Compiled Notes M105

M-105 ( COMPREHENSIVE FAMILY PLANNING)

Course Description :
This course deals with population dynamics, population program,
assessment of family planning (FP) client, modern methods of FP,
promotion/counseling, motivation, provision of FP services and
management of a family planning clinic.
Course Objectives :
At the end of the course, the student should be able to:
1. Discuss the relationship of population dynamics to the population program of the country
2. Enhance counseling skills
3. Promote FP and motivate couples to use FP methods
4. Provide FP services
5. Develop skills in FP clinic management
Course Outline :
Lesson I. Introduction
A. Terminologies Related to Family Planning
1. Family Planning - planning allows 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. A womans ability to space and limit her pregnancies has a direct impact on her health and well-being as well as on
the outcome of each pregnancy.
2. Population refers to a group of people.
3. Demography is the statistical study of living populations. It can be a very general science that can be applied to any kind of
dynamic living population, that is, one that changes over time or space .

The study of the characteristics of human populations, such as size, growth, density, distribution, and vital statistics.
It encompasses the study of the size, structure, and distribution of these populations, and spatial and/or temporal
changes in them in response to birth, migration, aging and death.
4. Fertility definition
The ability to conceive and have children.

5. Infertility is when a persons fertility is diminished. A couple is typically suspected as being infertile if they are unable to
get pregnant after 12 months of trying. There are many causes of infertility. Fertility treatments may be able to help a person who
is infertile and get pregnant.
6. Sterility- is a complete lack of fertility, and should not be confused with infertility. A person who is sterile has no potential
to produce offspring ever, while a person who is infertile may be able to get pregnant with treatment or over time.

7. Migration - definition can be the movement of people from one place to another.
There are two main types of migration:
1. Internal migration- migration within one country
2. International migration movement from one country to another.

The Reasons for migration can be divided into two main aspects;
1. push factors
Push factors are those in their old place which force people to move. Ex. There maybe civil wars or wars in general in
the country, but political or religious oppression, climate changes , lack of jobs or simply poverty .
2. pull factors
Pull factors are factors in the target country which encourage people to move; these include peace and safety, a
chance of a better job,better education, social security, a better standard of living in general as well as political and
religious freedom.

6. Responsible Parenthood is a state being a responsible parents. It refers to the skills , abilities and responsibilities of
the parents in rearing and educating their children. The ability o f the parents to respond the needs and aspirations of the
family and children. It refer to couples decisions to ensure the best possible life for the family and community they belong to.
7. Reproductive Health is defined as a state of complete physical , mental and social well being and not merely the absence
of disease in all matters relating to the reproductive system. It refers to health and well being of women and men in terms of
sexuality, pregnancy ,birth and related conditions, diseases and illness.
B. Population Profile of the:
1. World
Estimate of 7 billion as of 2011
As of 2007, the average birth rate for the whole world is 20.3 per year per 1000 total population, which for a world
population of 6.6 billion comes to 134 million babies per year. (source Wiki)
There were 365 days in 2007, 24 hours per day and 60 minutes per hour so 365 x 24 x 60= 525600 minutes per year.

In 2007 there were 134 000 000 babies born/yr divided by 525 600 minutes/yr = 255 babies born every minute.

2. Philippines Population
103,775,002 (July 2011 est.)

NSO According to the National Statistics Office, three Filipinos are born every minute.

According to the Human Development Report, almost 2 million babies are born in the Philippines every year. With the 4,000 born every day, only 1 out of
8 will get to finish college. Source: KRUSADA ABS CBN

C. Factors which influence Population Growth

All of us belong to a population. Changes in the population means changes the manner and way we live by means of
resources we were able to afford such as food and services.
1. Migration this is a process wherein people move from one region or country another to settle.
People who move out from one place lessens the population of the place.
People who move into a place increase the populace of the place.
People migrate to seek better opportunities and livelihood.
2. Fertility rate is the average number of births that a woman would have during the reproductive years.
If fertility rate persists and trends continue, world population is expected to increase.
If patterns continue for the future , demographers predict further decline in living standards and world supply of
food and energy.
3. Births/Deaths ratio
When number of people born is equal to the number of people who die, the population of that place , remains the
same. This is zero growth
When the number of people die exceeds the number of people born, the population declines or decreases. The
population grows old when birth rate is low.
When the number of people who are born is greater than the number of people who die, the population increase.
This results in a young age structure.
D. Effects of Rapid Population Growth To:
1. Education Scarcity of resources prevents children from acquiring sufficient education. Low education due to increasing
tuition fees and demand of education
2. Economics/employment , insufficiency of the countrys national income forces the government to resort to international
borrowings. Job opportunities cannot cope up with the demands for work; un employment increases, lower labor costs.
when you increase the supply of something, the cost of using it goes down.
3. Health and nutrition demand on services hospitals, public health, A family with low income suffers malnutrition and
delayed medical attention, or even foregoes such medical altogether.

4. Housing - poor housing

5. Facilities countrys resources are more utilized, infrastructure expansion
6. Environment- struggling infrastructure - transport, roads etc. rising property values and limited stock.
7. Peace and Order crimes increases, high un lawful acts , trafficking of human persons and violence, law enforcers will
be out numbered.
Source: Instructors Guide for Family Planning for Schools of Midwifery in the Philippines.

What is Family Planning?

(WHO)
means deciding when is the right time to have children, what is the appropriate number of children for a couple to have
The right time to have children :
a. Woman is between 20 and 35 yrs. Old
b. Woman has not been pregnant for the last 3-5 yrs.
c. Woman has fewer than four children
d. Woman has no illness
e. When a couple wants to have a child.
( PFPP)
Family planning is voluntary.
Positive action to plan and decide the number of children they wanted and when to have them
Achieved by legal, medically accepted family planning methods
Helps childless couples to have children
Make sure pregnancies occur only during the right time in a mothers life.
What is the Concept of Family Planning ?
The concept of Family Planning is Responsible Parenthood .
Couples should responsible for the outcome of their sexual union.
They are rational beings of making intelligent decisions about family size and family life.
If pregnancy is planned and children are desired, the child is assured of their love, protection and provision of physical and
emotional needs to enable the child to live a productive life.
The child is therefore born not by chance , but by choice.

E. The Philippine Family Planning Program

History of Family Planning in the Philippines
Tribal times:
Family planning were crude and cruel.
Children were killed
The aged and sickly were abandoned
Having children after the second child was a crime. The babies were killed mostly by drowning or
beheading. However this law is applied only to poor families.
From 1920 1950s
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Things were better.

Sex education was finally given to girls, but for the purpose only of preparing them for marriage.
Information dissemination on the merits of family was prioritized.
Health providers were more intensively trained.
In 1970 1980s
The National Population Program was established. The emphasis was on Effective Maternal and
Child Health Care Delivery.
The Department of Education initiated the Population Education Program, where family planning is
integrated in the curricula of Medicine , Nursing , Midwifery , social works and other allied courses.
Population Commission ( POPCOM ) became the central planning and coordinating body of the
Philippine Population Program.
Research was intensified
Health benefits were constantly emphasized.
In 1990s
The thrust is on safe motherhood and child survival.
The constitution specifies mandates on Family Planning
Article XI, Section 12
Article XV , Section 3

The Philippine Family Planning Program Definition:

The Philippine family planning program recognizes the constitutional right of all Filipinos to exercise their
freedom of conscience as to the number and spacing of their children, as well s the family planning
method that is right for them, consistent with their religious and moral beliefs and in consonance with the
ideals of a democratic country.

