National Family Planning Program (NFPP) PDF

NATIONAL FAMILY PLANNING Nursing Lecture PROGRAM Dr. Regie De Jesus NATIONAL FAMILY PLANNING PROGRAM (NFPP) Vision For Filipino women and men achieve their desired family size and fulfill the reproductive health and rights for all through universal access to quality family planni...

NATIONAL FAMILY PLANNING Nursing Lecture PROGRAM Dr. Regie De Jesus NATIONAL FAMILY PLANNING PROGRAM (NFPP) Vision For Filipino women and men achieve their desired family size and fulfill the reproductive health and rights for all through universal access to quality family planning information and services. NATIONAL FAMILY PLANNING PROGRAM (NFPP) Objectives To increase modern Contraceptive Prevalence Rate (mCPR) among all women from 24.9% in 2017 to 30% by 2022 To reduce the unmet need for modern family planning from 10.8% in 2017 to 8% by 2022 NATIONAL FAMILY PLANNING PROGRAM (NFPP) Mission In line with the Department of Health FOURmula One Plus strategy and Universal Health Care framework, the National Family Planning Program is committed to provide responsive policy direction and ensure access of Filipinos to medically safe, legal, non- abortifacient, effective, and culturally acceptable modern family planning (FP) methods. SIX FACETS OF FAMILY PLANNING QUALITY CARE choice of method, technical competence of providers, informing and counseling clients, interpersonal relations, mechanisms to encourage continuation and appropriateness and acceptability of services. GUIDING PRINCIPLES OF THE NFPP 1. Respect For The Sanctity Of Life. aims to prevent abortion and therefore can save the lives of both women and children. 2. Respect For Human Rights. available using only medically and legally permissible methods provided regardless of the client’s sex, number of children, sexual orientation, moral background, occupation, socio-economic status, cultural and religious belief GUIDING PRINCIPLES OF THE NFPP 3. The Freedom Of Choice And Voluntary Decision. Couples and individuals will make family planning decisions based on informed choice including their own moral, cultural or religious beliefs. 4. Respect For The Rights Of Clients To Determine Their Desired Family Size. Couples and individuals have the basic right to decide freely and responsibly the number and spacing of their children LEGAL BASES OF FAMILY PLANNING PROGRAM Republic Act No. 10354: Responsible Parenthood and Reproductive Health Act of 2012 (RPRH Law) Executive Order No. 12, s. 2017: Attaining and Sustaining “Zero Unmet Need for Modern Family Planning” Through the Strict Implementation of the Responsible Parenthood and Reproductive Health Act, Providing Funds Therefor, and for other Purposes SAFE PREGNANCY Right age to be pregnant =20-35 years old, not less than 20 & not more than 35 Right interval of pregnancy=once in 3 or 5 years Home Base Mother’s Record (HBMR): the record used for care of mothers in CHN SAFE PREGNANCY Policies Non coercive (give freedom of choice) Integration of Family Planning in all Curricular Program: LOI 47 states that Family Planning is to be integrated in all school curricular programs, either baccalaureates or non-baccalaureates, enrolled separately as one unit SAFE PREGNANCY Policies Multi-Sectoral Approach: establish relationship with other agencies which can either be: Intrasectoral Intersectoral-Local or International (WHO, Unicef, USAID) SAFE PREGNANCY It is reasonably certain that a woman is not pregnant if: menstrual period started within the last seven days. gave birth within the last four weeks. had an abortion or miscarriage within the last seven days. gave birth within the last six months, is breastfeeding often, and has not had menstruation NATIONAL FAMILY PLANNING PROGRAM (NFPP) CONTRACEPTIVE METHOD *No birth control, EXCEPT ABSTINENCE, is 100% effective. NATURAL ARTIFICIAL Abstinence Withdrawal (78%) Temporary Permanent Fertility-Awareness Based Barrier Vasectomy a. Cervical Mus (Billing’s) b. Basal Body Temperature Hormonal c. Sympto-Thermal BTL d. Standard Days/Calendar IUD (Copper T A. FERTILITY AWARENESS- BASED METHODS FAB methods are family planning methods that focus on the awareness of the beginning and end of the fertile time of a woman’s menstrual cycle. involve: Determination of the fertile and infertile periods of a woman within the menstrual cycle. Observation of the signs and symptoms of infertility and fertility during the menstrual cycle A. FERTILITY AWARENESS- BASED METHODS Signs of