RESPONSIBLE PARENTHOOD

(Family Planning)
THE PHILIPPINE FAMILY PLANNING PROGRAM
In consonance with the National Objectives for Health (NOH) for 2005-2010, which specifies a clear and
concrete way of achieving the targets set in the Millennium Development Goals (MDGs) and the Medium
Term-Philippine Development Plan (MTPDP), the family planning program aims to contribute to reduce
the following :
1.
2.
3.
4.

Infant death
Neonatal mortality
Under five deaths
Maternal death

Vision of Family Planning Program

To empower women and men to live healthy, productive, and fulfilling lives with the right to achieve their
desired family size through quality, medically sound and legally permissible family planning methods.
Mission of Family Planning Program
The DOH, in partnership with the LGUs, NGOs, private sector, and communities shall ensure the
availability of FP information and services to men and women who need them.
Goal of Family Planning Program
To provide universal access to FP information and services whenever and wherever these are needed.
Objectives of Family Planning Program
1. The FP program addresses the need to help couples and individuals achieve their desired family
size within the context of responsible parenthood and improve their reproductive health to attain
sustainable development
2. It aims to ensure that quality FP services are available in DOH- retained hospitals, LGU-managed
health facilities, NGOs, and the private sector.
Guiding principle of FP / Four Pillars of the FP program:
1. Responsible Parenthood- It is the will and ability to respond to the needs and aspirations of the
family. It promotes the freedom of responsible parents to decide on the timing and size of their
families in pursuit of a better life.
2. Respect for Life- The 1987 constitution protects the life of the unborn from the moment of
conception. FP aims to prevent abortions thereby saving life of both women and children.
3. Birth Spacing- Proper spacing of 3-5 years from recent pregnancy enables women to recover
from pregnancy and to improve their well-being, the health of the child, and the relationship
between husband and wife, and between parents and children.
4. Informed Choice- Fully informed of the method including side effects, disadvantages and
advantages. Couples and individuals may choose the methods that they will use to exercise

responsible parenthood in accordance with their religious and ethical values and cultural
background, subject to conformity with universally recognized international human rights.
Policies of FP - Administrative Order No. 50-A s. 2001, prescribes the key policies for FP
services focus on modern FP methods including Natural family planning;
1.
2.

3.
4.
5.
6.
7.
8.

The FP Program is viewed as a health intervention initiative to promote the overall health of all
Filipinos.
FP information and services will be provided based on voluntary and informed choice to all
women and men of reproductive age regardless of age, sex, number of children, marital status,
religious beliefs, and cultural values .
Only medically safe and legally acceptable contraceptive methods shall be made available in all
government, NGO, and private health facilities.
Quality care must be promoted and ensured in providing FP services. Privacy and confidentiality
should be strictly observed in the provision of services at all times.
Effort must be undertaken to orient clients on fertility awareness as the basic information to fully
understand and appreciate FP.
Multi-agency agency participation is essential. Involvement of the private sector, academe,
church, media, community and other stakeholders are encouraged at all levels of operations.
FP services, in the context of reproductive health approach, must be integrated in the delivery of
other basic health services.
Sustainability of FP services and commodities must be promoted through the localization of the
Contraceptive Self- Reliance (CSR).

Strategies of Family Planning Program:

1.
2.
3.
4.
5.
6.

Focus service delivery to the urban and rural poor.

Reestablish the FP outreach program.
Strengthen FP provisions in regions with high unmet needs.
Promote frontline participation of hospitals.
Mainstream modern natural family, (DOH AO # 132, S. 2004)
Promote and implement CSR strategy. (DOH AO# 158, S. 2004)

METHODS OF FAMILY PLANNING:

A. I- FERTILITY AWARENESS- BASED METHODS (FAB) these are Natural Family
Planning contraceptive methods hinged on the awareness of the beginning and end of the
fertile time of a womans menstrual cycle either to achieve or avoid pregnancy.
> The method include practicing abstinence, which provides a time barrier between the sperm and
the egg by avoiding sexual intercourse during the fertile phase.
>These method therefore, depend upon the couples ability to identify the fertile phase of each
menstrual cycle, and their motivation and discipline to practice abstinence when required.
> To be effective as a means of contraception, FAB methods require appropriate counseling,
adequate teaching of the technique and supportive follow up
* METHODS UNDER FERTILITY AWARENESS-BASED (FAB)

