Family Planning

Table of Contents
1. What is Family Planning?
2. Major Tasks of the RCH Programme
3. Contraceptive Methods
4. MTP (Medical Termination of Pregnancy)
5. Permanent or Terminal Methods (Sterilisation)
6. Concluding Notes
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What is Family Planning?

Family planning refers to practices and services that enable individuals and couples to decide freely and responsibly the number, timing and spacing of their children. The objective is to promote the health and welfare of women, children and families by preventing unwanted pregnancies, planning desired births and regulating intervals between pregnancies.

The family planning programmes in India were initiated in 1951-52 and have been periodically revised since then. The programmes were reorganised under the Reproductive and Child Health (RCH) approach, which was launched in 1997. Apart from contraception, these programmes include awareness generation, maternal and child healthcare, and protection against sexually transmitted infections including HIV/AIDS.

Primary objectives of family planning include:

• To avoid unwanted births.
• To bring about wanted births.
• To regulate the interval between pregnancies.
• To determine the number of children in a family.

History and slogans related to the small-family norm:

• India is recorded as one of the first countries to introduce a national family planning programme (1952).
• In 1977 the policy emphasis shifted towards a broader family welfare approach: "To improve the quality of life of people."
• 1970 slogan: "Do ya Teen Bas"
• 1980 slogans: "Sons or Daughter - Two will do" and "Second after 3 years".

Major Tasks of the RCH Programme

• Creating awareness among the public about reproductive biology, contraception, safe sex and sexually transmitted diseases.
• Providing facilities and support so that individuals can build a reproductively healthy life; this involves both governmental and non-governmental agencies.
• Sex education in schools to give adolescents correct information on reproductive organs, puberty, safe and hygienic sexual practices, STDs and HIV/AIDS, and to dispel myths and misconceptions.
• Educating married and marriageable couples about available birth control options, antenatal and postnatal care, importance of breastfeeding and gender equality to create socially conscious families of the desired size.
• Implementing action plans that provide medical assistance for reproductive health problems including pregnancy care, delivery, contraception, abortions, menstrual disorders and infertility requires strong infrastructure and trained personnel.
• Statutory ban on sex-determination by amniocentesis: Prenatal diagnostic techniques such as amniocentesis can detect chromosomal abnormalities and developmental disorders in the foetus. Because such techniques were being misused for sex determination leading to female foeticide, their use for sex determination is prohibited by law.

Contraceptive Methods

Methods that prevent unwanted pregnancies are called contraceptive methods. Broadly they are classified as:

• Temporary (spacing) methods.
• Permanent (terminal) methods.

Chemical Methods

Chemical contraceptives use spermicidal agents or surface-active chemicals that attach to sperm, inhibit oxygen uptake or disrupt sperm membranes and thereby kill or immobilise sperm.

Examples and formulations used:

• Vaginal foams and tablets such as "Today".
• Creams or jellies such as "Nim-76" (DIPAS).
• Common chemical constituents include ZnSO₄, KMnO₄, boric acid, lactic acid and citric acid; these act as spermicides.

Mechanical or Barrier Methods

Barrier methods physically prevent the meeting of sperm and ovum.

• Male condom - made of latex; acts as a barrier to sperm and also offers protection against most sexually transmitted infections including HIV.
• Intrauterine Devices (IUDs/IUCDs) - devices inserted into the uterus by trained health personnel.

Types of IUDs:

• Non-medicated IUDs (for example, Lippes loop).
• Copper-releasing IUDs (for example, CuT, Cu7, Multiload 375).
• Hormone-releasing IUDs (for example, Progestasert, LNG-20).

Mechanism of IUDs:

• IUDs increase phagocytosis of sperm within the uterus.
• Copper ions released from copper IUDs suppress sperm motility and reduce fertilising capacity.
• Hormone-releasing IUDs make the uterine environment unsuitable for implantation and render the cervical mucus hostile to sperm.
• IUDs are particularly suitable for women who wish to delay pregnancy or space children; they are widely accepted in India.

Hormonal Methods

Hormonal methods are among the most effective forms of contraception (high efficacy when used correctly). They work by altering the normal hormonal regulation of the menstrual cycle and ovulation.

