introduction essay for family planning

Family Planning Essay Sample

Family planning is a crucial thing that every single person on this planet should think about because of the limited number of resources that exist on the earth. If family planning will not be given much attention then there is going to be competition rather we should say tough competition among human beings to grab the maximum resources for their survival.

• Introductory Part on Family Planning Essay
• Main Body Of Family Planning Essay
• Conclusion :- Family Planning Essay

Essay Sample On Family Planning

Introductory Part on Family Planning Essay Planning your family is one of the most important decisions you will make in life. It can be a difficult decision to make, but it is crucial that you plan ahead before having children because this decision will affect your entire life and the lives of those around you. There are many different ways to go about planning for your family, so take some time to think about what would work best for you and your future family. Main Body Of Family Planning Essay Family planning is, therefore, must in such places so that the pressure on the resources of the region can be lowered to a great extent. There are nations like China where the rise of the population has taken a massive range in the country and now the government is trying to have control over the growth of the population. We can see how the population growth of China is in a stagnant state for the past couple of decades. This is because it has taken control of the growth of the population by asking the citizens for better family planning where they cannot reproduce more than one child in their life. Family planning is not only associated with the personal life of a person but at the same time, it is a national issue. It can be associated with the fraction of youth in the population of a country, pressure on the economy and other resources, and competition for survival. If a nation is lacking a young population there is a fair chance that it is going to face severe challenges in the future. This is because when the working population of the country is less than the old one then it is a great concern for the country which can be tackled by the family planning by the citizens by thinking about the growth of the country on a world scale. Various instructions are given by the government of many countries that are concerned with the family planning that citizens are supposed to follow. Buy Customized Essay on Family Planning At Cheapest Price Order Now Must View: Essay Sample On “Adoptive Family Advantages And Disadvantages” Conclusion :- Family Planning Essay Family planning is a very important part of our lives. It’s not just about birth control, it’s also about the emotional and physical well-being of each person in the family. As we know, there are many factors that can affect one or more members of the family including illness, accidents, marriage breakdowns, and work pressures. The truth is that every member has to be considered when making decisions on how often to have children as well as what kind of contraceptive methods will be used. Hire USA Experts for Family Planning Essay Order Now

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Home > Books > Family Planning

Introductory Chapter: Family Planning

Submitted: 07 March 2018 Published: 13 June 2018

DOI: 10.5772/intechopen.76418

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Family Planning

Edited by Zouhair O. Amarin

To purchase hard copies of this book, please contact the representative in India: CBS Publishers & Distributors Pvt. Ltd. www.cbspd.com | [email protected]

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Author Information

Zouhair amarin *.

• Department of Obstetrics and Gynecology, Jordan University of Science and Technology, Irbid, Jordan

*Address all correspondence to: [email protected]

1. Overview

Men and women have used contraception, in one form or another, for thousands of years. Most individuals at some time in their lives will use contraception. The worldwide trend towards delayed onset of childbearing and smaller families means that many women will need to use contraception for up to 30 years and will use different methods at different stages of their lives [ 1 ].

The ideal contraceptive method needs to be highly effective with no side effects, cheap, independent of intercourse, rapidly reversible, widely available, acceptable to all cultures and religions, and easily distributed and can be administered by non-healthcare personnel [ 2 ].

2. Classification and key points

Contraceptives are classified into hormonal, in the form of combined oral contraceptives (COCs), combined hormonal patches, progesterone only preparations, that include injectables and subdermal implants, intrauterine contraception in the form of copper intrauterine contraceptive devices (IUCD) and hormone releasing IUCDs, barrier methods in the form of male and female condoms, coitus interruptus, natural family planning, emergency contraception, female sterilisation and vasectomy [ 1 , 2 , 3 ].

Natural methods are physiologic-based methods that use neither chemical nor mechanical contraceptive method. These are least effective and not reliable. Fertility awareness and periodic abstinence emphasise avoidance of intercourse shortly before and after estimated ovulation period, therefore it is important to decide the fertile window of the cycle [ 4 , 5 , 6 , 7 , 8 , 9 , 10 ].

Fertility awareness and periodic abstinence relate to the fertile window of the cycle through the assessment of cervical mucus and the basal body temperature [ 1 , 2 , 3 ].

The calendar (rhythm) method is based on the assumptions that a human ovum is capable of fertilisation only for approximately 24 h after ovulation, that spermatozoa can retain their fertilising ability for only 48 h after coitus, and that ovulation usually occurs 12–16 days before the onset of the subsequent menses [ 1 , 2 , 3 , 4 ].

The menses are recorded for six cycles to approximate the fertile period. The earliest day of the fertile period is determined by the number of days in the shortest menstrual cycle subtracted by 18. The latest day of the fertile period is calculated by the number of days in the longest cycle subtracted by 11. After determining the earliest and latest days of the fertile window as mentioned above, abstinence should be for 2 days before the earliest day and 2 days after the latest day of the fertile period depending on spermatozoa viability [ 1 , 2 , 3 , 4 ].

Regarding cervical mucus, when a woman is not fertile, the mucus is light or sticky. During the day before and the day of ovulation, the most fertile time period, the increase in oestrogen levels causes more copious mucus that is clear and slippery [ 3 , 4 , 5 , 6 ].

The basal body temperature method stems from the fact that 2 or 3 days after ovulation, hormonal changes cause a rise in body temperature between 0.3 and 0.9°C, when measured as the first thing in the morning before getting out of bed [ 3 ].

Symptothermal methods include checking for breast tenderness or mittelschmerz (the lower abdominal pain or cramping some women feel around the time of ovulation) [ 3 ].

The advantages of the fertility awareness and periodic abstinence relate to the non-use of hormones, no side effects, enables a woman to understand her body’s cycles, promotes cooperation between partners, and is useful in couples with religious or cultural believes not meeting with hormonal or barrier contraception [ 6 , 7 , 8 , 9 ].

The disadvantages are due to the need for varying amounts of training, and are difficult to use in cases of recent childbirth, breastfeeding, recent menarche, approaching menopause, recent discontinuation of a hormonal method, irregular cycles, and being unable to interpret fertility signs [ 6 , 7 , 8 , 9 ].