Fertility Changes in the cervical mucus: Cervical mucus can be used to determine the beginning and end of the fertile days. Changes in the basal body temperature: Basal body temperature can be used to determine when ovulation has passed and the fertile days have ended. The first day of menstruation is the sign for keeping track of a woman’s menstrual cycle. A.1. Cervical Mucus test Billing’s Method by Dr. Billing Spinnbarkheit (came from a German word Spinner which means to play with the cervical mucus with the finger) or A.1. Cervical Mucus test Wet & Dry Method: Wet Cervical Mucus (Fertile): abundant, stretchy & transparent Dry Cervical Mucus (Safe & Not fertile): whitish, pasty & adhesive With perfect (correct) use, this method is 97% effective With typical use, it is 80% effective A.1. Cervical Mucus test Alternative Two Day Mucus-Based Method Rule states that two dry days (no secretions for two consecutive days) signify that intercourse will not result in pregnancy. A.2. Basal Body Temperature (BBT) Get the temperature early morning (or resting body temperature (i.e., body temperature after three hours of continuous sleep) which should be monitored daily at the same time Lowered before ovulation (0.3-0.6°C) followed by an increase by 0.3-0.6°C which means that the woman is fertile Her infertile days begin from the fourth day of the high temperature reading to the last day of the cycle. A.2. Basal Body Temperature (BBT) A.2. Basal Body Temperature (BBT) All days from the start of the menstrual cycle up to the third high temperature reading are considered fertile days. With perfect use, this method is 99% effective. With typical use, its effectiveness is 80%. A.3. SYMPTO-THERMAL METHOD (STM) STM is based on the combined technology of the Basal Body Temperature (e.g. the resting body temperature) and the Cervical Mucus/Billings Ovulation Method together with other signs (i.e., breast engorgement, unilateral lower abdominal pain) which indicate that the woman is fertile or infertile. This method is 98% effective as correctly used. A.4. STANDARD DAYS METHOD (SDM)/ CALENDAR METHOD Requirement: Menstrual cycle should be regular; obtain 4-6 months cycle SDM is based on a calculated fertile and infertile period for menstrual cycle lengths that are 26 to 32 days. Women who are qualified (e.g. with 26 to 32 days menstrual cycles) to use this method are counselled to abstain from sexual intercourse on days 8-19 to avoid pregnancy. A.4. STANDARD DAYS METHOD (SDM)/ CALENDAR METHOD Couples on this method use a device, the color-coded “Cycle Beads”, to mark the fertile and infertile days of the menstrual cycle. SDM is 95.25% effective with correct use and 88% with typical use.  How to use Cycle Beads Assess the length of the menstrual cycle if it falls within the range of 26–32 days by considering the following information: The last menstrual period The previous/past menstrual period When she expects her next menses  How to use Cycle Beads 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, which can be used in marking the days of the cycle.  How to use Cycle Beads On the first day of the menstrual cycle (e.g. first day of menstrual bleeding), she puts the ring on the red bead and marks with an “x” the date on the calendar  How to use Cycle Beads She moves the ring to a bead each day. It is recommended that she moves the ring every morning upon waking up so that she does not forget. The brown beads signify infertile days while the white beads signify fertile days. When the ring is on a white bead, she abstains from sexual Advantages of Fertility- Awareness Based Methods Effective when used correctly and consistently. No physical side effects. No prescription required. Inexpensive; no medication involved. No follow-up medical appointments required Advantages of Fertility- Awareness Based Methods Better understanding of the couple about their sexual physiology and reproductive functions. Shared responsibility for family planning. Foster better communication between partners. All FAB methods can be used for spacing, limiting, and achieving pregnancy. Disadvantages of Fertility- Awareness Based Methods May inhibit sexual spontaneity. Except for SDM, need extensive training - it takes about two to three cycles to accurately identify the fertile period and how to effectively use it. Require consistent and accurate record keeping and close attention to body changes. Disadvantages of Fertility- Awareness Based Methods Require periods of