Family planning is a conscious decision making of woman and man about the most convenient time for parenthood, for having a desired number of children and about the time and interval between the pregnancies. The aim of family planning is giving birth to healthy and desired children, as well as a responsible and conscious parenthood. Family planning is one of the basic human rights and liberties.
All the girls have the right to develop from their childhood and teenage years to the age an adult woman and then become mothers. Pregnancy and childbirth before the age of 18, when the physical development of a female organism is incomplete, bears increased risk for the health of adolescent mother and her child.
Pregnancy and childbirth of the women older than 35, increase the risks for both the mother and her child.
After four pregnancies and deliveries, the risks are the following: anemia and bleedings during childbirth, children with dysfunctions or low birth weight and other complications affecting both the mother and her child.
There are different acceptable and effective contraception methods, which are the most adequate ones for every couple following the doctor’s advice.
Contraception should be considered seriously before sexual relations. Family planning is the shared responsibility of both the man and woman.
The girls who are getting into sexual relations should take into consideration the medical checkup, advice on contraception and regular visits to the gynecologist.
The mother’s body needs two years for recovery after the pregnancy, delivery and nursing of the small baby.
In cases of shorter intervals, the likelihood of premature childbirth or low a birth weight is higher. Such children are exposed to increased risks of lethal outcome in the first year of the life, increased complications in growth and development.
Contraception
Contraception includes the methods and means for preventing fertilization and conception.
Some opt for abstinence (restraining from sexual relations), as a prevention from pregnancy and sexual diseases. Abstinence gives time and the possibility of overall growth and development for the adolescents.
There is no such thing as the best contraception method for everyone. Each and every couple or individual should consider more elements when deciding: needs, duration, price, age, accessibility, inconveniences and other.
When selecting the proper method, following aspects should be taken into consideration:
Accessibility – some methods are applied without the medical checkup and a prescription Costs – related with income Effectiveness – the real effectiveness (not in theory) expressed through the rate of ineffectiveness Health risks – contraception method should be adjusted to the health condition of the person Consequences of undesired pregnancy – the more serious consequences of pregnancy are, the more effective contraception should be applied Participation of both partners in decision making – selection of contraception method is different for a couple in a long lasting faithful relationship and for a person inclined to frequent change of partners or to occasional sexual contacts
The reasons for contraception can be:
Personal desires, attitudes and values (to postpone the pregnancy, limit the number of children, not willing to have children) Health reasons (diabetes, heart related diseases, HIV-infection, inherited diseases) Social and economic reasons (economic status of the family, employment of the woman, social care for the children, etc.)
Knowing the facts on contraceptive methods and the doctor’s advice will help in selecting the contraception method. The most effective contraception method for adolescents is low dose hormone pill with parallel use of a preservative. This is a double protection – from undesired pregnancy and from sexually transmitted diseases, including HIV/AIDS
Contraception means and methods
Contraception has been applied for preventing undesired pregnancy for several thousand years.
Contraceptive methods and means can be divided into following groups: barriers (mechanical and chemical), hormone methods, uterus inserts, surgical methods, natural methods, interrupted relation and post-coital prevention (emergency contraception).
Barrier contraceptive means are a mechanical or chemical barrier to entering of the spermatozoids into the vagina and the uterus. These are: preservative (male and female), diaphragm and spermicidal means. The main advantage of barrier contraception (especially preservative) is the protection from sexually transmitted diseases. There are very few side-effects and no doctor’s recommendations are needed for most of them.
A preservative is a thin elastic gum mad of latex, which is put on the penis in erection before any sexual contact whatsoever. Proper use should be practiced and consistently applied during every sexual relation. The new preservative should be used for every sexual relation. The top of the preservative (1 to 2 cm of empty space) should be pressed by fingers pushing out the air and putting it over the whole sexual organ. After the ejaculation pull the penis out while still in erection, hold the condom in order not to slip out, take it off, wrap it and through it into the garbage. One should pay attention to the quality, purpose (vaginal, anal or oral sexual relation) and expiration date of the condom. A quality preservative is made of latex, moist and spread with nonoxynolom-9 and it is electronically tested.
Femidom – (women’s preservative) a flexible, thin and plastic tube (polyurethane), spread with spermicidal cream. It is inserted in to the vagina before the sexual intercourse. On the sealed end of the femidom is the elastic ring, which is squeezed and inserted into the vagina. When the femidom is correctly inserted, the elastic, wider ring hangs some 5 cm outside the vagina. After the sexual intercourse when the male sexual organ is taken out of the vagina, the open end of the femidom should be bent and taken out from the vagina, then wraped and thrown away into the garbage. New femidom should be used during every new sexual relation.
Diaphragm – it is a thin rubber cap, 5-10 cm in diameter with a strengthened elastic side. Together with the spermicidal cream, it is inserted into the vagina before the sexual relation so that it covers the entrance of the vagina and in this creating a barrier for the spermatozoids to enter into the vagina. It is removed from the vagina between 6 and 24 hours after the sexual relation. The gynecologist prescribes the size of the diaphragm and instructs the woman on how to insert it and take it out.
Hormone contraception is based on synthetic forms of female sexual hormones (estrogen and progesterone or just progesterone), which are capable of altering the woman’s hormonal cycle. The hormones are taken orally, by injection or inserted under the skin.
The hormonal means are:
• Hormone pills (combined pill containing estrogen and progesterone; mini pill combining progesterone), • Hormone injections • Hormone implants • Hormones have double effects: they prevent ovulation and change the composition of the membrane of the cervix so that cervical mucous becomes thick, protecting it from the entrance of spermatozoids into the uterus and ovary tubes
Application of hormone contraception can have side-effects and counter-indications (very rarely among the girls). Therefore the gynecologist checkup and medical advice are necessary. Hormone pills are extremely effective, but at the adolescent age they are applied with a low dose of hormone (low dose pills). Hormone contraception can be obtained only upon the doctor’s prescription.
