lecture I
Course:
Family planning
Definition:
There are different definitions of family planning. An expert committee of WHO defined family planning as “ a way of thinking and living adopted voluntarily, upon the basis of knowledge, attitudes and responsible decisions by individuals and couples, in order to promote the health and welfare of the family group and thus contribute effectively to the social development of a country”.
Another expert committee defined family planning as: “practices that help individuals or couples to attain certain objectives: to avoid unwanted births, to bring about wanted births, to regulate the intervals between pregnancies, to control the time at which births occur in relation to the ages of the parent, and to determine the number of children in the family”.
Concept of family planning:
Family planning is associated with numerous misconceptions, e.g sterilization, birth control. The recognition of its welfare concept came only a decade and a half when it was named Family welfare Program. The concept of welfare is very comprehensive and is basically related to quality of life. The family welfare program aims at improving quality of life. So, family planning is not synonymous with birth control, but family planning includes:
1- The proper spacing and limitation of births.
2- Advice on sterility.
3- Education for parenthood.
4- Sex education.
5- Screening for pathological conditions related to reproductive system.
6- Genetic counseling.
7- Premarital consultation and examination.
8- Carrying out pregnancy test.
9- Marriage counseling.
10- The preparation of couples for the arrival of their first child.
11- Teaching home economics and nutrition.
These activities vary from country to country according to national objectives and policies with regard to family planning. This is the modern concept of family planning.
High risk pregnancy:
High risk cases include the following:
1- Elderly primi (30 years and over).
2- Short statured primi (140 cm and below).
3- Mal-presentation e.g. breech, transverse lie.
4- Ante-partum hemorrhage and threatened abortion.
5- Pe-eclampsia and eclampsia.
6- Anemia.
7- Twins and hydramnios.
8- Previous still-birth, intrauterine death, manual removal of placenta.
9- Elderly grandmultiparas.
10- Prolonged pregnancy (14 days after expected date of delivery).
11- History of previous caesarean or instrumental delivery.
12- Pregnancy associated with general diseases, cardiovascular, kidney, liver diseases, diabetes and tuberculosis.
Family planning is related to every phase of the maternity cycle. The mother is psychologically more receptive to advice on family planning than at other times. Educational and motivational efforts must be initiated during the antenatal period.
Objectives of family planning programs:
Family planning and health have a two way relationship. The principal health outcomes of family planning were listed and discussed by a WHO scientific group. Family planning saves and improves lives by preventing unwanted pregnancy and its consequences, while helping meet women’s and men’s needs. Avoiding unintended pregnancies through the use of contraception prevents maternal and infant deaths, helps prevent unsafe abortion, and enables women to limit births to their healthiest childbearing years.
Family planning and Millennium Development Goals
1 – Eradicate poverty and hunger:
Family planning reduces the aggregate demand for scarce food products. Better birth spacing reduces low birth weight and poor maternal nutrition. Family planning results in more wealth and less hunger.
2 – Achieve universal primary education:
Girls often drop out of school due to unintended pregnancy or to help care for younger siblings. Family planning prolongs education and helps girls in particular to achieve their dreams for the future.
3 – Promote gender equality and empower women:
Unplanned pregnancy diverts women from other life plans e.g employment. Using family planning empowers women. Involving men in family planning can lead to changes in gender norms.
4 – Reduce child mortality:
Family planning prevents unintended pregnancy, thus reducing infant deaths and increasing child survival.
5 – Improve maternal health:
Terminating unintended pregnancy, is associated with unsafe abortion which is one of the main cause of maternal deaths especially in young women. Universal access to reproductive health including family planning reduces the risk of maternal morbidity and mortality.
6 – Combat HIV/AIDS:
Contraception is the best preventive measure against HIV. Women with HIV who have unintended pregnancy run the risk of transmitting the virus to their children. Preventing unwanted pregnancy among HIV positive women reduces the number of HIV positive births and is three times more effective than providing antiretroviral treatment to mothers during pregnancy, birth, and breastfeeding. Family planning offers more choices to women, helping address gender-based inequities, and can encourage adoption of safer sexual behaviour, through the promotion of condoms for dual protection (prevention of pregnancy and sexually transmitted infections including HIV).
7 – Ensure environmental sustainability:
A family with fewer children needs less food, land, and water. Moreover, family planning is five times less expensive than conventional green technologies for reducing atmospheric carbon dioxide that leads to climate change. Slower population growth helps protect the environment and contributes to sustainable socio-economic development not only for individuals, but also for society in general.
8 – A global partnership for development:
Global investment in family planning programs have contributed to strong collaboration among international agencies, governmental ministries, multinational organizations and local community groups. Family planning is also an investment in overall development. Population growth is directly associated with education, economic development, women’s rights, quality of care, and access to services.