Family planing over view worldwide eta.ppt

Family planning is major issues worldwide and locally focused on the improvements of individual and the population health by using different contraceptive methods

1. 1

2. What is family planning ?
Amharic terminologies
Ye beteseb ekid?
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3. LEARNING OBJECTIVES
›Define Family planning
›Over viewing global family planning
› Over viewing local context of family planning
›Contraceptive use and trends
›Contraceptive method mix
›Unmet need for family planning
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4. Family planning refers to a conscious effort by a couple to limit or
space the number of children they have through the use of
contraceptive methods.
Definition
Family planning means having the number of children you want
when you want them, by allowing women and men to control the
number and spacing of their children.
4

5. Family planning helps women, men, and their families preserve their
health and fertility and also contribute to improving the overall quality
of their lives.
Fertility regulation implies properly spacing births, limiting the
number of births and delaying the first birth until the required
physical maturity has been reached.
However, other factors are considered as well, such as prevention of
sexually transmitted infections/diseases (STD/Is), unwanted
pregnancy and its consequences, reproductive tract infections,
infertility, child survival and safe motherhood.
5

6. Contraceptive use is a voluntary method of lowering fertility and
spacing births.
The level of contraceptive use and the intention of future use of
contraceptive in any country are interrelated with the educational,
economic, social, religious and cultural background of the people of
the country.
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7. 7
0
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2
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4
5
6
7
8
9
Developing countries
Developed countries
Billions

8. Overview of Global Family Planning
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9. US
›In 1900, six to nine of every 1000 women died in
childbirth (600-900/100,000) and one in five
children died during the first 5 years of life
›Distributing information and counseling about
contraception and contraceptive devices was
illegal under federal and state laws
›In 1912, the modern birth-control movement
began
9

10. Margaret Sanger, a public health nurse concerned about the
adverse health effects of frequent childbirth, miscarriages, and
abortion, initiated efforts to circulate information and provide access
to contraception
In 1916, Sanger challenged the laws that suppressed the distribution
of birth control information by opening the first family planning clinic
in Brooklyn, New York.
She was publishing her own news paper under the theme "no
woman can call herself free who doesn't own and control her own
body"
By the 1930s, a few state health departments (e.g., North Carolina)
and public hospitals had begun to provide family planning services
10

11. By 1933, the average family size had declined to 2-3 children
In 1960, the era of modern contraception began when both the birth
control pill and intrauterine device (IUD) became available
During the 1970s and 1980s, contraceptive sterilization became
more common and is now the most widely used method in the
United States.
IUD use increased during the early 1980s, then declined because of
concerns about intrauterine infections.
In the 1980s and 1990s, the use of condoms increased among
adolescents
11

12. Stopes, Marie Carmichael (1880-1958), British birth control
campaigner
›Degrees in Geology, Botany, & Geography.
In 1905 she obtained her DSc and became Britain's youngest
female Doctor of Science
She had become interested in the subject of birth control and
became a campaigner after meeting Margaret Sanger
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13. She popularized birth control as an aid to marital relationships
In 1921, she opened the first British birth control clinic in Holloway,
London
Her radical views were criticized by traditionalists and religious
groups
Despite such opposition Stopes continued her campaign,
concentrating on the Far East, where poverty made birth control a
more urgent issue than in Britain
In 1918 Stopes wrote a concise guide to contraception called Wise
Parenthood
http://www.spartacus.schoolnet.co.uk/Wstopes.htm
http://www.bbc.co.uk/history/historic_figures/
stopes_marie_carmichael.shtml
13

14. Worldwide
›The most important determinant of declining fertility in developing
countries is contraceptive use
›Overall fertility declined by approximately one third from the 1960s
through the 1980s, from an average of six to four children per
woman
›Dramatic decreases in some parts of the world
 (e.g., 24% decline in fertility in Asia and Latin
America,
approximately 50% in Thailand, and
 approximately 35% in Colombia, Jamaica, and
Mexico).
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15. 15

16. As fertility declined in developing countries, the infant mortality rate
decreased from approximately 150 deaths per 1000 live births in the
1950s to approximately 80 per 1000 in the early 1990s.
Among married women of reproductive age in developing countries;
90% women report using modern methods (e.g., female sterilization,
oral contraceptives, and IUDs).
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17. Contraceptive use and trends
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18. 62 million US women are in the childbearing age
The typical woman only wants 2 children
98% have used at least one contraceptive method
62% are currently using
31% of the 62 million do not need to use (pregnant, infertile,
postpartum, not sexually active)
7% are at risk of pregnancy but not using
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19. Method mix
›Pill and female sterilization have been the leading contraceptive
methods since 1982
›The pill is used by those who are younger than 30
›By age 35, more women relay on sterilization
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20. 20

21. 21

22. 22

23. 23
Other
4%
Traditional
Methods
13%
Male
Sterilization
5%
Female
Sterilization
9%
Condom
14%
IUD
8%
Pill
16%
Not Using a
Method
31%

24. 24
Female
Sterilization
22%
Pill
6%
Injectable or
Implant
4%
Male Condom
3%
IUD
15%
Traditional
Methods
6%
Other
<1%Male
Sterilization
3%
Not Using
a Method
41%

