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Family Planning - jhdjqb
Business Administration
Pangasinan State University
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FAMILY PLANNING
Overview of the Philippine Family Planning Program
AO no. 50-A , s. 2001: The National FP Policy Prescribes the key policies for FP services focused on modern FP methods, including natural family planning.
Republic Act 10354: The Responsible Parenthood and Reproductive Health Act of 2012
SECTION 11. Integration of Responsible Parenthood and Family Planning Component in Anti-Poverty Programs. The⚫ DOH shall implement programs prioritizing full access of poor and marginalized women as identified through the NHTS-PR and other government measures of identifying marginalization to reproductive health care, services, products and programs.
Sustainable Development Goals ⚫ SDG 3 supports universal access to sexual and reproductive health care services, including family planning. ⚫ SDG 5 supports universal access to sexual and reproductive rights.
Vision 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 FP methods.
Mission The DOH, in partnership with the LGUs, NGOs, private sector, and communities shall ensure the availability of FP information and services to all men and women of reproductive age who need them. Goal
To provide universal access to FP information and services whenever wherever these are needed.
Objectives
- To help couples and individuals achieve their desired family size within the context of responsible parenthood and improve their RH to attain sustainable development.
- To ensure quality FP services are available in DOH-retained hospitals, LGU- managed health facilities, NGOs, and the private sector.
Four Pillars/ Guiding Principles of the FP Program
- Responsible Parenthood
- Respect for life
- Birth Spacing (at least 3 years)
- Informed Choice
The FP Program Methods ❑ Fertility Awareness Based Method (FAB) •Billings Ovulation/ Cervical Mucus Method •Basal Body Temperature •Sympto-thermal Method •Standard Days Method •LAM
The FP Program Methods
Modern methods ❑ Permanent methods Female sterilization Male sterilization ❑ Supply methods Pills IUD Injectable Male condom
What is FP Unmet Need?? The proportion of currently married women who are not using any modern methods of FP but do not want anymore children or prefer to space births.
FAMILY PLANNING AND
REPRODUCTIVE
HEALTH
Prevention and Management of RTIs, including STIs like HIV
Individuals with FP needs are sexually active which makes them at risk for sexually transmitted infections (STIs) like HIV.
Clients who are at risk of contracting STIs need dual protection through the use of FP method such as condoms that also provide protection from pregnancy.
Risk assessment for STIs is part of determining the client’s eligibility for IUD use (both for initial and continuing use)
Adolescent and Youth Health ⚫ Adolescents have the potential to be sexually active and need to be advised and counseled about safe and responsible sexual practices, including FP.
⚫Orientation on fertility awareness and counseling are basic services which will help promote responsible sexuality among adolescents. Responsible sexuality will help reduce unplanned pregnancies and RTIs.
HEALTH BENEFITS OF FAMILY PLANNING
Benefits to Mothers Reduction in Maternal Mortality and Morbidity ⚫ Prevention of high risk pregnancies among women who are too young, too old, too many or too ill to bear children safely
⚫ Unplanned pregnancies are avoided and pregnancies are spaced by at least three years
⚫ Prevention of closely spaced pregnancies that leads to and worsen such
conditions as anemia and maternal malnutrition
Benefits to Infant and Child
Reduction in Infant and Child Mortality and Morbidity
⚫ Globally, an estimated 14 million infants and children under age five die every year, mainly from respiratory and diarrheal diseases complicated by malnutrition
⚫ Recent studies indicate that the lowest risks for fetal death, pre-term delivery, small for gestational age, neonatal death, and low birth weight occur when births are spaced from three to five years. (Demographic and Health Surveys, 2002) Benefits to Infant and Child
⚫ Properly spaced children at least 3 years will be given the love, attention, care and time from mothers and fathers to attend to their growth and development.
⚫ Fewer children in the family will be provided more opportunities for adequate food, clothing, good education and good health.
⚫ Breastfeeding protects infants against diarrheal and other infectious disease as well as protects mothers from postpartum hemorrhage
Benefits to the Fathers
⚫ Provides fathers who are suffering from chronic illnesses (eg. Diabetes, Hypertension) enough time for treatment and recovery from those illnesses
⚫ Lightens his burdens and responsibilities in supporting his family since he will only be providing for the number of children he can afford to support
⚫ Enables him to give his children good home, good education and better future
⚫ Need for referral for laboratory examinations or further management, if necessary. ⚫ Need and schedule of follow-up visit(s)
Fertility Awareness-Based Methods Definition
⚫ FP methods which involve ⚫ Determination of the fertile & infertile periods of a woman ⚫ Observation of the signs and symptoms of fertility and infertility during the menstrual cycle ⚫ Timing of sexual intercourse to achieve or avoid pregnancy ⚫ Effectiveness depends on the couple’s ability to identify fertile and infertile periods and motivation to practice abstinence when required
Signs of Fertility ⚫ Changes in the cervical mucus: determines the beginning and end of the fertile days. ⚫ Changes in the basal body temperature: determines when ovulation has passed and the fertile days have ended.
