Que. 1. What do you mean by Reproductive Health?

Ans. 1. Reproductive Health implies that people are able to have a satisfying and safe sex life and that they have the capability to reproduce and the freedom to decide if, when and how often to do so.

Que. 2. What are the reproductive rights?

Ans. 2. The reproductive rights of a person in reproductive age group are as follows –

• Reproductive decision making
• Rights to have access to the information and means needed to exercise voluntary choice
• Equality & equity, free from gender description
• Reproductive security, including freedom from sexual violence & harassment
• Right to privacy
• Right to access to appropriate health care services.

Que. 3. What are the adverse outcomes if pregnancies taking place within 24 months of a previous birth?

Ans. 3. The adverse outcomes in above condition may be Abortions, Premature labor, PPH, Low birth weight babies, fetal loss and maternal death.

Que. 4. What do you mean by the Immediate Postpartum Period?

Ans. 4. It is the period within 48 hours after delivery.

Que. 5. What do you mean by the extended postpartum period?

Ans. 5. Extended postpartum period is period between 6 weeks to the first 12 months after birth of baby.

Que. 6. Why is immediate postpartum period important?

Ans. 6. As it is the ideal time for –

• Educating and counselling for exclusive breastfeeding as a contraceptive method.
• Counselling on Family planning
• PPIUCD insertions

Que. 7. What is the early postpartum period?

Ans. 7. It is the period up to 7 days after delivery.

Que. 8. Why is early postpartum period important?

Ans. 8. Because during this period one can undergo postpartum sterilization (PPS) and messages on Lactation Amenorrhea Method (LAM) may be reinforced.

Que. 9. Why is extended postpartum period important?

Ans. 9. Spacing methods like IUCD & other methods as per the medical eligibility criteria (MEC) can be provided. Laparoscopic / Minilap tubal ligation can also be performed during this period.

Que. 10. Why is postpartum period considered crucial for family planning?

Ans. 10. During the postpartum period women are highly motivated and receptive to accept family planning methods. Demographic & health survey show that 40% of women in the first year postpartum intend to use a family planning method but are not doing so.

Que. 11. Which are the conditions in baby resulting after short birth interval?

Ans. 11. The conditions resulting after short birth interval in a baby are as follows –

• Being born pre term
• Being small for the gestational age
• Death during newborn period or childhood

Que. 12. In India, what proportion of women have in the first year postpartum an unmet need for family planning?

Ans. 12. 65%

Que. 13. What proportion of women are using any modern method of family planning during the first year postpartum?

Ans. 13. 26%

Que. 14. When one will expect return of fertility after delivery in partially breastfeeding or not breastfeeding women?

Ans. 14. Women may resume menses within 4-6 weeks of delivery.

Que. 15. When one will expect return of fertility following an abortion?

Ans. 15. Fertility returns, following an abortion in a woman within 10-11 days.

Que. 16. After spontaneous or induced abortion, a woman should wait till what time before attempting next pregnancy?

Ans. 16. 6 months

Que. 17. For healthy Spacing, what should be the ideal birth to pregnancy interval?

Ans. 17. The birth to pregnancy interval is the time period between a live birth and the start of next pregnancy. Ideally it should be 24 months or 2 years (but not more than 5 years).

Que. 18. For healthy spacing, what should be the ideal birth to birth interval?

Ans. 18. 36 months

Que. 19. What proportion of births in India does not fall in ideal birth to birth interval?

Ans. 19. 61%.

Que. 20. Why should IUCD not be inserted from 48 hours to 6 weeks following delivery?

Ans. 20. Because there is increased risk of infection and expulsion.

Que. 21. What are the timings of IUCD insertions?

Ans. 21. The usual timings of IUCD insertion are as follows –

1. Immediate postpartum –

• Post placental – within 10 minutes after expulsion of the placenta following a vaginal delivery on the same delivery table.
• Intracaesarian – during caesarian delivery, after removal of placenta and before closure of the uterine incision.
• Within 48 hours after delivery

1. Post abortion – following an abortion, if there is no infection, bleeding or any other contraindications.
2. Extended postpartum – any time after 6 weeks postpartum.

Que. 22. What are the advantages of an IUCD insertion in the immediate postpartum period?

Ans. 22. The advantages of an IUCD insertion in the immediate postpartum period are as follows –

• Convenience, save times and additional visit.
• Safe
• No risk of uterine perforation because of thick wall of uterus.
• Reduced perception of initial side effects (Bleeding & Pain)
• Reduced chances of heavy bleeding
• No effect on amount or quality of breast milk.
• Woman has an effective FP method before discharge.
• Service providers are certain that woman is not pregnant and require minimal additional instruments, supplies and equipment

Que. 23. What is the specific limitation of IUCD insertion in the immediate postpartum period?

Ans. 23. Increased risk of spontaneous expulsion which reduces when trained and skilled person with right technique does the insertion.

Que. 24. What are the timings of counselling for immediate PPIUCD?

Ans. 24. The timings of counselling for immediate PPIUCD are given below –

• During antenatal visits
• During admission
• During early labor
• On the first day of postpartum period
• Prior to scheduled Caesarian section

Que. 25. When should be the first follow up visit after immediate PPIUCD insertion if there is no complication?

Ans. 25. 6 weeks

Que. 26. What services are to be provided to woman coming for follow up visit after immediate PPIUCD insertion?

Ans. 26. Followings to be done during 1^st follow up visit –

• Ask for any complaint
• Ask for spontaneous expulsion of IUCD
• Clinical assessment for anemia if there is history of excessive or prolonged bleeding following insertion
• Per speculum examination to assess if strings of IUCD are visible in the vagina
• Do Pelvic examination if required
• If she has no complaint, there is no need of additional follow up visits
• Tell lady to come again if there is any problem like heavy bleeding, severe pain or spontaneous expulsion

Que. 27. Which standard universal precautions of infection prevention must be followed during IUCD insertion?

Ans. 27. The standard universal precautions of infection prevention to be followed are given below –

• Hand washing following all steps
• Self-protection such as wearing gloves and physical barrier
• Safe work practices and maintaining asepsis
• Maintain environmental cleanliness
• Processing of equipment and other items.

Que. 28. What are the contraindications for the insertion of the immediate PPIUCD?

Ans. 28. The contraindications to PPIUCD insertion are as follows –

• Chorioamnionitis
• Postpartum endometritis/ metritis or puerperal sepsis
• More than 18 hours from rupture of membranes to delivery of the baby
• Unresolved PPH
• Extensive genital trauma

Que. 29. How will you prepare 0.5% chlorine solution using 30% bleaching powder?

Ans. 29. Mix 15 grams (3 leveled teaspoons) of commercially available bleaching powder in one liter of tap water after making paste with small quantity of water and mix well by stirring it.

Que. 30. Which forceps is used for the immediate postpartum IUCD insertion?

Ans. 30. Long placental (Kelly’s) forceps.

Que. 31. Mention the tips for reducing spontaneous expulsion of PPIUCD.

Ans. 31. The tips for reducing Spontaneous expulsion of PPIUCD are given below –

• Right Technique –
• Elevate the uterus
• Place IUCD at fundus of uterus
• Sweep instrument to the side of the uterine cavity
• Keep placental forceps closed while going in and open while coming out of the uterine cavity
• Right Instrument –
• Use long placental forceps to reach the uterus
• Right Time –
• Post placental & intracaesarian insertions have lowest expulsion rates

Que. 32. What are the warning signs after PPIUCD insertion that require immediate assessment?

Ans. 32. The warning signs after PPIUCD insertion requiring immediate assessment are given below –

• Heavy vaginal bleeding
• Severe lower abdominal discomfort
• Fever and not feeling well
• Unusual vaginal bleeding
• Suspected expulsion
• Any other problems or questions she has related to IUCD.

Que. 33. What are the instructions mentioned on IUCD card that are given to woman after insertion?

Ans. 33. The instructions mentioned on IUCD cards are as follows –

• Type of IUCD inserted
• Date of IUCD insertion
• Month and year when IUCD will need to be removed or replaced
• Date of postpartum follow up visit
• Where to go or call if she has problems or questions about her IUCD.

Que. 34. What are the possible signs/symptoms of displacement of PPIUCD?

Ans. 34. The possible signs/ symptoms of displacement of PPIUCD are given below –

• IUCD can be visualized in the cervix or upper vagina after displacement
• The woman has discomfort or pain
• Length of the string visible in the vagina is not consistent with fundal positioning in an immediate postpartum uterus.

