Family Planning | 1

Family Planning
I. INTRODUCTION The overall goal of Family Planning is to provide universal access to family planning information and services wherever and whenever these are needed. Family Planning aims to contribute to: reduce infant deaths, neonatal deaths, under-five deaths, maternal deaths. It has the following objectives: 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. Ensure that the quality of Family Planning services are available in DOH retained hospitals, LGU managed health facilities, NGOs, and private sector. There are different strategies adopted to achieve goal and objectives such as: Focus service delivery to the urban and rural poor Re-establish the Family Planning outreach program Strengthen Family Planning provision in regions with high unmet needs Promote frontline participation of hospitals Mainstream modern Natural Family Planning Promote and implement CSR strategy

Family Planning | 2 II. CONTENT The principal information that student nurses will convey is Family Planning. The content of the discussion includes the description of Family Planning, its methods, brief description of methods, misconceptions about family planning methods and the roles of a public health nurse on family planning program. III.LESSON PLAN A. Learners The learners of the discussion are the residents of Pulung Cacutud area. Reducing maternal and child deaths are one of the major concerns of the student nurses. The reason of conducting lecture in the health center is to educate the residents of the said resettlement area in terms of Family Planning. As the old adage goes, An ounce of prevention is worth a pound of cure, in which the earlier the information is given to the populace the better for them to develop a very healthy practice. B. Topic The scope of the topic contains the Family Planning and its methods particularly Female Sterilization , Male Sterilization, Pill , Male condom, Injectables, Lactating Amenorrhea Basal Body Method or LAM, Mucus/Billings/Ovulation, Temperature, Sympto-thermal

method, Two Day Method, Standard Days Method. It also includes misconceptions about family planning methods and the roles of a public health nurse on family planning program.

Family Planning | 3 C. Objectives

Student Centered
After 45 minutes of discussion the student nurses will:

Establish rapport to the listeners, the residents of Pulung Cacutud area. Provide basic knowledge about Family Planning Arouse the interests of the listeners towards proper consultation to the health center. Persuade the listeners to follow the suggested measures.

Client Centered After 45 minutes of discussion the listeners will: Establish rapport to the student nurses. Comprehend the teaching given by the student nurses as evidenced by their ability to answer the questions given by the student nurses related to their health teachings. Collaborate with the student nurses through participating in the question and answer portion.
Classify the necessary measures to take in Family Planning

Methods D. Method of Teaching The method of teaching that will be utilized is an open discussion process with the use of different visual aids and pictures. Subsequently, the listeners will be requested to ask some questions about the topic and at the same time the student nurses will ask questions in return to determine the amount of information gathered.

Family Planning | 4 E. Materials Written Visual Aids Content to be taught I. Introduction Appropriate education for family planning, methods of family planning and The student nurses will Teacher-Learner Activities

its description and methods. By knowing the be able to establish rapport its with the listeners to gain misconceptions, the student nurses are able to their trust and participation. enhance the knowledge of the listeners as well as assisting them to obtain an optimum level of wellness. II. Concept The student nurses will of family be able to assess the There This includes: 1. Female Sterilization Description/Uses: Safe and simple surgical procedure which The student nurses will provides permanent contraception for women be able to discuss and show who do not want more children. Also known as to the listeners the Family bilateral tubal ligation that involves cutting or planning blocking the two fallopian tubes. misconceptions family planning. Advantages: The student nurses will methods, about are different types

The Family Planning Methods:

planning methods used to prevent pregnancy. awareness of the listeners Family Planning by asking them for any background knowledge then correct respectfully if ever wrong.

Family Planning | 5 Permanent method of contraception. A be able to make sure that single procedure leads to lifelong, safe and the very effective contraception Nothing to remember, no supplies needed, and no repeated clinic visits required Does not interfere with sex The student nurses will Results in increased sexual enjoyment no be able to ask questions based on the discussion to need to worry about pregnancy No effect on breastfeeding quantity and quality of milk is not affected No known long term side effects or health risks Minilaparotomy can be performed after a women gives birth Disadvantages: Uncommon complications of surgery: infection or bleeding at the incision site, internal infection or bleeding, injury to internal organs, anesthesia risk uncommon with local anesthesia In rare cases, when pregnancy occur. It is more likely to be ectopic than in a woman who has not undergo the procedure Requires physical examination and minor surgery by trained service provider Requires an operating set up Permanent-reversal Do not protect surgery against is difficult, sexually expensive, and not available in most areas transmitted infections including HIV/AIDS be assess their comprehension and their cooperation. The student nurses will able to assess of means topic the the the of to understanding listeners discussion questioning regarding by the the listeners understand them in a better way.

towards

listeners

ascertain if the interaction was effective.

