Overview of family planning, its program and recent advance

1. Recent advance in
Family planning
Presented by:
SHIKHA BASNET
MPH-2021
SPH & CM
Total Slides: 51

2. Outline of Presentation
• Family planning Introduction
• History of Family planning
• Global scenario
• South East Asia
• Nepal Scenario
• Family Planning methods
• Recent Advance
• Conclusion
• References
4/6/2022 2

3. Family Planning
4/6/2022 3

4. Introduction
• Family planning is defined as “the ability of individuals and couples to anticipate
and attain their desired number of children and the spacing and timing of their
births. It is achieved through use of contraceptive methods and the treatment of
involuntary infertility”
-WHO
• Family planning refers to supplies and services which enable individuals and
couples to attain and plan for their desired number of children, and the spacing and
timing of births.
4/6/2022 4

5. Introduction (2)
• Supplies include modern contraceptive methods and services include health care,
counselling and information and education related to sexual and reproductive
health.
• The ability of individuals to determine their family size and the timing and spacing
of their children has resulted in significant improvements in health and in social
and economic well-being.
• International studies have repeatedly confirmed that family planning ranks among
the most cost-effective of all health services, along with other basic and preventive
health measures such as vaccinating children and preventing HIV/AIDS.
4/6/2022 5

6. Introduction (3)
• Family planning could prevent up to one-third of all maternal deaths by allowing
women to delay motherhood, space births, avoid unintended pregnancies, and
unsafely performed abortions, and stop childbearing when they have reached their
desired family size.
• Contraceptive information and services are fundamental to the health and human
rights of all individuals.
4/6/2022 6

7. Introduction (4)
• The Family Planning Sustainable Development Goals model demonstrated that
improvements in socioeconomic status along with investments in family planning
maximize long-term progress towards reducing poverty and food insecurity and
increasing income.
• At the individual level, there are benefits in infant, child and maternal health
outcomes (SDG 3), improved educational outcomes (SDG 4), gender equality and
women’s empowerment (SDG 5) and equal access to the labor market, social
protection and the political process (SDGs 5, 8, and 16).
4/6/2022 7

8. History of Family planning
• Family planning has been of practice since the 16th century by the people of West
Africa.
• In 1968, Human Rights Conference was held in Tehran which considered
voluntarism in family planning
• Reproductive health and right was defined by the United Nations (UN) in 1994 at
the Cairo International Conference on Population and Development.
• The Government of Nepal began to offer family planning services from 1965
4/6/2022 8

9. Milestone of Family planning program in
Nepal
Year History
1965 Government adopted family planning policy as a means of maintaining a balance
between population growth and economic growth.
1968 a national service delivery system was started with the establishment of the Family
Planning and Maternal-Child Health board
1995 Ministry of population and environment was established following the FP and
reproductive health principles of ICPD
1998 National reproductive health strategy was formed
1998 Safe motherhood policy: need of FP services as a key components of maternal care.
2000 National adolescent health and development strategy was endorsed
2003 National safe abortion policy
2005 MoPE dissolved and its population division was merged in the MOH and the MOH
renamed as MOHP.
4/6/2022 9

10. 4/6/2022 10
Source: https://ourworldindata.org/world-population-growth-past-future

11. Trend in Growth of population in Nepal
4/6/2022 11
Source: https://worldpopulationreview.com/countries/nepal-population

12. Trends of Fertility and Contraceptive use
in Nepal
4/6/2022 12

13. Global Scenario (1)
• Expanding access to contraception is an essential component of achieving
universal access to sexual and reproductive health-care services, as called for in
the 2030 Agenda for Sustainable Development.
• In 2020, among 1.9 billion women of reproductive age (15-49 years), 1.1 billion
women are considered to have a need for family planning, meaning that they
desire to limit or delay childbearing.
• Of these women, 851 million are using a modern method of contraception and 85
million are using a traditional method.
4/6/2022 13

14. Global Scenario (2)
• An additional 172 million women are using no method at all, despite their desire
to avoid pregnancy, and thus are considered to have an unmet need for family
planning.
• Still, nearly 1 in 10 women of reproductive age worldwide have an unmet need
for family planning: they want to avoid or postpone pregnancy but are not using
any form of contraception.
4/6/2022 14

15. 4/6/2022 15
Source: United Nations, Department of Economic and Social Affairs, Population Division. (2020). Estimates and Projections of Family Planning Indicators 2020.

16. South East Asia
• Central and Southern Asia has seen the largest decline in the number of
women with unmet need since 2000.
• Globally, the number of women aged 15-19 years who had unmet need for
family planning decreased from 17 million in 2000 to 14 million in 2020.
• The large decline in unmet need among adolescent girls and young women
in Central and Southern Asia from over 6 million women in 2000 to 2.6
million in 2020 was the primary reason for the decrease at the global level.
4/6/2022 16

17. 4/6/2022 17
Source: United Nations, Department of Economic and Social Affairs, Population Division. (2020). Estimates and Projections of Family Planning indicators 2020.

18. 4/6/2022 18

19. Nepal Scenario (1)
• Family planning (FP) is one of the important components of Nepal’s national
health system.
• The aim of National FP program is to ensure individuals and couples fulfil their
reproductive needs and rights by using quality FP methods voluntarily based on
informed choices.
• FP has been enshrined as a fundamental right in the constitution, and included in
the basic health service package under the Public Health Act 2018, thus paving a
way towards universal health coverage.
4/6/2022 19

20. Nepal Scenario (2)
• FP is an essential health care services of Nepal Health Sector Program II
(2010‐2015), National Family Planning Costed Implementation Plan 2015‐ 2021,
Nepal Health Sector Strategy 2015‐2020 (NHSS) and the Government of Nepal’s
commitments to FP2020.
• The total fertility rate (TFR) of women aged 15-49 declined from 4.1 children per
women in 2000 to 2.3 in 2016 and has declined to 2.0 in 2019.
4/6/2022 20

21. SDG Target
4/6/2022 21
Target and Indicators 2020 status Source 2030
3.7.1 Proportion of women of reproductive age (aged
15-49 years) who have their need for family planning
satisfied with modern methods
61.9 NMICS 80
a. Contraceptive prevalence rate (modern methods)
(%)
44.2 NMICS 60
b. Total Fertility Rate (TFR) (births per women aged
15-49 years)
2.0 NMICS 2.1
c. Adolescent birth rate (aged 10-14 years, aged 15-
19 years) per 1,000 women in that age group
63 NMICS 30

22. 4/6/2022 22
Source: DoHS, Annual Report 2076/77 (2019/20)

23. 4/6/2022 23
Source: DoHS, Annual Report 2076/77 (2019/20)

24. Major activities (1)
Provision of regular comprehensive FP service including post-partum and post
abortion FP services
Provision of long acting reversible services, Permanent FP Methods or Voluntary
Surgical Contraception (VSC)
FP strengthening program through the use of decision-making tool (DMT)and
WHO medical eligibility for contraceptive (MEC) wheel
Micro planning for addressing unmet need of FP in hard to reach and underserved
communities
Provision of RANM and VSP service to increase FP service use
4/6/2022 24

25. Major activities (2)
Integration of FP and immunization service
Satellite clinic services for long acting reversible contraceptives
Contraceptive update for Obstetrician/Gynecologist, nurses & concerned key
players
Interaction program on FP and RH including ASRH with pharmacist and
marginalized communities
Community interaction with satisfied clients for promoting permanent method and
IUCD
4/6/2022 25

26. 4/6/2022 26

27. Temporary Methods
4/6/2022 27
Natural Methods
• Abstinence
• Coitus interruptus or withdrawal method
• Lactational amenorrhea
Biological Methods
• Calendar (rhythm) method
• Basal body temperature method
• Cervical mucus method (billings method)
Hormonal Contraceptive Method
• Contraceptive skin patch
• Vaginal ring
• Pills (Combined and Minipill)
• Injection
• Implant
• Emergency Pill
• Intrauterine device
Chemical Method
• Foams
• Creams, jellies and pastes
• Soluble films
I. Mechanical Family Planning Method
• Male condoms
• Female condoms
• Diaphragms
• Cervical cap
• Intrauterine devices (IUD)
• Sponge

28. Permanent methods
Male Sterilization
• Vasectomy
Female Sterilization
• Minilap
4/6/2022 28

29. Recent Advance
4/6/2022 29

30. Reversible Inhibition of Sperm Under
Guidance (RISUG) (1)
• In 1979, Prof. Sujoy K. Guha, School of Medical Science and Technology, Indian
Institute of Technology, proposed a radically new technique of male contraception
• RISUG is a co-polymer of Styrene Maleic Anhydride (SMA) dissolved in
Dimethyl Sulfoxide (DMSO) to form a gel
• It is a non-surgical method of male sterilization that is inexpensive, highly
effective, and reversible.
4/6/2022 30
https://bacandrology.biomedcentral.com/articles/10.1186/s12610-020-0099-1

31. Reversible Inhibition of Sperm Under
Guidance (2)
• It involves an injection of the solution into each of the patient's Vas deferens,
which forms a layer around the vas walls partially (but not completely) blocking
the flow of sperm cells.
• It causes the disruption of the membrane of spermatozoa and release of enzymes
that are essential for the fertilization of ova.
• Thus the ejaculation after RISUG contains infertile spermatozoa.
4/6/2022 31
https://bacandrology.biomedcentral.com/articles/10.1186/s12610-020-0099-1

32. Reversible Inhibition of Sperm Under
Guidance (3)
• RISUG was formulated as an occlusive polymer which was claimed to sterilize
subjects by single injection and reversed at any time following vas occlusion.
• Within 72 h of injection, RISUG forms electrically charged precipitates in the
lumen and further layers the lumen wall and inner walls of vas deferens.
• Precipitates are dominated with positive charge creating an acidic environment.
Passing through the RISUG injected vas deferens, sperms suffer ionic and pH
stress, causing acrosomal damage, rendering them unable to fertilize oocytes.
4/6/2022 32
https://bacandrology.biomedcentral.com/articles/10.1186/s12610-020-0099-1

33. Reversible Inhibition of Sperm Under
Guidance (4)
• RISUG has also been tested successfully in number of human volunteers during
Phase-I, Phase-II and Phase-III clinical trials. Presently the drug is under extended
Phase-III clinical trials at various centers in India.
• In 2018, a total of 315 subjects enrolled at 5 different centers in the country were
reported to show no adverse side-effects of the drug with overall contraceptive
efficacy of 99.02%.
• If approved for widespread application, it could provide an alternative to the
current two major methods of male contraception: Condoms and vasectomies
4/6/2022 33
https://bacandrology.biomedcentral.com/articles/10.1186/s12610-020-0099-1

34. 4/6/2022 34
RISUG: mode of action. (A) Vas is exposed from inguinal region and RISUG is injected in both vas
deferens towards distal region by a micro-syringe. (B) RISUG coats the wall of the vas deferens
blocking sperm movement. (C) Complete reversal obtained after DMSO/NAHCO3 is injected
bilaterally, flushing component of RISUG

35. Advantages of RISUG over other methods of
male contraception
RISUG creates a physical and chemical barrier preventing sperm from reaching the
oocyte. The polymer is injected into the vas deferens through the non scalpel
technique, thus avoiding surgery in the initial sterilization procedure.
1. Early azoospermia:
• Clinical trials with RISUG demonstrate promising results showing azoospermia in
subjects as early as 4 weeks after the injection that is sustained over years. A few
sperms that are observed in ejaculates after RISUG were found to be functionally
inactive.
4/6/2022 35

36. Advantages of RISUG over other methods
of male contraception
2) Reversibility:
• In any contraceptive method a great concern is the reestablishment of fertility
when required.
• Removal of SMA co-polymer can be induced by injecting DMSO or
NaHCO3 that acts as partial solvent.
• After preclinical trials in various animal models based on blockage of vas
deferens without any toxicity, the studies have been moved toward its reversibility
aspect without affecting cellular integrity.
• Despite the promising results of reversibility in animal models, the reversibility
studies have not yet been carried out in humans.
4/6/2022 36

37. Kyleena
• Smallest and the lowest dose of 5 years IUD
• The Kyleena IUD consists of a soft, flexible polyethylene (plastic) frame in the
shape of a T.
• The Kyleena IUD contains 19.5 milligrams (mg) of levonorgestrel. It releases
17.5 micrograms (mcg) of this hormone per day. After one year, this rate slowly
declines to 9.8 micrograms daily, and then to 7.4 micrograms per day.
4/6/2022 37
Kyleena
Source: https://www.kyleenahcp.com/

38. 4/6/2022 38

39. Sayana Press (1)
4/6/2022 39
• It is a lower-dose formulation and presentation of the contraceptive Depo-
Provera, manufactured by Pfizer Inc.
• a subcutaneous self administered contraceptive injection for women.
• pre-filled with the drug, so the injection is ready-to-use.
• single-dose container with 104 mg medroxyprogesterone acetate (MPA) in 0.65
ml suspension for injection.
• prevent pregnancies for 3 months.
•

40. 4/6/2022 40

41. • It is suitable for community-based distribution and for women to administer
themselves through self-injection with minimal training.
• The first Sayana Press introduction launched in Burkina Faso in July 2014.
• It is being launched in Nepal in two districts: Nawalpur and Sindhuli, by the
reproductive health agency Ipas Nepal in coordination with the UK’s Department
for International Development (DFID) and the MoH.
4/6/2022 41
Sayana Press (2)

