FAMILY HEALTH

FAMILY HEALTH

METHODS OF FAMILY PLANNING :

1)TEMPORARY FAMILY PLANNING METHOD
 Behavioural method/Natural method
Chemical method
Mechanical method
 Hormonal method
2)PERMANENT FAMILY PLANNING METHOD/SURGICAL METHOD
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Chemical method:
• Foam tablets
• Jelly and paste(Spermicidal)
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Spermicides:
• These are creams, gels, sponges or pessaries that contain a chemical
that kills sperm.
• They can increase the effectiveness of certain barrier methods of
contraception such as a diaphragm.
• However, they don't provide reliable contraception when used alone.
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Mechanical family planning methods:
• Male condoms
• Female condoms
• Diaphragms
• Intrauterine devices (IUD)
• Sponge
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Male condoms:
• It's a thin latex rubber or polyurethane placed over a man's erect
penis during sex to trap sperm at the point of ejaculation.
• It must be put on the penis as soon as it becomes erect and
before any contact takes place with the vagina. Men should withdraw
as soon as they have ejaculated and take care not to spill any semen.
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• Condoms must be used with care as they can slip off or tear.
• Advantages: easily available; offers protection against sexually
transmitted infections including HIV/AIDS.
• Effectiveness: 94%-98% depending on correct use.
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Female condom ( Femidom ) :
• It's a thin polyurethane sheath placed inside the vagina (also covering
the cervix and the area outside) to stop sperm from entering. It can
be put in at any time before sex .
Advantages: offers protection against sexually transmitted infections,
including HIV/AIDS.
Effectiveness: 95% if used correctly.
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Diaphragms/cervical cap :
• A diaphragm or cap is a dome of rubber which is fitted by the woman
over her cervix before sex. It acts as a barrier to stop sperm getting
through to the uterus. It should be used with a spermicidal cream,
jelly or pessaries that contain a chemical that kills sperm.
• The diaphragm must stay in place for six hours after sex.
Advantages: only needs to be used when the couple has sex
• Spermicides may cause irritation or an allergic reaction.
Effectiveness: 92%-96% if used correctly.
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Intrauterine Devices :
• An IUD - also known as a Coil, is a small plastic and copper device,
usually shaped like a 'T', which is fitted into the woman's uterus by a
doctor using a simple procedure.
• It works by foreign body reaction, by creating cellular/biochemical
changes in endometrium/uterine fluids. It impairs viability of gamete.
• An IUCD can stay in place for five years , sometimes for 10 years.
• It can also be used as an emergency method of contraception within
five days of unprotected intercourse.
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• Advantages: no need to think about it once it is in place and it last for

a long time.
• Considerations: There is a higher risk of infection for women with
more than one partner. It may cause heavier, more painful periods.
• Effectiveness: 98%-99%.
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Copper T :
• 10 years
• 99.2 % effective
• Copper on IUD acts as spermicide, IUD blocks from implanting
• Must check string before sex and after shedding of uterine lining.
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Progestasert :
• 1 year
• 98% effective
• T shaped plastic that releases hormones over a one year time frame
• Thickens mucus
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Effectiveness:
When used correctly, it’s about 99% effective as birth control except for
women weighing 90 kilograms or more when it is only about 92%
effective.
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Hormonal family planning methods :

• Vaginal ring
• Pills ( Combined & Minipill )
• Injection
• Implant
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Vaginal Ring:
• A soft, flexible vaginal ring, which is about 2 inches in diameter,
delivers low doses of estrogen and progestin into the body. This helps
prevent pregnancy by suppressing ovulation and thickening the
cervical mucus, which helps block sperm from entering the uterus.
• The ring is inserted into the vagina and left for 3 weeks. It is then
removed for 1 week, during which a woman menstruates, and a new
ring is inserted after the 1-week "break."
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• The vaginal ring is at least 98 percent effective with perfect use, which
refers to always correct and consistent use.
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Combined oral contraceptive pill :
• This is the most common type.
• It contains two hormones - estrogen and progesterone which
prevents ovulation and alters the consistency of cervical mucus.
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Effectiveness:
99% if taken correctly.
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• One pack of Nilocon white contains 21 hormonal tablets and 7 Iron

tablets.
• The composition of each white colored tablet contains Levonorgestrel
0.15 mg, Ethinyl estradiol 0.03 mg and each brown tablet contains
Ferrous Fumarate 75 mg.
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Side-effects:
• Breast tenderness
• Nausea
• Increase in headaches
• Moodiness
• Weight change
• Spotting
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Taking OCPs:
• Once a day at the same time everyday
• Use extra contraception such as condoms for next 1 week if you
missed two or more pills or started new pack 2 or more days late
• take the last pill you missed now, even if this means taking 2 pills in 1
day
• carry on taking the rest of the pack as normal
• The pill offers no protection from STD’s
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Contraindications for Use of Combined Oral Contraceptive Pills (OCPs):
Absolute contraindications:
1. Breast Cancer
2. Genital Cancer
3. Liver disease
4. History of thromboembolism
5. Cardiac abnormalities
6. Congenital hyperlipidemia
7. Undiagnosed abnormal uterine bleeding
8. Pregnancy
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Relative contraindications:
1. Age > 40 years
2. Smoking and age > 35 years
3. Mild hypertension
4. Chronic renal disease
5. Epilepsy
6. Migraine
7. Nursing mothers (0 – 6 months)
8. Diabetes mellitus
9. Gall bladder disease
10. History of infrequent bleeding
11. Amenorrhoea
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Beneficial Effects of Combined Oral Contraceptive Pills (OCPs):
• Benign breast disorders (Fibrocystic disease, Fibroadenoma)
• Pelvic Inflammatory Disease (PID)
• Ectopic pregnancy
• Iron deficiency anemia
• Benign ovarian disease (Ovarian cysts)
• Malignant ovarian disease (Ovarian cancer)
• Endometrial cancer
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Non-contraceptive benefits of combined OCPs: –
• polycystic ovary syndrome (PCOS)
• endometriosis
• adenomyosis
• anaemia related to menstruation
• painful menstruation (dysmenorrhea)
• mild or moderate acne
• irregular menstrual cycles
• dysfunctional uterine bleeding
THANK-YOU
FAMILY HEALTH
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• Populations around the world are rapidly ageing. Ageing presents
both challenges and opportunities.
• It will increase demand for primary health care and long-term care,
require a larger and better trained workforce and intensify the need
for environments to be made more age-friendly.
• Yet, these investments can enable the many contributions of older
people whether it be within their family, to their local community
(e.g. as volunteers or within the formal or informal workforce) or to
society more broadly.
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• Between 2000 and 2050, the proportion of the world's elderly

population will double from about 11% to 22%.
• The absolute number of people aged 60 years and above is expected
to increase from 605 million to 2 billion over the same period.
• Most of this increase is occurring in developed countries.
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In Nepal, the trend has been the same; there were 1.5 million elderly
inhabitants in 2001 and 2.1 million elderly inhabitants in 2011 who
constituted 6.5% and 8.14%, respectively, of the country's total
population in these two years.
During the years 1991-2001, the annual elderly population growth rate
was 3.39%, higher than the annual population growth rate of 2.3%; the
life expectancy has been increasing gradually due to the advancement
in socioeconomic development and sciences, particularly medical
sciences.
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• According to the 2011 census, there are around 2.1 million people
aged 60 or above in Nepal.
• In Nepal, individuals over 60 years of age are considered elderly.
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• Societies that adapt to this changing demographic and invest

in Healthy Ageing can enable individuals to live both longer and
healthier lives and for societies to reap the dividends.
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• The Decade of Healthy Ageing (2020-2030) is an opportunity to bring

together governments, civil society, international agencies,
professionals, academia, the media, and the private sector for ten
years of concerted, catalytic and collaborative action to improve the
lives of older people, their families, and the communities in which
they live.
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• Every person in every country in the world should have the
opportunity to live a long and healthy life.
• Yet, the environments in which we live can favour health or be
harmful to it.
• Environments are highly influential on our behaviour, our exposure to
health risks (for example air pollution, violence), our access to quality
health and social care and the opportunities that ageing brings.
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• Healthy Ageing is about creating the environments and opportunities
that enable people to be and do what they value throughout their
lives.
• Everybody can experience Healthy Ageing.
• Being free of disease or infirmity is not a requirement for Healthy
Ageing as many older adults have one or more health conditions that,
when well controlled, have little influence on their wellbeing.
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Healthy Ageing and functional ability :
WHO defines Healthy Ageing “as the process of developing and maintaining
the functional ability that enables wellbeing in older age”.
 Functional ability is about having the capabilities that enable all people to be
and do what they have reason to value. This includes a person’s ability to:
• meet their basic needs;
• to learn, grow and make decisions;
• to be mobile;
• to build and maintain relationships; and
• to contribute to society.
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• Functional ability is made up of the intrinsic capacity of the individual,
relevant environmental characteristics and the interaction between
them.
• Intrinsic capacity comprises all the mental and physical capacities that
a person can draw on and includes their ability to walk, think, see,
hear and remember.
• The level of intrinsic capacity is influenced by a number of factors
such as the presence of diseases, injuries and age-related changes.
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• Environments include the home, community and broader society, and

all the factors within them such as the built environment, people and
their relationships, attitudes and values, health and social policies, the
systems that support them and the services that they implement.
• Being able to live in environments that support and maintain your
intrinsic capacity and functional ability is key to Healthy Ageing.
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Key considerations of Healthy Ageing:
• Diversity: There is no typical older person. Some 80-year-olds have
levels of physical and mental capacity that compare favourably with
30-year-olds.
• Others of the same age may require extensive care and support for
basic activities like dressing and eating.
• Policy should be framed to improve the functional ability of all older
people, whether they are robust, care dependent or in between.
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Inequity:
• A large proportion (approximately 75%) of the diversity in capacity
and circumstance observed in older age is the result of the cumulative
impact of advantage and disadvantage across people’s lives.
• Importantly, the relationships we have with our environments are
shaped by factors such as the family we were born into, our sex, our
ethnicity, level of education and financial resources.
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Healthy Ageing and Active Ageing :
• Healthy Ageing is the focus of WHO’s work on ageing between 2015 –
2030.
• Healthy Ageing replaces the World Health Organization’s
previous Active ageing: a policy framework developed in 2002.
• Healthy Ageing, like Active Ageing, emphasizes the need for action
across multiple sectors and enabling older people to remain a
resource to their families, communities and economies.
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Age-friendly environments:

• Health and well-being are determined not only by our genes and
personal characteristics but also by the physical and social
environments in which we live our lives.
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• Environments play an important role in determining our physical and
mental capacity across a person’s life course and into older age and
also how well we adjust to loss of function and other forms of
adversity that we may experience at different stages of life, and in
particular in later years.
• Both older people and the environments in which they live are
diverse, dynamic and changing. In interaction with each other they
hold incredible potential for enabling or constraining Healthy Ageing.
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• Creating environments that are truly age-friendly requires action in
many sectors: health, long-term care, transport, housing, labour,
social protection, information and communication, and by many
actors – government, service providers, civil society, older people and
their organizations, families and friends. It also requires action at
multiple levels of government. The following key approaches are
relevant to all stakeholders:
• combat ageism;
• enable autonomy;
• support Healthy Ageing in all policies at all levels.
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• As people age, their health needs tend to become more complex with
a general trend towards declining capacity and the increased
likelihood of having one or more chronic diseases.
• Health services are often designed to cure acute conditions or
symptoms and tend to manage health issues in disconnected and
fragmented ways that lack coordination across care providers, settings
and time.
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• Health systems need to be transformed so that they can ensure

affordable access to evidence-based medical interventions that
respond to the needs of older people and can help prevent care
dependency later in life.
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• Universal Health Coverage (UHC) is defined by WHO as ensuring that

all people and communities receive the quality services they need,
and are protected from health threats without financial hardship.
• Without considering the health and social care needs of the
increasing numbers of older people, UHC will be impossible to
achieve.
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WHO has identified three approaches that will better serve the needs
of older populations:
• Develop and ensure access to services that provide older-person-
centred and integrated care;
• Orient systems around intrinsic capacity;
• Ensure there is a sustainable and appropriately trained health
workforce.
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To support these approaches WHO:
• develops and shares evidence-based guidance on how to provide
integrated care to older populations, especially those in less
resourced settings;
• provides technical assistance and support to countries to develop
evidence-based policies;
• promotes approaches to improve health workers’ knowledge and
competencies on Healthy Ageing.
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• These actions support efforts to enhance universal health care,

address non-communicable diseases, and develop long-term-care
systems.
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Long-term-care systems:
• Older people continue to have aspirations to well-being and respect
regardless of declines in physical and mental capacity.
• Long-term-care systems enable older people, who experience
significant declines in capacity, to receive the care and support of
others consistent with their basic rights, fundamental freedoms and
human dignity.
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• These services can also help reduce the inappropriate use of acute
health-care services, help families avoid catastrophic care
expenditures and free women usually the main caregivers to have
broader social roles.
• While global data on the need and unmet need for long-term care do
not exist, national-level data reveal large gaps in the provision of and
access to such services in many low- and middle-income countries.
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• The WHO long-term care series aims to catalyse change and

encourage the development of sustainable and equitable long-term
care systems worldwide.
• The series will do this by sharing regional experiences of long-term
care, including gaps, challenges, models of care and support worth
considering; and providing guidance on key issues, such as financing,
human resourcing, monitoring and research.
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The Global strategy and action plan on ageing and health:

• In 2014, the World Health Assembly asked the Director-General to

develop a comprehensive Global strategy and action plan on ageing
and health.
• After consideration by the Executive Board in January 2016 and by the
Sixty-ninth World Health Assembly “Multisectoral action for a life
course approach to healthy ageing: global strategy and plan of action
on ageing and health” (Document A69/17) and a related resolution
(WHA69.3) were adopted in May 2016.
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• The Strategy is a significant step forward in establishing a framework

for Member States, the WHO Secretariat and partners to contribute
to achieving the vision that all people can live long and healthy lives.
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The Strategy (2016 – 2020) has two goals:
• five years of evidence-based action to maximize functional ability that
reaches every person; and
• by 2020, establish evidence and partnerships necessary to support a
Decade of Healthy Ageing from 2020 to 2030.
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• Specifically the Strategy focuses on five strategic objectives:
• commitment to action on Healthy Ageing in every country;
• developing age-friendly environments;
• aligning health systems to the needs of older populations;
• developing sustainable and equitable systems for providing long-term
care (home, communities, institutions); and
• improving measurement, monitoring and research on Healthy Ageing.
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• The World Health Assembly discussed on May 26, the draft Global
strategy and plan of action on ageing and health and document
A69/A/CONF./8, containing the draft resolution entitled “The global
strategy and action plan on ageing and health 2016-2020: towards a
world in which everyone can live a long and healthy life”.
• After a supportive discussion with interventions of 41 Member
States, 10 NGOs, and 2 observers, the draft strategy and resolution
were considered, noted and adopted.
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• Nepal too is entering a phase of demographic transition. In the next

few years, the over-60 population is predicted to reach 10 percent of
the overall population, congruent with global changes in the elderly
population.
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• Wealthier countries tend to have larger elderly populations, displayed

