INTRODUCTION:

Contraception means preventing the union of the sperm and ovum; suppressing ovulation; or interfering with
the implantation of fertilized ovum in the uterus.
The term contraception includes all measures temporary or permanent, designed to prevent pregnancy due to
the coital act.

DEFINITION:
Contraceptive methods are the preventive methods to help avoid unwanted pregnancies. They include all
temporary and permanent measures to prevent pregnancy resulting from coitus.
-WHO

INCIDENCE:
Last few years, the contraceptive prevalence rate for modern methods of contraception in India is 42.8%
(48% for all methods), with female sterilization "accounting for 34.2%, pill use for 2.1%, IUD use for 1.6%
and condom use for 3.1%. Male sterilization accounts for 1.9%.

CHARACTERICTCS OF IDEAL CONTRACEPTIVES:

 Highly effective
 No side effect
 Safe
 Cheap
 Easily distributed
 Health care personnel not required
 Acceptable to all cultures & religions
 Simply apply
 Long lasting

METHODS OF CONTRACEPTION:
CONTRACEPTION

Spacing method Terminal method

Natural method Barrier method Vasectomy Tubectomy

Withdrawal method Physical method
Safe period Chemical method
Basal body temp Intrauterine devices
Ovulation & Hormonal method
cervical mucus Post conceptional method
Rhythm method
Abstinence
1. Spacing Method:-
• Help in prevention of pregnancy used. as long as they want
• These methods com help in timing and spacing of Pregnancies, preventing are unwanted children.
This methods temporary method. It has two types

(ⅰ) Natural Method:

• Natural method does not involve the use of any of the man made devices.
• These methods are useful for timing and Spacing of pregnancies.
 Withdraw method-
In this method the penis is withdrawn from the vagina before ejaculation, in this way semen io prevented
from entering the uterine, cavity and pregnancies does not take place.
Merits:-
• It involves no cost
• It does not require any other device
• with self control and discipline it can be fairly effective
Demerits:-
•Require a great dead of self control
• Thus failure rate is very high
• Suggest delay in withdraw can lead to pregnancy
 Safe Period:
Based upon the process of ovulation and menstrual cycle which helps in determination of the safe period
when coitus can be done and unsafe period when coitus can be avoided to prevent pregnancy.
Merits:-
• Does not require any man made device
Demerits:-
• Require self control by the partners during the highly unsafe period
• Not suitable for the women who does not have regular period
• Failure rate is high
 Basal body temperature:
• Identifying fertile and infertile period of a woman’s cycle by daily taking and recording of the rise in body
temperature during and after ovulation.
• Just before ovulation, a woman’s BBT falls about 0.5 F. at time of ovulation, her BBT rises a full degree.
• This higher level is maintained the rest of menstrual cycle.
 Merits:-
• It is easy to assess at home

• Helps to confirm the ovulation

Demerits :-

• it won’t work for irregular menstrual cycle

 Ovulation & cervical mucus:-

The cervix produces mucus that changes in amount, colour, and texture during your menstrual cycle. Before
ovulation, the mucus increases in amount and becomes thin and slippery. After ovulation, the mucus
decreases in amount and becomes thicker and less noticeable.
Merits :-

 Does not require any man made device

 Easily understandable
Demerits :-
 High failure rate
 Difficulty predicting ovulation
 Requires commitment
 Doesn't protect against STIs
 Time and effort

 Rhythm method :-

In this method, you use past menstrual cycles to estimate the time of your ovulation. When used on its own,
this is the least reliable method of birth control. It should be avoided if your menstrual cycles are shorter
than 26 days or longer than 32 days.
Merits :-
 Does not require any man made device
 Easily understandable
Demerits :-
 It’s not always reliable, especially who having irregular menstrual cycle
 Everyone can not understand easily, it requires practice.
 Abstinence :-
It involves complete avoidance of sexual contact.
Merits :-
 It has no side effects
 It does not need any cos
2. Barrier methods:
Barrier method are those methods which prevent meeting of sperms with the ovum. There are many major
types of barrier methods :-
 (i) Physical barrier methos:

