9. Fertility

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FERTILITY
Lecturer : Elizabeth Nyirenda
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Introduction
• https://www.youtube.com/watch?time_
continue=187&v=mdR8o_mChKY
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Definition of Concepts
• Fertility: This is the actual childbearing
performance of individuals, couples,
groups or population. Measures of
fertility normally refer only to live births.
By convention, measures of fertility are
related to mothers aged 15 - 49.
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Definition of Concepts
• Natural fertility: fertility where couples do not
alter their reproductive behaviour. In practice
this can be taken to mean the fertility of
populations whose members do not use
contraception or induced abortion.
• Fecundity: The physiological capability of a
man, woman or couple to produce a live birth.
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Definition of Concepts
• Menopause: The permanent cessation of
menstruation at the end of reproductive years. The
mean age at menopause of most populations for
which measurements of fertility exist falls between
ages 45-50.
• Menache: This is the on-set of ovulation in a
woman’s life. It marks the potential beginning of
the childbearing years.
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Definition of Concepts
• Spemarche: This is the onset of the production of
sperms in a boy child.
• Live birth: This is a complete expulsion or
extraction from its mother, a product of
conception, irrespective of duration of pregnancy
which after shows signs of life such as beating of
heart, pulsation of umbilical code and movement
of muscles.
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Sources of Fertility Data
•
•
•
•
Population census
National Surveys e.g. DHS
Populations Registers
VRS
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Measuring Fertility
• Reasons why not calculate fertility with
reference to fathers:
• In theory there is no reason why fertility rates
expressed with reference to the father should
not be calculated.
1. In practice it is very difficult to determine
paternity.
2. The biological limits on the age range of male
fertility are less restrictive. This can make
measures problematic.
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Measures of Fertility
• Crude Birth Rate (CBR) – This the annual
number of births per thousand population
at Mid year.
• Example : Egypt 1990
CBR = (B/P) *1000
Births = 1, 737,000
Mid Year Population = 52,426,000
CBR = 33.1
• Int: There were 33 births per 1000
population in 1990 in Egypt
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Measures of Fertility
• General Fertility Rate (GFR)- The number of live
births occurring in a year per 1,000 women of
childbearing age.
Example : Egypt 1990
Births – 1,737,000
Women 15-49 – 12,423,000
GFR =( B/W15-49)*1000
= 140
Int : They were 140 births per 1000 women of
reproductive age in Egypt in 1990
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Measures of Fertility
• Child Woman Ratio (CWR): The ratio of all
children aged 0-4 years to women aged 1549 years in the population.
• Example : Egypt 1990
• Children 0-4 -7588000
• Women 15-49 – 12423000
• CWR = [C(0-4)/ W (15-49)]*1000
=611
Int :There were 611 children per 1000 women of child
bearing age in Egypt in 1990
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Measures of Fertility
• Age Specific Birth Rate (ASBR)- Is the annual
number of births to women in a particular age
group per 1,000 women in that age group.
• Total Fertility Rate (TFR) -Is the average
number of live births a woman would have by
age 50 if she were subject, throughout her life,
to the age specific fertility rates observed in a
given year. The calculation assumes there is no
mortality and is expressed as number of
children per woman.
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Measures of Fertility
TFR = ∑ ASFR (15-49) *5
Or
TFR = [∑ ASFR (15-49) *5]1000
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Measures of Fertility
• Completed Family Size (CFS)( Mean Parity)- Is
the number of children ever born to women
who have completed their reproduction, i.e.,
those aged 50 and older
• Mean Age at Child Bearing (MACB)
Is the mean age of mothers at the birth of their
children if women were subject throughout their
lives to the age-specific fertility rates observed in
a given year. It is computed as the sum of agespecific fertility rates weighted by the midpoint
of each group.
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Measures of Fertility
• Gross Reproductive Rate (GRR)- Refers to the average
number of female births that a woman would give
birth to by the time she reached the end of her
reproduction if she experienced age specific fertility
rates prevailing in that year.
• Net Reproductive Rate (NRR) -refers to the average
number of female births born to women aged 15-49
years that would survive to the end of their
reproductive period after experiencing the prevailing
fertility and mortality levels.
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Measures of Fertility
Population x , 2015
Age group
A
15-19
20-24
25-29
30-34
35-35
40-44
45-49
Totals
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Women
B
Births
C
9,493,761
8,678,024
9,341,226
10,179,403
11,369,766
11,049,377
9,607,011
69,718,568
484895
965122
1083010
889365
424890
81027
3624
3,931,933
ASFR
D (C/B)
TFR
0.05108
0.11121
0.11594
0.08737
0.03737
0.00733
0.00038
0.411
2.053
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Fertility in Zambia
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2010 CPH
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Fertility Indicators
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Levels, Patterns, Differentials and
Trends in Fertility
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Levels , Patterns , Differentials
and Trends in Fertility
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PRB – Zambia 2010 Census
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Fertility Patterns and
Differentials
EDUCATION STATUS
• Most studies have discovered an inverse
relationship between education and
fertility. Studies have also found a
positive correlation between education
status and contraception use.