The lactational amenorrhea method (LAM) is the use of breastfeeding as a contraceptive method. Elevated prolactin levels and a reduction of gonadotropin-releasing hormone from the hypothalamus during lactation suppress ovulation. To use breastfeeding effectively as a contraceptive requires mothers either feed the baby nothing but breast milk or, at the very least, breastfeed for almost all feedings. In addition, the baby must be less than 6 months old, and the mother should have amenorrhea. As soon as the first menses occurs, she should start using another method of contraception [ 4 , 10 , 11 , 12 , 13 , 14 ].

Withdrawal (coitus interruptus) is a traditional family planning method in which the man completely removes his penis from the woman’s vagina before he ejaculates. As a result, spermatozoa do not enter the vagina and fertilisation is prevented. The failure rate of this method is around 20%. Effectiveness depends largely on the man’s capability to withdraw prior to ejaculation [ 3 ].

Barrier methods include male condoms, female condoms, diaphragms with spermicides, cervical caps, creams, and foams [ 3 ].

Male condoms act as a physical barrier that prevents pregnancy by blocking the passage of semen. The available types include latex (natural rubber), natural membrane (lamb intestine), and polyurethane [ 3 ].

Advantages of the male condom include male participation, very inexpensive, effective in preventing pregnancy when used correctly, minimal side effects, protection against sexually transmitted infections, except HPV and HSV. Disadvantages include reduced sensitivity, erection problems, lack of cooperation, not very effective with wrong use, and latex allergy [ 3 ].

To minimise user error, male condoms should be used with every act of intercourse, used ‘from start to finish’, rim being held during withdrawal to prevent slippage or leakage, usage of appropriate lubricants (oil-based lubricants may damage the condom, and correct storage. The failure rate with perfect use is 2%, and with typical use is 15% [ 3 ].

Female Condoms are ‘one-time use’, they include a lubricant, spermicides are not recommended, can be inserted up to 8 h prior to intercourse, and can remain in place for up to 8 h. They protect against sexually transmitted infections. The failure rate with perfect use is 5%, and with typical use is 20% [ 3 ].

Female condoms contain two flexible rings and measures 7.8 cm in diameter and 17 cm long. The ring at the closed end of the sheath serves as an insertion mechanism and internal anchor that is placed inside the vaginal canal. The other ring forms the external patent edge of the device and remains outside of the canal after insertion [ 3 ].

The diaphragm is a dome-shaped latex (rubber) cup which is inserted into the vagina before intercourse and covers the cervix. Diaphragms prevent sperm from gaining access to the upper reproductive tract (uterus and fallopian tubes) and serve as a holder of spermicide. It must be inserted no longer than 6 h prior to coitus and left in the vagina at least 6 h but not longer than 24 h [ 1 , 2 , 3 ].

The cervical cap is a small, soft, rubber cap that fits directly over the cervix acting as a barrier to sperms. It is introduced 8 h before intercourse and left for 48 h. It is small, and works for 48 h. It must be fitted by a physician, and does not protect against sexually transmitted infections. The failure rate is 15–20% [ 1 , 2 , 3 ].

The mechanism of action of the spermicide nonoxynol-9 is by the virtue of its surfactant effect that destroys the sperm cell membrane. Its advantages include ease of use, and can use intermittently without advance planning. Its disadvantages include not providing protection against sexually transmitted infections, and its frequent use (more than twice per day) may cause tissue irritation that could increase susceptibility to HIV. Failure rates (when used alone) are about 20% with perfect use, and 30% with typical use [ 1 , 2 , 3 ].

Injectable progestin (depot medroxyprogesterone acetate 150 mg IM q 12 weeks) has the advantages of being highly effective, discreet and private, its use is not linked to coitus, and it does not require users to remember (only four times a year). Disadvantages include irregular periods or amenorrhea, delayed return to fertility, adverse effects on lipids, and decreased bone mineral density with long-term use [ 1 , 2 , 3 ].

Subdermal implants contain levonorgestrel and are inserted subcutaneously in the upper arm. There use lasts between 3 and 5 years, according to the type [ 2 , 3 ].

Transdermal patches release 150 mg norelgestromin and 20 mg ethinylestradiol daily. They form a 4.5 cm square that can be worn on the lower abdomen, buttocks, upper outer arm, upper torso (except breasts). One patch is applied every week for 3 weeks, followed by a patch-free week. They are as reliability as combined oral contraceptives, but may cause allergy, and breast tenderness [ 15 , 16 , 17 , 18 ].

Vaginal rings release etonogestrel 120 mg, and ethinylestradiol 15 mg daily. The ring is used continuously for 3 weeks, removed, and a new ring is inserted 1 week later. They too are as reliable as combined oral contraceptives [ 15 , 16 , 17 , 18 ].

Intrauterine contraceptive devices are long-acting contraceptives intended to be used for several years. They can be inert, copper releasing, or progesterone releasing devices.

Copper T 380 is a T-shaped IUCD that is made of polyethylene with fine copper wire wrapped around the vertical stem. This device consists of 380 mg of copper covering portions of its stem and arms. Its contraceptive effectiveness continues for 10 years; after which time it must be replaced [ 2 , 3 ].

Progesterone releasing devices are intrauterine systems that release 20 mcg of levonorgestrel per day into the uterine cavity for as long as 5 years. The direct effect on the lining of the uterus results in less bleeding, than experienced with other IUCDs. They act through fertilisation inhibition, cervical mucus thickening, inhibition of sperm motility and function, endometrial suppression, induction of weak foreign body reaction, and the inhibition of ovulation in some cycles [ 15 , 16 , 17 , 18 ].

Intrauterine contraceptive devices produce no adverse systemic effects, do not require daily attention, easy to use, not linked with sexual intercourse, provides long acting contraception, can be inserted immediately following an uncomplicated abortion in an uninfected uterus, and allow for rapid return to fertility. Their failure rate is between 0.1 and 0.6%. Ectopic pregnancies are reduced overall; however, the ratio of extrauterine to intrauterine pregnancy is increased if conception does occur [ 2 , 3 ].

