Family planning

According to the definition of WHO experts (1970), the term "Family planning" refers to those types of activities that are aimed at helping individuals or couples achieve certain results: avoid unwanted pregnancy, give birth to wanted children; regulate the interval between pregnancies; control the choice of time of childbearing depending on the age of the parents and determine the number of children in the family.

Family planning activities must necessarily be oriented both towards a specific individual and towards the family as a whole, since the reproductive behavior of a modern family is largely determined by its socio-hygienic characteristics, in which medical and social factors and lifestyle are of significant importance.

Family planning is an essential element of primary health care, necessary to maintain health and ensure regulation of reproductive function to give birth to only desired children.

Based on the definition of reproductive health as the absence of diseases of the reproductive system and (or) disorders of the reproductive function with the possibility of carrying out reproduction processes with complete physical, mental and social well-being, the factors that determine it can be classified into two main groups: medical and social. The main medical factors of reproductive health of the population of a region or social group are:

• level of gynecological morbidity;
• maternal and infant mortality rates;
• the prevalence of medical abortion as a means of family planning;
• contraceptive use rates;
• frequency of infertile marriages.

Social factors of reproductive health are determined by:

• existing legislation and traditions in the country regarding family planning;
• the educational level of the population in matters of family planning and contraception;
• availability (economic and actual) of both advisory assistance on the above issues and the contraceptives themselves.

According to the medical and biological point of view on family planning, the latter “contributes to the reduction of infant mortality, strengthening the health of mother and child, and reducing infertility.”

The right to family planning or to free and responsible parenthood (UN, 1968) is an inalienable right of every human being.

The main tasks for preserving and strengthening reproductive health and family planning, facing specialists at various levels of medical care, are currently:

• propaganda of family planning ideas;
• sex education;
• counseling on contraception, sexual and reproductive health;
• correction of sexual and reproductive health disorders. Their solution has the ultimate goal of reducing the overall level of gynecological morbidity and the number of abortions.

The main work on promoting the ideas of family planning and the possibility of using modern methods of contraception lies with level 1 doctors. The further use of the chosen method of family planning by a woman largely depends on the completeness and accessibility of the information received during the consultation.

If the doctor does not have information on the problem of interest to the woman, he must refer her for consultation with a gynecologist at a higher level of specialized care. At these levels, obstetricians and gynecologists are not only required to conduct a full consultation, but also, if necessary, recommend a system of medical measures aimed at increasing the acceptability of the contraceptive method used by the woman.

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Pregnancy monitoring

1. Monitoring the vital functions of the mother and fetus.
2. Screening of abnormal development and formation using ultrasound diagnostic methods.
3. Monitoring fetal growth and placental condition.
4. Screening of pregnant women and fetus for Rh factor; administration of Rh immunoglobulin as indicated.
5. Monitoring the diet, nutritional status and weight dynamics of a pregnant woman with regular diet correction.
6. Hypoallergenic nutrition for pregnant women (as indicated).
7. Study of alpha-fetoprotein in the blood serum of pregnant women.
8. Monitoring of blood pressure, urinary sediment, peripheral blood.
9. Prescription of glucocorticoids for risk of respiratory distress.
10. Control of urogenital infection.
11. DNA analysis to exclude hereditary diseases or generalized infections (as indicated).
12. Amniocentesis or chorionic villus sampling (as indicated).
13. Screening for alcohol, drugs, cotinine (as indicated).
14. "School" for pregnant women on all issues of lifestyle, physical, psychological, and hygienic preparation for childbirth.
15. "School" on breastfeeding and nipple preparation.

Childbirth safety, breastfeeding induction and bonding

1. Gentle technique, presence of husband or other family members, free choice of position, minimal use of anesthetics.
2. Immediate attachment to the breast in the delivery room with prolonged skin-to-skin contact, mother and child staying together, loose swaddling, free feeding.
3. Maximum limitation of exposure to allergens.
4. Limit the use of concentrated oxygen, protect the respiratory tract and eyes by prescribing antioxidants.
5. Diagnostics and monitoring of transient and pathological conditions.
6. Immunization.
7. Monitoring the nutrition of a nursing mother and the dynamics of the newborn's body weight.
8. Control of biota formation.
9. Maintaining a regular light regime.

