• FP Refers to voluntary decision and action taken by acouple or individual to delay, space or limit child bearing• Family planning means deciding how many children tohave and when to have them. Birth control is acornerstone of the concept.• FP services are provided to all adults who voluntarilyseek the services regardless of the parity or maritalstatus.
• The family planning services offered by the NationalFamily Planning Program include; Education and counseling.The provision of contraceptives. Education about sex and parenthood. Management of infertility
• The population size of TZ has almost tripled from 12.3mil in1967 to 34.4mil in 2002 while the national economy did notgrow significantly.• With an annual growth rate of 2.9%, Tanzania’s populationhas been projected at 65 million by 2025. Based on thefact that all of the girls who will enter childbearing age overthe next decade have already been born, and the fact thatalmost 50% of the country’s population are under 15 years,Tanzania’s population growth is set to remain at 2.8% by2025, according to the National Bureau of Statistics (NBS)national projections.• Therefore it became evident that improvement in thequality and expansion of services such as health andeducation is unlikely to happen without controlling rapidpopulation growth
• High fertility levels are partly attributable to early initiationof childbearing coupled with socio-cultural practices thatplace emphasis on big families, hence contributing torapid population growth. 26% of mothers are teenage(15-19) in Tanzania.• High Maternal Mortality Rate due to illegalabortion, frequent pregnancies, high parity, and womenhaving children at ages recognized as high risk.• High infant and child mortality rate
• Achievement:The total fertility rate (TFR) has slightly decreased from anaverage of 5.6 children per woman of reproductive age (15-49) in 2007/08 to an average of 5.4 children per woman ofreproductive age in 2009/10• Challenge:Factors contributing to high fertility still pertain andcontinued advocacy efforts are needed to sustain anenabling environment necessary for reduction in TFR.The impact is especially significant in the peripheral areaswhere health facilities are poorly equipped.
• Achievement:There is a drop in the high rate of maternal deaths of 578per every 100,000 live births in 2004-5 to 454 per every100,000 live births 2010.• Challenge:According to a United Nations Report released inSeptember 2010, Tanzania is among countries in the worldthat still have high rates of maternal death despite fallingrates of maternal mortality at the global level.
• Achievement:Good progress has been made in reducing the infant andunder-five mortality rate from 58 and 91 deaths of infantsper 1,000 live births in 2007/08 to 51 and 81 deaths per1,000 live births, respectively, according to the 2010 TDHS.• Challenge:UN Report placed Tanzania as the third country with thelargest number of death of children in Africa after Nigeriaand Democratic Republic of Congo.
• AchievementAccording to the DHS, 34% of married women are currentlyusing a method of contraception (traditional and modern)compared to 26% of married women that were using any methodin 2004/05. The survey showed that the number of marriedwomen that were using modern methods of contraception (i.e.,oral contraceptive pills, contraceptive injectables, IUDs, implants,sterilization and condoms) has continued to increase from only20% of the married women in 2004/05 to 27.4% in 2009/10.Challenge:About 22% of married women in Tanzania who want to preventor delay a pregnancy and use contraception do not have accessto a method because of weak infrastructure, electricity andspace of storageSocio-cultural barrier: gender inequalities, low womenempowerment and misconceptions of various health relatedissues exist.
1. Some service providers’ attitudes towards FP are poor and they lack motivation toreach out to clients with accurate information.2. Low public awareness of reproductive health matters such as management ofpregnancy, newborn care, childcare and related complications. For example, someclients associate condom use with extra-marital sex and vasectomy as castration.3. Advocacy to improve public knowledge on FP towards overcoming the negativeperceptions in some of the FP methods is greatly needed.There are numerous reasons that are attributable to the situation of reproductive healthcommodities being insufficient. One is that of funding. Donor support in thecommodities dropped from $560 million in 1995 to $460 million in 2003.The Global Programme to Enhance Reproductive Health Commodity Security revealsthe same trend between 2007 and 2013, the amount needed was $750,000,000 only$208,528,277 was receives while $170,041,267 was pledged and still $371,430,456was needed.4. Inconsistent and ineffective FP messages, limited support by indigenousorganizations to advocate for FP, and inadequate skilled personnel especially for Intra-Uterine Device (IUD) and implants.
