Family planning (FP) means that “everyone should plan their family so that all children are born when wanted, expected, and welcome”. The health benefits of family play a major role in protecting the lives of the infants, children, women, and the family as a whole.
Family Planning Methods
There were many available types of family planning methods, and many categories of people can be involved in the provision of FP advise, information, and services, as long as they have received necessary training and instruction.Similarly, FP can be provided in varied settings (from levels 1-6) and within facilities operated by various providers(publ;ic, mission, private), provided they conform to the basic requirement for the provision of a particular FP method.
Hormonal Contraceptives
Methods in this work by affecting the body’s hormonal system in various ways. They are contraceptives only, and do not provide protections against STIs and HIV.
COMBINED ORAL ORAL CONTRACEPTIVE PILL
This pill contains a combination of progesterone and oestrogen in proportion and quantity that vary across the various preparations. The pill act by inhibiting ovulation and thickening cervical mucus, thus providing a physical barrier to spermatozoa and making the endometrium too thin for implantation.
Client Education
This should contain the following information with regard to the pill:
It is highly protective against pregnancy.
Pregnancy rate increases if the pill is not taken regularly.
It may be associated with minor complaints, such as nausea, headache, weight gain ,and gastrointestinal upsets.
It is unsuitable for breastfeeding mothers because of its suppressive effect on the production of milk output.
If you forget to take a pill, take it as soon as you remember. Take the next pill at the regular time even if it means taking 2 pills on the same day.
Return to the clinic incase of the following:
Suspected pregnancy
Swelling or pain in legs
Yellowing of skin or eyes
Pain in abdomen, chest, arms or shortness of breath.
Severe headache, depression, or vision difficulties.
Side effects: Although many side effects of oral contraceptives use have been eliminated with low dose pills, some women still experience irregular menstrual bleeding, nausea, weight gain, headaches, skin color changes, and other side effects. These may go away after several months or continue as long as the oral contraceptive is taken.
Complications:
There is increased risk of cardiovascular disease in women over 35 years of age who smoke.
There is increased risk of hypertension.
Users exposed to STIs may be at risk of serious disease, including PID and possible cervical cancer.
Non-contraceptive benefits:
Reduces menstrual flow(lighter, shorter periods).
Decreases dysmenorrhoea.
Protects against ovarian and endometrial cancer.
Decreases against benign breast disease.
Give some protection against ectopic pregnancy.
PROGESTERONE-ONLY PILL
This is a pill that is taken daily and contains only progesterone. It acts by altering cervical mucus, making it thicker/denser, thus preventing sperm transport. It also suppresses ovulation and inhibits fertilization of fertilized ovum.
Client Education
This should include the following:
Used in breastfeeding mothers since it does not interfere with lactation.
Has a high level of pregnancy protection.
There is a need for compliance on a daily regime.
Unrelated to sexual intercourse.
May cause menstrual irregularities.
If client forgets to take 1 pill, take it as soon as they remember
Clients should return to the clinic immediately for a pregnancy check in 45 days have passed since the last menstrual period.
Side effects Users may experience irregular bleeding patterns.
Complications: Studies to date have shown no long-term complications.
Non-contraceptive benefits:
Does not affect lactation.
Lighter shorter periods.
Decreased breast tenderness.
Does not increase blood clotting.
Decreases dysmenorrhoea.
Protects against endometrial cancer.
EMERGENCY CONTRACEPTIVES
Emergency contraceptives reduce the occurrence of pregnancy in unprotected intercourse from 8% to 2% (75% protection). Indications are the following:
Unprotected intercourse
Rape
Condom leakage
Condom breakage/slippage.
COMBINED ORAL EMERGENCY CONTRACEPTIVES
Ethynyl oestradiol 50 mcg + levonorgestrel 150 ug 2 tabs orally STAT and 2 tab 12 hourly later.
Ethynyl oestradiol 30 mcg + levonorgestrel 150 ug 4 tablets STAT followed by 4 tabs after 12 hours.
