Family planning in Tanzania

Explains about family planning methods, importance, side effects, contraindications, challenges and the system used in Tanzania.

1. FAMILY PLANNING Supervisor: Dr. Shubi Presenter: Joyce Mwatonoka , MD4 Feb 2016

2. OUTLINE Introduction Methods of family planning (contraceptive methods) Disadvantages and Side effects of contraceptives Contraindications of contraceptives Advantages of family planning Implementation of family p lanning s ervices in Tanzania Barriers to practicing family planning/the unmet need for contraception Challenges in implementation of family planning services in Tanzania Recommendations References

3. Introduction Family planning refers to the factors that may be considered by a couple in a committed relationship and each individual involved in deciding if and when to have children.

4. Family planning allows individuals and couples to anticipate and attain their desired number of children and the spacing and timing of their births. It is achieved through use of contraceptive methods and the treatment of involuntary infertility.

5. One area for greater attention is maternal health. Up to 25% of all maternal deaths are due to pregnancies in certain groups of women: very young women, very old women, pregnancy within short birth intervals and women with more than four children or existing health problems.

6. Contraceptive methods Temporary methods Combined oral contraceptives (COCs) or “the pill” 92% - 99% Progestogen -only pills (POPs) or "the minipill “ 90% - 99% Implants ( progestogen , upper arm) 99% Progestogen only injectables 97% - 99% Monthly injectables or combined injectable contraceptives (CIC) 97% - 99%

7. Combined contraceptive patch and combined contraceptive vaginal ring (CVR). New, limited reaserch on effectiveness. Intrauterine device (IUD): copper containing >99% Intrauterine device (IUD) levonorgestrel >99% Male condoms 85% - 98% Female condoms 79% - 90% Basal Body Temperature (BBT) Method 75% - 99% Lactation amenorrhea method (LAM) 98%-99% Spermicides eg:Conceptrol , Delfen Foam

8. 2. Permanent methods Male sterilization (vasectomy) Female sterilization (tubal ligation)

9. 3. Traditional methods Calendar method / rhythm method / Ogino-Knaus Method 75% - 91% Withdrawal (coitus interruptus ) 73% - 96%

10. 4. Emergency contraception L evonorgestrel 1.5 mg, progestogen only pills used to prevent pregnancy up to 5 days after unprotected sex. Does not disrupt an already existing pregnancy. 99%.

11. Disadvantages and Side effects of contraceptives Nausea Weight gain Sore or swollen breasts S potting, between periods Lighter/heavier periods Mood changes including depression Abdominal pain Hair loss

12. Other adverse effects (rare) may include; blood clots, stroke, liver diseases, hypertension, heart diseases, severe headache and eye problems (blurred vision). Also other methods like vasectomy requires surgery which might not be affordable to some individuals.

13. Absolute contraindications Thrombophlebitis or thromboembolic disorders Cerebro -vascular or coronary artery disease Carcinoma of the breast or other estrogen -dependent neoplasia Undiagnosed abnormal genital bleeding Known or suspected pregnancy Benign or malignant liver tumor

14. Relative contraindications Age over 45 Diabetes Hypertension Smoking Gallbladder disease Gestational cholestasis History of renal disease Impaired liver function Hyperlipidemia

15. Advantages of family planning Reducing adolescent pregnancies Slowing population growth; economic advantage, better life Preventing pregnancy-related health risks in women; including early pregnancies and unsafe abortions. Reducing infant mortality due to closely spaced pregnancies and early pregnancies

16. Helping to prevent HIV/AIDS; fewer infected babies from HIV mothers, condoms provide dual protection Family planning reinforces people’s rights to determine the number and spacing of their children Empowering people and enhancing education; time for additional education, parents invest more in each child

17. Implementation of Family Planning Services in Tanzania The government of Tanzania has all along recognized the importance of Family Planning methods which are registered and allowed by the Ministry of Health. In 1969, while presenting the second Five Year Development Plan to the Annual General Meeting of the ruling Party (TANU) the then Mwalimu Julius K. Nyerere warned the nation that:

18. “Giving birth is something in which mankind and animals are equal, but rearing the off spring and especially educating them for many years is a unique gift and responsibility of man to look after them properly rather than thinking about the number of 6 children and the ability to give birth for it happens that man’s ability to give birth is greater than his ability to bring up the children in a proper manner”.