Que. 35. What is the management of displacement of the PPIUCD?

Ans. 35. Using a HLD or sterile placental forceps, remove the IUCD and insert the same IUCD if not contaminated, with all aseptic precautions. If the IUCD has been contaminated, discard and use a new IUCD.

Que. 36. What are the clinical features of uterine perforation?

Ans. 36. The clinical features of uterine perforation are given below –

• Sudden loss of resistance to the inserting instrument during PPIUCD insertion
• Unexplained pain
• Uterine depth greater than expected

Que. 37. What is the management of uterine perforation during PPIUCD insertion?

Ans. 37. The management of uterine perforation during PPIUCD insertion are as follows –

• If suspected during insertion, stop the procedure immediately and gently remove the instruments & IUCD.
• Keep the client at rest, start an IV drip and observe the vital signs, abdominal tenderness, guarding or rigidity.
• If there is severe abdominal pain, any change in vital signs or peritoneal signs appear, refer for surgical emergency intervention.
• Prophylactic antibiotics can be given.

Que. 38. What is the management of client with discomfort/ pain during PPIUCD insertion?

Ans. 38. The management of client with discomfort/pain during PPIUCD insertion is given below –

• Reassure the client that a moderate amount of discomfort is associated with insertion.
• Continue communicating with the client during the procedure.
• Perform the procedure as gently and as quickly as possible.

Que. 39. The risk of upper genital tract infection among IUCD users is less than 1%. What are the causes of infection of upper genital tract following PPIUCD insertion?

Ans. 39. The Causes of upper genital infections following PPIUCD insertion are as follows –

• Faulty technique (due to lack of proper infection prevention practices)
• Pre- existing infections.

Que. 40. What are the clinical features of upper genital infection?

Ans. 40. The clinical features are given below –

• Low abdominal pain
• Painful intercourse
• Fever
• Bleeding after intercourse
• New onset of pain associated with periods
• Bleeding between periods after resumption of normal period
• Abnormal vaginal bleeding
• Nausea and vomiting

Que. 41. What is the management of IUCD string problems?

Ans. 41. The management of IUCD string problems is as follows –

• Reassure the woman and her partner that the strings are very flexible and not harmful.
• If it is bothersome to the woman’s partner, strings can be cut short if they are long.
• If the strings are too short and bother the partner, a new IUCD may be inserted.

Que. 42. What is the management of partial or complete IUCD expulsion?

Ans. 42. The management is as follows –

• If complete expulsion of the IUCD is confirmed, insert IUCD if desired after assessing the client for excluding pregnancy and infection or counsel for other FP methods.
• If partial expulsion of IUCD is confirmed, remove the IUCD and provide another IUCD if desired and appropriate or counsel for other FP methods.
• If IUCD appears to be embedded in the cervical cancer and cannot be removed by the standard technique, refer the woman to a specialist.

Que. 43. What are possible clinical features of pregnancy with an IUCD in place?

Ans. 43. The clinical features of pregnancy with IUCD in place are as follows –

• Missed menstrual period
• Other features of pregnancy
• Missing strings
• Strings which are shorter or longer than expected

Que. 44. How will you confirm complete expulsion of IUCD?

Ans. 44.  Complete expulsion of IUCD can be confirmed by the –

• Seen by woman
• X- Ray
• Ultrasound

Que. 45. What are the objectives of follow up care in IUCD insertion?

Ans. 45. The objectives of follow up care in IUCD insertion are as follows –

• Assess the woman’s overall satisfaction with the IUCD and address any questions or concerns she may have.
• Identify and manage potential problems
• Reinforce key messages

Que. 46. When will you remove IUCD in follow up care?

Ans. 46. IUCD will be removed in following conditions –

• If client is not satisfied and willing to remove
• Puerperal Sepsis
• Perforation of the uterine wall
• Persistent uterine cramping of unknown origin

Que. 47. Who can use PPIUCD?

Ans. 47. Most postpartum women can safely use the PPIUCD, including those who are young, breastfeeding or doing hard work.

It is especially good for women who think they do not want any more children, but want to delay sterilization until they are certain.

Que. 48. What is the effectiveness of an IUCD?

Ans. 48. The IUCD is more than 99% effective in preventing pregnancy, making it one of the most effective, reversible contraceptive methods currently available.

Que. 49. How much is compensation offered to a service provider and ASHA on one PPIUCD insertion?

Ans. 49. Rs. 150/- to each on one PPIUCD insertion.

Que. 50. When were Emergency Contraceptive Pills (ECPs) introduced by Government of India in the national family welfare program and with what objectives?

Ans. 50. In 2003 with the objective to prevent unwanted pregnancies.

Que. 51. What is the relation of unsafe abortions with the maternal mortality and morbidity?

Ans. 51. Unsafe abortions are one of the leading causes of maternal mortality, being responsible for 8% of the total maternal deaths. It is also a major contributor to maternal morbidity.

Que. 52. What does the Emergency Contraception term implies?

Ans. 52. Emergency Contraception refers to back up methods for contraceptive emergencies which women can use within the first few days after unprotected intercourse to prevent an unwanted pregnancy.

Que. 53. What are the indications of emergency contraception?

Ans. 53. The indications of emergency contraception are as follows –

• After voluntary sexual act without contraceptive protection
• Incorrect or inconsistent use of regular contraceptive methods
• In case of contraceptive failure or mishap
• In the event of sexual assault

Que. 54. What are the different methods of emergency contraception?

Ans. 54. Different methods of emergency contraception are given below –

• High doses of Progesterone only pill containing Levonorgestrel (LNG)
• High doses of combined oral contraceptives (Yuzpe regimen)
• IUCD such as CuT 380A

Que. 55. What is approved dose preparation of ECPs by Drug Controller of India?

Ans. 55. Levonorgestrel (LNG) 0.75/1.5 mg tablet

Que. 56. What is the mechanism of action of ECPs?

Ans. 56. Emergency Contraceptive Pills (ECPs) interfere with ovulation/ fertilization/ implantation depending on the phase of the menstrual cycle of women. ECP is not effective once the process of implantation of fertilized ovum has begun.

Que. 57. What are the advantages of ECPs?

Ans. 57. The advantages of ECPs are as follows-

• Safe & effective
• Easy to use and widely available
• Can be taken at any time during the menstrual cycle
• Prior physical examination is not required
• Available without a prescription from registered medical practitioner
• Can be given to women in whom hormonal contraceptive pills are contraindicated
• Can be used as many times as needed
• No serious medical complications reported
• Does not associated with congenital defects
• Does not increase the risk of ectopic pregnancy

Que. 58. What is the mode of administration of ECPs?

Ans. 58. ECPs must be preferably taken within 72 hours of an unprotected intercourse, the earlier the better. Dosage – Single tablet of 1.5 mg or 2 tablets of 0.75 mg each or 1 tablet of 0.75 mg each 12 hours apart.

Que. 59. What are the limitations of ECPs?

Ans. 59. The limitations of ECPs are as follows –

• The closure a woman is to ovulation at the time of unprotected intercourse, higher is the pregnancy risk and lower is the efficiency of ECPs.
• Failure of emergency contraception to prevent pregnancy beyond the time frame of efficacy window (72-120 hours).

Que. 60. What is the effect of ECP on menstrual cycle of woman?

Ans. 60. Normally ECPs does not effect on woman’s menstrual period. But in 10-15% women, ECPs change the amount, duration and timing of the next menstrual period. These effects are usually minor and does not need any treatment.

Que. 61. Which category of clients need to be informed & educated on ECPs?

Ans. 62. – Clients using condom & oral pills as there is chances of contraceptive mishap.

• Potential Contraceptive users
• Clients exposed to unprotected sexual act/ rape.

Que. 63. Does ECPs affect breastfeeding?

Ans. 63. ECPs, being progestin pill does not affect the quantity & quality of breast milk so can be used in breast feeding women within 72 hours of unprotected intercourse.

Que. 64. If the recommended time limit of 72 hours of using ECPs have been crossed, what should be done?

Ans. 64. Either insert interval IUCD at this stage or refer her to appropriate Health Center.

Que. 65. If client becomes pregnant after using ECPs, What will be the next step?

Ans. 65. Now there are only two options left,

• Explain her that ECPs are not 100% effective, counsel for MTP.
• In case she wants to continue pregnancy, assure her that there will be no harm to the fetus as a result of ECP use.

