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Family planning is a concept associated with much confusion and is often typecast as basic birth control. But, it is a multifold concept that includes the well-being of the mother, child and the family. Essentially, family planning takes into consideration the social and economic status of the family along with the reproductive health of the couple. The aim of most family planning programs is to ensure a healthier pregnancy and a happier childhood.

So what all does it include?

Apart from contraception methods, family planning includes education and counselling on sexual health to help people in the reproductive age in properly planning pregnancies while also avoiding STDs and maintaining good sexual health. This is especially needed in developing countries and in low-income groups which either do not have the access to good healthcare and education facilities or lack knowledge thereof.

Still not clear enough?

It's not as difficult as it seems right now. Read on to find out more about family planning, what exactly it is and what benefits you can get by adopting a family planning program.

  1. Family planning benefits: for women, men and society
  2. Family planning methods
  3. Natural family planning methods

A decision to opt for a family planning program is beneficial for both the genders along with the children and society. Here is what a good family planning program will provide for every sect of the society

For women

Family planning hosts a wide range of benefits for women. A lot of women hesitate when it comes to the use of contraceptives and taking the decision about pregnancy and the choice is usually made by the family or the husband. According to WHO, about 100,000 maternal deaths can be avoided if women were given the choice of deciding if they want a child.

Here is how a family planning method assists in avoiding this:

  • Deciding the age of childbearing: The best age to a healthy pregnancy in women is between 18 to 35 years. The risk of pregnancy complications is much higher at a relatively younger and older age. Younger women are more easily prone to high blood pressure and older women who had borne more than 5 children already are at risk of uterine rupture, bleeding and death. A family planning program gives the independence of this choice to women, thus ensuring that they don’t suffer from complications and health risks.
     
  • Preventing unwanted pregnancies: Unwanted pregnancies are another cause of maternal deaths According to a report by WHO, millions of women die every year due to unsafe methods of abortions and incomplete abortions. Such pregnancies can be avoided by using proper contraceptive techniques. Also, it is best to take a 6-month gap after a miscarriage or an abortion before trying to get pregnant again.
     
  • Reducing the total number of pregnancies: Limiting the number of children you have may not only be helpful economically but also it is important for the health and well being of the mother. The chances of multiple births, birth defects and pregnancy complications increase to about 3 times after the 4th or 5th child. Pregnancy also takes a toll on a woman’s body and older women are anyway at a higher risk of mortality. Also, it is important to ensure that the expecting mother is not suffering from diseases like anaemia or hepatitis since these diseases can lead to maternal or fetal mortality.

Identification of STDs and health problems, fertility treatment, educating the family on the emotional needs of the pregnant woman and pregnancy care are other facilities that a good family planning program provides for women.

For children

Family planning isn’t only aimed at society and couples but it takes into consideration the health and upbringing of children too.

The first step is avoiding the first child before the woman attains the age of 18-19. At this age, a woman’s body is more capable of taking a pregnancy to the term without any complications.

Increasing the gap between your first and the next child is yet another factor that contributes to the health of your children. It is estimated that keeping less than 18 months between births makes the neonates more prone to low birth weight and premature births.

Furthermore, a second birth within the first 12 months of your first child would be detrimental to the growth of the latter. This is because breastfeeding stops early and the child is not provided enough care. It is best to keep at least 2 years of gap between subsequent pregnancies to ensure the proper development and growth of your infants. (2)

For the father, family and society

Since family planning helps in reducing the number and spacing of children and improving women’s health, it plays an important role in improving both the social and economic status of the family. A smaller family doesn’t have as many expenses and more spaced children get better attention, care and love. It will also give a better chance to women to be an active part of society, which ultimately leads to their character development.

Avoiding early pregnancies may give more space and time to women to get into education and careers and reduces dependency, which could provide more balanced individuals to the economy. Smaller families promoted by family planning programs are more self-dependent and lead a better lifestyle.

An overall reduction in population means a reduced load on environmental and community resources including health and sanitation facilities and transportation. It further improves the education system. (3)

Family planning methods include optimum use of resources, manpower and tools to provide counselling, health services, education and contraception facilities to people. The Family planning division, Ministry of Health and Family welfare summarises various strategies that are currently being focussed in the family planning vision ‘2020’ in India. (4) These include:

  • Counselling
  • Postpartum family planning
  • Fixed day strategy, which includes fixing a day for demonstrating the use and safety of IUDs and various contraceptive methods.
  • Male participation
  • Community-based strategies including ASHAs: home delivery of contraceptives and pregnancy detection kits, couple and family counselling

It also involves the participation of both the private and public sector and developing manpower and resources for implementing the various programs effectively.

