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CHAPTER I

THE BACKGROUND AND REVIEW OF RELATED LITERATURE


AND STUDIES

Introduction
Family Planning has been defined as the process of regulating and spacing the births of
children and helping subfertile couples beget children (Salcedo et. Al, 2002). It is a voluntary
action of married couples to make informed decisions when to have children,, how many to have,
and how far apart, when to have them, and when to stop t the least risk to the health of the
mother and the best chance to survival of the child. It is the conscious effort of married couples
to determine the number and spacing of births of children. It thus means responsible parenthood
for it aims to prepare married couples for the responsibility of procreation and socialization of
children.
One of the major issues confronting the Filipino family relating to its well- being and
survival is the health concerns of the members of the family especially the mother and the child.
Many Filipino couples are unaware of the maternal and child health dangers brought about by
too close and or too many pregnancies. It is advisable for a mother to space childbirth by at least
two years. On the part of the mother, she will be protected from the risk of mortality, because too
close pregnancies cause maternal depletion, a condition that sets in when the womans body
loses the strength and the capacity to nurture life. This is because giving birth is bloody and the

fetus itself is the mothers blood. It takes two years for a mother to recover from pregnancy and
childbirth (Sanchez, 2009).
Another concern is the economic aspect. The economic growth of the Philippines is
moving at a slow pace. Majority of the Filipino are poor. There is a severe shortage of proper
nutrition, housing, education and employment opportunities especially in the rural areas. The
more children to rear, the less time and resources for proper and attentive care in terms of
medicine, clothes, home space textbooks, recreation etc. These issues coupled with the rapid
increase in population; there is an urgent need to plan families thus the birth of the Family
Planning program in the country. The government believes that a strong family makes a stronger
nation.
The department of health is the lead agency for the family planning program of the
Philippines. Its centerpiece mission is A health mother begets a healthy child . It is indented to
improve the health of the mother by providing safe and approved methods to reduce the risk of
pregnancy as well as improve the health of children by spacing between births. It is intended to
give better quality life to every citizen, to strengthen the family, informed choice, and
responsible parenthood. It is then on this premise that the researchers thought of coming out with
this investigation to find out the level of awareness of married couples as to the contraceptive
methods in order to know if the couples were give complete, correct, and appropriate information
along this area and delivery services down to the community level.
United Nations Millennium Development Goals (MDGs) are the goals crafted and
agreed by the different countries and leading development institutions in order to meet the needs

of the worlds poorest. All of these goals are targeted to be achieved by 2015. (United Nations,
2013)
One of the millennium Development Goals, MDG5 (Improve Maternal Health), is
geared towards the improvement of maternal health care by targeting to reduce by three-quarters
the maternal mortality ratio in 1990 by 2015 and by achieving universal access to reproductive
health. United Nations (2013) reported positive gains in the recent past but the condition in the
developing countries continues to be a concern. The mortality rate ratio in the world has declined
by 47 percent since 1990 but the ratio in developing counties is still higher than the developed.
Moreover, there were gains in terms of access to reproductive health with the increase in the
number of women receiving the antenatal care in developing countries from 63 percent in 1990
to 81 percent in 2011, but it remains that only half of women receive substantial health care in
the developing countries. Also, the progress made in terms of lowering the rates of teenage
pregnancy has slow down.
In the Philippines, the concern for higher maternal deaths remains. Recently, the United
Nations Development Programme ( UNDP, 2013) described the country as in critical danger of
not achieving the target on improving maternal health by 2015. The maternal rate mortality
(MMR) in the country was reported to have increased from 162 per 100,000 live births in 2009
to 221 per 100,000 live births in 2011 (Alave, 2012). This is far from the countrys target of 52
per 100,000 live births in 2015 in line with MDG5. Earlier, there was a prediction that the MMR
of the country in 2015 is 140 (2.7 times the target) (UNFPA, 2005; Conception, 2013).
Should the current trend continue, the overall maternal mortality ratio (presently
estimated at 162 as measured by the 2006 Family Planning Survey), is forecast to decrease to
140 in 2015, 2.7 times the target of 52 (Romualdez, 2010). The contraceptive prevalence rate