A national mandated priority public health program to attain the country's national health development. A
health intervention program and an important tool for the improvement of the health and welfare of
mothers, children and other members of the family.
It also provides information and services for the couples of reproductive age to plan their family according
to their beliefs and circumstances through legally and medically acceptable family planning methods.

Promote the following values:

Responsible sexual behavior

Delayed marriage

Safe motherhood

Child survival

Counterfeiting the trends towards abortion

The program is anchored on the following basic principles.

Responsible Parenthood which means that each family has the right and duty to determine the
desired number of children they might have and when they might have them. And beyond responsible
parenthood is Responsible Parenting which is the proper upbringing and education of children so that
they grow up to be upright, productive and civic-minded citizens.

Respect for Life. The 1987 Constitution states that the government protects the sanctity of life.
Abortion is NOT a FP method:

Birth Spacing refers to interval between pregnancies (which is ideally 3 years). It enables women
to recover their health improves women's potential to be more productive and to realize their personal
aspirations and allows more time to care for children and spouse/husband, and;

Informed Choice that is upholding and ensuring the rights of couples to determine the number
and spacing of their children according to their life's aspirations and reminding couples that planning
size of their families have a direct bearing on the quality of their children's and their own lives.

Intended Audience:
Men and women of reproductive age (15-49) years old) including adolescents
Area of Coverage: Nationwide
Mandate: EO 119 and EO 102

Vision:
Empowered men and women living healthy, productive and fulfilling lives and exercising the right to
regulate their own fertility through legally and acceptable family planning services.

Mission
The DOH in partnership with LGUs, NGOs, the private sectors and communities ensures the
availability of FP information and services to men and women who need them.
ces to men and women who need them.
Program Goals:
To provide universal access to FP information, education and services whenever and wherever these
are needed.
Aims: To arrest the problem of high infant and maternal mortality. There is a need to implement an earnest
Philippine Family Planning Program, emphasizing safe motherhood and child survival. Specifically aimed
to :

Reduce neonatal deaths

Infant deaths

Under five deaths

Maternal deaths

Source: internet www.doh.gov.ph , Public Health Nursing in the Philippines

Policy statements:
1. Family Planning as a health intervention.
The program is positioned as a health intervention initiative to promote overall health of Filipinos, specially women
and children. Family planning will significantly contribute to the reduction of maternal and infants deaths in the
country.
2. Family Planning as a means to prevent high -risk pregnancies.
Concurrently, women of reproductive age are considered high risk for pregnancy because they are:
a. Too young ( less than 18 yrs ) or too old ( over 34 yrs. Old )
b. Have four or more pregnancies
c. Have closely spaced pregnancies ( women need at least 3 yrs to recover health from physical stress
during pregnancy )
d. Concurrently ill ( they have existing disease or disorders like iron deficiency anemeia)
3. Family Planning as a means to reduce maternal deaths
The leading cause of death among women with reproductive age is related to pregnancy and childbearing. Post
partum hemorrhage tops the list followed by hypertensive disorders of pregnancy ( pre-eclampsia and eclampsia.)
4. Family Planning as a means to prevent abortions.
One of six pregnancies in the Philippines ends up in illegal abortion because they are either unplanned or
unwanted. There are estimated 300,000 to 400,000 cases of illegal abortions each year, many of which end up with
complications such as sepsis or death.
5. Family Planning as a reproductive right for women.
Family Planning services shall be delivered to respond to the unmet needs and demands of women.
6. Family planning as a means towards responsible parenthood.
Successful families dont happen by accident. Planning for the future reflects the will and the ability to respond to
the needs of the family and children..Family Planning will be geared towards helping support of the family and
promote its welfare, values and unity.
7. Family Planning as a means to reduce poverty.
Family planning shall contribute to the national development through provision of oppurtunities to improve health of
men, women and children to enable to participate actively in the socio economic development.

Source: Manual on Quality Integrated Reproductive Health Service Protocol 2001

The Five PILLARS OF Family Planning

Non coercion: It is the right of every couple to determine their own family size and
choose the method which conforms to their moral convictions and religious beliefs.

Integration : Family Planning is integrated into existing programs in health,

education, social welcome, community development. Etc.

Multi agency participation: Practically all government units/departments are

enjoined to actively help promote the family planning program of the government.
Taking the most active part are the Dept. of Health, DepEd and interior and local
government.

Multi-sectoral involvement: The family planning program operates on a broad base

of partnership between government and private agencies, performing the following
functions: research, training, information, education, communication and service
delivery.

Policy against abortion: Family planning ,despite its dedication to keeping

population down, never sactions abortion as method of contraception. Life is held
sacred right from conception.

Why Family Planning Program of the DOH?

Because pregnancy is physiologic process, the health sector aims to make pregnancy for the woman and
gestation of the fetus as safe and medically proven uneventful as far as possible.
Proper counseling of couples on the importance of FP will help the couples inform on the right choice of FP
methods, proper spacing of birth and addressing the right number of children.
Birth spacing of three to five years interval will help completely recover the health of a mother from
previous pregnancy and children. The risks of complications increases after the second birth.

F. Review and Update on Laws and Legislations Related to Family

Planning
Constitutional Mandates of family planning
Article II , Section 12
The state recognizes the sanctity of family and shall protect and strengthened the family as a basic autonomous social
institution . It shall equally protect the life of the mother and the unborn from conception. The natural and primary right and
duty of parents in the rearing of the youth for civic efficiency and the development of moral character shall receive the
support of the government.
Article XV ,
Section 1
The state recognizes the Filipino family as the foundation of the nation . Accordingly , it shall strengthen its solidarity and
actively promote its total development
Section 3
The state shall defend the right of the spouses to found a family in accordance with their religious convictions and the
demands of responsible parenthood.
Further the state shall uphold the right of children to assistance including proper care and nutrition and special protection
from all forms of neglect, abuse, cruelty, exploitation and other conditions prejudicial to their development.
PD 965 requires applicants for marriage license to receive instructions on family planning and responsible parenthood in
every day or municipality.
LOI 47 ( Instructions of the President of the Philippines to the DECS ).
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 In order to facilitate the implementation of the population program, you are hereby directed to inform all schools of
medicine, nursing midwifery, allied medical professionals and social work to prepare, plan and implement the integration of
family planning in their curricula and to require to their graduates sufficient instruction in family planning.
RA 7392 ( The Philippine Midwifery Law )
Section 23
The practice of midwifery consists of performing and rendering. Primary Health Care services in the community ,
including nutrition and family planning.
Based on the implementing Guidelines of RA 7392 a midwifes Family Planning services are limited tot eh motivation and
counseling of clients. In order that a midwife may be allowed to do medical and surgical interventions she should have a
certificate from the DOH ,POPCOM. and Midwifery Certification Board.
PD 79 Section 4
The POPCOM shall have the following purposes and objectives
e) To make family planning a part of broad educational program.
f) To encourage all person to adopt safe and effective means of planning and realizing desired family size so as to
discourage and prevent resorting to unacceptable practice of abortion.
h) to provide family planning services as part of overall health care
i) to make available all acceptable methods of contraception, except abortion to all Filipino citizens desirous of
spacing, limiting or preventing pregnancies.
Section 5 The POPCOM shall have the following duties and powers
a) To employ nurses and midwives to provide, dispense and administer all acceptable methods of
contraception to all citizens of the Philippines , provides such has been trained.
Adm. Order 49 : Adoptation for the Standard days method in addition to Natural Family Planning
Adm . NO. 50 National Family Planning policy
G. Benefits of Family Planning to the following:
1. Mothers health
Helps mother recover her body between pregnancies
Allow sick women recover from ailment before becoming pregnant again
2. Child health
Better care and nurturing
For better chance to grow up healthy and strong
3. Family s health
Lets the parents give enough time and attention to each child
Give family time to participate community activities.
Improve marital relationship to find satisfying and enjoying married life of having pregnancies at the right time
and proper spacing. The home is the fertile ground for normal emotional development of children.

