Family Planning

CDC rating:Ten Great Public Health Achievements -- United States, 1900-19991. Vaccination2. Motor-vehicle safety3. Safer workplaces4. Control of infectious diseases (has resulted from clean water and improved sanitation)5. Decline in deaths from coronary heart disease and stroke6. Safer and healthier foods7. Healthier mothers and babies (have resulted from better hygiene and nutrition, availability of

antibiotics, greater access to health care)8. Family planning (has altered social and economic roles of women)9. Fluoridation of drinking water

10. Recognition of tobacco use as a health hazard

OutlineFamily planning refers to the factors that may be considered by a couple in a committed relationship and each individual involved in deciding if and when to have children.

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

● Concepts● Measures● Programs

Space&TimeNumber (desired family size, stopping behavior)

Time/age at birth (delay of the first birth, spacing of births)

Concepts● Fertility and its Determinants● Birth Control● Unmet Need in Family Planning

Davis&Blake (April 1956)● Factors affecting exposure to intercource (intercourse variables)

○ Those governing formation and dissolution of unions in reproductive ages○ Those governing the exposure to intercourse within unions

● Factors affecting exposure to conception (conception variables)● Factors affecting gestation and successful parturition (gestation variables)

intercourse variablesformation and dissolution of unions

● Age of entry into sexual unions● Permanent celibacy: proportion of women

never entering sexual union● Amount of reproductive period spent after or

between unions○ When union is broken by divorce,

separation, or desertion○ When union is broken by death of

husband

exposure to intercourse within unions

● Voluntary abstinence● Involuntary abstinence (from impotence,

illness, unavoidable but temporary separation)● Coital frequency (excluding periods of

abstinence)

conception variables● Fecundity or infertility as affected by involuntary causes● Use or non-use of contraception

○ By mechanical or chemical means

○ By other means (rhythm, withdrawal, simulated intercourse without penetration, other “perversions”)

● Fecundity or infertility as affected by voluntary causes (sterilization, subincision, medical treatment, etc.)

gestation variables● Foetal mortality from involuntary causes● Foetal mortality from voluntary causes

Bongaarts’ model of proximate determinants (1978)

Fertility is a function of

● Length of union (nuptiality)● Contraception● Post-partum sterility (length of breastfeeding)● Induced abortion

which squeeze fecundity

Later he included pathological sterility

Need in Birth Control Appears in Demographic Transition

Demographic transition

World Population Growth1 billion – 1800

2 billion – 1927

3 billion – 1959

4 billion – 1974

5 billion – 1987

6 billion – 1998

7 billion – 2011

Demographic explosion

How to measure● MWRA (a number of married women in reproductive ages)● Contraceptive prevalence● Unmet need in family planning

MWRA● Population at risk● Denominator

Contraceptive PrevalenceContraceptive prevalence is the percentage of women who are currently using, or whose sexual partner is currently using, at least one method of contraception, regardless of the method used. It is usually reported for married or in-union women aged 15 to 49.

Unmet NeedAlso known as “KAP-gap”

Women with unmet need are those who are fecund and sexually active but are not using any method of contraception, and report not wanting any more children or wanting to delay the next child. The concept of unmet need points to the gap between women's reproductive intentions and their contraceptive behaviour.

Unmet need worldwide data//MDG data

UN

CP (top) & UN (bottom)

Prevalence > < Unmet Need

Effectiveness of contraceptionThe Pearl Index, also called the Pearl rate, is the most common technique used in clinical trials for reporting the effectiveness of a birth control method.

It is a statistical estimation of the number of unintended pregnancies in 100 woman-years of exposure

Usually two Pearl Indexes are published from studies of birth control methods:● Actual use Pearl Index, which includes all pregnancies in a study and all months (or

cycles) of exposure● Perfect use or Method Pearl Index, which includes only pregnancies that resulted

from correct and consistent use of the method, and only includes months or cycles in which the method was correctly and consistently used

Trussel table

Trussel table 2James Trussell, Contraceptive failure in the United States, Contraception 83 (2011) 397–404

“Typical use” (Netherlands)Past six months

ProgramsUnfortunately I have no experience in programming family planning.

It is a separate subject which requires a separate training course.

The USSR opposed FP movement.

Reply to population growth

National Security Study MemorandumNSSM 200

Implications of Worldwide Population Growth For U.S. Security and Overseas Interests

(THE KISSINGER REPORT)December 10, 1974

Declassified in 1989

Development of the USA roleGlobal gag rule, since 1984, Reagan administration

The Mexico City Policy is an intermittent United States government policy that required all non-governmental organizations (NGOs) that receive federal funding to refrain from performing or promoting abortion services as a method of family planning with non-US government funds in other countries.

Reagan>>Bush>>Clinton>>Bush>>Obama

Government policies to influence the level of fertility

Percentage of countries in each group

Government support for family planningPercentage of countries in each group

International assistanceRH is not FP

The endThank you for attention

ExamClass sends me a link to the Google table, containing:● Name● Country● Title of presentation● Date of presentation● The topic student wish to discuss during the exam (mismatched with

presentation), you will have five minutes

I will add score results by May 25, the exam will adjust your score

See you on May 26, at 3 p.m.