Family Planning | 6 Clients may have limitation in

physical activities such as heavy work and lifting heavy objects immediately after surgery Percent of effectiveness: Perfect use: 99.5 % Typical use: 99.5 % 2. Male Sterilization Description/Uses: Permanent method wherein the vas deferens (passage of sperm) is tied and cut or blocked through a small opening on the scrotal skin. It is known as vasectomy. Advantages: Very effective 3 months after the procedure Permanent, safe, simple, and easy to perform Can be performed in a clinic, or at a primary care center No resupplies or repeated clinic visits No apparent long term health risks An option for couples not whose female partner could undergo permanent

contraception A man who had vasectomy will not lose his sexual ability or ejaculation Does not affect male hormonal function, erection and ejaculation Do not lessen but actually increase the

Family Planning | 7 couple's sexual drive and enjoyment The man can have better sex since he does not fear that his partner will get pregnant Disadvantages: It may be uncomfortable due to slight pain and swelling 2-3 days after the procedure Reversibility is difficult and expensive Bleeding may result in hematoma in the scrotum Percent of effectiveness: Perfect use: 99.9% Typical use: 99.8 % 3. Pill Description/Uses: Contains progesterone contraceptions. Advantages: Safe as proven as through extensive studies Convenient and easy to use Makes menstrual cycle occur regularly and predictable Reduces gynecologic symptoms such as painful menses and endometriosis Reduces the risk for ovarian and endometrial cancer Reversible, rapid return to fertility hormones-estrogen taken daily to and prevent

Family Planning | 8 Does not interfere with sexual intercourse Often not used correctly and consistently, lowering its effectiveness Has side effects such as nausea, dizziness, or breast tenderness which are not generally harmful but which some women may find difficult to tolerate May pose health risk for small number of women Offers no protection against sexually transmitted infections. Effectiveness may be lowered when taken with certain drugs such as rifampicin and most anticonvulsants Can suppress lactation Requires regular resupply

Disadvantages:

How it is used: Drugs are taken daily per orem Percent of effectiveness: Perfect use: 99.7 % Typical use: 92.0 % 4. Male condom Description/Uses: Thin sheath of latex rubber made to fit on a man's erect penis to prevent the passage of sperm cells and sexually transmitted disease organisms into the vagina. It provides dual

Family Planning | 9 protection from STIs including HIV preventing transmission of disease microorganisms during intercourse. Advantages: Safe and has no hormonal effect Protects against microorganisms causing STIs/HIV Encourages male participation in Family Planning Easily accessible Is used in managing premature ejaculation May cause allergy for people who are sensitive to latex or lubricant May decrease sensation, making sex less enjoyable for other partner Interrupts the sexual act Requires a man's cooperation for its use Condom is inserted into the erected penis preventing the sperm from getting in contact with the egg cell Percent of effectiveness: Perfect use: 98% Typical use: 85 % 5. Injectables Description/Uses: Contains synthetic hormone, progestin

Disadvantages:

How it is used:

F a m i l y P l a n n i n g | 10 which suppresses ovulation, thickens cervical mucus, making it difficult for sperm to pass through and changes uterine lining. Advantages: Reversible No need for daily intake Does not interfere with sexual intercourse Perceived as culturally acceptable by some women Private since it is not coitally dependent Has no estrogen related side effects such as nausea, dizziness, nor serious complications, such as thrombophlebitis or pulmonary embolism Does not affect breast feeding quality and quantity of milki s not affected Has beneficial noncontraceptive effects Drug containing progestin is injected into the body to suppress ovulation making sperm difficult to pass through uterine lining Percent of effectiveness: Perfect use: 99.7% Typical use: 97.0% 6. Lactating Amenorrhea Method or LAM Description/Uses: Temporary introductory postpartum method of postponing pregnancy based on physiological infertility experienced by Breast How it is used:

F a m i l y P l a n n i n g | 11 Feeding 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 required It contributes to improve maternal and child health and nutrition Disadvantages: Considered as an introductory, short term FP method which is effective only for the maximum of 6 months postpartum The for extended periods of time (i.e working mother, etc) Fully or nearly full BF may be difficult to maintain for up to 6 months due to a variety to social circumstances Disadvantage to women who do not pass any of the three criteria to practice lactation amenorrhea How it is used: Amenorrhea Fully or nearly fully breastfeeding her infant Infant is less than 6 months Perfect use: 99.5 % Typical use: 98 % 7. Mucus/Billings/Ovulation Percent of effectiveness:

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Description/Uses: Abstaining from sexual intercourse during fertile (wet) days prevents pregnancy. Advantages: Can be used from that by an any women disease of or reproductive age as long as she is not suffering condition difficult. Disadvantages: Cannot be used by women with the following conditions: Medical conditions that would make pregnancy especially dangerous How it is used: Recording of menstruation and dry days Inspecting Recording the day Percent of effectiveness: Perfect Use: 97% Typical Use: 80% underwear the regularly most for fertile presence of mucous observation/characteristics at the end of unusual in results extraordinary

vaginal discharge that makes observation

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8. Basal Body Temperature Description/Uses: BBT method is identifying the fertile and infertile period of a womens cycle by daily taking and recording of the rise in body temperature during and after ovulation. Advantages: Very effective

Disadvantages: Requires to take BBT everyday and time to record temperature. Couples may practice abstinence during fertile periods. How it is used: Thermometer is placed in axilla or under the tongue to get the temperature at least 3 hours of undisturbed rest during (upon waking up and before any activity) throughout the menstrual cycle. Cover line is being determined to identify the highest temperature from day 6 to 10 of the menstrual cycle to identify thermal shift (the three consecutive temperature above the cover line labelled as days 1, 2, 3). Intercourse is allowed only from the 4th day of thermal shift until the end of the cycle. These are

F a m i l y P l a n n i n g | 14 known as absolute infertile phase days. Percent of effectiveness: Perfect Use: Basal body temp: 99% Typical Use: Basal body temp: 80% 9. Sympto-thermal method Description/Uses: STH method is identifying the fertile and infertile days of the menstrual a cycle as of determined through combination

observations made on the cervical mucus, basal body temperature recording and other signs of ovulation. Advantages: All natural; no drugs or devices are needed. Inexpensive. Normally involves spouse in mutual fertility awareness. Acceptable to all religions. A scientific method based upon systematic observation and recording of the natural, periodic signs of fertility and infertility. Disadvantages: Requires systematic charting. Requires mutual decisions about

F a m i l y P l a n n i n g | 15 abstinence. Percent of effectiveness: Perfect Use: Sympto-thermal: 9% Typical Use: 80% 10. Two Day Method Description/Uses: Is a simple fertility awareness based method of FP that involves Cervical secretions as an indicator of fertility Women checking the presence of secretions everyday Advantages: Can be used by women with any cycle length No health related side effects associated Incurs very little or no cost Immediately reversible Promoted male partner involvement in FP Enhances self discipline mutual respect, cooperation, communication and shared responsibility of the couple for the FP Provides opportunities for enhancing the couples sexual life Can be integrated in health and FP services

F a m i l y P l a n n i n g | 16 Acceptable education Not dependent the on medically qualified can be personnel; technology to couples regardless of

culture, religion, socioeconomic status, and

transferred by a trained autonomous user Once learned, may require no further help from health care providers Disadvantages: Needs the cooperation of the husband Can become unreliable for women who have conditions that cause abnormal cervical secretions Does not protect the client from HIV/AIDS Percent of effectiveness: Two Days Method: 96.5% Typical Use: 86% 11. Standard Days Method Description/Uses: A new method of natural family planning in which all users with menstrual cycles between 26 and 32 days are counseled to abstain from sexual intercourse on days 8-19 to avoid pregnancy. The couple use color coded cycle beads to mark the fertile and infertile days of the menstrual cycle