Economic Benefits
o

The Philippines, which is already experiencing a serious rice shortage, would be able to decrease its
dependence on foreign imports such as rice with fewer mouths to feed. Additionally, the Philippine government would be
able to save millions in state revenue that would otherwise go toward addressing unintended pregnancies. The

government spends 8.2 billion Philippine pesos in medical care for unintended pregnancies. If family planning were put in
effect, it would only spend 0.6 billion Philippine pesos on unintended pregnancies and 4 billion on contraceptive services
and supplies. That is a savings of almost 4 billion Philippine pesos.

Reducing Maternal Deaths

o

Many women die from pregnancy (or delivery) because they are too young (under 18 years old), too old
(older than 35 years), have pregnancies that are too close to each other (less than 3 years apart) or have had too many
pregnancies. According to the Philippine Daily Inquirer, as many as 2,100 maternal deaths in the Philippines each year
could be prevented with family planning. It could also prevent deaths related to ill-health resulting from unintended
pregnancies. About 4,000 women die in the Philippines each year because of pregnancy-related causes.

Work Benefits
o

According to Family Health International, family planning users are more likely to work than non-users
because it gives women the time to seek work opportunities outside the home. Women in the Philippines have said that
larger family size increase their household responsibilities and make them unable to seek paid work. More children also
require more income, thus a vicious cycle is formed. Filipina women said they need more money to care for their children,
but more children prevent them from seeking work opportunities. Family planning provides a solution to both issues.

Social Benefits
o

Women in the Philippines who use family planning are more likely to join community activities, religious
organizations and take part in community projects, the Family Health Organization says. Filipina women say these
activities enabled them to socialize, interact with peers and generally raised their self-esteem. Family planning also
increased their status at home, with many Filipina women saying they are equal decision-makers, enabling them to work
and travel outside their communities.
Source: Internet www.google.com
Assignment; Evaluation: To be submitted next meeting.

1.

What are the factors affecting the quality of life of people?

2. What are the consequences of rapid population growth?

3. Describe the population in your community .

Is your community overpopulated or under?

4. Are there resources plentiful or scarce . Explain.

Lesson II. Human Sexuality

A. Understanding Human Sexuality
Dimensions of human sexuality
1. Biospysical - includes how female and male reproductive organs work
2. Psychophysiological describes the physiological changes as well as the psychological responses during
sexual experience
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3. Socio cultural includes the effects of societal beliefs, mores and traditions about sex.
Biophysical dimension:
A. Female
A. mons pubis
B.Clitoris
C. vestibule
D. Labia majora
E.labia minora
F. Vaginal orifice

The female sex organs are distinguished

external and internal genitalia.

between the

A. External Structures:
1.

2.
3.

4.
5.
6.
7.
8.
9.

10.
11.

Mons Veneris/Pubis Pad of fat

which lies over the
symphysis pubis where dark and curly
hair grow in
triangular shape that begins 1-2 years
before the onset of
menstruation. It protects the
surrounding
delicate tissues from trauma.
Labia Majora Two (2) lengthwise fatty folds of skin extending from mons veneris to the perineum that protect
the labia minora, urinary meatus and vaginal orifice.
Labia Minora 2 thinner, lenghtwise folds of hairless skin extending from clitoris to fourchette.
Glands in the labia minora lubricates the vulva
Very sensitive because of rich nerve supply
Space between the labia is called the Vestibule
Clitoris small, erectile structure at the anterior junction of the labia minora that contains more nerve endings. It
is very sensitive to temperature and touch, and secretes a fatty substance called Smegma. It is comparable to the penis
in its being extremely sensitive.
Vestibule the flattened smooth surface inside the labia. It encloses the openings of the urethra and vagina.
Skenes Glands/Paraurethral Glands located just lateral to the urinary meatus on both sides. Secretion helps
lubricate the external genital during coitus.
Bartholins Gland/Vulvovaginal Glands located lateral to the vaginal opening on both sides. It lubricates the
external vulva during coitus and the alkaline pH of their secretion helps to improve sperm survival in the vagina.
Fourchette thin fold of tissue formed by the merging of the labia majora and labia minora below the vaginal
orifice.
Perineum muscular, skin-covered space between the vaginal opening and the anus. It is easily stretched during
childbirth to allow enlargement of vagina and passage of the fetal head. It contains the muscles (pubococcygeal and
levator ani) which support the pelvic organs, the arteries that supply blood and the pudendal nerves which are important
during delivery under anesthesia.
Urethral meatus external opening of the urethra. It contains the openings of the Skenes glands which are often
involved in the infections of the external genitalia.
Vaginal Orifice/Introitus external opening of the vagina, covered by a thin membrane called Hymen.

1. urether
2. fimbrae
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3.cervix
4. rectum
5. vagina
6. anus

The internal reproductive organs in the female include:

Vagina: The vagina is a canal that joins the cervix (the lower part of uterus) to the outside of the body. It also is
known as the birth canal.

Uterus (womb): The uterus is a hollow, pear-shaped organ that is the home to adeveloping fetus. The uterus is
divided into two parts: the cervix, which is the lower part that opens into the vagina, and the main body of the uterus,
called the corpus. The corpus can easily expand to hold a developing baby. A channel through the cervix allows sperm to
enter and menstrual blood to exit.

Ovaries: The ovaries are small, oval-shaped glands that are located on either side of the uterus. The ovaries
produce eggs and hormones.

Fallopian tubes: These are narrow tubes that are attached to the upper part of the uterus and serve as tunnels
for the ova (egg cells) to travel from the ovaries to the uterus. Conception, the fertilization of an egg by a sperm, normally
occurs in the fallopian tubes. The fertilized egg then moves to the uterus, where it implants into the lining of the uterine

wall

The fimbriae of the uterine tube, also known as fimbriae tubae, are small, fingerlike projections at the
end of the fallopian tubes. They are connected to the ovary.

