This document discusses barriers to contraceptive use globally and in Sudan specifically. It begins with an introduction on family planning and contraceptive use trends globally. It then discusses the large unmet need for contraception worldwide, particularly in Africa and benefits of family planning. Barriers to use discussed globally include socioeconomic factors, limited access, side effects, and cultural/religious opposition. Barriers in Sudan specifically include shortage of facilities, staff turnover, socioeconomic factors, low awareness, and lack of dedicated funding. Figures show contraceptive use in Sudan is only 7.7% with unmet need over 28%, among the lowest rates in the region.

1. Barriers to Contraceptive
use
by
Sawsan Mustafa Abdalla
Osman Mohammed Abass
Geneva Foundation for Medical Education
and Research
GFMER Sudan 2012
Forum No: ( 3 )

2. Name of presenter
Name Position Institution
Sawsan Mustafa Abdalla Associated Professor National Ribat University
Osman Mohammed
Abass
State Ministry of Health
Name Position Institution
Sawsan Mustafa Abdalla Associated Professor National Ribat University
Osman Mohammed
Abass
State Ministry of Health
Name of contributors

3. 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

4. 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).

5. 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).

6. 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).

7. 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).

8. 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.

9. 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).

10. 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).

11. 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).

12. 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.

13. 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)

14. Barriers Globally
• Those barriers included lack of agreement on contraceptive
use and on reproductive intentions; husband's 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)

15. 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).

16. 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).

17. 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).

18. Contraceptive use in
Sudan
• Unmet need increased from 5.0% in 2006 to
28.9% in 2010.

19. 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

20. 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

21. 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)

22. 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
28.9
15.4
23.4
23.6
24.2
26.9
27.6
27.6
27.8
28.9
28.9
29.1
29.4
32.2
33.7
35.6
.0 5.0 10.0 15.0 20.0 25.0 30.0 35.0 40.0
sudan
West Darfur
Blue Nile
Kassala
Red Sea
Northern
Gadarif
North Darfur
Wite Nile
Gezira
Sinnar
South Kordofan
Khartoum
River Nile
North Kordofan
South Darfur

23. 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
9.0
2.1
2.5
3.0
3.5
4.2
4.4
5.8
6.6
7.3
8.7
9.7
12.8
16.4
21.3
21.6
.0 5.0 10.0 15.0 20.0 25.0
sudan
South Darfur
North Darfur
Blue Nile
South Kordofan
West Darfur
Kassala
Red Sea
North Kordofan
Sinnar
Gadarif
Gezira
Wite Nile
River Nile
Khartoum
Northern

24. References
1-WHO, Fact sheet, Family planning and barriers to contraceptive use,2012
2-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

25. References
7- UNAIDS. 2002. Report of the Global HIV/AIDS Epidemic, 2002.
Geneva: UNAIDS. 86-87.
8- UNFPA. 2002. Programming for Prevention in Various Stages of an
HIV/AIDS Epidemic. HIV Prevention, Now: Programme Briefs. No. 8.
New York: UNFPA.
9- UNFPA. 2003. Draft Working Paper: Myths, Misperceptions and
fears 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 of
the Scientific Literature. (Discussion Paper). 19.
13- UNFPA. 2002. Condom Programming for HIV Prevention. HIV
Prevention Now: Programme Briefs. No. 6.

27. Thanks
Thanks
Thanks