Family Planning Module: 1. An Overview of Population and Family Planning

Study Session 1  An Overview of Population and Family Planning

Introduction

Family planning helps people have the desired number of children, which as a result improves the health of mothers and contributes to the nation’s social and economic development. In most developing countries, including Ethiopia, it is common practice for women to have too many children, too close to one another. As a consequence, the population size of the country has grown dramatically but economic growth has not kept in parallel with it. Such an unbalanced population size will inevitably have a negative impact on the wellbeing of the nation. Family planning is one of the strategies which is proving to be effective in tackling these problems.

In this study session, you will learn about the problems resulting from having many children, the impact on the health of mothers and children, population size and growth and its social, economic and health consequences, population pressures on the environment, the benefits of family planning, and the current family planning programmes in Ethiopia.

Learning Outcomes for Study Session 1

When you have studied this session, you should be able to:

1.1  Define and use correctly all of the key words printed in bold. (SAQs 1.2 and 1.5)

1.2  Describe uncontrolled fertility and its impact on the health of mothers and children. (SAQs 1.1 and 1.2)

1.3  Discuss population size and growth and its social, economic and health consequences. (SAQs 1.2 and 1.3)

1.4  Discuss population pressures on the environment. (SAQ 1.4)

1.5  Describe the social, economic and health benefits of family planning. (SAQs 1.3 and 1.6)

1.6  Explain the profile of current family planning programmes in Ethiopia. (SAQ 1.7)

1.1  Uncontrolled fertility

This session starts by highlighting the issue of uncontrolled fertility and its effect on the health of mothers and children. Uncontrolled fertility can be defined as when an individual or couple fail to plan their future family size to match the economic level of their family. As a result, fertility is often higher in developing countries than in developed ones, which means that women living in poorer countries, like Ethiopia, tend to have more children in their lifetime.

It is estimated that, on average, African women have 5.6 live births during their reproductive period, and the average number of live births per Ethiopian woman is currently 5.4. This average varies across rural and urban areas of the country. For instance, the fertility rate is as low as 1.4 in Addis Ababa, while it is as high as 7.4 in the Oromia Region.

As a result of the high fertility rate, poor health conditions in general, and inadequate availability of medical care, the risks of pregnancy are higher in Africa than anywhere else. An African woman’s chance of dying from pregnancy-related causes, such as obstructed labour, post-partum haemorrhage, hypertensive disorders of pregnancy, post-partum infections, and unsafe abortion, averages 900 per 100,000 live births.

In contrast, the risk of maternal death in the industrialised nations averages 27 per 100,000 live births. In Ethiopia, for instance, an average of 673 women per 100,000 live births die from pregnancy-related causes. Similarly, in developing countries, including Ethiopia, high fertility carries the highest risk of death in children under five years of age because it is usually difficult for African families to provide all their children with enough food and health care. Therefore, the children can be easily affected by severe malnutrition and infections, both of which are the most common causes of under five mortality. For every 1,000 live births, there are 140 deaths of children under five years in sub-Saharan Africa and 127 in Ethiopia.

In general, compared to countries with lower fertility rates, countries that have high fertility rates often have higher maternal, child, and infant death rates.

1.2  Population size and growth

In the previous section you learnt about uncontrolled fertility and its impact on maternal and child health. Here we will look at the difference between population size and growth, and the link between fertility and population size and growth. It is important to differentiate between population size and the population growth rate. Population size is a measurement of existing population at any point in time, while the population growth rate tells us what is happening to the population in terms of whether it is growing, getting smaller, or remaining constant.

The main objective of family planning is to achieve this last scenario (a low birth rate, and a low death rate). Why? Because one of the factors that influences population growth is excess fertility. In countries where the fertility rate is higher than the death rate there will be fast population growth. This is typical of the current African population. Although the annual rate of increase varies from country to country, on average the world population is growing at 1.5% every year. If this growth rate continues (see Figure 1.1), the world population will be 12 billion by 2050. According to the 2007 Ethiopian census, this country’s population is currently increasing by 2.6% (about two million) each year and should this rate of growth continue, it is estimated that the population of the country will double every 23 years.

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Figure 1.1  Expansion of the human population of the world from 40,000 BC to AD 2025. The diameter of each ring corresponds to the estimated population number at that date. (Source: data derived from McEvedy and Jones, 1978, SDK125, Book 1, p7)

As the population is growing very rapidly, the need for food, schools, jobs and health services is also increasing. Most of the countries in Africa already have high population growth rates estimated at 3% a year, and this is especially true of sub-Saharan Africa which includes Ethiopia. Therefore, it is becoming very difficult for these countries to provide enough food, schools, jobs and health services for everyone in the existing population.

1.3  Population and the environment

Rapid population growth, low agricultural production and destruction of the environment are practices common to most of the sub-Saharan African countries, including Ethiopia. As people tend to live in crowded situations on small pieces of land, there has been an increase in demand for agricultural and grazing land, as well as woodland for fuel and construction, so that extensive and rapid deforestation and soil erosion has occurred. For example, Ethiopia has lost about 13.6% of its forest density since 1950. This situation in turn facilitates drought and hunger.

As a result of uncontrolled population growth in Ethiopia, population density has increased rapidly over the last 30‒40 years, and it is projected that population density will be 166 people per square kilometre in 2050, compared with a figure of 72 people per square kilometre in 2005. This implies that the population will be forced to live in overcrowded areas with small pieces of land to cultivate and, as a result, will eventually end up in extreme poverty and even hunger.