demographically as a reversed age pyramid. This is because
prosperous countries are able to take better care of the elderly,
resulting in healthier, longer life spans.
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• Older people are considered to be ‘functionally able’ if they have the
capabilities that enable them to be and to do what they value.
• Healthy ageing is one of WHO’s primary focuses, between 2015-2030,
as the decade between 2020-2030 has been dubbed the ‘decade of
healthy ageing’. This policy stresses inter-sectoral coordination to
enable older people to remain a resource, and not a burden to their
families, communities and the economy.
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• There are a lot of challenges in Nepal for healthy ageing. The
population is ageing at such speed that the existing health care
system and economy might fail to mitigate the challenges of ageing.
• The 60-plus population currently constitutes around nine percent of
the total population, which is expected to rise to 11 percent by 2030.
In this light, a paradigm shift is expected in the pattern of diseases
within this population.
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• Non-communicable diseases have now surpassed the burden of
communicable diseases.
• Diseases like diabetes mellitus, hypertension, chronic diseases of the
lungs, liver, heart and kidney, neuro-degenerative disorders like
Parkinson’s, Alzheimer’s and other dementias, fatal diseases like
cancers are on the rise.
• Consequently, the burden of disability attributable to these illnesses is
enormous.
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Reported health status of the elderly:
• Diabetes
• Hypertension
• COPD
• Asthma
• Gastritis
• Musculoskeletal disorder (Joint pain, osteoporosis)
• Allergy
• Cancer
• Incontinence
• Depression
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Geriatric problems:
• Vision problem(e.g. cataract)
• Hearing problem
• Dental problem
• Memory issues
• Sleep disorder
• Unintentional weight loss
• Bowel control problem
• Bladder control problem(Incontinence)
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• Despite this, health has been one of the least prioritised sectors by
the government, constantly reflected in the budget of the last
decades.
• Even in the current fiscal year, the health sector received just 4.29
percent of the total federal budget of Rs 1,315 billion.
• Moreover, the concentration of health-related infrastructure, as well
as human resource, in the urban regions poses another threat to the
accessibility and availability of quality care, not only for the older but
also the general population.
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• In terms of geriatric care, the situation is pitiful. Nepal, despite having

a geriatric population of nearly nine percent, has only had three
registered geriatricians till date (one geriatrician for every hundred
thousand older people).
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• Among various health institutions, only eight of them have started

geriatric services. Despite the government’s policy to establish
geriatric wards in every hospital with more than 100-bed capacities,
the crunch of skilled human resources (doctors as well as paramedics)
is a serious issue that needs to be addressed immediately.
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• Another challenge with regards to healthy ageing is the lack of
rehabilitative and long-term care services for older people. Over the
past decades, we have witnessed a boom in curative health services
(large hospital-based) both in the public as well as the private sector.
But long-term care services have always been under-shadowed.
• With non-communicable diseases on the rise, long-term care services
are necessary to address the enormous burden to both family and
society of disabilities that can result due to these morbidities.
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• Older people will not be healthy and happy if their care is simply
limited to providing quality health facilities.
• Our growing cities and urban areas are unfriendly to the older
populations.
• The lack of proper infrastructure for the disabled and the elderly has
meant that they have a difficult time navigating cities.
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• Multiple sectors and partners need to take up collective strategic

efforts to meet WHO’s goals for the healthy ageing decade. Our
country needs active support for planning and action from
international agencies like WHO. Relevant research should be
promoted and the existing healthcare system should be aligned with
the needs of the elderly.
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• The importance of long-term care services, besides usual curative

services, should be accepted at the policy level. The country needs to
increase its expenditure in health and focus in the development of
skilled human resources (geriatricians as well paramedics).
• The state should provide healthy, active, independent and
contributory living prospects to senior citizens. We should remember
that ‘older people might be retired, but they are not tired’.
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• Local governments, in collaboration with communities, must strive to
create geriatric-friendly communities that guarantee physical, familial
as well as social security for the older population.
• Stakeholders must take into consideration the convenience of older
people while building local infrastructure and make them as geriatric
friendly as possible.
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• The younger generations of families should play a pivotal role in

ensuring ‘healthy and happy ageing’ for seniors at home. Our children
will learn from the way we treat our parents and grandparents.
• Furthermore, the prompt evaluation of seemingly minor health issues
with geriatricians can prevent catastrophic complications.
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• Nepal’s demography is aging rapidly, yet few studies to date have
examined how this has affected the health and well-being of the
elderly, defined as those above 60 years in Nepal’s Senior Citizen Act
(2006).
• We should aim to assess perceived life satisfaction, and evaluate its
relationship with nutritional health and mental well-being among the
increasing Nepalese elderly population.
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• Government Initiatives The government started to include plans,
policies and programmes for family-based security system to enable
elderly to lead a dignified life since the Ninth Five Year Plan (1997-
2002). Since then many initiatives have been taken focusing on the
followings:
• Health The Nepalese Council of Ministers on 2061-05-03 BS adopted a
guidelines entitled Jeshtha Nagarik Swashthopachar Sewa Karyakram
Karyanyowan Nirdeshika 2061BS (Senior Citizens Health Facilities
Program Implementation Guideline, 2061BS) which attempts to
provide medical facilities to the old age people.
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• The government has provision to establish Jeshtha Nagarik
Swashthopachar Kosh (Senior Citizens Health Facilities Fund) in each
district. The government allocates some fund each year for each district
for the purpose.
• Following the “Senior Citizens Health Facilities Program Implementation
Guideline, 2061BS”, the poverty affected elderly people are provided free
medicine and treatment up to NRs.2000 at a time in all 75 districts from
the fund.
• The Government has proclaimed through the budget speech of fiscal year
2066/67 that the government will provide free health service for heart
and kidney patient of 75 years and above age.
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• The fiscal year (2066/67) budget also had also provision to establish
one health center for the elderly “Aarogya Aashram” in each of the
five development regions of the country.
• However, these schemes have limited coverage and the government
is severely constrained by the financial, trained human resources and
institutional capacity to provide the needed support and care for
elderly.
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• The government had pension scheme for retired public servants and
their widows and children.
• Majority of the population receive no pension and must depend on
family support and personal savings.
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Old-age Homes :
• There is an Old Age Home in the premises of temple Pashupati Nath
(Pashupati Bridrashram) for the destitute elders.
• Ministry of Women, Children and Social Welfare operates the old-age
home that has the capacity for only 230 elderly people. This is the
only one shelter for elderly people run by the government which was
established in 1976 as the first residential facility for elders.
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• There are about 70 organizations registered with the government
(GCN 2010) spread all over Nepal. These organizations vary in their
organizational status (government, private, NGO,personal charity),
capacity, facilities, and the services they provide. Most of them are
charity organizations.
• About 1,500 elders are living in these old-age homes at present.
These private organizations are providing services to elderly out of the
individual’s initiatives. The services are determined with the consent
of the individual generosity. The services and care, virtually, do not
include aspects that are essential to cater elderly in these Homes.
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• Despite these initiatives, the Government does not have any official
records on how many old age destitute people are taking shelter in
these Old Age Homes (Briddhashrams).
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• Legal Provisions The Interim Constitution of Nepal, 2006 (Art. 13) has
made a provision for separate Act, Rules and Regulations specially to
protect the rights of elders. In accordance with the Madrid
International Plan of Action on Ageing (MIPAA) 2002, the government
has already formulated and promulgated separate Acts, Rules and
Regulations.
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The National Plan of Action, 2062 developed for senior citizens deals
with various aspects such as economic and social security, health and
nutrition, participation and involvement, education and entertainment
and legal condition and reforms.
These legal instruments emphasize both equity and equality for elders.
Different ministries are made responsible to ensure proper
implementation of the provisions made.
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• The popular programs on ageing like Old-Age-Allowance, Senior

Citizen Health Treatment Fund (Jeshtha Nagarik Upachar Kosh) have
been implemented more on the basis of general assumptions and
common understanding of the society rather than with concrete
research findings.
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National Policies, Acts and Regulations: Social Security
• Civil Code 1963
• Local Self Governance Act 1999
• Senior Citizen Policy 2058
• National Plan of Action on Ageing 2062
• Senior Citizen Act, 2063 and Regulations 2065
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• The government in 2019 announced an increase in the allowance for
senior citizens by Rs 1,000, taking the sum to Rs 3,000, but senior citizens
said they were still not happy.
• The budget for fiscal year 2019/20 said the elderly citizens will get Rs
3,000 monthly allowance. Earlier, senior citizens, those above 70 years of
age, were entitled to Rs 2,000 as monthly social security allowance.
• Similarly, Dalits, senior citizens of Karnali state, people fully disabled and
partly disabled of above 60 years have been incorporated in this
programme.
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• The senior citizen allowance scheme was in 1994-95 starting with Rs 100 for people
aged over 75.
• The allowance sum remained the same for eight years. It was in 2004-05 when the
allowance was raised to Rs 175.
• The allowance sum was later increased to Rs 500 in 2008. The sum was doubled to
Rs 1,000 in 2014.
• In 2015,the senior citizen allowance was doubled to Rs 2,000.
• In fiscal year 2019/20, the elderly citizens got Rs 3,000 monthly allowance. Earlier,
senior citizens, those above 70 years of age, were entitled to Rs 2,000 as monthly
social security allowance.
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• In annual budget for fiscal year 2021/22,the monthly senior citizen

allowance has been increased to Rs 4,000.
• Prior to this, the monthly senior citizen allowance was Rs 3000 which
has now been increased by Rs 1,000.
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• The minimum age limit to receive old-age allowance lowered to 68

years from the existing 70 years in 2022.
THANK-YOU
FAMILY HEALTH
FAMILY HEALTH
Progesterone-only pill (mini pill) :
Unlike the combined pill, this only contains the hormone Progesterone. It
works by thickening the cervical mucus, which acts as a barrier to stop
sperm entering the womb.
It also makes the lining of the womb thinner, to prevent it accepting a
fertilized egg.
This type of pill is good for women who are breast-feeding, older women,
smokers and others who cannot use the combined pill.
It can also help with pre-menstrual syndrome (PMS) and painful periods.
FAMILY HEALTH
• Advantages: the pill does not interfere with the spontaneity of sex.
• It must be taken at the same time each day or at most within three
hours of that time. It will not work if taken over three hours late, or if
have vomiting and diarrhea, in these cases extra protection is needed.
It can cause irregular bleeding and periods may stop altogether while
taking it.
• Effectiveness: 98% if taken correctly.
FAMILY HEALTH

• The progestin-only pill (POP), also called the “Mini-pill,” is a type of

birth control pill (oral contraceptive) that comes in a pack of 28 pills.
• Every pill is an “active” pill.
FAMILY HEALTH

Types of progestin-only pills:

• There are many brands of Progestin-only Pills (POP) but they are all
the same dose and contain the same active ingredient –
norethindrone, 0.35 milligrams (mg) daily.
FAMILY HEALTH
Contraceptive injection :
• It's an injection of hormones that provides a longer-acting alternative
to the pill. It works by slowly releasing the hormone progesterone
into the body to stop ovulation.
• Each injection lasts for about 12 weeks. Injections may reduce heavy
or painful periods and may give some protection against cancer of the
uterus.
FAMILY HEALTH
• Advantages: unlike the pill, don’t need to remember to take a tablet
every day.
• Periods can become irregular or stop altogether. It can take over a
year for fertility to return to normal after stopping contraceptive
injections, so if patient is planning to start a family in the near future,
it may not be suitable.
• Effectiveness: 99%.
FAMILY HEALTH

• Currently depot- medroxy progesterone acetate(DMPA) known as

Depo-Provera is the injectable contraceptive acceptable and available
in Nepal.
• Given every three months.
• Available as ‘Sangini’ in Nepal.
FAMILY HEALTH
How it works?

• Stops ovulation
• Stops menstrual cycles
• Thickens cervical mucus
FAMILY HEALTH
• Commercially launched in September 1994, Sangini, a three monthly
injectable, is most widely used family planning method among other
reversible methods.
• Each ml of Sangini is comprised of Medroxyprogesterone Acetate 150
mg.
• Sangini is a temporary contraceptive that is convenient, reliable,
affordable, and professionally administered.
• Its targeted customers are women of age group 18-35 who want to
come off the pill and yet are not ready for long term contraception.
FAMILY HEALTH
SIDE EFFECTS:

• Extremely irregular menstrual bleeding and spotting for 3-6 months

• Weight change
• Breast tenderness
• Mood change
• Skin patches
FAMILY HEALTH
FAMILY HEALTH
Contraceptive implant :
It's a small stick containing the hormone progesterone which is inserted
under the skin in the arm. The hormone is slowly released into the
body, preventing ovulation, sperm from reaching an egg or an making
implantation difficult in uterus.
Advantages: implants are a good method for women who want a long-
term contraceptive, as each implant lasts for three years.
Periods can become irregular or stop altogether.
Effectiveness: 99%.
Different Types of Subdermal implants like Jadelle, Implanon.
FAMILY HEALTH

• Jadelle, a two-rod implant, introduced since 2008.

• The product was initially launched in the Kathmandu Valley and
replaced the six-rod Norplant.
FAMILY HEALTH
FAMILY HEALTH
FAMILY HEALTH

Emergency Contraception:
Contraception provided to women to prevent unintended pregnancy
following an unprotected act of sexual intercourse.

• Emergency contraception pills can reduce the chance of a pregnancy

by 75% if taken within 72 hours of unprotected sex.
FAMILY HEALTH

• Prevents ovulation
• Alters the environment of the uterus, making it disruptive to the
egg and sperm
FAMILY HEALTH
Types of Emergency contraception:

• Combined oral contraceptive pills

• Intrauterine Contraceptive Devices(IUCD)
• Progestin-only pills
FAMILY HEALTH
FAMILY HEALTH
• e-CON, launched in 2009, is an emergency contraceptive pill designed
to prevent accidental pregnancies.
• When taken within 120 hours of unprotected sex, it is effective in
preventing pregnancy.
• The two pills provided (each containing Levonorgestrel 0.75 mg) may
be consumed at once, or the second pill may be taken at an interval of
12 hours.(Total dose= 1.5 mg of Levonorgestrel ).
• e-CON is an emergency contraceptive pill. It is not recommended for
regular use.
FAMILY HEALTH
• Post-coital (or "morning after") recommended within 72 hours of
intercourse.
• Two methods are available:
(a) IUD : The simplest technique is to insert an IUD, if acceptable,
especially a copper device within 5 days.
(b) Hormonal : More often a hormonal method may be preferable.
Levonorgestrel 0. 75 mg tablet is approved for emergency
contraception. It is used as one tablet of 0.75 mg within 72 hours of
unprotected sex and the 2nd tablet after 12 hours of 1st dose.
FAMILY HEALTH

Or,
Two oral contraceptive pills containing 50 mcg of ethinyl estradiol
within 72 hours after intercourse, and the same dose after 12 hours. Or,
Four oral contraceptive pills containing 30 mcg of ethinyl estradiol
within 72 hours and 4 tablets after 12 hours.
Or, Mifepristone 10 mg once within 72 hours. Recently WHO has
shown that lower doses (10 and 50 mg) are as effective as a dose of
600 mg of mifepristone in the context of emergency contraception .
FAMILY HEALTH
Surgical family planning methods(Sterilization):

• Vasectomy (Male)
• Tubal ligation (Female)
• Minilaparotomy
• Laparoscopy
FAMILY HEALTH
Male sterilization:
• Vasectomy:-division or occlusion of the vas deference prevents the
passage of sperms.
• Methods:-
1- Clips
2- Diathermy
3- Percutaneous injection of sclerosing agents or occlusive substances.
• The success of the procedure is verified by the absence of sperms from
two consecutive samples of ejaculate collected at least 4 weeks apart.
FAMILY HEALTH

• It takes about 3 months for the semen to become totally free of sperm. A
couple must use another method of birth control or avoid sexual
intercourse until a sperm count confirms that no sperm are present. In
this test, the number of sperm in a semen sample is counted.
• You won’t be sterile immediately. For many men, sperm is still present for
a few months afterward. You’ll need to ejaculate 20 times or more before
your semen is free of sperm.
• Your doctor will analyze your semen six to twelve weeks after your
vasectomy. This exam measures the amount of sperm left in your semen.
FAMILY HEALTH
VASECTOMY:
• Male sterilization procedure
• Ligation of Vas Deferens tube
• No-scalpel technique available
• Faster and easier recovery than a tubal ligation
• Failure rate = 0.1%, more effective than female sterilization
FAMILY HEALTH

• In a vasectomy, the vas deferens tubes are tied, cut, clipped, or

sealed to prevent the release of sperm into the semen. This prevents
a woman’s egg from being fertilized with the man’s sperm.
FAMILY HEALTH
• Minilaparotomy—A small incision (cut) is made in the abdomen. The
fallopian tubes are brought up through the incision. A small section of
each tube is removed, or both tubes can be removed completely. Less
often, clips are used to close off the tubes.
• Laparoscopy—A device called a laparoscope is inserted through a
small incision made in or near the belly button. The laparoscope
allows the pelvic organs to be seen.
The fallopian tubes are closed off using instruments passed through
the laparoscope or with another instrument inserted through a second
small incision.
FAMILY HEALTH
Contraceptive Efficacy
It is assessed by measuring the number of unplanned pregnancies that
occur during a specified period of exposure and use of a contraceptive
method. Two methods used are: – Pearl Index–and Life table analysis.
FAMILY HEALTH
Pearl Index (PI) :