The disadvantages of intrauterine contraceptive devices are that they must be inserted and removed by a trained health care provider, are associated with a risk of uterine perforation at the time of insertion, increased dysmenorrhea occurs with the copper IUDs, and increased menstrual blood loss occurs in the first few cycles. Whether IUCDs increase the risk of pelvic inflammatory disease (PID) is controversial. They do not have any of the potential non-contraceptive benefits of hormonal contraceptives, and may be expelled unnoticed, and they do not protect against sexually transmitted infections [ 15 , 16 , 17 , 18 ].

Contraindications to the use of intrauterine devices include a history of previous PID in the past year or active PID, active cervical or endometrial infections, abnormal or distorted uterine cavity, undiagnosed genital bleeding, uterine or cervical malignancy, a history of ectopic pregnancy, increased susceptibility to infection (e.g., those with leukaemia, diabetes, valvular heart disease, or AIDS), Wilson disease, and known or suspected pregnancy [ 15 , 16 , 17 , 18 ].

Combined oral contraceptives were first licenced in early 60s of the last century. Millions of women worldwide have taken it since. They contain synthetic oestrogen and a progestogen (synthetic derivative of progesterone). Oestrogens are mainly ethinylestradiol: 20, 30, 35, 50 μg, and mestranol 50 μg [ 2 , 3 ].

Second-generation progestogens include norethisterone acetate 0.5, 1.0, 1.5 mg, and levonorgestrel 0.15, 0.25 mg. Third-generation progestogens include gestodene 0.075 mg, desogestrel 0.15 mg, norgestimate 0.25 m, anti-mineralocorticoid and anti-androgenic: drospirenone 3 mg [ 2 , 3 ].

Combined oral contraceptives are metabolised in the liver and are excreted by the kidney. Their types include monophasic, biphasic, and triphasic. Most brands contain 21 pills and 7 days’ pill-free interval. Some are taken every day with seven placebo pills. Oestrogens inhibit ovulation by suppressing FSH and LH, thus making the endometrium atrophic. Progestins suppress LH, and thicken cervical mucus (making it less penetrable by sperms).

Counselling topics of COC users should include safety and efficacy (depends on the right use of the pill), how COCs work, possible side effects, what to do with the missed pill, when to consult a physician, and special circumstances (diarrhoea, vomiting, and medication) [ 2 , 3 ].

The ‘must ask questions’ before prescribing COCs include the personal characteristics of age, weight, smoker, previous family planning, obstetrics and gynaecology history [(last menstrual period, last delivery or miscarriage, breast feeding, dysfunctional uterine bleeding), past medical history (breast disease, liver disease, gall bladder disease, headache, epilepsy, diabetes, hypertension, cardiac disease, DVT, stroke) and drug history (anti epileptics, antibiotics, anticoagulants)] [ 15 , 16 , 17 , 18 ].

Do you think you could be pregnant?

Do you have high blood pressure?

Do you have diabetes?

Have you ever had stroke, blood clot in your leg, or other heart problems?

Do you have breast mass or known breast disease?

Do you have liver disease, hepatitis, jaundice, or gallbladder disease?

Do you have migraine headaches?

Do you have abnormal vaginal bleeding?

Are you breast feeding?

Are you above 35 yrs. and smoke >15 cigarettes per day?

Are you going for a major surgery soon?

Common questions that are posed by users include missing pills, break through bleeding, when to start the pill, what pill is the best, and side effects. Most side effects are minor. A woman should stop the pill immediately when she develops abdominal pain, chest pain, headache, eye symptoms (blurred vision, brief loss of vision), and sharp leg pain.

When non-menstrual problems arise, such as dizziness, women should be reassured as this usually diminishes over time. If there is nausea and vomiting, then pills should be taken with foods. If there is weight gain, women should be counselled about healthy eating habits and exercise. If side effects persist and are unacceptable, switching pill formulation or adopting another method should be considered [ 1 , 2 , 3 ].

In cases of unexplained vaginal bleeding or amenorrhea, the cause should be assessed (pregnancy or disease). Reinforcement of correct pill taking should be considered in women with breakthrough bleeding. Non-steroidal anti-inflammatory medication may be administered, or the use more potent progestins may be used in women with prolonged bleeding. In case of amenorrhea, women should be reassured, with no need for medical treatment. If side effects persist and are unacceptable there might be a need to switch to another method [ 1 , 2 ].

After making sure that the woman is not pregnant, COCs are started in the first 5 days of menstrual cycle. After day 5, a backup method should be used for 7 days. Postpartum, and non-breast feeding women, delay for 3 weeks, and if breast feeding, delay for 6 months [ 2 , 3 ].

When one or two active pills are missed, the missed pill should be taken as soon as remembered, and other pills should be taken on schedule with no need for a backup method. If three or more pills are missed, then a pill should be taken as soon as it is remembered, to be continued for at least 7 days, and to use back up measures for at least 7 days. The take-home message is to always take the missed pill as soon as remembered, continue taking the pill as usual, with three or more missed pills, backup measures until the woman has 7 days of pills [ 15 , 16 , 17 , 18 ].

Deciding on what pill is the best is a matter of trial. A woman can switch pills anytime she chooses, and anytime is a good time to stop. On the other hand, there is no need to take a break from the pill once in a while [ 16 ].

Some antibiotics and antiepileptic drugs known to induce hepatic cytochrome P450 (CYP450) isoenzyme cause decreased sex hormone levels in women taking oral contraceptives, raising the potential for decreased effectiveness of oral contraceptives and increased risk of unplanned pregnancy. Drugs that do not induce this hepatic isoenzyme are not thought to compromise the effectiveness of oral contraceptives.

Although fertility declines with age, effective contraception is still required in women over 40 years of age who wish to avoid pregnancy. According to International Guidelines, there are no contraceptive methods that are contraindicated based on age alone. However, there are some medical conditions more common in older women that may make the use of some contraceptive methods inappropriate. Effective nonhormonal and progestin-only methods provide safe options for women who should avoid oestrogen-containing contraceptives [ 15 , 16 , 17 , 18 ].

Lactational amenorrhea method (LAM) is the use of breastfeeding as a contraceptive method. Elevated prolactin levels and reduction of GnRh during lactation suppresses ovulation. For postnatal contraception, LAM users should begin breastfeeding immediately after delivery. It is highly effective for up to 6 months in amenorrheic exclusive breast feeders. As soon as the first menses occurs, the mother should start using another method of contraception [ 15 ].

