Family planning

According to the definition of WHO experts (1970), the term "family planning" refers to those activities that aim to help individuals or couples achieve certain results: to avoid unwanted pregnancies, to produce the coveted children; regulate the interval between pregnancies; control the timing of childbearing, depending on the age of the parents and determine the number of children in the family.

Measures to ensure family planning must necessarily be aimed at both a certain person and the family as a whole, since the reproductive behavior of a modern family is largely determined by its social and hygienic characteristics, in which medico-social factors and lifestyles are essential.

Family planning is an essential element of primary health care, necessary to maintain health and ensure the regulation of the childbearing function for the birth of only coveted children.

Proceeding from the definition of reproductive health, as the absence of diseases of the reproductive system and (or) violations of the reproductive function, with the possibility of reproductive processes with full physical, mental and social well-being, the factors determining it can be attributed to two main groups: medical and social. The main medical factors of reproductive health of the population of the region or social group are:

• the level of gynecological incidence;
• the level of maternal and infant mortality;
• the prevalence of medical abortion as a means of family planning;
• indicators of use of contraception;
• frequency of infertile marriages.

Social factors of reproductive health are defined:

• existing legislation and traditions in the field of family planning;
• the educational level of the population in matters of family planning and contraception;
• accessibility (economic and actual) as advisory assistance on the above issues, and the contraceptives themselves.

In accordance with the medical and biological point of view on family planning, the latter "helps to reduce infant mortality, strengthen maternal and child health, reduce infertility."

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

The main tasks for the preservation and strengthening of reproductive health and family planning, faced by specialists of various levels of medical care, are currently:

• propaganda of family planning ideas;
• sexual 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 incidence and the number of abortions.

The main work to promote the ideas of family planning and the possibility of using modern methods of contraception rests with level 1 doctors. From the completeness, accessibility of the information received during the woman's consultation, the further use of the chosen method of family planning

If the doctor does not have information on the problem that is of interest to the woman, he should direct the consultation to a higher-level gynecologist. At these levels, obstetricians and gynecologists are not only obliged to conduct a full consultation, but also recommend, if necessary, a system of medical measures aimed at increasing the acceptability of the used woman method of contraception.

[1], [2], [3]

Monitoring of pregnancy

1. Monitoring of the basic functions of the vital functions of the mother and fetus.
2. Screening of abnormal development and formation by methods of ultrasonic diagnostics.
3. Monitoring of fetal growth and placenta condition.
4. Screening of the pregnant and fetus by Rh factor; the introduction of rhesus immunoglobulin according to indications.
5. Monitoring of the diet, nutritional support and weight dynamics of the pregnant woman with regular dietary correction.
6. Hypoallergenic nutrition of a pregnant woman (according to indications).
7. A study of fetoprotein of pregnant blood serum.
8. Control of blood pressure, urinary sediment, peripheral blood.
9. The appointment of glucocorticoids in the risk of respiratory disorders.
10. Control of urogenital infection.
11. DNA analysis to exclude hereditary diseases or generalized infections (according to indications).
12. Amniocentesis or chorion biopsy (according to indications).
13. Screening for alcohol, drugs, cotinine (according to indications).
14. "School" is pregnant on all issues of the regime of life, physical, psychological, hygienic preparation for childbirth.
15. "School" for breastfeeding and nipple training.

Safety of labor, induction of breastfeeding and bonding

1. Gentle technique, the presence of a husband or other family members, free choice of posture, minimal use of anesthetics.
2. Immediate application to the chest in the delivery room with prolonged skin contact, joint mother and child stay, free swaddling, free feeding.
3. Maximum exposure limit for allergens.
4. Limiting the use of concentrated oxygen, protecting the respiratory tract and eyes through the administration of antioxidants.
5. Diagnosis and monitoring of transitional and pathological conditions.
6. Immunization.
7. Monitoring the feeding of the nursing mother and the dynamics of the body weight of the newborn.
8. Control of biota formation.
9. Support for the regularity of the light mode.

Screening of diseases of the newborn

1. Phenidketonuria.
2. Galactosemia.
3. Ketoaciduria.
4. Hypothyroidism.
5. Hyperplasia of the adrenal glands.
6. Cystic fibrosis.
7. Biotinidase insufficiency.
8. Homocystinuria.
9. Histidemia.
10. Tyrosinemia.

Post-neonatal complex

1. Monitoring the nutrition of the nursing mother, the dynamics of her body weight and newborn, the development of breastfeeding.
2. Monitoring the evolution of reflexes, development of the psyche and motor acts.
3. Monitoring of relationships in the systems "mother-child", "father-child", "child and family as a whole".
4. Screening diagnosis in the first weeks of life:
   • aminoaciduria;
   • methylmalonic acidemia;
   • hypercholesterolemia;
   • insufficiency of a-1-antitrypsin;
   • infection with tuberculosis and HIV;
   • risk of sudden death syndrome;
   • risk of ill-treatment in the family;
   • risk of hearing and vision impairment;
   • risk of progressive lesions of the central nervous system.
5. "School" of parents on hygiene, feeding, creating an enriched environment for development, massage and gymnastics for children of the first weeks and months of life, measures for the overall safety of the child, preventing sudden death in the presence of its increased risk.
6. Beginning of children's diaries on nutrition, behavior, sleep patterns, motor and emotional reactions, etc.