Que. 66. When will be follow up counselling required among ECPs users?

Ans. 66. Among ECPs users, follow up counselling will be required in following circumstances –

• Her period is late by more than a week of the expected date
• Menstrual bleeding is too scanty in amount or too small in duration
• She wants to use regular FP method
• She needs some clarification about ECPs use

Que. 67. When was Family Planning Indemnity Scheme launched?

Ans. 67. 1^st April 2013

Que. 68. What is the objective of Family Planning Indemnity Scheme (FPIS)?

Ans. 68. State /UTs would process and make payment of claims to acceptors of the sterilization in the event of death/ failure/ complications/ indemnity cover to doctors/health facilities.

Que. 69. What is the coverage of FPIS?

Ans. 69.  The scheme is uniformly applicable for all states/UTs. Claims arising out of cases of sterilization operations which were detected and reported after 1^st April 2013 will be covered under the scheme.

Que. 70. How much buffer stock should be kept at State, district & Sub center level in the supply chain management of PTKs?

Ans. 70. 5% at state level, 5% at district level & 50% at HSC level.

Que. 71. Are the PTKs, part of ASHA drug kit?

Ans. 71. Yes. PTKs are distributed free of cost to the clients in the field by ASHA.

Que. 72. To categorize LAM, which are the mandatory conditions?

Ans. 72. The mandatory conditions of LAM are given below –

• The mother’s menstrual bleeding has not returned
• The baby is fully or nearly fully breastfed and is fed often day & night
• The baby is less than 6 months old

Que. 73. What is the mechanism of action of LAM?

Ans. 73. LAM prevents the release of eggs from ovaries (ovulation). Frequent breastfeeding temporarily prevents the release of natural hormones that cause ovulation.

Que. 74. How effective is the LAM?

Ans. 74. As commonly used, about 2 pregnancies per 100 women using LAM in the first 6 months after childbirth. When used correctly, less than one pregnancy per 100 women using LAM.

Que. 75. What are the advantages of LAM?

Ans. 75. The advantages of LAM are as follows –

• It is a natural family planning method.
• It supports optimal breastfeeding, providing health benefits for the baby & the mother
• It has no direct cost for family planning or for feeding of the baby

Que. 76. Why do women prefer fertility awareness methods?

Ans. 76. Women prefer fertility awareness methods because of following reasons –

• Have no side effects
• Do not require procedures and supplies
• Help woman learn about their bodies and fertility
• Allow some couples to adhere their religious or cultural norms about contraception
• Can be used to identify fertile periods

Que. 77. What is the effectiveness of fertility awareness methods when used as commonly?

Ans. 77.  As commonly used, in the 1^st year about 25 pregnancies per 100 women users.

Que. 78. What is the pregnancy rates with consistent & correct use of fertility awareness methods?

Ans. 78. Standard days method —- 5 pregnancies per 100 women users (1^st year)

Calendar rhythm method – 9 pregnancies per 100 woman users (1^st year)

Two days method  ———– 4 pregnancies per 100 woman users (1^st year)

BBT method ——————– 1 pregnancies per 100 woman users (1^st year)

Ovulation Method ————- 3 pregnancies per 100 woman users (1^st year)

Symptothermal method —— 2 pregnancies per 100 woman users (1^st year)

Que. 79. How many days of abstinence or use of another method might be required for each of the fertility awareness methods?

Ans. 79. Number of days varies based on the woman’s menstrual cycle length. The average number of days a woman would be considered fertile- and would need to abstain or use another method- with each method is as follows –

SDM – 12 days, Two days method – 13 days, Symptothermal method – 17 days & ovulation method – 18 days.

Que. 80. In standard days method, when can the couple have unprotected intercourse?

Ans. 80. The couple can have unprotected sex from day 1 to day 7 of the menstrual cycle and from day 20 until her next monthly bleeding begins (Day 8 to Day 19 of every cycle are considered fertile days for all users of the SDM).

Que. 81. In SDM, which memory AIDs may be used?

Ans. 81. Cycle beads & Calendar

Que. 82. What is the pre-requisite of calendar rhythm method?

Ans. 82. Before relying on this method, a woman records the number of days in each menstrual cycle for at least 6 months.

Que. 83. How a woman can estimate the fertile period using calendar Rhythm Method?

Ans. 83. The woman subtracts 18 from the length of her shortest recorded menstrual cycle. This tells her the estimated first day of her fertile period. Then she subtracts 11 days from the longest recorded cycle. This tells her the estimated last day of her fertile period.

Que. 84. What do you mean by Vasectomy?

Ans. 84. Vasectomy, a method of male sterilization, is a simple, minor surgical procedure done under local anesthesia. It is one of the safest and most effective family planning methods and is one of the few contraceptive choices available to men.

Que. 85. What is the failure rate of vasectomy?

Ans. 85. Between 0.2% to 0.4%.

Que. 86. What exactly is done in the vasectomy?

Ans. 86. In vasectomy, a small opening is made in the man’s scrotum and the vas differens on either side is closed off. This keeps sperms out of the semen. The man can still have erections and ejaculate semen, but his semen no longer makes a woman pregnant because it has no sperm in it.

Que. 87. What are the advantages of Vasectomy?

Ans. 87. The advantages of vasectomy are as follows –

• Very Effective
• Permanent
• Nothing to remember except to use condoms or another family planning method for at least 3 months initially
• Does not affect the man’s ability to have sex
• Increased sexual enjoyment because no need to worry about the pregnancy
• No supplies to get, no repeat clinic visits required
• No apparent long term health risks

Que. 88. What are the advantages of vasectomy compared to female sterilization?

Ans. 88. These are as follows –

• Probably slightly more effective
• Slightly more safer
• Easier to perform
• If there is charge, often less expensive
• Can be tested for effectiveness at any time.

Que. 89. What are the disadvantages of Vasectomy?

Ans. 89. The disadvantages of vasectomy are given below –

• Common minor short term complications of surgery
• Usually uncomfortable for 2-3 days
• Pain in scrotum, swelling & Bruising
• Brief feeling of faintness after procedure
• Uncommon complications of surgery
• Bleeding or infection at incision or side
• Blood clots in scrotum
• Reversal surgery is difficult & expensive
• Requires another contraceptive method for initial 3 months after vasectomy
• No protection against STIs/HIV

Que. 90. What are the conditions in which we have to delay the vasectomy & refer the client to treatment?

Ans. 90. If beneficiary has –

• Active sexually transmitted infection
• Inflamed (Swollen & Tender) tip of penis, ducts or testicles
• Scrotal skin infection or mass in the scrotum
• Acute systemic infection or significant gastroenteritis
• Filariasis or elephantiasis

Que. 91. What are the conditions in which you have to refer the client to a higher center for vasectomy?

Ans. 91. The conditions are given below-

• Hernia in the testis
• Undescended testicles on both sides
• Current – AIDS related illness
• Coagulation disorders

Que. 92. Why some men prefer vasectomy as contraception?

Ans. 92. Some men prefer vasectomy as contraception because –

• It is safe, permanent & convenient
• Has fewer side effects and complications
• The man take responsibility for contraception – takes burden of the family
• Increases enjoyment & frequency of sex

Que. 93. How does No Scalpel Vasectomy differ from conventional vasectomy using incisions?

Ans. 93. The points of difference are as follows –

• NSV uses one small puncture instead of 1 or 2 incisions in the scrotum
• No stitches are required to close the skin
• Special anesthesia technique needs only one needle puncture instead of 2 or more

Que. 94. What are the advantages of Non Scalpel Vasectomy (NSV)?

Ans. 94. The advantages of NSV are as follows –

• Lesser pain and bruising and quicker recovery
• Fewer infections & less chances of hematoma
• Total time for the vasectomy has been shorter when skilled provider uses the no scalpel approach

Que. 95. Does vasectomy increase a man’s risk of cancer or heart disease later on?

Ans. 95. No, vasectomy does not increase the risk of testicular or prostatic cancer or heart disease.

Que. 96. Can a man who has a vasectomy transmit or become infected with STIs/HIV?

Ans. 96.  Yes. Vasectomies do not protect against STIs including HIV. All men at risk of STIs/HIV, whether or not they have had vasectomies, need to use condoms to protect themselves and their partners from infection.

Que. 97. What is the failure rate of Female sterilization?

Ans. 97. < 2%, even 10 years after the surgery. In the first year – 0.5 pregnancies per 100 women

Que. 98. What exactly is done in the female sterilization?

