Family Planning Proposal

INTRODUCTION Family planning and correct spacing of pregnancy can avert nearly one-third of maternal mortality and 10% of child mortality.The current approach in Family Planning emphasizes on offering high quality contraceptive services among eligible clients on a voluntary basis. The National Population Policy 2000 has recognized asits immediate objective the task of addressing the unmet need for contraception to achieve themedium term objective of bringing the Total Fertility Rate (TFR) to replacement level by 2010( i.e to reduce the Net Reproductive Rate to 1) so as to achieve the long-term goal of populationstabilization by 2045.

It is important to initiate a family planning method soon after childbirth for maintaining healthy spacing

Usage of an IUCD in the immediate postpartum period will not cause a change in the quality or in the amount of breastmilk . It is very suitable method for women who are uncertain about permanent sterilization.

IUCD should not be used by women with abnormal shaped uterus .If there is an infection during delivery, the IUCD should be inserted only after treating it. The IUCD does not protect against HIV and other STD and hence should not be used by women with high risk for STD. A pelvic examination is necessary before insertion.

IUCDs that are copper bearing act mainly to prevent fertilization . Copper ions alter the fluid in the uterus and tubes . Hence the sperm motility and sperm function is reduced. Thus the sperm does not reach the fallopian tubes to fertilize the egg. In the endometrium it also causes a foreign body reaction releasing macrophages and preventing implantation. It is more than 99% effective .

It begins working immediately and is effective for 10 years after which it should be replaced by another copper T or some other method of family planning can be used. If necessary it can be removed before 10

The anterior and the posterior wall of theuterus lie close together.

The lower part is extremely thin andfloppy due to stretching .

Uterine body is tilted forward usually and it is markedly mobile. The thin and stretched lower segment contributes to its mobility.

The extreme curvature noted on bimanual examinationis due to the heavy and thick body as compared to the thin stretched lower segment .

The uterine axis is at a right angle to the vaginal axis.

There is no change in the consistency and the size of the uterus for 48 hours.

In 2weeks , the uterus straightens and shrinks thus completely descending inside the pelvis . The lower segment cannot be appreciated..

In 5-6 weeks , the nonpregnant size is reached.

Cervical changes after delivery

After the 3rd stage of labor, the cervix is thin, flabby , collapsed and extremely soft.

The outer margins are lacerated. The cervix readily admits two fingers for few days due to its slow contraction.

Within 1 week there is progressive narrowing and thickening .

When involution is complete the cervix is tightly closed and firm in consistency while the characteristics of a parous cervix is