Demography4 & Family Planning

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Hormonal Contraceptives:

Hormonal Contraceptives Combined Pill- Contains synthetic oestrogen and progestogen Given for 21 consecutive days beginning on 5 th day of menstrual cycle. Followed by a break of 7 days, when bleeding occurs. This is considered first day of the next cycle Pill should be taken every day at a fexed time, preferably before going to bed at night. If the user forgets to take a pill, she should take one as soon as she remembers and take the next days pill at the usual time.

PowerPoint Presentation:

Mala D and Mala N- levonorgestrel 0.15 mg, and ethinyl oestradiol 0.03 mg. Package of 28 pills, 21 contraceptive pills and 7 brown film coated 60mg ferrous fumarate tablets. Others include- Femilon EE 0.02 mg, desogestrel 0.15 mg Choice EE 0.03 mg, Norgestrel 0.30 mg Ovral G EE 0.05 mg, Norgestrel 0.50 mg Gynovlar 21 EE 0.05, Norethisterone Acetate 3.00 mg

Progestogen only Pill:

Progestogen only Pill Also known as Mini Pill Never gained widespread use due to poor cycle control and increased pregnancy rate. May be used in older women for whom the combined pill is contraindicated due to cardiovascular risks.

Post coital contraception:

Post coital contraception Morning After Pill – used within 72 hours of an unprotected intercourse or rape. IUD inserted if acceptable Levonorgestrel 0.75 mg followed by another tablet after 12 hours Two oral pills with 50 mcg of Ethinyl estradiol and 2 after 12 hours Four oral pills with 30 or 35 mcg of Ethinyl estradiol and 4 after 12 hours. Mifepristone 10 mg once within 72 hours.

Mode of Action:

Mode of Action Prevent the release of ovum from the ovary by blocking the pituitary secretion of gonadotropin. Progestogen only preparations render the cervical mucus thick and thereby inhibit sperm penetration

Adverse Effects:

Adverse Effects Cardiovascular Effects- Women who had used the pill had 40% higher death rate than women who had never taken the pill. Myocardial infarction, cerebral thrombosis, venous thrombosis with or without pulmonary embolus. Risk increased substantially with age and smoking. Cardiovascular complication associated with oestrogen content of the pill.

PowerPoint Presentation:

Carcinogenesis- trend towards increased risk of cervical cancer with increased duration of use of oral contraceptives. Metabolic effects- elevation of blood pressure, alteration of serum lipids with decreased high density lipoproteins. Related to high dose of progestogens. Liver disorders- hepatocellular adenoma, gall bladder disease and cholestatic jaundice can occur. Lactation- preperations with high amount of oestrogen may effect the quantity and constituent of breast milk, may also cause premature cessation of lactation. Ectopic pregnancy- more likely to occur those taking progestogen only pills Breast tenderness and fullness Weight gain Headache and migraine may be aggravated or triggered by the pill

Beneficial Effect:

Beneficial Effect Using the pill may give protection against 6 diseases – benign breast disorders including fibrocystic disease and fibroadenoma, ovarian cysts, iron deficiency anaemia, pelvic inflammatory disease, ectopic pregnancy and ovarian cancer.

contraindications:

contraindications Absolute- Cancer of the breast and genitals Liver disease History of thromboembolism Cardiac abnormalities Congenital hyperlipidaemia Undiagnosed uterine bleeding Special problems requiring surveillance- Age over 40 or smoking and age over 35 Mild hypertension Chronic renal disease Epilepsy Migraine Nursing mothers in the first 6 months Diabetes mellitus Gall bladder disease History of infrequent bleeding or amenorrhoea.

Medical supervision:

Medical supervision An examination before prescribing oral pills is required. Women taking oral contraceptives should be advised annual medical examinations.

Depot Formulations:

Depot Formulations Progestogen only injectables DMPA- Depot medroxyprogesterone acetate, i.m. injection of 150 mg given every 3 months Does not affect lactation, but causes weight gain, irregular menstrual bleeding and prolonged infertility after its use. Good use among multiparae of age over 35 who have completed their family. Acts primarily by suppression of ovulation, but also by effect on the endometrium, fallopian tube and on production of cervical mucus. NET EN – Norethisterone Enantate Intramuscular 200 mg every 60 days Deep intramuscular gluteus injection with a thick needle

Postconceptional methods:

Postconceptional methods Menstrual Regulation- Aspiration of uterine content 6-14 days of a missed period, before most pregnancy tests become positive. Cervical dilatation is indicated only in nullipara or apprehensive subjects. No aftercare is necessary. Differs from abortion as – Lack of certainty that pregnancy is being terminated Lack of legal restrictions and Increased safety of the early procedure.

