Introduction to family planning learning material

Introduction to family planning learning material

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  Maternal and ChildHealth Nursing III (NSG 413) Introduction to Family Planning By Temilade Ogundare (Mrs)
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  Learning Objectives By theend of the training, students should be able to: • define family planning, • explain the history of family planning both nationally and internationally, • state rationale for family planning and • explain the constraints to family planning acceptance
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  THE CONCEPT OFFAMILY PLANNING INTRODUCTION The phrase family planning tends to have different meanings to different people. It may mean birth spacing, fertility regulation, birth control, tailoring resources to contraception, mother and child health, family welfare. In fact family planning probably means all these although different countries and or programmes may emphasize any of the meanings as their objective. • Family planning according to WHO definition, is a way of thinking and living that is adapted voluntarily, upon the basis of knowledge, attitude and responsible decision by individuals and couples in order to promote the welfare of the family group and thus contribute effectively to the social development of a country.
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  • Family planninghas also been defined as “Having children by choice and not by chance”. Sulaiman, (1990) gave the working definition of family planning as “the process of family formation decision by which a couple or individual in exercising their basic human right and considering their situation choose voluntarily: • - Whether or not to have children • - When to start childbearing • - The time interval between births • - How many children are affordable • - When to stop child bearing • - Whether to use effective contraceptive methods to effect their decision so as to achieve social, economic and health benefits for the family members and the community at large.
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  HISTORY OF FAMILYPLANNING Historical Development of Family Planning: Man’s desire to control his reproduction is as old as humanity. Aristotle, a great philosopher in the 4th century B.C. stated that the state will be best served by keeping the population stable. In the early history of African culture, the mother and infant were separated from the father for prolonged periods of time following childbirth, this practice insured abstinence from sexual relationship for both partners and a good nutritional period for the infant. Therefore, we have seen that family planning is as old as history itself. In 1797 Jeremy Bentham advocated birth control in England. However, Francis was the first to achieve mass impact by giving illustrations and proofs of the “Principles of Population” that was published in 1882 proposed contraception to controlling reproduction.
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  Thomas Malthus anEnglish man who stated in his essay on principle of population that poverty was unavoidable because the means of production could not increase as quickly as the population. In 1881, Dr. Aletta Jacobs in Holland started the first systematic work in contraception. She and her medical colleagues gave professional assistance to birth control advocates in other countries. Egyptians, as early as 1850 B.C. described various methods of birth control in scrolls. HOW MARGARET SANGER PIONEERED FP WORK IN THE U.S.A. In 1912, Margaret Sanger was called out with a doctor to a truck driver’s wife in New York who had just committed an abortion and was seriously ill. The woman was nursed back to health and warned that another abortion could take her life.
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  In 1914, MargaretSanger was called out again to the same woman who had committed another abortion but unfortunately died before Sanger could arrive. This incident made Sanger concerned about the suffering of women with unwanted pregnancies and abandoned children. On October 16, 1916, Margaret Sanger, her sister Ethel Bryrne also a nurse and associate, Fania Mindell (a woman) in the Brownsville community of Brooklyn, New York, opened the first family planning clinic. This was closed down 9 days later by authorities who were against family planning. Margaret Sanger and her sister were imprisoned for this act. She then went on hunger strike for 103 hours. This led the U.S. women to demonstrate against her imprisonment and made an appeal to the government for her release. Margaret Sanger was eventually released and allowed to carry on with her pioneering work in family planning. In 1920, Margaret Sanger single handedly founded the first family planning clinic in U.S.A.
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  HISTORY OF FAMILYPLANNING IN NIGERIA The Planned Parenthood Federation of Nigeria is a private leading non- governmental organisation in Nigeria and a member of the International Planned Parenthood Federation (IPPF). PPFN is a successor of Family Planning Council of Nigeria. The proposal to establish Family Planning Council of Nigeria was as a result of incidence of two tragic cases of septic abortions in Lagos in 1957 which attracted considerable media publicity. In reaction, a committee was set up by the Lagos Marriage Guidance Council to study the need for modern family planning practice in the country. The committee’s report revealed that illegal abortions were rampant in the country among both married and unmarried women with undesired pregnancies.
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  In addition, itrecognized and identified the need for modern FP practices as a way of stemming or checking the negative trend. Consequently, in 1958 the Marriage Guidance Council established the first Family Planning Clinic at Lagos City Council managed by Dr. Adeniyi Jones of Ministry of Health. The clinic soon folded up due to inadequate financial support. However, in 1962, Pathfinder Fund held consultation with members of National Council of Women’s Societies in Lagos (NCWS) on setting up FP services. Following the consultation, a family planning committee was set up in the country with responsibilities for FP activities and marriage counseling. This pioneer body consisted of people from all walks of life, educators, lawyers, journalists, health professionals and religious leaders, etc. Family planning clinics were later re-established in the country by the committee with the assistance of Pathfinder Fund, Population Council and International Planned Parenthood Federation (IPPF) to provide fund, FP counseling and contraceptive services.
