Family planning for community Health workers

1. Family planning for community Health workers by Dr. Wilson Imongan

2. Outline • Family Planning • population issues, • Relevance of family planning, • Family Planning Methods • Family planning commodities

3. Introduction Contraception is deliberate prevention of pregnancy using any of the several methods. • Birth control prevents a female sx cell (egg) from being fertilized by a male sx cell (sperm) and/or implanting in the uterus • A variety of methods to choose from, although most options are or women • selecting a method is a personal decision that involves consideration of many factors including convenience, reliability, side effects etc

4. Classification Broadly classified as a, Temporary, b, permanent Temporary: are reversible – natural fp, coitus interrupts, barrier methods, IUCD, & hormonals. (most contracetives are reversible. They do not affect a perso’s ability to be pregnant once it is halted) Permanent: vasctomy and tubal ligation.

5. Temporary Methods A, Barrier Methods • physically block sperm from entering the uterus to unite with an egg, • Must be used with each sexual intercourse. Easy to use but may not be convenient. • Barrier methods include male and female condom, cervical caps and spermicides.

6. Emergency Contraception • Methods used by women after unprotected intercourse to prevent fertilization or implantation of the fertilized egg. • Two methods – • Emergency oral contraceptive pills (taken the morning after in 2 doses 12 hours apart. Effective if taken within 72 hours.) Major SE – Nausea • Call health care provider if severe – may prescribe antiemetics • Next period should begin within 2 – 3 weeks 2 Emergency insertion of iucd.

7. Population Matters

8. Human Population Growth The term population is defined as the number of persons living in a geographicallocationat a particular time. The world’s population is now over 7.1 billion people.

9. World population has risen sharply • Global human population was <1 billion in 1800. • Population has doubled just since 1963. • We add 2.5 people every second (79 million/year). Figure 7.2

10. Is population growth really a problem? Some say YES: • Not all resources can be replaced. • Even if they could, quality of life suffers. • Nations do not become stronger as their populations grow. Some say NO: • People can find or manufacture additional resources to keep pace with population growth. • Nations become stronger as their populations grow. Population growth leads to resource depletion, which can result in declining food production, industrial output, and population.

11. Factors affecting population growth rates Population growth depends on rates of birth, death, immigration, and emigration. (birth rate + immigration rate) – (death rate + emigration rate) = population growth rate Natural rate of population change: Change due to birth and death rates alone, excluding migration

12. Fertility rates affect population growth rates Total fertility rate (TFR) = average number of children born per woman during her lifetime. Replacement fertility = the TFR that keeps population size stable For humans, replacement fertility is about 2.1. The Nigerian Total Fertility Rate is 5.7 Family planning can lower TFR

13. Source: Nigeria 2008 demographic and health survey: key findings.

14. Population Growth in Nigeria What does high fertility mean for the health of families & the individual? How does population growth affect Nigeria’s development? Strategies for managing population growth Population and the Quality of Life in Nigeria

15. Population Growthin Nigeria Photo: Population Service International (PSI)

16. Nigeria is in the second stage of the demographic transition • Stage I: High birth rate; High death rate • Stage II: High birth rate, low death rate • Stage III: Low birth rate; low death rate

17. The effect of high fertility after Four Generations

18. Projected population of Nigeria, 2000- 2025 225 million 118 million

19. The “footprint” will grow larger with economic and population growth but Nigeria’s Land Mass remains the same!!!

20. How can Nigeria bring down its fertility rate? • Delayed Marriage • Increased birth Spacing • Prolonged Breastfeeding • Delayed commencement of Sexual Activity • Increased use of modern Contraception

21. Invest in fp • To prevent “demographic fatigue,” where government is unable to meet the social, economic, and environmental challenges imposed by rapid population growth. • Human population is rising by 79 million people annually.

22. Why Invest in fp World wide Every minute: • 380 women become pregnant. (190 of these did not plan to be pregnant) • 110 women experience pregnancy related complications, • 40womenhave unsafe abortion • 1woman dies from pregnancy related cause. FMOH CLMS Training manual 2003

23. Family Planning

24. What is family planning? • The practice of controlling the number of children one has and the intervals between their births, particularly by means of contraception or voluntary sterilization. "family-planning clinics“ • Family planning allows individuals and couples to anticipate and attain their desired number of children and the spacing and timing of their births. • It is achieved through use of contraceptive methods and the treatment of involuntary infertility. • A woman’s ability to space and limit her pregnancies has a direct impact on her health and well-being as well as on the outcome of each pregnancy.

25. Importance of family Planning • Reinforces people’s rights to determine the number and spacing of their children. • Reducing rates of unintended pregnancies, and hence reduces the need for unsafe abortion • Secures the well-being and autonomy of women, • Supports the health and development of communities • Condoms provide dual protection against unintended pregnancies and against STIs including HIV. • Reduces the risk of unintended pregnancies among women living with HIV, resulting in fewer infected babies and orphans

26. Importance of fp 2 • Family planning allows spacing of pregnancies and can delay pregnancies in young women at increased risk of health problems and death from early childbearing, and can prevent pregnancies among older women who also face increased risks • Reduces risk of maternal mortality. • Reduces the need for unsafe abortion. • Improves child spacing, prevents ill-timed pregnancies and births, thus reducing highest infant mortality rates • Family planning is key to slowing unsustainable population growth and the resulting negative impacts on the economy, environment, and national.