Most common technique used in clinical trials for measuring the

effectiveness of a birth control method.
PI is no. of failures per 100 woman years (HWY) of exposure.
Pearl index(PI) = Total accidental pregnancy X 1200
Total months of exposure
FAMILY HEALTH

Eligible Couples :

A currently married couple with wife in reproductive age group (15–45

years).
FAMILY HEALTH
Couple Protection Rate (CPR):
It is an indicator of prevalence of contraceptive practice in a
community.
CPR is percent of eligible couples (ECs) protected against one or the
other approved methods of family planning, viz. condoms, OCPs, IUDs,
sterilization
NRR = 1 can be achieved if: CPR >60%.
CPR= Total no. of ECs protected by any of 4 approved methods × 100
Total no. of ECs in the community
FAMILY HEALTH

Effective Couple Protection rate (ECPR): –

• ECPR is percent of eligible couples (ECs) protected against one or the
other approved methods of family planning, viz. condoms, OCPs,
IUDs, sterilization taking into account their effectivity.
FAMILY HEALTH
• Contraceptive prevalence rate is the percentage of women who are
practicing, or whose sexual partners are practicing, any form of
contraception. It is usually measured for women ages 15-49 who are
married or in union.
• Contraceptive prevalence rate(CPR) is a major indicator for
monitoring and evaluating the National Family planning programme.
• According to NDHS 2016, CPR(All methods) is 52.6% and CPR(Modern
method) is 43%.
FAMILY HEALTH
Unmet need of family planning in Nepal:
Women with unmet need are those who are fecund and sexually active but
are not using any method of contraception, and report not wanting any more
children or wanting to delay the next child. The concept of unmet need
points to the gap between women's reproductive intentions and their
contraceptive behavior.
• The unmet need of family planning is still high in Nepal, beyond the huge
achievements in this sector.
• Unmet need of family planning is defined as a gap between one’s indicated
fertility preferences and his or her contraceptives use at a given period.
FAMILY HEALTH

• Unmet need is not only limited to whether women/husbands were

not provided with family planning facilities; it also means that
provided services have not been introduced as a motivating source to
women due to lack of adequate information and qualitative services.
• According to NDHS 2016,it is 24%.
FAMILY HEALTH

Role of men in family planning:

There is a growing understanding in public health community of need
to constructively involve men in sexual and reproductive health (SRH)
programs including family planning

Therefore increased attention should be placed on the critical role that

men can play in reproductive health and family planning.
FAMILY HEALTH

The government of Nepal recognizes that men play an important role in

couples' decision making about using contraceptive methods, and their
engagement is crucial for reducing unmet need for family planning.
THANK-YOU
FAMILY HEALTH

Rights-based family planning is an approach to developing and

implementing programs that aims to fulfill the rights of all individuals to
choose whether, when, and how many children to have; to act on those
choices through high-quality sexual and reproductive health services,
information, and education; and to access those services free from
discrimination, coercion, and violence.
FAMILY HEALTH
• Over the last several years, globally increasingly interrogating
programs and practices to ensure the rights of clients are considered
and respected.
• Now, these efforts in pursuit of the promise of rights-based family
planning programming as a standard practice are leading to the first
insights on what it takes to operationalize this approach and measure
its impact on programs, progress, and people.
FAMILY HEALTH

• Rights-based family planning involves the application of key human

rights principles to how programs are planned, implemented,
monitored, and evaluated.
• Policies, plans, and programs can only be considered rights-based if
they are designed and implemented to respect, protect, and fulfill the
principles for all people.
FAMILY HEALTH
• The fundamental right of individuals to decide, freely and for
themselves, whether, when, and how many children to have is central
to the vision and goals of Family Planning 2020 (FP2020).
• The international community has agreed that the right to health
includes the right to control one’s health and body, including sexual
and reproductive freedom.
• However, more remains to be done to ensure that human rights are in
fact treated as the cornerstone of any family planning effort: from
global initiatives to national programs to community-based projects.
FAMILY HEALTH

• In order to ensure that FP2020 and its mechanisms embody and espouse the
ideals grounded in existing rights agreements and frameworks, the Rights and
Empowerment Working Group (RE WG) has established a common understanding
of rights principles as they relate to ten dimensions of family planning:
FAMILY HEALTH
Ten dimensions of family planning:
• Agency and autonomy
• Availability
• Accessibility
• Acceptability
• Quality
• Empowerment
• Equity and non-discrimination
• Informed choice
• Transparency and accountability
• Voice and participation
FAMILY HEALTH
• The rights principles outlined in this document must be realized in order to
reach and sustain goals for meeting contraceptive needs.
• These rights principles are informed by and build upon existing human rights
principles and resources that seek to integrate rights-based approaches
specifically for family planning into programming.
• Ensuring that human rights principles are at the center of family planning
policies, programs, measurement and contraceptive markets represents
some of our most challenging work.
• However, as a global initiative, FP2020 recognizes that investing in human
rights is critical to growing sustainable, equitable and effective programs
with lasting impact.
FAMILY HEALTH
• By securing and fulfilling the rights of an additional 120 million women and
girls to access family planning information and services by the year 2020,
FP2020 efforts will result in fewer unintended pregnancies, fewer women and
girls dying in pregnancy and childbirth, including from unsafe abortions, and
fewer infant deaths. Moving this agenda forward will rely on fostering
meaningful partnerships among governments, civil society, the private sector
and beneficiaries.
• Rights violations must be brought to light and addressed when they occur. Yet
equal attention needs to be paid to empowering and informing clients so they
know, understand, claim their rights, and can become pivotal partners in
ensuring the realization of rights in future family planning and health
development initiatives.
FAMILY HEALTH
Responsible parenthood :
• Responsibility parenthood is an ability of parents to detect the need
of happiness and desire of children and helping them to become
responsible children.
• It is the shared responsibility of husband and wife to determine and
achieve the desired number, spacing, and timing of their children
according to their own family life aspirations, and concerns.
• Responsible parenthood doesn’t limit only on fulfilling the demand of
children and rearing them up properly but goes beyond that.
FAMILY HEALTH
• Marriage should be done at the right age as right age at marriage
helps to start a new life and new family in a right time.
• The size of a family should be decided by both parents together.
• Being responsible parents also refers to becoming parents at the right
age where both of them are physically and mentally mature to start a
family.
• Proper spacing between the births of children is also necessary for
health of a mother and child. This also assures that every child
receives the attention and care they deserve.
FAMILY HEALTH
10 principles of the responsible parenting:
1) What you do matters
• This is one of the most important principles
• Children learn from the parents
• They see, observe, imitate and adapt the behavior of the parents
• One needs to act the same way that they want their children to be
FAMILY HEALTH
2) You cannot be too loving
• Everybody loves their child
• But the love of parents should never spoil them
• In fact it’s the things like leniency, material possession that spoils
them
• Parents need to be careful on that matters
FAMILY HEALTH

3)Be involved in your child’s life

• It is necessary for parents to be involved in child’s life in both physical
way and mental way
• Parents needs to talk to them and also listen them carefully
• Parents should manage to provide undivided attention towards
children every day.
FAMILY HEALTH

4)Adapt your parenting to fit your child

• Parents needs to keep the track and pace with the child’s
development
• Parents need to understand the children milestone as per the age
FAMILY HEALTH
5) Establish and set rules
• Parent need to maintain and regulate the child’s behavior.
• Strict actions and punishment may also be required.
• Parents can set up the rules and make children follow them.
FAMILY HEALTH
6) Foster your child’s independence
• A responsible parent needs to teach their children self-control and
encourage independence.
• Parents should teach them to make responsible decisions and
shouldn’t frequently intervene in their choices.
FAMILY HEALTH
7) Be consistent
• Consistency is the key to disciplines.
• Rules for children shouldn’t change from day to day. This makes the
children confuse.
• Before that, the parents need to make sure that the rules made are
logical and based on valid reason and are not just imposition of
power.
FAMILY HEALTH
8) Avoid harsh discipline
• Parents should never adopt the harsh way.
• They should never hit a child, under any circumstances.
• This has negative impacts on child.
• Punishment should be mild and used carefully.
FAMILY HEALTH

9) Explain your rules and decisions

• Good parents have clear expectations
• They communicate this to their children in clear way and explain them
as per their age.
FAMILY HEALTH
10) Treat your child with respect
• Children should be treated with equal respect.
• Their views, opinions should be listened and valued.
• Speak politely.
• Treat them kindly.
• This is the best way to teach them how to treat and respect others.
FAMILY HEALTH
NECESSITIES OF RESPONSIBLE PARENTHOOD:
a) Maintain healthy family size
• Responsible parenting is concerned with the maintaining the desired
size of family, maintaining the spacing and having desired family size
• The decision is made based on the health status, social and economic
concerns
• This will further help parents in responsibly handling the situation in
the future and also prepares them to face challenge
FAMILY HEALTH
b) Support
• Children require the support of the parents
• Responsible parenting will help in building the supportive relation
between children and parents
• Parents would be able to support their children in every steps of their
life
FAMILY HEALTH
c) Morality
• Children learns from the parents
• They become what their parents are
• Responsible parenting is necessary to teach children the right
behavior, culture the healthy habits and morals and also to guide in
right direction throughout.
FAMILY HEALTH

d) Others
• Encouraging independent thought. It is duty of parents for better
controlling over the children.
• Responsible parenting is also necessary to avoid the financial burden
and stay prepared.
FAMILY HEALTH
• Parenting styles (Practices of Parenthood):
Giving orders: It is often called as authoritarian style of parenting .
The parents are very rigid and strict.
) Giving in: It is also called permissive parenting style. They set no
limits. Children grow up without guidelines .
Giving choices: It is also known as democratic style of parenting. It is
the most effective style of parenting. It is based on equality and
respect .Parents are more aware of a child's feelings and capabilities.
FAMILY HEALTH

Practices of parenthood:
1)Authoritarian parenthood(autocratic style)
2)Authoritative parenthood (balanced way of parenthood, democratic)
3)Indulgent /Permissive parenthood
4)Uninvolved /Neglect parenthood
FAMILY HEALTH
THANK-YOU
FAMILY HEALTH
FAMILY HEALTH
Maternal health:
Maternal mortality
The maternal mortality ratio (MMR) in Nepal decreased from 539
maternal deaths per 100,000 live births to 239 maternal deaths per
100,000 live births between 1996 and 2016.
In 2016, roughly 12% of deaths among women of reproductive age
were classified as maternal deaths(NDHS 2016).
FAMILY HEALTH
• Maternal Mortality rate (MMR): Maternal deaths expressed as per
100,000 live births, where a ‘maternal death’ is defined as ‘death of a
woman while pregnant or during delivery or within 42 days (6 weeks)
of termination of pregnancy, irrespective of duration or site of
pregnancy, from any cause related to or aggravated by the pregnancy
or its management but not from accidental or incidental causes’.
• Maternal deaths expressed as per 100,000 live births.
• MMR is a ratio(Maternal mortality rate is a misnomer; MMR is not a
rate).
• MMR = No. of maternal deaths in a given year × 100,000
Total no. of live births in the same year.
FAMILY HEALTH
CAUSES OF MATERNAL MORTALITY:
Direct obstetric deaths(80%) are those resulting from obstetric complications of
the pregnancy state (including pregnancy, childbirth and the puerperium to 42
days), such as deaths as a result of obstetric haemorrhage or eclampsia.

 Indirect obstetric deaths(20%) are those resulting from previous existing disease
or disease that developed during the pregnancy which was not a result of direct
obstetric causes, but which was aggravated by the physiologic effects of
pregnancy, such as cardiac conditions aggravated by pregnancy.
FAMILY HEALTH
FAMILY HEALTH

• Over the past decade, more women in Nepal are giving birth in a
health facility than at home – another factor that has reduced the risk
of postpartum haemorrhage (loss of blood following the birth), which
is the leading cause of maternal deaths worldwide.
FAMILY HEALTH
• Most maternal deaths are preventable, as the health-care solutions to
prevent or manage complications are well known. All women need
access to high quality care in pregnancy, and during and after
childbirth.
• Maternal health and newborn health are closely linked. It is
particularly important that all births are attended by skilled health
professionals, as timely management and treatment can make the
difference between life and death for the mother as well as for the
baby.
FAMILY HEALTH
• Severe bleeding after birth can kill a healthy woman within hours if
she is unattended. Injecting oxytocin or giving misoprostol
immediately after childbirth effectively reduces the risk of bleeding.
• Infection after childbirth can be eliminated if good hygiene is
practiced and if early signs of infection are recognized and treated in a
timely manner.
• Pre-eclampsia should be detected and appropriately managed before
the onset of convulsions (eclampsia) and other life-threatening
complications. Administering drugs such as magnesium sulfate for
pre-eclampsia can lower a woman’s risk of developing eclampsia.
FAMILY HEALTH

• To avoid maternal deaths, it is also vital to prevent unwanted

pregnancies. All women, including adolescents, need access to
contraception, safe abortion services to the full extent of the law, and
quality post-abortion care.
FAMILY HEALTH
• Nepal has committed to doing its part to achieve Sustainable
Development Goal (SDG) target 3.1 of reducing the global MMR to
less than 70 maternal deaths per 100,000 live births by 2030. To
achieve this ambitious target, Nepal will need to reduce its MMR by
at least 7.5% annually addressing severe inequities in maternal health
access, utilization and quality.
• Millennium Development Goal (MDG) (Goal 5): Reduce maternal
mortality by three-fourths by 2015.
FAMILY HEALTH
Maternal mortality (Key facts):
• Every day in 2017, approximately 810 women died from preventable
causes related to pregnancy and childbirth.
• Between 2000 and 2017, the maternal mortality ratio (MMR, number of
maternal deaths per 100,000 live births) dropped by about 38% worldwide.
• 94% of all maternal deaths occur in low and lower middle-income
countries.
• Adolescents face a higher risk of complications and death as a result of
pregnancy than other women.
• Skilled care before, during and after childbirth can save the lives of women
and newborns.
FAMILY HEALTH
• Maternal mortality is unacceptably high. About 295 000 women died
during and following pregnancy and childbirth in 2017.
• The vast majority of these deaths (94%) occurred in low-resource
settings, and most could have been prevented.
• Sub-Saharan Africa and Southern Asia accounted for approximately
86% (254 000) of the estimated global maternal deaths in 2017. Sub-
Saharan Africa alone accounted for roughly two-thirds (196 000) of
maternal deaths, while Southern Asia accounted for nearly one-fifth
(58 000).
Source: WHO
FAMILY HEALTH
• At the same time, between 2000 and 2017, Southern Asia achieved
the greatest overall reduction in MMR: a decline of nearly 60% (from
an MMR of 384 down to 157).
• Despite its very high MMR in 2017, sub-Saharan Africa as a sub-region
also achieved a substantial reduction in MMR of nearly 40% since
2000. Additionally, four other sub-regions roughly halved their MMRs
during this period: Central Asia, Eastern Asia, Europe and Northern
Africa.
• Overall, the maternal mortality ratio (MMR) in less-developed
countries declined by just under 50%.
FAMILY HEALTH

• The high number of maternal deaths in some areas of the world

reflects inequalities in access to quality health services and highlights
the gap between rich and poor.
• The MMR in low income countries in 2017 is 462 per 100 000 live
births versus 11 per 100 000 live births in high income countries.
FAMILY HEALTH
The Safe Motherhood Initiative:
 Conference on Safe Motherhood was held in Nairobi, Kenya in 1987.
 The Conference was the beginning of a safe motherhood initiative to
reduce maternal mortality by 50% by the year 2000.
FAMILY HEALTH
What is Safe Motherhood?

