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

Source: https://tracknation.in/story/family-planning-for-neet-pg-psm-iucd-antara-mala-n-chhaya-sterilisation-timing-eligibility-incentives (TrackNation — free UPSC notes with PYQs)

> NEET PG Community Medicine: healthy timing and spacing of pregnancy, India's basket of contraceptives (IUCD 380A/375, injectable MPA 'Antara', Mala N, centchroman 'Chhaya', Nirodh), when each method can start after delivery or abortion, COC contraindications, missed-pill rules, sterilisation eligibility and follow-up, and ASHA/PPIUCD incentives — from MoHFW and NHSRC manuals, with a postpartum timeline diagram, verified MCQs and cards.

## Start Here

🎯 **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

| **Method**

 | **Key facts (national programme)**

 |
| IUCD 380A / IUCD 375

 | Copper IUCDs: 380A protects 10 years, 375 protects 5 years; also emergency contraception if inserted within 5 days

 |
| Injectable MPA ('Antara')

 | 150 mg IM every 3 months; window 2 weeks early to 4 weeks late; first dose only after an MBBS doctor screens; fertility returns 7–10 months after the last dose

 |
| Mala N (COC)

 | 28 pills: 21 hormonal (levonorgestrel 0.15 mg + ethinyl estradiol 30 µg) + 7 iron pills; taken daily without a break

 |
| Centchroman ('Chhaya')

 | Non-hormonal, non-steroidal; twice a week for 3 months, then once a week

 |
| Condoms ('Nirodh')

 | The only method giving dual protection (pregnancy + STI/HIV)

 |
| Female sterilisation

 | Minilap (modified Pomeroy) or laparoscopic (Falope rings)

 |
| Male sterilisation

 | Conventional or no-scalpel vasectomy

 |

- 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.*

| **Method**

 | **After vaginal delivery**

 | **After abortion**

 |
| IUCD

 | PPIUCD within 48 h (or during caesarean); interval IUCD from 6 weeks

 | Within 12 days of a completed surgical abortion

 |
| Injectable MPA

 | From 6 weeks if breastfeeding; from 4 weeks if not

 | Within 7 days of completed abortion

 |
| Centchroman

 | Any time, even before 4 weeks

 | Within 7 days of completed abortion

 |
| Combined pill

 | Not before 6 months if breastfeeding; not before 3 weeks if not

 | —

 |
| Female sterilisation

 | Within 7 days (postpartum minilap only) or from 6 weeks (interval)

 | With surgical MTP or within 7 days

 |

## 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

- 380A: 10 years · 375: 5 years.

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

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

- Breastfeeding: 6 weeks · not breastfeeding: 4 weeks.

- 7–10 months after last dose.

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

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

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

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

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

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

- Minilap within 7 days; interval from 6 weeks.

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

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

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

- 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

**Answer: (a)** — IUCD 380A protects for 10 years; IUCD 375 for 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

**Answer: (d)** — PPIUCD within 48 hours of vaginal delivery or during caesarean section; otherwise wait for interval insertion at 6 weeks.

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

- (a) 48 hours

- (b) 30 days

- (c) 6 weeks

- (d) 12 days

**Answer: (d)** — Post-abortion IUCD within 12 days of completion of abortion.

**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

**Answer: (a)** — Twice weekly for 3 months, then once a week; non-hormonal.

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

- (a) 2 months

- (b) 1 month

- (c) 3 months

- (d) 6 months

**Answer: (c)** — A single 150 mg IM dose protects for 3 months; window: 2 weeks early to 4 weeks late.

**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

**Answer: (c)** — Breastfeeding: at 6 weeks; non-breastfeeding: at 4 weeks.

**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

**Answer: (c)** — Fertility returns 7–10 months after the last injection — a delay, not infertility.

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

- (a) vitamin B12

- (b) placebo sugar

- (c) folic acid only

- (d) iron

**Answer: (d)** — 21 hormonal pills (LNG 0.15 mg + EE 30 µg) and 7 iron pills.

**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

**Answer: (d)** — COCs are not used in breastfeeding women under 6 months postpartum (or non-breastfeeding under 3 weeks).

**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

**Answer: (c)** — Missed 3+ in week 3: finish hormonal pills, start a new pack next day, back-up for 7 days.

**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

**Answer: (b)** — Women 22–49, men 22–60; ever-married; at least one child over 1 year.

**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

**Answer: (c)** — Within 7 days after birth (postpartum minilap); otherwise interval sterilisation from 6 weeks.

**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

**Answer: (d)** — Semen examination at 3 months confirms azoospermia; the certificate is issued then.

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

- (a) the condom

- (b) MPA

- (c) centchroman

- (d) the IUCD

**Answer: (a)** — Condoms (Nirodh) provide dual protection.

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

- (a) 24 months

- (b) 12 months

- (c) 18 months

- (d) 36 months

**Answer: (d)** — Wait at least 24 months after a birth before conceiving, i.e. a birth-to-birth interval of at least 36 months.

**Q16.** Under the PPIUCD incentive scheme, the acceptor receives

- (a) ₹500

- (b) ₹300

- (c) ₹150

- (d) ₹1000

**Answer: (b)** — ₹300 to the acceptor; ₹150 each to the provider and the ASHA.

**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

**Answer: (b)** — Within five days of (the first) unprotected intercourse.

**Q18.** The most common technique for minilap tubectomy is

- (a) fimbriectomy

- (b) the modified Pomeroy technique

- (c) Irving technique

- (d) Falope ring application

**Answer: (b)** — Modified Pomeroy for minilap; Falope rings for laparoscopic sterilisation.

### 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.