Natural contraception methods are based on restraining from sexual relations during the woman’s fertile period. The woman can learn to follow her menstrual cycle and determines the ovulation and fertile period, so that the couple restrains from sexual relations. The natural methods are: measuring basal body temperature, thickness of cervical mucous (Billings method), calendar or rhythmic method (Ogino-Knaus method), symptom-thermal method (combination of the above mentioned), determining the level of hormones in the urine or mucous by a special device.
Sterilization is a highly effective and permanent surgical method of contraception. Sterilization of men (vasectomy) includes cutting and tying of the seminal duct. Sterilization of women includes cutting and tying of the ovary tube, so that the entrance of spermatozoids to the ovary unit is prevented. None of these methods can influence the sexual life. The man continues with ejaculation of the ejaculation liquid (without spermatozoid), while the woman still has menstrual periods. This method is applied in cases when the persons have a desired number of children, but pregnancy might threaten their health.
Intrauterine device – a plastic and/or metal insert sized 2-4 cm inserted into the uterus by the gynecologist. It used to be in the form of a spiral and remained known under this name, but today it is produced in the T letter form. Some types of intrauterine devices contain copper, while some release small quantities of female hormone progesterone. They provide protection for the period of one to ten years depending on the type applied. These devices are convenient only for the women who have already had children and are not recommendable for the girls, since they can increase the risk on inflammatory diseases of internal sexual organs. The intrauterine device causes temporary change in the uterus and ovary tubes so that they prevent fertilization; they impede the mobility of spermatozoids through the woman’s reproductive tract and decrease the possibility of fertilization; they prevent the implantation of ovary unit into the uterus because they affect its mucous; they change cervical mucous and prevent the spermatozoids of entering into the uterus. Interrupted intercourse or retraction is pulling the penis out of the vagina before the ejaculation so that the entrance of spermatozoids into the vagina is prevented. This is a very unreliable contraceptive method and is applied only when there are no other methods available. A certain quantity of spermatozoids can flow out before ejaculation and only one spermatozoid is sufficient for pregnancy. Apart from unreliability, this method cannot protect from sexually transmitted diseases.
Emergency or post-coital contraception, known also as “morning after pill”, and is applied after the sexual intercourse, which took place during the fertile period and for some reason the contraception was not applied. Post-coital protection is applied only as an “emergency aid” and is not recommended as a regular method of birth control. This method postpones the ovulation and/or prevents the insertion of a fertilized ovum in to the uterus.
There are two types of post-coital protection:
• Hormone method to be applied within 72 hours from the sexual intercourse; two doses of hormone pills are applied (estrogen or the combination of estrogen or progesterone) with intervals of 12 hours • Insertion of intrauterine device, 5 days after the sexual intercourse at latest (only for women who have already given birth)
Both methods should be prescribed only by the practitioner. The women who have applies post-coital protection should take up a medical checkup one month after, so as to make sure that the pregnancy did not happen. Post-coital protection is applied only in cases of mistake, mishaps or emergency (rupture of preservative, fallen out diaphragm or the fill forgotten; in cases of raping or incest). Contraception for sexually transmitted diseases
• Hormone contraception, intrauterine device, natural contraception methods and interrupted sexual intercourse ARE NOT THE PROTECTION from sexually transmitted diseases, including HIV/AIDS • Spermicidal means (creams, foam, gel, vaginal inserts) and the diaphragm CAN ONLY PARTLY PROTECT from some sexually transmitted diseases • Preservative is the only contraceptive means for EFFECTIVE PROTECTION against sexually transmitted diseases, including HIV/AIDS • Latex preservative with spermicidal Nonoxynol-9, should be used PROPERLY AND CONSISTENTLY during each and every sexual intercourse, with the exception when the two healthy partners are in permanent and mutually faithful relation
Important facts
• The pregnancy may occur even during the first sexual intercourse, even without penetration into the vagina • The pregnancy may occur when the sexual intercourse takes place during a menstrual period • The pregnancy may occur even if the woman doesn’t reach an orgasm • The pregnancy may occur in each and every position during sexual intercourse • Breast feeding does not prevent pregnancy completely • Taking a shower and rinsing after the sexual intercourse does not prevent from pregnancy • Interrupted sexual intercourse is not an effective protective method
Abortion is the interruption of pregnancy that can happen spontaneously or intentionally (artificial or induced abortion).
Spontaneous abortion may be caused by diseases, infections and sexually transmitted diseases, anomalies of the fetus or uterus etc.
Induced abortion is a medical operation with the purpose to interrupt the pregnancy and is regulated by law. In Croatia, the abortion is a legal measure and can be provided under safe conditions in healthcare institutions. In countries where this measure is illegal, the death rate among women is high because the abortion is usually conducted in non-hygienic conditions and unprofessionally. Risks and complications of induced abortion are:
• Direct complication: perforation of the uterus, injuries of other internal organs, injury of cervix, bleeding, infection, sepsis • Long-term complications and consequences: increased risks of ectopic pregnancy, chronic inflammation of internal sexual organs, decreased fertility, lethal outcome
The reasons for abortion might be of different nature, such as health, social, economic or legal.
The abortion can be done until the 10th week of pregnancy by the woman’s request, while after this time by the recommendation of the doctor’s committee, if there are any threats for the health of the woman or the fetus
If the induced abortion takes place before the 6th week after the last menstrual period, the method of aspiration can be applied. If the pregnancy is longer than that, after dilatation of the cervical channel, the applied methods are aspiration and curettage, or evacuation and curettage. Both before the decision and after the abortion, counseling is necessary.
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