Family Planning Methods, Contraceptive Devices and Its Effectiveness !

What is Family Planning?

Family planning is simply a process of planning a family
In other words, family planning is also known as contraception
Family planning can be defined as the voluntary decision made by the responsible individuals and couples in order to determine the desired family size and timing/spacing of births
Family planning is about deciding the desired number of children and spacing between the pregnancies by the couples
However, Family planning is not merely related to finalizing the number of children/family members but it is also related to the good health and nutrition of the mother and child
Planning a family reduce the chances of unwanted pregnancy and the need for abortion which ultimately contributes for the good health of the mother

Benefits/Advantages of Family Planning

It prevents pregnancy related health risks to the women
Reduces unwanted pregnancy
Reduces infant and maternal mortality- which may result due to high number of pregnancies for a woman
Reduces adolescent/teenage pregnancies
Slows down population growth

Types of Family Planning/Contraceptive Methods

Broadly categorizing, family planning methods can be categorized into traditional and modern family planning methods. A brief idea about all the methods is mentioned below:

Traditional methods:

Traditional methods of family planning mainly includes two methods-

Calendar method or rhythm method	Withdrawal (coitus interruptus) method
This method of contraception from its name itself requires the use of calendar	Withdrawal method of contraception requires the man to withdraw his penis from the female partner’s vagina before ejaculation
In this method, the couple prevents pregnancy by avoiding unprotected vaginal sex during the 1^st and last fertile days of menstrual cycle	Here the male partner’s job would be to ensure that the sperm is ejaculated outside the female body so that chances of fertilization could be prevented
	This method is usually not considered as effective as it may seem because the timing of withdrawal is difficult to determine and there are more chances of ejaculating inside the vagina

Modern methods:

There are different methods of family planning under this section of modern methods. They are:

Hormonal contraceptives: Among different hormonal contraceptives, 4 major hormonal contraceptives are described briefly below:-

Combined oral contraceptive (COC)/pill

Progestogen-only contraceptive pill/ Progestogen only injectables:

Monthly injectables/combined injectable contraceptives (CIC):

Combined contraceptive Patch and Contraceptive vaginal ring (CVR)

This contraceptive/pill contains two hormones; estrogen and progestogen which prevents the release of matured eggs from the female ovaries

This pill/injection only contains progestogen, no estrogen hormone.

For this method of contraception, injection is given to the female in her muscle. The injection contains estrogen and progestogen hormone

In this case, both progestin and estrogen hormone are released from the skin (in case of patch) or from the vaginal ring

It works by thickening the cervical mucosa which blocks the meeting of sperm and egg

This method may also contain Depo-Provera, which is also an injectable. However, depo/Depo-Provera only has progestin hormone and should be taken every 3 months to prevent pregnancy

This method prevents the release of eggs from the ovaries. In addition, this method is considered comparatively more safer than COC

Long Acting Reversible Contraception/Contraceptive (LARC): Long Acting Reversible Contraceptive (LARC) is the contraceptive devices which can be used for a long period of time once started. It can be used for three to five years or even more than that. Thus, does not involve regular worry about re-use time and again. They are also known as ‘fit and forget’ It includes:

Intrauterine device (IUD)	Implants
IUD is a small, flexible plastic device which is inserted into the uterus of the female.	Implants are contraceptive devices made of flexible rods or capsules and are inserted/placed under the skin of the upper arm
The device works effectively for five or more years	It contains progestogen hormone
IUD are of two types; one containing copper and the other containing levonorgestrel	It lasts/works for 3-5 years
In the 1^st case of copper, the copper wire damages sperm and prevents meeting with egg while in the case of levonorgestrel, it reduces the growth of lining of uterus called endometrium

Barrier methods: From the name itself, barrier methods are the contraceptive methods which creates barrier for sperm to meet with vagina. These methods must be used before having sexual intercourse/penetration. It mainly includes:

Male condom	Female condom
These are transparent plastic sheath which are kept over male penis to cover it	These are soft transparent plastic covering which are kept loosely inside a woman’s vagina
It prevents the male sperm to meet the female egg	It prevents barrier for meeting sperm and egg and also prevents STI’s.
It not only prevents fertilization but also prevents STI’s and HIV

Emergency contraception: This method of contraception is used in cases of sudden/unplanned conception. However, it must be noted that, emergency contraception should not be used as a regular method of family planning because of its wide range of harmful side effects in regular and long use. It includes:-

Emergency contraception pills

These are emergency pills which are immediately taken for unplanned and unprotected sex

These pill prevent pregnancy up to 5 days after unprotected sex

Permanent contraception: Permanent contraception refers to lifelong contraception. It is especially common and recommended to those male/female/couple who have already have child/children’s and possess no further child bearing wish in their life time. Permanent contraception can be done both in male or female. It includes:

Male sterilization (Vasectomy):	Female sterilization (Tubal ligation)
It is a permanent contraception method in which the vas deferens of male reproductive organ (which carries sperm from the testicles) is cut or blocked	It is a method of contraception in which the fallopian tube of female reproductive organ is cut/blocked.
It does not have any effect on male sexual performance	The blockage/cut in the fallopian tube prevents the egg to meet the sperm

Others/Natural Family Planning Methods: These basic advantage of these methods mentioned below are that, they do not possess any side-effects compared to other methods. They are:

Lactation Amenorrhea Method (LAM)	Standard Days Method (SDM)	Basal Body Temperature (BBM) Method	Sympto-thermal Method
LAM is a method of contraception for newly delivered mothers	For this method of contraception, the female can track their fertile period (which is 8-19 days of menstrual cycle) and avoid unprotected vaginal sex during those days	Here, the body temperature of female is regularly taken at the same time each morning to identify the ovulation cycle and fertile period	In this method, fertile period can be tracked by a female by observing the changes in her cervical mucosa, body temperature and consistency in cervix
This method works due to the effect of breast feeding on fertility		Rise in temperature may be from 0.2 to 0.5 degrees Celsius
This method of contraception requires the mother to continue Exclusive Breast Feeding (EBF) every 4-5 hours day and night		Rise in BBT for 3 full days represents that the ovulation has occurred and fertile period has passed which means that sex can be continued from the 4^th day
It is only applicable for those mothers whose monthly bleeding has not returned after delivery

Effectiveness of Family Planning Methods:

As there are variety of family planning methods, along with each of their’s functional difference, pros and cons; their effectiveness also varies a lot. No family planning methods are equally effective. Effectiveness of different family planning methods can be seen in the figure below: