UNIT2:MODERN FAMILY PLANNING►

UNIT1:NATURAL FAMILY PLANNING

  • UNIT1:NATURAL FAMILY PLANNING

    Key unit competence

    Provide natural family planning services

    Introductory activity 1

    a. What can you suggest for Family B to do in order to achieve sustainable 
    development and wellbeing?
    b. Do you know the methods that can be used for family planning?
    c. According to you, what are the methods that can be used easily without 

    visiting the health facilities?

    1.1 Introduction to family planning 

    a) What do you understand by family planning and contraception?

    b) Why do you think family planning is important?

    Learning activity 1.1

    1.1.1 Concepts of family planning

    Family planning refers to individual’s or couple’s’ conscious and informed decision 
    to decide when to become or not to become pregnant throughout the reproductive 

    years. 

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    Contraception is defined to the intentional use of artificial methods and/or other 
    techniques to prevent pregnancy as a result of doing sexual intercourse.
    Natural family planning This refers to the methods of contraception which do not 
    use hormones and devices. Natural family planning includes abstinence, coitus 
    interruptus, lactation amenorrhea, and fertility awareness methods.
    Modern family planning refers to all products and/ or medical procedures that 
    interfere with reproduction whenever there is coital activity. Some of the products 
    act by preventing ovulation from occurring and others may inhibit sperms from 

    fertilising the matured egg.

    1.1.2 Benefits of family planning

    Family planning can lead to sustainable development. It enables women and 
    couples to avoid unwanted pregnancies, attain the desired number of births, 
    and control the intervals between births. Family planning can contribute to 
    delaying pregnancy in young girls who may at increased risk of health problems 
    from early childbearing, and further reduces the rates of unsafe abortions and 
    HIV transmission. Family planning can benefit the education of girls and lead to 
    women’s empowerment within the community. In addition, family planning may 
    prevent pregnancies among older women who can be at increased risk of pregnancy 

    related complications.

    Self-assessment 1.1 

    i. With examples, explain the following terms:
     a.Family planning
     b.Contraception
    ii. Discuss the role of family planning for women in their reproductive age?

    iii. What can be the role of family planning for young adolescents?

    Homework 1.1

    Go to the computer lab and read about principles of family planning.

    1.2 Principles of family planning

    Learning activity 1.2

    In your own understanding, what are the principles of family planning that can be 

    considered in providing quality services to the clients?

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    Introduction

    Smaller families and increased child spacing contributes to reducing rates 
    of infant and child mortality. Family planning further improve the social and 
    economic conditions of women and their families, and improve maternal health. 
    Whilst providing family planning services, individuals’ and couples’ rights and 
    preferences have to be followed. This is achieved by following the principles of 
    families that are discussed in the next sections.
    Autonomy
    Providers should enable the women and individual couples to exercise free and 
    informed decision-making whilst choosing among a full range of safe, effective, and 
    possible family planning methods.
    Accessibility
    Family planning providers need to ensure that women and couples have the ability 
    to access accurate, clear and readily understood information about a variety of 
    family planning methods and how they are used. Health care facilities have to 
    ensure that contraceptive methods, trained providers, and contraceptive methods 
    are accessible to women and couples.
    Acceptability
    By acceptability, health care facilities, trained providers, and available family 
    planning options must be acceptable by women and couples. They must also meet 
    the medical standards, and individual preferences. Services provided and available 
    family planning methods must be sensitive to gender, life-cycle requirements, 
    dignity, and culture.
    Equity and non-discrimination
    Quality family planning services should be provided to women and couples free 
    from any form of discrimination such as age, gender, language, ethnicity, religion, 
    sexual orientation, income, and race. Women and couples must not be coerced 
    and/or violated when they seek family planning services from a healthcare provider.
    Quality
    Services and information provided to women and couples should be of good quality, 
    and should be based on the best available evidence. Quality encompasses a full 
    range of choices including quality contraceptive methods, accurate information, 
    and presence of technically competent providers, client-provider interactions that 

    respect the clients’, confidentiality, and preferences

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    Availability 

    By availability, family planning enabling environment with the following is ensured:
    a) Health care facilities, 
    b) trained providers;
    c) Counselling information
    d) contraceptive methods are available to ensure that individuals can exercise 
    full choice from a full range of contraceptive methods
    e) Availability of follow-up and removal services for implants whenever necessary 
    and needed.
    Empowerment
    Women and individual couples are empowered as principal actors and agents to 
    decide on their family planning needs. They are also empowered to implement these 
    decisions through seeking information about family planning, seeking services, and 
    choosing a family planning method suitable for them.
    Informed consent
    When providing family planning services, the provider needs to always seek the 
    woman’s and/or the couple’s informed consent and offer her comprehensive 

    information about the services provided as shown below

    Table 1.1: Informed consent applied to family planning services


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    1.3.1 Fertility awareness and calendar methods

