Family planning

Family Planning
Presented by:
Harsh Rastogi,
Nursing Tutor,
M.S. Institute of Nursing,
Lucknow.

•An Expert Committee (1971) of the
WHO defined family planning as "a
way of thinking and living that is
adopted voluntarily, upon the basis
of knowledge, attitudes and
responsible decisions by individuals
and couples, in order to promote
the health and welfare of the family
group and thus contribute
effectively to the social
development of a country“.
Definition

Another Expert Committee defined and described family
planning as follows:
"Family planning refers to practices that help individuals or
couples to attain certain objectives:
a) To avoid unwanted births;
b) To bring about wanted births
c) To regulate the intervals between pregnancies
d) To control the time at which births occur in relation to
the ages of the parent;
e) To determine the number of children in the family.
Cont…

•The United Nations Conference on Human Rights at
Teheran in 1968 recognized family planning as a basic
human right.
•The Bucharest Conference on the World Population held
in August 1974 endorsed the same view and stated in its
Plan of Action' that "all couples and individuals have the
basic human right to decide freely and responsibly the
number and spacing of their children and to have the
information, education, and means to do so".
Basic Human Rights

Cont…
•The World Conference of the International Women's Year
in 1975 also declared "the right of women to decide freely
and responsibly on the number and spacing of their
children and to have access to the information and means
to enable them to exercise that right".
•Thus during the past few decades, family planning has
emerged from whispers in private quarters to the focus of
international concern as a basic human right, and a
component of family health and social welfare.

Scope of family planning
services
•Family planning is not synonymous with birth control; it
is more than mere birth control.
•A WHO Expert Committee (1970) has stated that family
planning includes in its purview:
1) Proper spacing and limitation of births,
2) Advice on sterility,
3) Education for parenthood,
4) Sex education,
5) Screening for pathological conditions related to the
reproductive system (e.g., Cervical cancer),
6) Genetic counselling.
7) Premarital consultation and examination,

8) Carrying out pregnancy tests,
9) Marriage Counselling,
10)The preparation of couples for the arrival of their first
child,
11)Providing services for unmarried mothers,
12)Teaching home economics and nutrition, and
13)Providing adoption services.
•These activities vary from country to country according to
national objectives and policies with regard to family
planning.
•This is the modern concept of family planning.
Cont…

Health aspects of family
planning
•Family planning and health have a two-way relationship.
•The principal health outcomes of family planning were
listed and discussed by a WHO Scientific Group on the
Health Aspects of Family Planning.
•These can be summarized under the following headings:
a) Women's health
b) Foetal health
c) Child health

Health aspects of family planning

•Women's health: Maternal mortality, morbidity of women
of child bearing age, nutritional status (weight changes,
haemoglobin level, etc.) Preventable complications of
pregnancy and abortion.
•Foetal health: Foetal mortality (early and late foetal
death); abnormal development.
•Infant and child health: Neonatal, infant and pre-school
mortality. Health of the infant at birth (birth weight),
vulnerability to diseases.
Cont…

a) Women's health
•Pregnancy can mean serious problems for many women.
•It may damage the mother's health or even endanger her
life.
•In developing countries, the risk of dying as a result of
pregnancy is much greater than in developed countries.
•The risk increases as the mother grows older and after she
has had 3 or 4 children.
•Family planning by intervening in the reproductive cycle of
women, helps them to control the number, interval and
timing of pregnancies and births, and thereby reduces
maternal mortality and morbidity and improves health.

•The health impact of family planning occurs primarily
through:
i. The avoidance of unwanted pregnancies;
ii. Limiting the number of births and proper spacing, and
iii. Timing the births, particularly the first and last, in
relation to the age of the mother.
•It is estimated that guaranteeing access to family planning
alone could reduce the number of maternal deaths by 25
per cent, and child mortality by 20 per cent.
Cont…

•The essential aim of family
planning is to prevent the unwanted
pregnancies.
•An unwanted pregnancy may lead
to an induced abortion.
•From the point of view of health,
abortion outside the medical setting
(criminal abortion) is one of the
most dangerous consequence of
unwanted pregnancy.
i. Unwanted
pregnancies:

•Particular mention must be
made of the unmarried
mother who faces
significantly higher health
risks.
•There is also evidence of
higher incidence of mental
disturbances among
mothers who have had
unwanted pregnancies.
Cont…

•Repeated pregnancies
increase the risk of maternal
mortality and morbidity.
•These risks rise with each
pregnancy beyond the third,
and increase significantly
with each pregnancy beyond
the fifth.
ii. Limiting the
number of births
and proper
spacing:

•The incidence of rupture of the
uterus and uterine atony
increases with parity as does the
incidence of toxaemia,
eclampsia and placenta previa.
•Anaemia is a common problem
in mothers with many children
and the rate of still-births tends
to increase significantly with
high parity.
Cont…

•The somatic consequences
of repeated pregnancies
may also be exemplified in
the clear association
between the incidence of
cancer of the cervix and
high parity.
•Family planning is the only
way to limit the size and
control the interval between
births with a view to
improving the health of the
mother.
Cont…

•Generally mothers face greater risk
of dying below the age of 20 and
above the age of 30-35.
•In many countries, complications of
pregnancy and delivery show the
same pattern of risk, with the
highest rate below 20 and over 35
years of age.
iii. Timing of births:

(b) Foetal Health
•A number of congenital anomalies (e.g., Down's
syndrome) are associated with advancing maternal age.
•Such congenital anomalies can be avoided by timing
the births in relation to the mother's age.
•Further, the "quality" of population can be improved
only by avoiding completely unwanted births.
•In the present state of our knowledge, it is very
difficult to weigh the overall genetic effects of family
planning.

