Family Planning
Fatimetu M. (MPH/RH)
01/31/2025 1
Family Planning
is having the number of children you want when you
want them
•Objectives
–Limit family size
–Adequately space children
–Reduce maternal and child morbidity and mortality related
to complications of unwanted and high risk pregnancies
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Rationale for FP Programs
Demographic Rationale
Reducing high fertility and slowing population
growth
– Concerns over rapid population growth and high
fertility
– Surveys showed substantial unmet need for FP
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Health Rationale
The public health consequences of high fertility
became paramount
– High rates of infant, child, and maternal mortality
– Abortion and its health consequences
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Human Rights Rationale
• The right to control reproductive decisions
Partly in reaction to demographic rationale
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Advantages of FP
•For women
– Avoid unwanted and high risk pregnancies
– reduce morbidity and mortality
•Children
–Avoid morbidity and mortality
–Better feeding, Care, Clothing, Schooling
•Family
–Improves family well-being
–Better food, clothing, housing, living
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Advantages..…
•Nations: Better Economic development
•reduces the exploitation of natural resource by
reducing population growth
•People's economic situation move faster in
countries where women have fewer children.
•FP reduces youth dependency ratio
–Conservation of Natural resources
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Advantages..…
•World
–Low demands on natural resources
–Better opportunity for better life
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Patterns of fertility
• Fertility levels are much lower among highly
educated women and women living in Addis Ababa
• By region, the TFR is highest in Somali (7.2 children
per woman) and lowest in Addis Ababa (1.8 children
per woman)
• Women with no education have 3.8 more children
than women with more than a secondary education
(5.7 children versus 1.9 children)
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7.2
5.4 5.5
4.7
4.4 4.4
3.7 4.1
3.5
3.1
1.8
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Fertility by region, 2016
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5.7
4.2
2.2
1.9
No Eduction primary secondary More than
secondary
Fertility by education, EDHS 2016
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Fertility Trend in Ethiopia
• Current fertility can be measured using the age-specific
fertility rate (ASFR), the total fertility rate (TFR), the
general fertility rate (GFR), and the crude birth rate
(CBR).
• The ASFR provides the age pattern of fertility, while the
TFR refers to the number of live births that a woman
would have had if she were subject to the current ASFRs
throughout her reproductive years (15-49 years).
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Fertility Trend in …..
• The GFR is expressed as the number of live
births per 1,000 women of reproductive age
• CBR is expressed as the number of live births
per 1,000 persons in the population.
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Fertility Trend in …..
• An average woman will have 4.6 children in her
lifetime
• The TFR has declined in Ethiopia over time, from 5.5
children per woman in 2000 to 4.6 children per
woman in 2016
• Ideal family size declined by 0.9 between the 2000
and 2016 EDHS
• Men desire larger family size than women
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Fertility Trend
5.5
5.4
4.8
4.6
6
6 5.5
5.2
Total Rural
Urban
3 2.6
2.4 2.3
EDHS 2000 EDHS 2005 EDHS 2011 EDHS 2016
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Elements for successful FP program
• Well-trained and motivated staff
• Strong leadership and good management
• Communication and outreach strategies
• Supportive government policies
• Women empowerment
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Elements for successful….
• Programs guided by research, M&E, & MIS
• Logistics systems and continuous supply of
contraceptives
• Client-centered care Integration of services
• Mix of service delivery points
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Integration of Family Planning Services
• Integration can be done
– By adding FP services onto other programs OR
– Other programs on FP services
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Benefits of Integration
• Clients:
Offering multiple services at one location can increase
access and convenience for people seeking health care.
– women with HIV often prefer to obtain family planning
from their HIV care provider rather than disclose their
HIV status to another health care provider
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Benefits of Integration ....
• Providers:
– Integration of services can enable providers to
address the health of their clients more holistically
– Gives the opportunity to offer clients multiple
services.
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Benefits of Integration ....
• Programs:
– Integrated services can be more efficient and so can
serve more people for the same expenditures.
