It is the Right of every woman of child bearing age to have access to family planning. She should be given independent of her spouse or his decisions. The family planning provider must not discriminate based on their culture or religious beliefs, the client's age, financial status or gender. Simply put, all clients are equal... Lecture Date: Saturday 16th Dec 2017, Time: 8pm, Venue: Nursingworld Nigeria WhatsApp Group
Introduction: FAMILY PLANNING
Family planning is a conscious decision by individual or couples to choose for themselves when to start having children, how many children to have, how to space them or when to stop having children. So the individual or couple, is completely involved in it and choose from many contraceptive methods to help them plan their family and prevent unwanted pregnancy. They need to know that if they are having sex regularly and do not use a contraceptive method, about 8 of every 10 women will become pregnant during the next 12 months.
Every individual or couple wants different choice of Contraceptive method, Some do not want to take pills as they forget easily,some want to get pregnant immediately after stopping a contraceptive method, some do not want to get pregnant anymore. Some may need protection from STIs and will choose condoms to be used alone or in addition to another contraceptive method. So providers can help women,men and couples based on their preference and situation and choose a method that is best for them.
Most women seeking family planning services already know the method they want so it is the duty of the family planning counsellor, to assist them with all the necessary information on the method they want. And if it is not good for their situation, let them know but allow a client make an informed voluntary choice and is not denied a method.
So let's look at W.H.O's Definition of family planning.
Family planning is defined as "the ability of individuals and couples to anticipate and attain their desired number of children and the spacing and timing of their births. it is achieved through use of contraceptive method and the treatment of involuntary infertility".
Importance /purpose of family planning
1. It prevents unwanted pregnancies among individuals or couples and also among HIV positive women.
2. It reduces maternal and child mortality.
3. Helps couples decide the number of children they want, the spacing of the children, and also make them prepare financially.
4. It reduces the spread of sexually transmitted infections(STIs and AIDS).
5. It reduces the rate of infertility.
6. Consistent Breastfeeding provides natural contraceptive as it helps women who are not aware, those who lack money to purchase a contraceptive and those whose religion is against use of contraceptive.
7. It gives individuals and couples the opportunity to choose the method they like e.g those who don't like swallowing pills could go for implant. there by making everyone a partaker.
8. Combine oral contraceptive pills (COCs) offer significant protection from cancer.
We have 2 major types of family planning, they are:
1. The Natural family planning method.
2. The Artificial family planning method.
The Natural family Planning method:
It is also called fertility awareness or the Rhythm method. This is a method of birth control that does not use any drug or devices. it relies on abstinence from sexual intercourse during the most fertile phase of a woman's menstrual cycle. It consists of the basal body temperature method, the calendar/rhythm method, standard days method, symptom thermal Method, Breastfeeding, lactation Amenorrhea method and the cervical mucus method. The Natural FP is also used by some Faiths who do not believe in artificial FP e.g. The Roman Catholic Church
. The Natural Family planning is used in two ways
To prevent pregnancy or to Target the most fertile time for getting pregnant. I will explain briefly on this method: Under the Natural family planning method are:
1. The Basal Body Temperature: This is the body's temperature at rest. A woman's resting temperature rises between 0.4°F and 0.8°F on the day of ovulation and it stays elevated until the next menstrual period. In this method the woman needs to check her temperature every morning before getting out of bed using a special (basal body) thermometer.
Note: A woman will be most fertile during the two to three days before the temperature rises.
2. The cervical Mucus Method: This method is also known as the Billings method. Right before ovulation, the mucus from the cervix changes from being cloudy and scanty to being clear and slippery. The consistency of ovulation mucus is like that of an egg white and it can be stretched between the fingers. After the ovulation the mucus tends to dry up again. So this method is checked by using (inserting) clean hands to feel the mucus everyday, then write the result on a chart. This will help the woman know when she is to ovulate.
ðŸ‘‰safe day in people with long cycle
ðŸ‘‰free to have sex
Sticky or tacky:
ðŸ‘‰ovulation is about to begin
Slippery and stretched:
Back to dry:
ðŸ‘‰free to have sex
Let's know that Natural Family Planning is not something you do periodically or in few days it's something you do everyday and over several months. In fact I call it operation survey yourself bBecause it helps you understand yourself more
if the woman has an irregular period she should not use this method of contraceptive let her choose from other methods.