abstinence from sexual intercourse Require rigid adherence to daily routine of awaking at a fixed time, without any disturbance before taking the temperature (specific for BBT and STM). Can be used only by women whose cycles are within 26-32 days (specific for SDM). Offer no protection against STI, HIV/AIDS. B. LACTATION AMENORRHEA METHOD (LAM) LAM is the use of breastfeeding as a temporary family planning method. “Lactational”- means related to breastfeeding. “Amenorrhea”- means not having menstrual bleeding Three Criteria to qualify for the use of LAM: 1. The woman exclusively breastfeeds infant. Exclusively breastfeeding may be interpreted as: a. Exclusive means no supplements of any sort are given. Infant receives no other liquid or food, not even water in addition to breast milk. b. Very small amount (one or two swallows) of water, vitamins or antibiotics as medically prescribed. c. Simply put, the woman should use both breasts to breastfeed her baby on demand with no more than a four-hour interval between any two daytime feeds and no more than a six- Three Criteria to qualify for the use of LAM: 2. Amenorrhea. Mother’s monthly menstruation has not returned. In the first weeks postpartum (e.g. in the first 56 days postpartum), there is often continued spotting. This is not considered to be a menstrual period if the woman is fully lactating. Three Criteria to qualify for the use of LAM: 3. Infant is less than six months old. If she is fully breastfeeding and her menses have not returned, the effectiveness of LAM diminishes over time. Ovulation resumes in 20% to 50% of women near the end of the six-month postpartum. If any of the criteria is not met, it is no longer LAM. B. LACTATION AMENORRHEA METHOD (LAM) Mechanism of Action of LAM Works primarily by preventing the release of eggs from the ovaries (ovulation). Frequent breastfeeding temporarily prevents the release of the natural hormones that cause ovulation. The effectiveness of LAM as consistently followed at 99.5%; if typically used, it is 98%. B. LACTATION AMENORRHEA METHOD (LAM) RA 7600-Breastfeeding & Rooming-In Law DOH organized Maternal & Child Family Health Institute (MCFHI) with the following members: All government hospitals Private hospitals (volunteer) B. LACTATION AMENORRHEA METHOD (LAM) RA 7600-Breastfeeding & Rooming-In Law Normal involution (uterus goes back to normal) of the uterus: after 45 days or 5-6 weeks or 1 ½ months if not breastfeeding Frozen breast milk is to be put out of the freezer 2 hours before feeding (Body of Ref: 2-3 days / Freezer: 3-4 months) Left over milk should be discarded & should not be re-preserved or re-frozen because it is already contaminated Advantages of LAM It can be started immediately after delivery. It is economical and easily available. No prescription. No action is required at the time of intercourse. There are no side effects or precautions to its use. No commodities or supplies are required for clients or for the family planning program. Advantages of LAM Fosters mother-child bonding. It serves as a bridge to using other methods since LAM is used for a limited time only. It is consistent with religious and cultural practices. Disadvantages of LAM Full or nearly full breastfeeding pattern may be difficult for some women to maintain. The duration of the method's effectiveness is limited to a brief six- month postpartum period. If a mother and child are separated for extended periods of time (because the mother works outside the home), the breastfeeding practice required for LAM cannot be followed. Disadvantages of LAM There is no protection against STI, including HIV. difficult to convince some providers who are unfamiliar with the method that LAM is a reliable contraceptive.  NATIONAL FAMILY PLANNING PROGRAM PART Nursing Lecture Regie2 De Jesus, MAN C. HORMONAL CONTRACEPTIVE METHODS Three Types of Hormonal Contraceptive methods 1. Low-dose combined estrogen- progestin pills / Low-dose Combined Oral Contraceptive (Low-dose COC) 2. Progestin-only pills contain small amount of progestin-only. for breastfeeding women because it does not interfere with milk production. 3. Progestin-only injectable contraceptives -given intramuscularly C.1. Low-Dose Combined Oral Contraceptive (Low-Dose COC) contain hormones similar to the woman’s natural hormones - estrogen and progesterone. Prevent ovulation by suppressing follicle- stimulating hormone (FSH) [by estrogen] and luteinizing hormone (LH) [by progesterone]. It also causes thickening of the cervical mucus, which makes it difficult for sperm to pass through. Low-dose COCs do not disrupt an existing pregnancy. Two Types of Low-Dose COCs 28 pills in a packet, with 21 "active" pills containing hormones and seven "inactive or reminder" pills of a different color. The reminder pills do not contain hormones. 