A. BILINGS OVULATION/ CERVICAL MUCUS METHOD

B. BASAL BODY TEMPERATURE (BBT)
C. SYMTO-THERMAL
D. STANDARD DAYS
E. TWO DAYS
* GENERAL ADVANTAGES OF FAB METHOD
1. Effective when use correctly and consistently
2. No physical side effects
3. No prescription required
4. Inexpensive/ no medication involve, thus no medical appointments required
5. Better understanding of the couple about their sexual physiology and reproductive function
6. Encourage shared responsibility for family planning
7. Foster better communication
*GENERAL DISADVANTAGES OF FAB METHOD
1. May exhibit sexual spontaneity
2. Except for SDM, need extensive training takes about 2-3 cycles to learn to accurately
identify the fertile period and how to effectively use it
3. Requires a high level of diligence from both partners
4. Requires consistent and accurate record keeping and paying close attention to body changes
5. Requires period of abstinence, which may be difficult for some couple
6. Requires rigid adherence to daily routine of awakening at a fixed time, without enduring anny
disturbances before taking the temperature*(BBT and Sympto-thermal )
7. May be difficult to practice for women with multiple partners**(Ovulation method)
8. Can be use only by women whose cycles are within 26-32days***( SDM)
9. Offer no protection against STI/HIV/AIDS
A.1 Billing Ovulation Method/ Cervical Mucus Method- is the observation of the wet and dry
sensation in the vulva. The feeling of wetness and presence of mucus secretion which is wet,
slippery, and clear indicate a fertile period. The feeling of dryness and having no secretion or the
presence of pasty, non-stretchy mucus or unchanging mucus pattern a day after menstruation
indicate the non-fertile period.
>97% effective in perfect use, while 80% in typical use
> Abstaining from sexual intercourse during fertile (wet) days prevent pregnancy
* How it is used:
1. Recording of menstruation and dry days
2. Inspecting underwear regularly for presence of mucus
3. Recording the most fertile observation/characteristics at the end of the day.
*Symbols use to record /chart fertile and infertile days
R= menstruation or regla, spotting
D= dry or no mucus

M= dry with sticky, pasty, or crumbly mucus

X= wet with slippery clear, or watery mucus
Xx= for peak days or last day of wetness
1,2,3= post peak days
Heart symbol= dates of love making
Advantages:
*Can be used by any woman of reproductive age as long as she is not suffering from an unusual
disease or condition that results in extraordinary vaginal discharge that makes observation difficult
Disadvantages: cannot be used by woman with the following medical condition:

That would make pregnancy especially dangerous

Irregular menstruation cycles, vaginal bleeding between periods, heavy/long monthly bleeding
Recently gave birth or had a miscarriage
Exclusive breastfeeding
That affects the ovaries like stroke, serious liver disease, cervical CA, hypo and hyperthyroidism
Infectious disease/ disease that changes cervical mucus (eg. STIs or PID ) in last 3 months
Taking drugs that affects mucus like antidepressants, lithium, anti anxiety drug

A.2 BASAL BODY TEMPERATURE-is identifying the fertile and infertile period of a womans cycle by
daily taking and recording of the rise in body temperature during and after ovulation
> 99% effective in perfect use
>80% effective in typical use
> Can be use by any woman of reproductive age who is willing to take and record her BBT daily and
practice abstinence during fertile periods
> There are no medical precaution in the use of BBT. However, take note of any condition that will affect
body temperature such as infection, taking of alcohol etc.
* How to use:
A thermometer is placed in axilla or under the tongue to get the temperature at least 3hours of undisturbed
rest ( upon waking up and before any activity) throughout the menstrual cycle. Cover line is being
determine to identify the highest temp. from day 6-10 of the cycle to identify thermal shift ( the 3
consecutive temp. above the cover line labeled as days 1,2,3) intercourse is allowed only from the fourth
day of thermal shift until the end of the cycle. These are known as absolute infertile phase days.
A.3 SYMPTO-THERMAL METHOD is identifying the fertile and infertile days of the menstrual
cycle as determine through a combination of observation made on the cervical mucus and BBT recording
and other signs of ovulation.

