Family welfare:

Introduction:
Definition: According to WHO family welfare means married couple follows one of the family
planning methods on their own by following the family planning method, they improve their
own health, thereby improving national health.
Human development can be viewed as the process of achieving an optimum level of health and
well-being. t includes physical, biological, mental, emotional, social, educational, economic,
and cultural components.
!here is an improvement in the overall health of wor"ers automatically raises the national
output. According to World #evelopment $eport %&''(), improved health contributes to
economic growth in four ways* it reduces production losses caused by wor"er illness, it permits
the use of natural resources that had been totally or nearly inaccessible because of disease, it
increases the enrolment of children in schools and ma"es them better able to learn, and it frees
for alternative uses resources that would otherwise have to be spent on treating illness. !he
economic gains are relatively greater for poor people, who are typically most handicapped by ill
health and who stand to gain the most from the development of underutilised natural resources.
!he main focus of this paper is on +health, that is very critically lin"ed with family welfare. -oth
of these are important components of the Human #evelopment nde. %H#) that was first
introduced by the /nited 0ations #evelopment 1rogramme %/0#1) n &''2, and ever since
then it has been enlarged and refined in terms of the changing world scenario in all the spheres
that matter in the given conte.t. 3any new indices li"e, 4ender-$elated #evelopment nde.
%4#), 4ender 5mpowerment 3easure %453), and Human 1overty nde. %H1) have been
formulated.
!he criteria that have been used to evolve the concept of Human #evelopment nde. are very
well described below*
&. t includes many more human choices %relating to long and healthy life, ac6uisition of
"nowledge, 6uality of life, pollution-free environment, gainful employment, peaceful community
life, and so on) than only income %as in the case of 4ross 0ational 1roduct)7
8. t is simple and manageable in terms of the limited number of variables and pro.y variables
used in its computation7
(. t is based on a composite inde. rather than many indices. %!his initially posed the problem of
a common denominator, which was sorted out by introducing a scale between 2 and &, indicating
the actual progress in each indicator as relative distance from a desirable goal)7
9. t covers both economic and social choices %on the basis that both move hand in hand) by
incorporating appropriate indicators.

n terms of the H#, ndia is one of the lowest countries in the whole world. -ut in recent years,
there appears to be a marginal improvement in H# in the conte.t of ndia.
-ut, reality comes to the forefront when we loo" at the widespread deprivation and hardship,
starvation deaths in the midst of plenty, unsafe environment, deteriorating public culture, limited
and ineffective health facilities, poor infrastructure, deteriorating performances on a number of
critical social indices li"e, the infant mortality rates, and safety ha:ards. !he reason is that our
political process has largely failed to deliver the basic social needs. We have, therefore, to shed
our complacency, and we have to recognise the current euphoria about economic liberalisation.
3ar"et forces, no matter how efficiently they wor", cannot alone tac"le the issues involved. !he
;tate has to perform its basic role in the areas of social and human development.
Health and <amily Welfare are assessed in terms of the number of registered medical
practitioners, and the availability of hospital beds per &2,222 of population, the data for which
are available for limited years. t is seen that over the years the medical facilities have steadily
improved both in terms of the availability of medical practitioners and hospital beds. As
compared to &'=2-=&, the number of registered medical practitioners per &2,222 of population
has increased, though marginally, over the years. !he same is the case with hospital beds per
&2,222 of population.
Although the availability of these facilities shows an upward trend, yet these facilities,
considered in absolute sense, are e.tremely meager and even negligible in a country with a
massive population. An important point to remember is that illness care is not much of the
responsibility of the ;tate in ndia. A large proportion of people pay directly for the curative
services which are delivered to them either by private sector physicians of western medicine, or
by a large number of practitioners of indigenous and other systems. !he provision of preventive
and promotive health care services %which also include, to some e.tent, suitable housing,
sanitation, safe drin"ing water etc.) is, however, the responsibility of the ;tate. ;ome of the well-
meaning health programmes the 4overnment has launched so far is briefly mentioned below*