21 pills - "active/hormone containing” tablets.  Two Types of Low-Dose COCs These are effective, if perfectly used, 99.7%, as typically used, 92%. Correct and consistent use (preferably taken at the same time of the day or night) Too much heat may harden the pills and reduce the bioavailability Two Types of Low-Dose COCs Two Types of Low-Dose COCs Guidelines in Initiating use of Low-Dose COCs Advise the client to take one pill a day regularly, preferably at the same time, even if she is not having sex daily. A pack of 21 pills containing the “active” hormones estrogen and progestogen. This requires a seven-day rest period before starting a new pack. A 28-day pack would contain seven additional placebo or non-hormone tablets. No rest period required. Guidelines in Initiating use of Low-Dose COCs It is best that COCs are taken within the first five days of the menstrual period since conception is virtually nil at this time. If a woman started COC after the 7th day of onset of her menses, she should practice abstinence or use back up contraceptive for the next seven days. may be started anytime when certain that the client is not pregnant. What to do for MISSED PILLS? Missed pills are the most common cause of contraceptive failure and COC side effects like spotting and/or withdrawal bleeding. (within 24 hours) (more than 24 hours) Correcting Myths and Misconceptions have no apparent overall effect on the risk of breast cancer do not protect against STIs and HIV (offer condoms too) not recommended for breastfeeding women a woman is protected only as long as she takes the pill regularly do not disrupt an existing pregnancy. Correcting Myths and Misconceptions do not cause birth defects and will not harm fetus even if the woman becomes pregnant while taking the pill most women do not gain or lose weight due to COCs do not change the mood or sex drive of a woman safe for women with varicose veins Possible Side Effects and Management Side Possible Management Effects Causes Amenorrh  Possible pregnancy ea/  Check for pregnancy  Inadequate scanty  Reassurance endometrial build-up menses Spotting/  Missed pills  Encourage regular breakthr  More common with intake of pills at the ough low dose COCs same time each day bleeding  Taking pills at  Avoid missing pills different times of the  Take another pill from day another pack when  Vomiting and/or diarrhea or vomiting diarrhea within two  occurs within two hours of intake hours of intake  Drug interactions  Change method if taking rifampicin or anti-convulsant Possible Side Effects and Management Side Possible Management Effect Causes s Nausea  Possible flu or  Check for flu, infection infection or  Possible pregnancy pregnancy  Take pills at bedtime  Taking pills on an or with food empty stomach Headache  Estrogen effect  Take analgesics s (paracetamol) Refer if getting worse Breast  Effect of hormones  Recommend use of tendern in pills supportive bra C.2. PROGESTIN-ONLY PILLS (POPs) Prevents ovulation in about half of menstrual cycles. Causes thickening of the cervical mucus, which make it more difficult for sperm to pass through. pills “for breastfeeding women” (e.g. Daphne) Quality and quantity of breast milk are not affected. POPs are very effective: 99% for typical use 99.5% for perfect use C.2. PROGESTIN- ONLY PILLS (POPs) C.2. PROGESTIN-ONLY PILLS (POPs) Two kinds of POPs 1. 0.5 mg lynestrenol (Exluton – available in RHU) 2. 75 ug desogestrel Both are available in a 28 tablet package. C.2. PROGESTIN-ONLY PILLS (POPs) Starting POPs Menstruating Start within the first five days of the menstrual cycle, preferably on the first day At any time during the menstrual cycle if reasonably sure that the woman is not pregnant If not within the first five days of the menstrual cycle = abstain from sex or use a back-up method for the next two days C.2. PROGESTIN-ONLY PILLS (POPs) How to Manage MISSED PILLS Remember to emphasize the importance of not forgetting any pill, even just for a few hours. Advice the client that if she misses one or more pills, she may have spotting or breakthrough bleeding, and more importantly she will be at a greater risk of becoming