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1. Learning Outcome-2 Demonstrate knowledge of the practice of fertility control, quality FP service By: Birye Dessalegn (RN, BScN ) Address: [email protected] January/2018 2/27/2018 1

2. Objectives Describe history of family planning Discuss role of midwifes Identify family planning needs of adolescents and youth Explained appropriate and effective FP method for couples 2/27/2018 2

3. History (Evolution) of Family Planning Family planning services in developing countries have undergone a substantial evolution since the first programs, building on the pioneering work of Marie Stopes in the United Kingdom and Margaret Sanger in the United States , were launched in the 1950s In the early 1950s , the contraceptive products available were limited to condoms and barrier methods such as the diaphragm 2/27/2018 3

4. The Evolution of FP cont’d The development of two new methods of contraception—the OCPs (“the pill”) and the IUD—in the early 1960s spurred interest for making modern contraceptive technology available to countries around the world During the 1970s , when international family planning support was growing rapidly, The prevailing view among policymakers was that family planning leads to lower fertility, slower population growth, and economic development In the 1980s , integrating family planning service with maternal and child health services were introduced in many countries 2/27/2018 4

5. The Evolution of FP cont’d In 1994 the ICPD in Cairo placed women and reproductive health at the center of policy attention, and the key family planning issues were identified as individual : Benefits Rights Choice and Responses to unmet need 2/27/2018 5

6. Family planning service in Ethiopia 1964 The Family Guidance Association(FGA) of Ethiopia was established It is the first Ethiopian NGO to provide family planning services in the country 1971 FGAE becomes affiliated to the International Planned Parenthood Federation Since 1980 , the MoH (Ethiopia) further expanded FP services through cyclic country support programs by the United Nations Population Fund ( UNFPA ) and other stakeholders 2/27/2018 6

7. Family planning service in Ethiopia MOH integrated FP with the MCH services 1990 Marie Stopes International Ethiopia was established With the adoption of the population policy in 1993 , numerous local and international partners have come together to assist the government in expanding family planning programs and services 2/27/2018 7

8. Family planning service in Ethiopia In 1996, the MoH released guidelines for family planning services in Ethiopia 2000 Engender Health begins working in Ethiopia with private funding to expand access to clinic-based contraceptive services 2/27/2018 8

9. Rationale for Family Planning Programs Rationales of FP programs FP programs have been a key public health intervention in developing countries and a component of international development assistance programs for three reasons: Demographic Health and Human rights Each of these rationales can also be viewed as goals for family planning programs because each implied achieving certain changes or improvements 2/27/2018 9

10. What do think on Demographic Rationale? 1. Demographic Rationale Objectives of interventions at that time were: Reducing high fertility rate Lowering population growth Improving living standards Less impact on natural resources and the environment 2/27/2018 10

11. Demographic Rationale cont’d It was the predominant rationale for much of the late 1960s and 1970s During this period, the dominant paradigm argued that rapid population growth would not only hinder development, but was itself the cause of poverty and underdevelopment Population policies became widespread in developing countries during the 1970s and 1980s FP is a well-known intervention to achieve fertility reduction goals 2/27/2018 11

12. Demographic Rationale cont’d World Population Milestones 1 billion in 1804, 2 billion in 1927 (123 years later), 3 billion in 1960 (33 years later), 4 billion in 1974 (14 years later), 5 billion in 1987 (13 years later), 6 billion in 1999 (13 years later), 7 billion in 2011(13 years later) source: UN, World Population Prospects, 1998 revision 2/27/2018 12

13. 2/27/2018 13

14. Africa population by age group 2010 and 2030 2/27/2018 14

15. Ethiopia : Population Projection, 1995 - 2030 Source: Lesson 10 Population Policy and Projection www.ethiodemographyandhealth.org Aynalem Adugna 2/27/2018 15

16. Projected Number of Ethiopian Women in Their Reproductive Years (15 - 49) Source: Lesson 10 Population Policy and Projection www.ethiodemographyandhealth.org Aynalem Adugna 2/27/2018 16

17. 2. Health Rationale Health Rationale (in the 1980s) Use of contraception leads to healthier mothers and infants through birth spacing and prevention of pregnancies in the very young, very old, and women with many children During the 1980s, the public health consequences of high fertility for mothers and children are set of concerns for international community especially for developing countries High rates of infant, child, and maternal mortality as well as abortion and its health consequences 2/27/2018 17

18. Health Rationale The Safe Motherhood Initiative, a global campaign to reduce maternal mortality, launched in 1987, identified FP as one of four strategies—with: ANC safe delivery PNC—to reduce maternal mortality in developing countries 2/27/2018 18

19. Health Rationale … Benefits to women’s health 1 .Avoiding the extremes of maternal age (<15 (<18), >35 years) Young Pregnancy induced hypertension, obstructed labor… Older Mal- presentations , uterine rupture, hemorrhage , abnormal placenta… 2/27/2018 19

20. Health Rationale … 2.Decreasing risk by decreasing parity Risk of maternal death is 1.5 to 3 times higher for women with 5 or more children than for women with 2 or 3 children 3.Preventing high risk pregnancies (previous complications, chronic diseases, anemia…) 4.Decreasing abortion risks (“every child a wanted child”) 5.Non contraceptive benefits (Protection against STIs and reproductive tract cancers) 2/27/2018 20

