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Overview of Family Planning Methods/ Demographic indices/Natural Family Planning Methods


Overview of Family Planning Methods/ Demographic indices/Natural Family Planning Methods Dr E.O.Orji Consultant Obstetrician & Gynaecologist Dr Ernest O. Orji – PowerPoint PPT presentation

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Title: Overview of Family Planning Methods/ Demographic indices/Natural Family Planning Methods

Overview of Family Planning Methods/
Demographic indices/Natural Family Planning
  • Dr E.O.Orji

  • Family planning is a basic human right that
    benefits everyone
  • The goal of family planning
  • is to enable couples and individuals
  • to freely choose how many children to have and
    when to have them

  • This can best be done by
  • - making a full range of safe and effective
    contraceptive methods available and
  • -by giving men and women sufficient information
    to ensure they are able to make informed choices

Physician obligations
  • Are First do no harm(primum non nocere.
  • Assessing the balance between risks and benefit .

Assessing the balance between risk and benefit
WHO Definition
  • The World Health Organization (WHO) definition of
    family planning states that it is a way of
    thinking and living that is adopted voluntarily
    upon the basis of knowledge , attitudes and
    responsible decisions by individuals and couples
    in order to promote health and welfare of the
    family group and thus contribute effectively to
    the social development of the country

Unmet Need for Family Planning
  • the proportion of sexually active women who does
    not want to get pregnant or want to postpone
    pregnancy but they or their partners are not
    using contraceptives . This is 18 in Nigeria.
    About 3.5 million Nigerian women. Reasons for
    unmet need include accessibility,
    acceptability, affordability, fear of side
    effects etc

  • Demographystatistics of birth, deaths, diseases
    etc that shows the condition of a community.
  • Population the number of inhabitants found
    within a given area. The 1991 census put
    Nigerias population at 88.9 million. If the
    population continues unchecked, the population
    will double in 20 years.i.e in the year 2011,the
    population will be 177 million. Last census in
    2003 put Nigeria at 140 million.

  • Population Growth Rate the rate at which the
    population is increasing or decreasing in a given
    year due to natural increase (birth minus
    death).The current growth rate is 2.9 for
    Nigeria(NDHS 1999). This is considered as one of
    the highest in the world

  • Total Fertility Rate this is the average number
    of children a women can have throughout her
    childbearing years i.e14-49 years. In Nigeria
    this is 5.2 (NDHS 1999) as compared to Europe
    which is 1.8 and India 4.3.

  • Dependency Ratio this is the ratio of the
    economically dependent part of the population to
    the productive part i.e. the elderly (65years)
    and the young(15 years and below ) to the
    population in the working ages(15 to
    64years).47 of the Nigerian population is under
    the age of 15.Half of Nigerian population are
    dependent. This means that for each dependant in
    Nigeria, there is only one working adult. It
    contrast with most developed countries where
    about 2 or 3 adults are working for each dependant

Family planning mtds
  • Temporary methods
  • Permanent methods
  • Emergency contraception

Temporary methods
  • Natural regulation of fertility
  • Barrier methods,
  • Hormonal contraception
  • Intra uterine contraceptive devices
  • Implants
  • Emergency (Post coital ) contraception

Permanent methods
  • Sterilization
  • Female sterilization
  • Vasectomy
  • No-scalpel vasectomy (NSV)

World Health Organization (WHO) Eligibility
criteria for the use of various contraceptive
  • Category 1
  • A condition for which there is
  • no restriction for the use
  • of the contraceptive method

World Health Organization (WHO) Eligibility
criteria for the use of various contraceptive
  • Category 2
  • A condition where the advantages of using the
    method generally
  • outweigh the theoretical or proven risks

World Health Organization (WHO) Eligibility
criteria for the use of various contraceptive
  • Category 3
  • A condition where the theoretical or proven risks
    usually outweigh the advantages of using the

World Health Organization (WHO) Eligibility
criteria for the use of various contraceptive
  • Category 4
  • A condition which represents an unacceptable
    health risk if the contraceptive method is used

Effectiveness rate
  • Are expressed in terms of how many women
    experience pregnancies during their first year of
    using the method.

  • Perfect use reflects correct and consistent use,
    according to specified instructions, with every
    sex act
  • Typical use reflects the fact that most couples
    do not use their contraceptive methods correctly
    or consistently with every sex act . This rate,
    therefore, is considered more accurate than
    perfect use

Natural family planning methods (NFP)
  • Definition use of signs ,symptoms and cycle data
    to determine when ovulation occurs. When couples
    are using NFP ,they should abstain from
    intercourse during the at- risk fertile days.

