Importance of Family Planning

IMPORTANCE OF FAMILYPLANNING IN ARSH AND MCH Stella Akinso State Team Leader NURHI, Ibadan

FAMILYPLANNING , AN IMPERATIVE TO THE ACHIEVEMENT OF THE MDGs
Introduction
Review of some Nigerian Demographic status
ARSH, MCH, and Link to FP
Benefits of Family planning
Barriers to Access RH/FP services
NURHI- Bridging the Contraceptive gaps
Conclusion

USAID | Health Policy Initiative, Task Order 1Futures Group International
One Thomas Circle, NW, Suite 200,Washington, DC 20005

INTRODUCTION
‘ Every year, 9.2 million young children (including 3.7 million newborns) and 536,000 mothers die during pregnancy and childbirth, while approximately 76 million unintended pregnancies occur worldwide. The need for strengthened family planning efforts is imperative if the MDGs are to be achieved

INTRODUCTION
Several researches have indicated that It family planning may indeed be one of the most cost-effective development investments particularly in the achievement of the MDGs
FP offer one major solution to the problems of unwanted/unintended pregnancies among adolescent is access to comprehensive information, that enables young people to make informed decision to use contraceptives

NIGERIAN DEMOGRAPHIC SITUATION
Total Population Mid-Year 2009 estimated at 152.6 million and rate of population increase is 2.6%/year
Married Women of Reproductive Age estimated at 25.7 million-
Contraceptive Users estimated at 4.3 million for all methods
Unmet need according to 2008 DHS is 20.2%
Total contraceptive prevalence is 14.6% (all methods)
72% of all women and 90% of all men know at least one contraceptive method.

DEMOGRAPHIC/ FP SITUATION IN NIGERIA
Maternal mortality ratio according to the 2008 NDHS is 545,000/100,000
Total fertility rate is about 6 with many women desiring more children
Nigeria has more than 10% of all global under five death and carries a disproportionate burden of childhood mortality
HIV/AIDS prevalence 4.0%

Millennium Development
The millennium development goals are eight important, time-bound goals agreed to by member states of the United Nations and international development institutions and aimed at improving general standards of living globally :They are
Eradicate extreme poverty and hunger
Achieve universal primary education
Promote gender equality and empower women
Reduce child mortality
Improve maternal health
Combat HIV/AIDS, malaria, and other diseases
Ensure environmental sustainability
Develop a global partnership for development

FP AND MDGs- the link
Many studies and reports have confirmed that improving access and use of family planning programs will help to achieve the MDGs, particularly goals 4 and 5
If access to family planning services increases, then unmet need for FP could be met, therefore slowing population growth and reducing the costs of meeting the MDGs.

FP and Goals 4 & 5
In addition to saving cost through effective family planning programs, improving FP unmet needs can contribute directly to the MDGs 5&6 to reduce child mortality and improve maternal health; family planning helps reduce the number of high-risk pregnancies that result in high levels of maternal and child illness and death.
Prevent mortality and morbidity among adolescent resulting from clandestine abortion

In a multi-country study titled “Achieving the Millennium Development Goals by USAID: The Contribution of Family Planning,” looks at how one strategy— ‘ meeting the need for family planning—can reduce population growth and make achieving the MDGs more affordable in Nigeria, in addition to directly contributing to the goals of reducing child mortality and improving maternal health. ……….

FP NEEDS of young people
Many adolescent are ambivalent about sex and contraceptive
High level of risky sexual behaviour
High incidence of unwanted pregnancy and consequences
Of the over 600,000 annual abortion, over 60% are attributable to young unmarried girls
Young people need reliable information about access to contraceptives in order to protect themselves from STIs, including HIV/AIDS, and unintended pregnancies. Information about contraceptives is important for all young people whether they are abstaining from sex or are sexually active.

FP and some benefits
Family planning programmes are organized efforts in the public and private sectors, to provide contraceptive supplies, services, and information to couples and individuals who want to delay, space, or limit their children
Helps couples to achieve their desired birth spacing and family size
Offers protection against reproductive tract infections (condoms)
Promotes marital union
Prevent unwanted pregnancy, with its attendant risk of abortion, morbidity/mortality and high risk pregnancies

Challenges
FP programme largely donor driven, all commodities donated largely by UNFPA since 1998.
Inadequate resources for procurement of quality contraceptives, capacity building of service providers on Contraceptive Technology Update and Long term methods IUD and Implants.
Stock out of contraceptive commodities
Religious and Socio-cultural inhibitions

Challenges of Access to FP in Nigeria
YEAR AMOUNT
2010 $8,569,072
2011 $10,635,37
2012 $11,813,922
2013 $14,076,128
2014 $18,430,640
2015 $17,081695
About $6.5 m mobilized for 2010 from UNFPA,DFID and USAID

Challenges contd.
Inadequate demand creation activities.
Poor attitude of health workers.
Inadequate Male involvement.
Low status of women.
Geographical and financial access.
Weak LMIS reporting.
Non inclusion of Private sector in the distribution system
Lack of information, misconception
Socio-cultural and gender dimensions

NURHI is funded by the Bill & Melinda
Gates Foundation (BMGF)
And
Implementing Consortium made up of
John Hopkins University/Centre Communication Program (JHU/CCP)
John Snow International (JSI)
Association for Reproductive and Family Health, Nigeria (ARFH)
Centre for Communication Programs, Nigeria (CCPN)
NURHI -Who are we?