Ans. 98. In female sterilization, both fallopian tubes of a woman which carry eggs from the ovaries to the uterus are blocked or cut off. With the tubes blocked, the woman’s eggs cannot meet the man’s sperm. The woman continues to have menstrual period.

Que. 99. What is the Postpartum Sterilization?

Ans. 99. Postpartum Sterilization (PPS) is one of the most effective sterilization techniques. It is done within 7 days of delivery of baby. In the first year, failure rate is 0.05 pregnancies per 100 women and within 10 years after the procedure, 0.75 pregnancies per 100 women.

Que. 100. What are the advantages of female sterilization?

Ans. 100. The advantages of female sterilization are given below –

• Very effective method of contraception
• A single procedure leads to life long, safe and very effective family planning
• Nothing to remember, no supplies needed and no repeated clinic visits required
• No interference with Sex. Does not affect the woman’s ability to have sex
• No effect on breast feeding
• No known side effects or health risks
• Mini-laparotomy can be performed just after a woman give birth
• Helps protect against ovarian cancer.

Que. 101. What are the uncommon complications of tubectomies?

Ans. 101. The uncommon complications of tubectomies are as follows –

• Infection or bleeding at the incision
• Internal infection or bleeding
• Injury to internal organs
• Anesthesia risk

Que. 102. What are the disadvantages of female sterilization?

Ans. 102. The disadvantages of female sterilization are given below –

• Usually painful at first, but pain recedes after a day or two
• Uncommon complications of surgery
• In the rare cases that pregnancy occur, it is likely to be ectopic than in a woman who used no contraception
• Requires physical examination & minor surgery by a specially trained provider
• Compared to male sterilization, female sterilization is slightly more risky and often more expensive, if there is fee.
• Reversal surgery is difficult
• No protection against STIs & HIV/AIDS

Que. 103. What are the common causes of failure of female sterilization?

Ans. 103. The common causes of failure of female sterilization are as follows –

• An undetected luteal phase pregnancy that was present at the time of sterilization
• Surgical occlusion of a structure other than the fallopian tube (most often, the round ligament)
• Incomplete or inadequate occlusion of the fallopian tube
• Misplacement of the mechanical device
• Development of tubo- peritoneal fistula

Que. 104. Why some women prefer female sterilization?

Ans. 104. Some women prefer female sterilization because

• Has no side effects
• No need to worry about contraception again
• Is easy to use, nothing to do or remember

Que. 105. Which is the contraceptive method that can protect against both pregnancy and sexually transmitted infections/ HIV?

Ans. 105. Condoms.

Que. 106. Why some people prefer condoms as contraceptive method?

Ans. 106. Some people prefer condoms as contraceptive method because of following reasons –

• Have no hormonal side effects
• Can be used as a temporary or back up method
• Can be used without seeing a health care provider
• Easy to access
• Help protect against both pregnancy & STIs/HIV

Que. 107. How effective are male condoms?

Ans. 107. If the partners of 100 women start using condoms, with typical use there is likelihood of 14 of these women getting pregnant in the first year of use of condoms.

With Correct & consistent use every time, there are 3 pregnancies per 100 women in the first year of use.

Que. 108. What are the advantages of male condoms?

Ans. 108. The advantages of male condoms are given below –

• Prevents STIs including HIV, as well as pregnancy when used correctly and consistently with every act of sexual intercourse
• Can be used soon after child birth
• No hormonal side effects
• Helps prevent ectopic pregnancies
• Can be stopped at any time
• Offer occasional contraception
• Helps protect individuals in unexpected sex
• Can be used by men of any age
• Can be used without consulting a health provider
• Usually easy to obtain and sold at most places
• Enables a man to take responsibility of preventing pregnancy and disease
• Often helps to prevent premature ejaculation

Que. 109. What are the disadvantages of male condoms?

Ans. 109. The disadvantages of male condoms are given below –

• Latex condoms may cause itching for a few people who are allergic to the latex
• The couple must take the time to put the condoms on the erect penis before sex
• Small possibility that condoms might slip off or break during sexual intercourse
• If not properly stored or if used with oil based lubricants, condoms can go weak and break
• High motivation is required
• In some hampers the sexual sensations

Que. 110. Why is using condom every time important?

Ans. 110. Using condom every time is important because –

• Just one unprotected act of intercourse can lead to pregnancy or transmission of STIs
• Looking at a person cannot tell you if he or she has STIs. A person with STI & HIV can look perfectly healthy.

Que. 111. What are the steps of male condom use?

Ans. 111. The steps of condom use are as follows –

• Use a new condom for each act of sex.
• Check the condom package. Tear open the package.
• Before any physical contact, place the condom on the tip of the erect penis with rolled side out.
• Unroll the condom all the way to the base of the erect penis
• Immediately after ejaculation, hold the rim of the condom in place and withdraw the penis while it is still erect
• Dispose of the used condom safely

Que. 112. What condom users should not do to avoid the condom breakage?

Ans. 112. The condom users should not do the followings to avoid the condom breakage –

• Don’t unroll the condom first and then try to put it on penis.
• Don’t use lubricants with an oil base because they damage the latex.
• Don’t use a condom if the color is uneven or changed.
• Don’t use a condom that feels brittle, dried out or very sticky
• Don’t reuse condoms
• Don’t have dry sex.

Que. 113. What can a couple do to reduce the risk of pregnancy if a condom slips or break during Sex?

Ans. 113. If a condom slips or breaks, taking ECPs can reduce the risk that a woman will become pregnant.

Que. 114. Is allergy to latex condom is common?

Ans. 114. No it is very rare and uncommon.

Que. 115. How effective is female condom?

Ans. 115. Effectiveness varies depending on use, from 21 pregnancies per 100 woman (as commonly used) to about 5 pregnancies per 100 women using female condoms over the first year (as correctly used).

Que. 116. Why do some women say that they like female condoms?

Ans. 116. Some women say that they like female condoms because –

• Women can initiate their use
• Have a soft, moist texture that feels more natural than male latex condoms during sex
• Help protect against both pregnancy and STIs, including HIV.
• Outer ring provides added sexual stimulation for some women
• Can be used without consulting a service provider

Que. 117. Can female condoms effectively prevent pregnancy & STI/HIV both?

Ans. 117. Yes, female condoms offer dual protection.

Que. 118. Can a female condom and a male condom be used at the same time?

Ans. 118. Male and female condom should not be used together. This can cause friction that may lead to slipping or tearing of condoms.

Que. 119. Can female condom be used in different sexual positions?

Ans. 119. Yes, can be used in any sexual position.

Que. 120. Can female condom be used more than once?

Ans. 120. No, it is not recommended.

Que. 121. Can the female condom be used while a woman is having her monthly bleeding?

Ans. 121. Woman can use the female condom during her menstrual bleeding. If a woman is using tampon, it must be removed before inserting a female condom.

Que. 122. What are the advantages of female condoms?

Ans. 122. The advantages of female condoms are given below –

• Female can control it
• No medical condition limit its use
• More comfortable to men, less decrease in sensation than male latex condoms
• Offers greater protection as it covers both internal and external genitalia
• Stronger (polyurethane is 40% more stronger than latex) and therefore there is less frequent breakage (1% compared to 4% for male condoms)
• Longer self life even under unfavorable storage conditions
• Female condoms allowed women to continue their job without interruption during menstruation

Que. 123. What are the disadvantages of female condoms?

Ans. 123. The disadvantages of the female condoms are as follows –

• Difficulties in insertions & removal
• More expensive than male condom

Que. 124. What are spermicides?

Ans. 124. These are sperm killing substances inserted deep in the vagina, near the cervix, before sex. These are available as foaming tablets, melting or foaming suppositories, cans of pressurized foam, jelly, cream etc. e.g. nonoxynol – 9, benzalkonium chloride, chlorhexidine etc.

Que. 125. What is the mechanism of action of spermicides?

Ans. 125. Work by causing the membranes of sperm cells to break, killing them or slowing their movement thus preventing from meeting an egg.

Que. 126. Why do some women prefer spermicides?

Ans. 126. Some women prefer spermicides because of following reasons –

• Controlled by woman
• Have no hormonal side effects
• Increase vaginal lubrication
• Can be used without consulting a health provider
• Can be inserted ahead of time and so do not interrupt sex

Que. 127. Which woman is eligible for spermicides use?