    Learning activity 1.3.1

    Students watch a YouTube video titled ‘How I Use Natural Family Planning To 
    Prevent Pregnancy’ about fertility awareness methods: https://www.youtube.
    com/watch?v=lCsuefLt9eA&t=45s 
    1. What do you understand by fertility awareness as a family planning 
    method?
    2. With examples, explain different methods of fertility awareness that can 

    be used to prevent unwanted pregnancy?

    a. Fertility awareness method

    Fertility awareness methods (FAM) also known as the rhythm method, encompass 
    all methods that are used based on the fertile and infertile phases of a woman’s 

    menstrual cycle. 

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    Figure 1.2: Fertile period

    The fertile days are determined by correctly charting the span of the menstruation 
    cycle over a period of six months.
    The calendar method has indications, contraindications and mode of action as 
    follows:
    i) Indication
    • To all women in reproductive age and with regular menstrual cycle.
    • To all women who are capable of reading and able to chart properly.
    • To all women who are capable of abstaining from sexual intercourse 
    during the fertile period.
    • To all couples ready to use calendar method along with method with 
    barrier method during the fertile period to make it more effective.
    ii) Contraindication
    • Calendar method is not allowed to psychotic women.
    • Calendar method is not allowed to non-cooperative couples.
    • Calendar method cannot be used by a couple who is not ready to abstain 
    from sex during the woman’s fertile period.
    • Calendar method is contraindicated to women who have irregular 

    menstrual cycle.

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    iii)Mode of action
    Using a calendar, the woman monitors her menstrual cycle to track down her fertility 
    days starting from the first day of her menstrual period. The commencement of the 
    fertile period is determined by deducting or subtracting 18 days from the length of 
    the shortest cycles. The termination of the fertile days is determined by subtracting 
    11 days from the extent of the longest cycle (see figure 2 below).

    Table 1.2: Formula used to calculate fertility days using the calendar method

    A woman keeps track of the length of her menstrual cycles for at least 6 months. 
    Then she calculates her fertile window by subtracting 18 days from her shortest 
    cycle and 11 days from her longest cycle. For a woman whose shortest cycle is 24 
    days and longest cycle is 28 days, the calculation would be
    as follows:
    Shortest cycle 
    24
    -18
    =6
    Longest cycle
    28
    -11
    =17
    Based on this calculation, the woman’s fertile window would be days from 6th 
    to 17th day of her menstrual cycle. During these days, the woman and her male 
    partner should abstain from sexual intercourse or else use a condom to avoid 

    pregnancy in this period.

    Self-assessment 1.3.1

    i) How do you calculate the calendar family planning method?
    ii) When is the woman most likely to become pregnant if she is using calendar 
    method?
    iii) What precautions should be taken by the couple when they are using 

    calendar method?

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    Learning activity 1.3.2

    i) With the image above what do you understand by term ‘basal body 
    temperature’?

    ii) What factors do you think can affect basal body temperature?

    Introduction 

    The basal body temperature is the lowest normal temperature of a well person, 
    measured immediately after waking up and earlier after getting out of the bed. The 
    basal body temperature depends on the woman’s recognising the shift in her body 
    temperature around the time of ovulation. The BBT normally ranges from 36.2°C to 
    36.2°C during menses, and for about 5 to 7 days after. At about the time of ovulation, 
    a slight drop in temperature may occur, followed by a slight rise (approximately 
    0.4°C–0.4°C) after ovulation, in response to increasing progesterone levels. This 
    temperature elevation may last between 2 and 4 days before menstruation. 
    The basal body temperature drops to the lower levels recorded during the previous 
    cycle, unless pregnancy occurs.
    i) Indication
    • To all women who are capable of reading the thermometer measurements.
    • To all women who are capable to know that their temperature has risen 
    from their normal temperature.

    • To all women with no infection.

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    ii) Contra-indication

    • The women who cannot read measurements on the thermometer.
    • To all women with infection. e.g. vaginitis, malaria etc.
    • To all women who are not using warm blankets.
    iii)Mode of action
    This method works effectively if the woman has a temperature which does not 
    change. Hence, if a woman has a condition that may increase or lower her 

    temperature such as infection, fatigue, and anxiety, the method does not work.