pregnant. C.2. PROGESTIN-ONLY PILLS (POPs) How to Manage MISSED PILLS She needs to restart taking the pills as soon as possible. If she missed taking the pills by more than three hours, advise her to abstain from sexual intercourse or use a barrier method of contraception during the first 48 hours after restarting the pills. C.3. PROGESTIN-ONLY INJECTABLES (POIs) it is a three-month injectable contraceptive (90-day interval) Each standard dose contains 150 mg of the hormone, which is released slowly into the blood stream from the site of intramuscular injection, providing the client/user with a safe and highly effective form of contraception. C.3. PROGESTIN-ONLY INJECTABLES (POIs) POIs commercially available in the Philippines: 1. Depot medroxyprogesterone acetate (DMPA)/ Depo-Provera - given every three months 2. Norethisterone enanthate (NET- EN) - given every two months. C.3. PROGESTIN-ONLY INJECTABLES (POIs) Inhibits ovulation - After a 150 mg injection of DMPA, ovulation does not occur for at least 14 weeks. Levels of the follicle stimulating hormone (FSH) and luteinizing hormone (LH) are lowered and a LH surge does not occur. Thickens the cervical mucus - The cervical mucus becomes thick, making sperm penetration difficult. Effectiveness if perfectly used is 99.7%, if typically used, 97.0%. C.3. PROGESTIN-ONLY INJECTABLES (POIs) No need for daily intake Does not interfere with sexual intercourse Has no estrogen-related side effects such as nausea, dizziness, Helps prevent iron-deficiency anemia because of the scanty menses and the consequent amenorrhea C.3. PROGESTIN-ONLY INJECTABLES (POIs) Does not protect against STI/HIV/AIDS. Not possible to discontinue immediately, until DMPA is cleared from the woman’s body. Shake the vial to return the suspension to a milky white color. requires a sterile syringe and a 21- 23-gauge needle. C.4. PROGESTIN SUBDERMAL IMPLANTS (PSI) Norplant/ Implanon (brands) -it inhibits ovulation effective for 3 years but seldom advocated for use because it is usually expensive; the client buys the device (consists of 5 matchstick-sized capsules) & have it implanted at the health center by minor surgical incision in: upper inner arm because it is nearest to the brain (most common) external oblique thigh gluteal muscles C.4. PROGESTIN SUBDERMAL IMPLANTS (PSI) C.4. PROGESTIN SUBDERMAL IMPLANTS (PSI) can be removed anytime (e.g. if pregnancy is desired, after 3 years, or doctor’s advise) temporary side effects like headache, acne or pimples, weight gain, and breast pain, minor bleeding, vaginal itching, and menstrual cramps For first-time users, leave the bandage on the wound for a day to prevent contusion, avoid getting the wound wet for 3-5 days, clean the wound every day, avoid sexual contact for a week, consult a doctor for any unusual feeling after the procedure D. BARRIER METHODS D.1. Condoms Prevents entry of sperm into the vagina. Sperm and disease-causing organisms including HIV do not pass through intact latex rubber or polyurethane condoms. Some condoms have a spermicidal coating which adds to its effectiveness. In order to be effective must be used correctly and consistently. If correctly and consistently used, it is 98% effective; if typically used, 85%  D. BARRIER METHODS Condom Failure Inconsistent use- inconsistent use means condoms are not used in every sexual intercourse. Incorrect use Failure to hold on to the rim of condom when withdrawing, resulting in spills/ leaks; and Having intercourse first, then stopping to put condom on before ejaculation D. BARRIER METHODS Condom Failure Condom Breakage. Condom breaks can occur due to: Inadequate vaginal lubrication Defects in the condom itself Poor or improper storage with exposure to heat, ultraviolet light, and/or humidity Application of certain mineral and vegetable oils as lubricants, which can weaken the latex  Condoms Common Mistakes Unrolling a condom before putting it on (this causes tears or breaks) - Not “pressing the tip” of the condom - Tears caused by wearing of rings and fingernails - Putting a condom on with the rolled rim inward toward the penis instead of away from it - Stretching/pulling on the condom, which weakens the thin rubber Condoms Protects against sexually transmitted infections, including HIV Easy to use Safe, effective, and portable Allows men to share more responsibility for family planning Some men complain of decreased sensitivity Condoms Interrupts the sexual act Check package for manufactured or expiration