> 98% in perfect use and 80 % in typical use

A.4 THE TWO-DAY METHOD- is a simple fertility awareness based method of FP that involves cervical
secretions as an indicator of fertility and checking the presence of secretion everyday .
* if a woman notices any secretions today or yesterday, she could consider herself fertile and avoid
intercourse today(this is also what the billing ovulation is based on)
* ADVANTAGES AND DISADVANTAGES REFER TO BILLING OVULATION METHOD
A.5 STANDARD DAYS METHOD A new method of natural family planning in which all users with
menstrual cycles between 26 and 32 days are counseled to abstain from intercourse on days 8-19 to avoid
pregnancy. The couple uses a device, the color coded beads to mark the fertile and infertile days of
menstrual cycle.
*ADVANTAGES;
1. No health related side effects associated with its use
2. Increases self awareness and knowledge of human reproduction and can lead to a diagnosis of some
gynecologic patterns
3. No need for counting or charting since this method makes use of beads for tracking the cycle days
4. Can be used either to avoid or achieve pregnancy
5. Very little cost and promotes male partners involve in FP
6. Enhances self discipline and mutual respect
7. Provides opportunity for enhancing the couple sexual life
8. Can be integrated in health and FP services
9. Acceptable to couples regardless of culture, religion, socioeconomic status and educational level
10. Not dependent on medically qualified personnel; the technology can be transferred by a trained
autonomous user
11. Once learned, may require no further help from health care provider
*DISAVANTAGES;
1. Cannot be used by women who usually have menstrual cycle between 26 and 32 days long
*How to use ;
>abstain from sexual intercourse during fertile period
>used color coded beads to mark the fertile and infertile periods

>95% effective in perfect use and 88% in typical use

A. 6 LACTATIONAL AMENORRHEA METHOD (LAM) - is the use of breastfeeding as a temporary
introductory postpartum method of postponing pregnancy based on physiological infertility experience by
breastfeeding women.
* ADVANTAGES:
* LAM is universally available to all postpartum breastfeeding women
* Using LAM, protection from an unplanned pregnancy begins immediately postpartum
* No other FP commodities are require
*It contributes to improve maternal and child health and nutrition
* DISADVANTAGES;
* Considered as an introductory short term FP method which is effective only for a maximum of 6 months
postpartum
* The effectiveness of LAM may decrease if a mother and child are separated for extended periods of
times (i.e. working mother etc.)
* Full or nearly full BF may be difficult to maintain up to 6 months due to a variety of social
circumstances
* Disadvantage to women who do not pass any of the 3 criteria to practice LAM
**CRITERIA FOR LAM
1. Amenorrhea
2. Nearly or nearly fully breastfeeding infant
3. Infant is less than 6months old
>99.5% effective in perfect use and 98% in typical use
B. PERMANENT METHOD
B.1. FEMALE STERELIZATION (BTL)- Is a safe and simple surgical procedure which provides
permanent contraception for women who does not want more children. Also known as Bilateral Tubal
Ligation that involves the cutting or blocking the two fallopian tubes
* ADVANTAGES;
1. Permanent method of contraception. A single procedure leads to lifelong, safe and very effective
contraception
2. Nothing to remember, no supplies needed, and no repeated clinic visits required
3. Does not interfere with sex

