Family Planning

Family Planning

Lectures in Community Medicine

Dr.Sijal Fadhil Farhood AL-JOBORAE
FICMS (Baghdad)
MSc Community (Nahrain)
MBChB (Babylon University)

Motto of family planning

Having children by choice not by chance

Facts

-The perfect method does not exist
Abstinence-practiced perfectly
Contraceptives methods change based on the clients circumstances
-30% of married and 61 % of unmarried females(in the west) change methods within 2years
-Careful consideration of all factors can help a woman choose the best method

Introduction:

Waiting until the mother is at least 18 years old before trying to have children improves maternal and child health.
If additional children are desired after a child is born, it is healthier for the mother to wait at least 2 years after the previous birth before attempting to conceive (but not more than 5 years).
After a miscarriage or abortion, it is healthier to wait at least 6 months.

When planning a family women who are over the age of 35 should be aware of the risks of having a child at that age.

Introduction:

Older women are at a higher risk of having a child with autism and down syndrome, the chances of having multiple births increases, which cause further late-pregnancy risks, they have an increased chance of developing gestational diabetes, the need for a Caesarian-section is greater, older women's bodies are not as well-suited for delivering a baby. The risk of prolonged labor is higher. Older mothers have a higher risk of a long labor, putting the baby in distress.

Introduction:

Family Planning

DEFINITION

W H O

A way of thinking and living that is adopted voluntarily, upon the basis of knowledge ,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 (WHO 1971)

Globally….

Family planning is among the most cost-effective of all health interventions

OBJECTIVES

To avoid unwanted births and to bring about wanted births (for the sub fertile)

OBJECTIVES

To regulate the intervals between pregnancies (spacing)

OBJECTIVES

To control the time at which births occurs in relation to the ages of the parents (timing)


OBJECTIVES
To determine the number of children in the family (family size)

SCOPE OF FAMILY PLANNING SERVICES

1-
The proper spacing and limitation of births

SCOPE OF FAMILY PLANNING SERVICES

2-
Advice on sterility

SCOPE OF FAMILY PLANNING SERVICES

3-
Education for parenthood




SCOPE OF FAMILY PLANNING SERVICES
4-
Sex education

SCOPE OF FAMILY PLANNING SERVICES

5-
Screening for pathological conditions related to the reproductive system (e.g. cervical cancer)

SCOPE OF FAMILY PLANNING SERVICES

6-
Genetic counselling

SCOPE OF FAMILY PLANNING SERVICES

7-
Premarital consultation and examination

SCOPE OF FAMILY PLANNING SERVICES

8-
Carrying out pregnancy tests

SCOPE OF FAMILY PLANNING SERVICES

9-
Marriage counselling

SCOPE OF FAMILY PLANNING SERVICES

10-
The preparation of couples for the arrival of their first child

SCOPE OF FAMILY PLANNING SERVICES

11-
Providing services for unmarried mothers

SCOPE OF FAMILY PLANNING SERVICES

12-
Teaching home economics and nutrition

SCOPE OF FAMILY PLANNING SERVICES

13-
Providing adoption services



F
Family Planning Services..
Definition

Family planning services are defined as "educational, comprehensive medical or social activities which enable individuals, including minors, to determine freely the number and spacing of their children and to select the means by which this may be achieved."




IMPACT OF FAMILY PLANNING

WOMEN’S HEALTH

i-Avoidance of Unwanted Pregnancies



An unwanted pregnancy may lead to an induced abortion. Abortion outside the medical setting (criminal abortion) is one of the most dangerous consequences. There is also evidence of higher incidence of mental disturbances among mothers who have had unwanted pregnancies

WOMEN’S HEALTH

ii- Limiting the number of births and proper spacing



Repeated pregnancies increases the risk of maternal mortality and morbidity. These risks rise with each pregnancy beyond the third and increase significantly beyond the fifth.