Ans. 127. All women can safely use spermicides except those who –

• Are at high risk for HIV
• Have HIV infection
• Have AIDS

Que. 128. What is the diaphragm?

Ans. 128. Diaphragm, a soft latex cup that covers the cervix, is used with spermicidal creams, jelly or foam to improve effectiveness. Available in different sizes and the rim contains a firm, flexible spring that keep the diaphragm in place. It is inserted with the help of specifically trained provider.

Que. 129. What is the mechanism of action of the diaphragm?

Ans. 129. Works by blocking sperm from entering the cervix (acts as a barrier) while spermicides kill or disable sperms. Thus preventing sperm from meeting an egg.

Que. 130. How effective is diaphragm?

Ans. 130. Effectiveness varies depending on use, from 16 pregnancies per 100 women (as commonly used) to about 6 pregnancies per 100 women using diaphragm over the first year (as correctly used).

Que. 131. What are the health benefits of the diaphragm?

Ans. 131. The health benefits of diaphragm are given below –

• Protects against risk of pregnancy
• May help protect against certain STIs (Chlamydia, gonorrhea, PID, trichomoniasis)
• May protect against cervical pre cancer stage & cancer

Que. 132. What are the health risks associated with diaphragm?

Ans. 132. The health risks associated with diaphragm are as follows –

• UTIs
• Bacterial Vaginosis
• Candidiasis
• Toxic shock syndrome (extremely rare)

Que. 133. Why do some women prefer diaphragm?

Ans. 133. Some women prefer diaphragm because of following reasons –

• Controlled by women
• Has no hormonal side effects
• Can be inserted way ahead of time and so does not interrupt sex

Que. 134. Is the diaphragm uncomfortable for the woman?

Ans. 134. Not at all if inserted and fitted correctly.

Que. 135. Do spermicides increase the risk of becoming infected with HIV?

Ans. 135. Woman who use nonoxynol -9 several times a day may face an increased risk of becoming infected with HIV. Spermicides can cause vaginal irritation, which may cause small lesions to form on the lining of the vagina or on the external genitalia. These lesions may make it easier for a woman to become infected with HIV.

Que. 136. What is vaginal sponge?

Ans. 136. The vaginal sponge is made of plastic and contains spermicides. It is moistened with water and inserted into the vagina so that it rests against the cervix. Each sponge can be used only once.

Que. 137. What are the effectiveness and failure rate of combined oral contraceptive pills (COCs)?

Ans. 137. Effectiveness varies from 99.97% to 99.99%. The failure rate is 0.3% as commonly used and only 0.1% on correct and consistent use.

Que. 138. What is the mechanism of action of COCs?

Ans. 138. The mechanism of action of COCs are given below –

• Inhibition of ovulation by suppressing FSH & LH.
• Alteration of endometrium to make it unsuitable for implantation even if the ovum is fertilized
• Cervical mucus changes making it hostile to the sperms

Que. 139. What are the health benefits of Oral Contraceptive pills (COCs)?

Ans. 139. Important health benefits of COCs are as follows –

• Prevention of pregnancy
• Offers protection against ectopic pregnancy
• Regulates the menstrual cycle
• Lesser iron deficiency anemia due to less menstrual blood loss
• Less dysmenorrhea
• Less severe premenstrual symptoms
• Protection against cancer e.g. endometrial and ovarian cancer
• Protection against benign breast diseases like fibrocystic and fibro-adenomatous disease
• Protection against PID when compared to non-users
• Reduces risk of follicular cyst by 50% and corpus luteal cyst by 80%
• Reduced risk of low bone mineral density
• Reduction in acne

Que. 140. What are the common side effects of COCs?

Ans. 140. The common side effects of COCs are given below –

• Nausea, vomiting and decreased appetite which usually subsides gradually
• Oligo or amenorrhea
• Breast changes like edema, heaviness and tenderness
• Vaginal discharge
• Chloasma
• Weight gain
• Acne and oily skin

Que. 141. When should a woman start COCs?

Ans. 141. Within 5 days of start of menstrual bleeding.

Que. 142. Under MPV, who will receive NAYI PEHAL KIT?

Ans. 142. Newly Married Couples.

Que. 143. What will you do when a woman vomits within 2 hours of taking an active COC pill?

Ans. 143. She should take another active pill.

Que. 144. On appearance of which symptoms, woman taking COCs, should return to the clinic?

Ans. 144. On appearance of following symptoms woman taking COCs should return to the clinic –

• Severe, constant pain in belly, chest or legs
• Jaundice
• Headache on taking pills
• Brief loss of vision, brief trouble in speaking or limb movements

Que. 145. Which is the best hormonal pills for women who are breastfeeding?

Ans. 145. Progesterone only contraceptive pills

Que. 146. What is the mechanism of action of Progesterone only pills (POPs)?

Ans. 146. The mechanism of action of POPs are given below –

• Thickening of cervical mucus
• Suppression of ovulation
• Involution of uterus

Que. 147. How effective is the POPs?

Ans. 147. It is 99.95% effective with correct and consistent use.

Que. 148. Which progestins are available as POP?

Ans. 148. The progestins available as POP are as follows –

• Levonorgestrel
• Norgestrel
• Norethindrone

Que. 149. What are the advantages of POPs?

Ans. 149. The advantages of POPs are as follows –

• Can be used by lactating mothers 6 weeks after childbirth. Quantity and quality of breastmilk remains unaffected.
• No side effect of estrogen. Does not increase risk of estrogen related complications such as heart attack or stroke
• The client has to take 1 pill every day with no break, so easier to remember.
• Can be effective during breast feeding
• Even less risk of progestin related side effects such as weight gain and acne, then with COCs
• May help prevent benign breast disease, endometrial and ovarian cancer & PID

Que. 150. What are the disadvantages of POPs?

Ans. 150. The disadvantages of POPs are given below –

• Irregular menstrual bleeding
• On missing pills, risk of pregnancy increases
• Does not prevent ectopic pregnancy

Que. 151. How is allocation of Family Planning Indemnity Scheme (FPIS) done by GoI to the larger states/UTs?

Ans. 151. The allocation of funds by GoI to the states/UTs would be on the basis of either average amount of claims paid during the 3 years, or an amount not exceeding Rs. 50/- per acceptor of sterilization, whichever is less.

Que. 152. How is allocation of Family Planning Indemnity Scheme (FPIS) done by GoI to the smaller states/UTs?

Ans. 152. In smaller states/UTs where the average number of claims reported in the last 3 years is low, a minimum amount to the extent of Rs 5 lakhs may be proposed.

Que. 153. What are the benefits under the FPIS for death following sterilization?

Ans. 153. For death following sterilization (inclusive of death during process of sterilization operation) in hospital or within 7 days from the date of discharge from the hospital, a benefit of Rs 2 lakh is provisioned.

For death following sterilization within 8-30 days from the date of discharge from the hospital, a benefit of Rs 50,000/- is provisioned.

Que. 154. What are the benefits under the FPIS for failure of the sterilization?

Ans. 154. Under FPIS, for failure of sterilization a benefit of Rs. 30,000/- is provisioned.

Que. 155. What are the benefits under the FPIS for any complication arising out of sterilization?

Ans. 155. Cost of treatment in hospital and up to 60 days arising out of complication following sterilization operation (including complication during operation) from the date of discharge.

——————————————————Actual not exceeding Rs. 25,000/-.

Que. 156. What are the benefits under FPIS for indemnity per doctor/ health facilities?

Ans. 156. For indemnity per doctor/health facility but not more than 4 in a year ——————————————————– Up to Rs. 2 Lakhs per claim.

Que. 157. What are the documents required for claims following sterilization death?

Ans. 157. The documents required for the claims following sterilization death under FPIS are given below –

• Claim form cum medical certificate in original (Annex. I)
• Copy of consent form duly attested (Annex. II)
• Copy of sterilization Certificate (Annex. IV)
• Copy of proof of postoperative procedure/Discharge slip
• Copy of Death Certificate issued by Hospital/ Municipality or authority designated

Que. 158. What are the documents required for claim for failure of sterilization under FPIS?

Ans. 158. The documents required for the claims for failure of sterilization under FPIS are given below –

• Claim form cum medical certificate in original (Annex. I)
• Copy of consent form duly attested (Annex. II)
• Copy of sterilization Certificate (Annex. IV)
• Copy of any of the following diagnostic reports confirming failure of sterilization

1. In case of Tubectomy –

• Urine test report supported by physical examination/ ante natal card/ USG report
• MTP report
• Physical examination report
• USG report
• In extreme cases, birth certificate

1. In case of Vasectomy –

• Semen test report

Que. 159. What are the documents required for complication claim under FPIS?