“Encompasses a series of initiatives, practices, protocols and service

delivery guidelines designed to ensure that women receive high-quality
gynecological, family planning, prenatal, delivery and postpartum care,
in order to achieve optimal health for the mother, fetus and infant
during pregnancy, childbirth and postpartum”.
FAMILY HEALTH
• Safe motherhood is the concept or initiatives to ensure that women
receive high quality care in order to achieve the optimum level of
health of mother and infant.
• Safe motherhood is designed in a way that the women is ensured of
high-quality gynecological, family planning, prenatal, delivery and
postpartum care.
• Safe motherhood aims at improving maternal and child health and
eliminating the probable risk that can occur.
• Safe motherhood is required for obtaining the desired outcome of
pregnancy.
FAMILY HEALTH
• The goal of the Safe Motherhood Program is to reduce maternal and
neonatal morbidity and mortality and to improve the maternal and
neonatal health through preventive and promotive activities as well
as by addressing avoidable factors that cause death during pregnancy,
childbirth and postpartum period.
• Safe pregnancy, safe delivery and safe birth of new born are the major
components of safe motherhood. These components are achieved
through the principles of safe motherhood.
• Safe motherhood also ensures the safety of overall pregnancy and
health of mother and child.
FAMILY HEALTH
• Over half of maternal deaths are due to preventable or treatable
conditions.
• The maternal morbidity and mortality can be reduced through
preventive and promotive activities and by addressing avoidable
factors that cause death, which are included in safe motherhood
initiatives.
FAMILY HEALTH
FAMILY HEALTH
Pillars of safe motherhood can also be considered as the principles of
safe motherhood
• The basic pillars/principles of safe motherhood are:
1)Family planning
2)Antenatal care
3)Obstetric care
4)Postnatal care
5)Post-abortion care
6)STD/HIV/AIDS control
FAMILY HEALTH
1. Family Planning:
• FP is an important component of safe motherhood.
• It is necessary to ensure that individuals and couples have adequate
information and services regarding FP.
• FP is also necessary to plan the timing, number of children, spacing
between pregnancies, delay pregnancy, etc.
FAMILY HEALTH
2. Antenatal Care (ANC)
• ANC checkup is necessary to detect complications early and treat
them as soon as possible
• It is also essential to provide pregnant women with vitamin
supplements, iron tablets and vaccinations so that they can have a
healthy and strong pregnancy.
FAMILY HEALTH
3. Obstetric Care
• Obstetric care refers to all the care and health care level initiatives
provided to the mother to reduce maternal mortality and morbidity.
• Birth attendants should have the knowledge, skills, and equipment to
perform a clean and safe delivery.
• Moreover, emergency care for high-risk pregnancies and
complications are made available to all women who need it.
FAMILY HEALTH
4. Postnatal Care (PNC)
• It is necessary to ensure that postpartum care is provided to the
mother and baby.
• It includes counselling mothers about child handling, exclusive breast
feeding, etc.
• Moreover, PNC also comprises of providing awareness regarding the
FP, and managing the danger signs and symptoms seen in both
mother and child.
FAMILY HEALTH
5. Post abortion Care
• It is necessary to prevent complications of abortion.
• Post abortion care helps to identify/detect if there are any
complications of abortion.
• Useful to refer other reproductive health problems when necessary.
• An essential element of post abortion care services is providing the
woman with a family planning method before she leaves the facility.
• It also provides counselling and awareness about different family
planning methods.
FAMILY HEALTH
6. STD/HIV/AIDS Control
• HIV screening is done to prevent, and manage HIV and AIDS
transmission to the baby
• To assess risk for future infection
• To provide voluntary counseling and testing
• To expand services to address mother to child transmission.
FAMILY HEALTH
Major factors contributing to morbidity and mortality during motherhood:
Direct cause for the majority of maternal deaths are:
1. Severe bleeding
• Mostly bleeding after childbirth
• Includes antepartum, postpartum, abortion, and ectopic pregnancy.
2. Infections
• Usually after childbirth
• Includes infection of the uterus, tubes, urinary system and fetal infection.
• Also caused due to unhygienic delivery site and practice
FAMILY HEALTH
3. High blood pressure during pregnancy
• Includes pre-eclampsia and eclampsia

4. Complications from delivery

• Several complications can arise during the pregnancy
• Teenage pregnancy, advanced maternal age, parity, etc and many
other factors can cause complications.
FAMILY HEALTH
5. Unsafe abortion
• Common cause of maternal death
• Unsafe abortions are high in countries where abortion is not legalized.
FAMILY HEALTH
Indirect causes:
a) Three delays
These delays refer to:
• Delay in the decision to seek care (seeking care)
• Delay arrival at a health facility (reaching care) and
• Delay in obtaining the adequate treatment (receiving care)
FAMILY HEALTH

• These delays contribute to increase the complication in pregnancy.

However, these delays are determined by the educational status,
financial status, accessibility of health care and services, etc.
FAMILY HEALTH
b) Accessibility
• Health services and facilities are still not available in every knock and
corner of many countries
• Reaching health facility is often riskier in some places
• Lack of accessibility promotes the delay
FAMILY HEALTH
c) Poverty
• Poverty is the other important factor contributing to maternal deaths
• People of rural areas do not fancy health services
• Seeking health services often is not the priority to those people who
have to worry about hands to mouth
FAMILY HEALTH
d) Cultural practices
• Traditional practices often prevent individual from seeking health care
• Cultural practices also determine the care given to pregnant women,
food practices, etc.,
• Unsafe abortion is also an example of cultural practices.
FAMILY HEALTH
• The goal of the National Safe Motherhood Programme is to reduce
maternal and neonatal morbidity and mortality and improve maternal
and neonatal health through preventive and promotive activities and
by addressing avoidable factors that cause death during pregnancy,
childbirth and the postpartum period.
• Evidence suggests that three delays are important factors for
maternal and newborn morbidity and mortality in Nepal (delays in
seeking care, reaching care and receiving care).
FAMILY HEALTH
The way forward:
• Overall, Nepal has made substantial progress in improving maternal
health care access and utilization.
• However, disparities remain according to women’s socioeconomic
status, education level and place of residence. Additionally, efforts are
needed to improve the quality of maternal health care to end
preventable maternal deaths.
FAMILY HEALTH

• In the fiscal year 2021-22, 118 women died of birth-related

complications, according to the Ministry of Health and Population.
• The country has already missed its own 2020 target to reduce
maternal mortality to 125 per 100,000 births.
• The country had reduced the maternal mortality rate from 539 per
100,000 births in 1996 to 239 per 100,000 births in 2016,for which
the country even received the Millennium Development Goals award.
FAMILY HEALTH

• Teenage pregnancy is highest in Karnali Province (21%), followed by

Madhesh Province (20%), and lowest in Bagmati Province (8%).

• Source: NDHS 2022

FAMILY HEALTH
Maternal Care:
• The percentage of women who received antenatal care from skilled
provider for their most recent live birth in the 2 years preceding the
survey increased from 25% in 1996 to 94% in 2022.
• Similarly, those who made four or more ANC visits increased from 9%
in 1996 to 81% in 2022. The percentage of live births that are assisted
by a skilled provider has increased markedly, from 10% in 1996 to 80%
in 2022).
Source: NDHS 2022
FAMILY HEALTH
• Ninety-four percent (94%) of women reported receiving antenatal care from a skilled
provider for their most recent live birth or stillbirth in the 2-year period preceding the survey.
• Four in five women (81%) had at least four ANC visits for their most recent live birth.
• Overall, 96% of women took iron-containing supplements during their most recent
pregnancy.
• Overall, 93% of women with a live birth in the 2 years preceding the survey received
sufficient doses of tetanus toxoid injections to protect their baby against neonatal tetanus.
• Overall, 79% of live births and still births in the 2 years preceding the survey were delivered
in health facilities.
• Four in five (80%) live births and stillbirths were delivered by skilled providers.
• Overall, 70% of women with a live birth or stillbirth in the 2 years preceding the survey
received a postnatal check within the 2 days after delivery.
FAMILY HEALTH

Components of Maternal Care:

• Antenatal Care
• Intranatal Care
• Postnatal Care
FAMILY HEALTH
Antenatal care
• In 2016, 84% of pregnant women had at least one antenatal care
(ANC) contact with a skilled provider, defined as either a doctor, nurse
or midwife/auxiliary nurse midwife which was a 25% increase from
2011.
• The percentage of women who had four or more ANC visits increased
steadily from 50% in 2011 to 69% in 2016.
FAMILY HEALTH
Indicators:
Maternal Health (among women age 15-49)
Nepal Urban Rural
ANC visit with a skilled provider(%) 84 87 80
Births delivered in a health facility (%) 57 69 44
Births assisted by a skilled provider(%) 58 68 47
Source: NDHS 2016
FAMILY HEALTH
Antenatal Care :
• More than 8 in 10 women (84%) age 15-49 receive antenatal care
(ANC) from a skilled provider (doctor, nurse, and auxiliary nurse
midwife).
• The timing and quality of ANC are also important.
• Two-thirds of women have their first ANC visit in the first trimester, as
recommended.
• Seven in ten women make four or more ANC visits.
FAMILY HEALTH

• The majority of women (91%) take iron tablets during pregnancy.

• Eighty-nine percent of women’s most recent births were protected
against neonatal tetanus.

Source: NDHS 2016

FAMILY HEALTH
Delivery and Postnatal Care :
• More than half of births (57%) are delivered in a health facility,
primarily in government sector facilities.
• However, 41% of births are delivered at home.
• Overall, 58% of births are assisted by a skilled provider, the majority
by doctors.
• One in ten births are assisted by no one.
FAMILY HEALTH
• Postnatal care helps prevent complications after childbirth.
• More than half of women (57%) receive a postnatal check within two
days of delivery, while 42% did not have a postnatal check within 41
days of delivery.
• Similarly, 57% of newborns receive a postnatal check within two days
of birth, while 40% did not have a postnatal check.
Source: NDHS 2016
FAMILY HEALTH
• Although the report showed increases in skilled ANC utilization, only
49% of women received counselling on five critical components
during ANC: use of a skilled birth attendant (SBA), facility-based
delivery, information about danger signs during pregnancy, where to
go in case of danger signs and the benefits of postnatal care.
• Utilization of ANC services was a significant predictor of place of
delivery and SBA-assisted births.
FAMILY HEALTH

• Women in the highest wealth quintile with a high education level and
those residing in urban areas were much more likely to have four or
more ANC contacts from a skilled provider compared to women of
lower socioeconomic status and education and those living in rural
areas.
FAMILY HEALTH
Place of delivery and skilled birth attendance :

• Between 2011 and 2016, there was a 22% increase in both the
proportion of institutional deliveries (from 35% to 57%) and births
assisted by SBAs (from 36% to 58%).
• Doctors assisted 31% of total deliveries, and nurses and
midwives/auxiliary nurse midwives assisted 27%.
• While the percentage of deliveries attended by traditional birth
attendants decreased from 11% in 2011 to 5% in 2016, the home
birth rate remained high at 41%. Many women in Nepal still deliver
with no one present or with an untrained friend or relative.
FAMILY HEALTH

• Four in ten women age 15-49 in Nepal are anemic.

• Since 2006, anemia among women has increased from 36% to 41% in
2016.
FAMILY HEALTH
Postnatal care:
• The percentage of women who received a postnatal care (PNC)
assessment within two days following delivery rose from 45% in 2011
to 57% in 2016. 81% of women who delivered in a health facility and
13% of women who delivered elsewhere received PNC within two
days of delivery.
• However, there were significant socioeconomic disparities in PNC
utilization: 81% of women in the highest wealth quintile had an early
PNC visit compared to only 37% among women in the lowest wealth
quintile.
FAMILY HEALTH
ANTENATAL CARE :
Antenatal care refers to the health care provided to a pregnant woman
throughout pregnancy until labor.
Basically it is a screening program intended to detect complications
early; provide health education and implement effective health
promotive and preventive interventions.
FAMILY HEALTH
Components of antenatal care:
• Registration
• History taking
• Obstetric Examination
• Clinical service
• Health Education
• Immunization(Tetanus)
FAMILY HEALTH
ANTENATAL CARE :
Antenatal care is the care of the woman during pregnancy. The primary
aim of antenatal care is to achieve at the end of a pregnancy a healthy
mother and a healthy baby.
Ideally this care should begin soon after conception and continue
throughout pregnancy. In some countries, notification of pregnancy is
required to bring the mother in the prevention care cycle as early as
possible.
FAMILY HEALTH
Objectives :
The objectives of antenatal care are :
(1) To promote, protect and maintain the health of the mother during pregnancy.
(2) To detect "high-risk" cases and give them special attention.
(3) To foresee complications and prevent them.
(4) To remove anxiety associated with delivery.
(5) To reduce maternal and infant mortality and morbidity.
(6) To teach the mother elements of child care, nutrition, personal hygiene, and environmental
sanitation.
(7) To sensitize the mother to the need for family planning, including advice to cases seeking
medical termination of pregnancy; and
(8) To attend to the under-fives accompanying the mother.
FAMILY HEALTH
Antenatal care :

• WHO recommends a minimum of four antenatal check-ups at regular intervals to all

pregnant women (at the fourth, sixth, eighth and ninth months of pregnancy).
Pregnant women have to visit a health facility for antenatal care in 12th, 20th, 26th,
30th, 34th, 36th, 38th and 40th weeks of gestation according to new guidelines.
Pregnant women have to visit health facilities at least eight times for antenatal
care, every 15 days, after 36 weeks according to Department of Health Services,
2022.
FAMILY HEALTH
• During these visits women should receive the following services and
general health check-ups:
• Blood pressure, weight and foetal heart rate monitoring.
• IEC and BCC on pregnancy, childbirth and early newborn care and
family planning.
• Information on danger signs during pregnancy, childbirth and in the
postpartum period, and timely referral to appropriate health facilities.
FAMILY HEALTH

• Early detection and management of complications during pregnancy.

• Provision of tetanus toxoid and diphtheria (Td) immunization, iron
folic acid tablets and deworming tablets to all pregnant women, and
malaria prophylaxis where necessary.
FAMILY HEALTH

• Pregnant women are encouraged to receive at least four antenatal

check-ups, give birth at a health institution and receive three post
natal check-ups, according to the national protocols.
FAMILY HEALTH
Purpose of first visit:
• Facilitation of proper planning for the care to be provided to mother
and fetus.
• Calculation of expected date of delivery.
• Assessment of the health status of mother for any pre-existing
medical illness.
• To help in rapport building for continued antenatal care.
FAMILY HEALTH
Tasks to be carried out during antenatal visits:
• Antenatal examination
• Prenatal advice(e.g. Folic acid)
• Specific protection
• Mental preparation
• Family Planning
FAMILY HEALTH
ANTENATAL CHECK-UP:
The first visit, irrespective of when it occurs, should include the following
components :
• History taking: Any illness/ other problems/ drug intake etc.
• Physical Examination (pallor, pulse, respiratory rate, oedema, blood
pressure, weight, breast examination)
• Abdominal Examination
• Assessment of gestation age
• Laboratory Investigations
FAMILY HEALTH
Laboratory investigations :

• Routine: Pregnancy detection, Hb estimation, urine test for albumin

and sugar, etc.
• Screening: Blood group and Rh factor, HIV testing, Blood glucose
estimation, HBsAg for Hepatitis B, etc.
FAMILY HEALTH
PRENATAL ADVICE
• Total calorie requirement during pregnancy is additional 350 kcal per
day .
• Micronutrients are also required like iron, iodine, calcium and vitamins
in increased amounts compensate for baby’s needs.
• Maintain personal health: Personal cleanliness and dental hygiene,
adequate sleep, exercise, avoiding smoking.
• Drugs: No drugs should be taken without advice of health care provider.
FAMILY HEALTH
PRENATAL ADVICE
• Radiation: x- rays exposure should be avoided.

