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Major program policies of the Philippine Family Planning Program

Family Planning

Improvement of family welfare with main focus on womens health, safe motherhood and child survival Promotion of family solidarity and responsible parenthood

Major program policies of the Philippine Family Planning Program

Freedom of choice this policy will ensure the following: 1. The right to full information 2. The right to choose 3. The right to quality care 4. The right to sustain decisions

3 major high-risk factors in pregnancy

Getting pregnant too quickly (within 15 months from last delivery): the ideal spacing between births is at least 2 years Getting pregnant before age 20 or after age 35 years: ideal age for pregnancy is 20 to 35 years Getting pregnant after the 4th baby

Methods to prevent conception

1. Behavioral methods 2. Natural family planning 3. Chemical methods 4. Local barrier methods 5. Hormonal methods 6. Surgical methods

Methods to prevent conception

1. Behavioral methods Coitus interruptus/withdrawal with a high failure rate because the preejaculate contains sperms Coitus reservatus

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Methods to prevent conception

2. Natural family planning
Principles: a. The human ovum is susceptible to fertilization only for 18 to 24 hours. b. The sperms deposited in the vagina are capable of fertilizing the ovum for no more than 72 hours. c. Present methods of determining ovulation are inexact by about 48 hours.

Natural family planning: methods

a. Calendar method
b. Basal body temperature c. Billings/cervical mucus method d. Lactational amenorrhea method e. Sympto-thermal method

Example: 32-day cycle

Calendar method: using Ogino-knaus formula

32-14 = day 18 (ovulation day)

1 2 3 4 5 6 7

Subtract 14 from the number of days of the menstrual cycle to determine day of ovulation. Abstinence starts 5 days before ovulation and lasts up to 3 days after ovulation. If the menstrual cycle is highly irregular, 18/11 may be used: Subtract 18 from the shortest cycle, ex. 2818=10. Subtract 11 from the longest cycle, ex. 3311= 22. Abstinence is practiced from days 10 to 22.

8
15 22 29

9
16 23 30

10
17 24 31

11
18 25

12
19 26

[13
20 27

14
21 ] 28

Next month
1 8 15 22] 29 2 9 16 23 30 3 10 17 24 31 4 11 18 25 5 12 19 26 6 13 20 27 7

Basal body temperature: Physiologic basis 1. Pre-ovulatory temperature is low because of high estrogen level. 2. Post-ovulatory temperature rise is due to high progesterone level.

[14
21 28

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Basal body temperature: Procedure

1. Temperature is taken at the same time with the same thermometer after at least 4-6 hours of sleep. 2. Observe for decrease in temperature by about 0.5C. this indicates that ovulation is about to occur. Abstinence must be observed from here on. 3. Temperature goes up by about 1C and temperature is sustained for at least 3 days. Observe abstinence for 3 days after temperature rise.

Billings/cervical mucus method

Physiologic basis Cervical mucus changes under the influence of estrogen. Without fertile cervical mucus, sperm transport is impeded. Fertile mucus is clear, translucent, with the consistency of raw egg white.

Billings/cervical mucus method: Phases

Wet = menses Basic infertile pattern (BIP) = dry days or days of unchanging mucus

Wet = changing mucus which later becomes slippery until the peak (white mense); days of possible fertility
Dry = infertile days; day 4 after the peak until the end of the cycle

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Lactational amenorrhea method

Sympto-thermal method

Requirements for the method to be effective a. The mother must practice full breast feeding, i.e., she feeds the baby at least 6 times during the day and at least twice at night. b. Menses have not returned. c. This is effective for only 6 months after delivery.

Combination of of basal body temperature, Billings method and awareness of signs of ovulation, such as

a. Increased nipple erectility

b. Mittelschmerz c. Increased libido

Methods to prevent conception

3. Chemical methods use of spermicides

Methods to prevent conception

4. Local barrier methods Diaphragm Cervical cap Condom

Diaphragm

A dome-shaped rubber cap inserted into the vagina and over the anterior vaginal wall and cervix before intercourse Inserted up to 2 hours before intercourse and removed 6 hours after intercourse. After-care a. Wash with warm water and mild, unperfumed soap. b. Dust it with some cornstarch. c. Store in a cool, dry place

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Cervical cap

A plastic cap that snugly fits over the cervix Its design allows menstrual flow out through the cervix and self-cleaning with cervical mucus, while preventing sperm from entering the cervix. It can be left in place in definitely.

