Family Planning

What Is Family Planning?

File photo. Credit: Ernest Baah Family planning is a birth control mechanism that gives the woman control over the number of children she wishes to have and allows her to determine when births will occur in relation to each other and in relation to her age and/or the age of the father. Things that may play a role on family planning decisions include marital situation, career or work considerations, financial situations.

The importance of family planning is clear from its benefits to individuals, as well as to families, communities, and societies (AGI, 2003).

With effective family planning, women and couples can avoid unwanted pregnancies, bring about wanted births, and control the intervals between births. Family planning serves three critical needs:

1. it helps couples avoid unintended pregnancies;
2. it reduces the spread of sexually transmitted diseases (STDs); and
3. by addressing the problem of STDs, it helps reduce rates of infertility.

Family planning may be a component of the nurse’s role for the nurse employed in a family planning clinic, physician or nurse-midwife practice, and in the acute care setting, such as in the postpartum or gynecology units.

Family planning consists of two complementary components: planning pregnancy and preventing pregnancy.

Planning Pregnancy

For many women of childbearing age, a planned pregnancy occurs simply by discontinuing the use of contraception. However, pregnancy planning should include “prepregnancy” planning.

Good health and avoiding exposure to harmful substances are significant contributing factors for a successful pregnancy and a healthy baby. If the woman waits until she is pregnant to remedy factors that can put her or an unborn child at risk, it may be too late to prevent complications. The following Exhibit X-1 describes components of preconception care.

Preconception care is especially important for the woman with a history of problems with a previous pregnancy, such as miscarriage or preterm labor or birth. In many cases, identification and treatment of causative factors can reduce the risk for problems in subsequent pregnancies. Preconception care is equally important for the woman with a predisposing condition such as a chronic medical condition or a family history of genetic disorders.

Areas of Focus for Pregnancy Planning

Because a woman may not realize she is pregnant during the early and vulnerable weeks of fetal development, any woman of childbearing age should be aware of health problems or medication regimens that may adversely affect pregnancy and the birth of a healthy baby.

There are several key areas of focus while planning for a pregnancy. These areas include nutrition and exercise, lifestyle changes, chronic illness and genetic disorders, and medications.

1.   Nutrition and Exercise

The woman should optimize her intake of folic acid several months before becoming pregnant. Folate occurs naturally in foods, such as dark green leafy vegetables and legumes. If needed, the woman can take folic acid supplements to meet daily requirements.

Folic acid has been shown to decrease the incidence of neural tube defects such as spina bifidaOpens in new window. Since folic acid was recommended in 1992 and with the addition of folic acid to grain products in 1998, there has been a 2.6% decrease in the rate of neural tube defects (such as spina bifida) in the United States (March of Dimes, 2013).

Regular aerobic exercise conditions the heart, lungs, muscles, and other organs in preparation for the increased demands of pregnancy. Exercise can also be helpful in building up low-back and abdominal strength — two areas that can cause discomfort throughout pregnancy.

2.   Lifestyle Changes

Smoking cessation is an important consideration when planning for pregnancy. Women who smoke are at higher risk for miscarriage, lower infant birth weight, sudden infant death syndrome, and infant respiratory illnesses (Rodriguez-Thompson, 2013).

Alcohol intakeOpens in new window can affect the developing child, especially in the earliest weeks of pregnancy. Fetal alcohol syndromeOpens in new window is a cause of serious and irreversible birth defects, particularly mental underdevelopment. The level of alcohol intake that causes birth defects to occur is unknown, so women of childbearing age should abstain from alcohol before as well as during pregnancy.

3.   Chronic Illness and Genetic Disorders

A woman with a chronic illness, such as diabetes, asthma, heart disease, or high blood pressure, is at higher risk for poor pregnancy outcome. Therefore, the woman with a chronic disorder will need to consult with her health care provider about possible risks related to medications or therapies.

Adjustment of medication regimens before pregnancy can decrease the risk to the woman and her fetus. The woman should not abruptly stop any current medical regime without talking to her health care practitioner first.

Some women may need genetic counseling; their circumstances include the following:

• If the woman or her partner has a genetic disorder.
• If either partner is a known carrier for a genetic condition.
• If a previous child was born with a genetic syndrome, or if there is a strong family history of a genetically transmitted disorder.

4.   Medications

Many medications cross the placenta easily and can cause birth defects. Prepregnancy planning includes assessment of medications the woman is taking, including prescription, over-the-counter, and herbal remedies. This assessment allows for timely adjustments in dosage or alterations in choice of medication.

5.   Nursing Care

Nurses, especially those working in settings such as clinics or doctors’ offices or in public health, play an important role in pregnancy planning and preconception care.

A major nursing focus of preconception care is education and counseling, which you may offer through individual counseling or in traditional classroom settings. You may also be responsible for gathering the woman’s and her partner’s health histories, including current health status and lifestyle practices.

Nursing interventions include anticipatory guidance or teaching, discussing issues such as lifestyle, risk behaviors or risk factors, and corrective or preventive measures. Encourage the woman who is trying to become pregnant to follow the recommendations in Family Teaching Tips: Pregnancy Planning.

Preventing Pregnancy

Serious health consequences may result from unplanned pregnancy. Up to one half of unplanned pregnancies are terminated by induced abortion. Approximately 37% to 49% of all pregnancies in the United States are unplanned at the time of conception (Mosher, Jones, & Abma, 2012).

When pregnancy happens despite contraceptive use, either the method is imperfect (method failure) or the individual does not use the method perfectly (user error). Effectiveness grading of contraceptive methods compares perfect use scores and typical use failure rates.

Perfect use describes a contraceptive method used exactly as directed 100% of the time. Typical use accommodates the human tendency to forget or make errors. Perfect use has a lower associated failure rate than typical use.

There should be minimal side effects and low risk of long-term consequences. The best contraceptive does not directly interfere with lovemaking or sexual pleasure. It should be inexpensive and easy to maintain.

Protection from STIs is an additional consideration. Reversible methods should allow the couple to conceive readily after discontinuing use of the method. Table X-2 compares major contraceptive methods.