All of these are explained in detail in this section.

  1. Family planning counselling
  2. Postpartum (after delivery) family planning
  3. Preventing teenage pregnancies
  4. Other methods of family planning: contraception, sterilisation and pregnancy kits

Family planning counselling

Counselling is the first step toward family planning. It helps to decide whether the person wants to adopt a family planning method and which method is best for them. It also helps to know about the safety concerns and use of various contraceptive methods. Family planning (FP) counselling could either be individual, couple-based or include the family, depending on the need.

The Handbook of Reproductive, Maternal, Neonatal, and Child health counsellors, India, defines three types of FP counselling. (5)

General counselling

The very first step of FP counselling. It includes introducing the various family planning methods, their safety concerns and common issues related to them. It also includes:

  • Answering concerns about family planning and pregnancy.
  • Discussing various myths and misconceptions.
  • Discussing the family goals and concerns of the client.
  • The decision making begins at this counselling.

Method-specific counselling

Once the primary concerns and questions of the person have been sorted and they have made a choice about a particular family planning program. Specific counselling is provided about the choice of method this includes:

  • Finalising the choice of FP method.
  • Going through the procedures of the method.
  • Informing the how, when and whys of the usage.
  • Discussing the possible side effects and problems associated with that method and how to sort them.
  • Myths and misconceptions are also discussed again along with handing out written information brochures.

Follow up or return counselling

Follow up counselling includes feedback to know about the satisfaction of the person with the used method. The important points are repeated once again along with discussing and sorting out any problems or side effects being experienced. In case of severe problems, the method is discontinued or changed.

Follow up clients are also encouraged to inform other people about the available FP methods and counselling services.

Apart from this, special counselling sessions may be conducted to educate men about the needs of family planning since most of the time the decision to adopt a family planning method relies on them.

Also, men are usually less informed about family planning and reproductive issues since they don’t talk much about it or have misconceptions about loss of sexual pleasure or performance.

It also provides information on contraceptive usage, especially condoms since a lot of men don’t know how to.

To ensure proper spacing between children the government of India has included ASHA (Accredited Social Health Activists) to counsel newlywed couples on the importance of keeping at least 2 years of gap between births and about a 3-year gap between the first and the second child. You can talk to the local ASHA centre to know if they provide this service in your state.

Postpartum (after delivery) family planning

Most women take variable time to reach a healthy and fertile state after delivery, abortion or miscarriage. While some women may return to their fertile state within a month of childbirth, it might take longer due to breastfeeding or in case of a miscarriage. It is important that you keep yourself informed of your reproductive health as it is both necessary and important.

Postpartum family planning is really important to avoid unwanted pregnancies, avoid risks to maternal health and keep optimum spacing between births.

Indian government is especially focussing on PPFP since that is most commonly neglected and these services are not being offered currently in all Indian states, though there are family welfare centres and postpartum centres and many urban areas. (6)

The PPFP mainly emphasises on IUCDs (intrauterine devices) in place of sterilisation methods. This is mainly done to increase the gap between pregnancies.

Janani Suraksha Yojna: To achieve better PPFP, safer deliveries and better postnatal care to poor women, Janani Suraksha Yojna was introduced by the government of India in April 2015. Under this scheme, cash assistance is provided to the poor women by the central government. Again ASHAs serve as a connecting link between government and expecting mothers. The cash assistance depends on the state and the level of income of the individual or their family.

Apart from postpartum care, PPFP programs also provide IUD and spacing options to poor women. Depending on the woman’s choice, IUDs could be inserted right after delivery or within the first 6 weeks of childbirth. Various government and approved private institutions provide these services. You can talk to your local ASHA centre to know more about it. (7)

Preventing teenage pregnancies

As discussed before, pregnancy in the younger age poses a threat to the health of the mother and increases the risk of low weight births and preterm deliveries. It is important to get them educated about the risks of early pregnancies along with the safe sex practices.

ARSH clinics (at facility level) and ASHA centres (at community level) hold the responsibility to help and counsel teenagers about such issues including avoiding unwanted pregnancies, contraceptive methods and for helping them deal with pregnancy issues. It also provides information on safe abortion services. (8)(9)

Other methods of family planning: contraception, sterilisation and pregnancy kits

This includes various birth control methods, pregnancy test kits and contraceptives to reduce the risk of unwanted pregnancies and increase spacing between subsequent pregnancies. While most urban and educated population are aware of contraception, rural people are not quite well aware of them. Home delivery of pregnancy and contraceptive kits and information on all of these methods are provided through ASHA in such areas. However, they are also available in most ASHA centres in urban areas too.