• Family planning helps women to stay healthy andimproves the outcomes of their pregnancies.• Family planning can improve the economic position offamilies and communities and preserve naturalresources.• Prevent too-close spacing of pregnancy which increasesthe risk of miscarriage and premature births
• The government’s dedication to promote FP over the past severaldecades dates back to the 1970s.• In 1974, the government acknowledged the role of the FamilyPlanning Association of Tanzania (UMATI) established in 1959,and allowed it to expand FP services to public sector maternaland child health (MCH) clinics throughout the country.• Several national policy documents have been developedtargeting improvement of reproductive and child health services,which include maternal and newborn health.• Apart from ensuring that FP was integrated into maternal andchild health services in the 1980s and 90s, the government put inplace a number of policies, guidelines and frameworks to ensurethat FP become integral to socio-economic development.• Government had to revise the National Population Policy in orderto accommodate those new developments, in 2006 the RevisedNational Population Policy was published.• The main goal was to Coordinate and Influence other policies,strategies and programs that ensure sustainable development ofthe people and promoting gender equality and the empowermentof women.
These policies include:• The National Health Policy (2007);• National Road Map Strategic Plan to AccelerateReduction of Maternal and Newborn & child deaths inTanzania (2008-15);• Health Sector Strategic Plan III (2009-2015);• Primary Health Services Development Programme(2007-2017);• National FP Costed Implementation Plan (2010-2015);• National Strategy for Growth and Poverty Reduction(NSGPR).
• With specific reference to FP, the goals of the policywere:• To strengthen family planning services to promote thehealth and welfare of the family, community and thenation and eventually to reduce pop growth rate.• Making FP services available to all who want them.• Encourage every family to space births at least two yearsapart.
• The above situation calls for intensified efforts topromote family planning as part ofcomprehensive health strategy in TZ in order to:Avoid pregnancies before 18yrs and above 35yrs.Promote women health and family health at large by promotingchild spacing.Reduce unwanted pregnancies and hence abortions.Finally reduce the Maternal Mortality and Morbidity.
A. Reversible Method- Natural Method.- Barrier Methods.- Intrauterine contraceptive devices.- Hormonal Methods.B. Non Reversible Methods- Bilateral Tubal Ligation.- Vasectomy.
• Natural family planning involves trying to determine whenovulation will occur and timing sexual intercourse toeither achieve or avoid pregnancy.• Couples keep a chart to monitor changes in the womansbody(rising body temperature or thickening of the cervicalmucous, both of which suggest ovulation).
• This is an extremely important method ofcontraception worldwide and may be theonly one acceptable to some couplesbecause of cultural and religious reasons.• As birth control, natural family planning can be 90 to 98percent effective.
• Coitus interruptus-Also called withdrawal, involves removalof the penis from the vagina immediatelybefore ejaculation takes place.-It is not reliable as pre-ejaculatorysecretions may contain millions of spermand also it is hard to judge timing ofwithdrawal.
• The failure rates of natural methods are quitehigh, largely because couples find it difficult to abstainfrom intercourse when required or unable to withdraw thepenis before seminal discharge.
• Male Condoms•Have been heavily promoted in the SafeSex campaign to prevent spread of STDparticularly HIV/AIDS.•They are cheap and widely available topurchase or are even free from manyclinics
•When used properly they can be 95%-100% effective against unwantedpregnancies.•Some men and women may be allergic tolatex condoms but these days plasticcondoms are available.