Common hormonal methods include oral pills, injectables and implants.

• Female oral contraceptive pills:
  • Mala-N, Mala-D - daily combined oral pills.
  • Saheli - weekly non-steroidal oral pill (manufactured by Hindustan Latex Ltd.).
  • Quinestrol - monthly preparation.
• Regimen (combined oral pills): pills are commonly started in the early days of the menstrual cycle (e.g. from the 5th day) and taken for 21 days followed by 7 days of iron or placebo tablets as a withdrawal interval.
• Key hormonal components:
  • Norethisterone acetate (a synthetic progestin).
  • Ethinyl estradiol (a synthetic oestrogen).
• Mechanism:
  • Combined pills suppress the pituitary secretion of gonadotropins (FSH and LH) and thereby prevent ovulation.
  • Progestin-only preparations thicken the cervical mucus, making it difficult for sperm to penetrate, and may also alter the endometrium to hinder implantation.
• Male hormonal pill:
  • Gossypol - derived from cottonseed; it inhibits spermatogenesis but was withdrawn/banned in many places because it caused permanent azoospermia (irreversible loss of sperm production) in some users.
  • Synthetic progestins have been investigated for male contraception but are not in routine use as a safe reversible male pill.
• Injectables and implants:
  • DMPA (depot medroxyprogesterone acetate) - an injectable depot progestin given subcutaneously or intramuscularly for long acting contraception.
  • Norplant - an implant that slowly releases progestin over months to years.
  • These methods maintain elevated progestin levels that suppress gonadotropin secretion and therefore prevent ovulation.

Natural Methods

• Rhythm (periodic abstinence) - based on avoiding intercourse during the fertile period. (Traditional advice: the first seven days after menstruation and the seven days before the next period were considered comparatively safer; modern fertility awareness methods use more precise calculation of the fertile window.)
• Basal Body Temperature (BBT) - a woman records her resting body temperature daily; BBT shows a small rise (about 0.5 °C) at and after ovulation due to a rise in basal metabolic rate associated with progesterone secretion.


• Withdrawal (coitus interruptus) - the male withdraws his penis from the vagina just before ejaculation to avoid depositing sperm in the reproductive tract.
• Lactational amenorrhoea - frequent breastfeeding elevates prolactin levels which can suppress the menstrual cycle and ovulation for some months after delivery, providing a natural period of infertility while exclusive breastfeeding continues.

MTP (Medical Termination of Pregnancy)

Termination of pregnancy is regulated in India by the MTP Act, 1971. The Act permits medical termination of pregnancy under specified conditions and with prescribed safeguards; it is considered relatively safer when performed in the first trimester and becomes progressively riskier in the second trimester.

Common medical, social and legal grounds on which termination may be allowed include:

• Medical - where continuation of pregnancy poses a risk to the mother's life or health.
• Eugenic - where there is a substantial risk that the child would be born with serious physical or mental abnormalities.
• Humanitarian - pregnancies resulting from rape.
• Socioeconomic - where family circumstances make continuation of pregnancy undesirable (for example, the mother already having more than two or three children, as per policy considerations).
• Failure of contraceptive devices - unintended pregnancy despite contraception.

Permanent or Terminal Methods (Sterilisation)

Permanent methods of contraception are surgical procedures that permanently prevent conception by blocking gamete transport.

Key features and types:

• These methods are intended to be irreversible and are chosen by individuals or couples who do not want any (or more) children.
• Statistics (approximate distribution as recorded in many national programmes): female sterilisation constitutes the majority of sterilisation procedures (around 85%), while male sterilisation (vasectomy) accounts for 10-15%.
• Male sterilisation - Vasectomy: the vas deferens are surgically cut and sealed so that sperm cannot be expelled in the ejaculate.
• Female sterilisation - Tubectomy / Tubal ligation: the fallopian tubes are cut, tied or occluded so that eggs cannot travel from the ovary to the uterus and sperm cannot reach the egg.

Concluding Notes

Family planning combines medical methods, education and social policies to allow individuals and couples to make informed reproductive choices. Effective family planning improves maternal and child health, reduces unintended pregnancies and supports socio-economic development. Choice of method depends on medical suitability, desire for future fertility, convenience, protection against STDs and informed consent.