21. 3. Human Rights Rationale (in the 1990s) There is worldwide consensus that access to family planning services, counseling, and commodities is a basic human right , essential to the rights of the couple, the woman, and the child International agreements such as the declaration of the ICPD, Cairo in 1994 , declared that all married couples and individuals have the basic rights to decide freely and responsibly the number and spacing of their children and to have the information, education, and means to do so 2/27/2018 21

22. Human Rights Rationale cont’d The WHO Reproductive Health Strategy of 2004, among others, have made both RH and FP major international priorities In recent years there has developed a broad international consensus that there is a government responsibility to protect and promote the rights of individuals and couples to control their reproductive lives and have access to FP information and services 2/27/2018 22

23. Roles of a Midwife A midwife is a health care professional who provide health care services for women including: Gynecological examinations Contraceptive counselling and prescriptions during labor, delivery and after 2/27/2018 23

24. Various Roles of a Midwife: As a care giver Midwives provide high quality care to maximize the women’s health refer for any complications   As coordinator, Midwives coordinate care for all women As role of leader is to plan, provide and review a women’s care, with her input and agreement As a communicator, the midwives understand that effectiveness of communication 2/27/2018 24

25. Roles of a Midwife ….. They provide all information about all kind of family planning methods and help couple to take decision As an educator, midwives provide high quality, culturally sensitive health education in order to promote healthy, helpful family life and positive parenting Midwives provide information and counsel 2/27/2018 25

26. Family Planning Needs of Adolescents and Youth Young people may come to a family planning provider not only for contraception but also for advice about: physical changes sex, relationships family, and problems of growing up 2/27/2018 26

27. Continued …… Unmarried and married youth may have different sexual and reproductive health needs All contraceptives are safe for young people Their needs depend on their particular situations : Some are unmarried and sexually active Others are not sexually active While still others are already married Some already have children 2/27/2018 27

28. Continued …… Age itself makes a great difference, since young people mature quickly during the adolescent years These differences make it important to learn about each client first, to understand why that client has come, and to tailor counseling and the offer of services accordingly Young women are often less tolerant of side effects than older women 2/27/2018 28

29. Continued …… With counseling, however, they will know what to expect and may be less likely to stop using their methods Unmarried young people may have more sex partners than older people and so may face a greater risk of STIs Considering STI risk and how to reduce it is an important part of counseling Young women may have less control than older women over having sex and using contraception. They may need ECPs more often 2/27/2018 29

30. Continued …… Female sterilization and vasectomy Provide with great caution Young people and people with few or no children are among those most likely to regret sterilization Withdrawal One of the least effective methods of pregnancy prevention But it may be the only method available—and always available—for some young people. 2/27/2018 30

31. Continued …… Men are Important Supporters , Important clients To health care providers, men are important for 2 reasons: First, they influence women. Some men care about their partner’s reproductive health and support them Others stand in their way or make decisions for them Thus, men’s attitudes can determine whether women can practice healthy behaviors 2/27/2018 31

32. Continued …… Men are also important as clients Major family planning methods—male condoms and vasectomy—are used by men Men also have their own sexual and reproductive health needs and concerns in particular regarding sexually transmitted infections (STIs)—which deserve the attention of the health care system and providers. Providers can give support and services to men both as supporters of women and as clients 2/27/2018 32

33. Women Near Menopause A woman has reached menopause when her ovaries stop releasing eggs (ovulating) Because bleeding does not come every month as menopause approaches, a woman is considered no longer fertile once she has gone 12 months in a row without having any bleeding. Menopause usually occurs between the ages of 45 and 55. About half of women reach menopause by age 50. By age 55 some 96% of women have reached menopause 2/27/2018 33

34. Continued …… To prevent pregnancy until it is clear that she is no longer fertile, an older woman can use any method, if she has no medical condition that limits its use By itself, age does not restrict a woman from using any contraceptive method. Female sterilization and vasectomy: May be a good choice for older women and their partners who know they will not want more children Older women are more likely to have conditions that require delay, referral, or caution for female sterilization . 2/27/2018 34

35. Provide Services with care and Respect Young people deserve nonjudgmental and respectful care no matter how young they are. Criticism or unwelcoming attitudes will keep young people away from the care they need Counseling and services do not encourage young people to have sex, instead, they help young people protect their health 2/27/2018 35

36. To make services friendly to youth, you can: Show young people that you enjoy working with them Counsel in private areas where you cannot be seen or overheard Ensure confidentiality and assure the client of confidentiality. Listen carefully and ask open-ended questions such as “How can I help you?” and “What questions do you have?” Use terms that suit young people. Avoid such terms as “family planning,” which may seem irrelevant to those who are not married. 2/27/2018 36

37. Continued …… Use simple language and avoid medical terms. Welcome partners and include them in counseling, if the client desires Try to make sure that a young woman’s choices are her own and are not pressured by her partner or her family In particular, if she is being pressured to have sex, help a young woman think about what she can say and do to resist and reduce that pressure Practice skills to negotiate condom use. 2/27/2018 37

38. Continued …… Speak without expressing judgment (for example, say “You can” rather than “You should”) Do not criticize even if you do not approve of what the young person is saying or doing Help young clients make decisions that are in their best interest 2/27/2018 38

39. Continued …… Take time to fully address questions, fears, and misinformation about sex, sexually transmitted infections (STIs), and contraceptives Many young people want reassurance that the changes in their bodies and their feelings are normal Be prepared to answer common questions about puberty, monthly bleeding, masturbation, night-time ejaculation, and genital hygiene 2/27/2018 39

40. Thank You!! 2/27/2018 40