FAMILY PLANNING

Introduction: The world of conference of the International Womens year in 1975 also declared the night of women to decide freely and responsibly on the number and spacing of their children and to have access to the information and means to enable them to e ercise that night! Thus during the past few years" family planning has emerged from whispers in private #uarters to the focus of international concern as a basic human night and a component of family health and social welfare! Definition: There are several definitions of family planning! In e pert committee $1971% of the W&' defined family planning as ( a way of thin)ing and living that is adopted voluntarily upon the basis of )nowledge " attitudes and responsible decisions by individuals and couples in order to promote the health and welfare of the family group and thus contribute effectively to the social development of a country! *nother e pert committee defined and described family planning as follows (+amily ,lanning refers to practices that help individuals or couples to attain certain ob-ectives./ $a% To avoid unwanted births! $b% To bring about wanted births! $c% To regulate the intervals between pregnancies! $d% To control the time at which births occurs in relation to the ages of the parent and $e% To determine the number of children in the family! SCOPE OF SERVICES: W&' e pert committee $1970% has started that family planning includes./ $a% The proper spacing and limitation of births! $b% *dvice on sterility! $c% 1ducation for parenthood! $d% 2e education! $e% 2creening for pathological conditions related to the reproductive system! $f% 3enetic counseling!

$g% ,remarital consultation and counseling! $h% 4arrying out pregnancy tests! $i% 5arriage counseling! $-% The preparation of couples for the arrival of their first child! $)% ,roviding services for unmarried mothers! $l% Teaching home economics and nutrition and adoption services!

These activity varies from country to country according to national ob-ectives and policies and this is the modern concept of family planning! HEALTH ASPECTS OF FAMILY PLANNING: The principal health outcomes of family planning were listed as follows./

Womens Health Maternal mortality. Morbidity of women of child bearing age. Nutritional status Preventable complications of pregnancy and abortion.

Fetal Health Fetal mortality. Abnormal development.

Infant and Child Health Neonatal infant and pre school mortality. Health of the infant at birth. Vulnerability to

WOMEN S HEALTH ,regnancy may damage the mothers health on even endanger her life and the ris) increases as the mother grows older and after she has had 6 or 7 children! 8ut family planning helps them to control the number" interval and timing of pregnancies and birth and thereby reduces maternal morbidity and mortality rate and improves health! The health impact occurs primarily through./ $i% A!oid"nce of un#"nted $re%n"nc&'

The essential aim of family planning is to prevent the unwanted pregnancies which may lead to an induced abortion that is one of the most dangerous conse#uences and evidence of higher incidence of mental disturbances among mothers!

$ii%

Li(itin% t)e nu(*er of *irt)+ "nd $ro$er +$"cin%:'

9epeated pregnancy increases the ris) of maternal mortality and morbidity! The incidence of rupture of uterus! :terine artery" to aemia" eclampsia" placenta previa and most commonly anaemia" increases with high family! +amily planning is the only way to limit the si;e and control the interval between birth with a view to improving the health of the mother!

$iii%

Ti(in% of *irt):'

3enerally mothers face greater ris) of dying below the age of <0 and delivery show the same pattern of ris) with the highest ris) below <0 and over 65 of age! FETAL HEALTH:' * number of congenital anomalies are associated with advancing maternal age and this can be avoided by timing of births in relation to the mothers age! The #uality of population can be improved by avoiding completely unwanted birth" compulsory sterili;ation of all the adults suffering from certain diseases li)e leprosy" psychosis etc! In the present state of our )nowledge" it is very difficult to weigh the overall genetic effects of family planning! INFANT , CHILD HEALTH:' Issues relating to family planning are highly relevant to pediatrics! The family si;e and birth spacing will yield substantial child health benefits li)e/ $i% C)i-d (ort"-it& ' Increases when pregnancies occur in rapid succession! 8ut family planning insuring the survival of all children in a family! $ii% C)i-d %ro#t). de!e-o$(ent "nd nutrition :/ 4hild is li)ely to receive his full tone "care including nutrition he needs when the family si;e is small and births are properly spaced! $iii% Infectiou+ di+e"+e / children living in large si;ed families have an increase in infectious li)e gastroenteritis" respiratory and s)in infections! $iv% Inte--i%ence:/ 2tudies have shown a lower I= seen among children in larger families! THE WELFARE CONCEPT:'

The recognition of its welfare concept came only a decade and half after its inception" when it was named +amily Welfare ,rogramme! The concept of welfare is very comprehensive and is basically related to #uality of life! It aims at achieving a higher end that is to improve the #uality of life of the people! S("-- F"(i-& Nor(:' 2mall differences in the family si;e will ma)e beg differences in the birth rate! The difference of only one child per family over a decade will have a tremendous impact on the population growth! The ob-ective of the +amily Welfare ,rogramme in India is that people should adopt the (small family norm> to stabisi;e the countrys population! 2ymbolised by the inverted red triangle" the programme initially adopted the model of the 6 child family! The current emphasis is on three themes ? (2on or @aughter / two will do> (2econd child after6 years> (:niversal Immuni;ation>! *ll efforts are being made through mass communication that the concept of small family norm is accepted" adopted and norm into lifestyle of the people! E-i%i*-e Cou$-e+: In 1ligible couple refers to a currently married couple where in the wife is in the reproductive age" generally assumed to lie between the ages of 15 and 75! The (1ligible couple 9egister> is a basic document for organi;ing family planning wor)! It is regularly updated by each functionary of the family planning programme for the area falling within his -urisdiction! T"r%et Cou$-e+: In order to pin/point the couples who are a priority group within the broad definition of (eligible couples> the term (target couple> was coined! The term (target couple> was applied to couple who have had </6 living children and family planning was largely directed to such couples! Aow the definition has been enlarged to include families with one child or even newly married couple with a view of develop acceptance of the idea of family planning from the earliest possible stage! Cou$-e Protection R"te:

4ouple ,rotection 9ate $4,9% is an indication of the prevalence of contraceptive practice in the community! It is defined as the present of eligible couples effectively protected against child birth by one of the other approved methods of family planning li)e B:@" sterili;ation" condom" oral pill! etc! @emographer shows that demographic goal of A99 C 1 con be achieved only if 4,9 e ceeds D0E! Po$u-"tion Po-ic&: ,opulation policy refers to policies intended to decrease the birth rate of growth rates! 2tatement of goals" ob-ectives and targets is inherent in population policy! The policy reflects the (,olitical commitment> of the national government and the importance it attaches to the effective implementation of the +amily Welfare ,rogramme in India! CONTRACEPTIVE METHODS

METHOD 0I1! S$"cin% Met)od $1%! 8arrier 5ethod $a% ,hysical methods ? condom $dry nirodh" delu e nirodh" super delu e nirodhe% diaphragm vaginal sponge!

ADVANTAGE

DISADVANTAGE

$i% 1asily available" safe ine pensive" easy to use" no side erects! $ii% Fight compact" disposable! $iii% ,rovides $condomG protection against 2T@" &IH etc! $iv% @iaphragm has total absence of ris) and medical contra indication!

$i% 4ondom may slip off or lea) during coitus due to incorrect use! $ii% Interferes with se sensation locally! $iii% 8efore to use diaphragm needed to demonstrate the techni#ue! $iv% Haginal sponge is less effective!

$b% 4hemical method $i% There are surface active agents inhibits o ygen upta)e ? poams" creams" and )ills sperms! suppositories" soluble films!

$i% +ailure rate is high! $ii% 5ay cause mild burning or irritation! $iii% 5ust introduced correct region and repeated before each se act!

$c% 4ombined method ? both physical and chemical method! $<%! Intra uterine device./ $i% Aon/medicated I medicated! $4u/7" 4u/T<00" T4:/<<0c" Aova T etc!%

2ame as before!

2ame as before!

$i% 2implicity" inception" ta)es only few minutes! $ii% Ine pensive" highest continuation rate" free of systemic metabolic side effects! $iii% Ao need for continual motivation li)e pill!

$i% may cause bleeding" pain" pelvic infection" uterine perforation! $ii% may occur pregnancy ectopic pregnancy! $iii% 1 pulsion and mortality rate become high! $iv% 4hance of cancer and terato genesis! $i% has and adverse effect on cardio vascular system! $ii% &as increased ris) of cervical cancer and liver disorder! $iii% metabolic effect breast tenderness" weight gain" headache etc!

$6%! &ormonal method./ $a% 'ral pill" combined pill" ,'," ,4," long term pill" 5ala pill! $5ala/A" 5ala/@% etc! $b% @epot formulation in-ectible" subcutaneous implants" vaginal ring!

$i% ine pensive" easy to use and available! $ii% 100E effective in preventing pregnancy! $iii% remove an iety about the ris) of unplanned pregnancy!

METHOD $7% ,ost conceptional method ? Termination of pregnancy of abortion!

ADVANTAGE $i% 4an be spontaneous or induced! $ii% In India 7 million are induced and < million are spontaneous abortion!

DISADVANTAGE $i% 4omplications include hemorrhage" shoc)" and sepsis! $ii% :terine perforates" cervical in-ury" thrombo embolism" infertility" ectopic gestation" anesthetic I psychiatric complication!

$5% Mi+ce--"neou+: *bstinence $abstinence of se %! 4oitus interruptus $withdrawal before e-aculation%! 2afe period natural family planning method! $88T" 4ervical mucus method" sympthermic" breast feeding" birth control vaccine!

$i% 'nly sound in theory! $ii% Widely practiced method! $iii% based on observation and calendar techni#ue! $iv% natural method demands discipline and understanding se uality!

$i% ,elvic congestion vaginisms" an iety neurosis! $ii% needs high degrees of motivation!

0II1 Ter(in"Met)od $i% 5ale sterili;ation ? vasectomy! $ii% +emale sterili;ation ? Tubectomy!

$i% 2impler" faster less e pensive" no need for hospitali;ation! $ii% 2perm production" hormone output are not effected! $iii% can be performed in primary health centre level I in mass campaign!

$i% post opening complications li)e pain" haematoma" local in-ection etc! $ii% in cJo vasectomy sperm granules" spontaneous recanali;ation can cause impotence" headache fatigue! $iii% In cJo tubectomy punch of large blood vessels can occur!

N2RSES RESPONSI3ILITY:' $i% To organi;e" co/ordinate and monitor training in the community!

$ii% To upgrade the competence of +amily ,lanning" personnel and wor)er to provide technically sound" client centered" gender sensitive" +amily ,lanning I Welfare! $iii% To sensitise on family planning I population stabili;ation issues by holding orientation training programmes for the health wor)ers in the community!

$iv% To involve the community people in promotion of family planning I welfare programme!

CONCL2SION: The family planning $welfare% ,rogramme in India has come a long way and holds forth the promise that in the not very distant future" it may be accepted as a way of life by most people! *lthough birth control continues to occupy the same important position in the programme as it used to be in the earlier days the programme now aims at achieving a higher end and that is to improve" in con-unction with others development programmes" the #uality of life of the people! 3I3LIOGRAPHY

S-4 No1!

N"(e of t)e "ut)or K ,ar)

N"(e of t)e *oo5 Te tboo) of preventive and social medicine

Pu*-i+)er Edition 5Js 8anarsidas 8hanot ,ublishers

Edition 15th

P"%e No4 611/671