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  This was aresponse to alleviating some of the most pressing social and health problems in the country leading to child dumping, illegally induced abortion and high rate of maternal and child morbidity and mortality resulting from too closely spaced pregnancies. Added to them today, unprecedented high levels of adolescent sexuality with consequent social, health and biological problems. In 1964, the FP committee became FP Council of Nigeria (FPCN) In 1978, the FPCN was later renamed the Planned Parenthood Federation of Nigeria (PPFN) following an internal re-organisation. Over the years, PPFN has remained the pioneer as well as the largest Non-Governmental Organisation (NGO) promoting sexual and reproductive health including FP services in the country. The organisation has developed from supporting and complementing government services to provide alternate FP services to government and commercial sector. In addition, PPFN has provided significant FP information and service inputs as its contribution to the broad efforts at resolving the problems mentioned.
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  PPFN has 34branches and about 46 clinics in 34 States across the country. PPFN is registered under the land (perpetual succession) Act cap 98 in Nigeria. VISION: PPFN envisions a Nigeria where citizens freely and fully exercise their rights to a broad range of quality sexual and reproductive health and rights information and services in a society free of new HIV infections. MISSION: Through partnership and capacity building, PPFN will strive to increase access to quality sexual and reproductive health services using gender-sensitive strategies that respond to the diverse socio-cultural factors in the country. In addition to men and women, PPFN’s efforts are directed to adolescents and young people in recognition of the vulnerabilities of this important sub-group.
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  To be effective,PPFN will adhere to the principles of active community participation and transparent management. Complementing the efforts of the NGO in 1965, Professor Ojo of the Department of Obstetrics and Gynaecology, University College Hospital (UCH), Ibadan, started 5 p.m. – 7 p.m. FP Clinic in UCH and he was the first to train non-physician as FP providers in 1973. While Dr. (Mrs.) Ebun Delano who was already a trained FP provider worked with him. Family planning (FP) was integrated into the National Midwifery curriculum in 1981 and Nursing in 1987 respectively. On February 4, 1988, a National Policy on population was drafted and approved by Federal Government of Nigeria. Policies are guidelines for influencing decisions and course of action.
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  RATIONALE FOR FAMILYPLANNING HEALTH RATIONALE: To improve mother and child health which will subsequently enhance the building up of healthy families, societies and the nation at large? HUMAN RIGHT: Family planning is part of the basic needs and rights of every member of the society. Individuals should have the right to family planning information and voluntarily decide to practice. DEMOGRAPHIC: The long term effect of family planning is to control population growth either to reduce or to increase growth rate depending on the country’s population size, economic status, ideology and policy. CONSTRAINTS TO FAMILY PLANNING ACCEPTANCE Constraints to family planning can also be reasons why people want to have too many children.
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  1. Ignorance –some people do not know about family planning especially in the rural areas 2. Some do not believe in family planning 3. Poverty – some people cannot afford the cost of contraceptives 4. Availability – contraceptive supplies may not be available to meet clients demand 5. Fear of side effects of modern family planning methods (contraceptives). 6. Availability and accessibility of health care facilities in the rural areas. Family planning clinic is not available everywhere and if available may not be accessible (clients may have to trek long distances to family planning clinics). 7. Transport to clinics is either not available or too expensive 8. Rumours and misconceptions about family planning methods i.e. family planning can make people barren. 9. Poor client/provider relationship 10. There are no sufficient providers and health educators in rural and urban areas to diffuse taboos.
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  11. Non-involvement ofthe community in FP programmes 12. Socio-cultural factors: - Religious belief - Some religions forbids taking of drugs - Christians – “… be fruitful and multiply …” Genesis 1:28 - Islam – allows for many wives - Tradition e.g. wife inheritance - Value of children – large family (economic value) - Concept that God will provide for the need of the family, forgetting that God said that out of your labour thou shall eat - Occupation – farming, theatre actors, policemen and drivers - Belief in reincarnation - Polygamy and rivalry between wives – wives compete for favour from their husbands by how many children they can produce especially when majority of the children are females - Monogamy wives want more children to prevent husbands from marrying another
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  - Security inold age - Early marriage (teenage marriages) men prefer virgins. The younger the age of marriage the more babies are likely to be produced - Some taboos do not favour family planning - Uncertainty of the number of children that would leave up to old age - Family pressure i.e. pressure from mother in-laws – an only child is encouraged to have many children - Extended family system – poor families do not appreciate the enormous burden of child bearing so they dump their children to fortunate relations who can discharge parental responsibilities - To get respect and status (pride) - Divorce/separation - Belief that pregnancy must precede marriages – according to cultural belief, the purpose of marriage is child rearing, so to avoid problem of infertility in most native marriages the in- laws expect their wives to be pregnant except under Christian marriage which forbids sex before marriage - Educational factors