42. • The drug has already been tried and approved, and is available for use in 40
European countries including UK.
• Introductions of Sayana Press also aim to support the Family Planning 2020
coordinated effort to ensure that voluntary family planning services reach an
additional 120 million women and girls in the world’s poorest countries by 2020.
4/6/2022 42
Sayana Press (3)

43. • In 2015, the UK Medicines & Healthcare products Regulatory Agency (MHRA)
authorized Sayana Press for self-injection in the United Kingdom.
• The World Health Organization (WHO) also recommends self-administration of
Sayana Press “in contexts where mechanisms to provide the woman with
appropriate information and training exist, referral linkages to a healthcare
provider are strong, and where monitoring and follow-up can be ensured.”
4/6/2022 43
Does Sayana Press have regulatory approval for self
injection?

44. 4/6/2022 44

45. 4/6/2022 45
This study recruited women seeking injectable contraception at 14 public health
facilities in Nepal selected for geographic diversity. They enrolled women who self-
selected either Sayana Press or DMPA-IM and used structured interviews to obtain
baseline demographics and assess satisfaction and continuation rates at 1, 3, and 6
months.
What they concluded is Sayana Press is acceptable to women in Nepal with the
preference for Sayana Press over DMPA-IM (higher proportion chose the method
when counseled and given the option, better continuation).
Implications: The potential for self-injection with Sayana Press may have
implications for continuation and opportunity for future research and strategies to
roll out this innovative technology must be explored.

46. 4/6/2022 46
In this prospective cohort study, 380 18–45-year-old participants completed self-
injection training by licensed study nurses, guided by a client instruction booklet,
and practiced injection on prosthetics until achieving competence. Nurses
supervised participants' self injection and evaluated injection technique using an
observation checklist. Those judged competent were given a Sayana Press unit,
instruction booklet and reinjection calendar for self-injection at home 3 months
later. Participants completed an interview before and after self-injection.
The study concluded that Self-injection is feasible and highly acceptable among
most study participants in Uganda.
Results can inform self injection programs which aim to increase women's
autonomy and access to injectable contraception.
Source:Ref:eader.elsevier.com/reader/sd/pii/S0010782416304590? &originRegion=eu-west-1&originCreation=20211210063631

47. C
O
N
C
L
U
S
I
O
N
4/6/2022 47

48. References
 Program, I., Butler, A. and Clayton, E., 2021. Overview of Family Planning in the United
States. [online] Ncbi.nlm.nih.gov. Available at:
<https://www.ncbi.nlm.nih.gov/books/NBK215219/>
Who.int. 2021. Contraception. [online] Available at: <https://www.who.int/health-
topics/contraception
 Countdown2030europe.org. 2021. [online] Available at:
<https://www.countdown2030europe.org/storage/app/media/IPPF_FactSheet-
5_poverty.pdf
Who.int. 2021. Family planning/contraception methods. [online] Available at:
<https://www.who.int/news-room/fact-sheets/detail/family-planning-contraception
Un.org. 2021. [online] Available at:
<https://www.un.org/en/development/desa/population/publications/pdf/family/fam
4/6/2022 48

49. References
 PRB. 2021. ENGAGE Snapshot: Family Planning Leads to Poverty Reduction. [online] Available
at: <https://www.prb.org/resources/engage-snapshot-family-planning-leads-to-poverty-reduction/>
2021. [online] Available at:
<https://www.un.org/development/desa/dpad/wpcontent/uploads/sites/45/WESP2021_CH3_SA.pd
f>
Dhsprogram.com. 2021. [online] Available at:
<https://dhsprogram.com/pubs/pdf/FA119/FA119.pdf>
2021. [online] Available at:
<https://asiapacific.unfpa.org/sites/default/files/pubpdf/210112_unfpa_impact_of_covid19_on_hu
man_fertility_sp.pdf>
4/6/2022 49

50. References
Un.org. 2021. [online] Available at:
<https://www.un.org/development/desa/pd/sites/www.un.org.development.desa.pd/files/files/docu
ments/2020/Sep/unpd_2020_worldfamilyplanning_highlights.pdf>
2021. [online] Available at:
<https://nepal.unfpa.org/sites/default/files/pubpdf/FP%20Costed%20Implementation%20Plan.pdf>
Usaid.gov. 2021. Family Planning and Reproductive Health. [online] Available at:
<https://www.usaid.gov/global-health/health-areas/family-planning#dataSources>
PRB. 2021. Family Planning Saves Lives. [online] Available at:
<https://www.prb.org/resources/family-planning-saves-lives/>
https://www.injectsayanapress.org/
4/6/2022 50

51. 4/6/2022 51