    Self-assessment 1.3.2

    i) Describe how the woman’s basal body temperature changes across her 
    monthly cycle.
    ii) When is the basal body temperature likely to rise and why?
    iii) At what temperature can a couple using basal body temperature avoid 

    unprotected sexual intercourse?


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    Learning activity 1.3.3

    i) How does cervical mucus test can help the woman to predict the time of 
    her ovulation?

    Introduction

    The cervical mucus method refers to the recognition and interpretation of changes 
    in the amount and consistency of cervical mucus through the menstrual cycle. 
    Before ovulation, cervical mucus is thick and does not stretch easily. During the 
    fertility days, the cervical mucus becomes more abundant and thinner with an 
    elastic quality. After ovulation, cervical mucus becomes thick or may disappear 
    completely. This quality inhibits sperm from entering in the cervix. The change of 
    cervical mucus occurs to facilitate the viability and motility of sperm and allowing 
    the sperm to survive in the female reproductive tract until ovulation.
    i) Indicatio
    • To women who are capable of abstaining from coitus during ovulation.
    • To all couples who are capable of recognising the changes in appearance 
    of cervical mucus during the fertile period.
    • To all couples who are capable of being cooperative during the ovulation 
    time.
    ii) Contra-indication
    • This method is contraindicated to all women who feel uncomfortable 
    touching their genitals. 
    • The method is not allowed to all women with vaginal infections, sexual 
    transmitted infections, and hormonal imbalances should also not use 
    cervical mucus method.
    iii)Mode of action
    When a woman is using cervical mucus method, she is supposed to check her 
    vaginal discharge every day for consistency and recognition of the change in 

    appearance of her cervical mucus to determine her fertile period.

    Self-assessment 1.3.3

    i) Who should not use cervical mucus method in family planning?
    ii) When should a woman be cautious while determining her fertile period 

    using cervical mucus method?

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    1.3.4. Standard Days Method

    Learning activity 1.3.4

    Mrs. Lina have had a regular menstrual cycle of 30 days for six months. On 31st 
    July, she noticed that she had seen her menstrual bleeding. She is currently 
    using a cycle bead as a family planning method. 
    i) Which days will be safe for Mrs. Lina to do sexual intercourses with her 
    partner?

    ii) Which days will Mrs. Lina cannot do unprotected sexual intercourses?

    Introduction


    Standards Days Methods is another fertility awareness in which women and couple 
    use a cycle beads necklace to track their cycles (see the picture above). The cycle 

    beads have 32 beads, each representing a day in the woman’s menstrual cycle. 

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    i) Indication
    • To all women with regular menstrual cycle.
    • To all women who have had 3 menstrual cycles after child birth, with the 
    last one recording 26 to 32 days.
    ii) Contra-indication
    • To avoid unprotected sexual intercourse from 8th day to 19th day of every 
    cycle.
    • Uncooperative couples should not use SDM.

    iii)Mode of action

    The woman moves a rubber ring onto one bead each day based on her monthly 
    cycle. The red bead marks the first day of her period. Brown beads correspond to 
    safe days; that days when she may not likely become pregnant if she does sexual 
    intercourse. From the brown beads, the woman moves the rubber ring onto the 
    white beads. These white beads represent the when she is likely to get pregnant 

    and are labelled “unsafe” times to have unprotected vaginal intercourse.

    Self-assessment 1.3.4 

    1. Mrs. Dana has given birth one month ago. As she is not breastfeeding 
    regularly, she has seen her menstrual bleeding on 15 June. She wants to 
    use the cycle beads as a method of family planning. 
    i) At what date would you advise to explore the use of Standard Days 
    Method?
    ii) What would Mrs. Dana take into consideration before deciding to use a 

    cycle bead as a preferred family planning method?

    Homework

    Read the book ‘Family Planning: A Global Handbook for Providers’, Chapter 19; 

    Lactational Amenorrhoea, Page 257


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    Learning activity 1.3.5

    i) Explain how breastfeeding can delay ovulation after the birth of the baby?
    ii) Who can use Lactational amenorrhea and why?

