Family Planning In Jordan

Background An estimated 222 million women in developing countries would like to delay or stop childbearing but not using any contraception method Reasons for this include: • limited choice of methods; limited access to contraception, particularly among young people, poorer segments of populations, or unmarried people • fear or experience of side-effects; • cultural or religious opposition; • poor quality of available services; • gender-based barriers.

Background Family planning allows people to attain their desired number of children and determine the spacing of pregnancies. It is achieved through use of contraceptive methods and the treatment of infertility

Benefits of family planning Preventing pregnancy-related health risks in women Family planning allows spacing of pregnancies and can delay pregnancies in young women at increased risk of health problems and death from early childbearing, and can prevent pregnancies among older women who also face increased risks. Family planning enables women who wish to limit the size of their families to do so. Evidence suggests that women who have more than four children are at increased risk of maternal mortality. By reducing rates of unintended pregnancies, family planning also reduces the need for unsafe abortion A woman’s ability to choose if and when to become pregnant has a direct impact on her health and well-being.

Benefits of family planning Reducing infant mortality Family planning can prevent closely spaced and ill-timed pregnancies and births, which contribute to some of the world’s highest infant mortality rates. Helping to prevent HIV/AIDS Family planning reduces the risk of unintended pregnancies among women living with HIV, resulting in fewer infected babies and orphans. Infants of mothers who die as a result of giving birth also have a greater risk of death and poor health. In addition, male and female condoms provide dual protection against unintended pregnancies and against STIs including HIV.

Benefits of family planning Empowering people and enhancing education Family planning enables people to make informed choices about their sexual and reproductive health. Family planning represents an opportunity for women for enhanced education and participation in public life, including paid employment in non- family organizations. Additionally, having smaller families allows parents to invest more in each child. Children with fewer siblings tend to stay in school longer than those with many siblings.

Benefits of family planning Reducing adolescent pregnancies Pregnant adolescents are more likely to have preterm or low birth-weight babies. Babies born to adolescents have higher rates of neonatal mortality. Slowing population growth Family planning is key to slowing unsustainable population growth and the resulting negative impacts on the economy, environment, and national and regional development efforts. Many adolescent girls who become pregnant have to leave school. This has long-term implications for them as individuals, their families and communities.

Review of Contraceptive Methods Modern methods Traditional methods COC Coitus interruptus POP Fertility awareness methods Progesterone only injectable Abstinence Monthly CIC IUCD IUD levonorestrel Male condoms Male and female sterilization LAM Emergency contraception

Key Indicators Total fertility rate (TFR) Total fertility rate represents the number of children that would be born to a woman if she were to live to the end of her childbearing years and bear children in accordance with current age-specific fertility rates. http://data.worldbank.org/indicator/SP.DYN.TFRT.IN

Unmet need The percent of women of reproductive age who are married or in union, and sexually active but not using any method of contraception, and report not wanting any more children or wanting to delay the birth of the next child (WHO, 2013).

Contraceptive prevalence 61% of currently married women in Jordan are using a method of family planning: 42% are using modern contraceptive methods and 19% use traditional methods. Contraceptive prevalence increased in the 1990s, from 40% in 1990 to 56% in 2002 (Figure 1). Prevalence has increased from 56% in 2002 to 61% in 2012; however, the increase has been almost entirely in use of traditional methods. Modern method use has remained almost constant since 2002 at about 42% of currently married women, as shown in (Figure 1)

Figure 1: Trends in contraceptive use, 1990-2012 (Percentage of currently married women age 15-49 years) (DHS, 2012)

Contraceptive prevalence The most popular modern method is the IUD, used by 21% of married women. The next most popular modern methods are the pill (8%) and the condom (8%). Two percent of married women have been sterilized, while less than 1% are using injectable or implants. As for traditional methods, withdrawal is used by 14 percent of currently married women and rhythm or periodic abstinence is used by about 4%.

Discontinuation Rates An important concern for family planning programs is the rate at which users discontinue use of contraception and the reasons for such discontinuation. High rates of discontinuation indicate that a family planning program should focus greater attention on counseling and follow-up, which can reduce discontinuation rates by helping women deal with various obstacles to continued use. (DHS, 2012).

How to get Family Planning in Jordan Public Sector Government hospital Government health center Government MCH center University hospital/clinic Royal Medical Services

How to get Family Planning in Jordan Private Sector Private hospital/clinic Private doctor Pharmacy JAFPP UNRWA clinic Other NGO

Supply Pattern in Jordan more than four in ten modern contraceptive users obtain their method from a public source: 23% from a government health center, 12 percent from a maternal and child health center and 6% from a government hospital. More than half of women who use a modern method obtain the method from a private sector source, mainly pharmacies (15%), the Jordan Association of Family Planning and Protection (JAFPP) (11%), UNRWA clinics (10%), or private doctors (7%).

Supply Pattern in Jordan The source of family planning methods varies according to the method being used. For example, two fifths (39%) of condom users and 35% of pill users obtain their methods from a pharmacy, while IUD users are likely to obtain services from a private hospital or clinic, a government health center, or the JAFPP. More than half of women who are sterilized had the procedure at a government hospital (54%), while one-quarter used the Royal Medical Services.

References WHO media center: family planning http://www.who.int/mediacentre/factsheets/fs351/en / DHS: Department of Statistics (DOS) in Jordan 2012 http://www.dos.gov.jo/dos_home_e/main/linked- pdf/pop_2012.pdf

Project resources WHO web site http://www.who.int/countries/jor/en/ DHS: Department of Statistics (DOS) in Jordan 2012 http://www.dos.gov.jo/dos_home_e/main/linked- pdf/pop_2012.pdf Other relevant credible resources