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Arewa Nurses Forum Presentation: Family Planning
Date Posted: 30/Jun/2020
Our top Nursing leaders, our lecturers, comrades, senior colleagues, my colleagues, good evening. My name is Nurse Abubakar Koya, from Kano but working with FMC Birnin Kudu, Jigawa State. It gladdens my heart always to see that I share the little I know to my professional colleagues.
 
The the topic of the discussion is *family planning*.
 
I hope the presentation would be beneficial to us.. Questions, comments, and criticism would be entertained at the end of the presentation.
 
SYNOPSIS
Introduction
Definition
Contraception method
Traditional method
Conclusion
Reference
Inn Sha Allahu.
 
INTRODUCTION
Family planning is one of the 10 great public health achievements of the 20th century.1 The availability of family planning services allows individuals to achieve desired birth spacing and family size, and contributes to improved health outcomes for infants, children, women, and families.
 
Family planning services include:
✓Contraceptive services
✓Pregnancy testing and counseling
✓Pregnancy–achieving services including ✓preconception health services
✓Basic infertility services
✓Sexually transmitted disease services
✓Broader reproductive health services, including patient education and counseling
✓Breast and pelvic examinations
✓Breast and cervical cancer screening
✓Sexually transmitted infection (STI) and human immunodeficiency virus (HIV) prevention education, counseling, testing, and referral.
 
DEFINITION
Family planning services are defined as "educational, comprehensive medical or social activities which enable individuals, including minors, to determine freely the number and spacing of their children and to select the means by which this may be achieved".
 
METHODS OF CONTRACEPTION:
There are different methods of contraception, including:
✓long-acting reversible contraception, such as the implant or intra uterine device (IUD)
✓hormonal contraception, such the pill or the Depo Provera injection
✓barrier methods, such as condoms
✓emergency contraception
✓fertility awareness
✓permanent contraception, such as vasectomy and tubal ligation
 
WHAT IS LONG-ACTING REVERSIBLE CONTRACEPTION?
Long-acting reversible contraception (LARC) is a contraceptive that lasts for a long time.
 
There are two types of LARC:
the intra uterine device (IUD) that lasts for three, five or ten years
the implant that lasts for five years.
They are sometimes called *“fit and forget”* contraception because once it is put in, you don’t need to remember it every day or every month.
 
LARCs are the most effective types of contraception. They are more than 99% effective at preventing pregnancy.
 
WHAT IS EMERGENCY CONTRACEPTION?
There are two options for emergency contraception: the emergency contraceptive pill (ECP) or a copper IUD.
 
The ECP is approved to be taken up to three days after unprotected sex. If you are an average weight, the ECP is 98% effective. If you weigh more than 70kg, the ECP is less effective and a copper IUD is recommended. If you weigh more than 70kg and you choose to take ECP, you should ask if taking a double dose is the right option for you. The copper IUD can be inserted up to five days after unprotected sex, and is more than 99% effective at preventing pregnancy.
 
Emergency contraception can be used to prevent pregnancy if:
 
✓you haven't used protection
✓your normal contraception fails e.g. condom splits
✓you have missed more than one contraceptive pill
✓you have been vomiting or had diarrhoea while on the pill
✓you have missed your injection
✓you have been forced to have sex without contraception.
 
The ECP as your regular method of contraception is less effective than if you were using a LARC or hormonal method.
 
WHAT IS PERMANENT CONTRACEPTION?
Permanent contraception, sometimes called sterilisation, prevents all future pregnancies. It is very difficult or impossible to reverse. Permanent contraception is either a vasectomy or a tubal ligation.
 
KEY FACTS OF CONTRACEPTION
Among the 1.9 billion Women of Reproductive Age group (15-49 years) worldwide in 2019, 1.1 billion have a need for family planning; of these, 842 million are using contraceptive methods, and 270 million have an unmet need for contraception
✓The proportion of the need for family planning satisfied by modern methods, Sustainable Development Goals (SDG) indicator 3.7.1, was 75.7% globally in 2019, yet less than half of the need for family planning was met in Middle and Western Africa
✓Only one contraceptive method, condoms, can prevent both a pregnancy and the transmission of sexually transmitted infections, including HIV.
✓Use of contraception advances the human right of people to determine the number and spacing of their children.
 