27. Importance of Family Planning 3 • Family planning allows women to make choices about their own fertility. • It also saves lives and reduces suffering by preventing high risk pregnancies and reducing a woman’s likelihood of resorting to unsafe abortions. • Family planning prevents an estimated 150,000 maternal deaths in the developing world each year.

28. CONTRACEPTION

29. CONTRACEPTION • prevention of conception is called as contraception. • Contraception is useful to prevent population explosion. • It is also called Birth Control methods or Family Planning Methods. • This can be done by the female, male or at coital stages.

30. The Ideal Method Should Be: • Safe • 100% effective • Free of SE • Easily obtainable • Affordable • Acceptable to the user & sexual partner • Free of effects on future pregnancies

31. Contraception is the prevention of conception. • There two main types: • Permanent or Terminal methods: • Vasectomy or Male sterilization. • Tubectomy or Female sterilization. • Temporary or Spacing methods: • Barriers • IUCDs • Other methods.

32. TERMINAL METHODS I. VASECTOMY: • MALE STERILISATION: • A SIMPLE OUT PATIENT PROCEDURE. • THE ‘VAS DEFERENS’ IS ISOLATED AND CUT. • THE TWO ENDS ARE LIGATED.

33. VASECTOMY GYNAECOLOGY NURSING

34. TERMINAL METHODS II. TUBECTOMY: • FEMALE STERILIZATION: • PART OF THE FALLOPIAN TUBE IS REMOVED. • THE TWO ENDS ARE TIGHTLY LIGATED. • CAN BE DONE AS: • POST PARTUM STERILIZATION • LAPAROSCOPIC STERELIZATION

35. TUBECTOMY: TYPES GYNAECOLOGY NURSING

36. SPACING methods • BARRIER METHODS: A) PHYSICAL BARRIER: • CONDOMS • DIAPHRAGM • VAGINAL SPONGE • FEMALE CONDOM. B) CHEMICAL BARRIER:SPERMICIDAL • FOAMS • CREAMS • SUPPOSITORIES

37. CONDOMS SPERMICIDES GYNAECOLOGY NURSING

38. FEMALE CONDOM GYNAECOLOGY NURSING

39. DIAPHRAGM + SPERMICIDE A diaphragm is a flexible, latex, dome-shaped cup. It is designed to fit securely in the vagina to cover the cervix. GYNAECOLOGY NURSING

40. A foam sponge inserted into the vagina to prevent pregnancy VAGINAL SPONGE+ SPERMICIDE GYNAECOLOGY NURSING

41. INTRA UTERINE CONTRACEPTIVEDEVICES (IUCD): • FUNCTION BY PREVENTING IMPLANTATION. • I GENERATION: • NON MEDICATED: LIPPE’S LOOP • II GENERATION: MEDICATED BIOACTIVE • COPPER T • III GENERATION: HORMONE RELEASING • PROGESTASERT

42. LIPPE’S LOOP Cu T & PROGESTASERT GYNAECOLOGY NURSING

43. GYNAECOLOGY NURSING

44. IUDs are: • Safe, effective, convenient, reversible, long lasting, cost effective, easy to use. Providers can ensure safety by: • Careful screening • Proper follow-up

45. HORMONAL CONTRACEPTIVES • ALSO CALLED ORAL PILLS OR ORAL CONTRACEPTIVES. • ARE USUALLY HORMONES OR COMBINATIONS TAKEN BY MOUTH. • THEY CAUSE THE TEMPORARY CESSATION OF THE OVARIAN CYCLES. GYNAECOLOGY NURSING

46. ORAL CONTRACEPTIVES • COMBINED PILLS: • HAS BOTH ESTROGEN & PROGESTERONE. • PROGESTRONE ONLY PILL. • DEPOT FORMULATIONS • INJECTABLES: DEPOT PROVERA

47. OTHER METHODS • ABSTINENCE: THE BEST • COITUS INTERRUPTUS: • HISTORICALLY THE OLDEST IN HUMANS. • THE SEMEN WAS SPILLED ON THE GROUND. • THE MALE PILL: • GOSSYPOL : COTTON SEED OIL • KILLS SPERMATIDS.

48. NATURAL FAMILY PLANNING METHODS • SAFE PERIOD METHOD: • DURING THE FERTILE PERIOD, COITUS IS AVOIDED. • THE REST OF THE CYCLE IS ‘SAFE’ • OVULATION TESTS: • BASAL BODY TEMPERATURE CHARTS • CERVICAL MUCUS : BILLINGS METHOD • SYMPTOTHERMIC: ‘SELF RECOGNITION’

49. SAFE PERIOD METHOD GYNAECOLOGY NURSING

50. Thank you