Postnatally, less than 10% of women want another child within 2 years, and about 40% of women in the first year intend to use contraception, but do not do so. Generally, counselling for postnatal contraception should begin antenatally. Some methods are provided at delivery and during hospital stay such as IUCDs, female sterilisation, implants or injectables [ 15 ].

For puerperal contraception, spermicides and condoms may be used safely, withdrawal may be a simple but relatively unreliable, and episiotomies may still be tender. Fitting a woman with cervical cap or diaphragm may cause discomfort. The risk of toxic shock syndrome is increased when blood or lochia are present. Copper or progesterone releasing IUCDs may be inserted immediately after delivery, after caesarean section or within 48 h of delivery, otherwise insertion at 6 weeks. In menstruation, insertion is advisable on day 5 of the cycle [ 15 , 16 , 17 , 18 ].

The health benefits of oral contraception include a decrease in ovarian and endometrial Ca, ectopic pregnancy, anaemia, dysmenorrhoea, functional ovarian cysts, benign breast disease, and salpingitis [ 2 , 3 ].

Absolute contraindications for oral contraception include venous thromboembolism, pulmonary embolism, cardiovascular disease, cerebrovascular accident, pregnancy, malignancy, hepatitis, tumours, and abnormal liver function tests [ 3 ].

Relative contraindications for oral contraception include fibroids, lactation, diabetes mellitus, sickle-cell disease, hypertension, over 35-year-old smokers, over 40-year-old and risk of vascular disease, anovulation, depression, migraine, severe varicose veins, and hyperlipidaemia [ 2 , 3 ].

Complications of oral contraception include thromboembolism, cerebrovascular accident, hypertension, post pill amenorrhoea, cholilithiasis, and benign hepatic tumours [ 2 , 3 ].

Combined oral contraception should be avoided in breast feeders for 6 months. In lactational amenorrhoea, it is started when weaning begins. In non-breast feeders, it is started 3 weeks postpartum [ 3 ].

Progestin-only contraceptives (POCs) are produced in the form of implants, Depo-Provera and mini pills. Breast feeders should avoid using the progesterone only pills (mini pills) before 6 weeks postpartum. The mini pills can be used after 6 weeks up to 6 months. In lactational amenorrhoea, POCs may be delayed until 6 months. The main side effect of POCs is irregular bleeding [ 11 ].

Injectable Progestins include medroxyprogesterone (Depo Provera) 150 mg IM—3 months, norethisterone enanthate 200 mg IM—2 months. They should be considered when women have difficulty remembering, do not tolerate estrogenic, and are lactating [ 10 ].

Emergency contraception is the use of a drug or device to prevent pregnancy after unprotected sexual intercourse. The indications for its use include contraceptive failure (condom broke, pills forgotten), error in withdrawal or periodic abstinence, any unintended ‘sperm exposure’. Pregnancy is a contraindication for the use of emergency contraception [ 15 , 16 , 17 , 18 ].

Postcoital emergency contraception includes emergency contraceptive pills, containing estrogenic and progestin. It consists of two pills, and each contains 100 mcg of ethinylestradiol and 0.5 mg of levonorgestrel, ingested 12 h apart for a total of four pills. The first dose should be taken within the first 72 h after unprotected intercourse, or RU 486 (mifepristone) 50 mg single dose up to 96 h following unprotected coitus. Side effects include nausea, vomiting, headache, breast tenderness, abdominal pain, and dizziness [ 15 , 16 , 17 , 18 ].

Progestin-only postcoital emergency contraception treatment schedule comprises 1 dose of 750 mcg levonorgestrel taken as soon as possible and no later than 48 h after unprotected intercourse, and a second dose taken 12 h later. Side effects include nausea, vomiting, headache, breast tenderness, abdominal pain, and dizziness. Hormonal postcoital emergency contraception is about 90% effective [ 15 , 16 , 17 , 18 ].

The Copper T380 IUD can be inserted as many as 7 days after unprotected sexual intercourse to prevent pregnancy. Insertion of an IUCD is significantly more effective than other regimens, reducing the risk of pregnancy following unprotected intercourse by more than 99% [ 1 , 2 , 3 ].

For permanent contraception, tubal ligation is chosen by about 30% of women in developing countries, and about 10% of men undergo vasectomy. The mechanism of action of fallopian tube sterilisation is by cutting or mechanically blocking them to prevent the sperm and ovum from uniting. Can be performed laparoscopically or through a suprapubic ‘mini-laparotomy’ incision, or at caesarean section. The failure rate is 0.1% [ 1 , 2 , 3 ].

Tubal sterilisation is permanent, highly effective, safe, with quick recovery, lacks significant long-term side effects, cost effective, partner cooperation not required, and is not coitus-linked. Disadvantages include the need for general or regional anaesthesia, possibility of patient regret, difficult to reverse, future pregnancy could require assisted reproductive technology (such as in vitro fertilisation and intracytoplasmic sperm injection), and is more expensive than vasectomy [ 1 , 2 , 3 ].

At vasectomy, each vas deferens is cut to prevent the passage of sperm into the ejaculated seminal fluid. The failure rate is about 0.1%. Vasectomy is permanent, highly effective, safe, with quick recovery, lacks significant long-term side effects, cost effective, less expensive than tubal ligation, no partner cooperation needed, with removal of contraceptive burden from the woman. Disadvantages include the fact that reversal is difficult, expensive, often is unsuccessful. In addition, patients may regret decision, not effective until all sperm cleared from the tract, with no protection from sexually transmitted infections [ 2 , 3 ].

For reporting the effectiveness of a birth control method, the Pearl’s index is the most common technique used in clinical trials. It is the number of pregnancies occurring in 100 females using a certain contraception method for 1 year [ 3 ].

The Pearl index for various contraceptive methods is about 0.5 for COCs, 1 for injectables, implants and IUDs, 2 for progesterone only contraceptives, 2–5 for male condom, 20 for diaphragm, cervical cap and spermicides, and 45 for the rhythm method [ 2 , 3 ].

The relative cost per patient per year is 1 for vasectomy, 2 for female sterilisation, 2.5 for IUCDs, 8 for COCs, and 14 for barrier methods [ 2 , 3 ].