Ans. 159. The documents required for the complication claims under FPIS are given below –

• Claim form cum medical certificate in original (Annex. I)
• Copy of consent form duly attested (Annex. II)
• Copy of sterilization Certificate (Annex. IV)
• Original bills/receipts/cash memos along with original prescription and case sheet confirming treatment taken for complications due to sterilization.

Que. 160. What are the documents required under indemnity cover for doctors or health facility?

Ans. 160. The documents required under indemnity cover for doctors or health facility are given below –

• Intimation in writing
• Copy of Summon/ FIR
• Copy of sterilization Certificate (Annex. IV)
• Copy of consent form (Annex. II)
• Certificate from convener of QAC/CMO/CS designated for this purpose at district level confirming that sterilization was conducted by the doctor
• Copy of reward given by the court along with the original receipt for which payment is made to lawyer

Que. 161. Which section of FPIS does cover indemnity for doctors/ health facility?

Ans. 161. Section II

Que. 162. Under enhanced compensation scheme of GoI (2014), how much monetary benefit is expected to an acceptor of Minilap & PPS?

Ans. 162. Rs 1400/- & Rs 2200/- respectively

Que. 163. Under enhanced compensation scheme of GoI (2014), how much monetary benefit is expected to an acceptor of Vasectomy?

Ans. 163. Rs 2000/- only

Que. 164. Under enhanced compensation scheme of GoI (2014), how much monetary benefit is expected to a motivator/ASHA for Minilap tubectomy, PPS and Vasectomy?

Ans. 164. Rs 200/-for Minilap, Rs 300/- for PPS & Rs 300/- for vasectomy

Que. 165. Under enhanced compensation scheme (2014) in govt /public facilities what is the total package for Minilap, PPS & vasectomy?

Ans. 165. Rs 2000/-, Rs 3000/- & Rs 2700/- respectively

Que. 166. For accredited, private/ NGO facility what is the total package for tubectomy & vasectomy under the enhanced compensation scheme?

Ans. 166. Rs 3000/- & Rs 3000/- only

Que. 167. What is the eligibility of providers for performing Minilap tubectomy in a government facility?

Ans. 167. Trained MBBS doctor

Que. 168. What is the eligibility of providers for performing Laparoscopic Sterilization in a government or private accredited facility?

Ans. 168. DGO, MD (Obstetrics), MS (surgery) & trained in Laparoscopic Sterilization.

Que. 169. What is the timing of female interval sterilization?

Ans. 169. Should be performed within 7 days of the menstrual period (in the follicular phase of the menstrual cycle).

Que. 170. What is the timing of surgical procedure of PPS?

Ans. 170. Should be performed after 24 hours up to 7 days of delivery.

Que. 171. What are the requirements for the administration of LA in female sterilization?

Ans. 171. The requirements for the administration of LA in female sterilization are given below –

• An IV line is to be secured before the start of the procedure
• Lignocaine without adrenaline is the local anesthetic that is to be infiltrated on the OT table
• Client must be monitored and attended to after the parenteral administration
• Communication must be maintained with the client throughout the procedure

Que. 172. What are the indications of General Anesthesia (GA) in female sterilization?

Ans. 172. General Anesthesia is rarely necessary. The indications of GA are as follows –

• In case of non -cooperative patient
• In case of excessive obesity
• In case of a history of allergy to LA drugs

Que. 173. When should the sterilization certificate be issued following female sterilization?

Ans. 173. A certificate of female sterilization should be issued after one month of the surgery or after the first menstrual period by the MOs of the facility.

Que. 174. What are the intraoperative complications of female sterilization?

Ans. 174.  The intraoperative complications of female sterilization are given below –

• Nausea & Vomiting
• Vasovagal shock
• Respiratory depression
• Cardio-respiratory arrest
• Uterine perforation
• Injury to the urinary bladder
• Injury to the intraabdominal viscera and blood vessels
• Bleeding from the mesosalpinx
• Convulsions and toxic reaction to LA

Que. 175. What are the postoperative complications of female sterilization?

Ans. 175. The postoperative complications of female sterilization are given below –

• Wound sepsis
• Hematoma in the abdominal wall
• Intestinal obstruction, paralytic ileus & peritonitis
• Tetanus
• Incisional Hernia

Que. 176. What is a Camp in relation to sterilization services?

Ans. 176. A sterilization camp is defined as alternate service delivery mechanism, when operating team located at a remote facility (District Hospital/ Medical College/ FRU) conducts sterilization operations at a sub district health facility, where the services are not routinely available.

Que. 177. What should be the probable client load in a sterilization camp?

Ans. 177. For maintaining quality service, each surgeon restrict to conducting a maximum of –

• 30 laparoscopic tubectomy (for one team with 3 laparoscopes) or
• 30 vasectomy (NSV or conventional) or
• 30 Minilap tubectomy cases

Que. 178. What should be the timing of sterilization camps?

Ans. 178. Preferably between 9 AM to 4 PM

Que. 179. What is counselling?

Ans. 179. Counselling is a two way communication between a health care worker and a client, for the purpose of confirming or facilitating a decision by the client, or helping the client address problems or concerns.

Que. 180. What are the key components of counselling?

Ans. 180. The key components of counselling are as follows –

• Mutual trust is established between client and provider. The provider show respect for the client and identifies and addresses her/his concerns, doubts and fears regarding the use of contraceptive methods.
• The client and service provider give and receive relevant, accurate and complete information that enables the client to make decision about RMNCH services

Que. 181. What are the benefits of counselling?

Ans. 181. The benefits of counselling are given below –

• Good counselling results in higher client satisfaction
• Clients who receive good counselling are more likely to use RMNCH services more successfully

Que. 182. What are the tasks involved in counselling?

Ans. 182. The tasks involved in counselling are given below –

• Helping clients assess their own needs for a range of health services information and emotional support
• Providing information appropriate to clients identified problems and needs
• Assisting clients in making their voluntary and informed decisions
• Helping clients to develop the skills they will need to carry out decision

Que. 183. What should be quality of the counselling?

Ans. 183. Counselling should be CLEAR.

C——— Communicate clearly

L——— Listen

E——— Encourage & Empathize

A——— Ask

R——— Respect

Que. 184. What is the GATHER approach for counselling?

Ans. 184. The GATHER approach for the counselling means –

G——– Greet

A——– Ask

T——— Tell

H——– Help

E——— Explain

R——— Return

Que. 185. What are the types of Family planning counselling?

Ans. 185. The types of family planning counselling are as follows –

• General Counselling
• Method specific Counselling
• Return/ follow up counselling

Que. 186. What are the rights of the clients?

Ans. 186. The rights of clients are as follows-

• Information
• Access to services
• Informed Choice
• Safety of services
• Privacy & Confidentiality
• Dignity, comfort & expression of opinion
• Continuity of care

Que. 187. Name the first non-steroidal once a week contraceptive pill.

Ans. 187. Centchroman (Ormeloxifene).

Que. 188. What is the rate of use of OCPs in India?

Ans. 188. Very low i.e. only 4%.

Que. 189. What are the types of oral contraception?

Ans. 189. There are two types of oral Contraception –

1. Hormonal
2. Non-hormonal

HORMONAL –

• Combined Oral Contraceptive (COC)
• Progestin-only pill (POP)
• Levonorgestrel Emergency Contraceptive Pill (ECP)

Non- Hormonal – Centchroman (Ormeloxifene)

Que. 190. What is the failure rate of Centchroman with perfect use?

Ans. 190. 1-2 pregnancy per 100 women.

Que. 191. What is the failure rate of combined oral contraceptive pills?

Ans. 191. With perfect use —– 0.3 pregnancy per 100 women

With typical use —— 8 pregnancy per 100 women

Que. 192. What is the failure rate of progestin only pills (POPs)?

Ans. 192. With perfect use — Breastfeeding women – 0.3 pregnancy per 100 women

—-Non breastfeeding women – 0.9 pregnancy per 100 women

With typical use —- Breastfeeding women — 1 pregnancy per 100 women

—– Non breastfeeding women — 3-10 pregnancy per 100 women

Que. 193. Which are the benefits of family planning counseling?