The FAB Methods 1. Billings Ovulation Method (BOM) 2. 2. Basal Body Temperature Method (BBT) 3. Sympto-thermal Method (STM) 4. Standard Days Method (SDM) 5. Two-Day Method (TDM)
Billings Ovulation Method ⚫ Based on the daily observation of what a woman sees and feels at the vaginal area throughout the day. ⚫ Cervical mucus changes indicate whether days are fertile or infertile and can be used to avoid or achieve pregnancy. ⚫ The woman is instructed to observe and record her feeling of dryness or wetness in her vaginal area during the day. She abstains from sexual intercourse during the fertile, “wet” days
⚫ With perfect (correct) use, this method is 97% effective. However, with typical use, it is 80% effective.
Basal Body Temperature ⚫ Based on the changes in a woman’s resting body temperature which is lower before ovulation until it rises to a higher level after ovulation. ⚫ Infertile days begin from the fourth day of the high temperature reading to the last day of the cycle. ⚫ All days from the start of the menstrual cycle up to the third high temperature reading are considered fertile days. ⚫ Effectiveness: 99% (perfect use) and 80% (typical use)
Sympto-thermal Method ⚫ Based on the combination of the Basal Body Temperature & Billings Ovulation Method ⚫ Effectiveness as correctly used: 98% Standard Days Method Day 1 Pre-ovulation (infertile) Post-ovulation (infertile) Fertile days (D8 –D19)
Standard Days Method How To Use
- Assess the length of the menstrual cycle if it falls within the range of 26–32 days. ⚫ If the cycle length is less than 26 days or more than 32 days, the client cannot use the method.
- If the cycle meets the criteria, provide an SDM card and cycle beads.
How To Use 3. Show the woman the CycleBeads and instruct her on how to use it: ⚫ On the first day of the menstrual cycle (i., first day of menstrual bleeding), she puts the ring on the red bead and marks this day on the calendar.
⚫ She moves the ring to a bead each day preferably upon waking up. The brown beads signify infertile days while the white beads signify fertile days.
How To Use ⚫ When the ring is on a white bead, she abstains from sexual intercourse. ⚫ Draw the client’s attention to the dark brown and black beads. ▪ if menstrual bleeding occurs before the dark brown bead, her cycle is less than 26 days. ▪ if the ring has reached the black bead and still no menstrual bleeding, her cycle is more than 32 days. ⚫ If either condition happens twice in a year, she cannot reliably use the SDM as her FP method.
Women with Special Conditions Shifting from pills⚫ ⚫ menstrual cycles prior to the use of pills were 26-32 days and the current cycle is expected to be 26-32 days ⚫ Shifting from injectables ⚫ last injection at least 3 months ago ⚫ Menses have returned ⚫ Menstrual cycle prior to use of injectable was within 26-32 days ⚫ Last menstrual cycle was within 26- days ⚫ Recently used the IUD ⚫ IUD has been removed ⚫ Menstrual cycles while using the IUD were within 26-32 days ⚫ Last menstrual cycle is within 26-32 days ⚫ Postpartum and/or breastfeeding ⚫ Menstruation has returned ⚫ Has had at least 4 normal menstrual periods ⚫ Expects current cycle to be within 26- days
Return Visit ⚫ Instruct client to return ⚫ Within 7 days of her next menstrual period (bring CycleBeads, client card and partner, if possible)
For warning signs ⚫ If a day has passed since the rubber ring has reached the black bead and menstruation has not come (cycle length is >32 days) ⚫ If menstruation starts before the rubber ring reaches the chocolate brown bead (cycle length is <26 days)
Advantages of FAB Methods ⚫ Effective when used correctly and consistently. No physical side effects⚫ ⚫ No prescription required ⚫ Inexpensive; no medication involved ⚫ No follow-up medical appointments required ⚫ Better understanding of the couple about their sexual physiology and reproductive functions. ⚫ Encourage shared responsibility for family planning ⚫ Foster better communication between partners
Disadvantages of FAB Methods ⚫ May inhibit sexual spontaneity ⚫ Except for SDM, need extensive training ⚫ Require consistent and accurate record keeping and close attention to body changes ⚫ Require periods of abstinence from sexual intercourse ⚫ Can be used only by women whose cycles are within 26-32 days (Specific to SDM) ⚫ Offer no protection against STI, HIV and AIDS
Lactational Amenorrhea Method What is LAM
⚫ Contraceptive method that relies on the condition of infertility that results from specific breastfeeding patterns. ⚫ Use of breastfeeding as temporary family planning method. Criteria for LAM A woman is practicing LAM when the following conditions are met: 1. Fully or nearly fully breastfeeding
Two Types ⚫ 28 pills - has 21 "active" pills, which contain hormones, followed by 7 "inactive or reminder" pills of a different color. The reminder pills do not contain hormones ⚫ 21 pills - contains only the 21 "active" pills.
