Part I Family Planning 1

Dep’t of Public Health
CMHS, AMU, 2016

Session Objectives
After this session, you are expected to:
Define Family Planning
Discuss benefits of family planning
Conceptualize historical backgrounds of family
planning
Summarize global and national situations of FP
2
Family Planning (FP)
FP refers to the use of various methods of fertility
control that will help individuals or couples to have

the number of children they want when they want
them in order to assure the well being of children and
the parents.
3
Concepts in the definition:
 Prevent unwanted pregnancy & have when needed
 Deciding on number of children one wants to have
 Child spacing/deciding the interval b/n consecutive

birth
 Analyzing the number of children they desire to have
with their economic capacity
 Plan to give birth
4
What are the practical benefits of FP?
 At individual level:
 improved maternal and infant health;
 expanded opportunities for women’s education, employment and social
participation;
 reduced exposure to health risks; and reduced recourse to abortion and
subsequent complications
 To the families:
 reduced competition and dilution of resources;
 reductions in household poverty; and
 more possibility for shared decision-making
 To the society: accelerated demographic transition to speed economic

development.
5
Why family planning?
The three Rationale;

Demographic
Health, and
Human rights
6
Demographic rationale
It was the main concern during late 1960s & 70s
Reducing high fertility rates and slowing

population growth rate help to Improve living
standards, hence, Less impact on natural
resources and the environment
7
Health Rationale
Emphasized in 1980s
To reduce pregnancy and its risks especially if it is
too early, too close, too late and too many

Family planning could reduce maternal mortality by
20% or more
 Family planning helps women to protect them selves
from unwanted pregnancies and its effects; like
unsafe abortion
8
Health Rationale …
 FP saves children’s life by helping women space
births.
 The occurrence of low birth weight, infant
malnutrition and mortality rates will be reduced.

 Birth intervals of at least 3 years reduce infant
mortality by up to 50%
9
Health Rationale …
At family level, this improves family well being as couples
with fewer children are better able to provide them with

enough food, clothing, housing and schooling
The incidence and prevalence of STD including

HIV/AIDS is reduced; like use of condom
Some hormonal methods also help to reduce the risk of
cancer
10
Human rights rationale
The most recent, 1990s
Recognition to Women's rights, Reproductive
right, and Reproductive health of men and women

This rests on the belief that individuals and
couples have a right to control reproductive

decisions including family size and timing of birth.
11
History of Family Planning
 Contraceptives have been used in one form or another
for thousands of years throughout human history and
even prehistory.
 Family planning has been widely practiced, even in

societies dominated by social, political, or religious
codes that require people to “be fruitful and multiply”
(during ancient Athens)
12
History…
 The methods used before the 20thC were not always as

safe or effective as those available today
 Centuries ago, Chinese women drank lead and

mercury to control fertility, which often resulted in
sterility or death
13
History…
 Olive oil, ginger, tobacco juice were frequently smeared
on or around the vagina to kill semen.
 Drinking urine and animal parts along with mercury,
arsenic, etc
 Greek women jump backward seven times after
intercourse.
 French prostitutes had been using douches since 1600.
 As recently as the 1990s, teens in Australia have used

candy bar wrappers as condoms
14
History…
• 1916—Margaret Sanger opens first birth control clinic
in the United States. The next year she was deemed
guilty of “maintaining a public nuisance” and sentenced
to jail for 30 days, once released, she re-opened her clinic
and continued to persevere through more arrests and
prosecutions.
•
15
Late 1960’s—Feminists challenged the safety of oral
contraceptives (“the Pill”) as a result of confirmed
serious health risks associated with it-which led to
modifications of the Pill.
16
Global situation of FP
More than one-third of pregnancies in developing
countries are unintended

Two-thirds of unintended pregnancies in developing
countries occur among women who were not using

any method of contraception
17
Global situation…
Worldwide Fertility has fallen from about 6 in 1950 to
around 3 in 1998.
Between the early 1960s and 1998, fertility rates in the

developing world have declined from 6.1 to 3.3.
The sharpest declines occurred in

 East Asia 5.9 to 1.8
 Latin America—6.0 to 3.0
18
Family planning in Ethiopia
Traditional method has long history of use
Modern FP methods came in to practice since the

establishment of FGAE
However, family planning was considered as violating natural
rules and was opposed by the government and most of
religious leaders.
Due to this reason it had been working for few years, with out
government approval or permission, by collaborating with
Pathfinder for material support and supplies.
19
Ethiopia… FP
Around 1970, the FGAE obtained support/fund from
International Planned Parenthood Federation (IPPF) and had
strengthen the program.
At that time it was given by the mutual written consent of
both partners (male and female/husband and wife)

FGAE expansion of its program and raised awareness of the
community about the benefits of family planning,

Advocacy resulted in registration of FGAE as legal association
in 1974.
20
Ethiopia… FP
Family planning programs became public by the
government in 1981
Since then it has been given by FGAE based on the
rules/guidelines of the government.

