Explains about family planning methods, importance, side effects, contraindications, challenges and the system used in Tanzania.

1. FAMILY PLANNING
Supervisor: Dr. Shubi
Presenter: Joyce Mwatonoka, MD4
Feb 2016

2. OUTLINE
• Introduction
• Methods of family planning (contraceptive methods)
• Disadvantages and Side effects of contraceptives
• Contraindications of contraceptives
• Advantages of family planning
• Implementation of family planning services in Tanzania
• Barriers to practicing family planning/the unmet need for
contraception
• Challenges in implementation of family planning services in
Tanzania
• Recommendations
• References

3. Introduction
• Family 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.

4. • Family planning allows individuals and couples
to anticipate and attain their desired number
of children and the spacing and timing of their
births.
• It is achieved through use of contraceptive
methods and the treatment of involuntary
infertility.

5. • One area for greater attention is maternal
health. Up to 25% of all maternal deaths are
due to pregnancies in certain groups of
women: very young women, very old women,
pregnancy within short birth intervals and
women with more than four children or
existing health problems.

6. Contraceptive methods
1. Temporary methods
• Combined oral contraceptives (COCs) or “the pill”
92% - 99%
• Progestogen-only pills (POPs) or "the minipill“
90% - 99%
• Implants (progestogen, upper arm) 99%
• Progestogen only injectables 97% - 99%
• Monthly injectables or combined injectable
contraceptives (CIC) 97% - 99%

7. • Combined contraceptive patch and combined
contraceptive vaginal ring (CVR). New, limited
reaserch on effectiveness.
• Intrauterine device (IUD): copper containing
>99%
• Intrauterine device (IUD) levonorgestrel >99%
• Male condoms 85% - 98%
• Female condoms 79% - 90%
• Basal Body Temperature (BBT) Method 75% - 99%
• Lactation amenorrhea method (LAM) 98%-
99%
• Spermicides eg:Conceptrol, Delfen Foam

8. 2. Permanent methods
• Male sterilization (vasectomy)
• Female sterilization (tubal ligation)

9. 3. Traditional methods
• Calendar method / rhythm method / Ogino-
Knaus Method 75% - 91%
• Withdrawal (coitus interruptus) 73% - 96%

10. 4. Emergency contraception
• Levonorgestrel 1.5 mg, progestogen only pills
used to prevent pregnancy up to 5 days after
unprotected sex. Does not disrupt an already
existing pregnancy. 99%.

11. Disadvantages and Side effects of
contraceptives
• Nausea
• Weight gain
• Sore or swollen breasts
• Spotting, between periods
• Lighter/heavier periods
• Mood changes including depression
• Abdominal pain
• Hair loss

12. • Other adverse effects (rare) may include;
blood clots, stroke, liver diseases,
hypertension, heart diseases, severe
headache and eye problems (blurred vision).
• Also other methods like vasectomy requires
surgery which might not be affordable to
some individuals.

13. Absolute contraindications
• Thrombophlebitis or thromboembolic
disorders
• Cerebro-vascular or coronary artery disease
• Carcinoma of the breast or other estrogen-
dependent neoplasia
• Undiagnosed abnormal genital bleeding
• Known or suspected pregnancy
• Benign or malignant liver tumor

14. Relative contraindications
• Age over 45
• Diabetes
• Hypertension
• Smoking
• Gallbladder disease
• Gestational cholestasis
• History of renal disease
• Impaired liver function
• Hyperlipidemia

15. Advantages of family planning
• Reducing adolescent pregnancies
• Slowing population growth; economic
advantage, better life
• Preventing pregnancy-related health risks in
women; including early pregnancies and
unsafe abortions.
• Reducing infant mortality due to closely
spaced pregnancies and early pregnancies

16. • Helping to prevent HIV/AIDS; fewer infected
babies from HIV mothers, condoms provide
dual protection
• Family planning reinforces people’s rights to
determine the number and spacing of their
children
• Empowering people and enhancing education;
time for additional education, parents invest
more in each child

17. Implementation of Family Planning
Services in Tanzania
• The government of Tanzania has all along
recognized the importance of Family Planning
methods which are registered and allowed by
the Ministry of Health. In 1969, while
presenting the second Five Year Development
Plan to the Annual General Meeting of the
ruling Party (TANU) the then Mwalimu Julius
K. Nyerere warned the nation that:

18. • “Giving birth is something in which mankind
and animals are equal, but rearing the off
spring and especially educating them for many
years is a unique gift and responsibility of man
to look after them properly rather than
thinking about the number of 6 children and
the ability to give birth for it happens that
man’s ability to give birth is greater than his
ability to bring up the children in a proper
manner”.

