Professional Documents
Culture Documents
FACULTY OF MEDICINE
A.B.U. ZARIA
TOPIC: FAMILY PLANNING-
RANGE/CHOICE OF METHOD
PRESENTERS:
HAMZA AHMED TIJANI
MPH/MED/19604/2007-08
IBRAHIM NA’ALLAH
MPH/MED/ /2007-08
FEBRUARY, 2009
PRESENTATION OUTLINE
INTRODUCTION
DEFINITIONS
CONTENTS
• Global/ African / Nigerian FP Situation
• Attention to unmet needs
• FP range/ methods
• Safety / side – effects
• Implant removal/ sterilization reversal
• FP Counselling / informed Choice of
method
PRESENTATION OUTLINE (Cont’d)
• Delay child birth in Adolescence,
male responsibility, FP in post-
abortion care, post-partum period,
violence against women
• Quality of FP services
• FP and MDG’s
• Role of NGOs in FP
• Challenges of FP in Nigeria
RECOMMENDATIONS
CONCLUSION
REFERENCES
INTRODUCTION
Family planning is arguably considered
the most important component of
reproductive health as the outcome of other
components of RH largely depend on the
effectiveness of family planning .
FP first became the focus of international
concern as a basic human right in the United
Nations conference on Human Right
Teheran
INTRODUCTION (Cont’d)
This view was further endorsed at the Bucharest
Conference on world population in 1974 and re-
echoed at ICPD Cairo in 1994.
Bucharest Conference /ICPD Cairo emphasized
in their plan of action that ”All couples and
individuals have the basic human right to decide
freely and responsibly the number and spacing
of their children and to have information,
education and the means to do so”.
DEFINITIONS
FP is a preventive Health Service that provides
quality affordable and easily accessible RH care to
women and men during their reproductive years.
FP also refers to practices that help individuals or
couples to attain certain RH objectives namely:
To avoid unwanted pregnancies.
To achieve wanted pregnancies
To regulate the intervals between pregnancies
To control the time of pregnancy
To determine the number of children in the
family
GLOBAL / AFRICAN FP OVERVIEW
350 million eligible people do not have
access to FP services worldwide.
Low contraceptive prevalence mostly
in African Region
Most countries worldwide have
achieved birth control (one-child
family in china; 2 – child family in
India, etc).
Low utilization of contraception
among adolescents in sub-Saharan
Africa.
GLOBAL / AFRICAN FP OVERVIEW (Cont’d )
64 65
63
70
60
50
40 1990
29
1999
23 1999 modern
30
17 18
14 15
20
9
6
10
0
Know method Ever Used Currently Using Unmet need
REASONS FOR HIGH FERTILITY IN NIGERIA
Socio-cultural barriers
Lack adequate information and Health
Education
Poor access to FP services
Low level of utilization of services
Inadequate skills on the part of providers
Increased teenage pregnancy
Lack of male involvement
Low educational level
Poverty, high rate of unemployment
Inadequate/ irregular supply of contraceptives
Low status of women
UNMET NEEDS FOR FP
Refers to a situation where women or men who
are sexually active would prefer to avoid
pregnancy but nevertheless are not using any
contraceptive methods
About ¼ of women want to stop having children
or delay pregnancy but are not using
contraceptives
Unmet need is highest among adolescents,
among rural women and women with low
educational level
Unmet need for FP in Nigeria – 18.0%
REASONS FOR UNMET NEEDS
Combined pill
Progestogen - only
Post – coital pills (ECPs)
?Male pill (Gossypol)
Injectables
Subcutaneous Implants
Vaginal rings
TERMINAL METHODS
Consistent abstinence 0 0
Condom (Male) 3 14
Condom (Female) 5 21
FP COUNSELLING/ INFORMED
CHOICES
Aims to help the client make informed
choice.
Involves
• Effectiveness of FP method
• Advantages and disadvantages
• side effects and complications
• How to use the chosen method
• When to return
FP COUNSELLING/ INFORMED
CHOICES (Cont’d)
• Principle of “GATHER” is
employed
• Allow client to make a choice
• Non- judgemental
• Couple – counselling is important
to encourage male involvement
MEDICAL ELIGIBILITY CRITERIA FOR
FP METHODS
Category With Limited Clinical With Limited
Clinical
Adolescents
Men
Post – abortion care
Violence against women
Post – partum period
Pre-menopausal women
ADOLESCENTS
Adolescents – Age 10 – 19 years
Constitute 1/6th of world’s population
85% of adolescents in developing
countries
Girls age 15 – 19 years give birth to 15
million babies yearly
About 4 million abortions yearly
Girls age 15 – 19 years die from
pregnancy- related causes than any other
cause
In Nigeria – young people age 10 – 24
years – 32% teenage pregnancy – 25%.
