Family planning

BY
Jemal Y. (BSc, MPH/RH)
Email address:
jemalyusuf496@gmail.com,

3/4/2024 By Jemal Y.(BSc,MPH/RH) 1

 Session objectives

• Introduce some basic concepts the relation between

FP and Contraceptive.

• Identify the relationship between FP, Women and

Child health and its effect on development.

• Describe evolution and rationale of FP.

• Describe the different family planning methods.

• Identify characteristics of successful FP programs.

3/4/2024 By Jemal Y.(BSc,MPH/RH) 2

Brain Storming

 What is Family planning?

 What is contraceptive?

What is their difference and similarity?

3/4/2024 By Jemal Y.(BSc,MPH/RH) 3

• Definition
• Family planning refers the ability of individuals and
couples to anticipate and attain their
desired number of children and
the spacing and timing of their births.
• Contraception refers to all measures, temporary or
permanent, designed to prevent pregnancy.

• FP is broader concept, thus achieved through the use

of contraceptive methods and the treatment of
involuntary infertility.

3/4/2024 By Jemal Y.(BSc,MPH/RH) 4

 Family planning…..
It is a means of
• Promoting the health of women and families and
part of a strategy to reduce the high maternal
mortality rate, infant mortality rate and child
mortality rate.
• Preventing maternal mortality by reducing
exposure to pregnancy.
• Preventing pregnancy and abortion when
pregnancy is unwanted
• It is a means to ensure better economic
development
3/4/2024 By Jemal Y.(BSc,MPH/RH) 5
 Justifications for the provision of FP
• Decrease fertility rate, population growth
• Reduce maternal deaths by spacing or preventing
pregnancy
• Reduce too early, too late, too close, too many
pregnancies
• Reducing risk of unwanted pregnancies and illicit
abortion
• Brings immense benefits to children
• Improve family welfare
• Increase sustainable growth and decrease dependency
ratio

3/4/2024 By Jemal Y.(BSc,MPH/RH) 6

 Over all benefits of FP
1. Health benefits
 Reduces mortality and morbidity from pregnancy and
childbirth.(Spacing childbirth at intervals of three to five years
significantly reduces maternal, perinatal, and infant mortality rates.

 Preventing suffer and death from complication of unsafe abortion.

 prevents the depletion of maternal nutritional reserves(from

repeated pregnancy and child birth.
 Non contraceptive benefits
:-provides protection from (STIs), including HIV( condom)
:-provides special nutritional benefits to the infant and reduce the
risk of breast cancer(LAM)
3/4/2024 By Jemal Y.(BSc,MPH/RH) 7
 Over all benefits…..
2. Social Benefits
 Improves welfare of family(The death of a mother
results in the disruption of the family.

 Improves societal welfare(increased population size

results in poor social services, poor education, low status
of women in society).

 Uncontrolled population growth intensifies famine, war,

and migration(demographic entrapment).
 Reduce deforestation, erosion, and resource depletion
3/4/2024 By Jemal Y.(BSc,MPH/RH) 8
 Over all benefits…..
3. Economic benefits
 Enable women to attain a better employment
opportunities.
Reduce income- and resource-sharing from large
family
Promote sustainable development(decrease
dependency ratio
Promote wise use of natural resource(green
economy and minimize global warming)

3/4/2024 By Jemal Y.(BSc,MPH/RH) 9

 The Evolution of FP
•FP has received growing attention beginning in
the 1960s due to three things:

–Serious of discussion by different people

implication of rapid population growth

–International conferences attended by country

leaders
–Invention of contraceptives in the early 1960s.

3/4/2024 By Jemal Y.(BSc,MPH/RH) 10

 Rationales of FP programs
• Family planning 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.

3/4/2024 By Jemal Y.(BSc,MPH/RH) 11

 FP rationale….
1.The demographic rationale
 Concern of rapid population growth on economic
productivity, savings and investment, natural
resources, and the environment.
 It was the predominant rationale for much of the
late 1960s and 1970s.
2. The health rationale (in the 1980s)
 the consequences of high fertility for maternal,
infant, and child mortality.
3. The human rights rationale (in the 1990s)
 women’s rights, principally reproductive rights, and
the reproductive health of women and men. This is
associated with ICPD, in 1994.
3/4/2024 By Jemal Y.(BSc,MPH/RH) 12
History of Family planning service in Ethiopia
–Modern FP services in Ethiopia were pioneered by
the Family Guidance Association of Ethiopia
(FGAE), which was established in 1966.