4. Results in increase sexual enjoyment-no need to worry about pregnancy

5. No effect on breastfeeding, quantity and quality of milk not affected
6. No known long term side effects or health risk
7. Minilaparotomy can be performed after a woman gives birth
*DISADVANTAGES;
1. Uncommon complication of surgery: infection or bleeding at the incision site, internal infection or
bleeding, injury to internal organs, anesthesia risks uncommon with local anesthesia.
2. In rare cases, when pregnancy occurs, it is more likely to be ectopic than in a woman who has not
undergone the procedure.
3. Requires physical examination and minor surgery by trained service provider
4. Requires an operating set up
5. Permanent-reversal surgery is difficult, expensive and not available in most areas
6. Do not protect against sexually transmitted infections including HIV/AIDS
7. Client may have limitation in physical activities such as heavy work and lifting heavy objects
immediately after surgery
> 99.5% effective in both perfect and typical use
B.2 MALE STERILIZATION (VASECTOMY) is a permanent method wherein the vas deference
is tied and cut or blocked through a small opening on the scrotal skin. It is also known as vasectomy
* 2 approaches in vasectomy
1. Traditional/ incisional vasectomy where a small incision is done in the scrotal skin using a scalpel
2. No scalpel vasectomy (NSV) where a puncture wound using a vas dissecting forceps is made at
the midline of the scrotal skin to reach both vas on either side. This offers lesser pain and tissue
trauma, shorter operating and recovery time . NSV is now the operation of choice.
*ADVANTAGES:
1. Very effective 3 months after the procedure
2. Permanent, safe, simple, and easy to perform
3. Can be performed in a clinic, office or at a primary care center
4. No resupplies or repeated clinic visits
5. No apparent long term health risk

6. An option for couples whose female partner could not undergo permanent contraception
7. A man who had vasectomy will not lose his sexual ability and ejaculation, not affect hormonal
function
8. Does not lessen but actually increase the couples sexual drive and enjoyment
* DISADVANTAGES;
1. It may be uncomfortable due to slight pain and swelling 2-3 days after the procedure
2. Reversibility is difficult and expensive
3. Bleeding may result in hematoma in the scrotum
4. No protection against sexually transmitted infections including HIV/AIDS etc.
> 99.9% effective in perfect use and 99.8% in typical use
C. ARTIFICIAL METHODS:
C.1.a. COMBINE ORAL CONTRACEPTIVE- Are pill preparation that contains hormones
similar to the womans natural hormones-estrogen and progesterone- taken daily to prevent
conception. They are also known as Pills .
> Combine low dose pills suppress ovulation, without ovulation pregnancy cannot occur
> They also make the cervical mucus thick and inhospitable to sperm discouraging entry
to the uterus, secondary effects are changes in the endometrium and reduction in sperm
transport in the fallopian tube
** ADVANTAGES:
1. Safe as proven through extensive studies
2. Convenient and easy to use
3. Makes menstrual cycles more regular and predictable
4. Reduces symptoms of gynecologic conditions such as painful menses and endometriosis
5. Reduces the risks of ovarian and endometrial cancer
6. Reversible rapid return to fertility: fertility returns after discontinued use
7. Does not interfere with intercourse
***DISADVANTAGES:
1. Often not use correctly and consistently, lowering its effectiveness
2. Has side effects such as nausea, dizziness, breast tenderness, which are not generally harmful
but which some women may find difficult to tolerate
3. May pose a health risks for a smaller number of women
4. Offers no protection against sexually transmitted infections, including HIV
5. Effectiveness may be lowered when taken with certain drugs such as rifampicin and most
anticonvulsants
6. Can suppress lactation
7. Requires regular supply
99.7% effective in perfect use and 92% in typical use
** OTHER DELIVERY SYSTEM OF COMBINE ORAL CONTRACEPTIVE

1. TRANSDERMAL CONTRACEPTIVE- called Ortho Evra develop in the United States, is a

2cm path that can be applied to the abdomen, upper torso, upper outer arm, or buttocks where
it continuously releases low doses of estrogen and progestin through the skin and into the
blood stream, A single patch is used for a week , discard and replace with a new one. Three
weeks of use are followed by a free week to allow menses.
2. VAGINAL RING called Nuva ring, is a flexible and transparent ring that is slightly smaller
than a diaphragm. Inserted into the vagina, where it continuously releases low doses of
estrogen and progesterone. (follow same procedure with TC)
C.1.b. Progestin only Pills - Oral hormone contraceptive that contains progestin only.
** ADVANTAGES:
1. Can be used by breastfeeding mothers 6 weeks after birth. No effect on the quality and
quantity of milk. Can be very effective during breastfeeding
2. No estrogen side effects
3. Better compliance in pill taking, as women take only 1 pill everyday with no break.
4. Even less risks of progestin side effects such as acne and weight gain
5. May help prevent benign breast disease, endometrial and ovarian cancer, PID
**DISADVANTAGES:
1.
2.
3.
4.

