Family Planning Dr.

Sijal Fadhil Farhood AL-JOBORAE

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Motto of family planning:

 Having children by choice not by chance

Introduction:
Waiting until the mother is at least 18 years old before trying to
have children improves maternal and child health.
If additional children are desired after a child is born, it is healthier
for the mother to wait at least 2 years after the previous birth
before attempting to conceive (but not more than 5 years).
After a miscarriage or abortion, it is healthier to wait at least 6
months.

When planning a family women who are over the age of 35 should
be aware of the risks of having a child at that age.
Older women are at a higher risk of having a child with autism and
down syndrome, the chances of having multiple births increases,
which cause further late-pregnancy risks, they have an increased
chance of developing gestational diabetes, the need for a
Caesarian-section is greater, older women's bodies are not as well-
suited for delivering a baby. The risk of prolonged labor is higher.
Older mothers have a higher risk of a long labor, putting the baby in
distress.

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DEFINITION :
W H O:
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 (WHO
1971)
Globally :
Family planning is among the most cost-effective of all health
interventions
OBJECTIVES:
To avoid unwanted births and to bring about wanted births (for the
sub fertile)
To regulate the intervals between pregnancies (spacing)
To control the time at which births occurs in relation to the ages of
the parents (timing)
To determine the number of children in the family (family size)
SCOPE OF FAMILY PLANNING SERVICES:
1- The proper spacing and limitation of births
2- Advice on sterility
3- Education for parenthood
4- Sex education
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 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
13- Providing adoption services
Family Planning Services.. Definition
Family planning services are defined as "educational, comprehensive
medical or social activities which enable individuals, including minors,
to determine freely the number and spacing of their children and to
select the means by which this may be achieved."
IMPACT OF FAMILY PLANNING :
WOMEN’S HEALTH
i-Avoidance of Unwanted Pregnancies
An unwanted pregnancy may lead to an induced abortion. Abortion
outside the medical setting (criminal abortion) is one of the most
dangerous consequences. There is also evidence of higher incidence
of mental disturbances among mothers who have had unwanted
pregnancies

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 ii- Limiting the number of births and proper spacing
Repeated pregnancies increases the risk of maternal mortality and
morbidity. These risks rise with each pregnancy beyond the third
and increase significantly beyond the fifth.
With increased parity the following increase:
1- Rupture of the uterus
2- Uterine atony
3- Toxaemia
4- Eclampsia
5- Placenta previa
6- Nutritional anaemia
7- Stillbirths
8- Cancer of the cervix.. family planning is the only way to limit the
size and control the interval between births

iii-Timing of births
Generally mothers face greater risk of death below 20 and above 30-
35.
IMPACT OF FAMILY PLANNING ON :
FOETAL HEALTH

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 A number of congenital anamolies are associated with advanced
maternal age which can be avoided by timing pregnancy in relation
to maternal age.
CHILD HEALTH
A- Child mortality: It is well known that this increases if
pregnancies occur in rapid succession. A birth interval
of 2-3 years is considered desirable to reduce child
mortality.
B- Child growth, development and nutrition: The child is
not likely to receive his full share of love and care,
including nutrtional needs
C- Infectious diseases: Children living in large sized
families have an increased risk of infection especially
gastroenteritis respiratory and skin infections.
Natural Family Planning
2-3 percent of the world’s reproductive age population depends on
NFP which limits sexual intercourse to naturally infertile periods.
BIRTH CONTROL – CONTRACEPTION:
Refers to methods or devices used to prevent pregnancy. Planning and
provision of birth control is the essence of family planning.
BENEFITS OF CONTRACEPTION:
Contraception in developing countries has cut maternal deaths by 44%
(270,000 deaths averted in 2008). Teenage pregnancies are at
greatest risk of adverse outcomes e.g. preterm birth, LBW & infant
mortality, thus adolescents need comprehensive sex education and
access to reproductive health services, including contraception.
Birth control increases economic growth because of fewer dependent
children, more women participating in the workforce, and less
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consumption of scare resources. their children's schooling and body
mass index all substantially improve with greater access to
contraception.
Birth Control Methods:
A- Barriers: such as condoms, diaphragms, and the contraceptive
sponge;
B- Hormonal contraception :includes oral pills, patches, vaginal
rings, and injectable contraceptives;
C- Intrauterine devices (IUDs).

e.g. transdermal patch

 Emergency contraception can prevent pregnancy after

unprotected sex.
 Long-acting reversible contraception such as implants, IUDs,
or vaginal rings are recommended to reduce teenage
pregnancy.
Chance of pregnancy during first year of use:
Method Typical use Perfect use
No birth control 85% 85%
Combination pill 8% 0.3%
Progestin-only pill 13% 1.1%
Sterilization (female) 0.5% 0.5%
Sterilization (male) 0.15% 0.10%
Condom (female) 21% 5%
Condom (male) 15% 2%
Copper IUD 0.8% 0.6%
Hormone IUD 0.2% 0.2%
Patch 8% 0.3%
Vaginal ring 8% 0.3%
Depo Provera 3% 0.3%
Implant 0.05% 0.05%

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 Diaphragm and spermicide 16% 6%
Withdrawal 27% 4%
Standard Days Method ~12-25% ~1-9%

STERILIZATION:
Sterilization by means such as vasectomy and tubal ligation is
permanent contraception
eg. Split dose emergency contrceptive pills

Percentage of women using modern contraception:

Blue to pink :60-90%

Dark brown to black:6-18%
FAMILY PLANNING IN IRAQ:
 Barriers to birth spacing:
 1-The influence of persons in the. community(traditional
,religious).
 2-Availability of variety of methods.
 3-Accessibility of FP services.
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  Cost.

Grounds on which abortion is permitted:

 To save the life of the woman Yes
 To preserve physical health No
 To preserve mental health No
 Rape or incest No
 Foetal impairment Yes
 Economic or social reasons No
 Available on request No
Additional requirements:

 Approval from THREE physicians is needed in order to

obtain a legal abortion AND THIS SHOULD BE DONE IN A
STATE HOSPITAL.
 The written consent of the pregnant woman’s husband is
also necessary.

The United Nations’ Children Fund (2010) states that through 2005
and 2009, contraceptive use in Iraq was at 50%. This is because a
majority of Iraqi women are unaware of Iraq’s national policy and
how to access health facilities and obtain contraceptives.

Edited by : Mustafa Abdul Kareem

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