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CHAPTER 38

FAMILY WELFARE SERVICES

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IMPACT OF EARLY FREQUENT CHILDBEARING

Early Pregnancy

Early pregnancy is when a woman under 20 years of age gets pregnant. It usually refers to teens between 15-19 years of age.

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  • Health Consequences of Early Pregnancy
  • For Mother

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COMPREHENSIVE RANGE OF FAMILY PLANNING METHODS

Family planning is defined as the ability of individuals and couples to regulate and attain the desired number of children and the controlled pregnancy timing (spacing) by using various contraceptive methods.

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Purposes of Family Planning

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Criteria for Ideal Contraception

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Family Planning Methods

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  • Temporary Methods
  • Natural Methods
  • Abstinence
  • Coitus Interruptus
  • Lactational Amenorrhea Method (LAM)

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Biological Methods

  • Calendar (rhythm) method
  • Cycle beads or Tirumala method
  • Basal body temperature method

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Mechanical Family Planning Method

  • Condoms
  • Diaphragms
  • Cervical cap
  • Intrauterine devices (IUD)
  • Sponge

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Hormonal Contraceptive Methods

  • The hormonal methods of contraception are:
  • Combined hormonal contraceptive pill (COC)
  • Combined hormone skin patch
  • Combined hormone vaginal ring
  • Progestogen-only pills
  • Combined hormone injectable (Lunelle)
  • Progestogen injections
  • Subdermal contraceptive implants
  • Intrauterine contraceptive devices

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PERMANENT METHODS OF FAMILY PLANNING

  • Female Sterilization
  • Tubectomy

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Male Sterilization

  • Vasectomy

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Incisional vasectomy

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Non-scalpel vasectomy.

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EMERGENCY CONTRACEPTIVES

It refers to a backup method for contraceptive emergencies that a woman can adopt within the first few days after unprotected intercourse or contraceptive failure to prevent an unwanted pregnancy.

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Indications

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Levonorgestrel (LNG)

POP Emergency Contraceptive Pill

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Ulipristal acetate

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Mifepristone

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Copper IUCD

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Limitations of ECP Use

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Recommendations

  • Not applicable for pregnant women.
  • Breastfeeding women can use COCs or LNG regimens for ECPs without restriction.
  • Breastfeeding women can also use UPA, but breastfeeding is not recommended for one week after taking UPA because it is excreted in breast milk.

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  • Women with a history of ectopic pregnancies can use COCs, LNG, or UPA for ECPs without restriction.
  • Women with a history of severe CV disease can generally use COCs, LNG, or UPA for ECPs.
  • Women with liver disease can also use COCs, LNG, or UPA for ECPs.
  • There are no restrictions for using COCs, LNG, or UPA for ECPs in cases of rape.

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PEARL INDEX (PI)

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Disadvantages for PI

  • PI assumes a constant failure rate over time.
  • PI also provides no information on factors other than accidental pregnancy, which may influence effectiveness, calculations like dissatisfaction with the method, trying to achieve pregnancy, medical side effects, loss of follow-up.

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