19. • In 1973 the National Executive Committee
declared its support for the Family Planning
Association of Tanzania (UMATI) and directed the
Government (Ministry of Health) to assist UMATI
in the promotion and delivery of child spacing
services.
• In 1974 the Government (Ministry of Health)
directed that child spacing advice and services be
provided as an integral part of Maternal and Child
Health Services – (MCH) in all health facilities in
the country

20. • Chama Cha Uzazi na Malezi Bora Tanzania
(UMATI) is a not for profit, non-political voluntary
national NGO providing Sexual and Reproductive
Health (SRH) education, information and services
in Tanzania
• UMATI was established in 1959 as a Family
Planning Association of Dar es Salaam, and
became a full IPPF (International Planned
Parenthood Federation) Member Association in
1973

21. The following are the main activities of UMATI:
• Provision of information and education to the
general public; through seminars, printed
material (leaflets, posters, pamphlets)radio
and films.
• Training of medical and paramedical
personnel.
• Distribution of contraceptive supplies and
equipment (until such time that the
government is able to get its own supplies).

22. • Family planning services in Tanzania are provided
starting at the primary health care level ie
dispensaries and health centres
• Those methods which need surgery like tubal
ligation or vasectomy require secondary/tertiary
health care levels
• RCH card number 5 is used for women who start
using family planning
• And all these are filled in MTUHA book number 8

23. • Contraceptive prevalence (% of women ages
15-49) in Tanzania was last measured at 34.40
in 2010.
• It involved all women using any method of
family planning
• The prevalence was noticed to be higher in
non-married women compared to married
women

24. A chart showing prevalence of
contraceptive use in Tanzania

25. • On the other hand, the population of Tanzania
has grown from 34.4 million in 2002 to 44.9
million in 2012, a 30.5% increase in a period of
10 years.

26. A chart showing Tanzania population
growth (1967-2012)

27. Barriers to practice family
planning/the unmet need for
contraception
• Limited choice of methods
• Limited access to contraception, particularly
among young people, the poor or unmarried
people
• Fear or experience of side-effects
• Cultural or religious opposition eg; RCs
• Poor quality of available services
• Gender-based barriers.

28. Challenges in implementation of
family planning services in Tanzania
Basis of the Problem: Why the Challenge
• Key drivers lie in the roots of society and
government initiative. In many male dominated
societies in the developing world, women are not
empowered to take decisions for family planning.
Some other key factors are traditional social
attitudes and illiteracy. Failure of governments to
provide basic infrastructure to tackle this or to
facilitate public-private partnership to run family
planning programs.

29. Social and cultural factors
• Knowledge; people have no or limited knowledge
on family planning
• Attitude; Financial-having many children is
considered a benefit as it would mean more
hands to help on the field. Safety net-due to high
child mortality rate. Insurance for old age. Family
status.
• Behaviour; bias against the girl/boy child.
• Religious issues; Abortion is considered
unacceptable among both Islams and Christians.

30. Availability of Resources
• Economical; insufficient funds.
• Human personnel; Developing countries lack
human personnel in the medical field
• Tools and technologies

31. Structural Considerations
• Infrastructure gaps; In remote and rural areas
hospitals are often geographically far,
transportation is inadequate or unavailable
and so many go without any form of medical
help or are dependent on very basic facilities if
at all, through small clinics.

32. Recommendations
• Education and information; improved quality and
reach of reproductive health information, through
government incentivised (motivated) family planning
campaigns on TV, radio and posters with support from
local NGOs and local leaders. Research shows that
women with some secondary and higher education are
five times more likely to use modern methods than
women without education
• Women empowerment in decision making for family
planning
• Policy on child bearing

33. References
• TANZANIA NATIONAL FAMILY PLANNING
RESEARCH AGENDA 2013–2018
• WHO; Family Planning
• Stanford University (The challenges of
effective implementation of family planning
(reproductive health))
• AFP (Advance Family Planning)

34. “Women in Tanzania are the greatest workers….
One cannot expect these people to give birth
every year…… unless Tanzanians are careful, our
daughters will be giving birth every year like
rabbits”.
Mwl NYERERE.
THANK YOU FOR YOUR ATTENTION!