Family Planning

Key Messages

• Family planning is the ability of individuals and couples to anticipate and attain their desired number of children and the spacing and timing of their births. It is achieved through use of contraceptive methods and the treatment of involuntary infertility.[1]
• Access to safe, effective contraception saves the lives of women, girls and children.
• Family planning plays a crucial role in helping women remain healthy by preventing unwanted or untimely pregnancies.
• Access to family planning information and services are key to improving women's reproductive health (RH) status.
• Effective contraception prevents unwanted and mistimed pregnancies, which often end in unsafe abortions.
• When women have access to family planning and are able to space their pregnancies, they are better able to ensure their health and education as well as their family’s. Additionally, family planning can save children's lives by spacing pregnancies at least two years apart.
• A constant and accessible supply of RH commodities, such as contraceptives and condoms, are essential to manage unplanned pregnancies and sexually transmitted infections (STIs).
• Integrating male involvement in the community and in couples’ education about family planning is crucial.
• Although family planning is much more widely available from a decade ago, it is essential to address the remaining challenges of ensuring quality service provision and increased usage.

Overview

More than 120 million women say they want to space or limit their families, but currently do not have accessible, affordable or appropriate means to do so. Women and adolescent girls in refugee and internally displaced settings struggle with unwanted, unplanned and poorly spaced pregnancies threatening their lives and the well-being of their children. While some women may choose to become pregnant, others may prefer not to become pregnant and face the difficulties of childrearing in a camp or other unstable setting. Yet, many of these women and girls do not have a choice because contraceptive services are often unavailable or they do not know where and when they are available. Even where services do exist, women and girls are often deterred from using contraception by cultural mores or political pressure to rebuild the population. Unwanted pregnancies, and the increase in unsafe abortions, are also by-products of a breakdown in social order in which rape and sex work may become more common.

In 1994 few family planning services were available to conflict-affected populations. Significant strides have been made in family planning availability over the last decade, and today family planning services are more available. However, substantial challenges remain to improve service provision and increase awareness and usage of family planning in conflict-affected settings.

Facts

Global Statistics

• Family planning can prevent 25 to 30 percent of all maternal deaths.[2]
• The annual birth rate for women in sub-Saharan Africa is 4.4 percent compared to 1.3 percent in industrialized countries.[3]
• If cutbacks in procurement assistance continue at the current rate, UNFPA estimates that a gap of $470 million between what is needed to fulfill people’s demand for contraceptives and what is available will develop by 2015. This will result in 265 million unwanted pregnancies.[4]
• About 123 million women around the world, mostly in developing countries, are not using contraception in spite of an expressed desire to space or limit the numbers of their births.[5]
• According to a study in 2003, 137 million women in the developing world have an unmet need for contraception, and an additional 64 million with an unmet need for a modern method of contraception.
• In Africa, only 20 percent of married women use modern contraception. In some parts of the continent, the proportion drops to under 5 percent.[6]
• Of the nearly 175 million pregnancies each year, as many as half are unwanted or ill-timed.[7]
• Where contraception is inaccessible or of poor quality, many women will seek to terminate unintended pregnancies. Estimates from the World Health Organization indicate that 19 million unsafe abortions take place each year, that is, approximately one in ten pregnancies end in an unsafe abortion.  Almost all unsafe abortions take place in developing countries.[8]
• While unsafe abortions are entirely preventable, the World Health Organization reports that 1 in 270 unsafe abortions will lead to fatal complications, all of which occur in developing countries. Nearly half of all deaths from unsafe abortion occur in sub-Saharan Africa, where unsafe abortion constitutes between 10 to 50 percent of all maternal deaths.[9]
• In Africa 59 percent of all unsafe abortions are among young women aged 15 to 24.[10]

Refugee/Internally Displaced/Conflict-affected Statistics

• A global evaluation of RH services in refugees and internally displaced settings, which included approximately 8.5 million displaced people, found that almost all sites offered at least one family planning method, including oral contraceptives (96 percent), condoms (95 percent) and injectable hormones (89 percent).[11]
• Only five percent of women and eight percent of men could name at least two modern methods of family planning according to a study conducted in Angola. Use of modern contraceptives among women was 2.5 percent.[12]
• A fertility management study of Burmese women refugees living in Thailand showed that two-thirds tried to induce their own abortion through herbal medicines such as “Kathy Pan”, through the insertion of sticks into the vagina, and by pummeling their pelvic areas. In one local Thai public hospital, sterilization was the only family planning method offered along with post-abortion care.[13]
• A study of refugee women in Tanzania revealed that 39 percent of women who sought family planning services discontinued their visits due to their husbands’ disapproval.[14]
• Displaced and marginalized populations in Colombia tend to have larger families due to lack of access and awareness regarding family planning.[15]
• A 2001 Johns Hopkins University/Centers for Disease Control and Prevention (CDC) study found that at least three modern methods of family planning were available in 41 out of 52 refugee camps surveyed (79 percent).[16] This is a significant increase from the early 1990s when family planning methods were provided in refugee camps on an ad hoc basis. However, it is important to note that these findings do not reflect the situation in all camps, in IDP settings, or in new and chronic emergency settings.
• In a study conducted among internally displaced persons in Angola, fertility rates were significantly higher than the national average.[17]

Case Studies

The internally displaced are at higher reproductive health risk in Sri Lanka

It has been estimated that over one million people have been displaced due to civil unrest and war in Sri Lanka since the 1980s. Research commissioned by Marie Stopes International (MSI) examined the RH status of internally displaced people (IDPs) in six districts. Results indicate that IDPs are at increased risk of ill reproductive health. For example, findings showed that:

• 42 percent of families have four or more children;
• 4 percent of pregnant women used family planning methods before their first pregnancy;
• 8 percent of sexually active adolescents use condoms;
• and 36 percent of adolescents have no knowledge of family planning.

Overcoming fears and learning more about family planning methods

Esther, a 23-year-old refugee, has two children and was widowed two years ago. One member of her micro-credit group organized by a nongovernmental organization (NGO) in Liberia died in childbirth. The group was not able to fulfill its commitment to repay the loan due to this member’s death. Esther informed the NGO of their plight and the loss of her friend, who left behind six children. Since her friend’s death, Esther became interested in finding out how women could avoid having many children. A staff person at the NGO requested the RH unit meet with Esther and her group. At the meeting, a few group members stated that they had heard about antenatal care and family planning, but did not know where to get services or did not have time to go and wait in line at a clinic for services. Esther said she was fearful of using family planning methods and of losing her sexual partners if she requests that they use a condom. To address these concerns, the RH trainer organized and conducted training sessions on family planning, which Esther attended. Esther also went to the family planning provider at a local health center supported by the NGO. After one month of counseling, Esther gained a better understanding of contraceptives and chose Depo Provera as her family planning method.

Resources

Click here for more resources on family planning.

Updated September 2006