An e.tensive net wor" of 1rimary Health >enters and ;ub->enters opened under the
3inimum 0eeds 1rogramme7
>ommunity Health Wor"er ;cheme % later called ?illage Health 4uide) of the ;eventies7
!he policy measures to integrate practitioners of traditional medicine into primary health
care as contained in the 0ational Health 1olicy of &'@87
!he 1rogramme of /rban -asic ;ervices %/-;) of the urban slums introduced in the
early eighties7
;igning of Alma Ata #eclaration on +Health for All, by the year 8222 which led to the
0ational Health 1olicy ;tatement of &'@87
Aaunching of a number of disease-specific programmes to contribute to the health and
productivity of the poor7
5stablishment of a 0ational llness Assistance <und to achieve the obBective of + Health
for /nder 1rivileged,7
Aaunching of the 0ational ;urveillance 1rogramme for >ommunicable #iseases7
Aaunching of the 3ental Health 1rogramme7
#evelopment of rural health infrastructure under the 3inimum 0eeds 1rogramme7
Aaunching of !he >entral 4overnment Health ;cheme %>4H;)7
!he 3aBor 0ational Health 1rogrammes aimed at prevention, control and eradication of
communicable and non- communicable diseases should be made more effective.
0ational ;urveillance 1rogramme for >ommunicable #iseases7
!here is no end to such schemes, but the final effects of these schemes never reach the people for
whom these are meant. !here is a complete absence of the percolating effect. All this is due to
poor governance and lac" of complete bureaucratic control.
-esides the schemes that have been mentioned above, the 4overnment should also loo" at the
following*
1rovision of compulsory medical insurance supported fully by the 4overnment,
especially for the poor and low income classes7
5.tension of medical hospitals all over7
$educing the prices of life-saving medicines.
!ac"ling the maBor nutritional problems in ndia are 1rotein 5nergy 3alnutrition %153), odine
#eficiency #isorders %##), ?itamin A #eficiency %?A#) and Anemia.
We must remember that good health is the ultimate obBective in life. Once there is good health,
other things being given, it leads to the overall well-being of the familyChouseholdC and also of
the society.
The welfare concepts:
!he welfare concept of welfare is vary comprehensive and is basically related to 6uality of life.
!he family welfare programme aims at achieving a higher end-that is, to improve the 6uality of
life of the people.
Small-family norm:
;mall family small differences in the family si:e will ma"e big differences in the birth rate. !he
difference of only one child per family over a decade will has a tremendous impact on the
population growth.
!he obBective of the family welfare programme in ndia is that people should adopt the
small family norms to stabili:e the country,s population at the level of some &=(( million by
the year 82=2 A#. ;ymboli:ed by the inverted red triangle the programme initially adopted the
model of the (-child family. n the &'D2,s the slogan was the famous #O EA !een -as. n view
of the seriousness of the situation, the &'@2,s campaigning as advocated the 8-child norms. !he
current emphasis is on three themes* sons or daughters-two will do7 second child after (
years, and universal mmuni:ation.
A significant achievement of the family welfare programme in ndia has been the decline in the
fertility rate from F.9 in the &'=2s to 8.@ in 822F. !he national target was to achieve a net
reproduction rate of & by the year 822F, which is e6uivalent to attaining appro.imately the 8-
child norm. All efforts are being made through mass communication that the concept of small
family norm is accepted, adopted and woven into lifestyle of the people.
Eligible Couples:
An eligible couple refers to a currently married couple where in the wife is in the reproduction
age. !here will be at least &=2 to &@2 eligible couples per &222 population in ndia.
Target Couples:
!arget couples are the couples who have 8-( living children and have not adopted any family
planning method. !he definition has gradually enlarged to include families with one child and
even newly married couples.
Couple Protection ate !CP":
>1$ is an indicator of the prevalence of family planning practice in a community. t is defined as
the percentage of eligible couples effectively protected against childbirth by one or the other
approved methods of family planning.
ndia was the first country in the world to implement family welfare programme on national
wide basis by the 4overnment itself. However, it was only during third five year plan that family
welfare programme received more priority in the health schemes of the country. According to
ndian >onstitution, <amily welfare programme is a G;tate ;ubBectG but for proper coordination it
is a centrally sponsored item.
#ealth aspects of family planning:
<amily planning and health have a two-way relationship. !he principle health outcome of family
planning were listed and discussed by a WHO scientific group on the health aspects of family
planning.
$% &omen's health:
1regnancy can mean serious problems for many women,s. t may damage the mother
health or even endanger her life. in mother ris" of dying as a result of pregnancy is &2-82
times. !he ris" increases as the mother grows older and after she has had ( or 9 children.
<amily planning by intervening in the reproductive cycle of women helps them to control
the number, interval and timing of pregnancies and births and there by reduces maternal
mortality and morbidity and improves health.
. /nwanted pregnancies*
!he essential aim of family planning is to prevent the unwanted pregnancies. An
unwanted pregnancy may lead to an induced abortion. <rom the point of view health,
abortion outside the medical setting %criminal abortion) is one of the most dangers
conse6uences of unwanted pregnancies.
. Aimiting the number of births and proper spacing*
$epeated pregnancies increase the ris" of maternal mortality and morbidity. !hese
ris"s rise with each pregnancy beyond the third, and increase significantly with
each pregnancy beyond the fifth. !he incidence of rupture of the uterus and
uterine atony increases with parity as does the incidence of to.emia, eclampsia
and placenta previa.
. !iming of births*
4enerally mothers face the greater ris" of dying below the age of 82 and above,
the age of (2-(=.
-. <etal health*
!he number of congenital anomalies % e.g. down syndrome) are associated with
advancing maternal age. ;uch congenital anomalies can be avoided by timing the births
in relation to the mother,s age. <athers, the 6ulitityof population can be improved only
by avoiding completely unwanted births. n the parent state of our "nowledge, it is very
difficult to wait the overall genetic effect of family planning.
>. >hildren health*
. >hild mortality* it is well "nown that child mortality increases when pregnancies
occur in succession. A birth interval of 8-( is considered desirable to reduce child
mortality.
. >hild growth, development and nutrition* birth spacing and family si:e are
important factors in >hild growth and development. !he child should receive his
full share of love and care, including nutrition needs, when the family si:e is
small and births properly spaced.
. nfectious diseases* children living in large-si:ed families have an increases
infection, especially infectious gastroenteritis, respiratory and s"in infections.
The (ational Family &elfare Programme has four components,
%&) Administration and Organi:ation which includes recruitment of staff, getting
e6uipment and supplies.
%8) !raining-3edical, paramedical- and social wor"ers in this field.
%() ;ocial and Health 5ducation.
%9) ;upplies and ;ervices.
$D)I(IST$TI*( F$)I+, &E+F$E P*-$))E I( I(DI$:
>entre provides &22H assistance to ;tate 4overnments for service and educational purposes
towards family planning schemes. !he central government controls the planning and financial
management of the programme, training, research and evaluation. A 1opulation Advisory
>ouncil headed by the /nion 3inister of Health and members of parliament and persons
related to the field of population was set up in &'@8. #uring the second plan period, family
planning bureaus were established in every state at its head6uarters with an Additional #irector
of Health ;ervices and <amily 1lanning to direct the programme. One <amily Welfare
>ell is set up for each state as a lin" between the ;tate and >entral 4overnment. At the #istrict
level, since &'F(, there are #istrict <amily 1lanning bureaus under the >harge of #istrict <amily
Welfare Officers with facilities for publicity services, sterili:ation and for the ntra
/terine >ontraceptive application.
The District Family &elfare staff consists of:
#istrict <amily Welfare Officer &
3edical Officers 8
5.tension educator 8
nformation Officer &
;tatistician &
Administrative Officer &
>ler"CAncillary staff &
/rban family welfare centers are being reorgani:ed and have been established according to the
population. !he urban areas have been categori:ed into 9 types of Health 1osts. At present there
are &9'' urban family welfare centers in the country. n rural areas, family planning programme
has been integrated along with maternal and child health service programme of the e.isting
health care infrastructure i.e. primary health centre. As mentioned in the earlier chapter,
additional staff has been added to carry on family planning wor" in primary health centers.
CE(T$+
CE(T$+ )I(ISTE *F #E$+T# $(D F$)I+, &E+F$E
SECET$, *F #E$+T# $(D F$)I+, &E+F$E
DEP$T)E(T *F F$)I+, &E+F$E SPECI$+ SECET$,
SECET$E$+ &I(- TEC#(IC$+ &I(-
.*I(T SECET$, C*))ISSI*(E
Additional Add. Add Add.;ec. <ield Add, ;ec Add. ;ec... Add. Add.
;ecretary ;ec. ;ec. Organi:ed 3>H 3ass ;upplyI ;ec. ;ec.
1olicy Aided 1lan Operational 3edia and ntelligence5valuationI$esearch
#ivision1rogram -udget media and !ransport 5ducation 5.tension
#ivision ;ector >ommu- #ivision #ivision
0ication
ST$TE +E/E+
ST$TE )I(IST, *F #E$+T# $(D F$)I+, &E+F$E
$DDITI*($+ DIECT* *F #E$+T# $(D F$)I+, P+$((I(-
ST$TE F$)I+, &E+F$E 01E$1
.*I(T DIECT*
#eputy #eputy #eputy #eputy #eputy #eputy
#irector #irector #irector #irector #irector #irector
1rogramme 3edia Wing 3>H Wing #emographic I !raining Administrative
Wing 5valuation Wing Wing
Wing
!he organi:ation for the operation of family planning programmes at the >entre, ;tate and
#istrict level
DISTICT +E/E+
#;!$>! >OAA5>!O$
#;!$>! <A3AE W5A<A$5 -/$5A/
Administrative 3ass 5ducation and 5valuation #ivision
#ivision 3edia #ivision ;tatistical Officer
#istrict <amily #istrict 3ass
Welfare Officer 5ducation and
3edia Officer
!he >hristian 3edical Association of ndia has a very intensive family planning programme
operated through various mission hospitals in the country. !his family planning proBect of
>3.A.. Assists mission hospitals in the training of the health personnel, e.g. organi:ing periodic
wor"shops on family planning. Also it helps in supplying the units with necessary financial aid to
conduct vasectomies, puerperal and non-puerperal sterili:ationGs, administering oral pills etc.
t is relevant to mention now about the recent introduction of postpartum programme in ndia in
&'D2, through medical institutions. !he aim of this programme is to intensify or initiate family
planning activity in large hospitals, on women from the time they boo" themselves for delivery
in that hospital. #uring this time efforts are made to educate and motivate the mother and at the
time of 9-F wee"s after delivery to give postnatal chec" up. At this time, the mothers are
persuaded to adopt either one of the suitable birth control methods to avoid another pregnancy.
Family &elfare Programmes*

ndia, the largest democratic republic in the world, possesses 8.9H of the world,s land area and
supports &FH of the world population. t is the second most populous country after >hina. 5very
year it adds about &F million people to its large base of population.

3assive implication of rapid population growth had already diluted much of benefits of our
substantial economic growth since independence which made it obligatory to adopt a policy of
<amily 1lanning. ndia is the first developing country in the world to have a <amily 1lanning
1rogramme.

Family &elfare $cti2ities 3443-45 to 3446-47:




$eduction in fertility, mortality and population growth rates is maBor obBectives of the &2th 1lan.
!he focus will be on improving accesses to services to meet the health care needs of the women
in reproductive age group and of children below the age of = years and also to provide
contraceptives and spacing services to the desired people. !he main obBective is reducing the
birth rate to the e.tent necessary to stabili:e the population at a level consistent with the needs of
0ational development.

Eear
>rude -irth $ate >rude #eath $ate nfant 3ortality $ate
All ndia 1ondicherry All ndia 1ondicherry All ndia 1ondicherry
822& 8=.9 &D.' @.9 D.2 FF.2 88.2
8228 8=.2 &D.' @.& F.D F(.2 88.2
822( 89.@ &D.= @.2 F.( F2.2 89.2
8229 89.& &D.2 D.= @.2 =@.2 89.2
822= 8(.@ &F.8 D.F D.& =@.2 8@.2
1re-0atal #iagnostic !echni6ues %10#!)*

3ethod 8228-2( 822(-29 8229-2= 822=-2F 822F-2D
?asectomy &F 8& &D &' 89
!ubectomy &88D( &8=89 &&'&= &2&'9 &29='
./.# 92D= (D(D (&=2 (F8@ (=2F
Oral 1ills &(=F &D=@ &=@9 &@D& &D9(
>.> %>ondoms) @2FF &2=8F &2(D' ''(9 &2=D=
3.!.1 &9@F &(88 &F@( &''F &D8F
nstitutional #eliveries 8D8'2 8@8@F 8D'D@ 8F&D2 J9F@F9
Home #eliveries 99D (2@ &@= @= &&F
With a view to improve the declining se. ratio %0umber of females per thousand males) and for
containing the menace of female feoticide the 4overnment has brought into force the 1re-natal
#iagnostic !echni6ues %$egulation and prevention of 3isuse) Act, &''9 %10#! Act) with effect
from &.&.&''F. 10#! Act is being implemented in the /.!. with the direction of the ;upreme
>ourt. /nder the Act, (F 4enetic clinics are functioning in the /.!. with the approval of
Appropriate AuthorityC #irector of Health and <amily Welfare ;ervices. !he #eputy #irector
%<WI3>H) is the 0odal officer for the implementation of this Act in the /.!.