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2013-14 ZDHS
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Fertility Patterns and
Differentials
• ECONOMIC STATUS
• There is an inverse relationship between
economic status and fertility. This when we
use income levels of women and compare it
with fertility level; Most studies have
demonstrated that female participation in
economic activity tends to reduce their
fertility. e.g. in Zambia using census data to
compare fertility levels of women working and
those not working give the following trend.
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TFR BY WORKING STATUS
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1980
1990
2000
2007
Working
7.1
7.1
5.8
5.2
Not working
6.2
5.2
6.5
6.8
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Fertility Patterns and
Differentials
OCCUPATION
• Several studies have discovered that occupations
associated with primary industries such as
agriculture tended to have higher fertility
compared to tertiary industries. In most times
occupation of husband is used as an index.
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Fertility Patterns and
Differentials
• Residence
• Rural Areas have higher fertility than
urban areas. This is due to high unmet
need and low uptake of family planning.
• Other differentials that have been
studied in relation to fertility include
ethnicity; race and religion though minor
variations have been reported.
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FERTILITY LEVELS AND TRENDS
FOR THE WORLD
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Fertility Levels and Trends
•
•
•
•
Zambia
Sub-Suharan Africa
Africa
Global
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WPP 2017
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PRB – TFR 2018
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PRB – BIRTHS 2018
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Reasons for High Fertility in
LDR’s
• Most African societies are pressured to have children
because of the need to replenish society
• Children are seen as old age security. Social economic
and labour Insurance.
• Sex preference; in certain societies specific sexes are
preferred e.g. In Asia male children are preferred to
female children.
• Prestige; in some societies it is prestigious for one to
have large family.
• Low education levels and lack of participation in
economic activities.
• High unmet need for contraception
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Trends in Contraceptive use
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Reasons for High Fertility in
MDR’s
• Desire to acquire wealth so smaller families
normally have lower consumption levels.
• Its prestigious in developed countries to have
smaller family sizes
• Participation in economic activities is usually
high in MDRs
• Desire for quality children and not quantity
children
• Desire for upward mobility (rising social status)
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Fertility Theories
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Fertility Theories
Outline
• Introduction
• Davies and Blake intermediate variable
framework
• John Bongaarts Proximate Determinants
• Caldwells Theory of Intergenerational
Wealth Flows
• Q&A
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Fertility Theories
• Introduction
• Fertility comprises one of the greatest areas of
discontinuity between national policies and individual
goals.
• National governments have the power to greatly
influence mortality and migration policies but have
limited influence on fertility regulation or control.
Fertility largely remains a preserve of individual
decision.
• Fertility theories help to explain the reproductive
behavior of individuals , couples or groups.
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Fertility Theories
1. DAVIES AND BLAKE
• Introduction
• Davies and Blake developed a modified
intermediate variable framework to fertility
determinants.
• They were intensely interested in the determinants
and consequences of fertility-related attitudes and
behaviours. They listed 11 intermediate variables
that eventually influence fertility.
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Fertility Theories
The variables were classified into three
groups.
1-The intercourse variables
2-The conception variables
3-Gestation and parturition variables
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Fertility Theories
I.
FACTORS AFFECTING EXPOSURE TO
INTERCOURSE “INTERCOURSE VARIABLES”
(A)Those governing the formation and dissolution
of unions in reproductive age.
1.
2.
3.
Age at entry into sexual unions (legitimate and illegitimate)
Permanent celibacy: proportion of women never entering sexual
unions
Amount of reproductive period spent after or between unions
3a. When unions are broken by divorce, separation or desertion
3b. When unions are broken by death of husband
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Fertility Theories
B) Those governing the exposure to intercourse
within unions
4. Voluntary abstinence
5. Involuntary abstinence (from impotence,
illness, unavoidable but temporary
separations)
6. Coital frequency (excluding periods of
abstinence)
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Fertility Theories
II.
FACTORS AFFECTING EXPOSURE TO
CONCEPTION”( “CONCEPTION VARIABLES”)
7. Fecundity or infecundity, as affected by
involuntary causes, but including breastfeeding.
8. Use or non-use of contraception
a. By mechanical and chemical means
b. By other means.