NATURAL FAMILY PLANNING METHOD
Natural family planning is a form of birth control that doesn't involve pills or devices. As a result, you don't have side effects. With these methods, you track your fertility, which is when you are most likely to get pregnant.
 
HOW IT WORKS
Usually, a woman releases an egg from her ovaries at about the same time each month. That’s called ovulation. The egg moves through the fallopian tubes toward the uterus. An unfertilized egg can live up to 24 hours. Most women are fertile for about 6 days each month -- 5 before ovulation and the day of ovulation. Natural family planning uses different methods to pinpoint those fertility days.
 
TYPES
You can use natural family planning to control pregnancy in several ways:
 
RHYTHM METHOD.
One of the oldest ways of natural family planning, this is based simply on the calendar. A woman's normal menstrual cycle lasts between 28 and 32 days. Ovulation usually happens around day 14. So you would avoid unprotected sex on days 8 through 19, since that’s when you’re most fertile.
 
CERVICAL MUCUS OR OVULATION METHOD.
Here, you track the mucus your cervix makes. When you're ovulating, your mucus is clear, stretchy, and wet, like raw egg whites. You write down what your mucus is like each day so you know when you're ovulating.
 
BASAL BODY TEMPERATURE (BBT) METHOD.
Your temperature can rise between 0.5 and 1 degree when you ovulate and stay there until your next period. With this method, you take your temperature before you get out of bed each morning, before you have anything to eat or drink. BBT by itself isn't a good way to prevent pregnancy because charting your temperature tells you when ovulation has already happened.
 
SYMPTOTHERMAL METHOD. 
With this, you combine several methods, usually BBT and cervical mucus. Using more than one method can give you a better idea what's going on in your body
 
HOW EFFECTIVE IS IT?
Natural family planning isn't as effective as other methods of birth control. According to the CDC, the failure rate is 24%. That means about 1 in 4 women who use natural family planning will get pregnant.
 
You need to be careful, diligent, and have plenty of self-control to practice natural family planning. You have to follow instructions completely to be successful.
 
AT A GLANCE: FACTS ABOUT NATURAL FAMILY PLANNING
If natural family planning is followed correctly, it can be up to 99% effective. This means that 1 woman in 100 who use natural family planning will get pregnant in 1 year.
✓It is less effective if the instructions aren't carefully followed.
✓There are no physical side effects, and you can use it to plan when you get pregnant.
✓You have to keep a daily record of your fertility signals, such as your temperature and the fluids coming from your cervix – it takes 3 to 6 menstrual (monthly) cycles to learn the method.
✓Your fertility signals can be affected by illness, stress and travel.
✓If you want to have sex during the time when you might get pregnant, you'll need to use contraception, such as a condom, diaphragm or cap.
✓By using condoms as well as natural family planning, you'll help to protect yourself against sexually transmitted infections (STIs).
 
ADVANTAGES
✓It doesn't cause any side effects.
✓Natural family planning is acceptable to all faiths and cultures.
✓Most women can use natural family planning, as long as they're properly trained by a fertility awareness teacher.
✓Once you've learned the techniques, there should be no further need for input from health professionals.
✓Natural family planning can be used either to avoid pregnancy or to become pregnant.
✓It doesn't involve chemicals or physical products.
✓It can help you recognise normal and abnormal vaginal secretions, so you can be aware of possible infection.
✓It involves your partner in the process, which can help increase feelings of closeness and trust.
 
 DISADVANTAGES
✓Natural family planning does not protect against STIs such as chlamydia or HIV.
✓You'll need to avoid sex, or use contraception such as condoms, during the time you might get pregnant, which some couples can find difficult.
✓If you decide to abstain, there can sometimes be up to 16 days during which you cannot have sex, depending on your cycle.
✓It can be much less effective than other methods of contraception if the methods aren't followed accurately.
✓It won't work without continued commitment and practice.
✓It can take several menstrual cycles before you become confident in identifying your fertile time. During this time, you'll have to use barrier contraception, such as condoms.
✓You'll need to keep a daily record of your fertility signs.
✓It's not suitable for every woman.
✓Stress, illness, travel, lifestyle and hormonal treatments can disrupt your fertility signs.
✓If you use the emergency contraceptive pill, you'll need to wait for 2 complete cycles before relying on natural family planning again.
 