/nder the 10#! Act, a >entral ;upervisory -oard has been constituted under the >hairmanship
of 3inister of Health and <amily Welfare. Appropriate Authorities and Advisory >ommittees
have been constituted in all ;tates and /nion !erritories for implementation of 10#! Act.
Family planning:
Definition:
An e.pert committee %&'D&) of the WHO defined family planning as a way of thin"ing and
living that is adopted voluntarily, up on the basis of "nowledge, attitudes and responsible
decisions by individuals, couples, in order to promote the health and welfare of the family group
and thus contribute effectively to the social development of a country.
Family planning refers to practice that help individual or couples to attain certain
ob8ecti2es:
a) !o avoid unwanted baths
b) !o bring about unwanted births
c) !o regulate the intervals between pregnancies
d) !o control the at which births occur in relation to the age of parent,, and
e) !o determine the number of children in the family.
Scope of family planning ser2ices*
&. !he proper spacing and limitation of births,
8. Advice on sterility,
(. 5ducation for parenthood,
9. ;e. education,
=. ;creening for pathological condition related to the reproductive system %e.g. cervical
cancer),
F. 4enetic counseling
D. 1remarital consultation and e.aminination
@. >arrying out pregnancy test
'. 3arriage council ling
&2. !he preparation of couples for the arrival of their first child
&&. 1roviding services for un married mothers,
&8. !eaching home economics and nutrition, and
&(. 1roviding adoption services
Family planning methods*
C*(T$CEPTI/E )*T#*DS:
>ontraceptive methods are by definition, preventive methods to help women avoid unwanted
pregnancies. !hey include all temporary and permanent measures to prevent pregnancy resulting
from coitus.
!he last few year have witnessed a contraceptive revolution, that is, man trying to interfere with
the ovulation cycle.
!he contraceptive methods may be broadly grouped into two classes- spacing methods and
terminal methods, as shown below
9% SP$CI(- )ET#*DS
I% 0arrier methods
%a) 1hysical methods
%b) >hemical methods
%c) >ombined methods
. ntra-uterine devices
. Hormonal methods
?. 1ost-conceptional methods
?. 3iscellaneous
3% TE)I($+ )ET#*DS
&. 3ale sterili:ation
8. <emale sterili:ation
0arrier methods*
A variety of barrier or occlusive methods, suitable for both men and women are available.
!he aim is* to prevent live sperm from meeting the aim ovum.
$d2antages include protection from
se.ually transmitted diseases,
a reduce in the incidence of pelvic inflammatory diseases
protection from the ris" of cervical cancer
!hese methods re6uire a high degree of motivation on the part of the user.
a. P#,SIC$+ )ET#*DS*
C*(D*):
>ondoms are made of thin strong rubber and are meant to be used by men. f utili:ed properly it
is fairly reliable. t is very ine.pensive. >ondoms are freely available in ndia through
4overnment Agency. >ondoms are about '=H effective. >ondoms are manufactured in ndia and
this prevents conception by avoiding the deposition of semen in the vagina. >ondoms should be
free from any tear or lea". t can be used only once. Whether physiological and psychological
satisfaction is reached by the couples who use condoms is still a maBor 6uestionK
FE)$+E C*(D*):
t is a pouch made of polyurethane, which lines in vagina. An internal ring in the close end of the
pouch covers the cervi. and an e.ternal ring remains outside the vagina.
I% DI$P#$):
#iaphragms are a soft late. rubber cup shaped obBect that is inserted into the vagina so that they
fit over the cervi.. #iaphragms stop sperm from getting into the cervi.. !he diaphragm needs to
be si:ed and fitted by a doctor. t is recommended that the diaphragm is used with spermicide but
studies have shown using spermcide does not significantly increase effectiveness.
$d2antages are*

>an be inserted in advance

reusable

can be used during period

controlled by woman

'=H effective if used correctly

#oes not interfere with body,s natural hormonal system.

Disad2antages:

the diaphragm can move about during se. which means sperm can enter cervi.