• Warning signs: Mother should be told about warning signs and

symptoms where medical advice must be taken. Some signs include
swelling of feet, fits, headache, blurring of vision, bleeding or
discharge per vaginum.
FAMILY HEALTH
RISK APPROACH :
• The central purpose of antenatal care is to identify "high risk" cases
(as early as possible) from a large group of antenatal mothers and
arrange for them skilled care, while continuing to provide appropriate
care for all mothers.
FAMILY HEALTH
High Risk Pregnancies:
• Elderly primi (30 years and over)
• Short statured primi (140 cm and below)
• Malpresentations, viz breech, transverse lie, etc.
• Antepartum haemorrhage, threatened abortion
• Pre-eclampsia and eclampsia
• Anaemia
• Twins, hydramnios
• Previous still-birth, intrauterine death, manual removal of placenta
• Elderly grandmultiparas
FAMILY HEALTH
• Prolonged pregnancy (14 days-after expected date of delivery)
• History of previous caesarean or instrumental delivery
• Pregnancy associated with general diseases, viz. cardiovascular
disease, kidney disease, diabetes, tuberculosis, liver disease, malaria,
convulsions, asthma, HIV, RTI, STI, etc.
• Treatment for infertility.
• Three or more spontaneous consecutive abortions.
FAMILY HEALTH
Rural Ultrasound Programme :
• The Rural Ultrasound Programme aims for the timely identification of
pregnant women with risks of obstetric complication to refer to
comprehensive emergency obstetric and neonatal care (CEONC)
centres.
• Trained nurses (SBA) scan clients at rural PHCCs and health posts
using portable ultrasound.
• Women with detected abnormalities such as abnormal lies and
presentation of the foetus and placenta previa are referred to a
CEONC site for the needed services.
FAMILY HEALTH
INTRANATAL CARE :
• Childbirth is a normal physiological process, but complications may
arise.
• Septicaemia may result from unskilled and septic manipulations, and
tetanus neonatorum from the use of unsterilized instruments
• The need for effective intranatal care is therefore indispensable, even
if the delivery is going to be a normal one.
FAMILY HEALTH

Clean/Safe Delivery (The intranatal Care)

2 interventions strategies have been proposed.
• Essential Obstetric Care (EOC)
• Emergency Obstetric Care (EmOC)EOC is a key to reducing maternal
mortality
FAMILY HEALTH
Emergency obstetric care:
• Basic emergency obstetric and newborn care (BEONC) covers the
management of pregnancy complications by assisted vaginal delivery
(vacuum or forceps), the manual removal of placentas, the removal of
retained products of abortion (manual vacuum aspiration), and the
administration of parental drugs (for postpartum haemorrhage, infection
and pre-eclampsia and eclampsia) and the resuscitation of newborns and
referrals.
• Comprehensive emergency obstetric care (CEONC) includes surgery
(caesarean section), anaesthesia and blood transfusions along with
BEONC functions.
FAMILY HEALTH
The following major strategies have been adopted to reduce risks
during pregnancy and childbirth and address factors associated with
mortality and morbidity:
• Promoting birth preparedness and complication readiness including
awareness raising and improving preparedness for funds, transport and
blood transfusion.
• Expansion of 24 hours birthing facilities alongside AamaSuraksha
Programme promotes antenatal check-ups and institutional delivery.
• The expansion of 24-hour emergency obstetric care services (basic
and comprehensive) at selected health facilities in all districts.
FAMILY HEALTH
The aims of good intranatal care are :
• (i) thorough asepsis
• (ii) delivery with minimum injury to the infant and mother
• (iii) readiness to deal with complications such as prolonged labour,
antepartum haemorrhage, convulsions, malpresentations, prolapse of
the cord, etc.
• (iv) Care of the baby at delivery, resuscitation, care of the cord, care of
the eyes, etc.
FAMILY HEALTH
CLEAN DELIVERY KIT(SUTKERI SAMAGRI):
• CDK is basically used during home delivery, promoted since early
1995.
• Each packet of CDK consists of a razor, one plastic coin, one plastic
sheet, gloves, thread, and soap.
• The prime objective of promoting CDK is to make home births safer (if
by any reason pregnant women are unable to go for institutional
delivery).
FAMILY HEALTH
FAMILY HEALTH
FAMILY HEALTH

Post-Natal Care (Postpartum Care):

• Care of the mother after delivery

FAMILY HEALTH
Objectives of post- natal care:
• To prevent complications of postnatal period
• Restoring mother’s health and to ensure exclusive breast feeding
• Family planning advice
• Education of mother about child care services and mother-craft.
FAMILY HEALTH
Postnatal care:
Postnatal care services include the following:
• Three postnatal check-ups, the first in 24 hours of delivery, the second on the third
day and the third on the seventh day after delivery.
• The identification and management of complications of mothers and newborns and
referrals to appropriate health facilities.
• The promotion of exclusive breastfeeding.
• Personal hygiene and nutrition education, and postnatal vitamin A and iron
supplementation for mothers.
• The immunization of newborns.
• Postnatal family planning counselling and services
FAMILY HEALTH
Components of Postpartum Care Visit:
Early detection and management of complications
Complication readiness
Promoting health and preventing disease
Woman-centered education and counseling
FAMILY HEALTH
Steps to follow in Post partum care :
1) Greet the mother. Make her feel comfortable
2) Assess for emergency signs. Vaginal bleeding, Fever, Pallor, Looks
very ill
3) Check the records
4) Assess and educate about breastfeeding
5) Counsel about FP
FAMILY HEALTH
Routine Postpartum Care :
• Give any treatment or prophylaxis (Iron,calcium,Vitamin A ,Tetanus)
• Advise and Counsel
• Health education
• Schedule return visit
• Mother feels well BP, pulse & temperature normal
• No breast problems, breastfeeding well
• Uterus well contracted
• No problem with urination
• No pain or other concern
FAMILY HEALTH
Abnormalities in Postpartum Period:
 Elevated BP ,Pallor
Vaginal Bleeding ,Foul smelling lochia
Dribbling Urine, Pus or perineal pain, vaginal discharge
Feeling unhappy
Breast Problem
Infection/ Breast abscess ,Sore or cracked nipple,
Engorgement, Insufficient milk
Cough or breathing difficulty
RFERRAL
FAMILY HEALTH
Causes of MMR (globally):
• Hemorrhage (25%)
• Indirect causes (20%)
• Infection (15%)
• Unsafe abortion (13%)
• Eclampsia (12%)
• Obstructed labour (8%)
Millennium Development Goal (MDG) : Reduce maternal mortality by three-fourths by
2015.
From 2000 to 2017, the global maternal mortality ratio declined by 38 per cent ,from 342
deaths to 211 deaths per 100,000 live births.
 Source: WHO,2017
FAMILY HEALTH
Safe Motherhood and Reproductive Health Rights Act, 2018 :
Date of Authentication:
September 18, 2018 (2075/06/02 B.S)
Act No. 9 of the year 2075 B.S.
An Act enacted to provide for matters related to safe motherhood and
reproductive health rights
FAMILY HEALTH
Policies and programmes on Safe motherhood in Nepal.
• Second Long Term Health Plan (1997 – 2017)
• Safe Motherhood Policy (1998)
• National Safe Motherhood Program (2002–2017)
• National Safe Abortion Policy (2003)
• Maternal Incentive Scheme (2005)
• Safe Motherhood and Neonatal Health Long Term Plan (2006–2017)
FAMILY HEALTH
• National Policy on Skilled Birth Attendants (2006) 2006
• National Free Delivery Policy (2009)
• Nepal Health Sector Programme Implementation Plan II (2010 – 2015)
• Nepal Health Sector Support Strategy (2015-2020)
• Safe Motherhood Information Education Communication (IEC)
strategy (2003- 2008)
FAMILY HEALTH
Major Safe Motherhood Programs in Nepal
1. Aama program:
In 2005: Maternity incentive scheme (MIS) (Transport incentive)
In 2006: MIS was renamed as the safe delivery incentive programme
(SDIP) (Transport incentive and free delivery)
In 2009: SDIP was further evolved into Aama Program, which comprises
free institutional delivery care, and the safe delivery incentive
programme (SDIP), a cash incentive to women and care providers,
which was initiated in 2005.
FAMILY HEALTH
FAMILY HEALTH
CONTRACEPTIVE METHODS (Fertility Regulating Methods):

Contraceptive methods are, by definition, preventive methods to help

women avoid unwanted pregnancies. They include all temporary and
permanent measures to prevent pregnancy resulting from coitus.
FAMILY HEALTH
Characteristics of ideal contraceptive :
• Safe
• Effective
• Free of side effects
• Easily obtainable
• Affordable
• Acceptable to the user and sexual partner
• Free of effects on future pregnancies
FAMILY HEALTH

A method which may be quite suitable for one group may be unsuitable for
another because of different cultural patterns, religious beliefs and socio-
economic status.
No single method can likely meet the social, cultural, aesthetic and service
needs of all individuals and communities
FAMILY HEALTH
Cafeteria approach:

This is to offer all methods from which an individual can choose

according to his needs and wishes and to promote family planning as a
way of life.
FAMILY HEALTH

• The term conventional contraceptives is used to denote those

methods that require action at the time of sexual intercourse, e.g.,
condoms, spermicides, etc. Each contraceptive method has its unique
advantages and disadvantages.
• The success of any contraceptive method depends not only on its
effectiveness in preventing pregnancy but on the rate of continuation
of its proper use.
FAMILY HEALTH
GATHER approach:
Family planning counselling has six elements which can be remembered
as an acronym ‘’GATHER’’.
G – Greet, give respect, privacy, full attention
A – Ask about person’s need, situation
T- Teach about appropriate choice
H- Help persons select and understand the chosen method
E- Explain how to use and evaluate person’s learning
R- Return for follow-up
FAMILY HEALTH
Informed choice:
Informed choice is the process that a client passes through to make a
voluntary, well considered decision about his/her reproductive health
needs.
The client arrives at this decision based on accurate information in an
environment of full information about available methods and
resources.
FAMILY HEALTH
Target couples:
• In order to pin-point the couples who are a priority group within the
broad definition of "eligible couples", the term "target couple" was
coined.
• The term target couple was applied to couples who have had 2-3
living children, and family planning was largely directed to such
couples.
FAMILY HEALTH

The definition of a target couple has been gradually enlarged to include

families with one child or even newly married couples with a view to
develop acceptance of the idea of family planning from the earliest
possible stage.
In effect, the term target couple has lost its original meaning. The term
eligible couple is now more widely used.
FAMILY HEALTH

Eligible couples :
An "eligible couple" refers to a currently married couple wherein the
wife is in the reproductive age, which is generally assumed to lie
between the ages of 15 and 45.These couples are in need of family
planning services.
FAMILY HEALTH
• Couple protection rate (CPR) is an indicator of the prevalence of
contraceptive practice in the community.
• It is defined as the per cent of eligible couples effectively protected
against childbirth by one or the other approved methods of family
planning, viz. sterilization, IUD, condom or oral pills.
• Demographers are of the view that the demographic goal of NRR= 1
can be achieved only if the CPR exceeds 60 per cent.
FAMILY HEALTH

METHODS OF FAMILY PLANNING :

1)TEMPORARY FAMILY PLANNING METHOD
Behavioural method/Natural method
Chemical method
Mechanical method
 Hormonal method

2)PERMANENT FAMILY PLANNING METHOD/SURGICAL METHOD

FAMILY HEALTH
TEMPORARY FAMILY PLANNING METHOD
Natural family planning method:
• Calendar (Rhythm) method
• Basal body temperature
• Cervical mucous method
• Symptothermal method
• Ovulation awareness method
• Lactation amenorrhea method
• Withdrawal ( Coitus interruption )
FAMILY HEALTH
Natural Family planning methods :
• These methods involve finding out when a woman is at her most
fertile, so that she can be extra careful or avoid sex altogether during
these times. This can be done by using techniques such as the woman
keeping a daily record of her body temperature using a special fertility
thermometer.
• A combination of techniques is recommended to increase the
effectiveness of these methods.
FAMILY HEALTH

• These are a natural alternative to hormonal and barrier methods but

the techniques used require a significant level of motivation and a
clear understanding of how to monitor fertility.
• Natural methods of contraception also do not take into account
fluctuations in the menstrual cycle.
FAMILY HEALTH
Rhythm method:
• This method can be used for patients with regular cycles only.
• This is done depending on the exact knowledge of ovulation day and
avoiding intercourse during the days before and after ovulation;
• For example in a regular period that occurs every 28 days the exact
day of ovulation should be the day 14 so intercourse should be
avoided 4-5 days before and after this day.
FAMILY HEALTH

There are many methods to detect ovulation days;

1) Increase in body temperature by about 0.5 degree Centigrade.
2) Change in type of cervical mucous
3) Ovulation kits nowadays are available for ovulation day detection by
measuring LH surge
FAMILY HEALTH

METHODS OF FAMILY PLANNING :

1)TEMPORARY FAMILY PLANNING METHOD
 Behavioural method/Natural method
Chemical method
Mechanical method
 Hormonal method
2)PERMANENT FAMILY PLANNING METHOD/SURGICAL METHOD
FAMILY HEALTH

Chemical method:
• Foam tablets
• Jelly and paste(Spermicidal)
FAMILY HEALTH
Spermicides:
• These are creams, gels, sponges or pessaries that contain a chemical
that kills sperm.
• They can increase the effectiveness of certain barrier methods of
contraception such as a diaphragm.
• However, they don't provide reliable contraception when used alone.
FAMILY HEALTH
Mechanical family planning methods:
• Male condoms
• Female condoms
• Diaphragms
• Intrauterine devices (IUD)
• Sponge
FAMILY HEALTH
Male condoms:
• It's a thin latex rubber or polyurethane placed over a man's erect
penis during sex to trap sperm at the point of ejaculation.
• It must be put on the penis as soon as it becomes erect and
before any contact takes place with the vagina. Men should withdraw
as soon as they have ejaculated and take care not to spill any semen.
FAMILY HEALTH
FAMILY HEALTH

• Condoms must be used with care as they can slip off or tear.
• Advantages: easily available; offers protection against sexually
transmitted infections including HIV/AIDS.
• Effectiveness: 94%-98% depending on correct use.
FAMILY HEALTH
Female condom ( Femidom ) :
• It's a thin polyurethane sheath placed inside the vagina (also covering
the cervix and the area outside) to stop sperm from entering. It can
be put in at any time before sex .
Advantages: offers protection against sexually transmitted infections,
including HIV/AIDS.
Effectiveness: 95% if used correctly.
FAMILY HEALTH
FAMILY HEALTH
Diaphragms/cervical cap :
• A diaphragm or cap is a dome of rubber which is fitted by the woman
over her cervix before sex. It acts as a barrier to stop sperm getting
through to the uterus. It should be used with a spermicidal cream,
jelly or pessaries that contain a chemical that kills sperm.
• The diaphragm must stay in place for six hours after sex.
Advantages: only needs to be used when the couple has sex.
• Spermicides may cause irritation or an allergic reaction.
Effectiveness: 92%-96% if used correctly.
FAMILY HEALTH
FAMILY HEALTH
Intrauterine Devices :
• An IUD - also known as a Coil, is a small plastic and copper device,
usually shaped like a 'T', which is fitted into the woman's uterus by a
doctor using a simple procedure.
• It works by foreign body reaction, by creating cellular/biochemical
changes in endometrium/uterine fluids. It impairs viability of gamete.
• An IUCD can stay in place for five years , sometimes for 10 years.
• It can also be used as an emergency method of contraception within
five days of unprotected intercourse.
FAMILY HEALTH

• Advantages: no need to think about it once it is in place and it last for

a long time.
• Considerations: There is a higher risk of infection for women with
more than one partner. It may cause heavier, more painful periods.
• Effectiveness: 98%-99%.
FAMILY HEALTH
FAMILY HEALTH
Copper T :
• 10 years
• 99.2 % effective
• Copper on IUD acts as spermicide, IUD blocks from implanting
• Must check string before sex and after shedding of uterine lining.
FAMILY HEALTH
Progestasert :
• 1 year
• 98% effective
• T shaped plastic that releases hormones over a one year time frame
• Thickens mucus
FAMILY HEALTH

Effectiveness:
When used correctly, it’s about 99% effective as birth control except for
women weighing 90 kilograms or more when it is only about 92%
effective.
FAMILY HEALTH

Hormonal family planning methods :

• Vaginal ring
• Pills ( Combined & Minipill )
• Injection
• Implant
FAMILY HEALTH
Vaginal Ring:
• A soft, flexible vaginal ring, which is about 2 inches in diameter,
delivers low doses of estrogen and progestin into the body. This helps
prevent pregnancy by suppressing ovulation and thickening the
cervical mucus, which helps block sperm from entering the uterus.
• The ring is inserted into the vagina and left for 3 weeks. It is then
removed for 1 week, during which a woman menstruates, and a new
ring is inserted after the 1-week "break."
FAMILY HEALTH