(c) Child health
•Issues relating to family planning are highly relevant to
paediatrics.
•It would seem that family size and birth spacing. if
practised by all, will yield substantial child health benefits.
•These are:
a) Child mortality
b) Child growth, development and nutrition
c) Infectious diseases

•It is well known that child
mortality increases when
pregnancies occur in rapid
succession.
•A birth interval of 2 to 3
years is considered
desirable to reduce child
mortality Family planning
is, therefore, an important
means of ensuring the
survival of all children in a
family.
a) Child
mortality

•Birth spacing and family size are important factors in child
growth and development.
•The child is likely to receive his full share of love and care,
including nutrition he needs, when the family size is small
and births are properly spaced.
•Family planning, in other words, is effective prevention
against malnutrition.
b) Child growth, development and
nutrition:

Children living in large-
sized families have an
increase in infection,
especially infectious
gastroenteritis,
respiratory and skin
infections.
c) Infectious
diseases:

•Family planning is
associated with numerous
misconceptions - one of
them is its strong association
in the minds of people with
sterilization. Others equate it
with birth control.
•The recognition of its
welfare concept came only a
decade and half after its
inception, when it was
named Family Welfare
Programme.
The welfare
concept

•The concept of welfare is
very comprehensive and is
basically related to quality
of life.
•The Family Welfare
Programme aims at
achieving a higher end -
that is, to improve the
quality of life of the
people.
Cont…

•Small differences in the family size
will make big differences in the
birth rate.
•The difference of only one child per
family over a decade will have a
tremendous impact on the
population growth.
Small-family norm

•The objective of the Family
Welfare Programme in India
is that people should adopt
the "small family norm" to
stabilize the country's
population at the level of
some 1,533 million by the
year 2050 AD.
•Symbolized by the inverted
red triangle, the programme
initially adopted the model
of the 3-child family.
Cont…

•In the 1970s, the slogan was
the famous Do Ya Teen Bas.
•In view of the seriousness of
the situation, the 1980s
campaign has advocated the
2-child norm.
•The current emphasis is on
three themes: "Sons or
Daughters - two will do":
"Second child after 3 years",
and "Universal
Immunization".
Cont…

Cont…
•A significant achievement of the Family Welfare
Programme in India has been the decline in the fertility
rate from 6.4 in the 1950s to 2.3 in 2015.
•The national target was to achieve a Net Reproduction
Rate of '1' by the year 2006, which is equivalent to
attaining approximately the 2-child norm.
•All efforts are being made through mass communication
that the concept of small family norm is accepted, adopted
and woven into lifestyle of the people.

•An "eligible couple" refers
to a currently married
couple wherein the wife is in
the reproductive age, which
is generally assumed to lie
between the ages of 15 and
45, There will be at least 150
to 180 such couples per 1000
population in India.
•These couples are in need of
family planning services.
About 20 per cent of eligible
couples are found in the age
group 15-24 years.
Eligible couples

•On an average 2.5 million
couples are joining the
reproductive group every year.
•The "Eligible Couple Register"
is a basic document for
organizing family planning
work.
•It is regularly updated each
functionary of the family
planning programme for the
area falling within his
jurisdiction.
Cont…

•In order to pin-point the couples
who are a priority group within the
broad definition of "eligible
couples", the term "target couple"
was coined.
•Hitherto, the term target couple
was applied to couples who have
had 2-3 living children, and family
planning was largely directed to
such couples.
Target couples

•The definition of a target
couple has been gradually
enlarged to include
families with one child or
even newly married
couples with a view to
develop acceptance of the
idea of family planning
from the earliest possible
stage.
•In effect, the term target
couple has lost its original
meaning. The term
eligible couple is now
more widely used and has
come to stay.
Cont…

Couple protection rate (CPR)
• Couple protection rate (CPR) is an indicator of the
prevalence of contraceptive practice in the community.
• It is defined as the per cent of eligible couples effectively
protected against childbirth by one or the other
approved methods of family planning, viz. sterilization,
IUD, condom or oral pills.
• Sterilization accounts for over 60 per cent of effectively
protected couples.
• Demographers are of the view that the demographic
goal of NRR=1 can be achieved only if the CPR exceeds
60 per cent.

• Couple protection rate is based on the observation that
50 to 60 per cent of births in a year are of birth order 3
or more.
• Thus attaining a 60 per cent CPR will be equivalent to
cutting off almost all third or higher order births, leaving
2 or less surviving children per couple.
• Therefore, the previous National Population Policy was
to attain a CPR of 42 per cent by 1990 (end of Seventh
Five Year Plan), and 60 per cent by the year 2000.
• In short CPR is a dominant factor in the reduction of net
reproduction rate.
Cont…

Couple protection rate (CPR)
•During 2014-2015, the total number of family planning
acceptors by different methods was as follows.
Family planning methods Family planning acceptors
Sterilization 4.03 million
Vasectomy 0.07 million
Tubectomy 3.95 million
IUD insertion 5.28 million
Condom users 13.81 million
Oral pill users 5.6 million

•However about 45.28 per cent
eligible couples are still
unprotected against conception.
•Currently about 54.8 per cent
of eligible couples in the
reproductive age group 15-44
years were effectively protected
against conception by one or
the other family planning
method.
Cont…

•A state-wise break-up of the figures reported indicates
that while some states notably Punjab, Gujarat,
Maharashtra, Karnataka, Haryana and Tamil Nadu etc. are
forging ahead to cover more than half of their fertility
level population by contraception, the other states like
Bihar, Uttar Pradesh, Assam, Rajasthan, West Bengal,
Jammu and Kashmir etc. are lagging behind with low
contraceptive acceptance levels.
Cont…

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