Home delivery of contraceptives

This plan was initiated in the year 2011 and employs ASHA workers to deliver contraceptives including condoms, contraception pills (both oral and emergency).

ASHAs may charge a nominal amount for these contraceptives and it also helps them to introduce more family planning methods to rural areas. Since the introduction of this scheme in 2011, ASHA workers have been successful in introducing the concept of contraceptives to both genders and the program has been a huge success.

Unlike the problems with the free contraceptives supplied by the government, the stock of contraceptives is refilled every month in ASHA centres and proper records are kept for them.

Pregnancy test kits

Apart from contraceptives, ASHAs also deliver pregnancy detection kits at home. Since early detection of pregnancy plays a major role in maintaining maternal and fetal health, this program is important to provide detection services to rural women. Nischay is the name of the pregnancy detection kit provided by the Indian government.

 Apart from the other temporary birth control methods including, the Indian government also focusses on sterilisation methods like tubectomy and vasectomy as an option for permanent contraception.

(Read more: Birth control methods)

This includes methods that take into consideration the highly fertile phases of a woman’s reproductive cycle to avoid conceiving. Also known as fertility awareness, this consists of tracking calendar of your menstrual cycle, basal body temperature and cervical mucus. (10)

Calendar tracking

This method is mainly aimed at determining the most fertile time of your cycle. To find such days accurately you need to track your menstruation for about a year, starting from the first day of your menstruation. This would help you know the variations in your cycle.

The fertility window is generally from the 8th day to the 21st day of your cycle, however, it may vary in different women.

It is better to avoid having sex during this window if you are looking forward to avoiding pregnancy.

Basal body temperature

The body temperature of a woman rises anywhere between 0.4 to 1℉ on the day of ovulation and remains so until menstruation. Taking your daily temperature with a basal thermometer would let you know these slight changes in your body and the onset of your fertile period so you can take steps accordingly. However, it is not a reliable method since the body temperature may rise with illness, environment, alcohol or other factors.

Cervical mucus

Just like your body temperature, the consistency of your cervical secretions also change over your menstrual cycle. Following a dry period of about 3-4 days after your menstruation, the amount of mucus starts to increase until it becomes slippery, white and clear till the 9th day, marking the wettest day. Ovulation occurs within 2 days of this secretion.

Lactational amenorrhea

Lactational amenorrhea is yet another type of natural family planning method which relies on breastfeeding as a method of contraception. In lactational amenorrhea, a woman’s ovulation and menstruation are delayed due to the effect of prolactin, a hormone released in women during breastfeeding. As long as the child is exclusively breastfeeding (not taking anything apart from breastmilk), the hormone keeps on suppressing ovulation which acts as a natural contraception method then. However, this is only effective till the baby is 6 months of age since he/she needs more additions to the diet apart from breastmilk. Reduction in breastfeeding causes the prolactin levels to decline, which, in turn, makes the menstruation to return.

Also, this method could not be effective in protecting the woman from STDs and is hence ineffective as a good contraceptive.

Withdrawal method

Coitus (sexual intercourse) interruptus is also classified under natural family planning methods, this includes pulling out the penis from the vagina before ejaculation to avoid sperms from reaching the ova. However, it is not very effective as the semen may leak into the vagina before ejaculation and the person may not be able to withdraw on time. (11)

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References

  1. World Health Organization. Health benefits of family planning. Division of Reproductive Health, World Health Organization
  2. United States Agency for International Development. facts for family planning. United States federal government; [internet].
  3. Federal Democratic Republic of Ethiopia Ministry of Health. Family Planning: Blended Learning Module for the Health Extension Programme. Health Education and Training, Africa
  4. Family Planning Division Ministry of Health and Family Welfare Government of India. Handbook for Reproductive, Maternal, Neonatal, and Child Health . Government of India, Nirman Bhawan, October 2012
  5. Ministry of Health and Family Welfare. Family Planning. Chapter 9, Annual Report 2013-14
  6. Federation of Obstetric and Gynaecological Societies of India. Adolescent Friendly Health Centers- FOGSI. Adolescent health committee, India
  7. ARSH. Adolescent Reproductive and Sexual Health. Kerala, India 2008-09.
  8. American pregnancy association. Fertility Awareness: Natural Family Planning . Skyway Circle ,Irving, TX
  9. Natural Family Planning. Family Planning. Module: 4; Family Planning (NFP) Methods
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