• The vaginal ring is at least 98 percent effective with perfect use, which
refers to always correct and consistent use.
FAMILY HEALTH
FAMILY HEALTH
Combined oral contraceptive pill :
• This is the most common type.
• It contains two hormones - estrogen and progesterone which
prevents ovulation and alters the consistency of cervical mucus.
FAMILY HEALTH

Effectiveness:
99% if taken correctly.
FAMILY HEALTH
FAMILY HEALTH
FAMILY HEALTH

• One pack of Nilocon white contains 21 hormonal tablets and 7 Iron

tablets.
• The composition of each white colored tablet contains Levonorgestrel
0.15 mg, Ethinyl estradiol 0.03 mg and each brown tablet contains
Ferrous Fumarate 75 mg.
FAMILY HEALTH
Side-effects:
• Breast tenderness
• Nausea
• Increase in headaches
• Moodiness
• Weight change
• Spotting
FAMILY HEALTH

Taking OCPs:
• Once a day at the same time everyday
• Use extra contraception such as condoms for next 1 week if you
missed two or more pills or started new pack 2 or more days late
• take the last pill you missed now, even if this means taking 2 pills in 1
day
• carry on taking the rest of the pack as normal
• The pill offers no protection from STD’s
FAMILY HEALTH
Contraindications for Use of Combined Oral Contraceptive Pills (OCPs):
Absolute contraindications:
1. Breast Cancer
2. Genital Cancer
3. Liver disease
4. History of thromboembolism
5. Cardiac abnormalities
6. Congenital hyperlipidemia
7. Undiagnosed abnormal uterine bleeding
8. Pregnancy
FAMILY HEALTH
Relative contraindications:
1. Age > 40 years
2. Smoking and age > 35 years
3. Mild hypertension
4. Chronic renal disease
5. Epilepsy
6. Migraine
7. Nursing mothers (0 – 6 months)
8. Diabetes mellitus
9. Gall bladder disease
10. History of infrequent bleeding
11. Amenorrhoea
FAMILY HEALTH
Beneficial Effects of Combined Oral Contraceptive Pills (OCPs):
• Benign breast disorders (Fibrocystic disease, Fibroadenoma)
• Pelvic Inflammatory Disease (PID)
• Ectopic pregnancy
• Iron deficiency anemia
• Benign ovarian disease (Ovarian cysts)
• Malignant ovarian disease (Ovarian cancer)
• Endometrial cancer
FAMILY HEALTH
Non-contraceptive benefits of combined OCPs: –
• polycystic ovary syndrome (PCOS)
• endometriosis
• adenomyosis
• anaemia related to menstruation
• painful menstruation (dysmenorrhea)
• mild or moderate acne
• irregular menstrual cycles
• dysfunctional uterine bleeding
THANK-YOU
FAMILY HEALTH
FAMILY HEALTH

WHO definition of health:

• Health is a state of complete physical, mental and social well-being
and not merely the absence of disease or infirmity.
FAMILY HEALTH

The Biopsychosocial Model :

• The biopsychosocial model views health and illness behaviors as

products of biological characteristics (such as genes), behavioral
factors (such as lifestyle, stress, and health beliefs), and social
conditions (such as cultural influences, family relationships, and social
support).
FAMILY HEALTH

• Health psychologists work with healthcare professionals and patients

to help people deal with the psychological and emotional aspects of
health and illness.
• This can include developing treatment protocols to increase
adherence to medical treatments, weight loss programs, smoking
cessation, etc.
• Their research often focuses on prevention and intervention
programs designed to promote healthier lifestyles (e.g., exercise and
nutrition programs).
FAMILY HEALTH
Key Points :
• According to the biopsychosocial model, it is the deep interrelation of all three factors
(biological, psychological, social) that leads to a given outcome—each component on its
own is insufficient to lead definitively to health or illness.
• The psychological component of the biopsychosocial model seeks to find a psychological
foundation for a particular symptom or array of symptoms (e.g., impulsivity, irritability,
overwhelming sadness, etc.).
• Social and cultural factors are conceptualized as a particular set of stressful events (being
laid off, for example) that may differently impact the mental health of people from different
social environments and histories.
• Despite its usefulness, there are issues with the biopsychosocial model, including the
degree of influence that each factor has, the degree of interaction between factors, and
variation across individuals and life spans.
FAMILY HEALTH
• The biopsychosocial model of health and illness is a framework developed
by George L. Engel that states that interactions between biological,
psychological, and social factors determine the cause, manifestation, and
outcome of wellness and disease. Historically, popular theories like the
nature versus nurture debate said that any one of these factors was
sufficient to change the course of development.
• The biopsychosocial model argues that any one factor is not sufficient; it is
the interplay between people’s genetic makeup (biology), mental health
and behavior (psychology), and social and cultural context that determine
the course of their health-related outcomes.
FAMILY HEALTH
Application of the Biopsychosocial Model:
• The biopsychosocial model states that the workings of the body, mind, and
environment all affect each other. According to this model, none of these
factors in isolation is sufficient to lead definitively to health or illness—it is the
deep interrelation of all three components that leads to a given outcome.
• Health promotion must address all three factors, as a growing body of
empirical literature suggests that it is the combination of health status,
perceptions of health, and sociocultural barriers to accessing health care that
influence the likelihood of a patient engaging in health-promoting behaviors,
like taking medication, proper diet or nutrition, and engaging in physical
activity.
FAMILY HEALTH
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FAMILY HEALTH

• The biopsychosocial model has received criticism about its limitations,

but continues to carry influence in the fields of psychology, health,
medicine, and human development.
FAMILY HEALTH
• The biopsychosocial model reflects the development of illness through
the complex interaction of biological factors (genetic, biochemical,
etc.), psychological factors (mood, personality, behavior, etc.) and social
factors (cultural, familial, socioeconomic, medical, etc.).
• For example, a person may have a genetic predisposition for depression,
but he or she must have social factors such as extreme stress at work and
family life and psychological factors such as a perfectionistic tendencies
which all trigger this genetic code for depression.
• A person may have a genetic predisposition for a disease, but social and
cognitive factors must trigger the illness.
FAMILY HEALTH
• The biomedical model of health focuses on purely biological factors
and excludes psychological, environmental, and social influences.
• It is considered to be the leading modern way for health care
professionals to diagnose and treat a condition in most Western
countries.
• The model's focus on the physical processes (for
example, pathology, biochemistry and physiology of a disease) does
not take into account the role of social factors or individual
subjectivity.
FAMILY HEALTH
• Holistic medicine approaches the physical, emotional, spiritual, and
social aspects of a person as they relate to health and disease.
• It emphasizes prevention; concern for the environment and the food
we eat; patient responsibility; using illness as a creative force to teach
people to change; the `physician, heal thyself' philosophy; and
appropriate alternatives to orthodox medicine.
• Family medicine faces the challenge of integrating these humanistic
concepts with science.
FAMILY HEALTH
• The family is the unit of service in all health care delivery.
• The health of one member affects the welfare of other members in
the family.
• Every family is unique and it is affected by every aspect of community
life.
• The health service providers has to understand family ways,
traditions, customs and beliefs of the family.
FAMILY HEALTH
Family health:
• Is part of community health
• Is more than the sum of personal health of individual
• Is a unit of health care.
Definition of Family:
• “Family is a group of biologically-related persons living together and
sharing the common kitchen and purse.”
• “Family is group of two or more persons related by birth, marriage, or
adoption and residing together in a household” US Bureau of Census 1980.
FAMILY HEALTH

Family Health:
“a state of positive interaction between family members which enables
each members of the family to enjoy optimum physical, mental, social
and spiritual well being.”
“The health status of the family as a unit including the impact of the
health of one member of the family on the family as a unit and on
individual family members; also, the impact of family organization or
disorganization on the health status of its members.”
FAMILY HEALTH
Functions of the family:
• Socialization of family members
• economic stability
• sexual needs
• care of dependent members
• emotional support for members
• satisfy social, intellectual, emotional and psychological needs of
members.
FAMILY HEALTH

• Teaches children rules for behaviour and socially approved conduct.

• Provides members with sense of family identifications.
• Sickness role, interactions among family members in health, disease,
counselling and rehabilitation.
FAMILY HEALTH
Determinants of family health :
• Living and working conditions
• Physical environment,
• Psycho-social environment
• Education and economic factors
• health practices
• Cultural factors
• Gender etc.
FAMILY HEALTH

Scope and components of family health:

Problems faced by family: Broken homes, drug abuse, juvenile
delinquency, disability and rehabilitation, unmarried mothers,
teenage pregnancy
Reproductive health• Safe motherhood, ANC, delivery care, PNC,
Family planning, Nutritional deficiencies, LBW• STIs/RTIs/HIV/AIDS,
legal abortion, infertility services,• Adolescent health
FAMILY HEALTH
Child health:
• Child bearing, rearing,
• Child health services: nutrition, immunization, Growth monitoring
• Morbidity and mortality of children
• Social problems of children: Child abuse ,Abandoned or street
children, Child labour, Juvenile delinquency, battered baby syndrome
FAMILY HEALTH

Gender issues in family:

Gender based violence(GBV), Girls trafficking, Gender mainstreaming,
Female Genital Mutilation (FGM), female feoticide (sex-selective
abortion),
Aging: Problems of ageing, active ageing
Mental health: situation of mental health, its causes and prevention,
National mental health policy
FAMILY HEALTH
Sex” refers to the biological and physiological difference between
male and female : reproductive organs, chromosomal complement,
hormonal environment, etc.
 Gender is the social construction of the biological differences
between men and women.
Gender is not “Sex”.
Gender is not “Women’’.
FAMILY HEALTH
Concept of sex and gender:

Sex : Determined at birth, biological therefore cannot be changed.

Gender: Learned through socialization, social construct therefore can
be changed.
FAMILY HEALTH

Roles of family and peer group in health :

As there is a famous proverb, “The secret of health lies in the family”, a
family can play various roles to uplift the health status of its members.
FAMILY HEALTH
The family role may be summarized as below:
Family as a teacher
Family as a health service provider
Family as a counselor
Family as a motivator
Family as a monitor
Family as a trainer
Family as a controller
Family as a care taker
FAMILY HEALTH
peer group:
• A group of friends or associates usually of similar background social
status and age who are likely to influence a person’s beliefs and
behavior
• Members of a particular peer group often have similar interests and
backgrounds, bonded by the premise of sameness.
• Peer groups offer the chance to discuss interests that adults may not
share with their children
FAMILY HEALTH
Role of Peer group in health:
Serve as a source of health information
Help to reduce mental stress and anxiety
Help to be acquainted on physical and emotional changes
Give support in acute as well as chronic illness
Give support to during disability
• Though Peer group may have very positive roles on health but in many
circumstances there may be very harmful consequences on health like
- substance abuse, involvement in criminal activity and sexual abuse.
FAMILY HEALTH

Responsibilities of family in health and disease:

1. Child rearing
2. Socialization
3. Personality formation
FAMILY HEALTH
4. Care of dependant adult:
Care of sick and injured
Care of pregnant and childbirth
Care of aged and handicapped
Stabilization of adult personality
Familial susceptibility to diseases
Broken homes
Problem family
FAMILY HEALTH
Life cycle perspective in health:
The meaning of the term “life-cycle‟ is two-fold:
• “Firstly,” it reflects a continuum of age-stages where the needs of an
individual changes through their life, from conception to death.
• Secondly, it‟ refers to the different stages and events of life which an
individual or household passes through, and which often bring with it a
different status given to individuals such as becoming a widow/er, a
single mother, an adolescent, or unemployed.
FAMILY HEALTH

Life cycle perspective in health:

A life cycle perspective suggests that different intervention packages

should be developed and disseminated by considering various phases
of an individuals life-cycle starting from early neonate to old age.
FAMILY HEALTH
A life cycle perspective in health:
• Actions, both positive and negative, taken at one stage in a woman’s
life can and will affect her throughout her life.
For example: Exclusive breastfeeding during the first 6 months provides
infants with the antibodies and nourishment needed to begin a healthy
life. A woman who develops a reproductive tract infection and does not
receive appropriate treatment can become infertile.
Girls fed inadequately during childhood may have stunted growth. A
child who got appropriate caring during his/her childhood may develop
intellectually as well as physically throughout life.
FAMILY HEALTH
A example of life cycle perspective in MCH issues:
• Over the years, women’s health needs have been addressed through
maternal and child health programmes, focusing primarily on narrow
aspect of their lives.
• With this perspectives, women’s health is now being viewed
holistically – as a continuum of care that starts before birth and
progresses cumulatively throughout her life.
FAMILY HEALTH

This lifecycle approach extends beyond women’s reproductive role to

encompass women’s health at every stage and in every aspect of their
lives.
Through this approach, other health issues affecting women that were
previously overlooked, or thought not to exist, have become more
apparent.
FAMILY HEALTH
FAMILY HEALTH
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FAMILY HEALTH

Problems faced by the family:

For e.g. 1) Teenage marriage
2)Broken and dysfunctional family
3)Disability and rehabilitation
4)Gender based violence including girl trafficking
5)Substance abuse
FAMILY HEALTH
Nepal has a high incidence of gender-based violence(GBV) .Everyone regardless of
sex can be affected, women remain by large the main victim.

• In 2017,149 people were killed as a result of GBV in Nepal.

• Of these victims, 140 were female, 75 of whom were killed because of domestic
violence.
• In 2017, out of 680 documented cases, the main perpetrator was a family
member or relative in 163 cases of them.
• However, such cases are generally unreported due to the stigma attached to
GBV.
FAMILY HEALTH

• According to Nepal Demographic Survey 2016, 66% of women who

have experienced physical or sexual violence have not sought help to
end the violence, nor have they shared their experiences.
FAMILY HEALTH
• The National Women Commission (NWC), a government body that
protects and promotes women rights and interests, has been at the
forefront to address the problems of women who are victims of GBV.
• In December 2017, NWC launched its GBV helpline Khabar Garaun 1145,
which has received 37,249 calls from November 21, 2017 to June 30,
2018.
• Of the total calls, 677 cases were registered in the helpline’s case
management system, 413 were referred to partner service providers, and
264 cases were resolved.
FAMILY HEALTH
• On the upside, the reporting of GBV cases has increased, and
survivors have started coming forward.
• A total of 4559 callers were seeking information about GBV, existing
legal protections, and how to access support services.
FAMILY HEALTH

• Data at the Nepal Police shows 2,144 cases of rape and 687 cases of attempted
rape were reported in the fiscal year 2019-20,an increase from 1,480 cases of
rape and 727 cases of attempted rape from fiscal year 2017-18.
• The Criminal Code that came into effect in August 2018 increased the maximum
imprisonment for the rapist to 25 years, from the earlier 15 years.
FAMILY HEALTH

• Nepalese victims are plunged into the world of human trafficking in

different ways. Some hoped to find jobs as domestic workers in India
or Gulf countries but ended up being trafficked and raped in brothels
abroad.
• Others were simply whisked away from their families and sold to
brothels in India.
FAMILY HEALTH
• Research suggests that “approximately 12,000 children are trafficked
by strangers, neighbours and families to India every year mainly for
sexual exploitation” but also for work in fisheries, construction,
circuses, domestic work among many other forms of forced labour
and exploitation, also including illegal organ removal.
FAMILY HEALTH
• Women and girls from rural areas are promised work and trafficked to
urban centres within Nepal. Instead, they end up forced into
prostitution in one of the hundreds of restaurants, dance bars or
massage parlours that function as fronts for brothels in Kathmandu.
• It is estimated that 11,000 to 13,000 girls and women work there,
most of them underage. So, girl trafficking is prevalent problem in
Nepal.
FAMILY HEALTH

