sexually transmitted disease

d.   Abnormal vaginal bleeding

Hormonal Contraceptives

        These may be classified in to these

a.    Oral pills

b.   Injectables

c.    Self derminal implants

Oral Pills

·        These are oral contraceptives which contain small amount of eostrogen and progestrone

·        It prevents pregnancy by inhibiting ovulation

·        A packet of oral pills contain 28 pills of which 21 are contraceptive pills and the remaining 7 are pills should be started on the 5^th day of periods.

Advantages

·        Almost 100% effective

·        No interference with sexual intercourse

·        Reversible method

Disadvantages

·        Prior medical examination  is required before starting the pills

·        Side effects nausea, vomiting, dissiners head ache, intermenstrual bleeding, spotting weight grain and tenderness of the  breast may occur

·        Medical conditions as high blood pressure diabetics, chronic fever diseases or cancer of the breast or genitals

·        Nursing mothers during the first 12 months

Contraindications

·        Pregnancy

·        Women are 35 years of age

Injectable Contraceptives

        There are currently two types of injectable contraceptives available

·        Depo-provera (DMPA)

·        NET-EN

Advantages

·        They are most effective as vasectomy or tubal ligation

·        They are reversible method

Disadvantages

·        Side effects such as irregular bleeding, ammenorrhoea, heavy bleeding is rare.

Subdermal Implants

·        Norplant is a highly effective, safe and acceptable contraceptive despile menstrual disturbances

Advantages

·        Norplant is highly effective

·        Reversible

·        Estrogen free

·        Long acting contraceptives

Disadvantages

·        Medical practitioners are required for this procedure

·        Menstrual disturbances

Diaphragm (Dutch Cap)

·        It is a shallow cap made of synthetic rubber or plastic material. It is vaginal barrier in females

Method of Application

·        Diaphragm is inserted in to the vagina, prior to the sexual intercourse, where if covers the cervix completely and prevents the spermatozoa entering the uterus.

·        It is available in various size 70-80 mm accommodate most cases

Advantages

·        Does not interface with sexual intercourse

·        No side effects

·        They are cheap and can be used repeatedly for a long time

Disadvantages

·        Some training is required for proper insertion

·        No, quite suitable, if the vaginal muscles don’t have enough bone

·        After used, if must be washed, dried and stored carefully

Vaginal Sponge

·        It is a dome-shaped disposal sponge made up of polyurethane impregnated with 1gm of non-oxynol 9 as a spermicide

·        It act as a surfactant with either immobilize or sperm

Method of Application

·        Non-oxynol 9 release spermicide during coitus absorbs ejaculate and blocks the entrance to the cervical canal

·        It must be moisted before insertion to activate the spermicides the sponge should not be removed fro 6 hours after intercourse.

Advantages

        It prevents pregnancy by three ways

·        By the release of spermicides

·        Blocking the cervical openings

·        By absorbing the semen and destroying the sperm

Disadvantages

·        Less effective than diaphragm

FOAM TABLEYS

        There are vaginal tablets containing a spermicidal agent (non-oxynol.9)

Method of Application

·        A woman put a tablet moisted with water deep in to her vagina near to the external opening of the cervix 9-10mts before sexual intercourse.

·        In contact with water for moister the foam tablets forms at a thick foam enmeshes the sperm and reduces its mobility, the spermicidal agents kills the sperm

Advantages

·        Easy to use

·        Does not interface with sex

·        No side effect

Disadvantages

·        Occasional side effect includes irritation or burning in the vagina

·        Not an effect contraceptive

·        Deteriorates under conditions improper storage

CREAM AND JELLIES

        These are chemical contraceptives containing the spermicidal ‘Nonmynol-9”

Method of Applications

·        A measure quantity of the cream or jelly is introduced in to the vagina by a special applicator just before sexual intercourse.

·        At body temperature, they melt and spread in the vagina and provide a thin film of a chemical barrier the sperm is destroyed by chemical action

CONCLUSION

        Family planning and health have two way relationship. Family planning methods are classified in to two temporary and permanent methods. Family planning is not synonymous with birth control which was felt to be too negative and restrictive.

BIBLIOGRAPHY

1.   Myles Text Book for Midwives, Diane M. Fraser and Margaret A Cooper, 14^th Edition, Page No.675-685

2.   Community Health Nursing, K.Park, 5^th Edition, Page No.279-285.