This document provides an overview of family planning, including its history and impact. It discusses how family planning has altered social and economic roles of women and was recognized as one of the top 10 public health achievements of the 20th century. The document also outlines concepts related to family planning like fertility rates and birth control, and examines factors that influence family planning decisions around number and timing of children. Demographic trends showing global population growth are presented, demonstrating the need for family planning programs worldwide.

1. Family Planning

2. CDC rating:
Ten Great Public Health Achievements -- United States, 1900-1999
1. Vaccination
2. Motor-vehicle safety
3. Safer workplaces
4. Control of infectious diseases (has resulted from clean water and improved sanitation)
5. Decline in deaths from coronary heart disease and stroke
6. Safer and healthier foods
7. Healthier mothers and babies (have resulted from better hygiene and nutrition, availability of
antibiotics, greater access to health care)
8. Family planning (has altered social and economic roles of women)
9. Fluoridation of drinking water
10. Recognition of tobacco use as a health hazard

3. Outline
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.
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
● Concepts
● Measures
● Programs

4. Space&Time
Number (desired family size, stopping behavior)
Time/age at birth (delay of the first birth, spacing of births)

5. Concepts
● Fertility and its Determinants
● Birth Control
● Unmet Need in Family Planning

6. Davis&Blake (April 1956)
● Factors affecting exposure to intercource (intercourse variables)
○ Those governing formation and dissolution of unions in reproductive ages
○ Those governing the exposure to intercourse within unions
● Factors affecting exposure to conception (conception variables)
● Factors affecting gestation and successful parturition (gestation variables)

7. intercourse variables
formation and dissolution of unions
● Age of entry into sexual unions
● Permanent celibacy: proportion of women
never entering sexual union
● Amount of reproductive period spent after or
between unions
○ When union is broken by divorce,
separation, or desertion
○ When union is broken by death of
husband
exposure to intercourse within unions
● Voluntary abstinence
● Involuntary abstinence (from impotence,
illness, unavoidable but temporary separation)
● Coital frequency (excluding periods of
abstinence)

8. conception variables
● Fecundity or infertility as affected by involuntary causes
● Use or non-use of contraception
○ By mechanical or chemical means
○ By other means (rhythm, withdrawal, simulated intercourse without penetration, other
“perversions”)
● Fecundity or infertility as affected by voluntary causes (sterilization,
subincision, medical treatment, etc.)

9. gestation variables
● Foetal mortality from involuntary causes
● Foetal mortality from voluntary causes

10. Bongaarts’ model of proximate determinants (1978)
Fertility is a function of
● Length of union (nuptiality)
● Contraception
● Post-partum sterility (length of breastfeeding)
● Induced abortion
which squeeze fecundity
Later he included pathological sterility

11. Need in Birth Control Appears in Demographic Transition

12. Demographic transition

13. World Population Growth
1 billion – 1800
2 billion – 1927
3 billion – 1959
4 billion – 1974
5 billion – 1987
6 billion – 1998
7 billion – 2011

14. Demographic explosion

15. How to measure
● MWRA (a number of married women in reproductive ages)
● Contraceptive prevalence
● Unmet need in family planning

16. MWRA
● Population at risk
● Denominator

17. Contraceptive Prevalence
Contraceptive prevalence is the percentage of women who are currently
using, or whose sexual partner is currently using, at least one method of
contraception, regardless of the method used. It is usually reported for
married or in-union women aged 15 to 49.

18. Unmet Need
Also known as “KAP-gap”
Women with unmet need are those who are fecund and sexually active but
are not using any method of contraception, and report not wanting any
more children or wanting to delay the next child. The concept of unmet
need points to the gap between women's reproductive intentions and their
contraceptive behaviour.
Unmet need worldwide data//MDG data

19. UN

20. CP (top) & UN (bottom)

21. Prevalence > < Unmet Need

22. Effectiveness of contraception
The Pearl Index, also called the Pearl rate, is the most common technique
used in clinical trials for reporting the effectiveness of a birth control method.
It is a statistical estimation of the number of unintended pregnancies in 100
woman-years of exposure
Usually two Pearl Indexes are published from studies of birth control methods:
● Actual use Pearl Index, which includes all pregnancies in a study and all months (or
cycles) of exposure
● Perfect use or Method Pearl Index, which includes only pregnancies that resulted
from correct and consistent use of the method, and only includes months or cycles
in which the method was correctly and consistently used

23. Trussel table

24. Trussel table 2
James Trussell,
Contraceptive
failure in the
United States,
Contraception
83 (2011) 397–404

25. “Typical use” (Netherlands)
Past six months

26. Programs
Unfortunately I have no experience in programming family planning.
It is a separate subject which requires a separate training course.
The USSR opposed FP movement.

27. Reply to population growth

28. National Security Study Memorandum
NSSM 200
Implications of Worldwide Population
Growth For U.S. Security and Overseas
Interests
(THE KISSINGER REPORT)
December 10, 1974
Declassified in 1989

29. Development of the USA role
Global gag rule, since 1984, Reagan administration
The Mexico City Policy is an intermittent United States government
policy that required all non-governmental organizations (NGOs) that
receive federal funding to refrain from performing or promoting abortion
services as a method of family planning with non-US government funds in
other countries.
Reagan>>Bush>>Clinton>>Bush>>Obama

30. Government
policies to
influence the level
of fertility
Percentage of countries
in each group

31. Government support for family planning
Percentage of
countries in each
group

32. International assistance
RH is not FP

33. The end
Thank you for attention

34. Exam
Class sends me a link to the Google table, containing:
● Name
● Country
● Title of presentation
● Date of presentation
● The topic student wish to discuss during the exam (mismatched with
presentation), you will have five minutes
I will add score results by May 25, the exam will adjust your score
See you on May 26, at 3 p.m.