 Condom :
It is a thin rubber sheath which is use by men. It is rolled over the erect penis before having sex. This rubber
sheath prevents the entry of semen into the vagina. The condom must be held carefully when taking out the
penis from the vagina to prevent spilling of semen into the vagina
Merits :-
• It is most simple and effective method
• Easy to use
• Disposable
• Protect from all sexually transmitted disease
Demerits:-
• If not used correctly it may slip one get tear of and the semen gets spilled into vagina
• In some people may not enjoy sex because of interference with satisfaction.
 Diaphragm –
It is used by women in her vagina to form a barrier in front of the cervix. The diaphragm is dome shaped
and is like a shallow cap.
It is made of soft synthetic rubber on plastic with a stiff but flexible rim around the edge.
Merits :-
• A diaphragm along with spermicidal is very effective.
• failure rate is low
• There is no risk any kind of contraindication
Demerits:-
• It requires the assistance of doctor
• It requires privacy and time to place in the vagina.
• It requires periodical check up
 Vaginal Sponge:
It is small poly urethane foam sponge, diffuse with spermicide. The sponge is shaped in a way that it can be
filled on to the cervix and has a loop on its outer surface which can be to pull out the sponge after use.
Merits :-
• It Provides 24 hours protections.
• It should remain be there fore at least 6 hours after coitus
 Cervical cap :
The cervical cap should fit comfortably over the cervix with the brim adhering to the vaginal
fornices. Before a woman can successfully use the diaphragm or cervical cap, she will require
 detailed instructions for insertion, the opportunity to practice, and assistance/reassurance from her
health care provider.
(ii) Chemical barrier methods:
 Spermicides :-
Spermicides are composed of a spermicidal agent in a carrier that allows dispersion and retention of the
agent in the vagina. Nonoxynol-9 (N-9) is available in Canada as a vaginal contraceptive film or as foam.
Spermicides are available without a prescription. The use of a spermicide alone provides less effective
contraception than using it in combination with a barrier method.
Vaginal contraceptive film is a 2-by-2 in. sheet of film containing28% nonoxynol-9. It must be inserted at
least 15 minutes before intercourse in order to melt and disperse. If more than 3 hours have elapsed before
intercourse, another film must be inserted.
Spermicidal foam is effective immediately and for up to one hour after insertion. This preparation contains
12.5% nonoxynol-9. It is inserted in the vagina using a supplied applicator. A repeat application is required
prior to each additional act of intercourse.
Merits :-
 No prescription required
 No hormones
 Lubrication
 Easy to use
Demerits :
 High failure rate: Spermicides are considered one of the least effective birth control methods.
 May increase risk of HIV
 May increase risk of bladder or vaginal infections
 Messy to use: Some may find spermicides messy to use.
(iii) Intra uterine devices :
These are the devices which are placed in the uterine cavity. Earlier these devices were made up of silk
worm gut, silk and gold are- Three different types of IUD's generation
- First generation IUD'S
- Second generation IUD'S
- Third generation IUD'S
There are some hormone-containing IUDs either releasing progesterone (Progestasert ) or
levonorgestrel (LNG-IUS)
- Cu-T 200
- Cu-T 380A
- Multiload 250
- Multiload 375
- LNG-IUS
 Cu-T 380A : It is a medicated device containing copper. It carries 380 mm² of copper in total. The
vertical stem is wrapped with 314 mm² of fine copper and each arm has a 33 mm² copper bracelet.
The sum of these is 380 mm² (Fig. 36.1C). Two strings extend from the base of the stem. The stem
of the device is made of polyethylene frame. These two threads are used for detection and removal
of the device. In spite of copper being radiopaque, additional barium sulfate is incorporated in the
 device. The device is replaced every 10 years. However, this Cu-T 380A device has been used to
prevent pregnancy for 20 years.

 Multiload Cu 250. This device emits 60-100 µg of copper per day during a period of one year. The
device is to be replaced every 3 years.