Cervix comes from the Latin phrase that means neck of the womb and it is the part of the uterus that
joins with the top part of the vagina. This area is narrow and conical or cylindrical, protruding up into the upper
anterior portion of thevaginal wall

A. Lobe
B. Areola
C. Nipple
D. Lactiferous sinus
E. Lactiferous duct

B. Male reproductive system

Unlike the female reproductive system, most of the male reproductive system is located outside of the body. These
external structures include the penis, scrotum, and testicles.

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Penis: This is the male organ used in sexual intercourse. It has three parts: the root, which attaches to the wall of
the abdomen; the body, or shaft; and the glans, which is the cone-shaped part at the end of the penis. The glans, also
called the head of the penis, is covered with a loose layer of skin called foreskin. This skin is sometimes removed in a
procedure called circumcision. The opening of the urethra, the tube that transports semen and urine, is at the tip of the
penis. The penis also contains a number of sensitive nerve endings.
The body of the penis is cylindrical in shape and consists of three circular shaped chambers. These chambers are made
up of special, sponge-like tissue. This tissue contains thousands of large spaces that fill with blood when the man is
sexually aroused. As the penis fills with blood, it becomes rigid and erect, which allows for penetration during sexual
intercourse. The skin of the penis is loose and elastic to accommodate changes in penis size during an erection.
Semen, which contains sperm (reproductive cells), is expelled (ejaculated) through the end of the penis when the man
reaches sexual climax (orgasm). When the penis is erect, the flow of urine is blocked from the urethra, allowing only
semen to be ejaculated at orgasm.

Scrotum: This is the loose pouch-like sac of skin that hangs behind and below the penis. It contains the testicles
(also called testes), as well as many nerves and blood vessels. The scrotum acts as a "climate control system" for the
testes. For normal sperm development, the testes must be at a temperature slightly cooler than body temperature. Special
muscles in the wall of the scrotum allow it to contract and relax, moving the testicles closer to the body for warmth or
farther away from the body to cool the temperature.

Testicles (testes): These are oval organs about the size of large olives that lie in the scrotum, Most men have
two testes. The testes are responsible for making testosterone, the primary male sex hormone, and for generating sperm.
Within the testes are coiled masses of tubes called seminiferous tubules. These tubes are responsible for producing
sperm cells.

Epididymis: The epididymis is a long, coiled tube that rests on the backside of each testicle. It transports and stores sperm
cells that are produced in the testes. It also is the job of the epididymis to bring the sperm to maturity, since the sperm that
emerge from the testes are immature and incapable of fertilization. During sexual arousal, contractions force the sperm into
the vas deferens.

Vas deferens: The vas deferens is a long, muscular tube that travels from the epididymis into the pelvic cavity, to just behind
the bladder. The vas deferens transports mature sperm to the urethra, the tube that carries urine or sperm to outside of the
body, in preparation for ejaculation.

Seminal vesicles: The seminal vesicles are sac-like pouches that attach to the vas deferens near the base of the bladder.
The seminal vesicles produce a sugar-rich fluid (fructose) that provides sperm with a source of energy to help them move. The
fluid of the seminal vesicles makes up most of the volume of a man's ejaculatory fluid, or ejaculate.

Prostate gland: The prostate gland is a walnut-sized structure that is located below the urinary bladder in front of the rectum.
The prostate gland contributes additional fluid to the ejaculate. Prostate fluids also help to nourish the sperm. The urethra,
which carries the ejaculate to be expelled during orgasm, runs through the center of the prostate gland.

Bulbourethral glands: Also called Cowper's glands, these are pea-sized structures located on the sides of the urethra just
below the prostate gland. These glands produce a clear, slippery fluid that empties directly into the urethra. This fluid serves to
lubricate the urethra and to neutralize any acidity that may be present due to residual drops of urine in the urethra.

Ejaculatory ducts: These are formed by the fusion of the vas deferens and the seminal vesicles (see below). The ejaculatory
ducts empty into the urethra.

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Urethra/ureter: The urethra is the tube that carries urine from the bladder to outside of the body. In males, it has the additional
function of ejaculating semen when the man reaches orgasm. When the penis is erect during sex, the flow of urine is blocked
from the urethra, allowing only semen to be ejaculated at orgasm.

1. Ureter
2. seminal vesicle
3. Ejaculatory duct
4. prostate
5. bulbourethral gland
6. anus
7. vas deferens
8. epididymis
9. testis
10 scrotum

Psychophysiological Dimension
The psychophysiological dimension of human sexuality refers to the mind and body relationship especially during a sexual
experience.
There are 8 stages of sexual act:
1. Mutual consent- prerequisite for the mutual enjoyment of the sexual act
2. Foreplay- which refers to the stimulation of the bodys most responsive zones.
3. Arousal or excitement which readies both partners for the sexual intercourse itself.
4. Penetration refers to the insertion of the erected penis into vaginal canal
5. Coitus physical joining of the couples bodies characterized by movement that cause the penis to rub
against the clitoris and vaginal wall . thus increasing excitement
6. Orgasm refers to climax or highest point of sexual pleasure for both partners
7. Relaxation- point when the penis returns being soft and placid. And the man and woman feel a general
sense of well being satisfaction.
8. After play - preludes total rest and is the setting for complete oneness with each other.
Modern research collapse these into four phases:
1. Excitement
2. Plateau
3. Orgasmic
4. Resolution
In sexual act male response is more prone to be basic, whereas women tend to reflect three responses:
Multiple orgasm, orgasmic failure and single orgasm the most common to well adjusted woman and reserve the multiple
experience on special occasions when her moods allotted for intercourse.
Sociological dimension
The sociological dimension of human sexuality refers to the effects of the environment, including
economic factors that may positively or adversely affect attitude towards family formations.These
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factors include social class, level of education , religious orientation , family upbringing, community
environment.
Female sexual dysfunction
1. Primarily non orgasmic woman has never experienced orgasm by any means
2. Situationaly non orgasmic woman experience orgasm by some means but not currently with intercourse.
3. Dyspareunia pain during intercourse, unable to produce enough lubrication, also those who has
infections.
4. Vaginismic women usually have disruptive marriages. In this women , involuntary contractions of the outer
third of the vagina prevent insertion of the penis.
1.
2.
3.
4.

Male sexual dysfunction

Primary impotence or erective inadequacy- men will never achieve erections sufficient to the penetration of female.
Secondary impotence- has previously achieve an erection in his sexual relations, but losses his ability to achieve
erection 25% of his attempts at coitus.
Premature ejaculation- male is unable to delay ejaculation long enough for the female to achieve orgasm.
Retarded ejaculation or ejaculatory incompetence males has difficulty or fails to ejaculate intra vaginally.

Lesson assignment : Submitted on or before Jan 31, 2015

.
I.
Three dimensions of human sexuality and describe each.
II.
Female sexual dysfunction and explain each .
III.
Male sexual dysfunction and explain each.
IV.
Give four principles in planning and intervention of client with sex related problems.