PROGESTERONE ONLY EMERGENCY CONTRACEPTIVE
Levonorgestrel 750 ug 1 tab STAT and 1 tab after 12 hours.
INJECTABLE CONTRACEPTIVES
These are either progesterone only or combined progesterone plus oestrogen.
They comprise long-acting progesterone usually administered as deep intramuscular injections. They act by suppressing ovulation, inducing a thin atrophic endometrium, and producing a thick cervical mucus that is difficult for sperm to penetrate. They are available in these forms:
Depo Medroxyprogesterone Acetate (Dmpa): 150 mg per vial and is given as deep(depot)intramuscular injection every 3 months.
Norethisterone Enanthate (Net En): 200mg vials given at 2 months intervals
Client Education
They may be associated with heavy menses, amenorrhoea, or spotting.
Regular administration is required.
It is necessary to return to the clinic as scheduled to continue using the method.
Return to the clinic if one suspects pregnancy, or experience dizziness or heavy bleeding.
Side effects: Users may experience menstrual irregularity (amenorrhoea, spotting, and rarely heavy bleeding.
Complications: Studies today have shown no long-term complications.
Advantages: They contain natural oestrogen and hence have a protective effect on CVS and CNS and give better cycle control.
SUB-DERMAL IMPLANTS
Implants consist of 2 rods of levonogestrel 75 mg that are inserted under the skin of the arm, and slowly releases progesterone for up to 5 years. They act by thickening cervical mucus, suppressing ovulation, and causing atrophic changes in the endometrium that makes it unsuitable for zygote implantation. Etonogetrel 68 mg is a single rod of progesterone-only contraceptive implant that gives protection for years.
Client Education
The following is important:
May be associated with prolonged menses, spotting, or amenorrhoea.
Requires a minor surgical procedure for insertion and removal.
If possible, return to the same clinic if you desire implant or removal.
Return for removal anytime you desire, but it can be kept in place for 5 years.
Return to the clinic if you:
Suspect pregnancy
Experience pain, swelling or pus at the implant site
Experience dizziness or headache.
Experience heavy bleeding
Benefits include the following:
Highly effective
Immediate return to fertility
Continuous, long-term protection
Reduced menstrual flow
Protection against endometrial cancer and ectopic pregnancy
Does not affect lactation
Side effects: Users may experience infection at the insertion site, irregular menstrual bleeding (longer bleeding episodes, amenorrhea, or spotting).
Complications: Studies to date have shown no serious long-term complications
Intrauterine Contraceptive Device (IUCD)
This forms a highly protective, long-term family planning method that is in widespread use around the world. The modern IUCD is a plastic device usually bound with copper wire that is placed in the uterus through the cervix. Lippes loop has no copper. The IUCDs act by preventing implantation of fertilized ovum, inhibiting sperm mobility, and inhibiting fertilization. Copper T 380A is effective for 12 years.
Client Education
The following is important:
It is important to check regularly to ensure IUCD is in place
May cause dysmenorrhoea and menorrhagia.
Return to the clinic if you have:
Signs of pregnancy, heavy bleeding, or spotting.
Abnormal sexual pain or vaginal discharge.
Chills or fever
Dysmenorrhoea and menorrhagia
Desire for removal.
Benefits include the following:
Highly and immediately effective.
Long-term protection with immediate return to fertility upon removal.
Does not interfere with intercourse.
Can be used by women who are breastfeeding.
Side effects: Users may experience pain on insertion and increased menstrual bleeding and abdominal cramps for the first 1-2 periods.
Complications: Increased risk of anaemia if heavy bleeding occurs, perforation (rare) and increased risk of PID and associated infertility, especially within 4 months of insertion and in women at risk of STIs.
Displaced IUCDs: When threads are not visible at cervix and pregnancy is ruled out, then
Attempt removal with an alligator or simple artery forceps.
If this fails, then localization by ul;trasound, plain x-ray with tracer IUCD and removal.