Our vision is a Nigeria where supply and demand barriers to contraceptive use are eliminated.
Our goal is to increase modern CPR in selected urban areas (by at least 20 percentage points).
Focus on urban areas and the urban poor.
Strategic focus on integrated and reinforcing supply, demand and advocacy and building on existing capacity and resources .
Vision and Goal

See family planning through the eyes of the consumer, the family and the community
Take a holistic view of the supply side , to respond to the needs of the poorest and most vulnerable
Use a theory-based approach, rooted in a social ecological model
Key Principles

Committed to partnership, participation and capacity building
Supply and demand side initiatives will be integrally linked . Demand will push supply and supply will rise to meet the challenge
Build on what works while also discovering, testing and rewarding innovation
Key Principles (contd)

1. Develop cost-effective interventions for integrating quality family planning with maternal and newborn health, HIV/AIDS, post-partum and post-abortion care programs.
2. Improve the quality of family planning services for the urban poor with emphasis on high volume clinical settings.
3. Test novel public-private partnerships and innovative private-sector approaches to increase access to and use of family planning by the urban poor.
Objectives

4. Develop interventions for creating demand for and sustaining use of contraceptives among marginalized urban populations.
5. Increase funding and financial mechanisms and a supportive policy environment for ensuring access to family planning supplies and services for the urban poor.
Objectives

We believe that when we create demand, demand will drive supply. We will:
Create demand through innovative, consumer-first campaigns and activities;
Incentivize supply with the tools, training, supplies, and marketing support needed to meet demand and encourage continued investment in provision of quality FP services;
Use advocacy to address regulatory, financing, systems and medical issues
Focusing on increasing demand and incentivizing supply sets
market up for success, building long-term sustainability
Approach will create new sets of social norms for both consumers and providers
Strategic Approach

It is estimated that about 47% of Nigerians live in urban environment and as a result more families live in cramped and unsanitary conditions.
By 2035, 50% of Nigeria’s poor projected to be living in urban areas.
This unique nature of urban poverty requires inclusive interventions and strategies that transform the challenges of urban slums into opportunities.
Why is NURHI Focused on Urban Cities

The Project has six operational sites in the
country. These are:
Abuja
Ibadan
Kaduna
Ilorin
Zaria
Benin City
NURHI Project Sites

Year One— Discovery
Years Two and Three—Implementation
Years Four and Five: Continued Implementation and Scale Up to New Sites
Implementation Plan

Quasi-experimental design
4 intervention cities (Abuja, Ibadan, Ilorin, Kaduna); 2 comparison cities (delayed intervention) (Zaria, Benin City)
Assessment of overall program cost effectiveness.
Longitudinal study of women from each city
Assessment of impacts by program activity by city
Include approximately 3000 women per city
Inclusion criteria – married & unmarried women ages 15-49; followed at two-year intervals (baseline, midterm, end-line)
NURHI Discovery Activity MLE Quasi - Experimental Design

Strategic Area 2: Health Service Delivery
NSHDP Goal: To revitalize integrated service delivery towards a quality, equitable and sustainable healthcare
Indicator #30 (unmet need for FP) Baseline (21% NDHS 08) and Target (10% in 2015)
Indicator #35 (Contraceptive prevalence rate-modern) Baseline (9.7% NDHS 08) and Target (20% in 2015)
Indicator #36 (Health facilities experiencing stock-outs of key health commodities) Baseline (TBD) and Target (10% in 2015)
NURHI’s contribution to the National Strategic Health Development Plan (NSHDP)

Priority Area 7: Partnerships for Health
NSHDP Goal 7 : To enhance harmonized implementation of essential health services in line with national health policy goals
Indicator #47 (proportion of states/cities implementing at least 4 new PPP initiatives per year
Priority Area 8: Research for Health
NSHDP Goal 8: To utilize research to generate knowledge to inform policy, improve health, achieve national and internationally health-related development goals to contribute to the global knowledge platform
Indicator #51 (proportion of research and evaluation studies undertaken on identified critical areas in the NSHDP framework (baseline TBD and 60% in 2015)
NURHI’s contribution to the National Strategic Health Development Plan (NSHDP)

FP supply stock out in public health facilities at all levels
No dedicated FP funding for improved MNCH by government at all levels
FP/RH services currently not covered by NHIS
Observed Challenges to FP under the Integrated MNCH

NURHI collaborates with Government at three levels
Government to:
Provide the enabling environment for project success.
Respond to the current gap in FP commodities and supplies to avoid a crisis situation of stock outs.
Provide budgetary support to sustain FP/RH/MNCH programme at Federal/state/LGAs.
Expectations from Collaboration with Government

Expectations from THE MEDIA
Diffusion of information
Play Strategic role in our advocacy strategy
Advocate particularly to government to budget for RH/FP commodities
Provide correct information on FP to the populace
Strategic Partnership

CONCLUSION
By allowing women the freedom to control the number and spacing of their births, family planning helps women preserve their health and fertility and also contributes to improving the overall quality of their lives
Because the effects of family planning are not immediate, long-term benefits would be see beyond 2015.

CONCLUSION
Death due to abortion can be drastically reduced with effective FP programming
Barriers to FP are well know and can be effectively managed with good programme
Nation and state should put FP in their annual budget and rely less on donors
There is no one way strategy to address barriers to access and utilization of FP , multiple strategies should be employed

USAID | Health Policy Initiative, Futures Group Internationall
Lets make motherhood safe together . Thank you

Importance of Family Planning

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