Screening for newborn diseases

1. Phenylketonuria.
2. Galactosemia.
3. Ketoaciduria.
4. Hypothyroidism.
5. Adrenal hyperplasia.
6. Cystic fibrosis.
7. Biotinidase deficiency.
8. Homocystinuria.
9. Histidinemia.
10. Tyrosinemia.

Postneonatal complex

1. Monitoring the nutrition of a nursing mother, the dynamics of her body weight and that of the newborn, and the establishment of breastfeeding.
2. Monitoring the evolution of reflexes, development of the psyche and motor acts.
3. Monitoring relationships in the systems “mother-child”, “father-child”, “child and family as a whole”.
4. Screening diagnostics in the first weeks of life:
   • aminoaciduria;
   • methylmalonic acedemia;
   • hypercholesterolemia;
   • alpha-1 antitrypsin deficiency;
   • tuberculosis and HIV infection;
   • risk of sudden death syndrome;
   • risk of domestic abuse;
   • risk of hearing and vision impairment;
   • risk of progressive damage to the central nervous system.
5. "School" for parents on hygiene, feeding, creating an enriched development environment, massage and gymnastics for children in the first weeks and months of life, general child safety measures, and preventing sudden death if there is an increased risk.
6. Start keeping children's diaries on nutrition, behavior, sleep patterns, motor and emotional reactions, etc.

Programs for later periods of life

1. Regular nursing and medical examinations. The optimal technology for conducting examinations is various programs of the AKDO system (from programs for young children to adolescents). For all age groups - the program "AKDO - Nutrition".
2. Urine testing for bacteriuria, hematuria and proteinuria at least once every 2-3 years, determination of hemoglobin content in the blood at least once a year, ECG - at 1, 5, 10, 15 years.
3. Screening test for lead concentration at 1, 3, 5 years.
4. A set of educational programs for children and their parents on the formation and protection of their own health.
5. The Physical Perfection program for children of all ages. Creation of automated testing systems for physical activity and culture, individual selection of training regimen.
6. The "Giant" program is the creation of pedometry rooms with automated systems for recording and analyzing parameters of physical development, biological age, sexual maturation, and development rate.
7. The Optima program is an automated assessment of the diet and its correction.
8. The "Smart Girl" program is for monitoring neuropsychic development, its support and stimulation, correction of early deviations, and identification of children with high intelligence scores.
9. The Rainbow program is for screening and early diagnosis of visual impairments, prevention of myopia, strabismus and low vision.
10. The Symphony program is for screening and early diagnosis of hearing impairment in children in order to prevent hearing loss.
11. The "Kusaka" (or "Smile") program is for the prevention of caries and malocclusion.
12. The Allergoshield program is for early diagnosis and prevention of allergic diseases in high-risk families, as well as for organizing treatment, rehabilitation and educational measures for children with allergic diseases.
13. The Ascent program is a general registry of disabled children with monitoring of their rehabilitation in specialized centers.
14. The Sphinx program is for planning and monitoring children’s immunization.
15. The “Like Everyone Else” program is for children with neurotic disorders, enuresis and encopresis.
16. The Cicero program is for children with speech disorders.
17. The “Live Differently” program is aimed at preventing early arterial hypertension, atherosclerosis, and acute life-threatening conditions of cardiac origin in children with a hereditary predisposition.
18. The Future program is for early prevention of oncological diseases.
19. The "Will" program is for children who are getting involved in smoking, alcohol and drugs.
20. The "Tent" program is for children from socially disadvantaged families, victims of violence, children and teenagers with suicide attempts, young mothers, and families in critical situations.
21. The "Mirror" program is for continuous monitoring of mortality, occurrence of acute diseases, registration of chronic diseases, grouping of individual categories of pathology with selective growth.
22. The SHIELD - ECO program is for monitoring environmental safety, primarily for pregnant women and children.
23. The SOC DET program is aimed at studying the economics of families with children and organizing support for the poor.

