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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. CCP.

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

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  1. Family Planning:ACritical Intervention in Achieving Health and Development Goals in Africa

  2. 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.

  3. CCP In Africa, it is estimated that over 70% of the poor are women.

  4. 52% of young women give birth before age 20 in sub-Saharan Africa. Arzum Ciloglu/CCP

  5. 2.5 millionmothers 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

  6. 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.

  7. Dianne Lang 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.

  8. Family planning helps to: • save mothers’ and infants’ lives, • decrease abortion, • prevent mother-to-child transmission of HIV, and • meet development goals.

  9. Family Planning:ACritical Intervention in Achieving Health and Development Goals in Africa July 2004 SADC First Ladies Conference Dar es Salaam, Tanzania

  10. Family Planning “Enabling couples to determine whether, when, and how often to have children” USAID, 2004

  11. 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.

  12. How Does Family Planning … • Ensure safe motherhood, • Reduce abortion, • Prevent mother-to-child transmission of HIV, and • Meet development goals?

  13. 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)

  14. Worldwide Causes ofMaternal Death *includes ectopic pregnancy, embolism, anesthesia **includes anemia, malaria and others Source: WHO/World Bank, 1997

  15. Maternal Disabilities For 1 maternal death, 20 women will suffer short- or long-termdisabilities 1 maternal death 20 disabilities Source: WHO/World Bank, 1997

  16. Chronic anemia Infertility Stress incontinence Fistulae Chronic pelvic pain Emotional depression Maternal exhaustion Maternal Disabilities 49 million maternal disabilities (2001–2010) Source: Reduce Model application/WHO/AFRO

  17. 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

  18. 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

  19. Avoidable Pregnancy Risksin Tanzania Not in high-risk category 26% Avoidable pregnancy risk 57% Unavoidable pregnancy risk 17% Source: DHS, 1999

  20. Birth Spacing SavesChildren’s Lives Source: Rutstein, 2003

  21. Birth Spacing Saves Mothers’ Lives Source: Conde-Agudlo and Belizan, 2000

  22. Short Birth Intervals in Uganda 7-17 months, 18-23 9.6% months, 18% 48+ months, 13.1% 24-35 36-47 months, months, 42.4% 16.9% Source DHS, 2000-2001

  23. Births to Young Women and Older Women in Zambia 13% of births are to women older than 35 Luke Mwanza/CCP 10% of births are to women younger than 18 Harvey Nelson Source DHS, 2001-2002

  24. 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.

  25. Unmet Need and Contraceptive Prevalence Rate Percent Source: Country DHS 1997–2000

  26. Benefits of Eliminating Unmet Need for Family Planning Source: Data from PHNI DOLPHN and DHS websites

  27. Maternal Mortality Declines as Contraceptive Prevalence Increases Malawi Zambia Kenya Tanzania Namibia South Africa Source: Data from PHNI DOLPHN website

  28. 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

  29. 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

  30. Women’s Fertility Preferences in Malawi For Current or Last Pregnancy Source: DHS, 2000

  31. Family Planning Reduces Abortion in Ghana Source: SPECTRUM, 2004

  32. 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

  33. 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

  34. 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

  35. 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

  36. 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

  37. 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

  38. Cost-effectiveness ofFP Added to PMTCT (2007) Source: Stover, 2003

  39. 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

  40. Caregivers Citizens Contributors to economic development Mothers and Development Mothers are vital members of families and communities. Photo: Lora Lannotti

  41. Impact of Maternal Death on Families and Society Maternal death significantly affects children. • 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.

  42. Impact of Maternal Death on Families and Society • Women’s economic contributions are essential to alleviating poverty. • Maternal deaths and disabilities dramatically reduce the ability of families to emerge out of poverty.

  43. Losses in Productivity (2001–2010) Due to…

  44. Family Planning Programs Are Good Investments For every dollar the government spends on family planning, it gets a higher rate of return. Tunisia: 8.6 Indonesia: 12.5 Thailand: 14.0 Egypt: 30.0 Cost and Benefits of Family Planning Programs 30.00 14.00 12.50 8.60 Tunisia Indonesia Thailand Egypt

  45. 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

  46. Challenges for ImplementingFP Programs Demand for quality FP services • Increasing • population Lack of resources to meet demand • Increasing • awareness • HIV/AIDS • pandemic

  47. 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

  48. 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

  49. 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

  50. 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.

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