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Family Planning:A Critical Intervention in Achieving Health and Development Goals in Africa
The number of rural women in Africa living in absolute poverty has risen by 50% in the last two decades, as opposed to 30% percent for men.
In Africa, it is estimated that over 70% of the poor are women.
CCP
52% of young women give birth before age 20 in sub-Saharan Africa.
Arzum Ciloglu/CCP
2.5 million mothers in Africa will die in the next ten years, if there are no improvements in safe motherhood services and interventions.
Liz Gilbert/David and Lucille Packard Foundation
If there are no improvements made in the health and survival of African women, 7.5 million children will die in the next 10 years.
Approximately 2.1 million children in sub-Saharan Africa are living with HIV/AIDS, and most of them were infected with HIV through mother-to-child transmission.
Dianne Lang
Family planning helps to:• save mothers’ and
infants’ lives,
• decrease abortion,
• prevent mother-to-child transmission of HIV, and
• meet development goals.
July 2004
SADC First Ladies Conference
Dar es Salaam, Tanzania
Family Planning:A Critical Intervention in Achieving Health and Development Goals in Africa
Family Planning
“Enabling couples to determine whether, when, and how often to
have children”
USAID, 2004
Rationale for Family Planning Reducing high-risk pregnancies protects
women’s health.
Spacing births protects women’s and infants’ health.
Preventing unwanted pregnancies reduces abortions.
Using family planning methods can help prevent transmission of HIV.
Improving maternal health and stabilizing population growth can contribute to meeting development goals.
How Does Family Planning …
Ensure safe motherhood,
Reduce abortion,
Prevent mother-to-child transmission of HIV, and
Meet development goals?
How Does Family Planning Ensure Safe Motherhood?
“A woman cannot die a maternal death if she is not pregnant, so family planning can
directly and substantially reduce maternal deaths by helping women to avoid
unwanted pregnancies.”
Deborah Maine, expert on reproductive health in developing countries (1999)
Worldwide Causes ofMaternal Death
Obstructed labor
8%
Unsafe abortion
13%
Other direct
causes*8%
Indirect causes**
19%
Severe bleeding
24%
Infection15%
Eclampsia13%
*includes ectopic pregnancy, embolism, anesthesia**includes anemia, malaria and othersSource: WHO/World Bank, 1997
Maternal Disabilities
For 1 maternal death, 20 women will suffer short- or long-term disabilities
1 maternal death
20 disabilities
Source: WHO/World Bank, 1997
Maternal Disabilities
Chronic anemia
Infertility
Stress incontinence
Fistulae
Chronic pelvic pain
Emotional depression
Maternal exhaustion
49 million maternaldisabilities (2001–2010)
Source: Reduce Model application/WHO/AFRO
Avoidable Pregnancy Risks
Too many Birth order greater than 3
Too short Birth interval less than 36 months
Too early Mother’s age less than 18
Too late Mother’s age greater than 34, particularly when
combined with another risk factor
Avoiding High-Risk Pregnancy Saves Infant Lives
Each year…
6,661 infant lives would be saved— decreasing the country’s infant mortality rate by 17.2% — by eliminating ALL avoidable pregnancy risks in Zambia.
Source: POLICY, 2004
Avoidable Pregnancy Risksin Tanzania
Source: DHS, 1999
Most common avoidable high-risk categories
Too early – women younger than 18
Too many – birth order greater than 3
7%
26%
Too short – birth interval less than 24 months
6%
Multiple risk categories
18%
Not in high-risk category
26%
Avoidable pregnancy risk
57%
Unavoidable pregnancy risk
17%
Birth Spacing SavesChildren’s Lives
0.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
<18 18-23 24-29 30-35 36-41 42-47 48-53 54-59 60+
Birth Interval (months)
Rel
ati
ve R
isk
of
Mo
rtal
ity Neonatal Mortality
Infant MortalityUnder-Five Mortality
Source: Rutstein, 2003
Birth Spacing Saves Mothers’ Lives
Risk of Maternal Death by Length of Birth Interval
4.203.70
4.90
9.50
4.40
5.50
0
2
4
6
8
10
0-14 15-20 21-26 27-32 33-68 69+
Duration of Preceding Birth Interval (months)
Mat
erna
l Dea
th R
ate
per
10,0
00 W
omen
Source: Conde-Agudlo and Belizan, 2000
Short Birth Intervals in Uganda
Source DHS, 2000-2001
18-23 months,
18%
7-17 months, 9.6%
48+ months, 13.1%
36-47 months, 16.9%
24-35 months, 42.4%
Births to Young Women and Older Women in Zambia
Source DHS, 2001-2002
13% of births are to women older than 35
10% of births are to women younger than 18
Lu
ke M
wa
nza
/CC
P
Ha
rve
y N
els
on
Family Planning Reduces Mortality
FP reduces the number of women exposed to the risks of pregnancy.