Family planning benefits the wellbeing of families throughout the world. Using contraception can avoid unwanted pregnancies and space births, protect against sexually transmitted infections and provide other health benefits [ 2 , 3 ].

The World Health Organisation and World Bank estimate that $3 per person per year would provide basic family planning, maternal and neonatal health care to women in developing countries. This would include contraception, prenatal, delivery, and postnatal care in addition to postpartum family planning [ 1 , 2 , 3 ].

• 1. WHO, CCP, USAID. Family Planning: A Global Handbook for Providers. 2011. Available from: https://www.fphandbook.org/
• 2. WHO. Medical Eligibility Criteria for Contraceptive Use. 2015. Available from: http://apps.who.int/iris/bitstream/10665/181468/1/9789241549158_eng.pdf?ua=1
• 3. USAID. Facts for Family Planning. 2013. Available from: https://www.fphandbook.org/factsforfamilyplanning/
• 4. ACCESS-FP. A Guide for Developing Messages for Women in the First Year Postpartum. 2010. Available from: /toolkits/ppfp/guide-developing-messages-women-first-year-postpartum
• 5. Hatcher RA et al. Contraceptive Technology. 2011. Available from: https://www.usaid.gov/who-we-are/agency-policy
• 6. FHI. Long-Acting and Permanent Methods: Addressing Unmet Need for Family Planning in Africa. 2007. Available from: /toolkits/communitybasedfp/long-acting-and-permanent-methods-addressing-unmet-need-family-planning
• 7. The International Consortium on Emergency Contraception. Emergency Contraceptive Pill: Guidelines and Factsheets. 2012. Available from: http://www.cecinfo.org/publications-and-resources/partner-publications/#pub1
• 8. The International Consortium for Emergency Contraception. Status & Availability Database. 2018. Available from: http://www.cecinfo.org/country-by-country-information/status-availability-database/
• 9. Population Council. The Situation Analysis Approach to Assessing Family Planning and Reproductive Health Services: A Handbook. 1997. Available from: http://www.popcouncil.org/uploads/pdfs/1997_SituationAnalysisHandbook.pdf
• 10. MCHIP. Family Planning & Pregnancy Spacing Knowledge Practices and Coverage Survey. 2013. Available from: https://www.mcsprogram.org/wp-content/uploads/2016/11/Pregnancy-Module.pdf
• 11. FHI 360/PROGRESS. Postpartum Family Planning: New Research Findings and Program Implications. 2012. Available from: https://www.fhi360.org/resource/postpartum-family-planning-new-research-findings-and-program-implications
• 12. Family Planning and HIV Services Integration Toolkit on K4Health. FHI 360. Available from: /toolkits/fphivintegration
• 13. The Postabortion Care (PAC) Consortium. Post abortion care consortium. Available from: http://pac-consortium.org/resources/community/
• 14. FHI. Conclusions from a Technical Consultation: Community-Based Health Workers can Safely and Effectively Administer Injectable Contraceptives. 2009. Available from: http://www.who.int/reproductivehealth/publications/family_planning/WHO_CBD_brief/en/
• 15. ACCESS-FP. Postpartum Family Planning for Community Health Workers. 2010. Available from: /toolkits/ppfp/postpartum-family-planning-community-health-workers
• 16. EngenderHealth/The ACQUIRE Project. Counselling for Effective Use of Family Planning: Trainer’s Manual. 2008. Available from: http://www.engenderhealth.org/files/pubs/acquire-digital-archive/10.0_training_curricula_and_materials/10.2_resources/fp_curric_tm_part_1.pdf
• 17. USAID. Applying Quality Improvement to Integrate Family Planning in Maternal Health and HIV Services. 2012. Available from: http://www.hciproject.org
• 18. UNFPA. Family Planning and Young People: Their Choices Create The Future. 2006. Available from: http://www.unfpa.org/publications

© 2018 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution 3.0 License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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• How to write an essay introduction | 4 steps & examples

How to Write an Essay Introduction | 4 Steps & Examples

Published on February 4, 2019 by Shona McCombes . Revised on July 23, 2023.

A good introduction paragraph is an essential part of any academic essay . It sets up your argument and tells the reader what to expect.

The main goals of an introduction are to:

• Catch your reader’s attention.
• Give background on your topic.
• Present your thesis statement —the central point of your essay.

This introduction example is taken from our interactive essay example on the history of Braille.

The invention of Braille was a major turning point in the history of disability. The writing system of raised dots used by visually impaired people was developed by Louis Braille in nineteenth-century France. In a society that did not value disabled people in general, blindness was particularly stigmatized, and lack of access to reading and writing was a significant barrier to social participation. The idea of tactile reading was not entirely new, but existing methods based on sighted systems were difficult to learn and use. As the first writing system designed for blind people’s needs, Braille was a groundbreaking new accessibility tool. It not only provided practical benefits, but also helped change the cultural status of blindness. This essay begins by discussing the situation of blind people in nineteenth-century Europe. It then describes the invention of Braille and the gradual process of its acceptance within blind education. Subsequently, it explores the wide-ranging effects of this invention on blind people’s social and cultural lives.

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Table of contents

Step 1: hook your reader, step 2: give background information, step 3: present your thesis statement, step 4: map your essay’s structure, step 5: check and revise, more examples of essay introductions, other interesting articles, frequently asked questions about the essay introduction.

Your first sentence sets the tone for the whole essay, so spend some time on writing an effective hook.

Avoid long, dense sentences—start with something clear, concise and catchy that will spark your reader’s curiosity.

The hook should lead the reader into your essay, giving a sense of the topic you’re writing about and why it’s interesting. Avoid overly broad claims or plain statements of fact.

Examples: Writing a good hook

Take a look at these examples of weak hooks and learn how to improve them.

• Braille was an extremely important invention.
• The invention of Braille was a major turning point in the history of disability.

The first sentence is a dry fact; the second sentence is more interesting, making a bold claim about exactly  why the topic is important.

• The internet is defined as “a global computer network providing a variety of information and communication facilities.”
• The spread of the internet has had a world-changing effect, not least on the world of education.

Avoid using a dictionary definition as your hook, especially if it’s an obvious term that everyone knows. The improved example here is still broad, but it gives us a much clearer sense of what the essay will be about.