_FGAE’s first FP services were provided from a

single-room clinic run by one nurse.
_since then the service expanded all over the country.

–In 1980s as part of maternal and child health

program in the public health services by MOH with
the support of United Nations Population Fund
(UNFPA) and other stakeholders.

3/4/2024 By Jemal Y.(BSc,MPH/RH) 13

 History of FP in Ethiopia contin…
• Following Ethiopia’s adoption of a Population
Policy in 1993, local and international institutions
partnered with the government in expanding FP
programs and services.

• The national office of population was then

established to implement and oversee the
strategies and actions related to the population
policy.
• In 1996, the FMOH released Guidelines for FP
Services to guide stakeholders, as well as to
expand and ensure the quality of FP services
3/4/2024 By Jemal Y.(BSc,MPH/RH) 14
 Policy environment
 For the management of population dynamics in the interest
of achieving sustainable development, fp program is given
due consideration in:
The constitution( example article 35)
Health and population-related policies(national population
policy 1993)
Strategies(national RH strategy, GTP,HSTP) in Ethiopia
cover all major grounds and offer all necessary provisions,
creating an enabling environment for family planning

The Constitution of Ethiopia, in Article 35.9

“To prevent harm arising from pregnancy and child birth and in order to safeguard
their health, women have the right of access to family planning information,
education, and capacity”.(Federal Democratic Republic of Ethiopia, 1995)
3/4/2024 By Jemal Y.(BSc,MPH/RH) 15
 FP service delivery modalities in Ethiopia
A door-to-door service: providing family planning
packages at household level. The service includes
education, counseling and the provision of contraceptive
methods, such as oral pills, condoms and injectable.

Facility-based service delivery : providing the family

planning services in health facility such as IUCDs,
hormonal implants and sterilization.

Community-based distribution (CBD) :through outreach

and mobile services in areas that do not have any type of
health facility nearby.
3/4/2024 By Jemal Y.(BSc,MPH/RH) 16
 FP service delivery modalities cont….
Work place based services: providing the services
during certain hours at the workplace to saves
employees time, minimizes lost productivity .

Commercial retail sales(social marketing):sold

contraceptive at reduced or subsidised prices.
example DKT Ethiopia

Discuss in group the advantage and disadvantages of each model

3/4/2024 By Jemal Y.(BSc,MPH/RH) 17

 Range of services to be offered

• The following services shall be offered at each

level of the health system.
Counseling
Provision of contraceptive methods
Screening for reproductive organ cancers
Prevention, screening, and management for STIs,
including HIV
Prevention and management of infertility

3/4/2024 By Jemal Y.(BSc,MPH/RH) 18

 Target groups of FP services in Ethiopia…
The following groups of people are target groups
for family planning:
 Adolescents
Women in child bearing age
Post abortion
Post partum
Women’s living with HIV
 Some family planning methods, such as condoms, help
prevent the transmission of HIV and other sexually
transmuted infection
 Family planning /contraception reduce the need for abortion
especially unsafe abortion

3/4/2024 By Jemal Y.(BSc,MPH/RH) 19

 Types of family planning methods
Natural methods:
– Breast feeding as a contraceptive(LAM)
– Withdrawal (coitus interrupts)
– Periodic abstinence/Fertility awareness method:
avoiding sexual intercourse during the fertile phase
of the menstrual cycle
Calendar (rhythm) method,
 Basal body temperature method,
Cervical mucus (Billings ovulation) method,
Sympto-thermal method.

3/4/2024 By Jemal Y.(BSc,MPH/RH) 20

 Types of methods cont.