1.4  Family planning and its benefits

1.4.1  What is family planning?

Family planning is the decision-making process by couples, together or individually, on the number of children that they would like to have in their lifetime, and the age interval between children. This means that both halves of a couple have equal rights to decide on their future fertility. In planning their future children, partners need to have the right information on when and how to get and use methods of their choice without any form of coercion. Such planning therefore helps mothers and their children enjoy the benefits of birth spacing and having planned pregnancies.

Family planning is one of the leading strategies to improve family life and welfare, control unwanted population growth, and aid the development of the nation. This is the reason why Ethiopia has been developing its family planning programme since the 1960s (see Section 1.5).

1.4.2  Benefits of family planning

Social and economic benefits

Family planning reduces health risks to women and gives them more control over their reproductive lives. With better health and greater control over their lives, women can take advantage of education, employment and civic opportunities. Families with fewer children are often able to send those children to school so girls get a chance to attain higher education, and as an outcome, the age of their first marriage is often later and their years of fertility reduced. They also benefit from being an employee.

In addition, it is not difficult for parents to clothe and feed their children if they can limit their family size. The expenses that they need to care for a small-sized family will be less, so they can save more and be self-sufficient. With regard to social services, both the government and the family invest less if the family and population size is small. This can help save essential resources and thereby contribute to the economic growth of the nation as a whole.

Figure 1.2  A happy family.

In general, having a larger proportion of well-educated, healthy, productive and self-sufficient families can (Figure 1.2) contribute a great deal to the sustainable development of a country. In this regard, the social and economic benefits of the family are essential.

1.5  Family planning programme in Ethiopia

The modern family planning service in Ethiopia started as The Family Guidance Association of Ethiopia (FGAE), established in 1966. FGAE’s only family planning services were provided from a single-room clinic run by one nurse, at the former St Paul Hospital in Addis Ababa. FGAE’s programme activities and services are now broadly spread all over the country, creating a vast network.

In the last 20 years, with the adoption of the population policy in 1993, numerous local and international partners in family planning have come together to assist the government in expanding family planning programmes and services. The National Population Office was established to implement and oversee the strategies and actions related to the population policy. In 1996, the Ministry of Health released Guidelines for Family Planning Services in Ethiopia to guide health providers and managers, as well as to expand and ensure quality family planning services in the country.

Figure 1.3  Family planning service in a rural health post. (Photo: Ali Wyllie)

The Ministry of Health designed new outlets for family planning services in the form of community-based distribution, social marketing and work-based services, in addition to the pre-existing facility-based and outreach family planning services. Social marketing is about making available family planning methods at an affordable price using private retailers. Work-based services are services made available to users’ at their place of work, such as factories, prisons and schools. Moreover, in the last decade, integration and linkage between family planning services and HIV/AIDS care, along with maternal and other reproductive health services, has been emphasised in guidelines and strategic documents with the aim of enhancing family planning utilisation.

Currently, the service has been provided to rural communities at household level through the Health Extension Programme (Figure 1.3). Access to these services has been almost universal for all urban and rural communities, so that every woman in the population can get any contraceptive method of her choice free of charge. This is covered in more detail in the next study session.

See Table 1.1 for a summary of these services.

Summary of Study Session 1

In Study Session 1, you have learned that:

1. Uncontrolled fertility is when an individual or couple fails to plan their future family size and match it with their family-level economy. Fertility is often higher in developing countries, with women in poorer countries, like Africa, tending to have more children in their lifetime. It is estimated that, on average, African women have 5.6 live births during their reproductive period.
2. An African woman’s chances of dying from pregnancy-related causes averages 900 per 100,000 live births. In contrast, the risk of maternal death in industrialised nations averages 27 per 100,000 live births. In Ethiopia, for instance, an average of 673 women per 100,000 live births die from pregnancy-related causes.
3. Population size is a measurement of existing population at any point of time, while the growth rate tells us what is happening to the population in terms of it growing, shrinking, or remaining constant.
4. In countries where the fertility rate is higher than the death rate there will be fast population growth, and as a population grows rapidly the need for more food, more schools, more jobs and more health services will also grow.
5. Rapid population growth, low agricultural production, and destruction of the environment are common to most of the sub-Saharan African countries, including Ethiopia.
6. As a result of uncontrolled population growth in Ethiopia, population density has been increasing rapidly for the last 30‒40 years, and it is projected that the population density will be 166 people per square kilometre by 2050.
7. Family planning is the decision-making process by couples together, or individually, on the number of offspring that they would like to have in their lifetime, and how often to do so.
8. Family planning helps mothers avoid pregnancy when they are vulnerable because of their younger or older age, or when the desired number of children has been achieved. It can also help mothers space their children, so that they maintain good health and energy.
9. Family planning also helps mothers prevent unwanted pregnancy so and so avoid abortion and its consequences.
10. Modern family planning services in Ethiopia first started in 1966, led by the FGAE. The Ministry of Health designed new outlets for family planning services in the form of community-based distribution, and social marketing and work-based services, in addition to the pre-existing facility-based and outreach family planning services.

Self-Assessment Questions (SAQs) for Study Session 1

Now that you have completed this study session, you can assess how well you have achieved its Learning Outcomes by answering these questions. Write your answers in your Study Diary and discuss them with your Tutor at the next Study Support Meeting. You can check your answers with the Notes on the Self-Assessment Questions at the end of this Module.