 Multiload Cu 375: The device is available in a sterilized sealed packet with an applicator. There is
no introducer and no plunger. It has 375 mm² surface areas of copper wire wound around its
vertical stem. Replacement is every 5 years.

 Levonorgestrel-intrauterine system (LNG-IUS) :This is a T-shaped device, with polydimethyl-

siloxane membrane around the stem which acts as a steroid reservoir. Total amount of
levonorgestrel is 52 mg and is released at the rate 20 µg/day. This device is to be replaced every 7
years though approved for 5 years. Its efficacy is comparable to sterilization operation.

 Progestasert: It is a progesterone (38 mg) containing IUD. Progestasert is no longer manufactured.

 Lippes loop: It is a nonmedicated open ID. It is no longer used in India.

 Contraindications :
1. Pregnancy or suspected pregnancy;
2. Undiagnosed genital tract bleeding;
3. Presence of pelvic infection current or within 3 months
4. Distortion of the shape of the uterine cavity as in fibroid or congenital uterine-malformation;
5. Severe dysmenorrhea;
6. Known or suspected uterine or cervical neoplasia;
7. Postpartum or postabortal endometritis in last 3 months;
8. Sexually transmitted infections (STIs): Current or within 3 months;
9. Trophoblastic disease;
10. Significant immunosuppression
 Time of Insertion :
• Interval (when the insertion is made in the inter conceptional period beyond 6 weeks following
child-birth or abortion): It is preferable to insert 2-3 days after the period is over. But it can be inserted any
time during the cycle even during menstrual phase which has certain advantages (open cervical canal,
distended uterine cavity, less cramp). However, during lactational amenorrhea, it can be inserted at any time.
• Postabortal: Immediately following termination of pregnancy by suction evacuation or D and E,
or following spontaneous abortion, the device may be inserted. The additional advantage of preventing
uterine synechia can help in motivation for insertion.
 Immediate Postpartum:
• Post-placental within 10 minutes after expulsion of placenta following vaginal delivery.
 • Intracesarean insertion during cesarean delivery, after removal of the placenta and before closure of
the uterine incision.
• Within 48 hours after delivery before the patient is discharged from the hospital.
• Extended postpartum/interval any time after 6 weeks.
Merits :
(a) safe and highly effective, (b) immediate action, (c) long-term protection, (d) special benefit to women
having limited access or no access to postpartum care, and (e) immediate return to fertility after
removal. But the expulsion rate is high.

(iv) Hormonal methods :

These are long acting hormonal contraceptive Contains only synthetic progestogen. in three forms These
are available
- Injectable
- Subdermal implants.
- Vaginal ring
(a) Injectable contraceptives:
Progestagen only injectable:- There are two preparations which are available
- DMPA (Depot medroxy progesterone acetete)
- NET-EN (Norethisete zone acetete)
Both of this contain synthetic progestogen. It prevent ovulation.
Merits :
It is easy to administer, highly effective and irreversible, do not interfere with lactation.
Contraindication:
Abnormal uterine bleeding any malignancy of the genital tract, suspected malignant growth and cancer
breast
(b) Combined injectable contraceptives :

- This contains progestogen and oestrogen contraception action is similar to that of progestogen
only injectable
- The injection is given once in a month three days early or three days late.
- It is contraindicated in pregnancy. • women. having any other problem like diabetes, vascular
disorder etc.

