25. Family Planning - Dr. Abdu.ppRH is a state of complete physical, mental & 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 processestx

Family Planning

1. INTRODUCTION to RPRODUCTIVE HEALTH and FAMILY PLANNING LECTURE for C I MEDICAL STUDENTS Abdu Mengesha (MD) Assistant Professor in Obstetrics & Gynecology Subspecialist in Reproductive Endocrinology & Infertility (REI) April 19, 2022

2. OUTLINE Objectives Definition of RH Historical Development of the Concept of RH Magnitude of RH problems Indicators of RH Components of RH Definition of FP Fertility Trends and Contraceptive use FP Methods Medical Eligibility Criteria (MEC)

3. 1. OBJECTIVES After completion of this lecture the student should be able to:- Define reproductive Health Understand the magnitude of RH problems Understand and know the components of RH Define FP Understand the fertility trends and contraceptive use Understand and know the different FP methods Understand Medical Eligibility Criteria (MEC) and be able to use the MEC Wheel

4. 2. DEFINITION of RH RH is a state of complete physical, mental & 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 . The definition encompasses:- The ability to reproduce The ability to go through pregnancy and childbirth safely , with successful maternal and infant survival & outcomes Freedom to control reproduction The ability to obtain information about and access to safe , effective, affordable & acceptable methods of FP The ability to have a satisfying , safe sex life , free from fear of pregnancy and disease The ability to minimize gynecologic disease and risk throughout all stages of life There are some key characteristics that make RH unique compared to other fields of health:- It extends into the years before & beyond the years of reproduction , not just the time of reproduction Recognizes that access to RH care needs to be assured for people around the world It acknowledges gender roles , and the respect & protection of human rights Embedded in the set of concerns of RH are certain implicit rights of both men and women

5. 3. HISTORICAL DEV’T of the CONCEPT of RH 1960s: - rapid population growth recognized as a problem-UNFPA - rapid increase in availability of fertility reducing methods 1970s and 80s: - population policies became widespread in developing countries & were supported by UN & NGOs – International Planned Parenthood Federation (IPPF) 1972: - WHO established a special research program called HRP - Modern contraceptives seen as reliable & more effective 1978 (The Alma-Ata Declaration): - “PHC for all by the year 2000” - MCH services started with more emphasis on child survival - FP was the main focus for mothers 1987 (Safe Motherhood Initiative): - focused on maternal health aimed at reducing maternal mortality & morbidity by ½ by the year 2000 with the following pillars:- FP ANC Clean & Safe Delivery Essential Obstetric Care

6. 3. HISTORICAL DEV’T … 1994 (ICPD): - marks the key event in the history of RH Emphasis on quality of services Emphasis on availability & accessibility Emphasis on social injustice Emphasis on individual woman’s needs & rights 2000 (MDGs):- 8 goals set to be achieved by the year 2015, 4 are directly related to RH and the other 3 are indirectly related to RH and health overall Goal 3 – promote gender equality & empower women Goal 4 – reduce child mortality Goal 5 – improve maternal health Goal 6 – combat HIV/AIDS, malaria other diseases 2015 (SDGs): - most of the 17 SDGs are related to RH

7. 4. MAGNITUDE of RH PROBLEMS Half of the world’s women are between the ages of 15 & 49 years This group is highly vulnerable to problems related to sexual intercourse and pregnancy – STIs, infertility, cancer, abortion etc. Poverty, illiteracy, being economically disadvantaged & politically powerless fuels the problems RH problems are the leading cause of women’s ill health & mortality Maternal mortality of Ethiopia is high Contraceptive use rate in Ethiopia is low Unmet contraceptive need in Ethiopia is high (26% of unmarried)

8. 5. INDICATORS of RH A numerical measure (data) which provides information about the RH situation of population Help to asses needs, and monitor & evaluate program implementation and impacts An indicator can be:- Input – organizational resources (manpower, material, money) and policies Process – implementation (contacts, visits, examinations, referrals) Output – service output (prevalence, practice, knowledge), service utilization Impact – RH impact (fertility, morbidity, mortality) A good indicator has to be useful, scientifically robust, representative, understandable, accessible and ethical. Expressed in terms of rates, proportions, averages, categorical variables or absolute numbers Sources of data could be:- Routine service statistics Population censes Vital statistics reports Sample surveys Special studies