need to get used to inserting it

leaving diaphragm in for too long %over 89 hours) can increase ris" of infection

have to be fitted by doctor

does not protect against ;!#Gs

II% /$-I($+ SP*(-E:
Another barrier device employed for hundreds of years is the sponge. !he purpose
of preventing contraception. t is a polyurethane foam sponge measuring =cm .
8.=cm. ;aturated with the sperimicide, non.ynol-'. t is less effective than the
diaphragm. !he failure rate is in parous women-82 to 92C&22 women-years, in
nulliparous women about '-82C&22 women-years.
b. C#E)IC$+ )ET#*DS*
n the &'F2s, before the advent of /#s and oral contraceptives, spermicidal %vaginal
chemical contraceptives) were used widely. !hey comprise four categories
a) <oams* form tablets, foam aerosols
b) >reams, Bellies and pastes L s6uee:ed from a tube
c) ;uppositories L inserted manually
d) ;oluble films L > L film inserted manually
!he main drawbac"s of spermicides are* %a) they have a high failure rate %b) they must be
used almost immediately before intercourse and repeated before each se. act %c) they must be
introduced into those regions or the vagina where sperms are li"ely to be deposited, and %d) they
may cause mild burning or irritation, besides messiness. !hey are best used in conBunction with
barrier methods.
I(T$-1TEI(E DE/ICES
T,PES *F I1D*
!here are two basic types of /#* non-medicated and medicated. -oth are usually made of
polyethylene or other polymers7 in addition, the medicated or bioactive /#; release either
metal ions %copper) or hormones %progestogens)
!he non L medicated or inert /#s are often referred to as first generation /#s. !he copper
/#s comprise the second and the hormone-releasing /#s the third generation /#s. !he
medicated /#s were developed to reduce the incidence of side-effects and to increase the
contraceptive effectiveness. However, they are more e.pensive and must be changed after a
certain time to maintain their effectiveness.
FIST -E(E$TI*( I1Ds:
!he first generation /#s comprise the inert or non-medicated devices, usually made of
polyethylene, or other polymers. !hey appeared in different shapes and si:es-loops, spirals, coils,
rings, and bows. Of all the models, the lippes loop is the best "nown and commonly used device
in the developing countries.
+ippes loop:
Aippes loop is double-; shaped device made of polyethylene, a plastics material that is non-
to.ic, non-tissue reactive and e.tremely durable. t contains a small amount of barium sulphate
to allow M-ray observation. !he loop has attached threads or tail made of fine nylon, which
proBect into the vagina after insertion. !he tail can be easily felt and is a reassurance to the user
that the loop is in its place. !he tail also ma"es it easy to remove the loop when desired. ;ide-
effects such as pain and bleeding. !he larger loops %> and #) are more suitable for multiparous
women.
SEC*(D -E(E$TI*( I1Ds*
t occurred to a number of research wor"ers that the ideal /# can never be developed simply as
a result of obtaining changes in the usual shape or si:e. t was found that metallic copper had a
strong anti-fertility effect. !he addition of copper has made it possible to develop smaller devices
which are easier to fit, even in nulliparous women. A number of copper bearing devices are now
commercially available*
$d2antages of copper de2ices
- Aow e.pulsion rate
- Aower incidence of side-effects, e.g., pain and bleeding
- 5asier to fit even in nulliparous women
- -etter tolerated by nullipara
- ncreased contraceptive effectiveness
- 5ffective as post-coital contraceptives, if inserted within (-= days of unprotected-
intercourse.
The copper bearing de2ices introduced recently are -
%i) !>/ -882 >
%ii) !>/(@2 A or 9g
%iii) 0ova !
%iv) 3ulti load devices
>opper devices have become very popular in ndia accounting for ''.D percent of the
total /# insertions.
An ./.#. can be changed anywhere from &@ months to 89 months and also, depending on the
womenGs side effects and their convenience.
Process of application:
&. !he /# and the inserter to be sterili:ed.
8. !o be done by physician nurse or 3ultipurpose Health Wor"er.
(. >an be inserted at any time during the menstrual cycle. /sually insertion is done (
rd
to D
th
day
of the cycle or F
th
wee" after delivery.
9. n some cases &2 days after delivery or prior to leaving the hospital.
$D/$(T$-ES *F I1D*
;implicity, i.e., no comple. procedures are involved in insertion7 no
hospitali:ation is re6uired.
nsertion ta"es only a few minutes.
Once inserted /# stays in place as long as re6uired.
ne.pensive.
>ontraceptive effect is reversible by removal of /#
?irtually free of systemic metabolic side-effects associated with hormonal pills
Highest continuation rate, and
!here is no need for the continual motivation re6uired to ta"e a pill daily or to use
a barrier method consistently
C*(T$I(C$TI*(S:
A-;OA/!5*
;uspected pregnancy
1elvic inflammatory disease
?aginal bleeding un diagnosed
5tiology
>ancer of the cervi., uterus or adne.ia and other pelvic tumors
$evise ectopic pregnancy
$5AA!?5*
A05A3A
3enorrhagia
History of 1# since last pregnancy
1etulant cervical discharge
#istortion of the uterine cavity due to congenital malformations, fibroids.
/nmotivated person
Timing of insertion*
!he most propitious time for loop insertion is during menstruation or within &2 days of begin of
a menstrual period. !he /# insertion can also be ta"en up during the &
st
wee" after delivery
before the women leaves the hospital. ;pecial care is re6uired with insertions during the &
st
wee"
after delivery because of the greater ris" of preparation during this time. <urther immediate post-
partum insertion in associated with a high e.plosion rate. -ut /# insertion immediately after a
second trimester abortion is not recommended since there is a ris" of an infection.
SIDE EFFECTS $(D C*)P+IC$TI*(S *F I1Ds:
-leeding
1ain
1elvic infection
/terine perforation
1regnancy
5ctopic pregnancy
5.pulsion
<ertility after removal
>ancer and teratogenesis
3ortality
Hormonal contraception*
Hormonal contraception is widely classified as
&. Oral pills
>ombined pill
1rogesterone only pill
1ost-coital pill
Once-a-month pill
3ale pill
$ction:
%&) !o prevent the release of a ripe egg, i.e., to prevent ovulation.
%8) Acts on cervical mucosa and ma"es it strong there by it is impossible for the sperm to
penetrate it. Hence sperm cannot pass into the womb and tubes for fertili:ation.
%() !hey produce changes in endometrium that tend to prevent implantation, so that
endometrium is not ade6uately prepared to receive a fertili:ed ovum.
)ethod of use:
One pill a day should be ta"en. !he pill should be ta"en from the =
th
day, counting from the day
of menstruation and continued till the 8&
st
day. !his procedure has to be followed regularly.
A doctorGs prescription is needed for the pills for various reasons as there are contraindications
li"e*
%a) #isease of the liver.
%b) >ancer of the breast or reproductive organs.
%c) ?aricose veins.
%d) Asthma, ec:ema.
;o the pill has to be ta"en only after medical chec"-up.
!he pill may have side effects li"e, 0ausea, headache, swelling of breasts etc.
*ther functions of pill:
%&) 3any infertile women have become pregnant soon after discontinuing birth control tablets.
%8) Women who had repeated miscarriages were able to carry their babies through pregnancy
when put on oral pill.
%() !hose whose menstrual cycle was irregular became regular when given synthetic hormones.
!his oral pill is more suitable for educated women and those who have enough income to
purchase pills.
8. #epot formulations
nBectables li"e #31A, 05!-50, #31A-;>
In8ectables contracepti2es are of two types. 1rogestogen only nBectables and
combined inBectables.!wo hormonal contraceptive based on progestogen are used
that are #31A %#epot-medro.y progesterone acetate) and 0et-50 %norethisterm
emanate), that primarily e.ert effects by pressing ovulation. -oth #31Aand
05!-50 give by deep intramuscular inBection into the gluteus ma.imum in a dose
&=2 mg every three month 822 mg every F2 days respectively. !he initial
inBection of both should be given during the first five days of menstrual
cycle.#31A is more effective in preventing unwanted pregnency.#31A is
effective for three months in ''H women however the adverse effect is that it
may reduce fertility among women.
>ombined inBect able contraceptive are given at monthly interval plus or minus
three days. !hey contain a progestogen and estrogen.
Sub dermal Implants:
!he population council 0ew Eor" has developed a sub dermal implant called
0orplant for long term contraception. F silastic %;ilicon rubber) capsules which
contain progesterone are implanted sub dermally. !he hormone is slowly released
in very small amounts. 5ach capsule contains (= mgm of levonorgestrel. A more
recent device consists of 8 small rods inserted in the fore arm. t provides
effective contraception for over = years.
?aginal rings *
!his is another device that is being studied. n this new approach the vaginal rings
contain norgestrel which releases slowly the estrogen in vagina that observed
vaginal mucousa which facilitates in the prevention of conception by acting on the
sperms. With simple education a women can introduce this device by her and
remove it. !his is still under investigation but in a few yearsG time it will be
available for the public.
!he ndian >ouncil of 3edical $esearch is conducting clinical trials on a post
coital non steroidal oral pill namely >50!>H$O3A3;. !his drug is
manufactured in Auc" now, /.1. at >entral #rug $esearch nstitute. !he dosage is
F2 mg post coitus or &82 mg given once a wee".
1O;! >O0>51!O0AA 35!HO#;*
350;!$/AA $54/AA!O0*
Aoosely called very early abortion is a simple procedure done before the pregnancy test can even
determine pregnancy at F to &9 days of a missed period where contents of uterine are aspirated.
>omplications can be uterine perforation, menstrual disorder I infertility.
Women who missed their regular menstrual period and who strongly suspect that they are
pregnant but cannot or do not want to wait for the results of a pregnancy test can as" a
gynecologist for a simple procedure called variously menstrual regulation !)", menstrual
aspiration, or menstrual e;traction. ;ince there may not be an actual pregnancy to terminate,
this procedure is available even in some countries that prohibit abortions. t is mostly designed to
till the gap between Nforesight contraceptionN and Nhindsight abortion.N !he procedure is similar
to the one used for inserting intra-uterine devices %l/#s). Oust as in the case of an /# insertion,
the doctor inserts a small tube through the cervi. into the uterus. However, instead of depositing
the /# through the tube, he applies a vacuum at one of its ends, thus pulling out %i.e.,
