FAMILY PLANNING

Mahad Ali
BSc, MPH-RH
JHSC
Definition

Family planning services are defined

as "educational, comprehensive
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
Key facts

An estimated 225 million women in developing

countries would like to delay or stop childbearing
but are not using any method of contraception.
Some family planning methods help prevent the
transmission of HIV and other sexually transmitted
infections.
Family planning reduces the need for unsafe
abortion.
Family planning reinforces people’s rights to
determine the number and spacing of their
children.
Family planning allows people to
attain their desired number of children
and determine the spacing of
pregnancies. It is achieved through
use of contraceptive methods and the
treatment of infertility
Benefits of family planning

Promotion of family planning – and

ensuring access to preferred
contraceptive methods for women
and couples – is essential to securing
the well-being and autonomy of
women, while supporting the health
and development of communities.
1.Preventing pregnancy-related health
risks in women

A woman’s ability to choose if and when to

become pregnant has a direct impact on her
health and well-being. Family planning allows
spacing of pregnancies and can delay pregnancies
in young women at increased risk of health
problems and death from early childbearing, and
can prevent pregnancies among older women who
also face increased risks. Family planning enables
women who wish to limit the size of their families
to do so. Evidence suggests that women who
have more than four children are at increased risk
of maternal mortality.
By reducing rates of unintended pregnancies,
family planning also reduces the need for unsafe
abortion.
2.Reducing infant mortality

Family planning can prevent closely spaced

and ill-timed pregnancies and births, which
contribute to some of the world’s highest
infant mortality rates. Infants of mothers who
die as a result of giving birth also have a
greater risk of death and poor health.
3.Helping to prevent HIV/AIDS

Family planning reduces the risk of

unintended pregnancies among
women living with HIV, resulting in
fewer infected babies and orphans. In
addition, male and female condoms
provide dual protection against
unintended pregnancies and against
STIs including HIV.
4.Empowering people and enhancing
education

Family planning enables people to make

informed choices about their sexual and
reproductive health. Family planning
represents an opportunity for women for
enhanced education and participation in
public life, including paid employment in
non-family organizations. Additionally,
having smaller families allows parents to
invest more in each child. Children with
fewer siblings tend to stay in school longer
than those with many siblings
5.Reducing adolescent pregnancies

Pregnant adolescents are more likely

to have preterm or low birth-weight
babies. Babies born to adolescents
have higher rates of neonatal
mortality. Many adolescent girls who
become pregnant have to leave
school. This has long-term
implications for them as individuals,
their families and communities.
6.Slowing population growth

Family planning is key to slowing

unsustainable population growth and
the resulting negative impacts on the
economy, environment, and national
and regional development efforts.
Who provides family planning?

It is important that family planning is widely

available and easily accessible through
midwives and other trained health workers to
anyone who is sexually active, including
adolescents. Health care providers are trained to
provide (where authorized) locally available and
culturally acceptable contraceptive methods, for
example community health workers, also provide
counseling and some family planning methods,
for example pills and condoms. For methods
such as sterilization, women and men need to
be referred to a clinician.
Contraceptive use

Contraceptive use has increased in many parts of the

world, especially in Asia and Latin America, but continues
to be low in sub-Saharan Africa. Globally, use of modern
contraception has risen slightly, from 54% in 1990 to
57.4% in 2014. Regionally, the proportion of women aged
15–49 reporting use of a modern contraceptive method
has risen minimally or plateaued between 2008 and 2014.
In Africa it went from 23.6% to 27.6%, in Asia it has risen
slightly from 60.9% to 61.6%, and in Latin America and
the Caribbean it rose slightly from 66.7% to 67.0%
Use of contraception by men makes up a relatively small
subset of the above prevalence rates. The modern
contraceptive methods for men are limited to male
condoms and sterilization
Use of Contraception in Ethiopia

Overall, 38% of currently married women in

Ethiopia are currently using a contraceptive
method
The majority of women use a modern
method (41.6 percent) and 1 percent use
traditional methods. The injectable is by
far the most widely used method (27
percent), followed by implant (8 percent),
Pills (2 percent), and condoms (3 percent).
About one percent of women mentioned
the use of male sterilization and IUDs,
Modern Contraceptive methods

Combined oral contraceptives (COCs) or “the

pill”
Contains two hormones (estrogen and
progestogen)
How it works :Prevents the release of eggs from
the ovaries (ovulation)
Prevents pregnancy more than 99% with
consistent use.
Reduces risk of endometrial and ovarian
cancer; should not be taken while breastfeeding
Progestogen-only pills (POPs) or
"the minipill"
Contains only progestogen hormone,
not estrogen
Thickens cervical mucous to block
sperm and egg from meeting and
prevents ovulation
Effectiveness: 99% with correct and
consistent use
Can be used while breastfeeding;
must be taken at the same time each
day
Implants
Small, flexible rods or capsules
placed under the skin of the upper
arm; contains progestogen hormone
only
Same mechanism as POPs
Effectiveness: 99%
Health-care provider must insert and
remove; can be used for 3–5 years
depending on implant; irregular
vaginal bleeding common but not
harmful
Progestogen only injectables