9. 5. INDICATORS … Total Fertility Rate (TFR): 4.6 Contraceptive Prevalence Rate (CPR): 36% married and 59% of unmarried Maternal Mortality Ratio (MMR): 412 ANC Coverage: 62% Birth Attended by Skilled Personnel: 26% Availability of Basic Emergency Obstetric Care ( BEmOC ) Availability of Comprehensive Emergency Obstetric & Neonatal Care ( CEmONC ) Perinatal Mortality Rate LBW Prevalence Positive Syphilis Serology Prevalence in Pregnant Women

10. 5. INDICATORS … 11. Prevalence of Anemia in Women: 23% of reproductive age women 12. Percentage of Obstetrical & Gynecologic Admissions owing to Abortion 13. Reported Prevalence of Women with FGM 14. Prevalence of Infertility 15. Reported Incidence of Urethritis in Men 16. HIV/AIDS Prevalence 17. Knowledge of HIV-related Prevention Practices

11. 6. COMPONENTS of RH Quality FP services Promoting Safe Motherhood:- ANC, Safe Delivery & PNC Prevention & Treatment of Infertility Prevention & Management of Complications of Unsafe Abortion Safe Abortion services Treatment of Reproductive Tract Infections including STIs Information and Counseling on human sexuality, responsible parenthood and sexual & reproductive health Actively Discouraging HTP such as FGM GBV - violence related to Sexuality & Reproduction Functional and Accessible Referral

12. 7. DEFINITION of FP FP is the use of various methods of fertility control that will help individuals (men and women) or couples to have the number of children they want and when they want them in order to assure the well being of children and parents It simply means preventing unwanted pregnancy by safe methods of prevention It is a critical component of RH program It is part of the strategy to reduce high maternal, infant and child mortality and morbidity: can avert 30% maternal death and 10% child mortality by spacing pregnancies 2 years apart using FP The origins and rationale for FP in developing countries are:- Demographic rationale Health rationale (benefits to women’s health, children’s health, women & their society) Human right’s rationale

13. 8. FERTILITY TRENDS and CONTRACEPTIVE USE Fertility and contraceptive use have an inverse relationship Replacement – level Fertility is the trend in developed countries:- each couple having an average number of two children with contraceptive prevalence rate of 75 – 84% TFR in developing countries is showing a decline but not to the level of replacement – level fertility Both fertility level and Contraceptive use vary according to women’s educational attainment, residence and other social & economic characteristics Contraceptive counseling is critical for the uptake of FP methods Bridge knowledge gap Help clients make informed choice Provide services The steps in contraceptive counseling is known by the acronym GATHER (Greet, Ask, Tell, Help, Explain and Return) TFR & CPR in Ethiopia: 5.5 to 4.6 and 8% to 36% in 2000 and 2016 respectively

14. 9. FP METHODS The Natural Methods A. Breast Feeding (LAM) B. Abstinence C. Withdrawal (Coitus Interruptus) D. Calendar Methods E. Cervical mucus (Billing’s) Method F. Sympto -thermal method 2. Artificial methods: Modern Contraceptives A. The Barrier methods (Diaphragm, Cups, Condom) B. Intrauterine Device (Copper IUCD, LNG IUD) C. Hormonal (Pills, Injectables, Implants) D. Surgical methods (tubal Ligation, Vasectomy) 3. Emergency Contraception (LNG, COC, IUCD)

15. 10. MEDICAL ELIGIBLITY CRITERIA (MEC) MEC is a guide developed by the WHO to help FP providers to recommend safe and effective contraception methods to individual woman It includes recommendations to initiate or continue use of a chosen method It has either 4 or 2 categories based on the level of clinical judgement

16. 10. MEDICAL … Good clinical judgment Category 1 – use method in any circumstance Category 2 – generally use method Category 3 – use of method not usually recommended unless other more appropriate methods are not available or not acceptable Category 4 – method not to be used Limited clinical judgment Category 1 – YES (Use the Method) Category 2 – NO (Do Not Use the Method)

17. 10. MEDICAL … The 2015 WHO MEC Wheel contains the MEC for starting use of contraception methods It has:- The inner disk shows the contraceptive methods The outer rim shows the specific medical conditions or characteristics The viewing slot shows the category

18. 10. MEDICAL … YouTube short video link for MEC Wheel demonstration: https://www.google.com/url?sa=i&url=https%3A%2F%2Fwww.youtube.com%2Fwatch%3Fv%3DM0z_2Kw-nKg&psig=AOvVaw2ARA8yegS_-v0RFrwIVroV&ust=1650392617191000&source=images&cd=vfe&ved=0CAkQjRxqFwoTCKDw6eOdnvcCFQAAAAAdAAAAABBJ

19. THANK YOU!