Overview of Reproductive Health and Family Planning

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Overview of Reproductive Health and Family
Planning
Basics of Community-Based Family Planning
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Learner Objectives

• By the end of the session, participants will
  have
• Defined terms related to FP
• Briefly described how FP contributes to the MDGs

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Objectives Continued

• Listed benefits of FP, birth spacing and birth
  limiting to individuals, societies and globally
• Understood FP as a health intervention and its
  importance for Maternal and Child Survival,
  Growth and Development

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Reproductive Health (RH) is

• A state of complete physical, mental and social
  well-being and not merely the absence of disease
  or infirmity, in all matters related to the
  reproductive system and to its functions and
  processes. People are able to have a satisfying
  and safe sex life and they have the capacity to
  reproduce and the freedom to decide if, when and
  how often to do so. Men and women have the right
  to be informed and have access to safe,
  effective, affordable and acceptable methods of
  their choice for the regulation of fertility, as
  well as access to health care for safe pregnancy
  and childbirth.
• ICPD Programme Of Action, Cairo, 1994

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Sexual and Reproductive Rights

• Gender equity
• The right to attain the highest standard of
  sexual and RH
• The right to safety and dignity
• The right to decide whether and when to have
  children, how many
• Rights to information about and access to a range
  of SRH services

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Sexual and Reproductive Rights (continued)

• The right to make decisions and to exercise
  control over ones sexuality and reproduction
  free of discrimination, coercion and violence
• The right to protect ones health and to prevent
  disease
• The right to choose among available options
• The right to privacy and confidentiality

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Reproductive Health is Essential to World
Development Goals, Declare 265 Leading
Development Experts.

• FP directly promotes Millennium Development Goals
  3 through 8
• MDG 3 Promote Gender Equality and Empower Women
  MDG 4 Reduce Child Mortality MDG 5 Improve
  Maternal Health MDG 6 Combat HIV/AIDS, Malaria
  and Other Diseases MDG 7 Ensure Environmental
  Stability MDG 8 Develop a Global Partnership
  for Development

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AND FP/RH indirectly promotes the other two
Millennium Development Goals

• MDG 1 Eradicate Extreme Poverty and Hunger
• MDG 2 Achieve Universal Primary Education

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What do we mean by.

• Family Planning

Birth limiting
Healthy Timing and Spacing of Pregnancies
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Family Planning is

• The conscious effort to regulate the number and
  spacing of births through temporary, long-term
  and permanent methods including emergency
  contraception

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Another Definition for FP

• Educational, medical or social activities which
  enable individuals, including minors, to
  determine freely the number and spacing of their
  children and to select the means by which this
  may be achieved
• US Department of Health and Human Services

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Birth Limiting

• Simply refers to situations where women do not
  want any more births

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Healthy Timing and Spacing of Pregnancies

• Birth to pregnancy interval refers to the time
  between birth and the next pregnancy
• Women should wait at least two years to become
  pregnant after their last birth
• Access to modern methods of contraception help
  men and women to space their pregnancies

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Healthy Timing and Spacing of Pregnancies

• After a live birth
• Couples need to use an effective family planning
  (FP) method of their choice continuously for at
  least 2 years but not more than 5 years after the
  last birth, before trying to become pregnant
  again.
• After a miscarriage or abortion
• Couples need to use an effective FP method of
  their choice continuously for at least 6 months
  after a miscarriage or abortion before trying to
  become pregnant again.
• For adolescents
• Adolescents need to use an effective FP method of
  their choice continuously until they are 18 years
  of age before trying to become pregnant.

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More Terms

• Total Fertility Rate (TFR)
• Contraceptive Prevalence Rate (CPR)
• Couple-years of protection (CYP)
• Number of users new to modern contraception (new
  users)
• Unmet Need

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Unmet Need

• Unmet need measures women who do not want any
  more births or those who want to postpone the
  next birth at least two more years birth
  limiting and birth spacing respectively, yet are
  not using a method of contraception

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Unmet Need

• There is a large unmet need for family planning
  worldwide 52 million unintended pregnancies
  could be averted annually by meeting the unmet
  need
• Unmet need in 12 Asian countries ranges from 6.9
  in Vietnam to 31.4 in Pakistan and 32.6 in
  Cambodia
• In East and Central Africa, unmet need ranges
  from 6.7 in Mozambique to 35.6 in Rwanda
• In West Africa, unmet need ranges from 9.7 in
  Tchad to 34.8 in Senegal
• DHS, 2001, Unmet need at the end of the century

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Unmet Need in Youth (15 24)

• Youth make up 1 billion (20 of the worlds
  population) and account for 1/3 of the unmet need
  among married women
• Unmet need for married youth in Sub-Saharan
  Africa is 7.3 at ages15-19 and 10.7 at ages
  20-24
• In Sub-Saharan Africa, unmet need for youth in
  union or married is 25.9
• Latin America 21.9
• Asia (except China) 23.2
• Middle East/North Africa 17.5
• Central Asia Republic 15.5
• Futures Group, 2005

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Family Planning and Infant, Child and Maternal
Mortality

• 10 million infants and children still die each
  year from preventable causes many of which are
  associated with too short birth intervals
• Greater than 500,000 women still die each year
  from preventable causes many of which are
  associated with too short birth intervals
• Worldwide there are 50 deaths / 100,000 live
  births due to unsafe abortions

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• What are the Benefits of Birth Spacing, FP, and
  Birth Limiting?