Ans. 193. The benefits of family planning counseling are as follows –

• Increases acceptance
• Enhances continuation of methods
• Dispels rumors and corrects misunderstandings about contraceptive methods
• Promotes effective use
• Increases client’s satisfaction

Que. 194. What are the non-contraceptive benefits of COCs?

Ans. 194. It protects against –

• Endometrial Cancer
• Ovarian cancer
• Iron deficiency anemia
• Polycystic ovarian syndrome
• Endometriosis

Que. 195. What should be done if a woman taking COCs vomits within 2 hours of taking a pill?

Ans. 195. Another pill from the pack should be taken as soon as possible and rest of the pills should be continued as scheduled.

Que. 196. How will you manage breast tenderness, a side effect of COC?

Ans. 196.  – Recommend to wear a supportive bra (including during strenuous activity and sleep)

• Try hot or cold compresses
• Suggest Ibuprofen (200-400 mg) or Paracetamol (500-1000 mg) or other pain reliever

Que. 197. When will you start POPs in a woman having regular menstrual cycles?

Ans. 197. Any day within 5 days of menstrual cycle.

Que. 198. When will you start POPs in a woman in postpartum period who is breastfeeding her child?

Ans. 198. Any time, if her monthly bleeding has not returned. No need for a backup method. If the monthly bleeding has returned, POPs can be started as advised for woman having menstrual cycles.

Que. 199. How does centchroman act?

Ans. 199. It acts as selective estrogen receptor modulator. In some tissues/organs of the body, it has weak estrogenic action (e.g. bones) while in others it has anti – estrogenic action (e.g. uterus, breasts etc.).

Que. 200. Which are the side effects of centchroman?

Ans. 200. Prolongation of menstrual cycles in some women. No other side effects.

Que. 201. When will you start and how to use centchroman?

Ans. 201. For initiation of the centchroman, the first pill is to be taken on the first day of period (as indicated by the first day of the bleeding) and the second pill three days later (i.e. fourth day of bleeding). This pattern of days to be repeated through the first 3 months.

Starting from the fourth month, the pill is to be taken once a week on the first pill day and should be continued on the weekly schedule regardless of her menstrual cycle.

Que. 202. How will you manage missed pills with centchroman?

Ans. 202. Take a pill as soon as possible after it is missed.

If pill is missed by 1 or 2 days but lesser than 7 days, the normal schedule should be continued and clients need to use a backup method (e.g. Condoms) till the next period starts.

If pill is missed by more than 7 days, restart as a new user.

Que. 203. What will you do if with centchroman, periods are delayed by more than 15 days?

Ans. 203. Pregnancy test to rule out pregnancy.

Que. 204. Can we use combined oral contraceptive pills containing an estrogen and a progestin as EC pills?

Ans. 204. Yes.

Que. 205. Whether Cu IUCD can be used as an emergency contraception?

Ans. 205. Yes if inserted within 5 days of unprotected intercourse.

Que. 206. Which are the contraindication for centchroman pills?

Ans. 206. The contraindication for centchroman pills are as follows –

• Polycystic ovarian diseases
• Cervical hyperplasia
• H/O Jaundice / liver disease
• Severe allergic state
• Chronic illness, like TB/Renal disease

Que. 207. Which are the specific indications for the use of ECPs?

Ans. 207. The specific indications for the use of ECPs are as follows –

• Unprotected intercourse because sex was coerced
• Unprotected intercourse because no contraceptive used during sex
• Unprotected intercourse due to contraceptive failure

Que. 208. What are the primary objectives of clinical assessment or screening prior to prescribing oral contraceptive methods?

Ans. 208. To determine that beneficiary –

• Is pregnant.
• Has any condition that affect the client’s medical eligibility to start or continue using a particular method
• Has any special problem that requires further assessment, treatment or regular follow up.

Que. 209. Will you provide POPs to a woman using medications for seizures or rifampicin or rifabutin for tuberculosis?

Ans. 209. Never provide POPs.

Que. 210. If a woman ever had breast cancer, will you provide COCs/POPs to her?

Ans. 210. Never. I will help her choose a non-hormonal method.

Que. 211. What is the method of demand estimation for COCs & ECPs?

Ans. 211. COCs (in cycles) ——– Estimated COC users *15 cycles + 10% buffer stock

ECPs (in tablets) ——————— Estimated ECP users (average of last 3 years) + 10% buffer stock

Que. 212. What is the method of demand estimation for POPs & Centchroman?

Ans. 212. Centchroman (in strips) —– Estimated centchroman users * 9 strips + 10% buffer stock

POPs (in cycles) —– For postpartum women —- estimated users* 7 cycles + 10% buffer stock

Que. 213. Which intervention is most important affecting reproductive, maternal, neonatal, child & adolescent health?

Ans. 213. Ensuring healthy timing and spacing of pregnancies.

Que. 214. Which are the types of injectable contraceptives?

Ans. 214. Injectable contraceptives are of 2 types –

• Progestogen only injectable (POI) containing only synthetic progesterone. They are of two types:

1. Depot Medroxy progesterone acetate (DMPA) – 3 monthly injection
2. Norethisterone enanthate (NET- EN) – 2 monthly injection

• Combined injectable contraceptive (CIC) – containing estrogen (usually ethinyl estradiol) and progesterone – 1 monthly injection

Que. 215. Which type of injectable contraceptive has been added to basket of choice, under the National Family Planning Program?

Ans. 215. DMPA, injectable contraceptive.

Que. 216. What is the mechanism of action of DMPA?

Ans. 216. DMPA acts in the following way:

• Inhibition of ovulation
• Thickening of cervical mucus which prevents sperm penetration in to the upper respiratory tract
• Thinning of endometrial lining, making it unfavorable for implantation of fertilized ovum.

Que. 217. On which factors, effectiveness of DMPA does depend?

Ans. 217. Effectiveness depends on timing of first injection, taking injections regularly on time, the injection technique and post injection care.

Que. 218. Is injectable MPA completely reversible?

Ans. 218. Yes, It is completely reversible; 7-10 months from date of last injection (average 4-6 months after 3 months effectivity of last injection is over).

Que. 219. Can injection MPA be used at any age or parity?

Ans. 219. Yes if they are at risk of pregnancy.

Que. 220. When will you start DMPA injection?

Ans. 220. A DMPA injection can be started anytime if it is reasonably certain that the woman is not pregnant. Prior physical examination is not required. If a woman is having menstrual cycles, can be started any day within the 7 days of menstrual cycle with no need for backup method.

Que. 221. Which are the side effects of DMPA?

Ans. 221. The side effects of DMPA are as follows –

• Irregular/prolonged bleeding
• Amenorrhea
• Mood swings
• Headache
• Change in weight
• Decrease in bone mass

Que. 222. Which are the eligibility criteria for DMPA?

Ans. 222. DMPA is safe for all women including who –

• Are of any age, including adolescents & women over 45 year old
• Have or have not had children
• Are unmarried
• Have just had an abortion or miscarriage
• Are smoker regardless of age
• Are breast feeding
• Are at risk of STI/HIV infection
• Are infected with HIV, whether or not on antiretroviral therapy.

Que. 223. Which are the physiological and medical conditions in which DMPA can’t be given to a woman?

Ans. 223. Those conditions are as follows –

• Breast feeding women less than 6 weeks postpartum
• Blood pressure 160/100 mm of Hg or more
• Unexplained vaginal bleeding

Que. 224. Where should DMPA vials be ideally stored?

Ans. 224. DMPA injection vials are to be stored preferably at room temperature between 15-30 degree Celsius in a dry, dust free place and not exposed to extreme hot, cold and direct sunlight. Don’t keep the injection vials in the refrigerator/ freezer.

Que. 225. Which are the sites of injection DMPA?

Ans. 225. The injection site for the DMPA is the upper arm (deltoid muscle), the buttocks (gluteus muscle, upper and outer quadrant) or thigh (outer anterior). The preferred, easily accessible and acceptable site is deltoid muscle.

Que. 226. How will you manage the side effects of DMPA, the irregular bleeding, in follow up care?

Ans. 226. Reassure client that this is common, not harmful and usually settles with time. For modest short term relief give NSAIDS such as –

• Ibuprofen 400 mg 3 times a day for 5 days
• Mefenamic acid or Tranexamic acid 500 mg 3 times a day for 5 days

Que. 227. How will you manage DMPA side effects, prolonged/heavy bleeding, in follow up care?

