Barriers to Contraceptive use by Sawsan Mustafa AbdallaOsman Mohammed Abass Geneva Foundation for Medical Education and Research GFMER Sudan 2012 Forum No: ( 3 )
Name of presenterName Position InstitutionSawsan Mustafa Abdalla Associated Professor National Ribat UniversityOsman Mohammed State Ministry of HealthAbass Name of contributorsName Position InstitutionSawsan Mustafa Abdalla Associated Professor National Ribat UniversityOsman Mohammed State Ministry of HealthAbass
Content of the presentation• Introduction• Global unmet need for contraception• Benefits of family planning• Barriers Globally• Contraceptive use in Sudan• Barriers To contraceptive use in Sudan• Figure 1• Figure 2• References• Blue Nile state
Introduction• 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(1).
Introduction• Family planning is an important strategy in promoting maternal and child health. It improves health through adequate spacing of birth and avoiding pregnancy at high-risk maternal ages and high parities. A woman’s ability to space or limit the number of her pregnancies has a direct impact on her health and well-being as well as the outcome of her pregnancy(2).
Introduction• Contraceptive use has increased in many parts of the world, especially in Asia and Latin America, but continues to be low in sub-Saharan Africa. Globally, use of modern contraception has risen slightly, from 54% in 1990 to 57% in 2012. Regionally, the proportion of women aged 15–49 reporting use of a modern contraceptive method has risen minimally or plateaued between 2008 and 2012. In Africa it went from 23% to 24%, in Asia it has remained at 62%, and in Latin America and the Caribbean it rose slightly from 64% to 67%. There is with significant variation among countries in these regions(1).
Introduction• Use of contraception by men makes up a relatively small subset of the above prevalence rates. The modern contraceptive methods for men are limited to male condoms and sterilization (vasectomy)(1).
Global unmet need for contraception• An estimated 222 million women in developing countries would like to delay or stop childbearing but are not using any method of contraception. Reasons for this include:• limited choice of methods;• limited access to contraception, particularly among young people, poorer segments of populations, or unmarried people;• fear or experience of side-effects;• cultural or religious opposition;• poor quality of available services;• gender-based barriers.
Global unmet need for contraception• The unmet need for contraception remains too high. This inequity is fueled by both a growing population, and a shortage of family planning services. In Africa, 53% of women of reproductive age have an unmet need for modern contraception. In Asia, and Latin America and the Caribbean – regions with relatively high contraceptive prevalence – the levels of unmet need are 21% and 22%, respectively(1).
Benefits of family planning• Preventing pregnancy-related health risks in women• Reducing infant mortality• Helping to prevent HIV/AIDS• Empowering people and enhancing education• Reducing adolescent pregnancies• Slowing population growth (1).
Barriers Globally• several socioeconomic factors are shown to be associated with high fertility• low levels of female education and income per capita• rural residence, and high infant and child mortality• In addition, the penetration of major religions (Christianity and Islam) has affected contraceptive use (3).
Barriers Globally• Other barriers to sustained contraceptive use included medically inaccurate notions about how conception occurs and fears about the effects of contraception on fertility and menstruation, which were not taken seriously by care provider.
Barriers Globally• undermined the effective use of contraception by girls.• Many contraceptives are encumbered with potentially unnecessary restrictions on their use. Indeed, fear of side effects, fostered by alarmist labeling, is a leading reason that women do not use contraceptives (4)
Barriers Globally• Those barriers included lack of agreement on contraceptive use and on reproductive intentions; husbands attitude on his role as a decision maker;• perceived undesirable side effects, distribution and infant mortality;• negative traditional practices and desires such as naming relatives,• and preference for sons as security in old age.• There were also gaps in knowledge on contraceptive methods, fears,• rumours and misconceptions about specific methods and unavailability or poor quality of services in the areas studied (5)
Barriers Globally• Thirty-five in-depth interviews and five group discussions were conducted with girls aged 14−20, and interviews with nursing staff at 14 clinics. Many of the girls described pressure from male partners and family members to have a baby or prove their fertility.(south Africa)(6).
Contraceptive use in Sudan• Contraceptive prevalence rate in Sudan is one of the lowest in the region, while the maternal mortality is among the highest globally. Services were initiated in 1965 and in 1985 were integrated into the primary health care system.• The reasons behind these low rates are probably many, considering the diverse cultural backgrounds (2).