• Mary Shelley’s  Frankenstein is a famous book from the nineteenth century.
• Mary Shelley’s Frankenstein is often read as a crude cautionary tale about the dangers of scientific advancement.

Instead of just stating a fact that the reader already knows, the improved hook here tells us about the mainstream interpretation of the book, implying that this essay will offer a different interpretation.

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Next, give your reader the context they need to understand your topic and argument. Depending on the subject of your essay, this might include:

• Historical, geographical, or social context
• An outline of the debate you’re addressing
• A summary of relevant theories or research about the topic
• Definitions of key terms

The information here should be broad but clearly focused and relevant to your argument. Don’t give too much detail—you can mention points that you will return to later, but save your evidence and interpretation for the main body of the essay.

How much space you need for background depends on your topic and the scope of your essay. In our Braille example, we take a few sentences to introduce the topic and sketch the social context that the essay will address:

Now it’s time to narrow your focus and show exactly what you want to say about the topic. This is your thesis statement —a sentence or two that sums up your overall argument.

This is the most important part of your introduction. A  good thesis isn’t just a statement of fact, but a claim that requires evidence and explanation.

The goal is to clearly convey your own position in a debate or your central point about a topic.

Particularly in longer essays, it’s helpful to end the introduction by signposting what will be covered in each part. Keep it concise and give your reader a clear sense of the direction your argument will take.

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As you research and write, your argument might change focus or direction as you learn more.

For this reason, it’s often a good idea to wait until later in the writing process before you write the introduction paragraph—it can even be the very last thing you write.

When you’ve finished writing the essay body and conclusion , you should return to the introduction and check that it matches the content of the essay.

It’s especially important to make sure your thesis statement accurately represents what you do in the essay. If your argument has gone in a different direction than planned, tweak your thesis statement to match what you actually say.

To polish your writing, you can use something like a paraphrasing tool .

You can use the checklist below to make sure your introduction does everything it’s supposed to.

Checklist: Essay introduction

My first sentence is engaging and relevant.

I have introduced the topic with necessary background information.

I have defined any important terms.

My thesis statement clearly presents my main point or argument.

Everything in the introduction is relevant to the main body of the essay.

You have a strong introduction - now make sure the rest of your essay is just as good.

• Argumentative
• Literary analysis

This introduction to an argumentative essay sets up the debate about the internet and education, and then clearly states the position the essay will argue for.

The spread of the internet has had a world-changing effect, not least on the world of education. The use of the internet in academic contexts is on the rise, and its role in learning is hotly debated. For many teachers who did not grow up with this technology, its effects seem alarming and potentially harmful. This concern, while understandable, is misguided. The negatives of internet use are outweighed by its critical benefits for students and educators—as a uniquely comprehensive and accessible information source; a means of exposure to and engagement with different perspectives; and a highly flexible learning environment.

This introduction to a short expository essay leads into the topic (the invention of the printing press) and states the main point the essay will explain (the effect of this invention on European society).

In many ways, the invention of the printing press marked the end of the Middle Ages. The medieval period in Europe is often remembered as a time of intellectual and political stagnation. Prior to the Renaissance, the average person had very limited access to books and was unlikely to be literate. The invention of the printing press in the 15th century allowed for much less restricted circulation of information in Europe, paving the way for the Reformation.

This introduction to a literary analysis essay , about Mary Shelley’s Frankenstein , starts by describing a simplistic popular view of the story, and then states how the author will give a more complex analysis of the text’s literary devices.

Mary Shelley’s Frankenstein is often read as a crude cautionary tale. Arguably the first science fiction novel, its plot can be read as a warning about the dangers of scientific advancement unrestrained by ethical considerations. In this reading, and in popular culture representations of the character as a “mad scientist”, Victor Frankenstein represents the callous, arrogant ambition of modern science. However, far from providing a stable image of the character, Shelley uses shifting narrative perspectives to gradually transform our impression of Frankenstein, portraying him in an increasingly negative light as the novel goes on. While he initially appears to be a naive but sympathetic idealist, after the creature’s narrative Frankenstein begins to resemble—even in his own telling—the thoughtlessly cruel figure the creature represents him as.

If you want to know more about AI tools , college essays , or fallacies make sure to check out some of our other articles with explanations and examples or go directly to our tools!

• Ad hominem fallacy
• Post hoc fallacy
• Appeal to authority fallacy
• False cause fallacy
• Sunk cost fallacy

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Your essay introduction should include three main things, in this order:

• An opening hook to catch the reader’s attention.
• Relevant background information that the reader needs to know.
• A thesis statement that presents your main point or argument.

The length of each part depends on the length and complexity of your essay .

The “hook” is the first sentence of your essay introduction . It should lead the reader into your essay, giving a sense of why it’s interesting.

To write a good hook, avoid overly broad statements or long, dense sentences. Try to start with something clear, concise and catchy that will spark your reader’s curiosity.

A thesis statement is a sentence that sums up the central point of your paper or essay . Everything else you write should relate to this key idea.

The thesis statement is essential in any academic essay or research paper for two main reasons:

• It gives your writing direction and focus.
• It gives the reader a concise summary of your main point.

Without a clear thesis statement, an essay can end up rambling and unfocused, leaving your reader unsure of exactly what you want to say.

The structure of an essay is divided into an introduction that presents your topic and thesis statement , a body containing your in-depth analysis and arguments, and a conclusion wrapping up your ideas.

The structure of the body is flexible, but you should always spend some time thinking about how you can organize your essay to best serve your ideas.

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Counselling for Maternal and Newborn Health Care: A Handbook for Building Skills. Geneva: World Health Organization; 2013.

Counselling for Maternal and Newborn Health Care: A Handbook for Building Skills.

12 family planning counselling.

• What is in this session?

It is important to help women and their partners to gain increased control over their reproductive health. One of the main ways you can do this is through counselling on family planning methods during late pregnancy, the postpartum and the post-abortion periods.

This session only provides an introductory overview on family planning counselling. If necessary and where possible, you should refer women to see a trained family planning provider and/or use family planning support materials, such as the WHO ‘Decision-Making Tool for Family Planning Clients and Providers’.

http://www.who.int/reproductivehealth/publications/family_planning/9241593229/en/index.html

• What skills will I develop?
• Providing information that builds on existing knowledge
• Facilitating shared problem-solving and decision-making
• Tailoring to specific family planning needs.