FP prevents higher risk births and allows for optimal birth spacing.
Unmet Need and Contraceptive Prevalence Rate
0
10
20
30
40
50
60
Kenya 1998
Tanz.1999
Uganda2000
Rwanda2000
Zimb.1999
Mozam.1997
Malawi2000
Use Unmet Need
Source: Country DHS 1997–2000
Per
cent
Benefits of Eliminating Unmet Need for Family Planning
5,857
2,966
6,024
2048
3,781
7,501
5,668
3,811
0
2,000
4,000
6,000
8,000
Malawi Zambia Uganda Tanzania
Maternal deaths with unmet needMaternal deaths without unmet need
Source: Data from PHNI DOLPHN and DHS websites
Maternal Mortality Declines as Contraceptive Prevalence Increases
Source: Data from PHNI DOLPHN website
0
200
400
600
800
1000
1200
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Contraceptive Prevalence Rate
Mat
ern
al M
ort
alit
y R
atio
s Malawi
South Africa
Namibia
Zambia
Tanzania
Kenya
How Does Family Planning Reduce Abortion?
“Women should have access to quality services for the management of complications
arising from abortion. Postabortion counseling, education, and family planning services should be offered promptly, which
will also help avoid repeat abortions.”
ICPD Programme of Action, Paragraph 8.25
Key Interventions that Support Postabortion Care
Family Planning – including a special emphasis on reaching high-risk women to provide postpartum and postabortion contraception
Reproductive Healthcare – including provision of appropriate postabortion treatment of infection and hemorrhage and referral for other reproductive health care services
Women’s Fertility Preferences in Malawi
Wanted Later18%
Unwanted Pregnancy
22%
Wanted Pregnancy
60%
Source: DHS, 2000
For Current or Last Pregnancy
Family Planning Reduces Abortion in Ghana
200,000
210,000
220,000
230,000
240,000
250,000
260,000
270,000
280,000
2000 2005 2010 2015
Year
Nu
mb
er o
f A
bo
rtio
ns
05
10152025
303540
4550
CP
R (
Per
cen
t)
Number of Abortions CPRSource: SPECTRUM, 2004
How Does Family Planning Prevent Mother-to-Child Transmission of HIV?
“FP among HIV-positive women means avoiding having HIV-positive babies/children.”
Staff member, Family Planning Association of Kenya
What Does Prevention of Mother-to-Child Transmission (PMTCT) Include?
Preventing women from becoming infected
Preventing unwanted pregnancies among HIV+ women
Providing antiretrovirals, safe delivery practices, and infant feeding options to reduce MTCT
Providing care and support for HIV+ mothers, children, and families
Women Receiving PMTCT Services Would Benefit from FP
All are sexually active and fertile
HIV+ women may have a special need for FP Avoid stress of pregnancy Avoid leaving orphans behind Promotes partner involvement –
advocates partner testing
Probability of future pregnancy is high (80%) if family planning is not used
There Is Need for FP among HIV+ Women
“Many should be educated [on family planning], both in hospital, clinics, and even for those you have come up with support groups. They should all be educated. Brochures and pamphlets could also be produced.”
HIV-positive woman, Kenya
When FP Is Added to PMTCT (2007)…
the number of HIV+ births is reduced.
