1. Actors, policies, programs and
activities of family planning in Sudan
By:
Dr. Dina Sami Khalifa
Dr. Hani Mohamed Ibrahim
Geneva Foundation for Medical Education and
Research
GFMER Sudan 2012
Forum No: ( 3 )

2. Name of presenter
Name Position Institution
Waleed Amin Head, Community Health Nursing UMST
Amal Khalil Coordinator, RCRU UMST
Name of contributors
Name Position Institution
Dina Sami Khalifa Epidemiologist Ahfad University for Women
(AUW)
Hani Mohammed Medical Director Um Bakhita Maternity
Ibrahim Research Assistant –RCRU Hospital .

3. Objective of presentation
• Introduction
• FP objectives in Sudan
• Policies of FP in Sudan
• Actors & Stakeholders of FP in Sudan
• FP programs & activities in Sudan
• Recommendations & Conclusion

4. Introduction
FP implies the ability of individuals and
couples to anticipate and attain their
desired number of children by spacing
and timing their births. It is achieved
through the use of contraceptive
methods and the treatment of
involuntary infertility.
FP guards individual health, rights, and
improves the quality of life of couples
and their children.

5. Elements of FP Services Suggested by International
Organizations¹:
• Range/choice of methods
• Delayed childbirth for adolescents
• Male responsibility
• Attention to unmet need/increasing demand
• Safety/side effects research
• Sterilization reversal
• Implant removal
• Quality services
¹ Hardee K, Yount K. From Rhetoric to Reality: Delivering Reproductive Health Promises through Integrated
Services. FHI 360. 2012 (Working paper: http://www.fhi360.org/en/RH/Pubs/wsp/wrkngpapers/rhetreal.htm)

6. Population Demography¹
• TFR in Sudan = 5.5 (2008 census ) (vs. 6.6 in 1993)
• Crude Death Rate (SHHS 2010) = 9.6 % ( vs. 26%
in1956)
• Pop Growth rate 2008 (before separation of South) =
2.6 (2.88 in 1956)
• U 5 Mortality rate = 78/1000 (vs. 233/1000 in 1956)
• U 15 years of age= 45%
• MMR in Sudan ( SHHS 2010) = 216/100000 (vs.
554/100000 in 1989 SHHS)
• Life expectancy at birth (2010)= 61.6 (vs. 38.2 in1956)
• No legal access to abortion services in Sudan
¹ Statistics from “Sudan population policy 2010 “ Document

7. In Sudan context, FP should be addressed as:
1. Primarily: To improve Maternal Health by
providing Child Spacing:
The most recent survey estimated maternal
mortality rate (216/100.000 LB) at national level
(225/100,000 rural and 194/100,000 urban.
((SHHS 2010)
2. Secondarily; To control population growth;
Low SES, increasing poverty, economic instability,
low resources for developing human capita.

8. Sudan Population Policy (SPP) targets for 2031 ¹:
• Decrease TFR: (NO TARGET FOR TFR mentioned
in SPP)
• Decrease population growth: (NO TARGET
mentioned in SPP)
• Increase FP use to 39% (currently 7%)
• Decrease crude death rate to 8%
• Decrease under 15 years of age to 37%
• Decrease MMR to 73/100000 LB
 Importance of FP as a strategy in improving
maternal health or stabilizing pop growth is not
clearly demarcated in Sudan Population Policy.
¹ Sudan Population Policy. 2010 Document (Draft)

9. Family Planning in the “25 years Strategic
Plan for Health Sector” 2003-2027¹
• Family planning is mentioned as one of the strategies
to reach the goal (Goal 3) of “ Reducing Maternal &
Child Mortality” through increasing contraceptives
prevalence rate among married couple. FP is NOT
stated as an OBJECTIVE.
• A policy priority mentioned in the plan is “Goods with
public health importance will be the responsibility of
the government; this would include environmental
health services, prevention of diseases, health
promotion and quality assurance.”  access to FP
through government sector constitutes > 70 %
¹ Sudan 25 year Strategic Plan for Health Sector 2003- 2027. doc.

10. Family Planning in National RH Policy¹
FP is mentioned in a separate statement in the RH
policy:
 “At primary health care level, the health visitors
and medical assistants will provide family
planning information and services for child
spacing and welfare of women. In remote villages
and nomadic settings, village midwives and
community health workers will act as change
agent and in addition to providing condoms refer
clients to the health facilities.”
¹ Sudan RH Policy Document

11. The policy also requires these services are
“kept confidential, and information about the
services provided is divulged after an informed
consent of the client. Further, such services,
particularly regarding reproductive choices
and birth control methods, following the
principle of voluntarism, are administered
after an informed consent of the client, and
will be provided free of charge.”

12. Actors and Stakeholders
Family planning services were introduced in the country in
the 1960s with.
1. The “ Sudan Family Planning Association” SFPA:
 An NGO that is pioneer in FP in Sudan till this day. UNFPA
is a key partner.
 Objectives ¹:
• Advocacy and Information, Education and Communication
(IEC) to religious and political leaders and the population.
• Improving the status of women as an indirect contribution
to successful family planning programs.
• Providing FP services through its 93 clinics and
government structures, and non-clinical services through a
community based distribution (CBD) project.
¹ www.ippf.org/en/Where/Country....

13. 2. The “Maternal and Child Health and Family Planning
project”. MOH & University of Khartoum:
• Established in 1980s
• Focus: VMW training on various MCH issues as well as
community outreach activities e.g. FP distribution
• It is considered a success story.¹
3. The “Sudan Fertility Control Association”:
• Established in 1976.
• Work with Sudan Family Planning Association to provide
family planning services throughout the country.
4. National Population Council:
• Worked intermittently in Sudan for more then 20 years
through the Middle East Capacity Awards (MEAwards)
program.
¹ El Tom AR, Farah AA, Lauro D, Fenn T. Community and individual acceptance: family planning services in
the Sudan. Ahfad J. 1987 Jun;4(1):12-30.