Medical programs of treatment and rehabilitation focus on the most common chronic diseases of childhood

This is already tertiary prevention, which provides for effective treatment and rehabilitation of children with chronic diseases detected at an early stage using screening diagnostic systems of primary and secondary prevention. Early detection of deviations allows for much more effective intervention in the course of the disease. Complexes of medical technologies are formed in connection with the profile of the deviations detected. The organization of medical examination, treatment and rehabilitation can take place in consultative rooms and centers created for joint use by several departments. To monitor the course of diseases and functional insufficiency, it is recommended to identify the following subgroups of children:

1. with delayed growth, motor, speech, and mental development;
2. suffering from allergic diseases;
3. with hearing impairments;
4. with visual impairments;
5. with damage to the musculoskeletal system;
6. with rheumatic diseases;
7. with diabetes;
8. with chronic gastrointestinal diseases and malabsorption;
9. with connective tissue dysplasia and joint hypermobility;
10. frequently and long-term ill;
11. those who have suffered traumatic brain injury, meningitis, encephalitis;
12. carriers of hepatitis and HIV viruses;
13. with sleep disturbances and risk of sudden death syndrome;
14. with congenital heart defects and rhythm disturbances;
15. with chronic kidney disease;
16. with endocrine diseases (except diabetes);
17. with chronic non-specific lung diseases;
18. infected with Mycobacterium tuberculosis.

Specialized care as a component of an individual health development strategy

It is essential that in the vast majority of clinical situations the priority of implementing strategies for managing a healthy child is maintained. The child must be given the maximum opportunity for normal growth and development, and all essential “rations” of stimulation must be provided for both borderline health disorders and chronic diseases. In doing so, we will thereby respond to the call of the WHO Director-General Lee Jong-wook (2005) to change the strategies of the medical service. He insisted:

1. on the priority of “vertical” programs;
2. on a combination of a wide range of health support activities;
3. on a primary focus on children, and not just on their illnesses;
4. to integrate different child protection services.

Family planning complex

1. Social and psychological counseling.
2. Complex of pre-conception examination and rehabilitation
   • measures to reduce the risk to the fetus and the future child:
   • genetic counseling;
   • detection of chronic infectious diseases, primarily urogenital and generalized infections, latent foci of infection, carriage of hepatitis viruses, cytomegalovirus, herpes, Epstein-Barr virus and parvovirus B-19;
   • diagnostics of chronic gastrointestinal diseases and their impact on the absorption and balance of essential nutrients;
   • identification and treatment of chronic cardiovascular diseases, assessment of the associated risk for the course of pregnancy;
   • determination of obvious or hidden anemia; clarification of the nature of anemia, its treatment and prevention of relapses in subsequent periods of pregnancy;
   • hemochromatosis screening;
   • detection of obvious or latent osteopenia, treatment and prevention of progression;
   • analysis of women's nutrition, calculation of multicomponents and provision for debt compensation and restoration;
   • determination of immunological status based on antibodies to native DNA and antinuclear antibodies;
   • testing for immunity to rubella, deciding on the advisability of immunization;
   • screening and diagnosis of antiphospholipid syndrome to make decisions on aspirin prophylaxis during pregnancy;
   • screening for plasma homocysteine levels and methyltetrahydrofolate reductase activity;
   • detection of dental disease and the presence of fillings containing amalgam (with possible refilling);
   • determination of the concentration of iodine excreted in urine, study of the state of the thyroid gland (ultrasound examination, hormonal function);
   • screening for heavy metals in hair and nails; if the content of lead, mercury, fluorine, cadmium, beryllium increases - analysis of their concentrations in the blood, consultation with a toxicologist, measures for elimination;
   • as indicated - screening for alcohol and drugs.

If significant risk factors for the future fetus are identified, advice is given on the implementation of treatment and recovery measures and temporary abstinence from conception.

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