Family Planning for NEET PG PSM: IUCD, Antara, Mala N, Chhaya, Sterilisation — Timing, Eligibility, Incentives

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🎯 Exam priority: High-yield (Tier 1). Family planning questions test durations (IUCD 10 vs 5 years, MPA 3 months), timing after delivery, COC contraindications, sterilisation eligibility and the programme's brand names. Everything here is from MoHFW reference manuals and the 2022 NHSRC family planning booklet for Community Health Officers.

CBME mapping: CM 10.

Healthy Timing and Spacing of Pregnancy

• High-risk pregnancies: mother < 18 or > 35 years; births less than 2 years apart; pregnancy within 6 months of a miscarriage/abortion; 5th or later pregnancy.

• Advice: first pregnancy not before 18; wait at least 24 months after a birth before conceiving (birth-to-birth interval at least 36 months); wait 6 months after miscarriage or abortion.

• Eligible couples are of reproductive age, 15–49 years. All methods are free through public facilities and ASHAs.

The Basket of Methods

• MPA: tell clients not to massage the injection site or apply heat, and to carry the MPA card. A late client beyond the window restarts as a new client.

• Chhaya missed pill: take it as soon as possible; if late by more than 7 days, restart as a new user.

• IUCD: insert only if no MEC category 4 condition; follow-up at 6 weeks or after the first period, whichever is earlier.

When to Start After Delivery or Abortion

When each method can start after delivery (time axis not to scale). Exclusive breastfeeding protects only until 6 months.

Combined Pills: Who Should Not Use Them and Missed Pills

• Not for: breastfeeding women under 6 months postpartum, non-breastfeeding under 3 weeks; smokers of more than 15 cigarettes a day aged 35+; deep vein thrombosis, heart disease, liver disease, breast cancer, migraine with focal neurological symptoms, unexplained vaginal bleeding, anticonvulsant use. Hypertension and long-standing diabetes with complications need a clinician's advice.

• Missed 1–2 pills: take one now and the next at the usual time. Missed 3+ in week 1–2: take one now, continue, back-up for 7 days. Missed 3+ in week 3: finish the hormonal pills, skip the iron pills and start a new pack next day, back-up for 7 days. Missed iron pills: just discard them.

Sterilisation

• Eligibility: ever-married; women 22–49 years, men 22–60; at least one child over one year old (unless medically indicated); neither partner already sterilised; written informed consent.

• Female: follow-up on day 7 and at 6 weeks/first period; certificate after one month. Postpartum only by minilap within 7 days; otherwise interval sterilisation from 6 weeks.

• Male (NSV): walks home 30 minutes later; use back-up contraception until azoospermia — semen examination at 3 months; certificate then.

• Sterilisation does not protect against RTIs/STIs/HIV. Complications, failure or death are covered by the Family Planning Indemnity Scheme.

Schemes and Incentives

• Home delivery of contraceptives by ASHA: Nirodh, Chhaya, Mala N and the emergency pill (Ezy Pill).

• Ensuring spacing at birth (ASHA incentive): ₹500 for delaying the first child 2 years after marriage; ₹500 for a 3-year gap between 1st and 2nd child; ₹1000 if the couple adopts a permanent method after 1 or 2 children.

• PPIUCD/PAIUCD: ₹300 to the acceptor, ₹150 to the provider, ₹150 to the ASHA.

• Nishchay pregnancy test kits are given out by ASHAs for early detection of pregnancy.

Traps the Examiner Sets

• IUCD 380A = 10 years, 375 = 5 years.

• PPIUCD: within 48 hours; post-abortion IUCD within 12 days.

• Chhaya is non-hormonal, twice weekly × 3 months then weekly — and safe while breastfeeding.

• MPA delays return of fertility (7–10 months) — not permanent infertility.

• Mala N has 7 iron pills, not placebo.

• Female sterilisation age 22–49; male 22–60; youngest child must be over 1 year.

• Vasectomy is not effective until azoospermia (~3 months).

Rapid-Revision Cards

• IUCD durations

  380A: 10 years · 375: 5 years.

• PPIUCD / PAIUCD timing

  PPIUCD ≤ 48 h (or at caesarean); PAIUCD ≤ 12 days after surgical abortion.

• Antara (MPA)

  150 mg IM every 3 months; window −2 to +4 weeks; first dose after MBBS screening.

• MPA after delivery

  Breastfeeding: 6 weeks · not breastfeeding: 4 weeks.

• MPA fertility return

  7–10 months after last dose.

• Chhaya (centchroman)

  Non-hormonal; twice weekly × 3 months, then weekly; ok in breastfeeding.

• Mala N

  21 LNG 0.15 mg + EE 30 µg; 7 iron pills.

• COC after delivery

  Breastfeeding: not before 6 months · not breastfeeding: not before 3 weeks.

• COC: no-go list

  Smoker > 15/day aged ≥ 35, DVT, heart/liver disease, breast cancer, migraine with aura, anticonvulsants.

• HTSP

  First pregnancy ≥ 18; wait 24 months after birth (36-month birth interval); 6 months after abortion.

• Sterilisation eligibility

  Ever-married; F 22–49, M 22–60; ≥ 1 child aged > 1 year.

• Postpartum tubectomy

  Minilap within 7 days; interval from 6 weeks.

• Vasectomy follow-up

  Back-up until azoospermia; semen test at 3 months.

• ASHA spacing incentives

  ₹500 delay 1st child 2 y · ₹500 3-y spacing · ₹1000 permanent method after 1–2 children.

• PPIUCD incentive

  ₹300 acceptor · ₹150 provider · ₹150 ASHA.

• Dual protection

  Condoms only.

Sources

Sources

Facts in this article were checked against these documents.

• Family Planning Program: Guidance Booklet for Community Health Officer — NHSRC / MoHFW, 2022 (link)

• Reference Manual for Injectable Contraceptive (DMPA) — Family Planning Division, MoHFW, 2016 (link)

• Reference Manual for IUCD Services — Family Planning Division, MoHFW, 2018 (link)

• Reference Manual for Female Sterilization — Family Planning Division, MoHFW, 2014 (link)

• Standards & Quality Assurance in Sterilization Services — Family Planning Division, MoHFW, 2014 (link)

Test Yourself: Practice Questions

Eighteen questions in NEET PG style.

Practice Questions (NEET PG pattern)

Original questions written in the style of the exam: +4 for a correct answer, −1 for a wrong one. Every answer was checked against the sources listed above. NEET PG papers are not published by NBEMS, so these are not past-paper questions.

Q1. The Copper IUCD 380A supplied under the national programme protects for

• (a) 10 years

• (b) 12 years

• (c) 3 years

• (d) 5 years

Q2. A postpartum IUCD after vaginal delivery should be inserted within

• (a) 7 days

• (b) 6 weeks

• (c) 12 days

• (d) 48 hours

Q3. After a completed surgical abortion, an IUCD can be inserted within

• (a) 48 hours

• (b) 30 days

• (c) 6 weeks

• (d) 12 days

Q4. Centchroman (Chhaya) is best described as

• (a) a non-hormonal, non-steroidal weekly pill taken twice a week for the first 3 months

• (b) an emergency contraceptive

• (c) a progestogen-only daily pill

• (d) a combined pill with iron

Q5. Each injection of medroxyprogesterone acetate (Antara) gives protection for

• (a) 2 months

• (b) 1 month

• (c) 3 months

• (d) 6 months

Q6. A breastfeeding mother wants injectable MPA. It can be started

• (a) immediately after delivery

• (b) 6 months after delivery

• (c) 6 weeks after delivery

• (d) 4 weeks after delivery

Q7. After stopping injectable MPA, return of fertility typically takes

• (a) 2–3 years

• (b) 1 month

• (c) 7–10 months from the last dose

• (d) immediately

Q8. The 7 non-hormonal tablets in a Mala N strip contain

• (a) vitamin B12

• (b) placebo sugar

• (c) folic acid only

• (d) iron

Q9. Combined oral contraceptives should NOT be given to

• (a) a woman with a past ectopic pregnancy

• (b) a 25-year-old non-smoker

• (c) a woman with dysmenorrhoea

• (d) a breastfeeding woman 3 months postpartum

Q10. A woman on Mala N missed three hormonal pills in the third week. She should

• (a) only discard the missed pills

• (b) take two pills and continue

• (c) finish the hormonal pills, skip the iron pills, start a new pack next day and use back-up for 7 days

• (d) stop the pack and wait for her period

Q11. The age limits for female sterilisation under the national programme are

• (a) 25–50 years

• (b) 22–49 years

• (c) 21–49 years

• (d) 18–45 years

Q12. Postpartum female sterilisation (minilap) should be done within

• (a) 48 hours of delivery

• (b) 6 weeks of delivery

• (c) 7 days of delivery

• (d) 3 months of delivery

Q13. After vasectomy the man should use back-up contraception until

• (a) the wound heals

• (b) the next day

• (c) 1 week

• (d) azoospermia is confirmed, usually about 3 months

Q14. The only contraceptive that gives dual protection against pregnancy and STI/HIV is

• (a) the condom

• (b) MPA

• (c) centchroman

• (d) the IUCD

Q15. The recommended minimum interval between two births under HTSP is

• (a) 24 months

• (b) 12 months

• (c) 18 months

• (d) 36 months

Q16. Under the PPIUCD incentive scheme, the acceptor receives

• (a) ₹500

• (b) ₹300

• (c) ₹150

• (d) ₹1000

Q17. An IUCD can act as emergency contraception if inserted within

• (a) 72 hours only

• (b) 5 days of unprotected intercourse

• (c) 10 days

• (d) 24 hours

Q18. The most common technique for minilap tubectomy is

• (a) fimbriectomy

• (b) the modified Pomeroy technique

• (c) Irving technique

• (d) Falope ring application

Active Recall

From memory: list India's basket of contraceptive methods with their brand names and durations; say when each can be started after delivery and after abortion; give the COC contraindications and missed-pill rules; and state sterilisation eligibility, timing, follow-up and the main family planning incentives.