(CPR) as a measure of access to reproductive health services is projected to increase from the
50.7 percent in 2008 to 60 percent in 2015- far below the target of 80 percent. Thus, without
extraordinary effort in health sector, attaining MDG4 is virtually impossible.
One effective and efficient way to address the problem of MMR is Family Planning
(UNFPA, 2008). It reduces the number of pregnancies, the number of abortions, and the
proportion of births at high risk because of complication. Although there was an increasing trend
in the contraceptive prevalence rate (CPR) of married women in the country since the late 1960s
(15 percent in 1968, 18 percent in 1975, 32 percent in 1985, 40 percent in 1995, 49 percent in
2005, and 51 percent in 2008) there has not been much progress in the last decade (NSO and ICF
Macro, 2009), between 2003 and 2008, the use of any method increased only by two percentage
points (49% to 51%), while use of any modern method increased only by less than one
percentage point. The 2011 Health Family Survey revealed the same result with the 2011
prevalence rate for modern methods placed at 37.7 percent, or 13 times the estimate for 1968,
which was 2.9 percent (NSO, 2013).
More than the low contraceptive prevalence rate (CPR) is the concern for the unmet need
for Family Planning in the country. Unmet need for Family Planning refers to the proportion of
currently married women who are not using any family planning method but do not want any
more children or prefer to birth space (Ericta, 2012). Filipino women with unmet need for
modern family planning, either to limit (women who want to stop childbearing) or space (want a
child after three or more years) was estimated from the 2008 National Demographic and Health
Survey to be about 22 percent with the following breakdown: 9 percent for spacing and 13
percent for limiting birth (NSO and ICF Macro, 2010). Recent estimate from 2011 Family Health
Survey placed the unmet need for family planning among married women in the Philippines at

19.3 percent, 10.5 percent for birth spacing and 8.8 percent for limiting births (Ericta, 2012).
Addressing the problem of unmet need for Family Planning has an important function towards
the attainment of the MDGs and health security for all (UNFPA, 2010).
The low contraceptive prevalence rate (CPR) and high unmet need are found among the
poorest households result from the 2011 Family Health Survey showed that the use of family
planning method is lower among women in poor households than those in non-poor households,
43.1% versus 51.3% (Ericta 2012). The difference is mainly due to the lowest quintile, 28.2%
while the lowest unmet needs are with the second, 19.5% and first quintile 20.5% (NSO, ICF
Macro, 2011).
In 2010, to promote universal health care, particularly for the Filipino poor families and
to respond to the challenges of meeting the MDGs by 2015, the Aquino Health Agenda
Achieving Universal Health Care for all Filipinos was launched (DOH administrative Order
No. 2010- 0036). One of the three thrust of the Agenda is the attainment of the health-related
MDGs by applying additional effort and resources in localities with high concentration of
families who are unable to receive critical public health services.
Always let the clients decide for themselves on the method that they will use, and help
them choose the method that is most appropriate for them. Factors to consider include the age of
the woman, woman's reproductive stage, the effectiveness of a method, the woman's health status
and personal considerations. No method is best for all women, nor is any method best for a
woman throughout her reproductive life.
The researcher wants to know the effects of the natural and artificial family planning
methods in the health condition of the selected mothers. This research will help us gather

relevant information that will be helpful to the community, especially Barangay San Antonio,
Fourth Estate Subdivision, Paranaque, City which is the location of this study.

Background of the Study


The researchers became interested to this study because of their experiences in Primary
Health Care and Midwifery Practice wherein its relevance to maternal health and we know that it
can be useful later on in our life. Family Planning plays a vital role to a mothers health because
it allows having birth spacing. Birth spacing enables mothers to allot time for recovery during
labor and delivery. Some methods also protect women from sexually transmitted diseases as
well.

Theoretical Framework
This study is based on Banduras Social Cognitive Theory. A centerpiece is the concept
of self-efficacy that has guided his research over the past two decades. Accumulating evidence
attests to the vital influence of perceived self-efficacy on motivation, health, achievement,
psychological well-being. Bandura's current theorizing and research is focused on the role of
symbolic modeling in the social diffusion of values and behavior change. Televised serial dramas
drawing on social cognitive theory are designed to address social issues (e.g., family planning) in
developing countries. This research blends his theoretical interests with an abiding concern for
improving social conditions.
A focus on family planning knowledge, comfort, self-efficacy, perceived social workers
and moral attitudes toward providing information on family planning clients. Findings revealed
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that greater religiosity, conservative political beliefs, a tendency to vote for Republicans, and a
"pro-life" abortion stance were associated with reported increased barriers in providing family
planning information. Participation in family planning coursework or training, and practicing in
an urban area were found to be related to lower reported barriers, regardless of religiosity. Years
of experience and work function had no significant effect on providing family planning
information. Moral objection ranked low as compared to other barriers. Lack of workplace
incentive and issues related to lack of family planning training and knowledge were of greater
importance in understanding barriers. Furthermore, many social workers lack accurate family
planning information, especially related to emergency contraception.

Figure1. Conceptual Paradigm of Banduras Social Cognitive Theory

This study is based on Levines theory of conservation. The model based on assumption
that the focus of Nursing is an open system of human beings interacting with their environment,
leading to state of health for individual which is an ability to function in social roles.