• Female Condom•Made of plastic, they are also available.•They offer particularly good protectionagainst infection.•Many couples find them unaesthetic andthey have not achieved widespreadpopularity
• Diaphragm•Are inserted into the vagina and coverthe cervix.•Should be inserted prior to intercourseand should be removed no earlier thansix hrs later.•Effective use of diaphragm involvescareful fitting and teaching.•Can be used with a spermicidal gel orcream.
• Combined Oral Contraceptive Pills (COC)• Contains a combination of two hormones, synthetic oestrogen andprogesterone.• They inhibit ovulation.• Easy to use and offers a very high degree of protection againstpregnancy with many other beneficial effects.• It is used mainly by young, healthy women.• They are absolutely Contra Indicated to pts with Circulatorydiseases, acute or severe liver diseases, oestrogen-dependentneoplasm e.g.breast cancer.• Side effects include irregular bleeding, vaginal discharge, breastpain, weight gain, nausea and vomiting, headaches, depression
• Progestogen only pills (POP)• Ideal for women who like the convenience of the pill but cannottake COC.• Particular indications for POP include breastfeeding, older women,presence of cardiovascular risk factors and diabetes
• Injectable progestogen• Also known as Depo Provera, each injection lasts around 12-13weeks.• It is highly effective and it is given by deep IM injection.• Its particularly good for those with difficulty in remembering to takea pill.• Side effects include weight gain, delay in return of fertility,persistent menstrual irregularity
• Sub-dermal implants• Norplant consist of 6 silastic rods which containlevonogestrel. They are inserted subdermally in theupper arm.• Release levonogestrel slowly and lasts for five years.• They are very effective.• Insertion and removal of Norplant must be done by atrained healthcare professional i.e client cannot start orstop use on her own.• Common SE include changes in menstrualbleeding, headaches, dizziness,nausea, nervousness,acne or skin rash, weight gain.• Implanon, single silastic rod, 3yrs.
• They are highly effective but not widely used in our setup.• Fitting of an IUD should be carried out by trainedhealthcare personnel only.• Ideal for women who want a long-term method ofcontraception independent of intercourse and whereregular compliance is not required.
• Types:•Plastic IUD e.g. LIppes loop•Copper-bearing IUD e.g. copper T•Hormonal releasing IUD e.g. progestogenreleasing IUD.
• They are long-lasting, 5-10yrs.• Common side effects include menstrual changes in thefirst 3 months.• Others, like PID is more likely to follow STD infection, orthe IUD may come out of uterus without the woman’sawareness.
The following indicators summarizes themost useful pieces of information availablefrom large scale survey for measuringcontraceptive practice.
• Contraceptive Prevalence Rate (CPR)• Proportion of women of reproductive age who are using(or whose partner is using) a contraceptive method atparticular point in time.• The CPR provides a measure of pop coverage ofcontraceptive use, taking into account all sources ofsupply and all contraceptive methods.• It is the most widely reported measure of outcome forfamily planning program at a population level.• Currently in TZ the contraceptive prevalence is 25%.
• Number of Current Users• The number of women (or their partners) ofreproductive age who are estimated to be using acontraceptive method at a given point in time.• Number of current users provide a summary measureof total program service volume.• But counting number of current users from programhas proven to be labour intensive and time consuming.• Also most researchers and evaluators are moreinterested in CPR
• Level of Past Use.• The proportion of women of reproductive age who haveever used a contraceptive method, include those whocurrently use one.• Provides a crude measure of the extent to which agiven population has experimented with methods ofcontraception i.e that they have first hand knowledgeby having tried it at some point in time.• In TZ 41% of women aged 15-49 and 48% of all menhave used a contraceptive method at some point intheir lives (1999).