• What am I going to learn?

By the end of this session you should be able to:

• Assess the family planning needs of individual women
• Communicate information on the importance of birth spacing and on family planning method use.
• Communicate information on the importance of family planning in the postpartum and post-abortion periods.
• Birth spacing and postpartum family planning

Family planning is about deciding how many children you choose to have and when you want to have them (timing of pregnancies and birth spacing). The recommended interval before attempting the next pregnancy is at least 24 months in order to reduce risks to the mother and infant. A woman can become pregnant within several weeks after birth if she has sexual relations and if she is not breastfeeding exclusively. It is important that as a health worker you discuss the importance of family planning and birth spacing, and help couples in choosing the contraceptive method that is right for them.

The role of family planning counselling is to support a woman and her partner in choosing the method of family planning that best suits them and to support them in solving any problems that may arise with the selected method. During late pregnancy, after giving birth and after an abortion, it is important that the woman or the couple receives and discusses correct and appropriate information so that they can choose a method which best meets their needs. If a woman, preferably with her partner, is able to make an informed choice, she is more likely to be satisfied with the method chosen and continue its use.

THE HEALTH BENEFITS OF BIRTH SPACING AND FAMILY PLANNING

• Delaying having children can give people the opportunity to complete education or further studies
• Waiting to become pregnant at least 24 months after birth can lead to health benefits for the mother and baby.
• Spacing births allows the mother to recover physically and emotionally before she gets pregnant again, and faces the demands of pregnancy, birth and breastfeeding.
• Limiting the number of children in a family means more resources for each child and more time for the parents to dedicate to each child.
• Family planning can also help couples in a sexual relationship not to be worried about the woman getting pregnant.
• STIs including HIV/AIDS can also be prevented with correct and consistent use of condoms.
• Younger women (adolescents) can delay pregnancy until their bodies are mature and they are ready in terms of their life course.
• Older women (over 35) can prevent unwanted pregnancies that are often risky for their health and can lead to complications for both mothers and infants.

When to counsel on birth spacing

You should begin discussing family planning during pregnancy, particularly during the third trimester, after birth and in the immediate postpartum period. Pregnant women need to know that if they are not exclusively breastfeeding they can get pregnant as soon as four weeks after the birth of their baby, even if they have not yet started their menstrual cycle. Several methods of family planning can be started immediately after birth, but others may need to be delayed if the woman is breastfeeding.

If the woman wants female sterilization or an Intrauterine Device (IUD) inserted immediately after childbirth, she should inform her birth attendant and plan to give birth in a health facility.

Advise women about the benefits of using breastfeeding as a family planning choice, known as the Lactational Amenorrhoea Method (LAM). LAM provides protection when the following three requirements are met:

• the woman is exclusively breastfeeding a baby, day and night
• during the first six months after birth and
• her menstrual periods have not returned.

Exclusive breastfeeding means that the baby is not given any other food or drink, not even water. She or he is only given breast milk. See Session 13 for more information on breastfeeding.

Once the baby reaches six months, or receives complementary foods or the mothers' periods have returned, she should use another family planning method. Before this time she needs to start thinking about what method she will use after LAM.

Counselling a woman on family planning after an abortion

When advising a woman how to care for herself after an abortion (see Session 9 as well), remember that it is important to discuss the use of a family planning method to prevent another unwanted pregnancy. Explain that she can become pregnant as soon as two weeks after an abortion if she begins to have sexual relations. A woman who has recently experienced an induced or spontaneous abortion should wait at least six months before another pregnancy to reduce risks to her health and to her future baby.

You can support her and her partner in choosing a method that meets their needs:

• If she has no post-abortion complications or infection, she can safely use any family planning method, and can start all methods immediately post-abortion (except for the natural calendar method, when she should wait for 3 months).
• If an infection is present or suspected, advise her to avoid intercourse until the infection is ruled out or fully treated. Delay female sterilization and IUD insertion until an infection is fully treated, but offer other methods to use in the meantime.
• For IUD insertion or female sterilization after a second trimester abortion, the provider may need special training because of the changed uterine size and the position of the fallopian tubes.
• If she thinks she could be at risk of getting STI/HIV, she should use a condom in all sexual relations.
• It may also be helpful to explain emergency contraception, and offer her emergency contraceptive pills to take home in case she needs them.

Male partner

The partner should be encouraged to take part in family planning counselling sessions, especially if the chosen method involves his cooperation, for example, condoms or natural methods. In some places research has shown that family planning method use is more successful when partners choose and agree upon a method together. First, ask the woman whether she would be happy for her partner to be involved. In some cases women may feel more comfortable if their partners are not present or if their partners are counselled on their own and/or by a male counsellor.

Within the community, men also need to participate in discussions on the importance and benefits of family planning and birth spacing. Men need to understand their role in reproduction so that they can share the responsibility for family planning and birth spacing. This can be done through outreach work or through discussion with men when they accompany their wives or partners to the health facility.

Partners should be encouraged to take part in family planning counselling sessions

Women with special needs.

Women with special needs may require extra time for family planning counselling. For example, adolescents who are not in a stable relationship, need emphasis placed on the importance of dual protection from STIs/HIV, as well as from pregnancy (see box next page). They may also need special assistance in obtaining the family planning method that suits them best. Women who are in violent relationships may also need special counselling and support to explore their alternatives (i.e. condom use may be unlikely). These women may also not be able to discuss family planning with their partners and may need extra help and support in using family planning methods. Women with physical disabilities may have special requirements in terms of which methods are suitable for their situation and disability. Women with severe physical or mental disabilities may have become pregnant due to rape or abuse. The family needs to be involved in such instances to ensure that this does not recur and also possibly to be involved in discussions around family planning for this woman. Women with HIV must be counselled on the necessity of using dual protection methods, even if their partner is HIV-positive, to prevent other STIs and strains of HIV developing.

Adolescents or unmarried women should also be offered family planning counselling. Sometimes this is difficult if the family or community disapproves of adolescent sexual activity and pregnancy. Explore ways you can work with adolescents, youth groups and schools to reach adolescents who may need support. Consider the counselling context, specifically any cultural norms you identified in Session 4 to help you locate any key gatekeepers in the community to help you address this topic with adolescents.