The theory stated also that the couples knowledge in family planning methods was based
on interacting with the said variables like age, educational attainment, and number of children
and monthly income that affects their ability to make use of the methods of family planning. As a
nurse, it is important to relate certain variables to couple to be able to maintain healthy in terms
of their reproductive health.
Conceptual Framework
The Philippines had an annual growth rate of 7.3 percent in 2010, a sharp increase from
1.1 percent in 2009, reaching its highest growth rate in over 30 years.1 The Philippines is
currently on target to reach its 2015 Millennium Development Goals in reduction of child
mortality, improved gender equality, fighting diseases including HIV and malaria as well as
improved access to drinking water and sanitation. However, work remains to be done in
improving access to universal primary education and reproductive health goals. While young
women are the focus of several government programs to delay the beginning of child bearing, the
Reproductive Health Bill has been in legislative debates for over two decades with strong
opposition from the Catholic Church. The Bill advocates a comprehensive program addressing
sexual and reproductive health and universal access to both traditional and modern family
planning services. The Philippines large share of youth population (34 percent of the country
population is younger than 15 years old2 ) provides a window of opportunity for high growth and
poverty reductionthe demographic dividend. But for this opportunity to result in accelerated
growth, the government needs to invest in the human capital formation of its youth. Gender
equality and womens empowerment are important for improving reproductive health. Higher
levels of womens autonomy, education, wages, and labor market participation are associated
with improved reproductive health outcomes.3 In the Philippines, the literacy rate among
females ages 15 and above is 94 percent. More girls are enrolled in secondary schools compared
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to boys with a ratio of female to male secondary enrollment of 109 percent.2 Half of adult
women participate in the labor force.2 Gender based violence is common; one-fifth of women
report having been victim of violence by a husband or intimate partner. Gender inequalities are
reflected in the countrys human development ranking; the Philippines ranks 77 of 157 countries
in the Gender-related Development Index.
Types of Family Planning
1. Natural Family Planning
a. Standard Days Method
The standard base method (SDM) is based on the physiology of the menstrual cycle and the
functional life span of the ovum and the sperm. It can be used by women if their menstrual
cycles are 26 to 32 days long. The client uses color-coded CycleBeads to mark the fertile and
infertile days of her menstrual cycle and to monitor her cycle length. Clients using this method
abstain from sexual intercourse on fertile days (days 8 to 19) to avoid pregnancy.
HOW EFFECTIVE IS THE SDM?
About 5 per 100 women who consistently and correctly use the method and abstain on fertile
days become pregnant over the first year of use.
HOW AND WHEN IS THE SDM USED?
The client keeps track of the days of her menstrual cycle and counts the first day of her monthly
bleeding as day 1.
Using the CycleBeads, the client moves the ring to the red bead to begin a new cycle and marks
that day on her calendar. She moves the rubber ring one bead every day.
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Days 8 to 19 of every cycle (when the ring is on the white beads) are considered fertile days for
all SDM users.
The couple avoids vaginal sex (or uses condoms, spermicides, or withdrawal) during days 8 to
19.
The couple can have unprotected sex on all the other days of the cycle (when the ring is on the
brown beads)days 1 to 7 at the beginning of the cycle and from day 20 until her next monthly
bleeding begins.

Pictue1. Shows how the Standard Base Method we used.


b. Basal Body Temperature
The Basal body Temperature (BBT) method involves identifying the fertile and infertile
periods of a womans cycle by taking and recording daily the rise in body temperature during and
after ovulation. BBT is the temperature of the body at rest after at least three hours of continuous
sleep before temperature taking. A womans Basal body Temperature (BBT) rises during her

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ovulation period and stays high until the next menstruation because of a rise in progesterone
level.

Picture2. Shows how the basal body temperature used by using a graph.
HOW EFFECTIVE IS THE BBT?
About 1 per 100 women who consistently and correctly use the method and abstain on
fertile days becomes pregnant over the first year of use.
HOW IS THE BBT METHOD USED?
The client takes her body temperature at the same time each morning before she gets out of bed
or does anything. She records her temperature on a special graph using a special thermometer.
She watches for her temperature to raise slightly0.2 C to 0.5 C (0.4 F to 1.0 F)just after
ovulation (about midway through the menstrual cycle).