To expand the service delivery strategy community based
distribution was also introduced

Currently almost all hospitals and health centres are
giving the services
21
Ethiopia… FP
Despite years of concern about rapid population
growth and the promotion of family planning,

Ethiopia still has high fertility rates and low CPR
 the following table shows such poor transition
22
Progress Of Modern Contraceptive Use And Its Effect In
Ethiopia, Selected Years From Available Community Based

Representative Surveys (Note that this figure is highly
inflated on health indicator)
Years (source) CPR (%) TFR (%) RNI (%)
1990 (NFFS) 5 6.4 2.9
2000 (EDHS) 8 5.9 2.7
2005 (EDHS) 15 5.4 2.5
2011 (EDHS) 27 4.8 2.4

23
What is unmet need?
Women have an unmet need if they
are sexually active
do not want to have a child soon or at all
are not using any contraceptive method
are able to conceive
24
Who has unmet need?
 15% of married women in developing countries
 24% in Sub-Saharan Africa
11% in South and Southeast Asia
10% in North Africa and West Asia
12% in Latin America and the Caribbean
 9% of never-married women in Sub-Saharan Africa
 5% of never-married women in Latin America
25
Reasons for nonuse of contraception can be:
Opposition to family planning
Lack of knowledge
Access and cost
Health concerns and side effects of methods
Misconceptions about pregnancy risk
26
What to do?
It is important to ensure that women have as many
contraceptive options as possible, to help them find a

method that most closely matches their needs—for
example,
 for a temporary or permanent method of
contraception, or
 for a hormonal or barrier method—and their
tolerance for side effects
27
What to do?
Male involvement!!
Awareness!!
Empowering women!!
Quality FP service
28
Quality in FP
Quality is often defined as meeting the needs of clients
Programs that are customer focused consistently involve
clients in defining their needs & in designing the services
Is fundamental to sustainable services
Providing and subsequently maintaining quality services can
only be accomplished through continuous problem solving
and quality improvement
29
Elements of quality of care in FP
Method choice
Information to clients
Technical competence
Interpersonal relations
Follow-up and continuity mechanisms
Appropriate constellation of services
Services related to teens
(By Judith Bruce, 1990)
30
What to consider?
Factors important when discussing and selecting
contraceptive method include:
Effectiveness - success if used regularly
Acceptability - easy to use
31
Interference with sexual activity
Availability - easy to get for continual use
Side effects- problems and significance
Reversibility - How easy to conceive again
32
Thanks!
PART-TWO CONTINUES
33

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Dep’t of Public Health

CMHS, AMU, 2016

Discuss benefits of family planning

Conceptualize historical backgrounds of family

control that will help individuals or couples to have

 Deciding on number of children one wants to have

 Child spacing/deciding the interval b/n consecutive

 expanded opportunities for women’s education, employment and social

 reductions in household poverty; and

 more possibility for shared decision-making

 To the society: accelerated demographic transition to speed economic

The three Rationale;

Reducing high fertility rates and slowing

To reduce pregnancy and its risks especially if it is

too early, too close, too late and too many

malnutrition and mortality rates will be reduced.

with fewer children are better able to provide them with

The incidence and prevalence of STD including

Recognition to Women's rights, Reproductive

right, and Reproductive health of men and women

couples have a right to control reproductive

 Family planning has been widely practiced, even in

 The methods used before the 20thC were not always as

 Centuries ago, Chinese women drank lead and

 As recently as the 1990s, teens in Australia have used

countries are unintended

countries occur among women who were not using

Between the early 1960s and 1998, fertility rates in the

The sharpest declines occurred in

Modern FP methods came in to practice since the

both partners (male and female/husband and wife)

community about the benefits of family planning,

rules/guidelines of the government.

distribution was also introduced

giving the services

growth and the promotion of family planning,

Ethiopia, Selected Years From Available Community Based

1990 (NFFS) 5 6.4 2.9

2000 (EDHS) 8 5.9 2.7

2005 (EDHS) 15 5.4 2.5

2011 (EDHS) 27 4.8 2.4

are sexually active

do not want to have a child soon or at all

are not using any contraceptive method

are able to conceive

 24% in Sub-Saharan Africa

11% in South and Southeast Asia

10% in North Africa and West Asia

12% in Latin America and the Caribbean

 9% of never-married women in Sub-Saharan Africa

 5% of never-married women in Latin America

Access and cost

Health concerns and side effects of methods

Misconceptions about pregnancy risk

contraceptive options as possible, to help them find a

Programs that are customer focused consistently involve

clients in defining their needs & in designing the services

Is fundamental to sustainable services

Providing and subsequently maintaining quality services can

only be accomplished through continuous problem solving