No intervention: 450,000
PMTCT (no FP): 410,000 10% reduction
PMTCT + FP: 380,000 16% reduction (range 13–20%)
Source: Stover, 2003
Additional Benefits ofAdding FP Are Substantial
Child deaths averted: 56,000 per year Better birth spacing
Orphans avoided: 150,000 per year Fewer births to HIV+ women
Mothers’ lives saved: 7,000 per year Reduced risk of pregnancy and delivery
Source: Stover, 2003
Cost-effectiveness ofFP Added to PMTCT (2007)
PMTCT (no FP) PMTCT + FP
Cost per infection averted $1300 $660
Cost per child death averted $2600 $360
Source: Stover, 2003
How Does Family PlanningMeet Development Goals?
“The state of health of a population is an essential element …It is therefore imperative to give health and environment high priority
so as to reduce poverty and implement sustainable development.”
Madagascar: Poverty Reduction Strategy Paper, 2003
Mothers and Development
Mothers are vital members of families and communities.
Caregivers
Citizens
Contributors to economic development
Photo: Lora Lannotti
Impact of Maternal Death on Families and Society
Surviving children are at 67% greater risk of death and illness.
Surviving children have poor growth and development.
Surviving children’s access to education and proper nutrition is reduced.
Maternal death significantly affects children.
Women’s economic contributions are essential to alleviating poverty.
Maternal deaths and disabilities dramatically reduce the ability of families to emerge out of poverty.
Impact of Maternal Death on Families and Society
Losses in Productivity (2001–2010) Due to…
Losses
Due to maternal deaths
$22 billion
Due to maternal disabilities
$23 billion
Total $45 billion
Family Planning Programs Are Good Investments
For every dollar the government spendson family planning, it gets a higher rateof return.
Tunisia: 8.6
Indonesia: 12.5
Thailand: 14.0
Egypt: 30.0
Cost and Benefitsof Family Planning Programs
Tunisia Indonesia Thailand Egypt
8.60 12.50 14.00
30.00
Governments Are Recognizing the Importance of Health
“Without good health, individuals, families, communities, and nations cannot hope to achieve their social and economic goals. It is therefore clear that the health sector will play a key role in poverty eradication and development in Uganda.”
Uganda, National Health Policy, 1999
Challenges for ImplementingFP Programs
• Increasing Increasing populationpopulation
• HIV/AIDSHIV/AIDS pandemicpandemic
• Increasing Increasing awarenessawareness
Demand for Demand for quality quality FP servicesFP services
Lack of Lack of resources resources to meet to meet demanddemand
Challenges for Implementing FP Programs
Allocation of resources African governments’ budgetary provisions
for FP and RH care are inadequate
Countries’ allocations for FP and RH care resources are decreasing
Increased support being given to HIV/AIDS
Failure of governments to give priority to FP
Challenges for Implementing FP Programs
Donor funding Donor funding has been filling FP and RH
care resource gaps
International donor funding for FP is decreasing
Increased support for HIV/AIDS
Changes in donor priorities
Donor fatigue
Challenges for Implementing FP Programs
Lack of popular support Religious groups do not always support FP
Many individuals have misperceptions about side effects of FP methods
Conclusions
There is a need for family planning services that is not being met.
Spacing births more than three years apart can protect maternal and infant health.
Family planning saves lives, decreases abortion, prevents mother-to-child transmission of HIV, and helps meet development goals.
Next Steps: What We Can Do
“Family planning is important for young people to delay childbearing and for
women to space their pregnancies and preserve their health.”
First Lady of Uganda
We need to…
Become better advocates for conveying the benefits of FP to local leadership
Increase government and private resources available for providing FP
Support programs that enable women to space births three or more years apart
Increase access to FP for HIV-positive women or couples
Engage men in the dialogue
How?
Start with our husbands to enlist their support for FP
Identify the organizations that will advocate for FP in our country
Work with district leadership and faith-based organizations to support FP
Work with Ministry of Planning/Finance and Ministry of Health to increase resources available for FP
July 2004
First Ladies
Dar es Salaam, Tanzania
Family Planning:A Critical Intervention in Achieving Health and Development Goals in Africa
Photos courtesy of Photoshare, a service of The INFO Project at www.photoshare.org