Lesson III.
Roles, Functions of midwife in Family Planning
The midwifes role or function as Family planning worker can be classified into three headings,
as defined under RA 7392 ( Philippine Midwifery Law ) and according to the Rural Health
Midwife Manual of DOH.
The Midwife perform the following functions:
A. As a health Educator /Counselor - act as an educator or teaching clients and giving
options or counseling.
Examples: premarital counseling, teaching mother how to determine her fertile days,
discussing different fp methods
B. As a Service provider provides and performs fp services
Examples: IUD insertion, dispense pills
C.. As a manager of Family Planning facility- manager , directs ,determine status of the
clinic such as logistics ,supplies others.

Examples: determining couples to be provided with pills.

In order for the midwife performed her threefold function as enumerated
above she should do following responsibilities:
1.Be thoroughly aware of issues affecting the health of both mother and child
15

2.Be well versed with family planning programs launched by the government
3. Be able to transmit health information to clients to motivate them to
cooperate
Other Roles of the midwife in Family Planning:
Aware of issues in relation to
mothers and children

Well -versed with Family

Planning Program
Transmit Health Information to
motivate clients to cooperate

Lesson IV
Menstrual cycle
Begins on the first day of menstrual bleeding and ends the day before menstrual
bleeding occurs again.
Average length is 26-35 days.
Menstrual bleeding normally lasts from three to five days.
Examples:
January 5 then February 3 29 days
January 24 then February 19 26 days
March 14 then April 12 29 days
March 14 then April 12 29 days
March 7 then April 9
33 days

The length of a woman's menstrual cycle can normally vary by a few days from cycle to cycle. A
menstrual cycle is usually 26 to 35 days long, but some women may have shorter or longer cycles and this can
be normal for them.Menstrual bleeding normally lasts from three to five days.
The menstrual cycle has three phases:
1. Pre-Ovulatory Phase
On the first day of the menstrual cycle, estrogen and progesterone levels are low.This causes the shedding of
the endometrium as menstrual bleeding.
The low levels of estrogen and progesterone stimulates the brain to produce Follicle-Stimulating Hormone
(FSH). This hormone, as it is called, stimulates the follicles
in the ovary to mature. One of these follicles will later further mature to be released
during ovulation.
The maturing follicles in the ovary produce estrogen. As the follicles mature further, the
estrogen levels increase.
Estrogen causes endometrium to thicken by cell multiplication and proliferationthe production of mucus to
become increasingly wet and lubricative

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2. Ovulatory Phase
When estrogen levels peak, the brain is stimulated to produce as Luteinizing Hormones
(LH). This sudden increase of luteinizing hormone causes the release of the mature ovum,
a process which is called ovulation.
Ovulation usually occurs 12-16 days before the onset of the next menses. Once ovulation occurs and the egg
has gone into the fallopian tube, it can be fertilized
by the male sperm for only up to one day (24 hours).
During this phase:
The lining of the uterus continues to thicken.
The egg is mature and is finally released.
The cervical mucus is wet, slippery, stretchy, and clear.
There is a feeling of vaginal wetness.
The cervix is soft and open.
3. Post-Ovulatory Phase
After ovulation, the remaining follicles that underwent initial maturation are transformed
into the corpus luteum.
The corpus luteum in the ovary produces estrogen in smaller amounts and progesterone
in greater amounts. This causes a drop in estrogen levels with higher levels of progesterone.
Progesterone causes the following changes to occur in the woman's reproductive system:
The cervical mucus becomes pasty and is no longer slippery and stretchy.
The vagina feels dry (this type of mucus does not allow sperm to travel into the
uterus and prevents the sperm from living more than a few minutes to a few
hours.)
The cervix becomes firm; the cervical opening closes so that sperm cannot pass
through to the uterus.
The basal body temperature increases and remains high for the rest of the cycle.
When there is no fertilization, the corpus luteum regresses. As the corpus luteum regresses,
the production of progesterone and estrogen decreases.
When estrogen and progesterone levels are low, menstruation occurs.
When fertilization occurs, the fertilized egg produces the Human Chorionic Gonadotropin
(HCG) hormone.
Effects of HCG:
The corpus luteum is maintained so that the estrogen and progesterone production is
sustained.
Due to the sustained levels of estrogen and progesterone, the endometrium is maintained
and menstruation does not happen.
Causes the pregnancy test to read positive.
FP AND PHYSIOLOGICAL CHANGES IN A WOMAN
Why are women on hormonal contraceptives not ovulating?
Women taking the hormonal contraceptives have consistent high levels of estrogen and/or
progesterone. The brain is not stimulated to produce FSH so that no follicles mature for
ovulation.
Why are most women on the progestin-only injectable, like DMPA, not having menses?

17

The endometrium is not developed because the estrogen effect (i.e., priming of the
endometrium) is surpassed by the higher progestin levels. So there is no endometrium
to shed off.
Why is the temperature higher after ovulation?
After ovulation, progesterone levels are high. Progesterone is thermogenic (e.g. giving
high temperature). The increased levels of progesterone, observed as an increase in
basal body temperature, signifies that ovulation has already occurred.
Why does the cervical mucus thicken in women using progestin-only contraceptives?
Progesterone causes the cervical mucus to thicken.

Lesson V : Family Planning Methods ( refer to separate copy )

Assignment-( Reporters )
Menstrual Phases - Orocio / Condom
Hormonal Methods - Estilio
Long acting . Permanent - Cabahug
FAB methods Sumbi

Lesson VI :
The Basic rights of clients:
Information. To learn about the benefits and availability of family planning.
Access. To obtain services regardless of sex, creed, color, marital status, or
location.
Choice. To decide freely whether or not to practice family planning and which
method to use.
Safety. To be able to practice safe and effective family planning.
Privacy. To have a private environment during counseling and services
Confidentiality. To be assured that personal information will remain confidential.
Dignity. To be treated with courtesy, consideration and attentiveness.
Comfort. To feel comfortable when receiving services.
Continuity. To receive FP services and supplies as long as needed.
Opinion. To express views on the services offered.
What is Informed choice?
Involves effective information on reproductive choices and counseling services to
help clients choose and use appropriate FP methods.
What is Voluntarism
Decision-making on choice of FP method is based on free choice and not obtained
through any special inducements or forms of coercion.
Importance of ICV ( informed choice and voluntarism )
Informed choice and voluntary decisions leads to:
Better method use
18

Client compliance
Continued method use
Promote clients satisfaction
Access to a range of contraceptive use, thus leading to high rate of
contraceptive use

Informed consent
Informed consent is the written voluntary decision of a client to accept a particular
FP method or to undergo a sterilization procedure.
Informed consent is the documentation of the clients voluntary decision to
practice or accept family planning specifically the surgical method of
contraception.
Types of Communication in FP/RH
Information-giving
Motivation
Counseling
Information-Giving
is a way of providing people with facts about family planning methods.
Motivation
includes all efforts to encourage people to practice family planning.
Counseling
is a two-way communication process between the provider and the client.
is a process wherein the provider assists the client in making a free and informed
decision about her/his fertility.
Effective Communication Skills
NON-VERBAL COMMUNICATION