With increased parity the following increase:

1- Rupture of the uterus
2- Uterine atony
3- Toxaemia
4- Eclampsia
5- Placenta previa
6- Nutritional anaemia
7- Stillbirths
8- Cancer of the cervix.. family planning is the only way to limit the size and control the interval between births

WOMEN’S HEALTH

iii-Timing of births

Generally mothers face greater risk of death below 20 and above 30-35.

IMPACT OF FAMILY PLANNING ON…….

FOETAL HEALTH

A number of congenital anamolies are associated with advanced maternal age which can be avoided by timing pregnancy in relation to maternal age.

CHILD HEALTH

A- Child mortality: It is well known that this increases if pregnancies occur in rapid succession. A birth interval of 2-3 years is considered desirable to reduce child mortality.



B- Child growth, development and nutrition: The child is not likely to receive his full share of love and care, including nutrtional needs

CHILD HEALTH

C- Infectious diseases: Children living in large sized families have an increased risk of infection especially gastroenteritis respiratory and skin infections.

Natural Family Planning

2-3 percent of the world’s reproductive age population depends on NFP which limits sexual intercourse to naturally infertile periods.

BIRTH CONTROL - CONTRACEPTION

Refers to methods or devices used to prevent pregnancy. Planning and provision of birth control is the essence of family planning.

BENEFITS OF CONTRACEPTION

Contraception in developing countries has cut maternal deaths by 44% (270,000 deaths averted in 2008). Teenage pregnancies are at greatest risk of adverse outcomes e.g. preterm birth, LBW & infant mortality, thus adolescents need comprehensive sex education and access to reproductive health services, including contraception.


Birth control increases economic growth because of fewer dependent children, more women participating in the workforce, and less consumption of scare resources. their children's schooling and body mass index all substantially improve with greater access to contraception.

Birth Control Methods:

A- Barriers: such as condoms, diaphragms, and the contraceptive sponge;

B- Hormonal contraception :includes oral pills, patches, vaginal rings, and injectable contraceptives;

C- Intrauterine devices (IUDs).

e.g. transdermal patch

Emergency contraception can prevent pregnancy after unprotected sex.

Long-acting reversible contraception such as implants, IUDs, or vaginal rings are recommended to reduce teenage pregnancy.

eg. Split dose emergency contrceptive pills

Chance of pregnancy during first year of use:

Method
Typical use
Perfect use
No birth control
85%
85%
Combination pill
8%
0.3%
Progestin-only pill
13%
1.1%
Sterilization (female)
0.5%
0.5%
Sterilization (male)
0.15%
0.10%
Condom (female)
21%
5%
Condom (male)
15%
2%
Copper IUD
0.8%
0.6%
Hormone IUD
0.2%
0.2%
Patch
8%
0.3%
Vaginal ring
8%
0.3%
Depo Provera
3%
0.3%
Implant
0.05%
0.05%
Diaphragm and spermicide
16%
6%
Withdrawal
27%
4%
Standard Days Method
~12-25%
~1-9%


STERILIZATION
Sterilization by means such as vasectomy and tubal ligation is permanent contraception

Percentage of women using modern contraception:

Blue to pink :60-90%
Dark brown to black:6-18%

•

FAMILY PLANNING IN IRAQ

Barriers to birth spacing:
1-The influence of persons in the. community(traditional ,religious).
2-Availability of variety of methods.
3-Accessibility of FP services.
Cost.


Grounds on which abortion is permitted:

To save the life of the woman Yes

To preserve physical health No
To preserve mental health No
Rape or incest No
Foetal impairment Yes
Economic or social reasons No
Available on request No

Additional requirements:

Approval from THREE physicians is needed in order to obtain a legal abortion AND THIS SHOULD BE DONE IN A STATE HOSPITAL.

The written consent of the pregnant woman’s husband is also necessary.

The United Nations’ Children Fund (2010) states that through 2005 and 2009, contraceptive use in Iraq was at 50%. This is because a majority of Iraqi women are unaware of Iraq’s national policy and how to access health facilities and obtain contraceptives.