(c) Oral contraceptive pills:

1. Combined pills (combination of estrogen with progestin)

MONOPHASIC: This pills contains a constant and fixed amount of estrogen and progestin in each of the
active pills through out the entire cycle (21 days of ingesting pills). Several brands of pills are available
where doctors choose according to the women’s individual needs.
-Ethinylestradiol and norethindrone are examples of this type of pill
 BIPHASIC: Biphasic pills contains a fixed amount of estrogen, whilethe amount of progestin increases
in the second half of the cycle.
Examples
: Ethinylestradiol and desogestrel (Azurette,Kariva, Mircette, Viorele)
TRIPHASIC: The amount of estrogen may be fixed or variable, while the amount of progestin increases
in 3 equal phases. Those levels change every seven days during the first three weeks of pills. This was
the first type of birth control pill Examples include Kariva and Mircette Ortho-Novum 10/11.
2. Progestin-only pills:
Progesterone-only pills (POPs) contains one active ingredient i.e.-Progesterone. These pills have to be taken
continuously without any interruption right from the beginning of the course. It also acts an alternative when
estrogen pills are contraindicated. They are also known as : “ Mini-pills’, since progesterone is the
active hormonal ingredient , estrogen-related side effects are avoided. But Failure rates are higher in POPs
as they do not include estrogen. Example include Cerazette, Cerelle, Micronor, Norgeston
3. Emergency contraception:
 Levonelle
- Levonelle contains levonorgestrel , a synthetic version of the natural hormone progesterone produced by
the ovaries.
-Taking it's thought to stop or delay the release of an egg(ovulation).
- Levonelle has to be taken within 72 hour (3 days) of intercourse to prevent pregnancy.
 EllaOne
-EllaOne contains ulipristal acetate, which stops progesterone working normally. This also works by
stopping or delaying the release of an egg.
-EllaOne has to be taken within 120 hours(5 days)of intercourse to prevent pregnancy.
(V) Post-conceptional Method:

These are the methods which are used after the missed period and pregnancy may or may not have
occured .This method is used in regulating and inducing the menstruation and terminating the
pregnancy ore aborting the fetus. These methods are -
- Menstrual Regulation
- Menstrual induction
- Abortion
2. Terminal method:
sterilization is only method which gives permanent protection from conception. Either husband and wife
can under go sterilization by a simple surgical operation.
(a) Vasectomy:
Vasectomy is sterilization of male. It is very simple and minor operation which takes hardly 15-20 mins.
The operation involves a small cut on both sides of Scrotum then a small portion of van deferens (1cm)
on either side of the scrotum is cut and ligated, folded back and sutured. the operation is does not affects
on sexual characteristics. The sperms not ejaculated along with semen.
 (b) Tubectomy:
It is sterilization of female. This is done b by resecting the small part of fallopian tubes and legate
closing of tubes can also be done by using the tubes with bands cups a small ends. The closing of tubes
can also be done by using other methods like closing the tubes band clips and electrocautery. The
operation com be done through abdominal or vaginal approach. The tubectomy can be done after
delivery, between delivery and after abortion.

MANAGEMENT FOR CONTRACEPTION IN INDIAN GOVERNMENT:

According to Ministry of health and family wellfare on 2024:
The following steps have been taken by the government to ensure family planning and population control in
the country:

Expanded Contraceptive Choices comprises of Condoms, combined oral contraceptive pills, Emergency
contraceptive pills, intrauterine contraceptive device (IUCD), and Sterilization are provided to the
beneficiaries. The Contraceptive basket has also been expanded with new contraceptives, namely Injectable
contraceptive MPA (Antara Programme) and Centchroman (Chhaya).
Mission Parivar Vikas is implemented in seven high-focused states and six North-Eastern states to improve
access to contraceptives and family planning services.
Compensation scheme for sterilization acceptors is provided to beneficiaries to compensate for the loss of
wages incurred.
Post-pregnancy contraception in the form of Post-Partum Intrauterine Contraceptive Device (PPIUCD),
Post-Abortion Intrauterine Contraceptive Device (PAIUCD), and Post-partum Sterilization (PPS) is
provided to beneficiaries.
‘World Population Day Campaign’ and ‘Vasectomy Fortnight’ are observed every year to boost awareness
on Family Planning and service delivery across all States/ Union Territories.
Home Delivery of Contraceptives Scheme by Accredited Social Health Activists (ASHAs).
Family Planning Logistics Management Information System (FP-LMIS) is in place for the management of
family planning commodities at all levels of health facilities.
ROLE OF A NURSE IN CONTRACEPTION :
• Nurse will educate the patients about the various methods of contraception
• Nurse will educate the patient & their family regarding advantages, disadvantages, and risk of the chosen
method.
• Nurse will educate the patient about dosages of OCP
• Encourage a positive attitude toward family planning
• Nurse will advice the couple regarding the uses of contraception methods
• Nurse will counsel the couple for permanent contraception method
•Nurse will evaluate the patient’s knowledge regarding contraception.
 SUMMARIZATION :
After the discussion of the topic the group will be able to know about the introduction of contraception,
definition of contraception, incidence , characteristics of ideal contraceptives, methods of contraception and
their merits & demerits.