    Introduction

    Lactational Amenorrhea Method is a type of natural family planning which depends on 
    the woman’s breastfeeding regularly (every two to three hours) without interruption 
    in the first six months after delivery. When the woman breastfeeds consistently, 
    prolactin levels become elevated and suppress ovulation.
    a. Indication
    • This method can be operational within 6 months after delivery.
    • If the mother has not had menstruation since the time of birth.
    • When the mother is able to breastfeed her baby at least every 2 to 3 hours 
    regularly without stopping within six months.
    b. Contra-indication
    • Not to be practiced after 6 months post birth.
    • Not to be used when the mother has had the return of menstrual period.
    • Not to be used by mothers who are not available to breastfeed their babies 
    regularly.
    c. Mode of action
    For this method to be more effective, LAM requires constant breastfeeding. Breast 
    feeding stimulates prolactin hormone which is responsible for breast milk production. 
    This hormone further hinders gonadotropin hormone which is responsible for 
    ovulation to be produced. Thus, when the woman does sexual intercourse, she will 

    not likely become pregnant.

    Self-assessment 1.3.5

    i) If the couple is using Lactational amenorrhea, what do they have to care of 
    to prevent the woman from becoming pregnant?
    ii) Discuss the factors that can influence the use Lactational Amenorrhea 

    Method.

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    1.3.6 Coitus Interruptus or withdrawal method 


    Figure1.7: Coitus interruptus

    Learning activity 1.3.6

    Read the book titled ‘Family planning: A global Handbook for Providers’ (2018 
    Edition), Chapter 18 and answer the following questions:
    i) What happens when a couple practises withdrawal method?
    ii) Whom can you likely recommend to practice coitus interruptus and why?
    iii) In your own opinion would you recommend coitus interruptus as a first 

    choice of family planning method?

    Introduction
    The male partner pulls his penis out of the vagina before ejaculation occurs to avoid 
    depositing sperm in or near the vagina. In so doing, he must keep his semen away 
    from the female partner’s external genitalia.
    i) Indication
    • All men in their reproductive age can use withdrawal method. 
    • It is indicated if there is no other family planning method available for 
    partners to use. 
    • This method requires much attention during the sexual act because at 
    times the man may reach climax and releases the pre-ejaculate fluid which 
    may contain sperm before withdrawing his penis to ejaculate outside the 
    vagina. 

    • This method might be appropriate for couples who are highly motivated 

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    and able to use it without failing.
    • It can also be used by couples with religious or philosophical reasons for 
    not using other methods of contraception. 
    • Coitus interruptus can be used by couples who are waiting to get another 
    alternative method immediately but find themselves in need of sexual 
    intercourse without having obtained that method. 
    • Couples who need a temporary method while they wait the start of another 
    method may choose to use coitus interruptus. 
    • Couples who do sex infrequently can choose coitus interruptus method. 
    ii) Contra-indication
    • Coitus interruptus must not be the method of choice if a man has premature 
    ejaculation issues. 
    • The method is also not appropriate for women with conditions that make 
    pregnancy an unacceptable risk because of the relatively high risk of 
    failure of coitus interruptus. 
    • This method is not allowed to couples who are not cooperative.
    iii)Mode of action
    When the man feels close to ejaculating, he must immediately remove his penis 
    from his female partner’s vagina to ejaculate outside and keeping his semen away 
    from her vulva. If man has ejaculated recently, before penetrating the female partner 
    again, he must urinate and clean the tip of his penis to remove any sperm that may 
    be remaining on his penis. The man should feel confident he can use withdrawal 
    correctly whenever he is engaged in the act of sex with his partner.

    Self-assessment 1.3.6 

    i) How does coitus interruptus method work?
    ii) Who would you recommend to not use coitus interruptus and why?
    iii) Describe how a male partner may pull out his penis from the vagina if the 

    couple is using coitus interruptus.

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    End unit assessment

    1. Explain briefly the principles of family planning?
    2. What are the signs that can make a woman to be conscious that is in her 
    fertile period with the help of cervical mucus?
    3. Discuss any factors that may affect Mrs. Lina’s use of cycle bead 
    successfully.
    4. Discuss the factors that can influence the use Lactational Amenorrhea 
    Method.
    5. How does coitus interruptus method work?
    6. The couple X have chosen to use Standard Days Method as their 
    preferred family planning method. The woman’s cycle in the last three 
    months had been between 28 and 32 days. The woman had seen her 
    periods on 5th April. 
    Draw a cycle bead and guide this couple on how they can use this method to 
    avoid unplanned pregnancy.
    7. You are sent to the community and meet a group of women on Umuganda 
    day. The village head requests you to offer an educational session about 
    natural family planning. 
    Explain how you will educate the above group on different methods of natural 
    family planning focusing on different methods’ mode of action, indications, and 

    contraindications.


    UNIT2:MODERN FAMILY PLANNING►