– avoid duplication of effort and save money that
might have been spent maintaining separate
facilities
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Challenges of integrated services
• In resource limited facilities increasing provider
workloads or complicating logistics systems.
• the demand and requirements for providing one
service, particularly a curative one, may squeeze out
another service, particularly a preventive one.
• New skill trainings may be needed at the beginning of
the service integration
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Guiding principles for integration
• All of the interventions being integrated must be
effective in meeting their specific health objectives.
• The interventions should address the same target
group
• Integrating the interventions should create synergies
that enhance the impact of all the services integrated
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Common Integration of FP service
• HIV/STI care and prevention
• maternal, newborn, and child health care
• Safe abortion services and post abortion care
• Paediatric clinic
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Measurements in FP
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Contraceptive Prevalence Rate (CPR)
• The proportion of women of reproductive age who
are using (or whose partners are using) a
contraceptive method at a particular point in time,
often reported for women married or in sexual union
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Contraceptive Prevalence…
• Contraceptive Prevalence rate (CPR) = U/P
• U = the number of women using a contraceptive
method at a given point in time
• P = the number of women of reproductive age (or
alternately, women of reproductive age currently
married or in union)
• Is measure of the met need
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• The contraceptive prevalence rate (CPR) for currently
married women age 15-49 in Ethiopia is 36%, with 35%
using modern methods and 1% using traditional methods.
• Fifty-eight percent of sexually active unmarried women use
contraceptive methods, with 55% using modern methods
and 3% using traditional methods (EDHS, 2016)
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Met and Unmet Needs of FP
CP is a measure of met demand for fertility
control.
Unmet need for contraception is measured as the
proportion of women in a sexual union
desiring to space or limit childbearing and not
using contraception
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• The most commonly used contraceptive method for
currently married women is injectables (23%),
followed by implants (8%).
• For sexually active unmarried women, the most
popular methods are injectables (35%), followed by
implants (11%), and male condom and emergency
contraception (4% each)
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Patterns of contraceptive use
• Current use of modern contraception for married
women is higher in urban areas (50%) than in rural
areas (32%).
• By region, currently married women in Somali have the
lowest use of modern contraception (1%), followed by
Affar (12%).
• The highest use of modern contraception among
currently married women is observed in Addis Ababa
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•
50
47
40
35 35
28 28 29 29
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Use of modern methods by region, EDHS, 2016
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Modern contraceptive use among currently married
women increases with education from 31% for
women with no education to 51% for women with
secondary education or higher.
• Use of modern contraception increases sharply with
wealth, ranging from 20% for women in the lowest
wealth quintile to 47% for women in the highest
wealth quintile
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Unmet need for Family Planning
• An important indicator for planning and
implementation of FP programs
• It tells how many women have the desire to
delay and stop further pregnancies but are not
using any type of contraceptive methods
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Unmet Need for Contraception Calculation
Women are defined as having an unmet need if they are:
•Fecund
•married or living in union
•not using any contraception
•do not want any more children, or
•want to postpone for at least two years
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Unmet need also includes:
• Pregnant or amenorrheic women
With unwanted or mistimed pregnancies/births, and
– Not using contraception at time of last conception
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Demand for Family planning
• Demand for family planning refers to the
desire or motivation of women or couples to
control future fertility
• Demand for family planning can by for
– limiting
– spacing
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Demand for FP Related Indicators
•Demand for FP= % (married) women using FP
+ % (married) women with unmet need for FP
•Percentage of demand satisfied= % (married)
women using FP / % (married) women with
demand for FP
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Contraceptive Continuation Rate
• The cumulative probability that contraceptive
acceptors are still using the adopted method
after a specific time duration (e.g., one year).
– All-method and method-specific continuation
rates
– Need prospective or retrospective data
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Contraceptive Failure Rates
• Cumulative probability that acceptors of a
contraceptive method will experience an unintended
pregnancy during use of a given method within a
specified period of time (e.g., one year)
– Need prospective or retrospective data
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Thank you
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