Methods of determining high risk fertile period
  • The basal body temperature(BBT) method
  • The calender/rhythm method
  • The cervical mucus method(CMM) or Billings
    ovulation method
  • The symthothermal method(STM)

NFP/FAM First-year fertility rate (100 women
years of use)
  • Methods Typical use Perfect use
  • Calender 25 9
  • Ovulation Method 25 3
  • Symptothermal 25 2
  • Post-ovulation 25 1

  • The success of the FAM depends on
  • -the accuracy of the method in identifying the
    womans actual fertile days
  • -couples ability to correctly identify the
    fertile time.
  • -couples ability to follow the rules of the
    method they are using

  • Involves men in family planning
  • No physical side effects
  • No effect on breastfeeding or breast milk
  • Safe and inexpensive
  • helpful for planning or preventing pregnancy
  • Acceptable to most religious groups that oppose
    conventional methods
  • Encourage couples to communicate about family
  • Educate people about women fertility cycles

  • Requires high motivation for success
  • Restrict sexual spontaneity
  • Not suitable for women with irregular menses
  • Requires a long time of practice
  • No protection for HIV/AIDS
  • Difficult to use after childbirth until menstrual
    cycle become normal and regular
  • Fever, vaginal infections and bleeding may affect
    effective use.

Instructions to clients for BBT method
  • Take temp. in the morning b/4 getting out of bed
    and b/4 eating or drinking anything(after atleast
    3 hours of sleep).
  • Take the temp. at the same time every morning in
    the same way ,either orally ,rectally or
    vaginally(orally for 5 mins,vaginally for 3 mins
    and rectally for 2mins).
  • Record the reading at the level the mercury
  • If mercury stops in between readings take the
    lower reading as your temperature

Instruction for BBT
  • Record reading on a temperature chart
  • Abstain from intercourse from the first day of
    your period until after the third consecutive day
    of rise in the body temp(use a back up or
  • Do not use this method if breastfeeding as the
    temp may not rise during this period
  • Request clients to repeat this instructions and
    demonstrate charting of the temperature on the

Calender / rhythm method
  • Record the first day of each menstrual cycle for
    6-12 months
  • Determine the beginning of the fertile period by
    subtracting 18 days from the shortest cycle
  • Determine the end of the fertile period by
    subtracting 11days from the longest cycle
  • If your longest period is 31 and the shortest
    23days ,then your fertile period is from the 5th
    to the 20th day of her menstrual cycle i.e 16

  • Abstain from intercourse during this period every
  • If your period is irregular do not use this
    method, use spermicidal or other barrier methods
    as well

The cervical mucus (billings) methods
  • Billings method is based on the changes that
    take place in the quantity and quality of the
    cervical mucus during the menstrual cycle. Prior
    to ovulation the mucus is thick. At ovulation the
    mucus becomes thin,clear,plenty in amount and
    watery. It is easily stretched between the
    fingers like egg white. After ovulation it
    becomes thick again and does not flow

Instruction to clients for Billings method
  • Abstain from intercourse during menstruation
  • Feel the vagina daily for mucus
  • Record findings daily on appropriate chart
  • Have sexual intercourse during the dry days when
    no mucus appears
  • Abstain from intercourse once mucus appears and
    continuous abstinence until four days after the
    mucus has ceased to be felt.
  • Do not douche as this appears to alter the nature
    of cervical mucus
  • Abstain from intercourse whenever there is
    intermenstrual bleeding.

Sympto-thermal method
  • This is a continuation of the temperature ,
    calender and mucus methods to determine time of
    ovulation. Other ovulation associated signs and
    symptoms such as breast tenderness , feeling of
    bloated ness, midcycle pain, vaginal bleeding ,
    vaginal spotting are also used in this method

Instructions to clients
  • Avoid intercourse during the fertile period as
    determined by BBT or Calender method, or when
    mucus is first noted, whichever comes first

Breastfeeding , lactation Amenorrhea Method(LAM)
  • Baby suckling on the mothers nipple causes a
    surge in maternal prolactin , which inhibits
    estrogen production and ovulation
  • In general , breastfeeding delays the return of
    fertility in the postpartum period . However ,
    LAM is an effective method only under specific
  • Woman breastfeeding exclusively , both day and
    night on demand (at least 90 of babys nutrition
    derived from breastfeeding)

  • The woman has amenorrhea(spotting which occurs in
    the first 56 days postpartum is not regarded as
  • The infant is less than 6 months old.
  • The medical duration of breast-feeding is
    approximately 3 months. It is wise to provide a
    woman with another method to use when she no
    longer fulfills all the conditions

  • Perfect use failure rate in the first 6
  • Typical use failure rate in first 6 months2

  • Most advantages and disadvantages are
    attributable to breastfeeding itself. The
    additional benefits accruing to LAM as a
    contraceptive method are minimal. These are
  • Involution of the uterus occurs more
    rapidlysuppresses menses
  • Breast-feeding pleasurable to some women
  • Facilitates bonding between mother and child (if
    not stressful)

  • Reduces risk for ovarian cancer and endometrial
    cancer,slight protective effect against breast
  • Can be used immediately after childbrith
  • Protects baby against asthma, allergies, URTI,
    diarrhoea by passage of mothers antibodies into
    breast milk
  • Facilitates postpartum weight loss in the mother
  • Less expensive and less time used for preparing
    and feeding

  • Return to menses unpredictable
  • Breastfeeding mother may be self conscious and
    may be inconvenient
  • No protection against STIs,HIV,AIDS
  • If the mother is HIV, there is a 14-29 chance
    that HIV will be passed to the infant via breast
    milk. Antiretroviral therapy decreases risk of
  • Sore nipples,breast engorgement and risk of
    mastitis are associated with breast-feeding

  • Women or couple that chooses to use Natural
    Family planning needs good counseling to the sue
    of these methods most effectively and
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