 BREASTFEEDING
Breastfeeding is beneficial for mother and baby. It provides the baby with a complete form of nutrition and immunological defence against infectious diseases. Breastfeeding strengthens the attachment between mother and baby. *Breast feeding also acts as a natural contraceptive.*
 
LACTATIONAL AMENORRHOEA METHOD (LAM)
The hormone prolactin, which is produced towards the end of pregnancy, stimulates the the production of breast milk. It also has a suppressant effect on the ovaries blocking ovulation. Each time the baby suckles at the breast he or she stimulates the secretion of prolactin. The level falls again after 3-4 hours. Provided the baby suckles frequently the prolactin level remains high, the milk supply is maintained and ovulation is suppressed.
 
 In 1998 a group of world experts agreed the necessary criteria for breastfeeding to act as a contraceptive. They termed the method lactational amenorrhoea method (LAM) and issued a consensus statement concluding that:
 
There is only 2% risk of pregnancy when:
✓The baby is less than 6 months old
✓The mother is exclusively (or almost exclusively) breastfeeding day and night, and
✓her periods have not returned
 
If any of the these conditions change, the risk of pregnancy is increased and the woman cannot rely on breastfeeding alone.
 
 CAUTION: 
Bleeding is a warning sign of fertility, but some women will ovulate before their first period, so it is possible to go straight from one pregnancy to another without having a period.
 
FACTORS WHICH MAY INCREASE THE RISK OF PREGNANCY
Women using LAM should understand the factors which may precipitate the return of fertility thus increasing the risk of pregnancy. These include:
 
✓less frequent suckling (longer intervals between feeds, particularly at night)
✓a reduction in total suckling time over 24 hours
✓the baby sleeping through the night
✓the introduction of supplementary feeds (formula, juice and solids)
✓the use of a dummy as a comforter
✓expressing milk (separation from the baby or returning to work)
✓anxiety, stress or illness in the mother or baby
✓the age of the baby (fertility returns over time despite breastfeeding)
 
CAUTION:
Bleeding is a warning sign of fertility, but some women will ovulate before their first period, so it is possible to go straight from one pregnancy to another without having a period.
 
FACTORS WHICH MAY INCREASE THE RISK OF PREGNANCY
Women using LAM should understand the factors which may precipitate the return of fertility thus increasing the risk of pregnancy. These include:
 
✓less frequent suckling (longer intervals between feeds, particularly at night)
✓a reduction in total suckling time over 24 hours
✓the baby sleeping through the night
✓the introduction of supplementary feeds (formula, juice and solids)
✓the use of a dummy as a comforter
✓expressing milk (separation from the baby or returning to work)
✓anxiety, stress or illness in the mother or baby
✓the age of the baby (fertility returns over time despite breastfeeding)
 
When the LAM criteria no longer apply, the mother should continue to breastfeed her baby but must switch to another family planning method.
 
Conclusion, it's clearly shown the effectiveness and the difference between contraception methods and natural method. It is left for us to compare and select the one we're going to apply. Nowadays, family planning is the only solution to many problems affecting our societies.
 
REFERENCE
[1] Kantorová V, Wheldon MC, Ueffing P, Dasgupta ANZ (2020) Estimating progress towards meeting women’s contraceptive needs in 185 countries: A Bayesian hierarchical modelling study. PLoS Med 17(2):e1003026. https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1003026
 
[2] United Nations, Department of Economic and Social Affairs, Population Division. Family Planning and the 2030 Agenda for Sustainable Development. New York: United Nations. https://www.un.org/en/development/desa/population/publications/pdf/family/familyPlanning_DataBooklet_2019.pdf
 
[3] Family Planning Can Reduce High Infant Mortality Levels. Guttmacher Institute. https://www.guttmacher.org/sites/default/files/report_pdf/ib_2-02.pdf
 
 
PRESENTED BY:
Nr. Abubakar Mustapha Koya
Kano state
 
MODERATED BY: 
Nr. Aminu Kabir Kurfi
Katsina state
 
And dedicated to our couple:
Nr. Abubakar Ishaq Kinbokun
Nr. Zainab M. Kabir
All of Niger state.

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