Menstrual induction:

Menstrual induction Based on disturbing the normal progesterone-prostaglandin balance by intrauterine application of 1-5 mg solution or 2.5-5 mg pellet of prostaglandin F2, performed under sedation. Within a few minutes the uterus responds with a sustained contraction lasting about 7 minutes, followed by cyclic contraction continuing for 3-4 hours. Bleeding starts and continues for 7 days.

Abortion:

Abortion Termination of pregnancy before the foetus becomes viable. 28 weeks or 1000 gms. Condition under which pregnancy may be terminated under Medical Termination of Pregnancy Act of 1971 Medical –danger to mother’s life Eugenic- substantial risk of child being born with physical or mental handicap Humanitarian- pregnancy due to rape Socio-economic- social or economic environment that could lead to injury to mother’s health Failure of contraceptive device. From 12-20 weeks opinion of two practitioners is required to terminate the pregnancy.

Safe period or rhythm method:

Safe period or rhythm method Calendar method Avoid intercourse from 8 th to 22 nd day of menstrual cycle

Terminal methods:

Terminal methods Female sterilization – tubectomy Male sterilization – vasectomy Advantages- One time method, does not require sustained motivation Most effective protection against pregnancy Most cost effective- Each procedure averts 1.5 to 2.5 births per woman.

Guidelines for Sterlization:

Guidelines for Sterlization Age of husband should not be less than 25 years, nor should it be over 50 years Age of the wife should not be less than 20 years or more than 45 years Motivated couple should have 2 children at the time of operation If the couple has 3 or more children, the lower limit of age of the husband or wife may be relaxed at the discretion of the operating surgeon.

Vasectomy:

Vasectomy One cm piece of Vas is removed after clamping. The ends are ligated and folded back on themselves and sutured in position so that the cut ends face away from each other. Acceptor is not immediately sterile, till 30 ejaculations.

Complications:

Complications Operative- pain, scrotal haematoma and local infection Sperm Granules- pain and swelling of approx. 7 mm. Spontaneous recanalization

Tubectomy:

Tubectomy Done as interval procedure, postpartum or at the time of abortion. Laproscopy Minilaprotomy

Evaluation of contraceptive methods:

Evaluation of contraceptive methods Pearl Index- Number of failures per hundred women years of exposure. Life Table Analysis- calculates a failure rate for each month of use.

Unmet need for family planning:

Unmet need for family planning Sexually active women who would like to prevent pregnancy, but are not using any methods of contraception. This is called Unmet need of family planning. According to NFHS-3 about 12.8% of married women in India have an Unmet Need for family planning.

Family Planning Delivery System- At Centre:

Family Planning Delivery System- At Centre Secretary of Government of India in Ministry of Health and Family Welfare is overall incharge. He is assisted by a Special Secretary and joint secretaries. Adviser (Mass Media and Communication) an officer of the rank of an Additional Secretary

At the state level:

At the state level State Family Welfare Bureau, a part of State Health and Family Welfare Directorate. At present 25 State Family Welfare Bureaus are functioning in the country.

At the District Level:

At the District Level District Family Welfare Bureau-consisting of 3 divisions Administrative Division headed by District Family Welfare Officer Mass Education and Media Division, in charge of District Mass Education and Media Officer Evaluation Division, in charge of a Statistical Officer.

At the Primary Health Centre:

At the Primary Health Centre Medical Officers are usually trained to provide MTP and sterilization Services. Program of CuT IUD insertion has been intensified.

At the village Level:

At the village Level Village Health Guides- one per 1000 population, mostly women, spreads knowledge and information to the eligible couples and provides supplies of oral pills and Nirodh. 3.23 lakh health guides are in position Trained Dais- conduct safe delivery in rural areas and act as family planning counsellors and motivators.

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