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The couple should avoid sex or use another method from the first day of menses until three
days after the rise in temperature.
A BBT that has risen above the clients regular temperature and stayed high for three full days
indicates that ovulation has occurred and that the fertile period has passed. The couple can have
unprotected sex on the fourth day and until her next monthly bleeding begins.
A client who has fever/colds or other changes in the body temperature may find the method
difficult to use.
c. Lactation Amenorrhea Method
It is primarily works by preventing ovulation. Frequent breastfeeding temporarily
prevents the release of the natural hormones that cause ovulation. This method is considered
effective under the following three conditions: (1) the monthly menstruation has not returned,
(2) the baby is fully or nearly fully breastfed and often day and night, and (3) the baby is less
than six months old.
HOW EFFECTIVE IS THE LAM?
When typically used, about 2 per 100 women in the first six months after childbirth become
pregnant.
When used correctly, about 1 per 100 women who use the method in the first six months after
childbirth become pregnant.
The risk of pregnancy is the greatest when a woman cannot fully or nearly fully
breastfeed her infant.
HOW IS THE LAM USED?
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The LAM can be started immediately after birth up to six months after childbirth. The client
should breastfeed immediately (within one hour) or as soon as possible after the baby is born.
The method can be used any time if the client has been fully or nearly fully breastfeeding her
baby since birth and her monthly bleeding has not returned.
WHAT ARE THE ADVANTAGES OF THE LAM?
The LAM is universally available to all postpartum breastfeeding women.
With the LAM, protection from an unplanned pregnancy begins immediately postpartum.
The LAM contributes to improved maternal and child health and nutrition breastfeeding and
weaning practices.
The LAM serves as a bridge toward the use of other FP methods.
WHAT ARE THE DISADVANTAGES OF THE LAM?
The effectiveness of the LAM may decrease among mothers who are separated from their child
for extended periods.
Full or nearly full breastfeeding may be difficult to maintain for up to six months.
WHO CAN USE THE LAM?
All breastfeeding women can safely use the LAM, but a client in the following
circumstances may want to consider other contraceptive methods:
Has HIV/AIDS

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Is using certain medications during breastfeeding (including mood-altering drugs, reserpine,


ergotamine, antimetabolites, cyclosporine, high doses of corticosteroids, bromocriptine,
radioactive drugs, lithium, and certain anticoagulants)
The newborn has a condition that makes breastfeeding difficult (including premature babies and
those that need intensive neonatal care, are unable to digest food normally, or have deformities of
the mouth, jaw, or palate)
2. Artificial Methods
a. Pills
The most widely used CHCs are COCs, which are commonly referred to a pills.
HOW ARE COC PILLS USED?
Pills should be taken once daily even if the client is not having sex daily.
If monthly menstruation/withdrawal bleeding is desired, a pack with 21 active pills that contain
the active hormones estrogen and progesterone should be taken with a seven-day rest period
before starting a new pack.
A 28-day pack including seven placebo or non-hormone tablets should be taken continuously.
The client should start a new pack immediately the day after the last pill of the current pack. A
rest period is not required.
If menstruation/withdrawal bleeding is not desired.
With multiphasic preparations, skipping the placebo week may result in a sudden change in
hormone levels. As this change may cause irregular bleeding, multiphasic preparations are not
recommended for continuous use.
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Pill users should have a backup contraceptive method, such as condoms, in case of missed pills.
The clients clinical history should be taken to determine her medical eligibility.

Picture3. How the pills use by women.


WHEN SHOULD USE OF COCs BEGIN?
COCs are best taken within the first five days of the menstrual period because pregnancy is not
possible at this time.
Women who start COCs after the fifth day of the onset of their menstruation should practice
abstinence or use a backup contraceptive for the next seven days.
Women who have not recently given birth can start taking COCs any time as long they are
certain that they are not pregnant.
Postpartum/post-abortion women
o Breastfeeding women may begin COCs at six months postpartum or when they quit
breastfeeding. COCs contain estrogen, which may decrease breast milk production.
o Postpartum women who are not breastfeeding may begin taking COCs three weeks after
delivery.

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o Following an abortion, women may begin taking oral contraceptives immediately. No


backup contraception is needed if the method is started within the first five days
following an abortion.
b. Injectable
Combined injectable contraceptives (CICs) are monthly injectable preparations that
contain a short-acting natural estrogen and long-acting progesterone. Once given
intramuscularly, these hormones are slowly released for 28 to 30 days. CICs come in the
following preparations:
25 mg depot-medroxyprogesterone acetate (DMPA) and 5 mg estradiol cypionate (Cyclofem)
intramuscularly injected once a month.
50 mg norethindrone enanthate and 5 mg estradiol valerate (Mesigyna) intramuscularly injected
once a month. This preparation is available in the Philippines as Norifam.
HOW EFFECTIVE ARE CICs?
CICs are 99.9% effective in preventing pregnancy when used properly. With typical use,
the effectiveness rate is lower at 97.0%.
WHAT ARE THE ADVANTAGES OF USING CICs?
Immediate effectiveness
Pelvic examination not required prior to use
Does not interfere with intercourse
Few side effects
Can be provided by a trained nurse or midwife
Contributes to decreased menstrual flow (lighter, shorter periods)
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Reduces menstrual cramps