Cues that portray feelings or opinions that are not verbally stated
Tone of Voice
The counselors tone of voice is important in building rapport or establishing a
comfortable environment for the client.
Asking Questions
Types of questions
1. Closed
2. Open
3. Probing
CLOSED QUESTIONS
Answerable by yes, no, a number, or a few words.
Used to:
Start a session
To gather data that may need further exploration
OPEN QUESTIONS
Have many possible answers.
19

Encourage the client to talk about her or his thoughts, feelings, knowledge, and
beliefs.
Often begin with how or what.
NOTE: WHY questions may be intimidating or seem judgmental. It is preferable to
use WHAT as in what are your reasons for or what makes you think ...
PROBING QUESTIONS
Help a counselor clarify the clients responses to open-ended questions.
There is some overlap between open-ended questions and probing questions.
Probing questions follow closed or open questions.
Examples:
You said that you were concerned about the potential bleeding associated with
DMPA. How would you feel about a method that does not cause menstrual
disturbances?
You told me that your husband wants to use a reliable method of contraception.
What are your thoughts about bilateral tubal ligation?
Active Listening
Listening to another person in a way that communicates understanding, empathy,
and interest.
Paraphrasing
Restating the clients message simply.
Guidelines:
1. Listen to the clients basic message.
2. Restate to the client a simple summary of what you believe is her/his basic
message.
3. Do not add any new ideas.
4. Observe a cue or ask for a response from the client that confirms or denies
the accuracy of the paraphrasing.
5. Do not restate negative images client may have made about themselves.
Example:
Client: "I want to use the IUD, but my sister said that it can travel around your
body and stick in the baby's head."
Counselor: "So you want to use IUD but you have concerns about its possible
effects on you and your baby?"
Clarifying
Making a guess about the clients message for the client to confirm or deny.
Guidelines:
Admit that you want to have a clear understanding of what the client is
saying.
Restate the clients message as you understood it, asking the client if your
interpretation is correct.
Example:
Client: I am using the pill and like it, but my sister says that with DMPA, I do not
need to remember to take anything.
Counselor: Let me see if I understand you. You are thinking about switching from
the pill to DMPA, because DMPA would be more convenient for you.
Using Simple Language
Another way of making clients comfortable during counseling is using words that
they can understand.

20

Avoid using technical, medical terms which may intimidate clients

Lesson VII :

Management of Family Planning Clinic Services

Quality is the most desirable outcome of a health intervention in terms

of:
maximum well-being for the client considering both the risks and benefits,
or the gains and losses; and provider satisfaction.
Three principles in managing for quality
1. Clients come first. Client-centered care

Helps clients achieve their reproductive goals

Includes upholding the principles of clients rights, informed choice and

voluntarism, and informed consent
2. Quality Management Triangle
Quality planning and design

Quality control

Quality improvement

3. Requirements in Delivering Quality FP Clinic Services

Appropriate health facility infrastructure

Competent staff

Adequate logistics

Components of a Facility-Based FP Services

A. FP Promotion
Emphasis On benefits of practicing FP
Awareness on the links of FP to other RH elements
Giving of correct information about FP and FP methods
Provision of full information on each FP method as the basis of clients in making
their decisions and choices
B.FP Counseling
Two-way, face-to-face communication in which the FP service provider helps a
client make a voluntary decision about her/his fertility and make an informed
choice on what method to use.
C. Provision of FP Methods
21

Includes provision of all medically approved, safe, effective, and legally acceptable
modern family planning methods.
The following services are performed, as needed:
o Physical assessment of clients including pelvic examination
o Screening for common and other gynecological problems (e.g. RTIs, STIs,
cervical cancer, breast cancer)
o Management/referral for services not available in the facility
o Simple laboratory procedures
D. Infection Prevention and Control
Prevention of the spread of infection during the provision of FP methods.
Aims to protect both clients and providers from the spread of infectious diseases.
E. Referral of Clients
Referral encompasses sending a client to or receiving a client sent by other clinics
or service providers for any FP or related services that the other clinic can ably
deliver.
o What needs to be referred?
o Where should clients be referred?
o How do you refer?

CP M105
Lesson I
Infection Prevention Family Planning Services
Infection Prevention in FP
Refers to the measures used in preventing the spread of infection during the
provision of FP services.
Aims to:
Minimize infections during the provision of FP services such as DMPA
injections, IUD insertion and removal, and voluntary surgical procedures
Prevent the transmission of serious life threatening diseases such as
Hepatitis B and AIDS for both clients and service providers.
Procedures are simple, effective, and inexpensive.
Protective Barriers
Physical, mechanical, or chemical processes which help prevent the spread
of infectious microorganisms from client to client, client to staff, or vice
versa.
Example:
Hand washing
Use of gloves
Correct use of antiseptics and disinfectants
Proper processing of instruments and other items
Proper disposal of sharps and wastes
Antisepsis
22

The prevention of infection by killing or inhibiting the growth of microorganisms on

skin and other body tissues through a chemical agent (antiseptic).
objects.

Decontamination
is the process that makes inanimate (non-living) objects safer for handling by
staff (especially cleaning personnel)
done before cleaning using a disinfectant like chlorine solution (0.5%).
Preparing 0.5% Chlorine Solution
Parts of water/part of chlorine
1 = 9 parts water/part of water
1 part chlorine in 9 parts water
Disinfection
Is the process that eliminates most, but not all, causing microorganisms from
inanimate objects.
Cleaning
The process of physically removing all visible blood, bodily fluids, or foreign
materials such as dust or soil from skin or inanimate objects.
High level of Disinfection
Eliminates all microorganisms except some bacterial endospores. Performed by
boiling or use of chemicals.
Sterilization
Process that eliminates all microorganisms (bacteria, viruses, fungi, and parasites),
including bacterial endospores from inanimate objects.

Processing Instruments and Other Items

Decontamination
Soak in 0.5%
Chlorine solution
10 minutes

Thoroughly Wash and Rinse

Acceptable
Acceptable

Wear Gloves,
guard against injury
from sharp objects

23

Methods
Methods

Sterilization

Autoclave
106 kPa pressure
9 15 lbs./sq.in.)
20 min. unwrapped
30 min. wrapped

High Level
Disinfection
(HLD)
Boil

Chemical

Lid on 20
minutes

Soak
20 minutes

Dry Heat
170 C
60 minutes

COOL
Ready for Use
Wrapped sterile packs cam be stored for up to one week. Unwrapped items should be
stored in a sterile or HLD container with tight fitting lid.

Standard Precaution .
Note: Consider every person as potentially infectious
Handwashing
When to do: Before
the day's work

examining a client

administering injections or drawing blood

performing a procedure (IUD or pelvic exam);

handling clean, disinfected, or sterilized supplies for storage

putting on sterile gloves

After
any situation in which the hands may be contaminated, such as handling
instruments or touching body secretions or excretions

examining a client

removing gloves
24

personal use of toilet

blowing nose, sneezing, or coughing
Gloves

When to use gloves;

To protect the health care provider from contact with potentially infectious
substances like body fluids of clients.
To protect the client from infections that might be present on the skin of the health
care provider.
Three types
Utility gloves for handling contaminated items, medical or chemical
performing housekeeping activities.

waste and

Non-sterile, examination gloves for contact with intact mucous

membranes or
for reducing the providers risk of exposure (i.e., routine
pelvic examination).
These gloves should be disposed after one use.