Injected into the muscle every 2 or 3

months, depending on product
Same mechanism as POPs
>99% with correct and consistent use
Delayed return to fertility (1–4
months) after use; irregular vaginal
bleeding common, but not harmful
Intrauterine device (IUD): copper
containing
Small flexible plastic device containing
copper sleeves or wire that is inserted into
the uterus
Copper component damages sperm and
prevents it from meeting the egg
>99% effectiveness
Longer and heavier periods during first
months of use are common but not
harmful; can also be used as emergency
contraception
Intrauterine device (IUD)
levonorgestrel
A T-shaped plastic device inserted
into the uterus that steadily releases
small amounts of levonorgestrel each
day
Suppresses the growth of the lining
of uterus (endometrium)
>99% effectiveness
Reduces menstrual cramps and
symptoms of endometriosis;
amenorrhea (no menstrual bleeding)
in a group of users
Male condoms

Sheaths or coverings
Forms a barrier to prevent sperm and
egg from meeting
98% with correct and consistent use
Also protects against sexually
transmitted infections, including HIV
Male sterilization (vasectomy)
Permanent contraception to block or cut
the vas deferens tubes that carry sperm
from the testicle
Keeps sperm out of ejaculated semen
99% after 3 months semen evaluation

3 months delay in taking effect while stored

sperm is still present; does not affect male
sexual performance; voluntary and
informed choice is essential
Female sterilization (tubal ligation)

Permanent contraception to block or

cut the fallopian tubes
Eggs are blocked from meeting
sperm
>99% effectiveness
Voluntary and informed choice is
essential
Emergency contraception
(levonorgestrel 1.5 mg)
Progestogen-only pills taken to
prevent pregnancy up to 5 days after
unprotected sex
Prevents ovulation
Reduces risk of pregnancy by 60–
90%

Does not disrupt an already existing

pregnancy
Traditional methods

Withdrawal (coitus interruptus)

Fertility awareness methods (natural
family planning or periodic
abstinence)
Unmet need for family planning

Definition
The percent with an unmet need for family
planning is the number of women with
unmet need for family planning expressed
as a percentage of women of reproductive
age who are married or in a union. Women
with unmet need are those who are fecund
and sexually active but are not using any
method of contraception, and report not
wanting any more children or wanting to
delay the birth of their next child.
Unmet need is especially high among
groups such as:

Adolescents
Migrants
Urban slum dwellers
Refugees
Women in the postpartum period
Meeting the need for family
planning is one of the most cost-
effective investments to alleviate
poverty and improve health.
Overall, 12 percent of currently
married women in Ethiopia have
an unmet need for family planning
services, 4 percent for spacing and
7 percent for limiting births
Proposed activities to address this unmet need:

Research
Understanding the needs and perspectives
of these groups.
Testing interventions to expand access to
and use of family planning methods.
Norms, tools and guidelines
Developing appropriate indicators to
measure unmet need for family planning.
Developing or adapting guidelines on
family planning for different population
groups.
Country support and advocacy
Supporting country initiatives to address
the unmet need for family planning.
Introducing "best practices" addressing
unmet need, including integration and
linkages, and financing for sustainability.
Developing national capacity to strengthen
health information systems to monitor
trends and to evaluate programme efforts
to address the unmet need.
Global unmet need for contraception

An estimated 225 million women in

developing countries would like to
delay or stop childbearing but are not
using any method of contraception.
Reasons for this include:

limited choice of methods;

limited access to contraception,
particularly among young people,
poorer segments of populations, or
unmarried people;
fear or experience of side-effects;
cultural or religious opposition;
poor quality of available services;
gender-based barriers.
The unmet need for contraception remains
too high. This inequity is fuelled by both a
growing population, and a shortage of
family planning services. In Africa, 23.2%
of women of reproductive age have an
unmet need for modern contraception. In
Asia, and Latin America and the Caribbean
– regions with relatively high contraceptive
prevalence – the levels of unmet need are
10.9 % and 10.4%, respectively (World
Contraceptive Reports 2013, UNDESA).
WHO issues new guidance on how to provide
contraceptive information and service

6 March 2014 | GENEVA - In advance of

International Women’s Day on 8 March 2014,
WHO is launched new guidance to help countries
ensure human rights are respected in providing
more girls, women, and couples with the
information and services they need to avoid
unwanted pregnancies.
An estimated 222 million girls and women who do
not want to get pregnant, or who want to delay
their next pregnancy, are not using any method of
contraception. Access to contraception information
and services will allow better planning for families
and improved health.
WHO guidance
recommendations

