METHODS OF FAMILY PLANNING
Family Planning is classified broadly as spacing and termination method.
Methods Of Family Planning
This method of birth control prevents pregnancy without the use of chemical agents of any physical device.
Total Abstinence: This is a practice of avoiding sexual intercourse for the purpose of preventing occurrence of pregnancy.
- It cost nothing except self-discipline on the couple.
- It is very reliable if practiced strictly as the failure rate is zero.
It is difficult to practice especially by the modern couples
It is otherwise known as temporal abstinence is the only control method which is officially approved b y the Roman Catholic Church, It is a “safe period”. The method to determine the approximate time of ovulation and the fertilization period includes:
- Recording the previous menstrual cycles, (Calendar Rhythm).
- Recording the basal body temperature, (Temperature Rhythm).
- Taking note of the excessive mucoid vaginal discharge, (Mucus Rhythm).
RHYTHM OR CALENDAR METHOD
This is based on recording women’s previous menstrual cycles so as to calculate their safe period. This is done b y subtracting twenty (20) days from the shortest to get the fertile period and ten (10) days is subtracted from the longest cycle to get last day of the fertile or unsafe period. The success rate of this method ranges from 78 -88% (Hanly, 2012).
Example: Shortest cycle 25-20 = 5
Longest cycle 31-10 = 21
This requires abstinence until the third day of the rise of temperature. This is because the basal temperature of the woman is more or less constant during the first part of the menstrual cycle until the day of ovulation. If there is no cold or infection to account for this elevation the woman can consider beyond the fertile period when the elevation has persisted for three days.
CERVICAL MUCUS OR BILLING BASAL METHOD
The cervical mucus changes during the menstrual cycle as estrogen and progesterone influences the mucus-secreting glands of cervix immediately after menstruation, the cervical mucus is sticking, thick and white. As ovulation nears, the mucus becomes thin slipping and clear to aid the passage of sperm into the cervix.
The slipping mucus can be stretched 6cm or more and has the consistency of the egg white. The stretching of the mucus is called spinnbarkeit. after ovulation, the mucus again becomes thicker factors that interfere with the accuracy of cervical mucus assessment include the use of anti-histamines, vaginal infections, contraceptive foam or jellies, sexual arousal, and recent copies,(Dapares et al, 2002).
- It is not costly
- No side effect.
- Difficult to calculate the safe period
- Compulsory abstinence from sexual act during certain period
- Not applicable during lactational amenorrhea or when period is irregular
- The Higher rate of ectopic or congenital abnormality of the fetus because of the changes of the union of aging sperm and ovum.
COITUS INTERRUPTUS (WITHDRAWAL)
It is oldest and probably the most widely accepted contraceptive method used by man. It necessitates withdrawal of erect penis shortly before ejaculation. It requires sufficient self-control by the man so that withdrawal of erected penis precedes ejaculation. Effectiveness: 50% - 80%
- Requires sufficient self-control by the man
- The woman may suffer anxiety vagina-times or pelvic congestion
- Chance of pregnancy is more
- Accident chance of sperm deposition in the vagina.
- Involves no chemical
- It is simple.
BREASTFEEDING As METHODS OF FAMILY PLANNING
Prolonged and sustained breastfeeding offers a natural protection of pregnancy. This is more effective in women who are amenorrheic than those who are menstruating. The risk of pregnancy to a woman who is fully breastfeeding and amenorrheic is less than two percent in the first six (6) months.
Breastfeeding inhibits ovulation in many women as long as the infant receives at least 10 feeding in 24hours. The prolactin secreted stimulates milk production also inhibits ovulation. If the woman supplements with formula or when the infant begins taking solid, milk in taking and thus prolactin secretion, falls and ovulation is then likely, remember that ovulation precedes menstruation, pregnancy can occur before the first menstrual period after birth.
This method prevents sperm deposition in the vagina or sperm penetration through the cervical canal. The objective is achieved by mechanical devices or chemical means, which produces sperm immobilization, or by combined means (Mindeh and Exter Court, 2000).
Mechanical Barrier: Are made of polyurethane or latex polyurethane. Condoms are thinner or suitable for those who are sensitive to latex rubber. It is the most widely practiced method used b y the male.
The efficiency of a condom can be augmented b y adding a spermicidal agent during its use.
Protection against sexually transmitted infections is an additional advantage. The method is suitable for couples who have contra-indication for the use of oral contraceptive or IUCD.
Female Condoms: Is a sheath or lining fluid that fits loosely inside the vagina. It is made of a thin, transparent and flexible film with flexible rings at both ends which aids in its insertion. It is very effective, it is very advantageous to women in the sense that they can initiate its use more and it has a soft moist texture that feels more than male latex condom during coitus. It is neither tight nor constricting like the male condom and does not the dull sexual sensation like that of a male.
Condom: Are pre-lubricated with silicon and are individually packed in sealed aluminum foils sachets which make it last for a long time. They are several varieties of condom available including latex, hypoallergenic and polyurethane (Durex, Report, 2002). Effectiveness: 86% - 97%
- Relatively inexpensive.
- Easy to get and use
- Provide some protection against Sexually Transmitted Infections.
- Do not need prescription
Diaphram/Cervical Cap: This is a thin rubber dome that fits over the cervix and is used with spermicides to kill sperm that passes the mechanical barrier (Derex Report, 2002). It has a flexible rim that covers the cervix and is inserted into the vagina before intercourse. Diaphram is used in combination with a spermicidal jelly or cream. Effectiveness: 80% - 94%.
