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

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 of Maternal Death *includes ectopic pregnancy, embolism, anesthesia **includes anemia, malaria and others Source: 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 maternal disabilities (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 Risks in 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 Saves Children’s Lives Source: Rutstein, 2003

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

Short Birth Intervals in Uganda Source DHS, months, 18% 7-17 months, 9.6% 48+ months, 13.1% months, 16.9% months, 42.4%

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

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 Source: Country DHS 1997–2000 Percent

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

Maternal Mortality Declines as Contraceptive Prevalence Increases Source: Data from PHNI DOLPHN website 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 Source: DHS, 2000 For Current or Last Pregnancy

Family Planning Reduces Abortion in Ghana Source: 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 of Adding 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

Cost-effectiveness of FP Added to PMTCT (2007) PMTCT (no FP)PMTCT + FP Cost per infection averted $1300$660 Cost per child death averted $2600$360 Source: Stover, 2003

How Does Family Planning Meet 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 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 TunisiaIndonesiaThailandEgypt

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 Implementing FP Programs Increasing Increasing population population HIV/AIDS HIV/AIDS pandemic pandemic Increasing Increasing awareness awareness Demand for quality FP services Lack of resources to meet demand

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

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

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

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 Family Planning: A Critical Intervention in Achieving Health and Development Goals in Africa Photos courtesy of Photoshare, a service of The INFO Project at