Women who are not breastfeeding experience changes in menstrual pattern

Less common side effects include headache and breast tenderness
Does not prevent ectopic pregnancy
Need to be taken at about the same time each day to work best

C.2. COMBINE INJECTABLE CONTRACEPTIVE ; ( no preparations are currently available in the

country but currently used in other country
> Are monthly injectable preparations containing a short- acting natural estrogen and a long- acting
progesterogen that are given intramuscularly, which are slowly released over a period of 28 days.
C.3. PROGESTIN- ONLY INJECTABLES:
> Progestin- injectable contraceptives contain the synthetic, hormone, progestin, administered by deep
intramuscular injection
* Stock available in the Philippines
1. 1ml 150mg Depot-Medroxyprogesterone Acetate (DMPA) or Depo- Provera
2. 3ml 150mg DMPA or Depo Trust
3. 1ml Ampoule 200mg Norethisterone Enanthate (NET- EN) or Noresterat
** DMPA is given every 3 months, whereas NET-EN Noristerat is administered every 2 months.
It suppresses ovulation, thickens cervical mucus, changes uterine lining

***ADVANTAGES:
1.
2.
3.
4.
5.

Reversible
No need for daily intake
Does not interfere with sexual intercourse
Perceived as culturally acceptable by women
Has no estrogen related side effects such as nausea dizziness, nor serious complication such
as thrombophlebitis or pulmonary embolism
6. Does not affect breastfeeding.
***DISADVANTAGES:
1.
2.
3.
4.
5.
6.
7.

Return to fertility is delayed- average is 10 months from the last injection

Requires an injection every 2 to 3 months to continue its effect
Does not protect against STI/HIV/AIDS
Menstrual irregularity during the first few month
Amenorrhea; some women get anxious if they do not have menses
Not possible to discontinue immediately, until DMPA is cleared from the womans body
There may be bone loss for long term users but study shows possibility of reversibility

C.4. SUBDERMAL IMPLANTS:

> Are progestin- only implants inserted under the skin in the womans upper arm or forearm
through a minor surgical procedure under local anesthesia, which releases progestin at a controlled rate,
thus providing very small doses to achieve the desired contraceptive
***ADVANTAGES:
1.
2.
3.
4.
5.
6.

Reversible-fertility returns almost immediately after the capsules are removed

Does not require daily intake
Does not interfere with intercourse
Effective within 24 hrs after insertion
No estrogen- related side effect
Does not affect breastfeeding

***DISADVANTAGES
1. Client cannot start or stop use on their own. Must be inserted and removed by a trained health
worker
2. Requires minor surgical procedure with local anesthesia
3. Discomfort after several days after insertion
4. Need to remove capsule after a certain period of time
5. Initial cost is high
6. It is more difficult to remove than to insert
D.BARRIER METHOD:- Are devices that mechanically/chemically hinder /prevent the union of the egg
cell and the sperm cell ( Fertilization )

d.1. Intrauterine Device(IUD)- a small plastic or metal device inserted into the womens uterus to
prevent pregnancy. It releases cooper or a hormone. Almost all IUD has one or two strings, or nylon
threads tied to a plastic frame, and hang through the cervical opening into the vagina.
***ADVANTAGES
1.
2.
3.
4.
5.
6.
7.
8.

Low cost and Local action

Has no effect on the amount and quality of breast milk
Does not interfere with intercourse
One time application
Immediate return to fertility upon removal
Can be inserted immediately after childbirth or after abortion
Can be easily removed or inserted by a trained health worker
Long lasting, 10 years

*** DISADVANTAGES:
1.
2.
3.
4.
5.
6.
7.

Has common side effects such as pain and cramping

Longer and heavier menstrual bleeding and with menstrual irregularities
Device may be expelled, without the women knowing
Requires a pelvic exam to insert the IUD
It requires a trained health worker to remove/insert it
Does not protect against STI/HIV etc.
Require self checking of IUD string from time to time

d.2. Male Condom- is a thin sheath of latex made to fit on a mans penis to prevent the passage
of the sperm cells and sexually transmitted disease organisms into the vagina. Some are coated
with lubricant or with spermicides.
>98% effective in perfect use and 85% in typical use
***ADVANTAGES
1.
2.
3.
4.
5.