Technical methods
– Hormonal methods(pills, Injectable, Implants)
– Mechanical (IUCD, Barriers)
– Chemical methods(Spermicide)
– Post coital contraception(ECP)
Permanent contraception
– Female sterilization/tubal ligation
– Male sterilization/vasectomy

3/4/2024 By Jemal Y.(BSc,MPH/RH) 21

 Based on effectiveness
• Based on their effectiveness contraceptive methods divided into
three categories
1- Most effective : Long-acting reversible contraception
(intrauterine contraception, contraceptive implants) and
sterilization. First choice of method
2 - Effective : Injectable contraceptives, OCs, the transdermal
contraceptive system, and the vaginal ring are also if taken
consistently and correctly is associated with a very low
pregnancy rate.
3- Least effective : Other methods of including
diaphragm/cervical caps, condoms, spermicides, withdrawal, and
periodic abstinence.

3/4/2024 By Jemal Y.(BSc,MPH/RH) 22

Ideal Family planning method:
– Widely acceptable
– Inexpensive
– Simple to use
– Safe
– Highly effective
• Efficacy of family planning depends on:
Fecundity of both partners
Intercourse in relation to ovulation
Type of contraceptive used
Intrinsic effectiveness of the method
Correct use of the method
3/4/2024 By Jemal Y.(BSc,MPH/RH) 23
 Choosing a method/preference
Choosing a method depends on:
– Efficacy - is expressed in effectiveness
– Convenience
– Duration of action
– Reversibility and time to return of fertility
– Effect on uterine bleeding
– Frequency of side effects and adverse events
– Affordability
– Protection against sexually transmitted diseases

3/4/2024 By Jemal Y.(BSc,MPH/RH) 24

 Barriers to wider use of fertility regulation

Potential users perception, concerns, and fears

regarding harmful effects on health
Poor coordination among agents
Poor quality family planning services
Male dominance and opposition to some
contraceptive methods
Traditional and cultural taboos
Religious barriers
3/4/2024 By Jemal Y.(BSc,MPH/RH) 25
 Strategic priorities in improving FP services
• The strategic priorities represent key areas for financial
resource allocation and implementation performance.

Priority1#: Demand Creation: To strengthen demand for

and increase acceptability of FP services, especially long-
term methods.
Priority 2#: Service Delivery and Access: To increase
the number of skilled providers delivering high-quality
contraceptive services and ensure access for all
populations, especially youth and pastoralists.

Priority 3#: Procurement and Supply Chain: To

improve the distribution of FP commodities and
consumables from the central level to service delivery
points.
3/4/2024 By Jemal Y.(BSc,MPH/RH) 26
 Strategic priorities Cont………..

Priority 4#: Monitoring and Coordination: To

improve multi-sectoral coordination in the
planning, implementation, and monitoring of FP
programmes at all levels.
Priority # 5: Financing: To increase the budget
allocation for family planning both at the federal
and regional levels to ensure reproductive health
commodity security.
 In general the strategic commitments prioritize outreach
to specific population groups and an increase in uptake
of LARCs(long-acting reversible contraceptives).

3/4/2024 By Jemal Y.(BSc,MPH/RH) 27

 Successful of family planning programs
•Make services accessible.
–Offering services through a variety of delivery points
makes methods available to more potential users
• Make services affordable.
–Partnerships between public-and private sector
services encourage clients to pay what they can
while public programs serve the poor for free or for
low fees
• Offer client-centered care.
• Planning and providing services with the clients in
mind help to make sure their needs are met and their
preferences are honored.
3/4/2024 By Jemal Y.(BSc,MPH/RH) 28
 Successful of family planning programs…..

• Rely on evidence-based technical guidance

–Up-to date service delivery guidelines ,tools, and
job aids can help translate research findings into
better practice
•Communicate effectively
–Communication grounded in behavior theory and
sensitive to local norms motivates clients to seek
services and helps them make good FP choices

3/4/2024 By Jemal Y.(BSc,MPH/RH) 29

Successful of family planning programs…..
• Build a high performing staff.
-Programs can keep workers motivated and on the
job by creating a good working environment
,matching skills with tasks, and rewarding a job
well done
• Integrate services appropriately
-Programs can address a wider range of health
needs by integrating services where appropriate
and offering referrals where it is not

3/4/2024 By Jemal Y.(BSc,MPH/RH) 30

THANK YOU!!
THE END

31