“Ensuring availability and accessibility

to the information and services they
need is crucial, not only to protect
their rights, but also their health.”
Dr Flavia Bustreo, WHO’s Assistant
Director-General for Family, Women,
and Children’s Health
The guidance recommends that everyone
who wants contraception should be able to
obtain detailed and accurate information,
and a variety of services, such as
counselling as well as contraceptive
products. It also underlines the need for no
discrimination, coercion or violence, with
special attention given to assuring access
to those who are disadvantaged and
marginalized.
Other key measures are scientifically accurate sex
education programmes for young people, including
information on how to use and acquire
contraceptives. The guidance states that
adolescents should be able to seek contraceptive
services without having to obtain permission from
parents or guardians. It also recommends that
women be able to request services without having
to obtain authorization from their husbands. It
emphasizes the importance of respecting the
privacy of individuals, including confidentiality of
medical and other personal information.
“A lack of contraception puts 6 out of 10
women in low-income countries at risk of
unintended pregnancy,” says Dr Flavia
Bustreo, WHO’s Assistant Director-General
for Family, Women, and Children’s Health.
“Ensuring availability and accessibility to
the information and services they need is
crucial, not only to protect their rights, but
also their health. These unintended
pregnancies can pose a major threat to
their own and their children’s health and
lives.”
Access to contraception

In low- and middle-income countries,

complications of pregnancy and childbirth are
among the leading cause of death in young
women aged 15–19 years. Stillbirths and death in
the first week of life are 50% higher among babies
born to mothers younger than 20 years than
among babies born to mothers 20–29 years old.
Access to contraception allows couples to space
pregnancies and enables those who wish to limit
the size of their families to do so. Evidence
suggests that women who have more than four
children are at increased risk of death from
complications of pregnancy and childbirth.
Many people who cannot currently
access contraception services are
young, poor, and live in rural areas
and urban slums. Efforts are under
way to address this need. The 2012
London Summit on Family Planning
committed to extend family planning
services to at least 120 million more
people by the year 2020.
“Global targets are stimulating much needed
action to increase access to modern
contraception,” says Dr Marleen Temmerman,
Director of WHO’s Department of Reproductive
Health and Research. “But we have to be careful
that our efforts to meet those targets do not lead to
human rights infringements. It is not just about
increasing numbers, it’s also about increasing
knowledge. It is vital for women—and men—to
understand how contraception works, be offered a
choice of methods, and be happy with the method
they receive.”
The International Conference on
Population and Development held in Cairo
in 1994 highlighted the importance of a
rights-based approach to family planning.
The past 20 years have seen a large
amount of work demanding and defining a
rights-based approach to health services—
including contraception. Yet there has been
comparatively little practical advice how to
do so. WHO’s new guidance aims to
address that gap.
The guidance also suggests ways to improve
supply chains and affordability, recommends
additional training for health workers, and outlines
a series of steps to improve access in crisis
settings, in HIV clinics, and during pre-natal and
post-natal care.
The new guidance complements existing WHO
recommendations for sexual and reproductive
health programmes, including guidance on
maternal and newborn health, sexuality education,
prevention of unsafe abortion, and core
competencies for primary health care.
Family Planning and the
Millennium Development Goals
FP is a cost-effective intervention that
can substantially improve health and
development. Universal, equitable
access to reproductive health,
including FP, is designated as
Millennium Development Goal 5B.
Indicators being used to track
progress include contraceptive
prevalence rates, unmet need for
family planning, and adolescent birth
rates
How FP might affect the MDGs
FP affects all eight of the UN’s MDGs,
specifically
MDG 1: Eradicate poverty and hunger—
Family planning can help improve the
economic status of families and countries,
and reduce demand for scarce food
resources
MDG 2: Universal primary education—FP
can help girls stay in school. Girls often
leave school because of unintended
pregnancies or to take care of younger
siblings
MDG 3: Gender equality—Access to
FP can empower women and change
gender norms.
MDGs 4 and 5: Maternal and child
when families can use FP to time,
space and limit their births, the health
of children and mothers improves
MDG 6: Combat when HIV-positive
women have access to FP to avoid
unintended pregnancies, the number
of infant HIV infections is reduced.
Also, FP allows HIV positive couples
to time conception when HIV
transmission risk is lowest
MDG 7: Environmental sustainability
—when individuals and couples use
FP to avoid unwanted pregnancies,
pressure on ecological resources—
including land, water and food—is
reduced.
MDG 8: Global partnerships Family
planning promotes global
partnerships.
Thank you