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Advantages: No health related side effects associated with its use Increase self awareness and knowledge of human reproduction and can lead to a diagnosis of some gynaecologic problems No need to counting or charting since the standard days method makes use of beads for tracking the cycle days Can be used either to avoid or achieve pregnancy Very little cost and promotes male partner involvement in family planning Enhances self discipline, mutual respect Provides opportunities for enhancing the couples sexual life Can be integrated in health and family planning services Acceptable education Not dependent the on medically qualified can be personnel; technology to couples regardless of culture, religion, socioeconomic status, and

transferred by a trained autonomous user Once learned, may require no further help from health care providers Disadvantages: Cannot be used by women who usually

F a m i l y P l a n n i n g | 18 have menstrual cycle between 26 and 32 days long How it is used: Abstain from sexual intercourse during fertile period Use color coded beads to mark the fertile and infertile periods Percent of effectiveness: Perfect Use: Standard Days: 95% Typical Use: 88% Misconceptions about Family Planning Methods There are misconceptions to Family

Planning methods. These misconceptions usually come from persons who lack knowledge and proper training, are inexperienced, or not updated on the use of Family Planning methods. They may also come from clients who had bad experience during IUD insertions or vasectomy procedures; that have side effects and many others. Several misconceptions are listed below with the corresponding proof from research. Some Family Planning methods causes abortion. This is not true. Abortion is the termination of pregnancy, while, Family Planning prevents pregnancy through the

F a m i l y P l a n n i n g | 19 use of contraceptives, and abstinence

during fertile periods, blocking of tubes, all of which prevent the meeting of egg and sperm. It prevents induced abortion by preventing unplanned pregnancies. Using contraceptives will render couples sterile. When couples use temporary methods such as fertility awareness based methods and contraceptives such as pills, IUD, injectables and condoms which are used for birth spacing, when pregnancy is desired, a couple can stop using the contraceptive method and they can have children again. Vasectomy in men and tubal ligation in women are considered permanent family size. Using contraceptive methods will result to loss of sexual desire. Sex drive or sexual desire varies from person to person. In general, use of contraceptives does not affect an individuals sexual desire. In fact, it frees the couple from the fear of unwanted pregnancies. This enhances the couples sexual relationship. methods and chosen by couples who have completed their desired

III.Summary

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Nurses play a vital role in Family Planning. The following activities that a nurse can do are: 1. Provide counseling among the clients will

help increase Family Planning acceptors and avoid defaulters. Inform, educate and convince mothers on the use of Family Planning methods. Inform and discuss the importance, disadvantages benefits/advantages and

Family Planning methods. Inform and educate about the side effects, complications and what to do if problems develop. Inform the effectiveness of Family Planning methods. Respect the clients choice of adopting, switching, or discontinuing methods. Provide Provide privacy during discussions all and physical examinations. confidentiality of personal information. Treat clients with courtesy, consideration, and attentiveness. Provide continuity of care for as long as the client desires. 2. Provide packages of health services among reproductive age group in all health facilities. Family Planning

F a m i l y P l a n n i n g | 21 Maternal and Child Health Nursing Management of reproductive tract Violence against women Management of breast and other

infections including STIs, HIV, AIDS

Reproductive Cancers 3. Ensure the availability of Family Planning Supplies and logistics for the client.

References: Cuevas, F. P., et al. (2007). Public Health Nursing in the Philippines (10th ed.). National League of Philippine Government Nurses, Inc. http://www.physiciansforlife.org/content/view/1303/36/ http://info.k4health.org/pr/j47/j47boxes.shtml

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Angeles University Foundation Angeles City College of Nursing

A Lesson Plan about

Family Planning
A Special Requirement in Community Health Nursing at Cacutud

Presented to

Lisabelle V. San Agustin, RN

Presented by

Bituin, Aurora D.C. Bustos, Carla V. Cortez, Ivan Smith B. Diwa, Krizia Marie N. Flores, Kathleen Joy M. Francisco, Anna Bernice G. Guanzon, Desiree Claire C. Manaloto, Donnie P. Torno, Lorelle Bianca N.

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BSN III-8/Group 32 November 30, 2010