When working with a pregnant adolescent, it is particularly important to discuss birth spacing and support her in planning when she would be ready for a next pregnancy.

• Dual protection (also see Session 14 on HIV)

Correct and consistent use of condoms with another family planning method for every sexual encounter is the best way to ensure dual protection against unwanted pregnancy and HIV/AIDS transmission.

Dual protection against both pregnancy and STIs, including HIV/AIDS, is an increasing concern for many women. You may need to counsel women and their partners about their options for dual protection.

Issues for women and their partners to consider are:

• Some people are more at risk than others (for example, those with new or multiple partners).
• Often people do not know if they or their partner has an STI as they may have no symptoms.
• A person with HIV can look and feel healthy.
• If someone is unsure about sexually transmitted infections, a test may be available.
• If you are sexually active (and are not 100% sure that your partner is not infected) then consistent and correct condom use is the only way to protect fully against STIs/HIV.
• Condoms can be used together with another method to ensure very effective protection from pregnancy and STIs.

Remember that only condoms protect against both pregnancy and STIs/HIV.

• Helping a woman to choose a method that is right for her

There is no single method of family planning which should be recommended for everyone. Family planning counselling can help a woman, and/or her partner choose which method best suits him or her.

There are various models of family planning counselling that can be applied, including the GATHER model (Greet the client, Ask about situation and needs, Tell about different methods and options, Help clients choose, Explain how to use a method, Return) or the REDI model (Rapport-building, Exploration, Decision-making, and Implementing the decision). In general, the steps or actions outlined below should be covered to counsel on family planning. To start the counselling process, remember the steps and skills outlined in Session 2 .

• you can ask if she knows about family planning, what she has heard about it, and if she knows it is important;
• explain that it is important to know that she can become pregnant soon after giving birth if she is not exclusively breastfeeding;
• you should also ask whether the woman or couple already have a family planning method in mind – those people who receive the method that they have planned for are much more likely to use it successfully. You can then help them assess if this method suits their situation and needs (e.g., Are you confident you could remember to take a pill every day?), or it may also be helpful to discuss other options in case there is a method that better suits his/her or their needs.
• plans for having more children;
• whether she and/or her partner want to use family planning;
• previous methods used and reasons for success or failure;
• experience with side-effects;
• popular beliefs about family planning and how these affect her decision to choose a particular method;
• her relationship and situation; Is she in a stable relationship? How often does she see her partner? How many partners does she have?; Is there need for dual protection from STIs, including HIV?
• her and her partner's HIV status or risk factors for HIV;
• regularity of sexual intercourse (especially for adolescents or unmarried women);
• partner's or family's views about family planning methods;
• ability to keep to routines.
• Can the method be used while breastfeeding?
• How effective is it?
• Are there any side-effects?
• Does it provide protection from STIs or HIV?
• Does it impact on sexual relations?
• How easy is it to use?
• Is it easy to stop using the method?
• Is the method reversible?
• How quickly will fertility return once method is stopped?
• Is there a need to do something before sex? (e.g. putting a condom on, inserting a diaphragm)
• Is it used continuously, or only used when needed?
• Is there a need to touch genitals?
• Check if she is eligible to use the chosen method Before giving out detailed information on method use, check if the woman is eligible to use the method. Some women who have recently given birth or who are breastfeeding may be unable to use certain methods (see table below). You can also check if she is able to start using the family planning method straight away. Some health conditions may prevent a woman from using certain methods.
• What the method is and how it works
• How effective it is at preventing pregnancy
• Side-effects: what the user can expect, and what to do about them
• How to use the method correctly
• What to do in case of a mistake in the use of the method or problems (missed pills, late for injection, condom splits)
• Information on when to return to the clinic
• Signs of complications to watch out for.

The best way to check whether a woman knows how to use the method is to ask her to explain to you in her own words how to use the method. You could also ask her to demonstrate the use of certain methods such as condoms or diaphragms, or you could consider demonstrating their use to her first, asking for her to repeat back the demonstration afterwards to ensure that she has fully understood.

Table Starting family planning methods after childbirth

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If you are working in a group carry out this activity as a role-play rotating the roles. Take time in advance to come up with a number of different roles. If you are working alone, ask a colleague to observe you counselling women.

• finding out what is already known
• dispelling any myths or misunderstandings regarding contraception
• engaging the woman and her partner in interactive discussion
• filling information gaps
• discussing the woman's/couples needs
• tailoring methods to their circumstances (physical, social)
• discussing characteristics of different methods
• joint decision-making
• Get the person who will be observing you to review this session beforehand. Remember to get permission from the woman or couple for the observer to be present if you will be carrying out this activity in a real situation rather than a role-play
• Ask the observer to give you feedback on your strengths and weaknesses during the counselling process using the points outlined above as a checklist. You can also refer back to Session 9 Activity 2 for a more general observer's checklist.

Because of expertise and knowledge and the respect person in the community have for this knowledge, we can sometimes inadvertently push people towards decisions that they are not ready to make or are not happy with. Skilled counsellors facilitate the process while taking a ‘back seat’ when it comes to making a decision. In other words they let the woman or couple reach their own decision. Your questioning and listening skills will help you to make accurate assessments and know where to provide guidance and where to take a step back, as people work through the information.

What did I learn?

The importance of establishing family planning during the post-abortion and postpartum periods cannot be underestimated. Providers need to work in an interactive way with women and their partners to discuss their family planning needs and to establish which methods will best satisfy their particular needs. Are you confident that you can discuss family planning issues with women and their partners during pregnancy and the postpartum period? Which skills do you need to develop and practise? Do you have access to Family Planning tools to assist you? Do you know where to refer women and their partners for specialist family planning advice?

Write down the answers to this information in your notebook, but also consider putting it together as a resource to share with your colleagues. Remember also that as you practise your counselling skills you should try and reflect on where you have improved and areas you feel you need to strengthen.

All rights reserved. Publications of the World Health Organization can be obtained from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: tni.ohw@sredrokoob ). Requests for permission to reproduce or translate WHO publications – whether for sale or for noncommercial distribution – should be addressed to WHO Press, at the above address (fax: +41 22 791 4806; e-mail: tni.ohw@snoissimrep ).

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