Sterile, surgical gloves for contact with the bloodstream or with tissue under the
skin like surgical procedures.

Antiseptics
Chemicals which kill or inhibit many, though not all, microorganisms while causing
little damage to the tissue.
Commonly used:
70% Isopropyl Alcohol
* Iodine solutions

WASTE MANAGEMENT
Purpose
Prevents the spread of infections to clinic personnel, clients, visitors, and the community.
Reduces the risk of accidental injury to staff, clients, and community.
Reduces bad odors.
Attracts fewer insects and animals which may be vectors of infectious agents.
Reduces the possibility of the soil or ground water contamination with chemicals or
microorganisms.
Kinds of Waste:
General wastes
-non-hazardous waste that poses no risk of injury or infections similar to household
trash.
Hazardous medical wastes
25

-these are wastes that can cause injuries or are potentially infectious.
Hazardous medical wastes

Infectious - these contain pathogens in sufficient concentration to cause diseases.

Pathological - consists of human tissues or fluids.
Pharmaceutical - expired, unused, and contaminated pharmaceutical products,
drugs, and vaccines.
Chemicals - these are discarded solid, liquid, and gaseous chemicals used in
cleaning, housekeeping, and disinfecting procedures.
Sharps - items that could cause cuts and puncture wounds.
Pressurized containers - full or emptied aerosol cans with pressurized liquid gas
or powdered materials.

Process of waste disposal

1. Sorting or segregation and containerization
2. Handling
3. Interim Storage
4. Final Disposal
Sorting and containerization
Categorizing wastes at the point of generation
Reduces the amount of wastes that need special handling
Segregation
Black container: general, dry, non-infectious waste
Green container: general, wet, non-infectious waste
Yellow container: infectious, pathologic waste
Red container -Sharp, puncture proof container with lid: needles, blades
Handling
Handle medical waste as little as possible before disposal.
When waste containers are full, close plastic containers and place in larger
containers at interim storage areas.
ALWAYS wear heavy, utility gloves when handling medical waste.
ALWAYS wash hands after handling waste and after removing gloves.
Interim storage

Storing of waste in the facility prior to collection.

Interim storage should not be more than two days.
Place waste in an area that is minimally accessible to clinic staff, clients, and
visitors.
Ensure that wastes are collected regularly, ideally on a daily basis.

Final disposal

General wastes : Collected by the municipal garbage collector and transported

to the final dump sites.
Solid medical wastes : Burying in a space at the back of the facility in a
pit.
26

Transporting waste to an off-site disposal site done by the waste collector of

hospital medical wastes.
Final Disposal
Liquid Medical Wastes
Pour liquid waste down a sink, drain or flushable
toilet.
Drains should not run through open gutters.
Rinse the sink or toilet thoroughly with disinfectant.
Decontaminate container and wash hands before removing gloves.
Sharps
Use sharps puncture proof containers.
Dispose of sharps containers when full.
Burial is the safest way to dispose of sharps.
HANDLING SHARPS
Use each needle and syringe only once.
Do not disassemble needle and syringe after use.
Do not recap, bend or break needles prior to disposal.
Decontaminate needle and syringe prior to disposal.
Dispose of needle and syringe in a puncture-proof container.
Use of multi-dose vials
Check the vial to be sure there are no leaks or cracks.
Check the solution to be sure that it is not cloudy and no particulate matter.
Wipe the top of the vial with a cotton swab soaked with 60-70% alcohol. Allow to
dry.
Use a new needle and syringe for each new person.
-Never use a contaminated needle or syringe that has been used previously.
Do not leave needles in multiple dose vials.
Important Points
Wear utility gloves.
Transport solid contaminated waste in covered containers.
Dispose of all sharp items in puncture resistant containers.
Carefully pour liquid waste down a utility drain or flushable toilet.
Decontaminate gloves and containers before cleaning.
Wash hands after handling infectious waste.
Key Messages
To create an infection-free environment, it is important that the rationale for each
of the recommended infection prevention processes (and its limitations) be clearly
understood by clinic staff at all levels from service providers to cleaning and
maintenance staff.

Because it is not possible to know in advance if a client is infected with Hepatitis B

or HIV, all items from all clients must be handled as if they were contaminated. All
clients must be treated as if they were infected.

Lesson II

FP Client Assessment
27

Definition
Is a process by which the health worker learns about the health status and the FP
needs of the client.
Initial step is to take the clinical history.
Data obtained are documented and evaluated.
Purpose
Establishes the clients health status.
Determines the clients eligibility for using a
contraceptive method.
Determines whether the client is in good health, needs further examinations and
management including closer follow-up and/or referral.
Identifies the need for additional procedures and/or laboratory examinations.
Steps of FP Client Assessment
1. Prepare the client.
Greet her cordially and ensure comfort.
Establish rapport with the client.
Establish the purpose of the visit.
Explain to the client procedures to be performed
(including physical
and/or laboratory examinations, if needed.)
Encourage the client to ask questions openly.
2. Take and record the clients health history using the FP Service Form 1.
3. Discuss with the client:
Findings based on the history.
Need to perform further examinations like physical
and/or laboratory
examinations.
Need for referral of laboratory examinations or further management.
Need and schedule of follow-up visit(s).
The Family Planning Service Form 1(FP Service Form 1)
Components
1. Personal data
2. Medical history (past and family)
3. Reproductive history
Menstrual history
OB history
FP history
Risk for STIs
VAWC
4. Present illness or health concern
A. Personal Data
1. Complete name of client
2. Name of husband
3. Clients age, sex
4. Occupation, average family monthly income
5. Educational attainment
6. Address
B. Medical History
28

Past illnesses
Hospitalizations
Accidents/Injuries
Allergies
Surgeries
Immunizations
Habits (smoking, drinking, substance abuse, etc.)
Family History (CVA, heart disease
C. Reproductive History
Menstrual History
Menarche - age of onset of menstruation
Last Menstrual Period (LMP) - first day of last menstrual period including
the number of days,
character (scanty, moderate, or heavy) of
menstrual flow and accompanying symptoms
Previous Menstrual Period (PMP) - first day of menstrual period prior to the
mentioned LMP

Obstetrical History
Gravidity (G) number of pregnancies regardless of outcome
Parity (P) - number of pregnancies reaching
viability (>20 weeks AOG)
Other information (F-P-A-L)
Full-term pregnancies
Pre-term pregnancies
Abortions
Living children
FP History
FP method currently being used
duration of use
satisfaction with use
FP method previously used
duration of use
reason/s for discontinuation or shifting
Reproductive goals/ intents
to achieve desired number of children
to limit or to space
Risk for STIs
Ask the client the following questions:
Do you suspect your partner to have another sexual partner?
Do you think your sex partner might have an STI?
Have you or your partner ever been treated for STIs?
Do you or your partner experience the following:
Unusual (pus-like, foul smelling) discharge from the vagina/urethra?
Itching and/or sores around the genital area?
VAWC
Ask the client the following questions:
How is your relationship with your husband or partner?
Does he know about your coming to the clinic?
29

Is he willing to cooperate or support you in using a FP method?