Programs for subsequent periods of life

1. Regular nursing and medical examinations. Optimum technology of examinations - various programs of the AKDO system (from programs for young children to adolescents). For all age groups - the program "AKDO - Nutrition".
2. Urine test for bacteriuria, hematuria and proteinuria at least once in 2-3 years, determination of hemoglobin in the blood at least once a year, ECG - at 1, 5, 10, 15 years.
3. Screening study for the concentration of lead in 1, 3, 5 years.
4. A complex of educational programs for children and their parents to form and protect their own health.
5. The program "Physical perfection" for children of all ages. Creation of automated testing systems of physical activity and culture, individual selection of the training regime.
6. The program "Gigant" - the creation of pedometrics cabinets with automated systems for removing and analyzing the parameters of physical development, biological age, puberty, the pace of development.
7. The program "Optima" - an automated assessment of the diet and its correction.
8. The program "Clever" - on the monitoring of neuropsychic development, its support and stimulation, correction of early deviations, the identification of children with high intelligence.
9. The program "Rainbow" - for screening and early diagnosis of visual impairment, prevention of myopia, strabismus and vision.
10. Program "Symphony" - for screening and early diagnosis of hearing impairment in children with the aim of preventing hearing loss.
11. The program "Kusaka" (or "Smile") - on the prevention of tooth decay and malocclusion.
12. The program "Allergoschit" - for the early diagnosis and prevention of allergic diseases in high-risk families, as well as for the organization of therapeutic and rehabilitation and educational measures for children with allergic diseases.
13. The program "Ascent" is a general register of disabled children with monitoring of their rehabilitation in specialized centers.
14. The program "Sphinx" - on the planning and monitoring of immunization of children.
15. The program "Like everything" - for children with neurotic diseases, enuresis and encopresis.
16. The program "Cicero" - for children with speech disorders.
17. The program "To live differently" - on the prevention of early arterial hypertension, atherosclerosis, acute life-threatening conditions of cardiac origin in children with hereditary predisposition.
18. The program "Future" - for early prevention of cancer.
19. The program "Will" - for children who are accustomed to smoking, alcohol and drugs.
20. The "Tent" program is for children from socially disadvantaged families, victims of violence, children and adolescents with suicide attempts, young mothers, families in critical situations.
21. The program "Zerkalo" - for the constant monitoring of mortality, the occurrence of acute diseases, chronic diseases, grouping of certain categories of pathology with selective growth.
22. The SHIELD-ECO program is for monitoring environmental safety, especially for pregnant women and children.
23. The program "SOC DET" - on the study of the economy of families with children, and the organization of support for the poor.

Medical programs of treatment and recovery for 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 early in the course of time using screening diagnostic systems for primary and secondary prevention. Early detection of abnormalities allows much more effective intervention during the course of the disease. Complexes of medical technologies are formed in connection with the profile of revealed deviations. The organization of medical examinations, treatment and rehabilitation can take place in advisory rooms and centers created for the combined use of several units. To monitor the course of diseases and functional failure, it is recommended to allocate the following subgroups of children:

1. with a delay in growth, motor, speech, mental development;
2. suffering from allergic diseases;
3. with hearing defects;
4. with visual impairment;
5. with defeat of the musculoskeletal system;
6. with rheumatic diseases;
7. with diabetes mellitus;
8. with chronic diseases of the gastrointestinal tract and malabsorption;
9. with dysplasia of connective tissue and hypermobility of joints;
10. often and long-term ill;
11. those who have suffered craniocerebral trauma, meningitis, encephalitis;
12. carriers of hepatitis and HIV;
13. with disturbances in night sleep and the 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 nonspecific lung diseases;
18. infected with mycobacteria tuberculosis.

Specialized assistance as a component of an individual health promotion strategy

It is very important that in the vast majority of clinical situations the priority of the implementation of strategies for managing a healthy child remains. The child needs to maintain the maximum opportunities for normal growth and development, to provide all the essential "rations" of stimulation both in borderline health disorders and in chronic diseases. In doing so, we will thus respond to the call of 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 promotion activities;
3. on the preferential orientation of children, and not only on their diseases;
4. on the integration of different child protection services.

Family Planning Complex 

1. Socio-psychological counseling.
2. Complex of pre-conception and rehabilitation
   • measures to reduce the risk to the fetus and the unborn child:
   • genetic counseling;
   • identification of chronic infectious diseases, especially urogenital and generalized infections, latent foci of infection, carriage of hepatitis viruses, cytomegaly, herpes, Epstein-Barr virus and parvovirus B-19;
   • diagnosis of chronic diseases of the gastrointestinal tract and their effect on the absorption and balance of essential nutrients;
   • identification and treatment of chronic diseases of the cardiovascular system, assessment of the risk associated with them for the course of pregnancy;
   • the definition of overt or covert anemization; clarification of the nature of anemia, its treatment and prevention of relapse in subsequent periods of pregnancy;
   • screening for hemochromatosis;
   • the detection of overt or covert osteopenia, treatment and prevention of progression;
   • analysis of women's nutrition, multicomponent calculation and security for debt recovery and recovery;
   • establishment of immunological status according to antibodies to native DNA and antinuclear antibodies;
   • testing for immunity to rubella, deciding on the appropriateness of immunization;
   • screening and diagnosis of antiphospholipid syndrome for decision-making on aspirin prophylaxis in pregnancy;
   • screening for homocysteine in the blood plasma and methyltetrahydrofolate reductase activity;
   • identification of the disease of the teeth and the presence of seals containing amalgam (with possible refilling);
   • determination of the concentration of iodine excreted in the urine, the study of the thyroid gland (ultrasound, hormonal function);
   • screening of heavy metals in hair and nails; with an increase in the content of lead, mercury, fluorine, cadmium, beryllium - an analysis of their concentrations in the blood, consultation of a toxicologist, measures for elimination;
   • on indications - screening for alcohol and drugs.

When identifying significant risk factors for the future fetus, give advice on the implementation of treatment and recovery measures and temporary abstinence from conception.

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