Contraceptive use in Sudan• RH service standards, including FP services, are developed and endorsed yet need to be applied• The results of the Sudan Household Health Survey (SHHS 2006) indicate that th contraceptive use rate, i.e. percentage of women aged 15-49 years currently married or in union who were using (or whose partner is using) a contraceptive method was only 7.7 %, compared to 9.0 % in the 2nd round of SHHS 2010 (2).
Contraceptive use in Sudan• Unmet need increased from 5.0% in 2006 to 28.9% in 2010.
Barriers To contraceptive use in Sudan Shortage in facilities providing family planning services(only 42% of health facilities including family centers & hospitals)• Turnover of the trained staff at all levels.• socioeconomic factors• low levels of female education and income
Barriers in Sudan• Low utilization of the available services.(according to statistical report only 3%of client attend to FP clinic• Insufficient logistics for management of drugs, family planning commodities and equipment• rural residence, and high infant and child mortality• rumours and misconceptions about specific methods
Barriers in Sudan• Shortage in the main providers at PHC(health visitors)• Low awareness of community with regard to the family planning services.• No governmental fund allocated for family planning commodities ,UNFPA is only donor for these commodities (provides only 12% from the total need)
RH.5: Unmet need for contraception Percentage of women aged 15-49 years currently married or in union with an unmet need for family planning , Sudan 2010 South Darfur 35.6North Kordofan 33.7 River Nile 32.2 Khartoum 29.4South Kordofan 29.1 Sinnar 28.9 Gezira 28.9 Wite Nile 27.8 North Darfur 27.6 Gadarif 27.6 Northern 26.9 Red Sea 24.2 Kassala 23.6 Blue Nile 23.4 West Darfur 15.4 sudan 28.9 .0 5.0 10.0 15.0 20.0 25.0 30.0 35.0 40.0
RH.4: Use of contraception Percentage of women age 15-49 years currently married or who are using (or whose partner is using) a contraceptive method, Sudan 2010 Northern 21.6 Khartoum 21.3 River Nile 16.4 Wite Nile 12.8 Gezira 9.7 Gadarif 8.7 Sinnar 7.3North Kordofan 6.6 Red Sea 5.8 Kassala 4.4 West Darfur 4.2South Kordofan 3.5 Blue Nile 3.0 North Darfur 2.5 South Darfur 2.1 sudan 9.0 .0 5.0 10.0 15.0 20.0 25.0
References1-WHO, Fact sheet, Family planning and barriers to contraceptive use,20122-MOH,Report, Primary Health Care, National Reproductive Health Programme,2011.3-Citation Manager Working Group on Factors Affecting Contraceptive Use, National Research Council. "6 Regional Analysis of Contraceptive Use." Factors Affecting Contraceptive Use in Sub-Saharan Africa. Washington, DC: The National Academies Press, 1993.4-Barriers to Contraceptive Use in Product Labeling and Practice Guidelines, American Journal of Public Health: May 2006,Vol. 96, No. 5, pp. 791-799.5-Barriers to contraceptive use in Kenya East Afr Med J. 1996 Oct;73(10):651- 9.6- Kate Wood, Rachel Jewkes ,Blood Blockages and Scolding Nurses: Barriers to Adolescent Contraceptive Use in South Africa, Reproductive Health Matters,Volume 14, Issue 27 , Pages 109-118, May 2006
References7- UNAIDS. 2002. Report of the Global HIV/AIDS Epidemic, 2002.Geneva: UNAIDS. 86-87.8- UNFPA. 2002. Programming for Prevention in Various Stages of anHIV/AIDS Epidemic. HIV Prevention, Now: Programme Briefs. No. 8.New York: UNFPA.9- UNFPA. 2003. Draft Working Paper: Myths, Misperceptions andfears regarding condom use – Facts and approaches.10- Issue Brief No. 1, American Foundation for AIDS Research,January 2005 11- PATH, 1994 quote in Jackson 106. 12- UNAIDS. 2003. Condoms for HIV Prevention: An Analysis ofthe Scientific Literature. (Discussion Paper). 19. 13- UNFPA. 2002. Condom Programming for HIV Prevention. HIVPrevention Now: Programme Briefs. No. 6.