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Benefits of Birth Spacing for Children Under Five
Thousands of deaths among children under age 5
could be averted annually if births occurred
after longer intervals.
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Child Health Outcomes

• For children under age 5, birth-to-pregnancy
  intervals of 45 months or longer are associated
  with the lowest risk of dying.
• Two-year birth intervals are associated with
  higher infant and child mortality risks than
  births occurring at 36-month birth intervals.

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Benefits of Birth Spacing for Infants
Select E E Countries spacing and deaths per
1,000 Infants Under Age One
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The Evidence for Benefits to Infants of Birth
Spacing

• Evidence indicates that birth-to-pregnancy
  intervals of
• 18 months or less are associated with significant
  risk of neonatal and perinatal mortality, low
  birth weight, small size for gestational age, and
  preterm delivery
• 27 months or less are associated with significant
  increased risk of stillbirths, and miscarriages
  relative to birth-to-pregnancy intervals of 27-50
  months
• 51 months or longer are associated with
  significant increased odds of stillbirths and
  miscarriages
• 59 months or longer are associated with
  significant increased risk of low birth weight,
  preterm birth, and small for gestational age

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Infant Health Outcomes

• For infant mortality, birth-to-pregnancy
  intervals of 24 months or less are associated
  with significant risk of mortality.
• Improving infant health is important because
• there are approximately 4 million newborn
  deaths and over 3 million stillborn deaths each
  year
• neonatal deaths account for 40-60 of child
  deaths

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Nutrition Outcomes
Source for figure Rustein, Shea, Effects of
Birth Interval on Mortality and Health
Multivariate Cross-Country Analysis, MACRO
International, Presentation at USAID, July 2000
Rutstein 2005 Dewey and Cohen, 2004.
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Nutrition Outcomes

• Malnutrition plays a role in more than half of
  all child deaths.
• Birth-to-pregnancy intervals up to 60 months are
  associated with a decrease in the risk of
  stunting and underweight among children
  under-five.

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Advantages of Birth Spacing and FP for Mothers

• For mothers, the benefits of spacing births
  include a lower risk of
• Maternal death
• Puerperal endometritis
• Premature rupture of membranes
• Anemia
• Third trimester bleeding
• FP can prevent at least 25 of all maternal
  deaths
• FP contributes to prevention of maternal-to-child
  transmission of HIV

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Maternal Health Outcomes

• The evidence indicates that birth-to-pregnancy
  intervals of
• Six months or less are associated with risk of
  maternal mortality, pre-eclampsia, premature
  rupture of membranes, puerperal endometritis,
  third-trimester bleeding, anemia, high blood
  pressure and 10 times the risk of induced
  abortion
• 27 months or less are associated with significant
  increased odds of induced abortion relative to 27
  50 months
• Five years or longer are associated with
  significant risk of pre-eclampsia, eclampsia and
  maternal death

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Maternal Nutrition Outcomes

• Results were mixed on the relationship between
  the birth-to-pregnancy interval and maternal
  nutritional status and anemia.

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Overview of Current Contraceptive Use

• The 1965 average was about 10 of couples using a
  method, now it is at 60 (UN 2003)
• Contraceptive use is rising in Anglophone
  Sub-Saharan Africa
• Contraceptive use is much lower in Francophone
  Sub-Saharan Africa (except for Togo) lt20
• Both South and Central America and Caribbean
  regions show patterns of steady rises in use
• The Middle East/North Africa contraceptive use
  has risen steadily (six of the 16 countries are
  at or above 60 of couples using a method)
• East Asia has the highest levels of contraceptive
  use
• Southeastern and Southern Asia have wide ranges
  in contraceptive use
• Futures Group, 2005, Profiles for FP and RH
  Programs

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Projections for Percentage Using Contraception

• Countries with very high or very low TFRs are
  projected to change the least
• Countries in the middle range are projected to
  change more rapidly
• For example
• Countries in 2005 with prevalence lt 10 improve
  only by 4.4 points by 2020
• Countries in the middle at 30 39, improve by a
  full 15.9 points
• At 70 or above, the average change is zero
• Futures Group, 2005, Profiles for FP and RH
  Programs

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Why is there such a High Unmet Need???
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Barriers to Birth Spacing

• A recent review of family planning programs in
  developing countries identified several barriers
  to birth spacing.
• Common barriers include
• Cultural traditions norms
• Gender inequality, including intimate partner
  violence
• Lack of knowledge
• Myths, fears and health concerns
• Lack of contraceptives and / or method of choice
• Method failure
• Quality of services provider bias and poor
  counseling
• Poor access to services including integration
  (e.g. with HIV services and post partum care)
• Poverty
• Fear of side effects
• Source Jansen, W. and L. Cobb. USAID
  Birthspacing Programmatic Review An Assessment
  of Country-Level Programs, Communications, and
  Training Materials, February 2004.

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Key Components of Quality Family Planning Services

• A Range of contraceptive methods, including NFP,
  consistently available
• Good Counseling
• Geographically accessible and acceptable services
• Organization of care / Integration
• Technical competence
• Facilities and supplies
• Clients rights

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Informed and Voluntary Decision Making

• Service options are available
• The decision-making process is voluntary
• Individual have appropriate information
• Good client-provider interaction (CPI), including
  counseling is ensured
• The social and rights context supports autonomous
  decision making

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FP Program Elements to Increase Use of FP

• Knowledge and Interest
• Quality and Access
• Social and Political Environment

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