NaspiratingN or Ne.tractingN) the lining of the uterus which would normally be shed in
menstruation. !he procedure ta"es only a few minutes and can easily be performed in a doctorGs
office.
3enstrual induction* 1rostaglandin <8 is applied intrauterinaly to disturb the normal
progesterone -prostaglandin balance that causes contraction of uterus, bleeding starts and
remains continuous for D to @ days.
A-O$!O0*
$bortion or Termination of pregnancy:
Abortion* is another method of birth control and to terminate pregnancy Abortion can be
spontaneous or of nduced type. Abortion is generally considered termination of pregnancy at 8@
wee"s of gestation when the fetus normally weighs &222 g .;tudies show that the optimal time of
termination of pregnancy is Dth and @th wee" of gestation.
!his is another recent addition to the birth control measures in ndia. t is a method where some
steps are ta"en after pregnancy occurs7 whereas in other methods, measures are underta"en
before conception ta"es place. Abortion is defined as termination of pregnancy before the lapse
of 8@ wee"s after conceiving. When adopted as a population control measure, it is confined to
the first &8 wee"s of pregnancy. Abortions are either spontaneous or induced. n ndia, induced
abortions are commonly carried out with the help of indigenous dais illegally7 nearly F.= million
abortions ta"e place annually, out of which (.' million are induced. ;tudies at Phanna, 1unBab
have showed that the abortions rate is about &2H of the confirmed pregnancies. An eight year
study at Aady Harding 3edical >ollege, 0ew #elhi indicates that in &'F8 there were (&@
abortions per &222 pregnancies. !herefore in view of these conditions the need for legali:ing
abortions has risen in ndia. n Hungary, the legal abortions e.ceed live births. 3any countries
have adopted this method widely and have reduced their birth rates. n Oapan, the birth rate was
(2 per &222 live births in &'9D and by &'=D it came down to &D per &222 mostly due to abortion
procedure and partly with other methods. t is estimated that worldwide the abortion ratio is 8F2-
9=2 per &222 live births. n ndia it is computed that about F million abortions occur every year
of which 9 million are induced.
!he +3edical !ermination of pregnancy -ill was passed by the ndian 1arliament in &'D& and
has come into force from April &'D8. !his see"s to advocate abortions under the following
circumstances.
!H5 35#>AA !5$30A!O0 O< 1$540A0>E A>! &'D&*
An Act to provide for the termination of certain pregnancies by registered medical practitioners
and for matters connected therewith or incidental thereto.
-e it enacted by 1arliament in the !wenty-second Eear of the $epublic of ndia as follows* -
ST$TE)E(T *F *0.EC,TS $(D E$S*(S
%&) !he provisions regarding the ndian 1enal >ode which were enacted about a century age were
drawn up in "eeping of with the than -ritish Aaw on the subBect. Abortion was made a crime for
which the mother as well as the abortionist could be punished e.cept where it had to be induced
in order to save the life of the mother .t has been stated that this very strict law has been
observed in the breach in a very large number of cases all over the conceal their pregnancy.
%8) n recent years, when health services have e.panded and hospitals are availed of the fullest
e.tent by all classes of society, doctors have often been e.panded and hospitals are availed of to
the fullest e.tent by all classes of society, doctors have offer been confronted with gravely ill or
dying pregnant women whose pregnant uterus has been tampered with a view to causing an a
abortion and conse6uently suffered very severely.
%() !here is thus avoidable wastage of the mother,s health, strength and , sometimes, life. !he
proposed measure which see"s to liberali:e certain e.isting provisions relating to termination of
pregnancy has been received %) as a health measure-when there is danger to the life or ris" to
physical or mental health of the woman7 %8) on humanitarian grounds- such as when pregnancy
arises from a se. crime health of the woman7 etc., and %() eugenic grounds- where there is
substantial ris" that the child, if born, would suffer from deformities and diseases.- 4a:ette of
ndia, 1t. , ;ection 8, 5.tra, dated 0ovember D, &'F', p @@2
3% Definitions%
n this Act, unless the conte.t otherwise re6uires, -
%a) N4uardianN means a person having the care of the person of a minor or a lunatic7
%b) NAunaticN has the meaning assigned to it in ;ection ( of the ndian Aunacy Act, &'&8 %9 of
&'&8)7
%c) N3inorN means a person who, under the provisions of the ndian 3aBority Act, &@D= %' of
&@D=), is to be deemed not to have attained his maBority7
%d) N$egistered medical practitionerN means a medical practitioner who possesses any recogni:ed
medical 6ualification as defined in clause %h) of ;ection 8 of the ndian 3edical >ouncil Act,
&'=F %&28 of &'=F), whose name has been entered in a ;tate 3edical $egister and who has such
e.perience or training in gynecology and obstetrics as may be prescribed by rules made under
this Act.
5% &hen pregnancies may be terminated by registered medical practitioners%
%&) 0otwithstanding anything contained in the ndian 1enal >ode %9= of &@F2), a registered
medical practitioner shall not be guilty of any offence under that >ode or under any other law for
the time being in force, if he terminates any pregnancy in accordance with the provisions of this
Act.
%8) ;ubBect to the provisions of sub-section %9), a pregnancy may be terminated by a registered
medical practitioner, -
%a) Where the length of the pregnancy does not e.ceed twelve wee"s, if such medical practitioner
is, or
%b) Where the length of the pregnancy e.ceeds twelve wee"s but does not e.ceed twenty wee"s,
if not less than two registered medical practitioners are, of opinion, formed in good faith, that-
%i) !he continuance of the pregnancy would involve a ris" to the life of the pregnant woman or of
grave inBury to her physical or mental health7 or
%ii) !here is a substantial ris" that if the child were born, it would suffer from such physical or
mental abnormalities as to be seriously handicapped.
5.planation -Where any pregnancy is alleged by the pregnant woman to have been >aused by
rape, the anguish caused by such pregnancy shall be presumed to constitute a grave inBury to the
mental health of the pregnant woman.
5.planation . -Where any pregnancy, occurs7 as a result of failure of any device or method used
by any married woman or her husband for the purpose of limiting the number of children, the
anguish caused by such unwanted pregnancy may be presumed to constitute a grave inBury to the
mental health of the pregnant woman.
%() n determining whether the continuance of a pregnancy would involve such ris" of inBury to
the health as is mentioned in sub-section %8), account may be ta"en of the pregnant womanGs
actual or reasonablyG foreseeable environment.
%9)
%a) 0o pregnancy of a Gwoman, who has not attained the age of eighteen years, or, who, having
attained the age of eighteen years, is a lunatic, shall be terminated e.cept with the consent in
writing of her guardian.
%b) ;ave as otherwise provided in clause %a), no pregnancy shall be terminated e.cept with the
consent of the pregnant woman.
<% Place where pregnancy may be terminated%
0o termination of pregnancy shall be made in accordance with this Act at any place other than-
%a) A hospital established or maintained by 4overnment, or
%b) A place for the time being approved for the purpose of this Act by 4overnment.
=% Sections 5 and < when not to apply%
%&) !he provisions of ;ection 9, and so much of the provisions of sub-section %8) of ;ection ( as
relate to the length of the pregnancy and the opinion of not less than two registered medical
practitioners, shall not apply to the termination of a pregnancy by a registered medical
practitioner in a case where he is of opinion, formed in good faith, that the termination of such
pregnancy is immediately necessary to save the life of the pregnant woman.
%8) 0otwithstanding anything contained in the ndian 1enal >ode %9= of &@F2), the termination
of a pregnancy by a person who is not a registered medical practitioner shall, be an offence
punishable under that >ode, and that >ode shall, to this e.tent, stand modified.
5.planation. - <or the purposes of this section so much of the provisions of clause %d) of ;ection
8 as relate to the possession, by a registered medical practitioner, of e.perience or training in
gynecology and obstetrics shall not apply.
6% Power to ma>e rules%
%&) !he >entral 4overnment may, by notification in the Official 4a:ette, ma"e rules to carry out
the provisions of this Act.
%8) n particular, and without preBudice to the generality of the foregoing power, such rules may
provide for all or any of the following matters, namely-
%a) !he e.perience or training, or both, which. a registered medical practitioner shall have if he
intends to terminate any pregnancy under this Act7 and
%b) ;uch other matters as are re6uired to be or may be, provided by rules made under this Act.
%() 5very rule made by the >entral 4overnment under this Act shall be laid, as soon as may be
aftFr it is made, before each House of 1arliament while it is in session for a total period of thirty
days which may be comprised in one session or in two successive sessions, and if, before the
e.piry of the session in which it is so laid or the session immediately following, both Houses
agree in ma"ing any modification in the rule or both Houses agree that the rule should not be
made, the rule shall thereafter have effect only in such modified form or be of no effect, as the
case may be7 so, however, that any such modification or annulment shall be without preBudice to
the validity of anything previously done under that rule.
7% Power to ma>e regulations%
%&) !he ;tate 4overnment may, by regulations, -
%a) $e6uire any such opinion as is referred to in sub-section %8) of ;ection ( to be certified by a
registered medical practitioner or practitioners concerned, in such form and at such time as may
be specified in such regulations, and the preservation or disposal of such certificates7 re6uire any
registered medical practitioner, who terminates a pregnancy, to give intimation of such
termination and such other information relating to the termination as may be specified in such
regulations7
%c) 1rohibit the disclosure, e.cept to such persons and for such purposes as may be specified in
such regulations, of intimations given or information furnished in pursuance of such regulations.
%8) !he intimation given and the information furnished in pursuance of regulations made by
virtue of clause %b) of sub-section %&) shall be given or furnished, as the case may be, to the >hief
3edical Officer of the ;tate.