Mechanism of Action ⚫ Prevents ovulation ⚫ Thickens the cervical mucus, which makes it difficult for sperm to pass through. Low-dose COCs do not disrupt an existing pregnancy.
Effectiveness ⚫ Correctly and consistently used = 99% ⚫ As commonly used = 92% Factors affecting effectiveness ⚫ Correct and consistent use ⚫ Proper storage, observance of shelf life and expiration date ⚫ Vomiting or Diarrhea ⚫ Drug Interaction Possible Side Effects ⚫ Nausea (first 3 months) ⚫ Spotting or bleeding between menstrual periods ⚫ Mild headaches ⚫ Breast tenderness ⚫ Amenorrhea
Management of Possible Side Effects Side Effect Possible Cause Management
Amenorrhea/scanty period Spotting/ breakthrough bleeding Due to possible pregnancy and inadequate endometrial buildup due to low-dose COCs -Missed pills -More common with low-dose COCs -Taking pills at different times a day -Vomiting and/or diarrhea within two hours of intake -Drug interaction Reassurance Encourage regular intake of pill at the same time each day; teach to make up for missed pills properly; Nausea -Possible flu or other infection -Possible pregnancy -Taking Low-dose COCs on empty stomach Headaches -estrogen effects associated with use of low-dose COCs Breast tenderness -Related to estrogen component of the COC Suggest taking low-dose COCs at bedtime or with food Suggest pain relievers (paracetamol, aspirin, etc) If get worse refer. Recommend to use supportive bra (including during strenuous activity and sleep); try hot or cold compress; pain relievers; rule out pregnancy
MOSQUITO BORNE DISEASE
PROGRAM ESSENTIAL IN PUBLIC
HEALTH
Mosquito Borne Disease Program: A Perspective
Program objectives: (2021)
Malaria To sustain the Zero cases (Local Transmission) and to conduct Active case finding for Imported cases
Dengue Reduction of Dengue cases per year
Filariasis Maintain prevalence rate
Indicators Malaria To sustain the Zero cases (Local Transmission)
Dengue
Reduction of 5% Dengue cases per year
Filariasis Maintain <1 microfilaria prevalance rate
Malaria (Imported) Accomplishment Five- year trend (Imported cases) 2016 Lake Sebu (1) 2017 Polomolok (1) Koronadal City (1) 2018 Tampakan (2) 2019 Polomolok (1) Tantangan (1)
Actions Taken and Intervention
OPLAN KULOB Regular visit of Provincial staff to Brangay Levels for monitoring.
Important: Give within 2 hours after a meal. Department of Health, Philippines
Adverse Reactions Abdominal pain nausea dizziness vomiting joint/muscle pain Diarrhea nausea fatigue rashes presence of nodules
Department of Health, Philippines
CONTRAINDICATIONS TO THE ANTIFILARIAL DRUGS Pregnant women Children below 2 years old Seriously ill persons Serious kidney disorder Cardiac disorder Seizure disorders
Persons with asthmatic attack during the day of mass treatment Severely malnourished children
GUIDELINES & PROCEDURES TREATMENT:
- Standard Treatment
- giving the drugs to individuals found to be positive (+) for microfilarial rate/antigen rate using the standard dosage of 6mg/kg body weight for 12 consecutive days
Formula: for Dietylcarbamazine Citrate (DEC)
body weight x 6mg/kg 50mg/tab.
Example:
50 kg. x 6mg/kg 50mg/tab = 300mg 50mg/tab = 6 tablets in three (3) divided doses = 2 tablets per meal (breakfast/lunch/dinner) = 6 tablets per day x 12 days Total: = 72 tablets
plus: 1 tablet single dose for Albendazole (400mg/tab)
Trainings (Barangay Levels) Conduct Training for Vector Surveillance for BHW Training includes the following: Vector Control Spraying Misting Fogging Mosquito net preparation
Border operations
Malaria Case Finding
Family Planning - jhdjqb
Course: Business Administration
University: Pangasinan State University
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