If one conceives with an IUCD remove it if possible; otherwise leave alone until delivery (ultrasound if possible) and counsel client accordingly.
Barrier Methods
THE MALE CONDOM
Condoms present a physical barrier to sperm deposition into the vagina.Condoms also offer some protection against STIs, including HIV/AIDS, HBV and carcinoma of the cervix.
Client Education
The following is important:
Before every intercourse, place the condom on the erect penis, leaving the tip empty to collect semen.
Withdraw the penis from the vagina after each ejaculation while the penis is still erect.
Remove the condom after use.
Do not reuse condoms.
Discard used condoms immediately in the toilet or pit latrine.
Using spermicide with condoms increases the effectiveness.
Complications may include local irritation if allergic to latex/lubricants.
May interfere with sexual pleasure for some people.
Benefits:
Fairly effective if used properly.
Immediately effective.
Highly effective protection against STIs and HIV.
May prevent premature ejaculation
Side effects: Some users experience sensitivity to rubber or lubricants.
THE FEMALE CONDOM
The female condom is a thin (0.05mm) polyurethane sheath, 7.8cm in diameter and 17 cm long. It is soft, loose fitting, and has 2 flexible rings. One ring is inserted into the vagina and acts as an internal anchor. The other ring forms the open edge of the device and remains outside the vagina after insertion.
The female condom provides protection for one act of sexual intercourse. It can be inserted (up to 8 hours) before intercourse but must be removed immediately after. There are no complications associated with it. Unlike the male condom, it can be washed and reused.
Surgical Contraception
Many factors have contributed to improved safety of voluntary surgical contraceptives in the last 30 years. These include improved anaesthetic methods, better surgical techniques, asepsis, improved training of personnel, and better selection and monitoring of clients.
TUBAL LIGATION
This is a voluntary irreversible procedure for fallopian tubal occlusion that can be done under general or local anesthesia by mini laparotomy or laparoscopy.
Client Education
The procedure is more or less irreversible (permanent).
Failure is very rare when done by a trained professional.
Counseling is absolutely necessary.
There is no loss of libido or vigour or health.
It is necessary to return to the clinic if the client experiences:
Postoperative fever, pus or pain at the surgical site.
Weakness or rapid pulse.
Vomiting or persistent abdominal pain.
Benefits:
Permanent: highly and immediately effective.
No change in sexual function.
Good for clients if pregnancy would be a serious health risk.
Does not affect lactation.
Side effects: Some users experience minor pain, bleeding, and wound infection following the procedure.
Complications: Injury to other organs (e.g., gut, bladder) and -rarely-death. Risk of complications is increased if general anaesthesia is used.
VASECTOMY
This is a voluntary surgical procedure done under local anesthesia, to cut and ligate the vas deferens so that spermatozoa cannot be ejaculated. It is gradually becoming accepted in kenya.
Client Education
Counseling is necessary, as this procedure is permanent and irreversible.
It is necessary to use condoms for at least 15 ejaculations or 3 months to ensure azoospermia.
Return to the clinic in case of:
Postoperative fever.
Excessive swelling, pus, or pain at the surgical site.
Side effects: Some users experience minor swelling,pain , infection, and bruising following the procedure. For pain give ibuprofen 400mg TDS for 5 days and for infection flucloxacillin 500mg QDS for 7 days.
Complications: Risk of serious complications or death is extremely low.
Periodic Abstinence (Natural Family Planning)
In this method, the couple avoid sexual intercourse during ovulation and for a safety magin before and after ovulation. Various techniques may be used to determine the fertile period: cervical mucus, basal body temperature, rhythm.
The benefits include:
No physical side effects and it is cheap.
No need for prescription by medical personnel.
Improved knowledge of the reproductive system and possible closer relationship between couples.
Client Education
Requires high motivation.
Has a high failure rate.
Assumes a regular, perfect menstrual cycle
Requires proper record keeping.
Has no health risks, except for pregnancy.
Side effects: None.
Complications: None