Family Planning methods and types

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.

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)