• Nepal’s civil society is trying to fight back. Every day, border monitors,
some of whom are trafficking survivors themselves, try to intercept
and rescue potential victims at border posts, preventing them from
being trafficked out of Nepal.
• Others raise their voices against the deep social stigma that pursues
its victims at home.
FAMILY HEALTH
• Human trafficking is a thriving business. It accounts for $150bn a year
worldwide, with women and girls making up 71 percent of all modern
slavery victims.
• Nepal is one of the most lucrative markets. From there alone, at least
54 girls and women are trafficked into India every day.
FAMILY HEALTH
• Nepal has one of the highest rates of child marriage in Asia – for both
girls and boys. Although the legal age of unions for both sexes is 20,
more than a third of young women aged 20-24 report that they were
married by the age of 18, and just over one in ten by 15.
• Nepali boys are among the most likely in the world to be child
grooms. More than one in ten is married before they reach 18.
FAMILY HEALTH
• Child marriage is a human rights violation, restricting children’s
choices, changing their course in life, and putting them at significant
risk of abuse and violence.
• A UNICEF study found that one in three married girls in Nepal had
been subjected to sexual violence by their husbands, while one in six
reported physical violence.
FAMILY HEALTH
• A child’s education is also significantly affected, with married girls in
Nepal 10 times more likely not to be in school than their unmarried
peers and married boys often pressured to begin working to support
the family.
• Girls’ right to health also comes under threat. Just over one in eight
Nepali women had babies before the age of 18, which puts them at a
higher risk of death or injury during childbirth.
FAMILY HEALTH
• The reasons behind child marriage in Nepal are complex. Poverty, the
low value attached to daughters, and lack of access to education are
contributory factors, while the caste system and patriarchal culture
similarly play a role. It increasingly appears that teenagers are
choosing their own partners and may even elope.
• In some cases, parents encourage adolescents to initiate their own
marriage to avoid the high costs associated with dowry or
wedding. Adolescents may also choose to elope as sexual expression
outside of marriage is not acceptable, to avoid forced or arranged
marriage or to escape from difficulties at home.
FAMILY HEALTH
• The devastating earthquakes of 2015 also led to fears that child
marriage could increase.
• Studies in other countries have shown that in disasters or crises, as
families lose homes and livelihoods, parents are more likely to marry
off their children in a bid to protect them and secure their futures.
FAMILY HEALTH

• Drug abuse is one of the serious social problems in Nepal and

elsewhere for a long time. Drug abuse has several effects over the
human life.
• Unemployment, broken family, crime, depression, love failure,
formation of peer group, mass media are major problems faced by
the youth of the country.
FAMILY HEALTH
According to the World Health Organization, ‘’disability’’ has three
dimensions:
• Impairment in a person’s body structure or function, or mental
functioning; examples of impairments include loss of a limb, loss of
vision or memory loss.
• Activity limitation, such as difficulty seeing, hearing, walking, or
problem solving.
• Participation restrictions in normal daily activities, such as working,
engaging in social and recreational activities, and obtaining health
care and preventive services.
FAMILY HEALTH

• Rehabilitation is defined as “a set of interventions designed to

optimize functioning and reduce disability in individuals with health
conditions in interaction with their environment”.
FAMILY HEALTH
• Family health can be defined as “a state of positive dynamic
interaction between family members which enables each member of
the family to experience optimal physical, mental, social and spiritual
wellbeing whether disease or infirmity is present or not.”
• Such healthy interactions between family members give rise to the
health of individuals of the family thus, contributing positively to the
community and national development.
FAMILY HEALTH
Family health exercise:
Disease(Case):
• Patient’s profile
• Family profile
• Educational status
• Social and cultural background
• Economic status
• Housing and environment
• Gender norms and values(Activity profile, Access and control profile)
FAMILY HEALTH

• Health seeking behaviour and KAP

• Impact of diseases on patient(Physical, psychological, social,
economic impacts)
• Impact of disease on family(Physical, economic, psychological impacts
including relationship between family members, social impacts )
• Role of family in disease causation, progression and recovery)
FAMILY HEALTH
BROKEN FAMILY :
• A broken family is one where the parents have separated, or where
death has occurred of one or both the parents.
• Dr. John Bowlby brought out clearly the concept of "mental
deprivation" as one of the most dangerous pathogenic factors in child
development.
• Separation of the child from its father (paternal separation) and
separation of the child from both of its parents (dual-parental
separation) are important factors in child development.
FAMILY HEALTH

• Children who are victims of broken families early in their childhood

have been found sometimes to display in later years psychopathic
behavior, immature personality and even retardation of growth,
speech and intellect .
• Children from these families may drift away to prostitution and crime.
FAMILY HEALTH
PROBLEM FAMILIES :

Problem families are those which lag behind the rest of the community.

In these families, the standards of life are generally far below the
accepted minimum and parents are unable to meet the physical and
emotional needs of their children. The home life is utterly unsatisfactory.
FAMILY HEALTH

• The underlying factors in most problem families are usually those of

personality and of relationship, backwardness, poverty, illness, mental
and emotional instability, character defects and marital disharmony.
• These families are recognized as problems in social pathology.
• Children who are reared in such an environment are victims of
prostitution and crime.
FAMILY HEALTH

• Problem families may be found in all social classes but are more
common in the lower social classes.
• The health visitor, the health inspector, the midwife, the social worker,
the medical officer of health, all can render useful service in
rehabilitating such families in a community.
FAMILY HEALTH

Dysfunctional Family:

A family is dysfunctional when conflict, neglect, and misbehaviour are

constant and everlasting.
Modern psychology defines dysfunctional families as those with
anxious systems within them.
FAMILY HEALTH

• There is a tremendous amount of emotional disturbance within the

family members, and it sometimes means that it is coupled with child
neglect and abuse.
• Children from dysfunctional families assume that this situation is
normal, as they are exposed to that environment regularly, and do
not know the different aspects of dealing with a dysfunctional family.
Dysfunctional family
Dysfunctional family
FAMILY HEALTH
• The family therefore plays an important part both in health and
disease in the prevention and treatment of individual illness, in the
care of children and dependent adults, and in the stabilization of the
personality of both adults and children.
• In most societies the family is the fulcrum of health services
• Medical schools are developing teaching programmes in family
medicine, because, as Florence Nightingale had said : "the secret of
national health lies in the homes of the people".
FAMILY HEALTH

Family life cycle:

Families are not constant; they are ever changing. A normal family-cycle
is generally conceived as having six phases.
FAMILY HEALTH

Basic model of nuclear family life cycle :

Phases of family life cycle Events characterizing
Beginning of phase End of phase
1. Formation Marriage Birth of 1st child
2. Extension Birth of 1st child Birth of last child

3. Complete extension Birth of last child 1st child leaves home

4.Contraction 1st child leaves home Last child leaves home of
parents
5. Completed contraction Last child has left home of 1st spouse dies
parents
6.Dissolution 1st spouse dies Death of survivor(Extinction)
THANK-YOU
FAMILY HEALTH
FAMILY HEALTH

• Child health and immunization service section is one of the four

sections of family welfare division which plans, executes and monitors
several activities of child health and immunization services.
FAMILY HEALTH

This section has two programs:

1)National immunization program
2)IMNCI program
FAMILY HEALTH
Child Health and Immunization Section:
The work of this section are as follows:
• Support the Ministry of Health and Population to prepare national policies,
strategies, directories, quality standards, and protocols regarding vaccinations
and child health.
• To prepare vaccine and vaccine supplies supply and distribution plan at national
level.
• Necessary assistance in new vaccinations involving regular vaccinations program.
• Analyzing the vaccine and child health, and to provide technical assistance to
national level policy.
• National level work on child health according to national policy and strategy.
FAMILY HEALTH
National Immunization Program:
• National Immunization Program (NIP) of Nepal (Expanded Program on
Immunization) was started in 2034 BS and is a priority 1 program.
• It is one of the successful public health programs of Ministry of Health
and Population, and has achieved several milestones contributing to
reduction in morbidity and mortality associated with vaccine
preventable diseases.
FAMILY HEALTH
• NIP works closely with other divisions of Department of Health
Services and national centres of Ministry of Health and Population,
and different partners, including WHO and UNICEF, supporting the
National Immunization Program.
• In the Decade of the Vaccines (2011 – 2020), NIP has introduced
several new and underutilized vaccines contributing towards
achievement of Global Vaccine Action Plan targets of introducing new
and underutilized vaccines in routine immunization.
• The program provides vaccination against 12 vaccine preventable
diseases. (FY 2076/77).
FAMILY HEALTH

• Fractional dose of inactivated polio vaccine (fIPV) was introduced in

routine immunization of Nepal with formal launch in October 2018.
• As per comprehensive Multi-year Plan for Immunization (cMYP)
2017-2021, several other vaccines, including rotavirus vaccine, was
planned for introduction in Nepal.
• Immunization services are delivered through 16,500 service delivery
points in health facilities (fixed sessions), outreach sessions, and
mobile clinics.
FAMILY HEALTH

• NIP has cMYP 2017 - 2021 aligned with global, regional and national
guidelines, policies and recommendations to guide the program for
five years.
• All activities outlined in the cMYP are costed and has strategies for
implementation.
FAMILY HEALTH
• NIP has a very good track record of meeting the targets for control,
elimination and eradication of vaccine preventable diseases. Small
pox has now become history due to eradication in 2034 BS (1977 AD).
Maternal and neonatal tetanus (MNT) was eliminated in 2005 and the
elimination status has been sustained since then.
• The last case of polio in Nepal was in 2010, and along with other
countries of the South East Asia Region, Nepal was certified polio free
in 2014. This status has been maintained since then.
FAMILY HEALTH

• Nepal is one of the first countries in the world to introduce JE vaccine

in routine immunization.
• In 2016, JE vaccine, which initially was given only in 31 endemic
districts, was scaled up all over the country, thus, further contributing
towards control of Japanese encephalitis in Nepal.
FAMILY HEALTH

• In August 2018, Nepal was certified as having achieved control of rubella and
congenital rubella syndrome. This certification is two years ahead of the
regional target year of 2020 and one year ahead of the national target of
2019.
• In July 2019, Nepal became one of the first four countries in the WHO
South-East Asia Region to control hepatitis B among children.

• Though measles burden has been reduced by > 95% compared to 2003, the
national target of achieving measles elimination by 2019 was not met.
FAMILY HEALTH

• In September 2019,member countries of WHO South East Asia region

including Nepal have resolved to eliminate both measles and rubella
by 2023 to prevent deaths and disabilities caused by these highly
infectious childhood killer diseases.
FAMILY HEALTH
FAMILY HEALTH
NATIONAL IMMUNIZATION SCHEDULE
FAMILY HEALTH
 NDHS 2011 NDHS 2016

NMR-33/1000 live births NMR- 21/1000 live births

IMR-46/1000 live births IMR- 32/1000 live births
U5MR 54/1000live births U5MR-39/1000 live births
FAMILY HEALTH

• In 2015, The World Health Organization (WHO) estimated that

pneumonia, diarrhea, malaria, injuries, and measles were major
causes of deaths in the postnatal period, and prematurity, birth-
related complications, and neonatal sepsis were the leading causes of
neonatal deaths.
FAMILY HEALTH

• Although substantial progress has been made in child survival in the

last few decades, the United Nations Inter-agency Group for Child
Mortality Estimation (UN IGCME) estimated that approximately 5.6
million children died before their fifth birthday in 2016.
FAMILY HEALTH
• Among those, 2.6 million (46%) died during the neonatal period.
Globally, the under-5 mortality rate (U5MR) dropped from 64 deaths
per 1,000 live births in 2006 to 41 in 2016. Likewise, neonatal
mortality rates (NMR) also dropped from 26 per 1000 live births in
2006 to 19 per 1000 live births in 2016.
• Sub-Saharan Africa and Southern Asia were the geographic areas
where 80% of the total under-5 deaths and neonatal deaths occur
(UN IGCME 2017).
FAMILY HEALTH
Community based-Integrated Management of Childhood Illness (Cb-
IMCI) :
• In Nepal, Child survival intervention began when Control of Diarrhoeal
Disease (CDD) Program was initiated in 1983.
• Further, Acute Respiratory Infection (ARI) Control Program was
initiated in 1987.
• To maximize the ARI related services at the household level, referral
model and treatment model at the community level were piloted.
FAMILY HEALTH
• An evaluation of this intervention in 1997 revealed that treatment
model was more effective and popular in the community than referral
model.
• In 1997/98, ARI intervention was combined with CDD and named as
CB-AC (Community Based- ARI and CDD) program.
• One year later two more components, nutrition and immunization,
were also incorporated in the CBAC program.
FAMILY HEALTH

• IMCI program was piloted in Mahottari district and was extended to

the community level as well.
• Finally, the government decided to merge the CBAC into IMCI in 1999
and named it as Community-Based Integrated Management of
Childhood Illness (CB-IMCI).
• CB-IMCI included the major childhood killer diseases like pneumonia,
diarrhoea, malaria, measles, and malnutrition.
FAMILY HEALTH

• The strategies adopted in IMCI were improving knowledge and case

management skills of health service providers, overall health systems
strengthening and improving community and household level care practices.
• After piloting of low osmolar ORS and Zinc supplementation, it was
incorporated in CB-IMCI program in 2005.
• Nationwide implementation of CBIMCI was completed in 2009 and revised
in 2012 incorporating important new interventions.
FAMILY HEALTH
Community-based New born Care Program :
Up to 2005, Nepal had made a huge progress in reduction of under-five
and infant mortality, however, the reduction of neonatal mortality was
observed to be very sluggish because the country had no targeted
interventions for newborns especially at community level.
FAMILY HEALTH

• State of world report, WHO showed that major causes of mortality

were infections, asphyxia, low birth weight and hypothermia.

• The Government of Nepal formulated the National Neonatal Health

Strategy 2004. Based on this ‘Community-Based New Born Care
Program (CB-NCP)’ was designed in 2007, and piloted in 2009.
FAMILY HEALTH

• CB-NCP incorporated seven strategic interventions: behaviour change

communication, promotion of institutional delivery, postnatal care,
management of neonatal sepsis, care of low birth weight newborns,
prevention and management of hypothermia and recognition and
resuscitation of birth asphyxia.
FAMILY HEALTH
• Furthermore, in September 2011, Ministry of Health and Population
decided to implement the Chlorhexidine (CHX) Digluconate (7.1%
w/v) aiming to prevent umbilical infection of the newborn.

• The government decided to scale up CB-NCP and simultaneously, the

program was evaluated in 10 piloted districts.
• Upto 2014, CB-NCP was implemented in 41 districts covering 70%
population.
FAMILY HEALTH
• As a result of CB-IMCI program strategy, the prevalence of pneumonia
and diarrhoea has reduced significantly over the last decades.
• The care-seeking practices and household level practices have
been improved. CB-IMCI program has become one of the role models
for a community-based program of Nepal.
• Other interventions which have a high contribution to the reduction
of post-neonatal child mortality are bi-annual supplementation of
Vitamin A program, expanded program on immunization.
FAMILY HEALTH

• On the other hand, essential newborn care practices were improved

in CB-NCP implemented districts.
• In both of the programs (CB-IMCI and CB-NCP), FCHVs were
considered as frontline health service providers but quality and
coverage of service were very low.
FAMILY HEALTH

• CB-NCP and CB-IMCI have similarities in interventions, program

management, service delivery and target beneficiaries.