May improve anemia as menses are reduced
Reduces the risk of ectopic pregnancy
Protects against some causes of pelvic inflammatory disease (PID)
WHAT ARE THE DISADVANTAGES OF USING CICs?
Some nausea, dizziness, mild breast tenderness, headaches, and spotting (minimal bleeding)
caused by the estrogen component of CICs but to a lower degree than those caused by COCs.
These side effects disappear within two or three injections because the natural estrogen
approximates the physiologic dose.
Effectiveness may be lowered by rifampicin and most anticonvulsants.
CICs can delay return to fertility by a few weeks from the last injection.
CICs can cause serious side effects, such as cardiovascular disease, butsuch cases are rare.
CICs do not protect against STIs, such as the human papillomavirus and HIV/ AIDS.
CICs cause changes in the menstrual bleeding pattern (irregular bleeding/ spotting) of some
women.
Users of CICs must return for injection every 30 days.
WHO CAN USE CICs?
This method is useful for women who want a highly effective contraceptive method but have
problems adhering to other CHC regimens.
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This method is also suitable for women who want the convenience of an injectable
contraceptive without the bleeding irregularities associated with progesterone-only injectable.
HOW ARE CICs USED?
A woman using CICs must be injected with one vial of the drug monthly. The drug may
be injected into the muscles of the upper arm, thigh, or buttocks. Infection prevention principles
must be observed in giving the injection and disposing of the needles and syringes.

Picture4. How the Injectable contraceptive use in the woman.


WHEN SHOULD USE OF CICs BEGIN?
Any time as long as the client is not pregnant.
Between day 1 and day 7 of the menstrual cycle, preferably on day 1.
If the client is reasonably sure that she is not pregnant, she may start using CICs even after the
first seven days of her menstrual cycle. However, she will need to abstain from sex or use a
backup for the next seven days after the injection.
Among postpartum women:
o Later than six months for breastfeeding women because CICs may affect the quantity of
breast milk;
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o At three to six weeks after childbirth for non-breastfeeding women.


o Immediately or within seven days for clients who just had an abortion.
WHAT ARE THE COMMON SIDE EFFECTS OF CIC USE?
Vaginal bleeding/spotting.
Certain drugs (rifampicin and most anticonvulsants) may reduce the effectiveness of CICs.
Clients must inform their providers if they are taking any medications.
Other side effects may include weight gain, dizziness, and mild headaches. These effects are
not dangerous and are transitory.
c. Condom
A male condom is a thin sheath of latex rubber made to fit on a mans erect penis to prevent
the passage of sperm cells by forming a barrier that prevents pregnancy. It also helps keep
infections in semen, on the penis, or in the vagina from infecting the other partner.
HOW EFFECTIVE IS THE MALE CONDOM?
The effectiveness of this method depends on the user. The risk of pregnancy or sexually
transmitted infection (STI) is greatest when condoms are not used with every sexual intercourse.
Protection against pregnancy
When used correctly with every sexual intercourse, only 2 per 100 women whose partners use
male condoms become pregnant over the first year of use.
As commonly used, about 15 per 100 women whose partners use male condoms become
pregnant over the first year of use.
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Protection against human immunodeficiency virus (HIV) and other STIs


When used consistently and correctly, condoms prevent 80% to 95% of HIV transmission that
would have occurred without a condom.
When used consistently and correctly, condoms reduce the risk of STIs.
HOW IS THE MALE CONDOM USED?
The following steps must be followed by the user when using a condom before sexual
intercourse:
1. Hold the pack, and look for any perforation or damage; check the expiration date as well. If
the pack is damaged or has expired, discard it.
2. Open the package properly and carefully; do not use fingernails, teeth, or anything that can
damage the condom.
3. Hold the condom in a way that the tip of the condom is facing away from the penis.
4. Press the tip of the condom between the thumb and index finger of one hand, and maintain it
there while the other hand places the condom with the rolled side out over the erect penis.
Pressing the tip prevents air accumulation.
5. Unroll the condom all the way down to the base of the erect penis; put on the condom before
the entry of the penis into the vagina.
6. After ejaculation, hold the rim of the condom at the base of the penis so it will not slip off
while withdrawing the penis out of the vagina before it completely loses its erection.

