Family planning is, keeping one’s family size under control.  Whereas over populated countries like India and China are struggling to keep down their booming population growth,   Rwanda   is also  promoting  small family norm.

Decision of a couple to decide their number of children is influenced by many cultural, social and religious factors. Keeping a family size small involves use of birth control techniques   to prevent unwanted pregnancies.

A small family has many advantages. It has a positive influence on a woman’s health. Repeated pregnancies  and  deliveries  increase  demand of   iron, calcium and other nutrients in the woman. This tends to cause chronic anemia and  osteoporosis.

Thus these women suffer from chronic body pain and weakness. Trauma during child birth can lead to urinary incontinence, i.e. inability to hold back urine.

Prolapse of the uterus is also often the result of multiple pregnancies, and leads to repeated urinary and vaginal infections.

Women also tend to develop hernia due to weakening of abdominal muscles caused because of frequent pregnancies. Sometimes   unwanted pregnancy is aborted illegally   which endangers the life of women.

Every pregnancy causes some emotional stress due to impact of hormonal changes and anxiety for the forthcoming delivery. Some women go into depression following delivery. 

Brunt of the economic and social stress of a large family always falls on the woman  Running the household , meeting day to day needs of the children  becomes stressful as number of children increases. 

Health of the children is also directly linked to a planned family. Family planning is not only about limiting the number of children but also spacing the children. 

It is seen that when   one child is feeding on breast and another arrives, the first child  is  neglected, because  the new born gets priority.   

This is one of the major reasons for malnutrition in children of poor communities and villages. There should be a reasonable interval, minimum 2 years or more between the children. 

Women are very much open to the idea of a small and planned family, , because they are the ones to suffer most   due to multiple pregnancies and child birth.. But most of the men world over are careless in  this issue. 

There are numerous instances where women very much want to adopt some contraception but men do not permit for same.
There are many cultural, religious and other factors involved.

Some people think that it is a sin to prevent pregnancies as it is forbidden in their religion. But they should realize the fact that thousands of years before when   religions had originated, there was no problem of population crunch in the world.

Diseases and wars consumed many lives, therefore more numbers were needed. But today, times have changed. In rural sector and families engaged in manual work, it is thought that more children will provide more working hands and hence more money. But instead of more money, there comes  in more   sickness and misery.

There are many myths related to contraceptive or birth control methods.  Men do not like to use   condoms , because they think that it is an offence against their masculinity. Sterilization is  a taboo.

Male sterilization ( vasectomy,  where tubes are tied to block movement of sperms)  is   simple, safe  and less time is needed for recuperation. After a certain number of   children, a man can undertake vasectomy to prevent further increase in his family size.  

I.U.D. (Intrauterine devices ) in women are good to space the pregnancies.  People have a wrong thinking   that I.U.D will cause infection and sterility.  Inserted in proper centers by trained personnel, they are very safe.    

Cervical caps and diaphragms are like a female condom and provide a barrier for entry of sperms. If used correctly are very effective in preventing unwanted pregnancy.

But in many cases, husbands do not allow their wives to use them,  thinking is that it diminishes their sexual pleasure. Secondly they being the boss want to dictate terms in all spheres of life including making babies.

Similarly many false perceptions are present regarding contraceptive pills also. People are scared of the possible adverse effects like cancers, heart attacks, e.t.c. But compared to their usefulness, side effects are few.  

Side effects develop over months or years of use in most of the cases.   Users are educated about possible side effects of pills, when prescribed.  Choice of the pill,   is decided as per the medical condition of the woman.

If a couple does not want to use any of the contraceptives at hand, they  out to exercise enough restraint. Withdrawing and ejaculating outside the vagina ( coitus interruptus) is also very useful to  prevent pregnancy.

But this is also not very popular with men. Once men get to know the advantages of a small family, family planning will get a big boost.
     
The author is a specialist in Internal Medicine

E-mail – rachna212002@yahoo.co.uk