3. The calendar method: This method helps you predict your fertile days by tracking the length of your cycles over several months. So how can we use this method. You must keep track of your menstrual cycle for at least 6 periods (6months) and this should be done using a calendar. How to do tracking with a calendar
-Mark the first day of each menstrual cycle for 6-12 months
-Count the total number of days between each cycle ( from first day of one period to the first day of the next period)
-You should chart at Least 6 cycles
-Find the shortest cycle in your records
-Determine the first day of your fertile period by subtracting 18 days from the shortest cycle.
-Determine the last day of your fertile period by subtracting 11days from the longest cycle.
Zino's shortest cycle is 23days and longest cycle is 31days
Shortest 23-18= 5,
Longest 31-11= 20.
So Zino's fertile period is from the 5th - 20th day of her cycle i.e. 16 days. So she has to abstain from sexual intercourse during this period every month.
Note: if the woman has an irregular period she should not use this method of contraceptive let her choose other method.
4. Standard days method:
This method can only be used by women whose menstrual cycles are 26-32 days long. If she has more than 2days longer or shorter cycle within a year, then this method would be less effective for her. Steps in this method
-Keep track of the day's of menstrual cycle then count the first day of monthly bleeding as day 1
-Avoid unprotected sex on day 8-9 cause it's considered as fertile days.
-The couple can have unprotected sex on all the other days of the cycle and from day 20 until next monthly bleeding begins.
-The couple can use memory aids e.g cycle beads to count.
5. Symptom thermal method: this is a combination of three methods listed above. They are: the calendar method, cervical mucus and the basal body temperature.
6. Breastfeeding, lactation Amenorrhea Method (LAM): In general, Breastfeeding delays the return of fertility at postpartum. However LAM is a contraceptive method based on exclusive Breastfeeding (6months).
Note: Baby sucking on the mother's nipple causes a surge in maternal prolactin which inhibit estrogen production and ovulation.
7. coitus interruptus: This is also known as the rejected sexual intercourse, withdrawal or pull-out method. In this method, the penis is withdrawn from the vagina just before ejaculation so that ejaculation takes place outside the vagina. In this way semen is prevented from entering the uterine cavity and pregnancy does not take place. It is more effective when used in combination with another method eg standard days method.
*It involves no cost
*It does not require any other device.
*With self control and discipline it can be fairly effective.
It requires a great deal of self control
*Slightest delay in withdrawal can lead to pregnancy.
*Pre- ejaculatory fluid contains enough quantity of semen that lead to pregnancy. Thus failure rate is very high.
ARTIFICIAL FAMILY PLANING
This method involves the use of chemicals or barriers in killing or preventing sperm from entering the uterus, hormones to trick the woman's body into believing fertilization shouldn't take place and surgery to prevent eggs or sperm from being released.
1. Barrier Method
2. Hormonal Method
3. Emergency Method
4. Permanent Method
This method prevents spermtozoa from entering the uterus either by chemical e.g spermicide or mechanical/physical obstruction eg condoms, cervical caps and diaphragms,
(1) Diaphragm: It's a dome shaped latex cap that is coated with spermicidal gel or cream and then placed high in the vagina before intercourse. The dome of the diaphragm covers the cervix.This prevent sperm from entering the cervix and also immobilize sperm near the cervical canal.
*Can be worn by any client without discomfort
*Protects against some STI
*Reduces risk of cervical cancer
* can be inserted up to 6 hours before before sex to avoid interruption
*Not readily available in Nigeria
*May be expensive for some client
*Causes/increases the risk of Urinary Tract Infection
*Requires Medical Examination.
Condoms are mechanical barrier devices used during sexual intercourse to reduce the probability of pregnancy or sexually transmitted disease. Types of condom: we have the
1. Male condom: which is worn over the erect penis, It could be in latex rubber condom which is more common (and modern), condoms made from natural tissues,and condoms made from synthetic materials (soft plastic).
2. Female condoms: which is a sheath of polyurethane. It's inserted into the vagina before genital contact. It has two flexible ring .a removable ring at the closed end to aid insertion and a fixed ring at the open end that sits on the vulva to hold the condom in place.
*No medical prescription required
*its cheap, Protect against some STIs
*Decreases sexual enjoyment
*It may burst or slide off a flaccid penis during withdrawal
*For the female condom application involves the woman touching her genitals.
3. Cervical cap:
This is a soft rubber cup to which spermicide is added before it is placed over the cervix. It kills sperm.
These are chemicals placed in the vagina to immobilize or destroy sperms.They are available in different forms
The active ingredient in most spermicidal is Nonoxynol-9 which also offers protection against STD
*No prescription is required
*It has no effect on breast milk
*It is reasonably cheap
*May produce burning sensation
*May increase risk of HIV transmission
*Some may melt in hot weather.
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