19. In 1973 the National Executive Committee declared its support for the Family Planning Association of Tanzania (UMATI) and directed the Government (Ministry of Health) to assist UMATI in the promotion and delivery of child spacing services. In 1974 the Government (Ministry of Health) directed that child spacing advice and services be provided as an integral part of Maternal and Child Health Services – (MCH) in all health facilities in the country

20. Chama Cha Uzazi na Malezi Bora Tanzania (UMATI) is a not for profit, non-political voluntary national NGO providing Sexual and Reproductive Health (SRH) education, information and services in Tanzania UMATI was established in 1959 as a Family Planning Association of Dar es Salaam, and became a full IPPF (International Planned Parenthood Federation) Member Association in 1973

21. The following are the main activities of UMATI: Provision of information and education to the general public; through seminars, printed material (leaflets, posters, pamphlets)radio and films. Training of medical and paramedical personnel. Distribution of contraceptive supplies and equipment (until such time that the government is able to get its own supplies).

22. Family planning services in Tanzania are provided starting at the primary health care level ie dispensaries and health centres Those methods which need surgery like tubal ligation or vasectomy require secondary/tertiary health care levels RCH card number 5 is used for women who start using family planning And all these are filled in MTUHA book number 8

23. Contraceptive prevalence (% of women ages 15-49) in Tanzania was last measured at 34.40 in 2010. It involved all women using any method of family planning The prevalence was noticed to be higher in non-married women compared to married women

24. A chart showing prevalence of contraceptive use in Tanzania

25. On the other hand, the population of Tanzania has grown from 34.4 million in 2002 to 44.9 million in 2012, a 30.5% increase in a period of 10 years.

26. A chart showing Tanzania population growth (1967-2012)

27. Barriers to practice family planning/the unmet need for contraception L imited choice of methods L imited access to contraception, particularly among young people, the poor or unmarried people F ear or experience of side-effects C ultural or religious opposition eg ; RCs P oor quality of available services G ender-based barriers.

28. Challenges in implementation of family planning services in Tanzania Basis of the Problem: Why the Challenge Key drivers lie in the roots of society and government initiative. In many male dominated societies in the developing world, women are not empowered to take decisions for family planning. Some other key factors are traditional social attitudes and illiteracy. Failure of governments to provide basic infrastructure to tackle this or to facilitate public-private partnership to run family planning programs.

29. Social and cultural factors Knowledge; people have no or limited knowledge on family planning Attitude ; Financial -having many children is considered a benefit as it would mean more hands to help on the field. Safety net -due to high child mortality rate. Insurance for old age . Family status . Behaviour; bias against the girl/boy child. Religious issues ; Abortion is considered unacceptable among both Islams and Christians.

30. Availability of Resources Economical; insufficient funds . Human personnel ; Developing countries lack human personnel in the medical field Tools and technologies

31. Structural Considerations Infrastructure gaps ; In remote and rural areas hospitals are often geographically far, transportation is inadequate or unavailable and so many go without any form of medical help or are dependent on very basic facilities if at all, through small clinics.

32. Recommendations Education and information ; improved quality and reach of reproductive health information, through government incentivised (motivated) family planning campaigns on TV, radio and posters with support from local NGOs and local leaders. Research shows that women with some secondary and higher education are five times more likely to use modern methods than women without education Women empowerment in decision making for family planning Policy on child bearing

33. References TANZANIA NATIONAL FAMILY PLANNING RESEARCH AGENDA 2013–2018 WHO; Family Planning Stanford University (The challenges of effective implementation of family planning (reproductive health)) AFP (Advance Family Planning)

34. “Women in Tanzania are the greatest workers…. One cannot expect these people to give birth every year…… unless Tanzanians are careful, our daughters will be giving birth every year like rabbits”. Mwl NYERERE. THANK YOU FOR YOUR ATTENTION!