Ans. 227. The line of management is as follows –

• Reassure the client
• Give NSAIDS/ Mefenamic Acid/ Tranexamic acid 500 mg 3 times a day for 5 days
• If there is no response with NSAIDS, give 50 mcg of ethinyl estradiol daily for 21 days or refer for further management
• In addition, give iron tablets and suggest food rich in iron to prevent anemia
• If bleeding becomes a health threat or if the woman wants, help her choose another method.

Que. 228. What is the Total Fertility Rate (TFR) of India?

Ans. 228. 2.0 (NFHS 5, 2019-21)

Que. 229. What is the mCPR of India?

Ans. 229. 56.5 % (NFHS 5, 2019-21)

Que. 230. What is the total unmet need for family planning in India?

Ans. 230. 9.4 % (NFHS 5, 2019-21)

Que. 231. What is the present teen age pregnancy rate of India?

Ans. 231. 6.8 % (NFHS 5, 2019-21)

Que. 232. What is the present unmet need for spacing in India?

Ans. 232. 4.0 % (NFHS 5, 2019-21)

Que. 233. What are the strategies for the Mission Parivar Vikas?

Ans. 233. The five pronged strategies for the MPV are as follows –

• Delivering assured services
• Building additional Capacity/ HRD for enhanced service delivery
• Ensuring commodity security
• Implementing new promotional Schemes
• Creating enabling environment

Que. 234. What is the goal of MPV?

Ans. 234. MPV districts should reach replacement level of 2.1 by 2025 in TFR.

Que. 235. Who are the target groups for the postpartum family planning counselling?

Ans. 235. Pregnant women/ just delivered women along with her husband or mother-in-law.

Que. 236. Why it is mandatory to practice appropriate infection prevention procedures at all times with all clients?

Ans. 236. To decrease the risk of transmission of infection to the acceptors and protect the health workers and other clients from exposure to infection.

Que. 237. What is the most important error encountered in insertion technique of PPIUCD, leading to increased risk of expulsion/

Ans. 237. To mistake the back or posterior wall of uterus for the fundus & release the IUCD there.

Que. 238. When will you change chlorine solution in the labour room?

Ans. 238. Once in 24 hours or whenever it becomes milky white or red in colour.

Que. 239. How can you prevent most of the immediate PPIUCD related complications?

Ans. 239. Most of the immediate PPIUCD related complications can be prevented by –

• Careful screening of clients
• Strict adherence to correct infection prevention techniques
• Correct & SOP guided insertion techniques.

Que. 240. What will you do if vomiting does occur within 2 hours of taking the dose of Emergency Contraceptive Pills (ECPs)?

Ans. 240. Repeat the full dose.

Que. 241. What is Lactational Amenorrhoea Method (LAM)?

Ans. 241. It is a natural family planning method based on the natural effect of breastfeeding on fertility.

Que. 242. At what interval, will you advise breastfeeding in LAM?

Ans. 242. Day time breastfeeding ————– Not more than 4 hours apart.

Night time breastfeeding ————————- Mo more than 6 hours apart.

Que. 243. Which is the anaesthesia of choice for female sterilization?

Ans. 243. Local Anaesthesia (LA).

Que. 244. Which condition does prevent use of condoms?

Ans. 244. Severe allergy to latex rubber denoted by severe itching, redness, swelling after condom use.

Que. 245. Up to what extent, consistent and correct use of condom can prevent HIV transmission?

Ans. 246. Up to 80 to 95% HIV transmission.

Que. 247. Why a woman should not rely on latex condoms during vaginal use of miconazole or econazole?

Ans. 247. As miconazole or econazole can damage latex.

Que. 248. What are the effects of frequent use of nanoxynol -9?

Ans. 248. Increased risk of HIV infection.

Que. 249. Why diaphragm should not be left more than 24 hours inside vagina?

Ans. 249. Because it increases the risk of toxic shock syndrome.

Que. 250. Which type of lubricant should only be used with latex diaphragm?

Ans. 250. Water or silicon based lubricants.

Que. 251. In which conditions, laparoscopic tubal ligation should not be done concurrently?

Ans. 251. In 2^nd trimester abortion & in the postpartum period.

Que. 252. What are the steps of preparation for sterilization surgery?

Ans. 252. The steps of preparation for sterilization surgery are –

• Counselling
• Pre-operative instructions
• Case selection
• Pre-operative assessment
• Review of surgical procedure
• Post-operative care

Que. 253. How does family planning interventions affect maternal and child health?

Ans. 253. Can avert more than 30% maternal deaths and 10% child mortality if couples spaced their pregnancies more than 2 years apart.

Que. 254. What are the factors on that effectiveness of progesterone only pill depend?

Ans. 254. Regular intake of pill at the same time every day.

Que. 255. What is Centchroman (Ormeloxifene)?

Ans. 255. It is a non-steroidal & non hormonal pill, taken twice a week on fixed days for the first 3 months followed by once a week thereafter. It is safe for breastfeeding women.

Que. 256. Which pill is also called morning after pills or post coital contraceptive pill?

Ans. 256. Emergency Contraceptive Pill (ECP).

Que. 257. Which progestin is contained in ECPs in the National Family Welfare Program?

Ans. 257. Levonorgestrel (1.5 mg per pill)

Que. 258. Who can use ECP?

Ans. 258. All women can use it safely & effectively including woman who cannot use hormonal contraceptive methods.

Que. 259. When will you start COCs in postpartum period, if woman is partially breastfeeding a baby?

Ans. 259. As soon as 6 weeks after childbirth.

Que. 260. Will you recommend COC to a woman if she is 35 years of age or older & smoke?

Ans. 260. Do not provide COC to her.

Que. 261. How much modern CPR does increase linearly by addition of single family planning method in National Family Welfare program?

Ans. 261. By 3-4%.

Que. 262. How will you give DMPA to clients?

Ans. 262. Intramuscularly (DMPA IM) or Subcutaneously (DMPA SC).

Que. 263. Which kind of reassurance was given by the WHO in its study on 3 million months of DMPA use?

Ans. 263. DMPA presents no overall risk for cancer, infertility or congenital malformations.

Que. 264. What is the duration of protection provided by DMPA?

Ans. 264. 3 months with a grace period of 4 weeks.

Que. 265. Why injectable DMPA is suitable for breastfeeding women after 6 weeks postpartum?

Ans. 265. As it does not affect quality, quantity & composition of milk.

Que. 266. What is the advantages of DMPA in terms of its use?

Ans. 266. The advantages are –

• Provides immediate postpartum (in non-breastfeeding women) & post abortion contraception.
• Protects against ectopic gestation
• Strong protective effect against endometrial cancer with no overall increased risk of breast, ovarian or cervical cancer.

Que. 267. Why one should not massage or apply hot fomentation at injection DMPA site?

Ans. 267. As it increases the absorption of DMPA.

Que. 268. How many districts are covered under Mission Parivar Vikas (MPV) across India?

Ans. 268. 146 districts.

Suggested further Readings:

• Family Planning : A global Handbook for providers 2011 update
• Contraceptive Updates : Reference Manual for doctors October 2005 by Ministry of Health & Family Welfare, Government of India
• Guidelines for administration of Emergency Contraceptive pills by Health Care Providers, November 2008 by Ministry of Health & Family Welfare, Government of India
• Manual for Family Planning Indemnity Scheme, October 2013 by Ministry of Health & Family Welfare, Government of India
• Handbook of Reproductive, Maternal, Neonatal & child Health (RMNCH) counsellors, October 2012 by Ministry of Health & Family Welfare, Government of India
• Guidelines for Pregnancy Testing Kits by Ministry of Health & Family Welfare, Government of India
• Standards for Female & male sterilization services, October 2006 by Ministry of Health & Family Welfare, Government of India
• Quality Assurance Manual for sterilization services, October 2006 by Ministry of Health & Family Welfare, Government of India
• Operational Guidelines on FDS (Fixed day static) approach for sterilization services under the family welfare program, November 2008 by Ministry of Health & Family Welfare, Government of India
• Standard operating procedures for sterilization services in camps, March 2008 by Ministry of Health & Family Welfare, Government of India
• IUCD reference manual for Medical Officers and Nursing Personnel, September 2013 by Ministry of Health & Family Welfare, Government of India
• Reference Manual for Oral Contraceptive Pills, March 2016 by Ministry of Health & Family Welfare, Government of India
• Reference Manual for Injectable Contraceptive (DMPA), March 2016 by Ministry of Health & Family Welfare, Government of India.