ADOLESCENTS (Cont’d)
8.3% of males age 15 – 19 years
have had sex by age 15 year
16.2% of girls in the same age –
group have had sex by 15 years
WHY FP / DELAY BIRTH IN
ADOLESCENTS?
Women less than 20 years are more
likely to suffer from complications of
pregnancy
Young women often seek for unsafe
abortion with its attendant
complications
STI`s higher among adolescents –
33% under 17 years
High prevalence of preterm delivery
and infant mortality in teenage
BENEFITS OF FP IN
ADOLESCENTS
Protection against unwanted
pregnancies
Protection from STI`s/HIV- AIDS
Prevention of Unsafe abortion
Increased Employment opportunities
Increased Educational opportunities
METHODS OF FP IN
ADOLESCENTS
• All contraceptives are safe for young
people
• Barrier methods (condom) are better for
young males contraception and
protection against STI`s
• ECP`s and Injectables are better for young
girls because they have less control over
sex.
• Young women are less tolerant to OCP`s.
• IUCDs, sterilization not desirable
MALE RESPONSIBILITY IN FP
Men are important supporters,
important clients
They have influence on women
They can use condoms and
vasectomy
Couple – counselling/ Joint –
decision-making about sexual and
reproductive health should be
encouraged.
MALE RESPONSIBILITY Cont’d
MALE RH SERVICES
Condom, vasectomy and counselling
about other methods
Conselling and help in other sexual
problems e.g Erectile Dysfunction
STI/HIV counselling, Testing and treatment
Infertility counselling
Screening for penile, testicular or prostate
cancer.
OBSTACLES TO MALE
INVOLVEMENT IN FP
1. Feminists’ extreme stance on
Gender equality -“It is my body !”
slogan.
2. FP service providers resistance in
providing male RHS
3. No clear definition of male RHS
4. Marginalization of males in RHS–
Emphasis is on women.
FP IN POST – ABORTION CARE
Fertility returns quickly within 2 weeks (1st
trimester abortion) and 4 weeks (2nd trimester
abortion).
Need for immediate access to FP services.
FP services to be integrated into PAC
COC’s, Injectables, Implants can be started
immediately
IUCDs, sterilization can be started when
infection is ruled out
FP IN VIOLENCE AGAINST
WOMEN (VAW)
Women experiencing violence have
special Health needs, many of them
related to sexual and Reproductive Health
Violence can lead to injuries, unwanted
pregnancy, STI`s etc
Counsel client with empathy, compassion
and non – judgmental manner.
Provide ECP`s if appropriate and wanted
Offer ECP pills for future use
QUALITY OF FP SERVICES
Refers to degree of excellence and
standards in FP services delivery, in order
to satisfy needs of clients
Adequate information on scope and
benefits of FP services to stakeholders
Adequate and regular supply of
contraceptives
Improved accessibility to FP services.
Technical competence in FP service
delivery
QUALITY OF FP SERVICES
(Cont’d)
Improving staff attitude and interpersonal
relationship
Provision of wide range of FP choices to
meet diverse groups
Appropriate mechanism for sustainability
of FP programmes
Collaboration with development partners
in FP services
FAMILY PLANNING AND
MDG’S
Strong relationship exists between
family planning and MDG’s.
MDGs 1, 2 and 3
Eradicating poverty, achieving
female education and promotion of
gender equality and equity are the
best strategies to uptake of FP
services
FAMILY PLANNING AND
MDG’S (Cont’d)
MDGs 4, 5 and 6
Effective family planning will reduce
incidence of unwanted pregnancies,
unsafe abortions, complications of
pregnancy and STIs/ HIV – AIDS.
Consequently there will be reduction of
child mortality, improvement in
maternal Health and reduce prevalence
of STIs / HIV-AIDS
FAMILY PLANNING AND MDG’S
(Cont’d)
MDG 8