Condom

Condom a thin, stretchable rubber sheath worn over the penis by the man during intercourse

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Methods to prevent conception

5. Hormonal methods (Anovulatory menstruation) prevent pregnancy by inhibiting the hypothalamus and anterior pituitary so that ovulation does not occur
Injectable Implant Oral

Injectable: Depo-provera (Depo-medroxyprogesterone) 3-month injectable contraceptive containing 150 mg of synthetic progestin

Implant: Norplant

6 capsules of progestin are inserted subcutaneously in the womans upper arm; contraceptive effect lasts for up to 5 years

Oral contraceptive pill (OCP)

Oral contraceptive pill (OCP)

Combination oral contraceptives contain continuous doses of estrogen and progesterone. Triphasic oral contraceptives there are 3 different combinations of estrogen and progestin taken during the menstrual cycle.

Available in 21- and 28-day regimens. 21-day regimen: begins on the 5th day of the cycle and continues for 21 days. 28-day regimen: additional 7 pills contain ferrous sulfate; the woman takes a pill every day.

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Oral contraceptive pill (OCP): instructions

a. Take the pill at the same time each day. b. If 1 pill is missed, she takes the pill as soon as she remembers it; she takes the next pill at the regularly scheduled time. c. If she misses 2 pills, she takes both as soon as she remembers. A second form of contraceptive is advised for the rest of the cycle. d. If she misses 3 pills, the remainder of the pills in the packet are discarded; another contraceptive is advised.

Oral contraceptive pill (OCP): contraindications

a. Undiagnosed vaginal bleeding b. Thromboembolic disorders c. Pregnancy d. Liver disease e. Coronary artery or cerebrovascular disease

Oral contraceptive pill (OCP): danger signs

A abdominal pain (severe) C Chest pain (severe) or shortness of breath H Headaches (severe) E Eye problems (blurred vision, loss of vision) S Severe leg pain (calf or thigh)

f. Heavy cigarette smoking

g. Breastfeeding

Minipill

Morning after pill

Progestin-only pill Ovulation may occur; alters cervical mucus; disturbs endometrial development prevents implantation Less side-effects

Taken after unprotected intercourse at midcycle Contains estrogen only

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Methods to prevent conception

6. Surgical methods Vasectomy

Vasectomy

Bilateral tubal ligation

A minor surgery where a 1 cm incision is made on the scrotal sacs and the vas deferens is tied and cut; sperm counts are done after

Bilateral tubal ligation: mini-laparotomy

Bilateral tubal ligation: laparoscopy

A 3 cm abdominal incision is made through which the tubes are tied/cauterized/cut. a. Interval mini-lap done during the first 7 days of the menstrual cycle b. Post-partum mini-lap done within the first 8 weeks after a normal delivery

1.5 cm abdominal incision is made below the umbilicus where a laparoscope is inserted. BTL is done through the laparoscope by cautery or with the use of clips.

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Method to prevent implantation: Intrauterine Device

A small, usually flexible appliance inserted into the uterine cavity.

IUD: Mode of action

Inhibits implantation through: local inflammatory response local production of prostaglandins interference with enzymatic and hormonal activity

IUD: Contraindications

a. Pelvic infection
b. Postpartum endometritis c. Septic abortion d. Pregnancy e. Endometrial or cervical malignancy f. Valvular heart disease g. Impaired response to infection h. Multiple sexual partners

motility of ovum in fallopian tube

It immobilizes sperms as they pass through the uterus.

IUD: Instructions
How to feel for IUD strings in the upper vagina during the first several months after IUD insertion, right before intercourse, and after each period Use a backup method of contraception during the first 3 months after IUD insertion Common side-effects Increased menstrual flow Increased menstrual cramping Spotting

IUD: Danger signs

P Period late or skipped period A Abdominal pain (severe) I Increased temperature, chills N Noticeable vaginal discharge; foul-smelling discharge S Spotting, bleeding, heavy periods, clots