%() Any person who willfully contravenes or willfully fails to comply with the re6uirements of
any regulation made under sub-section %&) shall be liable to be punished with the fine which may
e.tend to one thousand rupees.
?% Protection of action ta>en in good faith%
0o suit or other legal proceeding shall he against any registered medical practitioner for any
damage caused or li"ely to be caused by anything, which is in good faith done or intended to be
done under this Act.
3;>5AAA05O/;*
9% Complete $bstinence's
0ot practicable. 1sychological disturbance may result in both partners, leading to behaviour
patterns that no civili:ed society would accept.
3% Coitus Interrupts:
t is an ancient practice. !his consists of the man withdrawing the organ before eBaculation. !his
prevents sperm entering the womb and is about F2-D2H effective. -ut this results in physical and
mental dissatisfaction.
5% hythm )ethod@S$FE period:
Approved by >atholic >hurches particularly in women who have regular menstrual cycle and
who can "eep a record of it can practice this effectively. !his method is based on scientific fact.
Once a month only one ripe ovum is released and this can stay active and alive for &8-89 hours,
during which time it can be fertili:ed by a sperm. f fertili:ation does not ta"e place, the egg
brea"s apart and disappears. A sperm has an active life of 9@ hours during which time there is
chance to fertili:e the egg. 0ormally a woman produces a ripe egg about &9 days before the
onset of menstruation. -ut this may vary from &8th - &Fth day. ;o it is said that &8 days before
menstruation and && days after is said to be fertile period. t is effective for women whose
periods are regular. t is a reliable method for the educated couple and those with proper
understanding.
9. 0atural family planning methods*
-asal body temperature*
A womanGs body temperature varies throughout her menstrual cycle. !his temperature variation
is mediated by the hormone progesterone and, to a minor e.tent, the hormone AH. Eou can use
this information to predict ovulation.
/sing a special thermometer, called a basal body thermometer, you must ta"e your temperature
every morning -5<O$5 getting out of bed and record this on a chart %such as the one below).
Eour temperature rises between 2.9Q< and 2.@Q< on the day of ovulation. %Eour temperature will
begin to rise on #ay &( of a 8@ day cycle and continue to rise until appro.imately day &= - these
are the three days you are >O31A5!5AE /0;A<5.) <rom the day after ovulation until a few
days before your period, it will remain elevated. Eour temperature will begin to drop a few days
before your period. Eou should refrain from intercourse seven days before the temperature rise
until four days after.
Oust because temperature changes are very accurate in predicting the day of ovulation, they do not
predict it before it happens. !o be completely safe, you should consider unsafe days from the
first day of your period until the fourth day after the temperature rise. #onGt forget, sperm can
live up to seven days after intercourse.
>ervical mucus method
>ervical 3ucus has regular, cyclic pattern changes. !he cycle starts with the beginning of a
period and ends at the beginning of the ne.t period. 0ormally cloudy and tac"y, it becomes clear
and slippery %similar to egg whites) before ovulation. t will also be stretchy between your
fingers %spinnbar"eit). !o use these changes for birth control, you must be religious in observing
EO/$ pattern changes.
-eginning with your period, the days you are having your period are considered unsafe because
the blood can disguise changes in the mucus pattern. After your period, you may have a few days
when there is no mucus. !hese are called dry days and are safe. !he amount of mucus then
begins to increase once the egg starts to ripen. 3ucus will be cloudy, stic"y and white to
yellowish in color. !hese are also safe days. !hen the mucus changes to the slippery, clear
pattern a few days before ovulation. !his is the beginning of an unsafe %!H5 3O;! /0;A<5)
time. !he amount of mucus becomes the greatest Bust before ovulation. !he mucus may
suddenly become cloudy and stic"y again. t also may completely disappear Bust before your
period. <rom the beginning of the change in your mucus pattern until it disappears or changes
%four days after the greatest volume) are the days you must not have intercourse. Once you are
familiar with the mucus changes, you then only need to watch for changes until you are sure that
you have ovulated.
-reast feeding
-irth control vaccine
Terminal methods !steriliAation":
SteriliAation or Terminal method
tGs a good contraceptive procedure for those couples who want no more children. -oth men and
women get sterili:ations. !he number of women getting sterili:ed is more than male
sterli:ations.-ut the fact is male sterili:ation is a simpler, safer and cheaper process. Also, the
ris"s of complications are smaller. 3ale sterili:ation or vasectomy is performed under local
anesthetics. ?asectomies are &22H safe, if care is ta"en performing the operation.
)ale steriliAation: <irst of all vas is identified in the spermatic cord. Once it has been identified,
it,s removed at least Fcm after clamping. !he ends are legated, folded bac" and sutured so that
the cut ends may not reanaly:e in the future. !he stitches are removed on the =th day of
operation. !here are between 2-FH chances of recanali:ation of vas cut ends, a follow up for
three years is a good choice to minimi:e the possibility of re-fertility.
>omplications* !hey are very few such as pain, scrotal hematoma, spontaneous recanali:ation of
vas after operation. Another complication is appearance of sperm granules at &2-&9days after
operation. ;perm granules are hard masses appro.. Dmm in si:e, caused by accumulation of
sperm.
How to ta"e care after vasectomyK
!he male becomes sterile after (2 eBaculations have occurred after the vasectomy not as soon as
the operation is over. All vasectomy acceptors must avoid bath for 89hrs after operation. A
vasectomy acceptor doesnGt need bed rest after the operation but must avoid cycling or lifting
heavy weight for the first &=days of operation and wear a !-bandage or scrotal support in this
period. Peep the site clean and dry for &=days.
Female steriliAation: is less cost effective, it generally costs =times more than vasectomy. !here
are two well "nown techni6ues to carry out female sterili:ation namely laparoscopy and minilap
operation. Aaparoscopy* t,s a short time operation where the patient is re6uired to stay for a
minimum 9@hrs stay in hospital after operation. 1atient is selected before the operation, if
suitable for laparoscopy. #uring the operation an instrument called laparoscope is inserted into
the abdominal cavity and the abdomen is inflated with air to see the fallopian tubes. !he tubes
are occluded with the help of fallopian rings or clips. 3inilap operation* is a safe and simple
procedure and is suitable for post partum patients. !he operation is a modification of abdominal
tubectomy.A small abdominal incision 8.=-(cm is given under local anesthesia.
>omplications* >omplications are usually uncommon, but they might be of serious nature if
occur li"e puncture of large blood vessels.
PE)$(E(T STEI+IB$TI*( P*CED1ES:
+aparoscopic steriliAation R Aaparoscopic sterili:ation is a surgical procedure that is done in
an operating room at a time other than after childbirth. 4eneral or regional %e.g., spinal)
anesthesia is usually recommended. #uring the procedure, a small incision is made near the belly
button and in the lower abdomen and a telescope-li"e device %a laparoscope) is used to view the
fallopian tubes. !he physician uses rings or clips to close the fallopian tubes7 alternately, the
physician seals the tubes shut using electro coagulation %the fallopian tubes are burned and
become permanently sealed).
)inilaparotomy R A minilaparotomy is a surgical procedure done one to two days after
childbirth. t is done in an operating room using general, regional, or local anesthesia. !he
physician ma"es a small incision %one to three inches) in the abdomen, and then removes a
section of the fallopian tubes on each side. n the postpartum period, the procedure does not
lengthen the hospital stay.
One advantage of minilaparotomy is that a tissue specimen is removed to ensure that the
fallopian tubes have been completely cut. #isadvantages of minilaparotomy include a greater
need for pain medication, a slightly longer recovery time, and a larger surgical incision than with
a laparoscopic procedure.
#ysteroscopic steriliAation R Hysteroscopic sterili:ation is a procedure that may be done in the
office or operating room using local anesthesia. !he 5nsure permanent birth control procedure
uses a tiny coil mechanism, which is inserted through the cervi. and uterus into the fallopian
tubes.
After the coil is placed, scar tissue develops, causing the tubes to become sealed shut. !he
woman must use another form of birth control for three months after the coil is placed. At this
time, a procedure called hysterosalpingogram is performed to confirm that the tubes are bloc"ed.
f the tubes are not completely bloc"ed, the procedure may be repeated.
Hysteroscopic sterili:ation is best done seven to ten days after the start of a womanGs menstrual
period. n some cases, the provider will recommended an inBectable birth control treatment
%medro.yprogesterone acetateC#epo 1rover) two to three wee"s before the procedure to ma"e it
easier to place the coils %and eliminate the ris" of pregnancy beforeCafter the procedure).
!he advantages of hysteroscopy sterili:ation are that no sedation or general anesthesia are
re6uired %e.g., the woman is not sleepy and may drive herself home), and there are no incisions.
>ompared to other forms of surgical sterili:ation, hysteroscopy sterili:ation costs less, allows the
woman to spend less time in the hospital, is well tolerated, and causes less severe post-operative
pain.
!he disadvantages of hysteroscopy sterili:ation include the need for an alternate form of birth
control for three months after the coil is placed and the potential need to repeat the procedure. n
one study, appro.imately &= percent of women did not have complete bloc"age of one or both
tubes after three months.
PE)$(E(T STEI+IB$TI*( *1TC*)ES:
Complications R >omplications of laparoscopic and minilaparotomy procedures occur in
appro.imately & of every &222 procedures. !he most common complications include infection,
bowel or bladder inBury, internal bleeding, and problems related to anesthesia.
!he complication rate with hysteroscopy sterili:ation is appro.imately 2.28 per &222 procedures.
!he most common complication is perforation of the uterus %when an instrument creates a small
