Family Planning: A Critical Intervention in Achieving Health and Development Goals in Africa

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

“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


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


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


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


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


Photos courtesy of Photoshare, a service of The INFO Project at www.photoshare.org

Documents

Family Planning: A Critical Intervention in Achieving Health and Development Goals in Africa