• Both programs have duplicated interventions like management of

neonatal sepsis, promotion of essential newborn care practices,
infection prevention, and management of low birth weight.
FAMILY HEALTH

• Considering the management of similar kind of two different

programs, MoH decided to integrate CB-NCP and IMCI into a new
package that is named as CB-IMNCI.
FAMILY HEALTH
Community-based Integrated Management of Newborn and
Childhood Illnesses (Cb-IMNCI) :
CB-IMNCI is an integration of CB-IMCI and CB-NCP Programs as per the
decision of MoH on 2071/6/28 (October 14, 2014).
This integrated package of child-survival intervention addresses the
major problems of sick newborn such as birth asphyxia, bacterial
infection, jaundice, hypothermia, low birthweight, counseling of
breastfeeding.
FAMILY HEALTH

• It also maintains its aim to address major childhood illnesses like

Pneumonia, Diarrhoea, Malaria, Measles and Malnutrition among
under 5 year’s children in a holistic way.
FAMILY HEALTH

• In CB-IMNCI program, FCHVs are expected to carry out health

promotional activities for maternal, newborn and child health and
dispensing of essential commodities like distribution of iron, zinc,
ORS, chlorhexidine which do not require assessment and diagnostic
skills, and immediate referral in case of any danger signs appeared
among sick newborn and children.
FAMILY HEALTH

• Health workers will counsel and provide the health services like
management of non-breathing cases, low birth weight babies, common
childhood illnesses, and management of neonatal sepsis.
• Also the program has provisioned for the postnatal visits by trained
health workers through primary health care outreach clinic.
• CBIMNCI program has been implemented in 77 districts.
FAMILY HEALTH
Facility-based Integrated Management of Childhood and Neonatal Illnesses:
The Facility-Based Integrated Management of Neonatal and Childhood
Illnesses(FB-IMNCI)package has been designed specially to address childhood
cases referred from peripheral level health institutions to higher institutions.
The package is linked strongly with the on-going Community Based Integrated
Management of Neonatal and Childhood Illness (CB-IMNCI).
The package is expected to bridge the existing gap in the management of
complicated neonatal and childhood illnesses and conditions.
FAMILY HEALTH
Free Newborn Care Services :
The Government of Nepal (GoN) has made provisions on treating sick
newborn free of cost through all tiers of its health care delivery outlets.
The aim of this program is to prevent any sorts of deprivation to health
care services of the newborn due to poverty. Based on the treatment
services offered to the sick-newborn, the services are classified into 3
packages: A, B and C.
FAMILY HEALTH

• The new born corners in health posts and PHCs offer Package ‘A’,
district hospitals with Special Newborn Care Unit (SNCU) offer
Package ‘B’ and zonal hospitals and other tertiary hospitals offering
Neonatal Intensive Care Unit (NICU) provide services for Package ‘C’.
FAMILY HEALTH
Newborn Care Programme Provision :
For sick newborns:
A payment to health facilities for providing free sick newborn care. Facilities are
reimbursed for set packages of care: Packages 0, A, B and C costing nothing, NPR 1,000,
NPR 2,000 and NPR 5,000 respectively.
• Health facilities can claim a maximum of NPR 8,000 (packages A+B+C), depending on
medicines and diagnostic and treatment services provided.
Incentives to health service provider:
A payment of NPR 300 to health workers for providing all forms of packaged services to
be arranged from health facility reimbursement amounts.
FAMILY HEALTH

• The goal of the Free Newborn Care Service Package is to achieve the
sustainable development goal through increasing access of the
newborn care services to reduce newborn mortality.
• The program makes the provision of disbursing Cost of Care to
respective health institutions required for providing free care to
inpatient sick newborns.
FAMILY HEALTH

Goals, targets, objectives, strategies, interventions and activities of

IMNCI program :
Goal :
Improve newborn and child survival and healthy growth and
development.
FAMILY HEALTH
Targets of Nepal Health Sector Strategy (2015-2020):

• Reduction of Under-five mortality rate (per 1,000 live births) to 28 by

2020
• Reduction of Neonatal mortality rate (per 1,000 live births) to 17.5 by
2020
FAMILY HEALTH
Objectives:
• To reduce neonatal morbidity and mortality by promoting essential
newborn care services
• To reduce neonatal morbidity and mortality by managing major cause
of illness
• To reduce morbidity and mortality by managing major causes of
illness among under 5 years children
FAMILY HEALTH
Strategies:
• Quality of care through system strengthening and referral services for
specialized care
• Ensure universal access to health care services for new born and young
infant
• Capacity building of frontline health workers and volunteers
• Increase service utilization through demand generation activities

• Promote decentralized and evidence-based planning and programming

FAMILY HEALTH
Major interventions :
Newborn Specific Interventions :
• Promotion of birth preparedness plan
• Promotion of essential new born care practices and postnatal care to mothers and
newborns
• Identification and management of non-breathing babies at birth
• Identification and management of pre term and low birth weight babies
• Management of sepsis among young infants (0-59days) including diarrhoea
FAMILY HEALTH

Child Specific Interventions :

• Case management of children aged between2 -59 months for 5 major
childhood killer diseases (Pneumonia, Diarrhoea, Malnutrition,
Measles and Malaria).
FAMILY HEALTH
Cross-Cutting Interventions:
• Behaviour change communications for healthy pregnancy, safe
delivery and promote personal hygiene and sanitation
• Improved knowledge related to Immunization and Nutrition and care
of sick children
• Improved interpersonal communication skills of HWs and FCHVs
FAMILY HEALTH
Vision 90 by 20 :
CB IMNCI Program Vision
CB-IMNCI program has a vision to provide targeted services to 90% of
the estimated population by 2020.
FAMILY HEALTH
FAMILY HEALTH
Cb-IMNCI Program Monitoring Key Indicators :
Regular monitoring is important for better management of program.
Therefore, CB-IMNCI program has identified 6 major indicators to
monitor the programs that are listed below:
• % of Institutional delivery
• % of newborn who had applied Chlorhexidine gel immediately after
birth (within one hour)
• % of infants (0-2 months) with PSBI (Possible Serious Bacterial
Infection) receiving complete dose of Injection Gentamicin
FAMILY HEALTH

 % of under 5 children with pneumonia treated with antibiotics

• % of under 5 children with diarrhoea treated with ORS and Zinc
• Stock out of the 5 key CB-IMNCI commodities at health facility (ORS,
Zinc, Gentamicin,Amoxicillin/Cotrim, CHX)
FAMILY HEALTH
Nepal Every Newborn Action Plan (NENAP) :

It aims to achieve NMR of less than 11 deaths per 1000 live births and
stillbirth rate of less than 13 stillbirths per 1000 total births by the year
2035.
FAMILY HEALTH
UN DECLARATION OF THE RIGHTS OF THE CHILD :
The year 1959 ushered in a new era in child welfare. To meet the
special needs of the child, the General Assembly of the United Nations
adopted on 20th November 1959, the Declaration of the Rights of the
Child.
FAMILY HEALTH
The Rights of the Child are :
1. Right to develop in an atmosphere of affection and security and,
wherever possible, in the care and under the responsibility of his/her
parents.
2.Right to enjoy the benefits of social security, including nutrition,
housing and medical care.
3. Right to free education.
4. Right to full opportunity for play and recreation.
FAMILY HEALTH

5. Right to a name and nationality.

6. Right to special care, if handicapped.
7. Right to be among the first to receive protection and relief in times
of disaster.
8. Right to learn to be a useful member of society and to develop in a
healthy and normal manner and in conditions of freedom and dignity.
FAMILY HEALTH

9. Right to be brought up in a spirit of understanding, tolerance,

friendship among people, peace and universal brotherhood; and
10. Right to enjoy these rights, regardless of race, colour, sex, religion,
national or social origin.
FAMILY HEALTH

Nepal's Children's Act 2075:

On 18th September 2018, the Government of Nepal endorsed a new
Children's Act 2075, paving the way to respect, protect and fulfil the
rights of children in Nepal.
FAMILY HEALTH

• This new Children's Act means a lot for the children of Nepal. It builds
upon certain national and international provisions that are meant to
promote children's rights.
• Among them, the United Nations Convention on the Rights of the
Child (UNCRC) is of most importance.
FAMILY HEALTH

• Nepal's 2015 Constitution actually has an article dedicated to

children’s fundamental rights - but this new act translates these
provisions and the children’s fundamental rights provided in the
constitution, into a legislative provision, which then allows children to
exercise their rights legally.
FAMILY HEALTH
• The new Children's Act in Nepal is very different. It substantially
differs from the earlier children's act of 1992, as it recognises that
children are entitled to these rights - and the state has an obligation
to uphold their rights.
• This obligation is three-fold - the need to respect the rights, protect
the rights and fulfil the rights of Nepal’s children.
• Another new significant addition to the provision list includes that
everything must be done to promote the best interest of the children.
FAMILY HEALTH

Social problems in children:

• Child abuse
• Abandoned or street children
• Child labour (any child under the age of 18 should not be working in
any type of hazardous condition, as it would be against the ILO
convention 182- which bans all the worst forms of child labour)
• Conflict and refugee situation and it’s impact on child health
FAMILY HEALTH
• Child labour refers to any work that deprives children of their childhood,
their right to education, health, safety and mental development based on
the ILO standards on child labour
are defined by the ILO Minimum Age Convention, 1973 (No. 138) and the
Worst Form of Child
Labour Convention, 1999, (No. 182).

• In Nepal, there are over 1 million children engaged in child labour. A UNICEF
report carried out in 2021, estimates 17,000 of Nepal's child labourers are
working in brick factories.
• 1 in 10 of the workers in brick factories are children. Some are as young as 5
years old.
FAMILY HEALTH

• According to the WHO, the leading causes of death among children

under age 5 in 2016 were preterm birth complications, pneumonia,
birth asphyxia, intrapartum complications, congenital anomalies,
diarrhea, and malaria (WHO 2017).
• The discrepancy in child mortality was also observed by geography,
sex, and socioeconomic status (UN IGCME 2017).
FAMILY HEALTH

• In Nepal, diarrhea, upper respiratory tract infections, lower

respiratory tract infections, fever (typhoid and para-typhoid), anemia,
malnutrition, pneumonia, injury, birth asphyxia, and sepsis were the
top ten illnesses in under-5 children that lead to hospital admission.
FAMILY HEALTH
CHILD HEALTH PROBLEMS :

1. low birth weight

2. malnutrition
3. infections (diarhoea and pneumonia) and parasitosis
4. accidents and poisoning
5. behavioural problems.
FAMILY HEALTH

• The Nepal Demographic and Health Survey (NDHS) 2016 has explored
the prevalence of fever, diarrhea, and symptoms of acute respiratory
infection (ARI) in Nepal and reported that 21.0% of children had fever,
7.6% had diarrhea, and 2.4% had ARI symptoms 14 days before the
day of the survey.
• According to the same report, the NMR of Nepal was 21 per 1,000
live births, while the under-5 mortality was 39 per 1,000 live births.
FAMILY HEALTH

• The NDHS 2016 revealed that nearly a third of the causes of neonatal
mortality in Nepal were respiratory and cardiovascular disorders
(31%) and complications of pregnancy, labor, and delivery (30%),
followed by infection specific to the perinatal period (16%), congenital
malformations and deformations (7%), hypothermia (4%), sudden
neonatal death (6%), disorders related to the length of gestation and
fetal growth (2%), and others (5%).
FAMILY HEALTH

• Prevalence of diarrhea in Nepal was found to be higher among

children age 6-23 months, malnourished children, children from a
household with unimproved water and sanitation facilities, children of
poorer households, children of low-educated mothers, and mothers
who do not practice proper hand washing.
FAMILY HEALTH
Nepal’s Policies and Programs Aimed at Improving Child Health:
Child health is one of the priority programs of the Government of Nepal
(GoN). Previous national surveys showed that disparities exist in
childhood morbidity and mortality, which are higher in marginalized
communities, among the poor and uneducated, and those from a rural
area.
FAMILY HEALTH
• To ensure universal coverage of child health services and to reach
children from the hard-to-reach communities, the Child Health
Division (CHD) (now the Family Welfare Division) has developed and
implemented various community-based programs: the community-
based ARI and diarrhea control program (CBAC), the community
based integrated management of childhood illness (CB-IMCI), the
community based newborn care program (CB-NCP), the community
based integrated management of neonatal and childhood illness (CB-
IMNCI), an integration of CB-IMNCI and CBNCP, and a free newborn
care program.
FAMILY HEALTH
• The GoN has also mobilized female community health volunteers
(FCHVs) who provide services to those hard-to-reach communities.
• The GoN is also strengthening facility-based services by establishing
and expanding special newborn care units (SNCU) and neonatal
intensive care units (NICU) in the government hospitals.
FAMILY HEALTH
• Nepal has recently committed to improving child health in the
international arena by endorsing the “Committing to Child Survival: A
Promise Renewed” and the Sustainable Development Goals (SDGs)
that strive to end preventable deaths.
• Nepal has targeted the reduction of under-5 mortality to 28 per 1,000
live births and the neonatal mortality rate to 12 per 1,000 live births
by 2030.
FAMILY HEALTH
• Improving child mortality and morbidity is one of the government’s
commitments to the national and international communities.
• The GoN achieved its Millennium Development Goals (MDGs) target
of reducing under-5 mortality to 54 deaths per 1,000 live births by
2015, although there is more work to be done to meet the SDGs
target of reducing under-5 mortality to 28 deaths per 1,000 live births.
FAMILY HEALTH
• Even more challenging is the goal of reducing neonatal mortality to
below 12 per 1,000 live births from the current rate of 21 per 1,000
live births.
• In 2016, Nepal was successful in reducing neonatal mortality from the
2011 level, although the current NMR remains high compared to the
global NMR.
FAMILY HEALTH

• Symptoms of ARI, fever, and diarrhea are the major childhood

illnesses captured in the NDHS.
• The prevalence of ARI symptoms and diarrhea dropped significantly,
although the prevalence of fever showed a sharp rise in 2016 (17% in
2006 to 21% in 2016).
FAMILY HEALTH

• The prevalence of diarrhea was higher among children from

households with poor access to improved water and sanitation,
children below age 2, and children with higher birth order.
• The symptoms of ARI were more common among children who reside
in hilly areas, children from poor families, and children below age 2.
FAMILY HEALTH

Incidence of diarrhea per thousand under 5 years children was 375 in

FY 2075/76,being highest at Karnali. Lowest incidence was in Bagmati
province.
Total diarrhoeal deaths in health facility and PHC/ORC was 63 cases
which increased by 34% than last fiscal year.
In FY 2075/76,the proportion of diarrhoeal cases treated with ORS
and zinc as per national IMNCI protocol at national level was 95%.
FAMILY HEALTH
Acute Respiratory Infections:
As per CB-IMNCI protocol, every ARI cases should be properly assessed
and classified as no pneumonia, pneumonia and severe pneumonia and
given home therapy, treated with appropriate antibiotics or referred to
higher center as per indications.
The incidence of pneumonia at national level was 83 per 1000 under 5
children in FY 2075/76.
Highest ARI incidence was seen in Karnali and least in Bagmati
province.
FAMILY HEALTH
Child health surveillance:
• When a child is sick, parents know to take them to their doctor,
but paediatrician visits are just as important for healthy children as
they grow and develop.
• Regular check-ups are important for all children to keep track of their
physical, emotional and social development.
FAMILY HEALTH
• Child health surveillance is the concept that children should have
scheduled and regular paediatrician visits to screen and assess them
for any underlying health condition from infancy through
adolescence.
• This is to prevent disease and detect physical and developmental
abnormalities from an early age. The American Academy of
Paediatrics calls these visits well-child visits.
FAMILY HEALTH

• The health care team will conduct a physical examination, measure

height and weight,
• update immunisations, (recommended immunisation schedules) and
allow you, as a parent or care provider, to ask any questions you may
have regarding your child’s health.
E.g. Vaccine preventable diseases (VPD) surveillance
FAMILY HEALTH
Child survival strategies:
Recent advances in child survival have often been at the expense of
increasing inequity. Successive interventions are applied to the same
population sectors, while the same children in other sectors consistently
miss out, leading to a trend towards increasing inequity in child survival.
This is particularly important in the case of pneumonia, the leading cause
of child death, which is closely linked to poverty and malnutrition, and for
which effective community-based case management is more difficult to
achieve than for other causes of child death.
FAMILY HEALTH

• The key strategies for the prevention of childhood pneumonia are

case management, mainly through Integrated Management of
Childhood Illness (IMCI), and immunization, particularly the newer
vaccines against Haemophilus influenzae type b (Hib) and
pneumococcus.
FAMILY HEALTH

• There is a tendency to introduce both interventions into communities

that already have access to basic health care and preventive services,
thereby increasing the relative disadvantage experienced by those
children without such access. Both strategies can be implemented in
such a way as to decrease rather than increase inequity.
FAMILY HEALTH

• It is important to monitor equity when introducing child-survival

interventions. Economic poverty, as measured by analyses based on
wealth quintiles, is an important determinant of inequity in health
outcomes but in some settings other factors may be of greater
importance.
FAMILY HEALTH

• Geography and ethnicity can both lead to failed access to health care,
and therefore inequity in child survival. Poorly functioning health
facilities are also of major importance.
• Countries need to be aware of the main determinants of inequity in
their communities so that measures can be taken to ensure that IMCI,
new vaccine implementation and other child-survival strategies are
introduced in an equitable manner.
THANK-YOU