tear through the uterine wall). !his does not usually re6uire treatment and does not have any
long-term conse6uences.
)enstrual periods R there is no evidence that bleeding or uterine cramping increases after
sterili:ation. n fact, women who undergo sterili:ation are more li"ely to have fewer days of
bleeding during menstruation, a lower amount of blood loss, and less menstrual pain. However,
sterili:ed women have described more cycle irregularity than women who were not sterili:ed.
Se;ual desire R ;terili:ation does not affect se.ual desire or performance.
Pregnancy R it is uncommon for sterili:ation to fail, allowing a woman to become pregnant. n
one study of women who had laparoscopic or minilaparotomy sterili:ation and were followed for
@ to &9 years, appro.imately & percent of women became pregnant. !he ris" of pregnancy was
highest among women who underwent sterili:ation at a young age %under age (2) and among
women who had clips placed on the tubes.
!he failure rate for hysteroscopy sterili:ation is also 6uite low, estimated to be less than &
percent. -etween &''D and 822=, appro.imately =2,222 procedures were performed and F9
pregnancies were reported to the manufacturer. 3ost pregnancies occurred in women who did
not have appropriate follow-up %e.g., testing to confirm that the tubes were bloc"ed).
When pregnancy occurs after a sterili:ation procedure, it is more li"ely to be an ectopic
pregnancy. <or this reason, any woman who has had undergone sterili:ation and then misses or is
late for a menstrual period should consult her healthcare provider for advice about the need for a
pregnancy test.
$FTE PE)$(E(T STEI+IB$TI*( S1-E,:
+aparoscopy and minilaparotomy R A few hours after laparoscopic or minilaparotomy
sterili:ation, most women are able to go home. ;omeone should be available to drive and help as
needed. !here will be some discomfort at the incision site and menstrual-type cramping7 this can
be treated with pain medication such acetaminophen %!ylenolS) or ibuprofen %AdvilS,
3otrinS). ;ome women will have a sore throat %from a tube placed to help with breathing during
general anesthesia), nec" or shoulder pain, vaginal discharge, or light bleeding.
3ost women are able to return to a normal routine within a couple of days. !he woman is
usually instructed not place anything in the vagina %eg, tampons, douches) and to avoid se.ual
intercourse se. for appro.imately two wee"s.
#ysteroscopy R hysteroscopy sterili:ation, most women are able to drive themselves home or
bac" to wor"Cschool. f a sedative was used, the woman should have someone else drive her
home. 3ost women e.perience mild cramping, which can be treated with an over-the-counter
pain medication such as acetaminophen %!ylenolS) or ibuprofen %AdvilS, 3otrinS). A small
amount of vaginal bleeding or discharge may occur for a few days after the procedure7 no
treatment is re6uired. 3ost women are able to return to normal activities the same day.
!he woman should be sure to use an additional form of birth control %eg, pills, condoms,
diaphragm) until a test is done, usually three months later, to confirm that both tubes are
completely bloc"ed.
PE)$(E(T STEI+IS$TI*( I( &*)E(
!his is an abdominal operation in women and could be performed 9@ to D8 hours after delivery.
t is done by cutting the fallopian tubes through which eggs pass from the ovaries to the womb
and closing the cut ends of the tubes. !his procedure facilitates the ovum to get disintegrated into
the blood as there is no way for it to pass through the tubes to the uterus. !he egg is unable to
pass after this surgery but gets disintegrated into the blood. 0ow recently the method of vaginal
!ubectomy is gaining great importance. !his could be done nonpuerperaily only. !his is
advantageous for the simple reason that that there will not be any e.ternal scar and can be done
at any time. A !ubectomy is done during the present timings as a non puerperal surgery also on
those women who decide to adopt this permanent method. However in such situation it leads to a
laparotomy. $ecently Aaparoscopic sterili:ation is performed during 9@-D8 hours of post-partum
period. !his helps to avoid visible scar and minimum hospitali:ation but it is a sophisticated and
costly procedure.
3ini -laparotmy is a modification of abdominal !ubectomy. !he incision is 8.=cm to ( cm. t is
suitable for postpartum tubal sterili:ation. t is more safe, efficient and easy in dealing with
complications. 1uerperal sterili:ation is commonly done in ndia and is becoming popular
gradually.
-ut one has to remember that this is the terminal method of contraception.
PE)$(E(T STEI+IS$TI*( I( )E(:
t consists of cutting and tying the vas passage through which sperm travels from the testicles to
the genital passage %closure of small ductivas). !he effect of the operations is the absence of
spermato:oa in the semen7 thus pregnancy is prevented. 0o scalpel vasectomy is a new
techni6ue. t is a safe, convenient and acceptable to males.
!here are certain points to remember regarding vasectomy*
&. t does not produce impotence7 no gland or organ is removed.
8. t does not cause any mental illness or wea"ness.
(. After vasectomy some form of contraceptive has to be used for @-&8 wee"s as it ta"es that
long for semen to become completely free from spermato:oa. 5ach case should be
considered of its own. -oth husband and wife should agree for this surgery.
Criteria to be considered in carrying out 2asectomy:
&. 5ven with two children, vasectomy is considered ade6uate,
8. 3ale to be healthy,
(. 3an should be (= years of age
9. 3entally balanced,
Important points to remember for puerperal steriliAation:
8. t does not involve removal of se. glands.
(. t does not cause any wea"ness.
9. t is a permanent method, does not interfere with secretions of any hormone.
9. -oth husband and wife should give written consent.
!he 4overnment of ndia offers cash incentives to individuals undergoing sterili:ation operation.
F$)I+, &E+F$E C$)P:
!he responsibilities of the health wor"ers and health assistants are as follows*
0EF*E C$)P*
1repare an eligible couple register %5>$) village wise. Eou can prepare a list of
couples eligible for sterili:ation, in each village, i.e., those with 8-= living children.
1repare a list of sterili:ed couples who can help motivate other eligible couples in their
villages.
3otivate and inform eligible couples about the date, time and venue of the camp.
;elect suitable cases for sterili:ation. $eBect those who have fever, s"in eruption, hernia,
hydrocoele or any other infection. Anemic women with hemoglobin less than D2H should
be given iron and folic acid tablets.
As" the men to shave the public area and upper part of thighs before they come to the
camp. Advise all the people coming for operation to have bath and change clothes before
coming to the camp. !he community health wor"er can do this tas".
4ive each case a referral slip with 5>$ number on it.
!ransport may be arranged for the cases to reach the camp site. <or this you have to
coordinate with the medical officer.
D1I(- C$)P:
Assist in registration of cases and chec" that the other partner has not been already
sterili:ed. 4et their written, signed consent on the register.
Assist the 3.O. in the medical-chec"-up of cases before operation %female wor"er).
5.amine urine for sugar and albumin %female wor"er).
Assist in preparation of the patient %female wor"er)*
-- shaving of the public area and upper part of thighs in case of vasectomy or of lower
abdomen, public area and upper part of thighs in case of tubal ligation.
-- wash the part with soap and water with cotton swabs.
-- !-bandage or abdominal binder applied to the area.
J give psychological supportRallay fears and an.iety by simple e.planation of the
operation involved and the duration of operation.
J assist the doctor at operation %health assistants).
Assist with sterili:ation of instruments.
$FTE *PE$TI*(
>hec" vital signs of patients and record. nform any abnormalities.
Advice regarding post-operative care to patients as follows*
/$SECT*),:
4ive scrotal support until stitches are to be removed and advice the patient to*
Peep area dry and clean.
Have no se.ual intercourse for twelve %&8) eBaculations and to use 0irodh. 4ive &8
0irodh to each such person.
;titches to be removed at 1H>C;> by doctor or HA on third or fourth day.
Avoid cycling or heavy manual wor" for one month.
$eport if there is high fever, bleeding, swelling or pain in the scrotum.
$eport to 1H> for semen e.amination after twelve %&8) eBaculations.
T10$+ +I-$TI*(
Peep area dry and clean.
4et the stitches removed on si.th or seventh day at 1H> or sub- center.
0o heavy manual wor" or lifting heavy weights for three months.
1H0 should*
?isit sterili:ed person in the home on second or third day after operation to find out any
problems.
$emind the vasectomi:ed person or the ligated women to come to 1H>Csub-centre on the
third or fourth day and Fth-D
th
day for removal of stitches respectively.
0A!O0AA <A3AE 1AA0004 1$O4$A335
Increasing the Demand for FP Ser2ices
&. -y comprehensive media campaign to address the unmet need for family planning services, emphasi:e
on males as Nresponsible partnersN and to promote 0;?.
Sl%
*b8ecti2es
&
1ercentage reduction in unmet need for spacing methods among eligible couples
8
1ercentage reduction in unmet need for terminal methods among eligible couples
(
ncrease in contraceptive prevalence rate among eligible couples
9
$eduction in percentage of girls marrying below age &@
8.
-yorganisingintegrted$>Hcamps.
ntegrated $>H camps provide a wide range of services including counseling, antenatal and post-natal
chec"-ups, !! vaccination and <A distribution, $!C;! treatment, immuni:ation of children, />#
insertions, oral pills, condoms and sterili:ation services including 0;?. !hese camps will also provide
complete information on different type of services available. >amps will be conducted in all the @9
bloc"s as per the norms.
(. 3edical Officers, A03s and Ain" Wor"ers are being made responsible for spreading the message
among couples in general and counsel them to avail the services.
9. 5mergency contraceptives have been made available to all >H>s and 1H>s
Family Planning camps*
<amily 1lanning camps are being held at all bloc" level 1H>GsC>H>Gs on every !hursday on
rotation and at district hospital on every !uesday of each month.
T#E P*P1+$TI*( ECP+*SI*(:
ndia is noted for its large population, ran"ing second, ne.t to >hina, in the world. At present
ndiaGs population is e6ual to that of /.;.A., the then /.;.;.$., and Oapan put together. t is found
that ==,222 babies are born every day in ndia. !here are nearly 8& million births and @ million
deaths occurring annually which results in an addition of &( million populations each year. At
