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OVERVIEW OF FAMILY PLANNING METHODS/ DEMOGRAPHIC INDICATORS/ NATURAL FAMILY PLANNING METHODS

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OVERVIEW OF FAMILY PLANNING METHODS/ DEMOGRAPHIC INDICATORS/ NATURAL FAMILY PLANNING METHODS Dr Ernest O. Orji Definitions Family Planning: The World Health ... – PowerPoint PPT presentation

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Title: OVERVIEW OF FAMILY PLANNING METHODS/ DEMOGRAPHIC INDICATORS/ NATURAL FAMILY PLANNING METHODS


1
OVERVIEW OF FAMILY PLANNING METHODS/ DEMOGRAPHIC
INDICATORS/ NATURAL FAMILY PLANNING METHODS
  • Dr Ernest O. Orji

2
Definitions
  • Family Planning 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.
  • Demography statistics 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.

3
  • 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.

4
  • 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

5
Effects of population factors on socioeconomic
development
  • Agriculture This remains the basis of life. The
    growth of agric sector had been 1 as compared
    with 2.9 growth rate. This means less food for
    the teaming population and increased cost of
    stable foods.
  • Health
  • Crude birth rate is the number of births per
    1,000 population each year. In Nigeria it is 40.
  • The death rate is the number of deaths per 1,000
    individuals in the population each year. In
    Nigeria it is 14. The difference between birth
    and death rates is the natural increase in the
    population.
  • Birth rate 40
  • Death rate 14
  • Natural increase26(number per 1000population)
  • Maternal mortality ratio this is the number of
    maternal deaths per 100,000 live births. In
    Nigeria, this is 1500 per 100,000 . Family
    planning which can reduce unwanted and high- risk
    pregnancies will help to positively reduce
    Nigerias high mortality ratio.

6
  • Infant Mortality Ratio this is the number of
    infant deaths per 1,000 live births. In Nigeria ,
    it is 75 compared with less than 10 in US. In
    Ghana, the infant mortality rate is 89 and
    Liberia 138 . Here too , child spacing will help
    to reduce Nigerias infant mortality rate.
  • Education as a result of high birth rate, the
    number of children has increased rapidly leading
    leading to increase in school enrolment, increase
    in school teacher requirement and the number of
    schools required at all levels of education.

7
  • Employment the number of school leavers
    continues to increase with increase in urban
    rural migration and stretching of social
    amenities.

8
FAMILY PLANNING METHODS
  • Withdrawal methods
  • Natural family planning methods /lactational
    amenorrhoea methods(LAM)
  • Chemical agents and barrier devices
  • Hormonal(oral , injectables, implants)
  • Intra-uterine contraceptive devices
  • Voluntary surgical contraception
  • Emergency contraception
  • New trends in Family Planning

9
  • Description and type
  • Effectiveness
  • Mechanism of action
  • Advanyages and disadvantages
  • Prescribing precautions
  • Medical eligibility and non eligibility criteria
  • How to use
  • Return to fertility
  • Side- effects and complication management

10
Natural family planning methods(NFP) Fertility
Awareness based methods(FAM)
  • Definitionuse of signs ,symptoms and cycle data
    to determine when ovulation occurs. The same
    techniques may be used to help couples become
    pregnant by detecting ovultion. When couples are
    using NFP ,they should abstain from intercourse
    during the at- risk fertile days. With FAM ,
    couples use another method such as barriers or
    withdrawal during those days. The same
    techniquesused to teach fertility awareness can
    be used either to prevent pregnancy or to help a
    woman become pregnant.

11
Effectiveness
  • 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

12
NFP/FAM First-year fertility rate (100 women
years of use)
  • Method Typical use Perfect use
  • Calender 25 9
  • Ovulation Method 25 3
  • Symptothermal 25 2
  • Post-ovulation 25 1
  • FAM usually more effective than NFP

13
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)

14
Specific counselling issues
  • Advantages
  • 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
    planning
  • Educate people about women fertility cycles

15
Disadvantages
  • 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.

16
Clients who can use
  • Clents choice is infleunce by religion or other
    personal reasons
  • Other methods are contraindicated
  • Medical care is inaccessible
  • An inexpensive method is required

17
Clients who cannot use it
  • There is no knowledgeable instructor to teach the
    client
  • Client is not motivated
  • Client is not comfortable touching her genitals
  • Menses are irregular
  • There is alterations in cervical mucus e.g.
    infections, erosion
  • In the immediate post partum or post abortal
    periods

18
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
    stops
  • If mercury stops in between readings take the
    lower reading as your temperature

19
Instruction for BBT cont
  • Record readaing 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
    abstain)
  • 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
    chart

20
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
    days

21
  • Abstain from intercourse during this period every
    month
  • If your period is irregular do not use this
    method, use spermicidal or other barrier methods
    as well
  • Request clients to repeat this instruction

22
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

23
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.

24
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

25
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

26
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 effectivemethod only under specific
    conditions
  • 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
    menses)
  • The infant is less than 6 months old.

27
  • 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
  • Effectiveness
  • Perfect use failure rate in the first 6
    months0.5
  • typical use failure rate in first 6 months2

28
Advantages
  • 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)

29
Advantages contd
  • Reduces risk for ovarian cancer and endometrial
    cancer,slight protective effect against breast
    cancer
  • 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 xpensive and less time used for preparing
    and feeding

30
Disadvantages
  • 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
    transmission
  • Sore nipples,breast engorgement and risk of
    mastitis are associated with breast-feeding
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