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7. Remove the condom by sliding it off the penis, making sure not to spill semen on the vaginal
opening.
8. Make a knot of the condom, place it inside the package, and wrap it with a paper and dispose
of it properly. Reuse of male condoms is NOT recommended.
WHO CAN USE THE MALE CONDOM?
Couples who ask for its use and are reliable users;
Couples who want to use it as a backup method when the use of another method is interrupted;
Couples who are at high risk of STIs;
Couples who want to use it as a temporary method until another method is preferred;
Couples who have medical contraindications with other methods or those who personally prefer
condom use;
Men who have problems with premature ejaculation, as condoms can help delay ejaculation;
Postvasectomy clients who are waiting for sperm check or semen analysis after three months.
WHAT ARE THE KNOWN HEALTH BENEFITS AND RISKS OF MALE CONDOM USE?
Protects against the risks of pregnancy and against microorganisms that cause STIs, including
HIV;
Protects women against some STI-induced conditions (recurring pelvic inflammatory disease
and chronic pelvic pain [endometriosis], cervical cancer, and infertility);
Can cause severe allergic reaction among individuals with latex allergy (extremely rare).
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d. Intrauterine Devices
It is a small plastic device inserted into a womans uterine cavity to prevent pregnancy. It
releases copper or a hormone. Almost all IUDs have one or two strings or nylon threads tied to
the plastic frame. The strings hang through the cervical opening into the vagina.
HOW EFFECTIVE ARE IUDs?
IUDs are 99.4% effective with perfect use and 99.2% effective with typical use.
These rates indicate that 992 to 994 of every 1,000 women who use IUDs over the first
WHAT ARE THE ADVANTAGES OF USING THE TCu IUD?
Highly effective
Very safe
Local action
Has no effect on the amount or quality of breast milk
Low cost
Does not interfere with sexual intercourse
One time application
Immediate return to fertility upon removal
Can be inserted immediately after childbirth or after abortion
Can be easily inserted or removed by a trained provider
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Long-lasting effectiveness (12 years) year will not become pregnant.


WHAT ARE THE DISADVANTAGES OF USING THE TCu IUD?
Adverse effects
o Pain and cramping
o Long and heavy menstrual bleeding
o Menstrual irregularities
Device may be expelled, possibly without the client knowing it (especially for postpartum
insertions)
Requires a pelvic examination prior to insertion
Requires a trained health service provider for insertion and removal
Does not protect against sexually transmitted infections (STIs)
Requires regular self-checking of IUD strings during the first year of use
HOW DOES THE TCu IUD WORK?
The TCu 380A IUD prevents pregnancy by a combination of the following mechanisms of
action:
Inhibition of fertilization
Inhibition of sperm transport into the upper genital tract
Inhibition of ovum transport
e. Bilateral Tubal Ligation (BTL)

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It is a safe and simple surgical procedure that provides permanent contraception for
women who do not want more children. The procedure, also known as bilateral tubal ligation
(BTL), involves cutting or blocking the two fallopian tubes. Although this section also presents
endoscopic approaches to BTL, the standard procedure is minilaparotomy under local anesthesia
with light sedation.
HOW EFFECTIVE IS FEMALE STERILIZATION?
Female sterilization is 99.5% effective with perfect and typical use.
WHAT ARE THE ADVANTAGES OF FEMALE STERILIZATION?
Permanent method of contraception. A single procedure leads to lifelong, safe, and very
effective contraception.
Does not involve hormones. No changes in libido (sexual desire), menstrual cycle, or
breastfeeding ability.
It is an outpatient procedure.
Nothing to remember, no supplies needed, and no repeated clinic visits required.
Results in increased sexual enjoyment, as the woman does not need to worry about pregnancy.
No known long-term side effects or health risks.
Can be performed immediately after a woman gives birth.
Can be performed without any routine laboratory tests, blood tests, or cervical cancer
screening.

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WHAT ARE THE DISADVANTAGES OF FEMALE STERILIZATION?


Uncommon complications of surgery:
o Infection or bleeding at the incision site
o Injury to internal organs
o Anesthesia risks, which are uncommon with local anesthesia
BTL is a permanent method of family planning (FP), and some women may regret the decision
later. Reversal surgery is difficult, expensive, and unavailable in most areas. Successful reversal
is not guaranteed. Clients who may want to become pregnant in the future should not choose this
method. FP counseling is crucial.
In rare cases when pregnancy occurs, it is more likely to be ectopic compared with pregnancies
in women who have not undergone the procedure.
The procedure requires an operating room set-up and should be performed by a trained
provider.
Physical activities, such as heavy work and lifting heavy objects, immediately after surgery are
limited. The client may resume normal activities a week after the procedure.
The method does not protect against STIs such as HIV/AIDS.
WHAT ARE THE COMPLICATIONS?
Be aware of the warning signals and possible complications that may occur after the
female sterilization procedure. Immediately refer the client to the appropriate health facility
when she experiences any of the following:
o High fever (> 38 C) in the first four weeks;
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o
o
o
o
o

Pus or bleeding from the wound;


Pain, heat, swelling, or redness of the wound that worsens or does not subside;
Abdominal pain, cramping, or tenderness that worsens;
Fainting or extreme dizziness;
If the client thinks she might be pregnant with symptoms of ..A missed period

..Nausea ..Breast tenderness;


o If she has signs of ectopic pregnancy, such as ..Lower abdominal pain or tenderness on
one side ..Abnormal or unusual vaginal bleeding ..Faintness (indicating shock).