this rate it was estimated that by &'@&, the population of ndia would e.ceed D22 million. !he
&'@& census as of 3arch &st revealed that the population of ndia was F@( million %according to
the >entral -ureau of Health ntelligence, Health ;tatistics of ndia, 0ew #elhi, &'@&), where as
the World 1opulation $eference -ureau at Washington in /;A mentions that the &'@&
population of ndia was F@' million, However as mentioned earlier the population by now
%&'@8) would have reached nearly D22 million.
ndiaGs population is rapidly growing. !he following table will e.plain how fast the growth rate
has been during the past @2 years.
1opulation e.plosion*
&. 1opulation e.plosion create serious law and order problem because e.isting agencies
which are responsible for maintain law and order find it impossible to copes with the
problem.
8. t becomes very difficult to provide houses to the ever increasing pollution with the result
that the people begin to live in shums and shanties.
(. When vast maBority lives in shanties then the problem of maintain moral character arises.
3oral usually become low and results in many social problems.
9. t becomes difficult to maintain and even se. ratio which gets disturbed 6uite fre6uently,
resulting in many social problems.
=. !he society finds it almost impossible to provide employment opportunities to the
increasing pollution. !his results in poverty and unemployment.
F. 0ations finds it almost impossible to provide ade6uate health facilities to the growing
population.
D. t becomes also difficult for the nation to provide schooling and higher educational
facilities to the growing population.
@. When nation cannot provide facilities to the growing population, the result is that for
getting whatever facilities are available, corrupt means used.
1opulation problem has three dimensions.
t is concerned with,
%&) !he number of people versus limited amount of material resources.
%8) 1eople versus cultural resources.
%() ;ocietyGs ability to satisfy manGs total needs, physical, mental and social.
Over population has the following effect,
!a" Effect on nation
5ven if all the resources are tapped to feed the added mouths, this is not at ail sufficient. !his
leads to low standard of living, unemployment and overcrowding.
!b" Effect on family
<amily income in ndia is so low that if the number of people in a family to be cared for
increases, the parents will not be able to cope up with additional demands of food, clothing or
education- !his leads to less happiness and insecurity in the family.
!c" Effect on mother
3otherGs general health gets impaired with increased number of pregnancies. !he adverse effects
of repeated pregnancies lead to problems of anemia in a mother and ma"e her more prone to
other infections.
!d" Effect on child
f pregnancies occur too fre6uently in a family, the child gets very little attention7 thereby
problems of malnutrition and maternal deprivation occur.
According to Oohn #. $oc"efeller who was the >hairman of 1opulation >ouncil of /.;.A., the
obBective of wor" in family planning is
%
not the restriction of human life but rather its
enrichmentG. !herefore family planning may be defined as planned regulation by a married
couple of the pregnancies which are liable to result from their conBugal union through adoption
of methods selected to avoid unwanted pregnancies. ?ery often the very word G<amily 1lanningG
has a wrong connotation in the minds of people7 it is e6uated merely to G-irth >ontrolG. ;o it is
very important for nurses to understand this concept clearly.
C$1SES *F */EP*P1+$TI*(:
As nurses it is essential to "now the various reasons for such rapid growth of population. n ndia
several factors including religion and culture influence the si:e of the population.
!he important reasons for a high birth rate in ndia may be stated as follows
!a" Early age at marriage
!he need for every child to be married at an early age. !his increases the reproductive
span. !he Hindu 3arriage Act %&'==) provided &= years of age for females and &@ years
for males as minimum age of marriage. However, &'F& census showed that =2H of the
girls got married before the age of &= years, and nearly 82 million married females were
in the age group of &2-&' years. !he >hild 3arriage $estraint Act of &'D@ increases the
legal age at marriage from &= to &@ years for girls and &@ to 8& years for boys. ;tudies
reveal that in &''&, n many states the mean age at marriage for girls has already moved
to &' years. n the rural areas of 3adhya 1radesh, $aBasthan and /ttar 1radesh, marriages
continue to ta"e place when the girl is around &= years of age.
!b" Early puberty:
ndian girls attain puberty at the age of &8-&9 years, which is fairly early. 4irls getting married at
this age are liable to conceive and reproduce. Hence the number of children in a family could be
more leading to over population in the country.
!c" Standard of +i2ing:
-irth rates are high among those where living standards are low as they want more children to
ma"e up for high losses among infancy and early childhood period.
!d" Education:
5ducated parents are aware of the responsibilities towards their children. &'F& census showed
only 89H of the population were literate. !he literacy rate in the country has improved but there
is a. clear difference between literacy in males and females. According to &''& census total
literacy above D years of age is =8.&' with male literacy of F9.8 and females of ('.&'. ;o, as long
as this remains so low, population problem will continue. !he details of the literacy rate in
different states are given in !able 8F-8.
!e" Social Customs and Tradition:
n ndia there is a feeling that everyone should get married. f a boy or a girl is not married, the
parents feel the burden. !he community loo"s down upon the individual and the family if for any
reason the marriage is delayed.
>hildren are considered7 as a gift of 4od and their birth should not be obstructed.
Also there is a need felt by several communities to have a son to light the funeral pyre of the
father. !his practice too adds to more births in a family.
!f" $bsence of family planning:
n ndia people are still not aware of the concept of planning the families.
&orld population:
World population at mid-8222 was F.2Fbillion and is growing by D= million people per year. t
was &.Fbillion in &'2&. 3ore than '=H of the growth is ta"ing place in developing countries,
according to the /0 state of world population 8222. /0 LproBections are global population, now
on a declining growth trend, will be close to ' billion in 82=2.
Indian population*
ndia,s population crossed the one billion mar" at the start of the twenty-first century to
become the second largest, after china, and stood at &28D,2&=,89D on 3arch &, 822&.
According to previous results, the growth of 1opulation %annual) in the decade &''&-822&
was &.'H as against 8.&H in the previous decade, but it was still higher than the
assumptions ranging from &.Fto &.@H.
!he over &28D million population comprised =(&,8DD,2D@ males and 9'=,D(@,&F'
females. !he se. ratio of femalesC&222 males was an improvement over the &''& figure
of '8D.
+iteracy:
n the &''& the literacy rate is =8.8&H
n the 822& the literacy rate is F=.(@H %D=H for males and =9H for females)
!his means that (C9
th
of the male population and more than half of the female population
is literate.
n &''& the 3ale-female literacy rate from 8@.@9
n 822& the 3ale-female literacy rate from 8&.D2.
(ational population policy:
t is built on the e.perience of half a century in national family welfare programme.
4overnment of ndia has adopted a national population policy in 8222.
ObBective* is to meet the needs for contraception and health care infrastructure and
!o provide integrated service delivery for reproductive and child health care.
A commission on population has been set up to monitor and directions for the
implementation of the population policy.
(ational Population Policy by 3494:
1opulation policy refers to policies which intend to decrease the birth rate. n ndia the first
population policy was framed in &'DF emphasi:ing the increase in the legal minimum age at
marriage from &= to &@ years and &@ to 8& years for males.
!he new 0ational 1opulation 1olicy 8222 deals not only with fertility and mortality rates but
also with womenGs education7 empowering women for improved health and nutrition7 child
survival and health7 needs for family welfare services , that are yet to be covered7 health care for
neglected population, adolescent health7 participation of men in planned parenthood and
collaboration with 04Os.
(ational Socio-Demographic -oals for 3494*
&. Address the unmet needs for basic reproductive and child health services, supplies and
infrastructure.
8. 3a"e school education up to age &9 free and compulsory, and reduce drop outs at
primary and secondary school levels to below 82 percent for both boys and girls.
(. $educe infant mortality rate to below (2 per &222 live births.
9. $educe maternal mortality ratio to below &22 per &22,222 live births.
=. Achieve universal immuni:ation of children against all vaccine preventable diseases.
F. 1romote delayed marriage for girls, not earlier than age &@ and preferably after 82 years
of age.
D. Achieve @2 percent institutional deliveries and &22 percent deliveries by trained persons.
@. Achieve universal access to informationCcounseling, and services for fertility regulation
and contraception with a wide bas"et choice.
'. Achieve &22 per cent registration of births, deaths, marriage and pregnancy.
&2. >ontain the spread of Ac6uired mmunodeficiency ;yndrome %A#;), and promote
greater integration between the management of reproductive tract infections %$!) and
se.ually transmitted infections %;!) and the 0ational A#; >ontrol Organi:ation.
&&. 1revent and >ontrol communicable diseases.
&8. ntegrate ndian ;ystems of 3edicines %;3) in the provision of reproductive and child
health services, and in reaching out to households.
&(. 1romote vigorously the small family norm to achieve replacement levels of !<$.
&9. -ring about convergence in implementation of related social sector programs so that
family welfare becomes a people centered programme.
EFEE(CE:
&. P.1ar" par" te.t boo" of preventive and social medicine bhanot publications, 82
th
ed,
822', page no =DF-@D
8. Oudith Ann All ender >ommunity Health 0ursing 1romoting and protecting the public
health, Aippincott publications, F
th
edition, 822=, page no* D@'-'@
(. 3acia ;tanhope >ommunity and public Health 0ursing 3osby publications, Fth
edition, 8222, page no* D@8-@F.
9. Pasturi sunder rao An introduction to community health nursing , -..publications, (
rd

edition, 8222, page no*=D'-F29
=. www.docstoc.comC...family welfare
F. !e.t boo" of 40O/ >onducting family planning programmes page no. &D-&@