date and perforation. Do not use teeth or sharp object to open the package After ejaculation, hold on to the condom at the base of the penis while withdrawing penis from the vagina. Withdraw the penis while still D. BARRIER METHODS D.2.Cervical Caps and Diaphragms Prevent the sperm to pass the cervix Works better with spermicide Wore 30 minutes before coitus and keep up to 6 hours after coitus E. INTRAUTERINE DEVICE (IUD) Copper-bearing IUDs, such as the Copper T, act primarily by preventing fertilization (Rivera et al., 1999). Copper ions decrease sperm motility and function by altering the uterine and tubal fluid environment, thus preventing sperm from reaching the fallopian tube and fertilizing the egg. E. INTRAUTERINE DEVICE (IUD) TCu380A (Copper T) is effective for at least 12 years, although the United States Food and Drug Administration (USFDA) has approved it for only 10 years (as of this printing). Should be advised that it should be replaced or removed 12 years from the date of insertion. Pregnancy rate is less than 1% (0.8%) E. INTRAUTERINE DEVICE (IUD) Common Types Copper-bearing, which includes the TCu380A (Copper T), the Multiload, and the Nova T Medicated with a steroid hormone, such as Mirena@, the levonorgestrel- releasing intrauterine system E. INTRAUTERINE DEVICE (IUD) TCu380A looks like the letter "T" and contains barium sulfate so that it can be seen by x-ray. There are small copper bands on each "arm" of the T, which ensure that copper is released high in the fundus of the uterus. The "stem" is also wound with copper wire. E. INTRAUTERINE DEVICE (IUD) Reversible and economical Once inserted, they are convenient and extremely easy to use, providing worry-free continuous protection (for 12 years) No systemic side effects as its effects are confined to the uterus A client's fertility returns immediately after an IUD is removed E. INTRAUTERINE DEVICE (IUD) May be safely used by lactating and immediate postpartum women Although IUD failure is rare, expulsion is the most common cause (due to poor insertion skill of the provider, common among nulliparous, those with severe dysmenorrhea, and heavy menstrual flow) F. PERMANENT METHODS F.1. VASECTOMY known as male sterilization as it provides permanent contraception for men. It is a safe, simple, and quick surgical procedure. The procedure can be done in a clinic or office with proper infection prevention practices. The procedure involves tying and cutting a segment of the two vas deferens, which carries sperm. VASECTOMY F. PERMANENT METHODS F.1. VASECTOMY No scalpel vasectomy is a small puncture on the scrotum (not using a scalpel) to get the vas. With the two vas blocked, there will be no sperm in the semen. This is the DOH-approved procedure for vasectomy. Semen is still produced and found in the tubes after the blocked vas. F. PERMANENT METHODS F.1. VASECTOMY The man continues to have erections and ejaculates semen. It very effective at 99.9% for correct use Not immediately effective (use condoms or another effective method consistently for at least three months after the procedure and after a semen check showing no sperm has been performed) F. PERMANENT METHODS F.1. VASECTOMY Increased sexual enjoyment because no need to worry about pregnancy. Reversal surgery is possible but more difficult, expensive, may not be available in some areas, and success is not guaranteed. Pain in the scrotum, swelling and bruising which decreases for about two to three days F. PERMANENT METHODS F.2. BILATERAL TUBAL LIGATION (BTL) Bilateral tubal ligation (BTL) is known as female sterilization as it provides permanent contraception for women The service provider makes a small incision in the woman’s abdomen and ties and cuts the two fallopian tubes on each side of the uterus. These tubes carry eggs from the ovaries to the uterus. BILATERAL TUBAL LIGATION (BTL) BILATERAL TUBAL LIGATION (BTL) F. PERMANENT METHODS F.2. BILATERAL TUBAL LIGATION (BTL) With the tubes blocked, the woman’s egg cannot meet the man’s sperm. The woman continues to have menstrual periods after BTL It is a safe and simple surgical procedure BTL is very effective with an effectiveness rate of 99.5%. Does not affect the woman’s ability to have sex F. PERMANENT METHODS F.2. BILATERAL TUBAL LIGATION (BTL) Increased sexual enjoyment because no need to worry about pregnancy For interval cases, can be done six weeks after delivery If pregnancy happens (very rare), there is a greater risk for ectopic pregnancy