Role of the Health Centers and Midwives regarding Family Planning Program
Family planning centers are the main interface with the health care system for many of
the clients they serve. Increasingly, centers are leveraging that reality to connect clients not only
to insurance coverage but also to needed health care beyond what the centers provide directly.
This unique role could serve as a critically important stepping stone toward a sustainable path for
the family planning provider network in the emerging health care landscape.
The nationwide network of more than 8,000 publicly funded family planning centers
provides contraceptive and related services to more than seven million women a year. One in
four women who obtain contraceptive services in the Philippinesincluding half of poor women
accessing contraceptive caredoes so at a publicly funded family planning center. These women
receive other important, related care as well, including Pap tests, breast exams, and testing and
treatment for STIs. One in three women who get tested for HIV does so at a family planning
center.
It is therefore not at all surprising that six in 10 women who obtain care at a family
planning center describe it as their usual source of medical care. In fact, in many cases it may be
their exclusive source of care: according to one study conducted at Planned Parenthood centers,
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29% of adults and 19% of teens said the center was their only source of medical care. In other
words, family planning centers are a significant entry point to the health care system in the
Philippines.

Research Paradigm of the Study


Independent Variables

Dependent Variables

Profile of Mother in terms of:


Health Condition of the
Selected Mothers:

Age

Physical Aspect
Educational Attainment
Psychological Aspect
Civil Status
Emotional Aspect

Number of Children
Family Planning Methods
1.

Natural Methods:
a. Standard Days Method
b. Basal Body Temperature
c. Lactation Amenorrhea

Method
2. Artificial Methods
a. Pills
b. Injectable
c. Condom
d. IUD
e. Bilateral Tubal Ligation
Frame 1
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Frame 1

Frame 2
Figure2. Research Paradigm of the Study

Frame 1. Its show the independent variables which consist of the profile of the mother
and family planning methods that can be used by the respondents.
Frame 2. Shows the dependent variables which consist of the health condition of the
couples in terms of physical, psychological, and emotional aspect.

Statement of the Problem


This study aimed to determine the Effects of Natural and Artificial Family Planning
Methods to the Health Condition of the Selected Mothers in Brgy. San Antonio, Fourth Estate
Subdivision, Paranaque, City.
Specifically, study answered the following questions:
1. What is the profile of the respondent according to:
1.1 Age;
1.2 Civil Status;
1.3 Educational Attainment; and
1.4. Number of Children
2. What is the family planning method used by the mother?

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2.1 Natural Method


a. Lactation Amenorrhea Method;
b. Standard Days Method; and
c. Basal Body Temperature;

2.2 Artificial Method


a. Pills;
b. Condom;
c. Injectable;
d. IUD; and
e. Bilateral Tubal Ligation;
3. What is the status of the health conditions of the mother when using the Natural and Artificial
family planning methods in terms of:
3.1 Physical aspect;
3.2 Emotional aspect; and
3.3 Psychological aspect
4. Is there a significant relationship between the profile of the respondents and the effect of
Natural and Artificial family planning methods to the health condition of the selected mothers?
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Objectives of the Study


The main objective of this study is to determine the Effects of Natural and Artificial
Family Planning Methods to the Health Condition of Selected Mothers of Brgy. San Antonio,
Fourth Estate Subdivision, Paranaque, City.
Specifically, it aimed to accomplish the following:
1. To determine the profile of the respondent;
2. To identify the effect of natural and artificial family planning methods to the health condition
of the mother in terms of physical aspect, emotional aspect and psychological aspect;
3. To determine what type of family planning method they used;
4. To know the status of the health conditions of the couples when using the family planning
methods in terms of physical aspect, emotional aspect and psychological aspect.

Hypothesis
There is a no significant relationship between the profile of the respondents and effect of
the natural and artificial family planning methods on the health condition of mothers.

Scope and Delimitation of the Study


The scope of the study is all about the effect of the natural and artificial family planning
method in the health condition of mothers in Brgy. San Antonio, 4th Estate Subdivision. The
study focused on the personal profile of the mothers regarding with their age, civil status,
educational attainment and number of children in the family. The study will consider in the

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selection of 50 respondents. The researchers believed that this number of respondents is enough
to assess the validity and reliability of the study.