25. 25
Any
Method
19%
No
Method
82%
Rhythm
16%
Female
Sterilization
11%
Withdrawal
5%
Other
Traditional
11%
IUD
5%
Condom
5%Other
Modern
5%
Injectables
21%
Pill
21%

26. 26
Not Wanted
11%
Wanted
Later
16%
Wanted
73%

27. 27
54
30
44
16
45
22
Cameroon
2004
Kenya
2003
Madagascar
2003/2004
Philippines
2003
Morocco
2003/2004
Columbia
2005

28. Overview of Family Planning
Local Context
28

29. FGAE
Pathfinder provided small grant to group of Ethiopians in
1964 (1956 E.C.)
The group later evolved to the current FGAE
FGAE established in 1966
Initially operating in a room which was in the premises of
St. Paul Hospital
Became the first organization to open FP clinic in
Ethiopia (1974)
Became affiliate member of the (IPPF) international
planned parenthood federation (1975)
Contraceptive use and advertisement was illegal
Till recently FGAE was the main provider of community
and facility based FP in Ethiopia
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30. Penal code, proclamation
No. 158 of 1957
›Article 528 (2) the
advertising for
contraceptive or abortive
means is punishable under
the code of petty offenses
(Art 802)
Fine or arrest not exceeding
one month
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31. Since the early 1980s FGAE has been slowly expanding its services
and now running more than 20 RH clinics and 28 youth center
Particularly after the adoption of the national population policy and
introduction of RH concept, conducive environment was created to
expand FP service in various part of the country
Social marketing, currently all types of contraceptive methods are
available, the number of trained personnel has increased,
awareness has increased
31

32. women in the reproductive age group constitute in our country is
23.4% of the population. (CSA, 2015) CSA 30
th
Januray 2015.
Ethiopian women used to give birth to an average of more than 7
children in their life two decades ago (Total fertility rate)
According to the recent Mini-EDHS 2014, the average total fertility
among Ethiopian women has reduced to 4.1, with 2.2 in urban and
4.5 in rural areas.
Hence, the objective of the national health policy 14, were reducing
TFR to 4 by 2015 from 7.7 in 1990’s is achieved
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33. There is also huge disparity among regions of Ethiopia from 7 in
Somali region and 1.7 in Addis
The disparity is observed even among urban areas as a total fertility
rate of 3.4, 3.4 and 1.7 in Dire Dawa, Harari and Addis Ababa
Contraceptive Prevalence Rate (CPR) among currently married
women increased from 8.1% in EDHS 2000 to 41.8% in EDHS 2014
Hence, the objective of the national health policy, were increasing
the prevalence of contraceptive use from the 4.0% in 1990’s to
44.0% by the year 2015 is nearly achievable
33

34. While both rural and urban areas showed a consistent increase over
time, a nine-fold increase in CPR was observed in rural areas (from
4.3% in EDHS 2000 to 39.0% in EDHS 2014)
with urban areas increasing from 35.6% to 59.6% in the same period
when CPR almost quadrupled in only 9 years (from 10.9% in EDHS
2005 to 39.0% in EDHS 2014)
due to the contribution of HEWs in promoting behavioral change and
implementing FP services
much of this increase was attributable to the sharp increase in the
use of injectables (from 3.1% to 31.0% in the same period)
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35. Long acting family planning methods have been emphasized in the
last five years evidenced by increased implanon at community level
since 2009 and scale up of intrauterine contraceptive devices in
hundreds of districts since 2010
35

36. The number or percent women currently married
(in union) who are fecund and who desire to
either terminate (do not want anymore) or
postpone (at least 2 years) childbearing, but who
are not currently using a contraceptive method.
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37. Currently married (in union)
Fecund
Limiting
Spacing
Not currently using contraceptives
37

38. The total number of those with an unmet need for Family Planning
consists of two groups of women
›Women with an unmet need for limiting
›Women with an unmet need for spacing
SPACERS + LIMITERS
SPACERS: Those women who are unsure whether they want
another child or who want another child after two years but not
using any family planning method
LIMITERS: Those women who do not want another child but not
using any family planning method
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39. Women who are currently using a family planning method are said to
have a met need for family planning.
Women with an unmet need for family planning and those who are
currently using contraception together constitute the total demand for
family planning.
39
Contraceptive Prevalence
Unmet need
Total Potential Demand

40. Total potential demand for FP is measured by
Contraceptive used + unmet need
Related indicators
Demand for FP= %(married) women using FP +
% (married) women with unmet need for FP
Ethiopia 42 + 25 = 67%
Percentage of demand satisfied = % (married) women using FP/ %
(married) women with demand for FP
Ethiopia 42/67*100 = 62.6%
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41. This information is important not only to determine the total demand
but also to measure the percentage of that demand that is satisfied.
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42. The Indicators and Targets for HSTP
for the next five years (2015/16 to 2019/2020)
to reduce
 Total Fertility Rate (TFR) 4 to 3
 Contraceptive Prevalence Rate (CPR) 42 to 55
CPR: % of( married) women of reproductive age (15-49) who are
currently using a contraceptive method
CPR is a measure of met demand
No of women using any contraceptive method/*100
No of women age 15 to 49
42

