Effect on Family Planning on Health and Nutrition

Family planning programmes address important health problems. Maternal and infant death rates are extremely high in development world. Reported maternal death rates, for instance, are about 100 per 100,000 births in Mexico and 200 in Kenya, and possibly as much as 400 for developing countries as a whole, compared with about 10 in the US and UK. The complications of pregnancy account for 10 to 30 per cent of deaths among women of reproductive age in parts of Asia,  Africa, and Latin America, but less than 2 per cent in the US. and Europe. 

Deaths among children also arc shockingly frequent. In some Asian and African countries, death rates are as high as about 200 per 1,000 infants under age one and 35 per 1,000 children aged one to four. In contrast, death rates in the US and Europe are about 10 per 1,000 infants and virtually zero for children one to four. Children under age five make up 14 percent of the population in developing countries but account for up to 80 per cent of the deaths each year. By contrast, in developed countries children  under age five make up 8 per cent of the population but account for less than 3 per cent of deaths. 

In African countries one out of every four children dies before reaching adolescence, compared with one in 40 in developed countries. 

Avoiding High-Risk Pregnancies: Family Planning is an effective way to prevent maternal and infant mortality because family planning can help couples avoid high-risk pregnancies. Evidence from around the world shows that the risk of maternal or infant illness and death is highest in four specific types of pregnancy : 

1. pregnancies before age 18, 
2. pregnancies after  age 35, 
3. pregnancies after four births, and 
4. pregnancies less than two years apart. 

In other words, pregnancies can be considered high-risk if women are "too young, too old" or "if  children are too many, too close". In parts of Europe and North America as much as one-quarter of the decline in infant mortality in recent decades occurred because fewer and fewer births took place among older women with many children. 

In developing countries today about 5.6 million infant deaths and 200,000 maternal deaths could be avoided, if women chose to have  their children within the safest years with adequate spacing between births and completed families of moderate size. This amounts to about half of the estimated 10.5 million infant deaths and 450,000 maternal deaths now occurring and represents the combined effect of fewer births and lower death rates. 

Family Planning : Effective and Safe Prevention 

The wide choice of  family planning methods now available allows health programmes to offer an appropriate method to avoid each type of high-risk pregnancy. For example, oral contraceptives, condoms, and spermicides are particularly appropriate to postpone the first pregnancy and  to space births, whereas voluntary sterilization is highly effective for older couples who want no more children. 

Modern family planning methods are safe. Contraceptive products are not toxic even if used incorrectly - an important consideration for community-based or non-medical distribution. For some methods, such as condoms, spermicides, and Natural  Family Planning, the only important risks are those of accidental pregnancy. Other methods may pose only rare risks,  many of which can be reduced by following simple guidelines. With all methods,  family planning in developing countries is much safer than child-bearing. 

Moreover, some methods provide benefits beyond the control of fertility. Condoms and spermicides prevent the spread of venereal disease. Oral contraceptives reduce some menstrual problems and  help to protect against pelvic inflammatory disease, cancer of the uterine lining, cancer of the ovaries, anaemia, and rheumatoid arthritis. 

Maternal and Child Health 

There has long been evidence from developed countries that pregnancies "too young, too old, too many, too close" endanger maternal and infant health. Now there is new evidence - evidence that meets more rigorous standards of modern epidemiology - that these adverse effects are as strong or stronger in developing countries. In all settings pregnancies among adolescents, women over 35, and women with many previous births are more likely to involve life-threatening complications such as hemorrhage and high blood pressure. Closely spaced births may contribute to malnutrition and other maternal health problems.

The infants born as a result of high-risk pregnancies are even more vulnerable. Spacing of less than two years between births is hazardous  because it means lower birth weights and poorer nutrition, possibly  including a shorter period of breast-feeding or more competition for family resources and care. From infancy to adolescence, children born into large or closely spaced families experience more sickness, slower growth, and lower levels of academic achievement. Lower socio-economic status has similar effects, but birth patterns also are important. 

Family planning programmes cannot guarantee maternal and infant health, but by protecting families against high-risk pregnancy, family planning saves lives and reduces illness. As an essential element of primary health care, family planning can help to bring the goal of "Health for  All by the Year 2000" closer to realization.