1. 1 Lecture 8. FAMILY HEALTH AND FAMILY PLANNING Ass. Prof.PhD Daina Lucia

2. 2 In accordance with the WHO definition, a family is represented by a person or group of persons that live together and are blood relatives, either by marriage or adoption.

3. 3 FAMILY HEALTH AND FAMILY PLANNING From a social point of view, the family has not been studied or understood very well, though it raises important issues because: 1.The current way of gathering data in the health system does not have the family at its centre. 2.There are ambiguities in relation to the terms used in defining the concept of family health.

4. 4 FAMILY HEALTH AND FAMILY PLANNING WHO defines family health as more than summing the individual health of the persons who make up a family; family health expresses the inter- relations that are established within this social group.

5. 5 WHO recommends four groups of indicators for measuring family health: 1.demographic 2.medical 3.sociologic 4.economic

6. 6 1.DEMOGRAPHIC INDICATORS 1.1.The family structure, in terms of family members personal characteristics: - the number of persons that make up the family; - age; - educational level; - occupation.

7. 7 1. DEMOGRAPHIC INDICATORS 1.2.The average size of the family As a result of the tendency towards a decreasing birth rate (in developed countries, but also in Romania), the number of children in each family decreased while the number of families without children increased. At the international level, here is a tendency towards an increase in the average size of families, but also towards a larger number of families made up of a single person (usually old people).

8. 8 1. DEMOGRAPHIC INDICATORS 1.3.The family type The classic family type is the enlarged family. The modern family type – the nuclear family. 4 types of families: a. the nuclear family, made up of husband + wife + children; b. the vertically enlarged family: husband + wife + children + the parents of one of the spouses; c. the horizontally enlarged family made up of husband + wife + children + brother/sister of one of the spouses; d. family enlarged both horizontally and vertically : husband + wife + children + parents + brother/sister.

9. 9 1. DEMOGRAPHIC INDICATORS 1.4.The family life-cycle This concept appeared in the 1930s-1940s. The idea it originated from is that the family, from the moment of its formation (marriage) to its disappearance (death, divorce), goes through a series of stages that determine the modification of its functions, both favorably and unfavorably.

10. 10 1.4.The family life-cycle If we take into account the main demographic events that are significant for the family, the stages would be the following: StageEvent FormationMarriage ExtensionThe birth of the first child Complete extensionThe birth of the last child ContractionThe marriage of the first child and his/her leaving of the family Complete contractionThe marriage of the last child and the leaving of the parents DissolvingThe death of one of the spouses

11. 11 1.4. The family life-cycle The life cycle of the family is influenced by 1.Demographic factors: - birth rate; - mortality; - nuptiality; - divorciality. 2.Socio-economic factors: - the socio-economic level of development in a certain country; - the average income / family member; - the level of urbanization and industrialization. 3.Cultural factors: - the instruction level; - the cultural level of the respective population.

12. 12 1.4. The family life-cycle The main characteristics of the family life-cycle in Romania: - the average time-span of the family life-cycle is of 42 years; - women’s average age at marriage is of 21-22 years; - the fertility model is of the precocious type; - the divorciality phenomenon is increasing, which brings about a reduction in the life cycle of a family.

13. 13 1.DEMOGRAPHIC INDICATORS 1.5.Life and environment conditions of a family

14. 14 2.MEDICAL INDICATORS the prevalence of risk factors in a family; the prevalence of diseases in a family; the aggregation of diseases in a family; the identification of families with high risk of disease.

15. 15 3.SOCIOLOGIC INDICATORS (the sociological approach to family health) Starting from 5 questions, to which the alternative answers are: - almost always – 2 points - sometimes – 1 point - never – 0 points The APGAR family score has been established, the maximum number of points being 10: 1.I am satisfied because I can appeal to my family help when something is wrong. 2.I am satisfied because my family approaches and shares problems with me. 3.I am satisfied because my family accepts and supports my desire to engage in new activities. 4.I am satisfied because my family responds to my affective-emotional states (love, sadness, anger). 5.I am satisfied because there is a pleasant way of spending the free time in our family. The classification would be: - health family: 8-10 points - family with problems 6-7 points - risk family <6 points.

16. 16 4.ECONOMIC INDICATORS The economic approach to health presents interests for doctors to the extent to which economic factors can influence it. Two main economic aspects have been the object of numerous studies: –the cost of disease per family –the impact of disease upon the family.

17. 17 FAMILY PLANNING Definition: the conscious determination by the family of the number of their children wanted and the setting of births at certain intervals. Synonymy: –birth planning, –birth control, –birth limitation.

18. 18 There are two moments in developing the concept : The first moment: society and those responsible for the development of society and the health system realized that the population number increases excessively, and this growth determines important pressures over societies and families. Thus, the first family planning tendencies appeared: the reduction of children in families and the planning of births at determined intervals. The second moment: sterility treatment, in order to allow families have the desired number of children.

19. 19 Starting from the family attitude towards family planning, families can be grouped in: –Malthusian-type families: families that put family planning into practice; –Non-Malthusian family-types: families that do not use family planning. WHO has elaborated a model that includes the main factors influencing the attitude towards family planning and the interrelations among these factors.

20. 20 Introducing family planning is important because it can influence the health state of women and children: –on the one hand through the influence of pregnancies upon women and children; –on the other hand, they manifest themselves through the consequences of using, by women, of the different family planning techniques.

21. 21 Family planning prevents at least 3 types of high-risk pregnancies: –pregnancies before the age of 20; –pregnancies after the age of 35; –pregnancies at an inter-genezic interval of less than 2 years. In Romania, family planning actually started in 1990, though the most widely accepted form of family planning is still the abortion.

22. 22 CNTRACEPTIVE METHODS Oral contraceptives WHO has conducted epidemiologic cohort studies and case-control in order to highlight the possible influence of oral contraceptives upon women’s health state, respectively the possible epidemiologic association between the use of oral contraceptives and breast cancer.

23. 23 FAMILY PLANNING IN ROMANIA After 1989, family planning has been considered by the Ministry of Health and the experts of the World Bank that take part to the restructuring of the health system in Romania as an important health problem. The national program of family planning is based on 2 main elements: –The existing relation between illegal abortions and a high level of morbidity and mortality at women, and the high number of abandoned or handicapped children; –Acknowledging the right of families to determine the number of children they want.