14. 5. UN agencies contribution to FP:
• UNFPA ¹:
 “Advocacy for integration of reproductive health
commodity security, including HIV/AIDS commodities, in
the national health commodity system”
 “Support to integrating management and prevention of
sexually transmitted infections/HIV in reproductive health
services outlets, including services for young people”
 “Support to enhancing capacities of reproductive health
care providers”
 “Capacity building to implement minimum initial service
package in humanitarian settings”
¹ Sudan UNDAF document 2013-2016

15.  “Support to integrating management and
prevention of sexually transmitted infections/HIV
in reproductive health services outlets, including
services for young people”
 “Support to comprehensive condom
programming”
 “Strengthening of the knowledge base on socio-
cultural determinants to guide reproductive
health interventions, including for HIV
prevention”

16. • WHO¹:
 “Support MoH to scale up coverage of health
services, including: increasing the number of
PHC facilities delivering the integrated basic
RH package- Inclusive of FP services”
 “Capacity development of health cadres to
provide quality services”
¹ Sudan UNDAF document 2013-2016

17. FP activities/interventions in Sudan and expected impact
(Most of FP interventions/activities, no Evaluation Research is conducted)
 Mostly implemented: Capacity building of health personnel on FP
(UNFPA,WHO, NP): MD, MA, HV VMWs.  presumed effective if
training is tailored , phased and based on needs assessment.
 Community awareness raising ,advocacy & education on FP 
presumed effective if barrier to FP uptake is low acceptability
 Community-based distribution (CBD) of FP: a component of
community health outreach. Started 1996, still weak in Sudan. 
presumed effective if inaccessibility to FP is the problem
 Ensuring availability of FP commodities to all communities 
presumed effective if low supply/inequity in distribution of FP is
the problem

18.  Performance based approach to RH service delivery:
Incentives to HCP to provide RH services and commodities 
presumed effective if accessibility to FP is the problem but
will not guarantee effectiveness of FP (highly dependent on
capacity and skills of HCP)
 Integration of FP services with RH services  presumed
effective if it meets clients' needs, best utilizes a limited pool
of resources and may improve the efficiency and
effectiveness of services.

19. Barriers to FP programs implementation
Country level Barriers:
 Challenges to integration of FP service
delivery:
Integration can facilitate- - but does not guarantee -
implementation of services, due to the complexity of
RH service packages, the existence of established
vertical programs, and weak administrative capacity. ¹
¹ Hardee K, Yount K. From Rhetoric to Reality: Delivering Reproductive Health Promises through Integrated Services.
FHI 360. 2012 (Working paper: http://www.fhi360.org/en/RH/Pubs/wsp/wrkngpapers/rhetreal.htm)

20.  Challenges with expanded RH services: infrastructure
and referral systems; medical support, supplies and
logistics; updated & evidence based RH service
delivery guidelines; integrated HIS; delegation of
activities; competence of personnel; training for staff
and supervisors; supervision; and evaluation of
integrated programs.¹
 Cost & Funding: the assumption that Sudan
contributes two-thirds of the resources for RH, and
donors contribute the remaining one-third is a
challenge under current National Health Expenditure.¹
¹ Hardee K, Yount K. From Rhetoric to Reality: Delivering Reproductive Health Promises through Integrated
Services. FHI 360. 2012 (Working paper: http://www.fhi360.org/en/RH/Pubs/wsp/wrkngpapers/rhetreal.htm)

21. Community level barriers:
National research¹² has identified inequity in
distribution/uptake of FP and highlighted
barriers to effective FP uptake in the
community:
 Misplaced religious believes.
 Misplaced believes about side effects of FP
 Significant role of husbands mainly husbands
with lower educational level.
Low educational level of women.
¹ Ali et al. Use of family planning methods in Kassala, Eastern Sudan. BMC Research Notes 2011, 4:43
² Saghayroun AA, Khalifa MA. Fertility and Islam in the Sudan. Sudan J Popul Stud. 1984 Jun;1(2):1-28.

22. Opportunities for effective FP in Sudan
 Positive political commitment.
 Positive donor collaboration.
 Increasing collaboration with Academia to
undergo operation/evaluation research.
 Increasing range of stakeholders, such as policy-
makers, women's advocacy groups, grass-roots
organizers, service providers, and client
representatives, academia among others.

23. Recommendations:
• Addressing FP issues from a Maternal Health
perspective not Population Growth Control to gain
more religious, governmental and community support.
• Targeting religious leaders so as to increase community
awareness on importance of FP on the socio economic
level and health of mother and child.
• Targeting men as they constitute a large proportion of
decision making on use of FP ( 34.1% of families the
male is the sole decision maker on FP use) ¹
• Targeting women immediately postpartum via
counselling and follow-up on FP issues. Prime target
should be women with lower SES, high parity, low
educational level.
¹ Khalifa MA. Attitudes of urban Sudanese men toward family planning. Stud Fam Plann. 1988 Jul Aug;19(4):236-43.

24. • Massive and comprehensive FP promotion
campaigns addressing FP types, effective use,
side effects and health benefits. Campaigns
involving multiple influential stakeholders so as
tackle social determinants for the high FP unmet
need in Sudan.
• Strengthening policies to support CBD of FP
• Establishing Operational/ Evaluation research to
examine impact of the various FP interventions
in the country to provide evidence for new policy
& interventions.

25. Thank you