D. Present health status or concerns

Present complaint or concern
Onset, nature, and duration of present complaint or concern
Accompanying symptoms and precipitating/aggravating factors
Measures or medications taken to relieve symptoms and precipitating/aggravating
factors
Prior consultations or medications
Physical Examination
Steps
Remember (Proceed from head to toe . Inspect first, palpate later)
1. Take vital signs.

Blood Pressure

Pulse Rate

Respiratory Rate

Temperature

2. Prepare client.

Make the client comfortable.

If doing an internal exam: Ask client to void/empty bladder and wash

perineum.

Assure privacy and confidentiality.

Explain the procedures (what is going to happen and why).

3. Prepare needed instruments and supplies.

Prepare the instruments and supplies ahead of the actual Physical
Examination especially when there is no knowledgeable assistant around.
4. Conduct the physical examination.
If the health provider is a male, the female client may request a companion
while the physical examination is being conducted/performed.

Laboratory
Purpose
Laboratory tests are NOT ALWAYS REQUIRED (refer to WHO Applicability Chart)
30

Performed to further investigate abnormal findings on history taking and/or

physical examination
Hemoglobin Determination
To confirm and determine severity of anemia in a pale client.

Normal ranges depend on age and sex of client.

Normal ranges are:

Adult males: 14-18 gm/dl

Adult women: 12-16 gm/dl

Other Laboratory Examinations

Wet Smear - to find the causative agent of existing vaginitistrichomonas or gardnerella (

monilia,

Gram Stain - to determine the microorganism causing the STIchlamydia

gonococci or

Pap Smear - cervical secretions collected examined under a microscope in order

to look for pre-malignant or malignant changes

Acetic Acid - abnormal cells may be identified by applying acetic acid to areas of
suspected cervical lesions
Assignmnet: Wet smear - Riego
Gram Stain Ramos
Pap Smear - latuza
Acetic Acid Test Joven
Pelvic Examination Tiba

IUD insertion and Removal Cabahug

FP Assessment Sumbi FP
Breast Examination Estilo
MEC Whell Orocio

Demonstration on GATHER APPROACHED.

31

WHO Medical Eligibility Criteria (MEC)

WHO MEC is a reference tool for assessing clients on their eligibility for initiating
and continuing the use of a specific contraceptive method based on certain criteria
developed from
evidence-based standards.

Lesson III

Family Planning Counseling

Steps in GATHER Approach

GREET
ASK/ASSESS
TELL
HELP
EXPLAIN
RETURN/REFER
Six steps of counseling
Guide for doing counseling
Not all steps are applied the same way for all clients
The G (Greet) Step
Importance
Beginning of establishing rapport with the client.
Making the client comfortable.
Assuring confidentiality.
Tasks
Greet client and give your full attention.
Introduce yourself.
Offer client a seat.
Ask the reason for the visit and how you can be of help.
Ensure confidentiality.
The A (Ask/Assess) Step
Tasks
Ask client about self (use FP Form 1).
General/Demographic data
Medical/Obstetrical History
Check for medical conditions that will not warrant the use of specific FP
method based on the WHO MEC.
Assess reproductive needs.
Ask client if there are plans for another pregnancy. If yes, when she/he plans
to have this.
32

Assess clients knowledge and experience on FP

What is the knowledge of the client about FP?
Has client used any method? How long? Is client satisfied with FP method
used?.
Assess for violence committed against partner
How is clients relationship with husband/partner?
Does partner know about the clients visit to the clinic?
Will partner support clients use of FP method?
Assess for STI Risk.
Why assess for STI risk?
FP clients are sexually active, thus, they need to know about STIs.
If client gets STI, then there is a need for counseling on risks, symptoms, and
treatment and need supply of condoms.
IUDs should not be provided to clients with STI risks.
Questions that are asked in assessing STI risk:

How is your relationship with your partner?

Have you or your partner ever been treated for STIs in the past?
Do you think your partner might have STI?
Questions that are asked of the woman:

Do you have:
Unusual discharge from the vagina?
Itching or sores in or around the vagina?
Pain or burning sensation?

Questions that are asked of the man:

Do you:
Experience pain or burning sensation on urination?
Have open sores in the genital area?
Have pus from the penis?
Have swollen penis or testicles?

Determine that the woman is not pregnant by the following:

Menstrual period started within the last seven days
Gave birth within the last four weeks
Had an abortion within the last seven days
33

Gave birth within the last six months, is fully breastfeeding, and has not yet
had menstrual period
Has not had sexual intercourse since last menstrual period
Uses a modern/reliable family planning method correctly
FOR REVISIT CLIENTS
Ask if clients situation has changed since last visit.
Ask if reproductive needs have changed.
Ask if client has new concerns.
Ask if client has problems with the chosen FP method.
Reassess for STI/HIV risk.
Reassess relation with partner.

The T (Tell) Step

Importance
Provide information of FP methods based on reproductive need and knowledge.
Tasks
Tell the client about FP methods based on clients needs: short-term, long-term,
permanent.
Tell how the method works.
Explain effectiveness, advantages, disadvantages, and possible side effects of
each of the appropriate methods.
Correct misconceptions.
The H (Help) Step
Importance
Helps the client make a decision.
Tasks
Ask client what method she/he heard during the Tell step that interests her/him.
Check clients suitability for chosen method using the MEC Checklist for the chosen
FP method.
Remind client of the possible side effects of the method chosen.
Ask client how she/he can tolerate possible side effects.
Ask client if there is anything not understood; repeats information, as needed.
If client decides not to use a method:
Tell client about:
Risks of pregnancy
Availability of pre-natal services
Being able to return should the client wants to use a FP method
The E (Explain) Step
Importance
How to use the chosen method is explained.
Method is provided, if appropriate and available.
Tasks
Explain how to start and use the chosen method.
Describe warning signs, what to do should it occur.
Confirm clients understanding of what has been said by asking client to repeat
what has been said in her/his own words.
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 Correct misunderstanding.
For revisit clients
Ask client:
How client uses the present method and what the warning signs are.
To repeat instructions on how to use and what to do for warning signs.
Correct mistakes or misunderstandings.
The R (Return/Refer) Step
Important opportunity to:
Reinforce the decision clients have made to plan their family.
Discuss any problems they have with their chosen method.
Take seriously the clients concern with a supportive attitude and should never be
dismissed.
Tasks
Tell client when and where to return for
Routine follow-up
Schedule next visit
Encourage client to come back for any problems, including warning signs.
If chosen method/service is not available, refer client to other service providers or
facilities.
References:
APSOM- JPHIEGO Intructors Guide on Family Planning

End .

FP-CBT Basic Course Training of Trainors Manual 2013 DOH

Return Demonstration Family Planning Counseling using FP FORM 1

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