Integrating family planning into maternal health

From 1990 to 2015, the global maternal mortality ratio (MMR) decreased by 44 percent. A drop in the total fertility rate worldwide, due primarily to an increase in contraceptive use, resulted in 1.2 million fewer maternal deaths from 1990 to 2005. However, to reach the Sustainable Development Goals (SDG) target of reducing the global MMR to less than 70 per 100,000 live births by 2030, major challenges remain.

In 2008, contraceptive use averted approximately 44 percent of maternal deaths. However, 104,000 deaths could be averted annually by fulfilling unmet need. According to the World Health Organization (WHO), it is estimated that 800 women die every day of preventable causes related to pregnancy and childbirth. Ninety-nine percent of these deaths occur in low-and middle-income countries (LMICs) and are particularly prevalent in rural areas and among poorer communities, where access to a variety of modern contraceptive methods are limited and quality of available services are poor.

Maternal death is strongly correlated with high-risk births, and contraceptive use has proven to decrease the number of high-risk and high-parity births. Data from the Demographic and Health Surveys (DHS) for 27 LMICs demonstrate that of women who desire postponing pregnancy for at least 24 months following childbirth, two-thirds do not use modern contraceptive methods These women are at risk of becoming pregnant too quickly after a previous pregnancy, leading to increased risks of complications. These major complications contribute to 75 percent of all maternal deaths:

  • Severe bleeding from postpartum hemorrhage
  • High blood pressure during pregnancy, resulting in pre-eclampsia and eclampsia
  • Unsafe abortion
  • Infections
  • Delivery-related complications

Relatively little improvement in closing the gap between women’s reproductive intentions and their contraceptive needs have been made. Even though unmet need decreased from 65 percent in 2001 to 61 percent in 2012 in 21 LMICs, average modern Contraceptive Prevalence Rate (mCPR) was only 27 percent in 2012. This is strikingly low compared to the wordwide 2014 mCPR of 57.4 percent.

Data from the World Bank demonstrates that while MMRs for these LMICs have all decreased, the majority of these countries, primarily in sub-Saharan Africa, still have MMRs well above 300. These inequities suggest that family planning services have not yet penetrated the countries needing them the most. Innovative and integrated programs are needed to decrease unmet need, increase access to contraceptive methods and improve quality of services all while providing respectful and woman-centered care.

MMR (2014) CPR (2010)
Sierra Leone 1410 7.6
Chad 881 5.5
Central African Republic 872 26.3
South Sudan 823 4.9
Somalia 753 18.8
Liberia 741 12.9
Burundi 737 21.9
Cameroon 609 25.6
Guinea-Bissau 553 13.6
Sudan 318 11.8

2014 World Bank data for the top 10 countries with the highest MMR worldwide with their respective CPR values.

The SDGs target these issues by aiming to achieve “universal access to sexual and reproductive health and reproductive health care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programmes” by 2030. By placing reproductive health services on national and regional political agendas and fostering a framework that integrates family planning services into the arena of maternal health, a woman will have increased ability to decide when and if her first or next pregnancy should occur.

Additionally, increasing CPR also decreases unwanted pregnancies and the risk of unsafe abortions. Integrating family planning services into existing maternal health services can improve the quality of reproductive health care that is provided at critical time points in a woman’s life prior to, during, and after pregnancy.

Increasing access to contraception through maternal health services also benefits women by increasing their numbers in the workforce, which in turn improves household income and gives women the ability to invest in their health, education and their own well-being as well as that of other members of their households. Preventing an unwanted pregnancy also contributes to the social well-being of a woman. It is thus imperative that new approaches to implementing family planning services in LMICs be created and fostered. Integrating these services into the domain of maternal healthcare and health care systems overall accomplishes this goal not just by increasing availability of and access to contraceptive methods globally, but also by demonstrating that family planning is not a separate program but rather it is an integral part of the continuum of women’s sexual and reproductive health care.

Commonly Used Terms

  • Birth limiting:The period when men/women have completed their family size and do not plan to have any more pregnancies.
  • Birth spacing: The period during which men/women have not yet completed their families but desire to postpone their next pregnancy.
  • Contraceptive Prevalence Rate (CPR): The percentage of women of reproductive age (15-49) who are practicing, or whose sexual partners are using, a contraceptive method.
  • Modern contraceptive methods: Include, but not limited to, combined oral contraceptives, progestogen-only pills and injectables, implants, patches, vaginal rings, intrauterine devices, male/ female condoms, male/female sterilization, lactational amenorrhea method, emergency contraception. This is contrast to traditional methods, which include the calendar method or rhythm method and withdrawal (coitus interruptus).
  • Total Fertility Rate (TFR): The average number of children that would be born alive to a woman during her lifetime if she were to pass through her childbearing years conforming to the age-specific fertility rates of a given year.
  • Unintended/unwanted pregnancy: A pregnancy that a woman decides, of her own free will, is undesired.
  • Unmet need: The percentage of women who do not want to become pregnant but are not using contraception.
  • Unsafe abortion: The termination of an unintended pregnancy, either by a person lacking the necessary skills, in an environment lacking minimal medical standards, or both.

The Role of the MHTF

In January 2016, the MHTF organized an auxiliary session at the International Conference on Family Planning in Nusa Dua, Indonesia on respectful maternity care principles in the context of family planning. The MHTF also spoke in Population Action International’s Defining Quality event which aimed to elucidate new approaches to understanding the quality of family planning.

Source: Maternal Health Task Force

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