43. Family planning promotes happy, healthy and responsible individual
and family life by providing the necessary information, education and
services for safe pregnancy, delivery and child care that assures the
health survival of mothers and children.
This is achieved by avoiding pregnancy at too young or too old ages;
by avoiding inter-pregnancy intervals of less than two years and by
encouraging two or three pregnancies per mother.
- Improves couple relationships and family cohesiveness.
Studies show that freedom from worry of unplanned pregnancies
improves partner relations and family well-being because the mother
has more time to nurture her family.
43

44. FP considered to be part of the basic human rights of all individuals
or couples, as it was endorsed by the International Conference on
Population and Development in Cairo in 1994.
As a result of rapid population growth, many nations are unable to
meet the social needs of their people in such areas as education,
health, employment, shelter, and food.
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45. Because, they usually do not have enough savings for investment,
there is very little or no economic development for that specific
countries.
Family planning programs can help to reduce this rapid rate of
population growth to prevent the rapidly deteriorating quality of life of
society in general
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46. By enabling individuals and couples to have fewer children, family
planning helps communities to reduce the number of unproductive,
dependent, young people who form such a large portion of the
population of developing countries and whose demand for social
services like education, health, shelter, food, etc is very high.
46

47. Therefore, a very important contribution of family planning is the
liberation of women to participate in social and economic
development activities.
With fewer pregnancies, fewer children and longer inter-pregnancy
intervals, women can take full advantage of the available
educational opportunities and make their valuable contributions in all
fields of development.
Lessens high rates of infant, child, and maternal mortality as well as
abortion and its health consequences
- Important in fight against HIV/AIDS, particularly mother-to-child HIV
transmission
FP allows HIV-positive women to space births for optimal health and
contributes to programs providing VCT and PMTCT services.
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48. Reading assignment
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49. Emergency contraception is a way to prevent pregnancy after
unprotected sex.
-Often called the morning-after pill, emergency contraceptive pills
(ECPs) are hormone pills that can be taken up to 72 hours after having
unprotected sex.
-Emergency contraception is most effective when it is taken as soon as
possible after intercourse.
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50. But some studies have shown that it can still work up to 120 hours after
intercourse.
How Does It Work?
-In high doses, the hormones estrogen and progesterone can prevent
pregnancy.
-The number of pills taken depends on the type of pill being used.
-The first dose of pills should be taken within 72 hours of unprotected
intercourse, usually
 followed by a second dose of pills 12 hours later.
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51. The hormones may work in a number of ways to prevent pregnancy.
They may delay ovulation (the release of an egg during a girl's
monthly cycle), affect the movement and function of the sperm,
affect the development of the uterine lining, and disrupt the actual
fertilization process.
ECPs are less effective if fertilization has already occurred, If
implantation has already occurred and a girl is pregnant, ECPs will
not interrupt the pregnancy.
About 1 or 2 in every 100 women who use ECPs will become
pregnant despite taking ECPs within 72 hours after having
unprotected sex.
51

52. The progestin-only method uses the progestin levonorgestrel in a dose
of 1.5
 mg, either as two 750 μg doses 12 hours apart, or more recently
as a single dose.
-The combined or Yuzpe regimen uses large doses of both estrogen
and progestin, taken as two doses at a 12-hour interval.
It is possible to obtain the same dosage of hormones, and therefore the
same effect, by taking several regular combined oral contraceptive pills.
For example, 4 Ovral pills are the same as 4 Preven pills.
-The drug mifepristone may be used either as an ECP or as an
abortifacient, depending on whether it is used before or after
implantation.
The intrauterine device (IUD) can sometimes be used as a form of
emergency contraception.
But, this is rarely prescribed for teens, though.
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53. Monitoring : (literal definition)
Is an activity that involves continuous and systematic checking or
observing of program/project implementation to ensure that it is going
according to the plan.
Refers to the routine tracking of the project’s ongoing activities,
achievements and constraints.
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54. Monitoring:
Is an ongoing, continuous process;
Requires the collection of data at multiple points
throughout the program cycle, including at the
beginning to provide a baseline
Can be used to determine if activities need
adjustment during the intervention to improve desired
outcomes.
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55. Evaluation:
›Refers to the assessment of program implementation & its
success in obtaining pre-determined goals/ objectives.
›Measures how well the program activities have met
expected objectives
›Measures the extent to which changes in outcome can be
attributed to the program
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56. When do we need M&E:
›Monitoring should be conducted at every stage of the program,
with data collected, analyzed and used on a continuous basis.

›Evaluations are usually conducted at the end of programs.
However, they should be planned for at the start because they
rely on data collected throughout the program, with baseline data
being especially important.
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57. Inputs
›The resources invested in a program, for example, health
professionals, computers, condoms or training;
Processes
›The activities carried out to achieve the program’s objectives
Outputs
›The immediate results achieved at the program level
Outcomes
›The set of short-term or intermediate results at the population
level achieved by the program
Impacts
›The long-term effects, or end results, of the program, for
example, changes in health status
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