Safe and has no hormonal effect

Protects against microorganism causing HIV/AIDS/STI etc.
Encourages male participation in FP
Easily accessible
Is use to manage premature ejaculation

*** DISADVANTAGES;
1.
2.
3.
4.
5.
6.
7.

May cause allergy to people who are sensitive to latex or lubricant

May decrease sensation, making less sex enjoyable for either partner
Interrupts the sexual act
Requires a mans cooperation for its use
Possibility of ripping or slippage during sexual act
Association of condom use with immorality
May make people embarrassed to buy or ask partner to use condom

d.3. Female Condom- is a thin sheath made of soft transparent polyurethane plastic, about 7-8cm in
diameter and 17cm long.

> It has 2 flexible ring with a smaller diameter is found in the close end of the condom, w/c aids the
women in inserting it high to the vagina near the cervix and the other is a flexible ring found at the open
end covering the vulva
> 95% Effective in perfect use and 79% in typical use
*** ADVANTAGES
1.
2.
3.
4.
5.

Dual protection, it can both prevent pregnancy and avoid sexually transmitted infections
There is no hormonal effect and medical precaution to limit the use of this method
Does not alter milk production
No allergic reaction reported
The use of the method is under control by the women

***DISADVANTAGES;
1. It is not yet locally marketed
2. It is expensive and can be used just once
3. A woman has to touch her genital before inserting the condom
d.4. DIAPHRAGM- Is a small dome-shape soft rubber cup with a flexible rim that goes inside the vagina
over the cervix. It is fitted by a trained health provider and use with spermicidal jelly/cream which serves
as a lubricant
> 94% effective in perfect use and 84% in typical use
> Works in 2 ways, I block the sperm from entering the cervix, It also acts as a device tp hold spermicidal
cream/jelly against the cervix that can immobilize or kill the sperm cel

d.5. The Cervical Cap It is a cap shaped device made of soft rubber that fits over the cervix and is held
in place partially by suction between its firm flexible rim and the surface of the cervix as the upper
vaginal wall
> 74% effective in perfect use and 68% in parous women
*** ADVANTAGES
1.
2.
3.
4.
5.
6.

Safe and is client controlled

Has a dual effect
Can offer contraception when needed and can stop any time
Has no hormonal effect
Can be inserted 6hrs. or more prior to sex act
Can protect the women for up to 48hrs. after infectio

***DISADVANTAGES
1. May be less effective for a women who had given birth recently due to the size of the cervix
2. Needs to be always with spermicides
3. Should be wash with soap and clean water and requires careful storage

4. There is a higher rate of failure in parous than among nulliparous women

5. Needs initial fitting by a health care provider
6. Needs pelvic manipulation in fitting or positioning the cervical cap
d.6. SPERMICIDES are made of an inert base and chemicals which the women places in her vagina
shortly before sex or before the penis touches the vagina
> 82% effective in perfect use and 71% in typical use
***ADVANTAGES
1.
2.
3.
4.

Can be use and stop any time

Safe and easy to use with just time practice
Can be used as early as 15 minutes before sex to avoid interruption
May increase vaginal lubrication

***DISADVANTAGES:
1. Can cause irritation or an allergic reaction on the womans vaginal mucosa or the partners
penis especially if used several times a day
2. Increase rate of urinary tract infection in users
3. Requires having the method at hand and taking correct action before each act of sexual
intercourse
4. Requires an inserter into the vagina, may be messy
5. Interrupts sex if not inserted before hand
6. Foaming tablets may cause a warm sensation
7. For melting type, a waiting period of 10min. but not more than 1 hour is needed before its
effect takes place.