• Source of Supply (By Method)• The % distribution of the types of service delivery points cited byusers as the source of their contraceptive method.• Useful in family planning programme officials to show wherecontraceptive users obtain their supply, for both evaluatingprogram effectiveness and forecasting procurement needs• In Tanzania, current users (modern) are more likely to obtain theirsupply from the public sector (67%) than the private medicalsector (22%) or other private source (11%).• i.e. public sector is the source of modern contraceptives to 7 ofevery 10 current users
• Method Mix• Percentage distribution of contraceptive users bymethod.• It indicates the distribution of contraceptive use acrossdifferent methods of contraception.• It can reflect provider bias, supply problems and clientpreferences.• Essential in forecasting of commodity and serviceneeds in future.• In TZ, the most widely used methods are injectables(5%),the pill (5%), and male condom (4%) – 1999.From TDHS 2004-05, Injectables (8%), the pill (6%)and traditional method (6%).
• Contraceptive use has substantially increased over thepast 15yrs. In 1991-92 only 10% of all women were usingany contraceptive method; that proportion has more thandoubled to 25%.• On the other hand, in 1991-92, the use of any moderncontraceptive method among all women was at 6%, andthe % has almost tripled to 16% in 1999.• On specific method most notable is the steady rise in useof injectables, from less than 1% in 1991-92 to 5% in1999 to 8% in 2004/05.
• In spite of the sizeable proportion of women who say thatthey do not want to have any more children, theproportion of women who have been sterilized haschanged little.• Current use of traditional methods has increased fromabout 4% in 1991-92 to 7% in 1999, despite theincreased knowledge of modern contraceptive methodssince 1991-92
• Education• Is clearly related to the use of contraceptive method. Only 14% ofwomen with no formal education are currently using anycontraceptive, compared with 18% of women with incompleteprimary school, 27% of women who have completed primaryschool and 43% of women with at least some secondary education
• Parity• Current contraceptive use rises with the number of living children.The % of women using any contraceptive method rises rapidlyfrom 7% among women with no living children to 28% amongthose with one child and 30% among those with six or morechildren
• Religion• Some religions believe in natural methods ofcontraception and not modern ones.• Misconception about FP• A lot of individuals out there think that FP program isthere to sterilize them.• Worry over potential side effects• When expected side effects are not explained carefullyto the client.• Cultural beliefs• Some believe that more children will bring more wealthto their family.
• Abortion is illegal in Tanzania (except to save themother’s life or health), so women and girls turn toamateurs, who may dose them with herbs or otherconcoctions, pummel their bellies or insert objectsvaginally.• Infections, bleeding and punctures of the uterus or bowelcan result, and can be fatal. Doctors treating women afterthese bungled attempts sometimes have no choice but toremove the uterus.
• Worldwide, there are 19 million unsafe abortions ayear, and they kill 70,000 women (accounting for 13percent of maternal deaths), mostly in poor countries likeTanzania where abortion is illegal, according to the WorldHealth Organization.• More than two million women a year suffer seriouscomplications. According to UNICEF, unsafe abortionscause 4 percent of deaths among pregnant women inAfrica, 6 percent in Asia and 12 percent in Latin Americaand the Caribbean.
• Keeping abortion outlawed does not actually reduce thenumber of abortions; rather, it reduces the safety of thoseperformed.• Legal restrictions on abortion do not affect its incidence.For example, the abortion rate is 29 [per 1,000 womenaged 15–44] in Africa, where abortion is illegal in manycircumstances in most countries, and it is 28 [per 1,000women aged 15–44] in Europe, where abortion isgenerally permitted on broad grounds. The lowest ratesin the world are in Western and Northern Europe, whereabortion is accessible with few restrictions.
• Where abortion is legal and permitted on broad grounds,it is generally safe, and where it is illegal in manycircumstances, it is often unsafe. For example, in SouthAfrica, the incidence of infection resulting from abortiondecreased by 52% after the abortion law was liberalizedin 1996.• (ol by american humanist association)published 2012
• World Bank, World Development Indicators, November2010• National Family Planning Costed ImplementationProgram (NFCIP 2010-2015), Ministry of Health andSocial Welfare• Tanzania Demographic and Health Survey 2010 (TDHS)Preliminary Report August 2010.• TDHS 2004-05• Tanzania family planning landscapeassessment, October 2010