- Does not require partners involvement
- No serious side effect
- Good for person who do not have sex regularly
- Decreased risk of cervical cancer
- Not good for people who are allergic to latex
- Increase risk of developing urinary tract infection (U-T Is)
- Must be removed without 24hrs
- To remain in the vagina for at least 6 hours after intercourse.
ARTIFICIAL FAMILY PLANNING METHOD
These are non-natural methods used in preventing and spacing pregnancies and children, procedures or drugs (Akins, 2004). The effectiveness of contraception is an issue that is fast gaining importance (Obiunu, 2009). There is no single method that is hundred percent effective. It is said that ideally effective family planning method must be:
- Have no side effect
- Be cheap and accessible.
HORMONAL METHOD (ORAL PILLS)
This is one of the most effective methods of reversible fertility control that has been in use since 1960’s effectiveness 95% -99%
Mode Of Action: They act by suppressing the hypothalamic-pituitary system responsible for preventing ovulation (WHO, 2005).
It corrects menstrual irregularity, improves general health and prevents ovarian endometrial cancer.
Oestrogen and progesterone suppress follicle stimulating hormone and luteinizing hormone production thus causing the ovaries to go into resting state and ovulation will not take place.
FAILURE RATE: If the pill is taken correctly and consistently, its reliability will almost be 100% (Leifer 2003)
- Protects against pelvic inflammatory disease (PID)
- Regulates the menstrual cycle
- Reduces cramping in menstruation
- Reduces risk of endometrial cancer.
- May decrease sex drive
- Possible swing
- Rust be taken at same time each day
- Can cause hypertension
Sponge (today sponge): a soft round sponge inserted deep into the vagina to avoid pregnancy. Effectiveness 60%-90%.
- It is re-useable
- It can stay in place for 24 hours
- No prescription is required
- The sponge can dislodge during sexual intercourse.
- It cannot prevent disease
SURGICAL METHOD OF CONTRACEPTION
These methods are only used in cases where both partners agree not to have any more children or where the health of one or both of them make further pregnancies undesirable.
Two Methods Are Commonly Employed
- Female sterilization: this implies bilateral tubal ligation or salpingectomy. This can be done during the operation of caesarean section, or on the second or third post partum day if the patient had a vaginal delivery, or as an elective procedure in a non-pregnant woman. Before female sterilization is done, the husband and wife will give their informed consents because the operation is, as a rule, irreversible, (great thought must be given to the problem before the operation is performed). The consent of the husband and the wife must be obtained. It must also be remembered that every occasionally female sterilization in the form of tubal ligation alone may fail the only removal of the uterus can guarantee 100% contraception.
- The male sterilization is known as a vasectomy, in this operation the vas deferens is cut or tied to prevent Sperm from entering into the vagina.
OTHER METHOD INCLUDE
Dilatation and Curettage, first-trimester pregnancy termination can be achieved by dilation of the cervix and curettage of the uterus. It is not always easy to achieve dilatation of the cervix early in pregnancy. Cervical laceration and uterine peroration are risks which must be avoided.
Menstrual extraction or suction evacuation is to be preferred to dilatation and Curettage.
This is another form of contraceptive that is used in a form of form, suppository, tablet, jelly or cream that is applied into a vagina and is often used as a diaphragm, cervical cap or a condom. It activates the sperm this is not recommended for women for whom pregnancy would be dangerous
- It has a high failure rate
- This can cause irritation and or allergic reactions
- It does not protect against HIV/AIDs and STLs
SUBDERMAL IMPLANT IN METHODS OF FAMILY PLANNING
This method weakens the cervical mucus and stop ovulation. It consist of six capsules containing progestin that are inserted under the woman’s skin usually at the upper or lower arm
- It is highly effective
- It does not reduce breast milk production
- It prevents anemia
- It is also an alternative for women who cannot tolerate side effect
- It is easily reversible
- This requires a small incision and local anesthesia for insertion and removal.
- Is not advisable for short time contraception (one or two years).
- It does not protect against HIV/AIDS.
Depo-Provers (DMPA) and Noristerat (NET-EN) these are commonly used reversible contraceptives and is the method of choice for many women (Newton, 2003). Depo-Provers is more popularly used than NET-EN-Bott method are given by deep intramuscular injection DMPA is given on a 150mg dose at the 12-week interval through for some women the interval may be less NET-EN is used as a short-term contraceptive method e.g. alter a partner undergoes vasectomy unit the procedure is confirmed as effective.
Mode Of Action: This high dose of progestogen inhibits ovulation and it is formed to be released slowly into circulation. Effectiveness: more than 90% effective (Traser 1995), NET-EN. is slightly lower 98%-9% effective.
- It is long term method
- Reduces the risk of endometrial cancer
- It does not interfere with intercourse.
- Weight gain
- Menstrual irregularities
- Vomiting, depression, and mood swing.
Intra Uterine Contraceptive Device (IUCD)
These are plastic or metal (silver or copper) devices inserted into the uterus to prevent pregnancy. Examples of IUCDs are lipped “loop” (the coil), Copper T, Copper 250, 375, 380 and multi-load.
IUCD create an inflammatory response when inserted with the increased number of leucocytes destroying spermatozoa and ova.
Furthermore, gamete viability is impaired by alteration of uterine and tubal fluid (Darite, 2005). Copper affects endometrial enzymes, glycogen metabolism and estrogen uptake, thereby rendering the endometrium hostile to implantation. A copper IUCD can be inserted about five days following the estimated date of ovulation day 19 in a 28-day cycle (Mansour, 2006).