Significance of the Study


This study will give contribution to midwife education. The result can be utilize as a
basis for further study on the effects of the natural and artificial family planning methods on the
health conditions of the selected mothers in Brgy. San Antonio Fourth Estate, Paranaque, City.
This study was significant to the following target population:
Rural Health Practitioners: The result of this study will serve as benchmark for them in the
preparation and making of a community health program especially on giving the necessary
education on the different contraceptive methods of the family planning program of the
government.
Midwifery Students: This will give them further information on the weakness of the programs
of the family planning program especially on the use of contraceptive methods and to help
prepare such social responsibility to help promote the said program.
Midwife/Nurse Educators: The findings will provide them information to enrich their syllabus
and give emphasis on areas that has been found to be wanting and needs further consideration.

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Selected Mothers: To provides right information regarding family planning method. Enables her
to regain her health after the delivery and give enough time and opportunity to love and provide
attention to her husband and children.
Future Researchers: This study will serve as reference and to the authority to help in advocacy
to control the increasing number of population in barangay San Antonio, Fourth Estate
Subdivision.
Midwifery/Nursing Institutions: The findings of this study will used as a basis on what
contraceptive methods needs to be explained fully well to the target clients and will be the focus
in their community health nursing activity and outreach program.
Community Health Nurse/Midwife: This study could to have different experience and for their
job to be able to diagnose well the community and too much prioritize the needs of community.
Department of Health: This study will help them to improve the program and services of the
Family Planning in our country.
Barangay Health Center: To give and disseminate the information to the mothers regarding the
family planning program in the Philippines.
Local Government Unit: This study will help them to emphasize the importance of the family
planning in the mothers and the availability of the contraceptives in the Rural Health Unit.

Definition of Terms
Age- This refers to the age of selected mother as a respondent of this study.

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Artificial Method- Refers to the use of mechanical means in order to regulate the births of
children like pills, IUD, diaphragm and condom.
Basal Body Temperature (BBT) - The basal body temperature method is based upon fact that a
womans temperature drops 12 to 24 hours before an egg is released from her ovary and then
increases again once the egg has been releases.
Bilateral Tubal Ligation (BTL) - A permanent form of female sterilization which the fallopian
tubes are severed and sealed or pinched shut to prevent sterilization.
Civil Status- It refers to the status of the mother whether she is married, single, separate,
widowed and live-in.
Condom- Are the only method of contraception to protect against sexually transmitted diseases,
as well as pregnancy.
Educational Attainment- The highest degree of education an individual has completed.
Effect of Artificial Family Planning Method- It is refers to the respondents body adapt the
contraceptive method.
Effect of Natural Family Planning Method- It is refers to the respondent body stimuli to the
method.
Emotional Aspects- This is another factor that had the most influential to the couples. Examples
are episodes of depressions; relationship satisfaction; experienced nervousness when
contraceptive is used; mood swing and episode of anger outburst.

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Family Planning- is the process of regulating and spacing the births of children and helping
subfertile couples beget children.
Injectable- It is contraceptive that being inject to mother to prevent pregnancy.
Intrauterine Device (IUD) - Is a long acting reversible contraceptive birth control device placed
in the uterus.
Lactation Amenorrhea (LAM)- Lactation infertility is based upon the idea that a woman
cannot become pregnant as long as she breastfeed her baby.
Mother- This refers to the respondents women who inhabit or perform the role of bearing some
relation to their children, who may or may not be their biological offspring.
Natural method- Refers to the normal way of regulating and spacing the births of children like
the use of lactation amenorrhea, basal body temperature, calendar method, abstinence or
withdrawal.
Number of Children- It refers to the number of sons and daughter in your family.
Physical Aspects- This refers as the contributing factor that affects the couples in their health
condition. Examples are decrease in libido, able to maintain body weight, experience dizziness /
drowsiness, feeling of nausea and vomiting and feeling of light headache .
Pills- Oral contraceptives can thicken the cervical mucus, making it harder for sperm to enter the
uterus.
Profile- Refers to age, educational attainment, number of children and civil status of the
respondents of the study.

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Psychological Aspects- This refers to the factor that has great effects to the couples in terms of
choosing their methods to use and satisfaction. Examples are stress when family planning
method is unavailable, feeling of guilt using contraceptive methods, difficulty in thinking or
concentrating, cerate positive outlook in life / inability to thinking positively and change in selfperception.
Standard Days Method- This type of natural family planning method which the woman can
monitor the ovulation thru the beads.

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