CONCLUSION:’
The risks of contraception are usually less than the risks of pregnancy and childbirth, especially in
developing countries.
The best contraceptive method for a person depends on their values, preferences, and lifestyle. The World
Health Organization recommends that family planning programs offer a variety of methods, including
barrier, short-term reversible, long-term reversible, permanent, and emergency contraception.

BIBLIOGRAPGY:
1. Dutta, D.C."Textbook of obstetrics". 9th edition. New [Link] brothers medical publishers.2019; p.
495-511
2. Basavanthappa, B.T. "Textbook of Midwifery and reproductive Health Nursing". 1" edition. New Delhi.
Jaypee brothers medical publishers.201;p.532-7
3. Bhaskar ,Nima."Textbook of midwifery and obstetrics", 3rd edition. Bangalore EMMESS medical
publishers.2019;p.112-118
4. Sharma ,J.B."Midwifery and Obstetrical Nursing", 1" edition. Himachal [Link] publishing
company 2020;p.553-63
5. Swarnakar, K. "Community Health Nursing". 2nd [Link]. N.R. Brothers.2019;p.92-101
6.T,Sheema."Oral Contraceptives PDF".SCRIBED.6th Jan,2020.
[Link] pdf
MANAGEMENT FOR CONTRACEPTION IN INDIAN GOVERNMENT:
According to Ministry of health and family wellfare on 2024:
The following steps have been taken by the government to ensure family planning and population control in
the country:

Expanded Contraceptive Choices comprises of Condoms, combined oral contraceptive pills, Emergency
contraceptive pills, intrauterine contraceptive device (IUCD), and Sterilization are provided to the
beneficiaries. The Contraceptive basket has also been expanded with new contraceptives, namely Injectable
contraceptive MPA (Antara Programme) and Centchroman (Chhaya).
Mission Parivar Vikas is implemented in seven high-focused states and six North-Eastern states to improve
access to contraceptives and family planning services.
Compensation scheme for sterilization acceptors is provided to beneficiaries to compensate for the loss of
wages incurred.
Post-pregnancy contraception in the form of Post-Partum Intrauterine Contraceptive Device (PPIUCD),
Post-Abortion Intrauterine Contraceptive Device (PAIUCD), and Post-partum Sterilization (PPS) is
provided to beneficiaries.
‘World Population Day Campaign’ and ‘Vasectomy Fortnight’ are observed every year to boost awareness
on Family Planning and service delivery across all States/ Union Territories.
Home Delivery of Contraceptives Scheme by Accredited Social Health Activists (ASHAs).
Family Planning Logistics Management Information System (FP-LMIS) is in place for the management of
family planning commodities at all levels of health facilities.
METHODS OF CONTRACEPTION:
CONTRACEPTION

Spacing method Terminal method

Natural method Barrier method Vasectomy Tubectomy

Withdrawal method Physical method
Safe period Chemical method
Basal body temp Intrauterine devices
Ovulation & Hormonal method
cervical mucus Post conceptional method
Rhythm method
Abstinence

1. Spacing Method:-
• Help in prevention of pregnancy used. as long as they are
• These methods com help in timing and spacing of Pregnancies, preventing are unwanted children.
This methods temporary method. It has two types

(ⅰ) Natural Method:

• Natural method does not involve the use of any of the man made devices.
• These methods are useful for timing and Spacing of pregnancies.