9. Fecundity or infecundity as affected by voluntary
causes (sterilization or medical
treatment)
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Fertility Theories
III. FACTORS AFFECTING GESTATION AND
SUCCESSFUL PARTURITION (“GESTAION
VARIABLES”)
10. Foetal mortality from involuntary causes
(miscarriages)
11. Foetal mortality from voluntary causes
(induced abortion)
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Fertility Theories
2. JOHN BONGAARTS
Introduction
Bongaarts (1978) has been instrumental in
refining our understanding of fertility control, he
collapsed the 11 intermediate variables in Davies
and Blakes theory into 8 variables which he
called “PROXIMATE DETERMINANTS.
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Fertility Theories
• Bongaarts also suggests that, the difference in
fertility from one population to the next is largely
accounted by only four of those variables:
1.
2.
3.
4.
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age at marriage,
use of contraceptives,
incidence of abortion , and
involuntary infecundity ( especially infecundity as
affected by breastfeeding practices).
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Fertility Theories
• Proximate determinants of fertility
1. *Proportions of women married or in sexual
unions
a. Age at first marriage
b. The proportions of women who never enter
sexual unions
c. The frequency of divorce, widowhood, and remarriage
d. Exposure outside marriage
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Fertility Theories
2. Patterns of sexual activity
a. Frequency of intercourse
b. Postpartum abstinence
c. Spousal separation
3.* Breastfeeding and lactation
amenorrhea (postpartum infecundability)
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Fertility Theories
4.* contraception use (including sterilization)
5.* induced abortion
6. Foetal loss (spontaneous intrauterine
mortality)
7. Natural infertility
8. PathologicalUNZAinfertility
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Fertility Theories
Bongaarts Model
• Bongaarts proposed a simple but ingenious model
(method) of quantifying the relative effects of the
proximate determinants of fertility in a given
population.
• The model is based on the view that the effect of
each of the proximate determinants-marriage,
breastfeeding and postpartum abstinence, and
contraception and induced abortion-is to reduce
fertility in a given population from some
hypothetical level which might be achieved.
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Fertility Theories
• TFR=TF x Ci x Cc x Ca x Cm.
TF – Total Fecundity
Ci – Index of postpartum infecundability
Cc – Index of contraception
Ca - Index of abortion
Cm – Index of Marriage
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Fertility Theories
1. The index of marriage ( Cm) refers to the
proportion married, taking account of the
ages of married females and the relative
importance of each age group in child
bearing.
• The index equals 1 if all women of
reproductive age are married, and 0 if
none are married
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Fertility Theories
2. The index of contraception ( Cc) takes
account of the prevalence and
effectiveness of contraception.
• The index of contraception equals 1 if
contraception is absent or completely in
efficient, and 0 if all fecund women use
100 per cent effective contraception.
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Fertility Theories
• The index of induced abortion (Ca) ranges from 1,
in the absence of induced abortion , to 0 if all
pregnancies are aborted.
• The index of postpartum infecundability (Ci)
equals 1 in the absence of breastfeeding and
postpartum abstinence, and 0 if the duration of
infecundibility is infinite.
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Fertility Theories
• The four proximate determinants each have the
potential to reduce the total fertility rate.
• If they have no limiting effect- as would occur if all
women of reproductive age were married, and
contraception, abortion and breastfeeding were
absent- fertility would rise to an average of 15.3 births
per woman. Bongaarts and Potter (1983) called this
maximum figure total fecundity (TF).
• By multiplying TF by each of the proximate
determinants TFR can be obtained.
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Fertility Theories
• 3. Caldwell’s Intergenerational Wealth
Flow Theory
Introduction
• John Caldwell’s wealth flows theory proposes a
direct link between family structure and
fertility (Caldwell, 1976).
• According to the theory, there are only two
forms of family structure, differing principally
in the direction of wealth flows among
generations.
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Fertility Theories
• In primitive and traditional societies, net
wealth flows are primarily upward from
younger to older generations, and
individual interests are subjugated to
corporate interests. In developed
nations, family structure is organised in
terms of downward wealth flows where
parents are expected to provide for
children’s economic wellbeing.
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Fertility Theories
The theories proposes that;
A. Fertility decisions in all societies are
economically rational responses to familial
wealth flows.
B. In societies with net up ward flow of wealth,
the economically rational decision is to have as
many children as possible ( within the constraints
imposed by biology) because each additional
child adds positively to a parents wealth, security
in old age, andUNZAsocial
and political wellbeing.
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Fertility Theories
C. In societies with net downward wealth
flows, the economically rational decision is to
have no children or the minimum number
allowed by a psychological disposition that
derives pleasure from children and parenting.
The worldwide transition from high to low
fertility is the result of a change in family
structures from upward to downward wealth
flows.
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Fertility Theories
• This change in family structure was due to the
spread of new values that placed a premium on
individual satisfaction and achievement.
• Those values emanated from the educated
middle class in the west and are now being
exported to the developing world through mass
formal education.
• Implicit in the education materials and
expectations of schools is the individualistic value
system that produces downward wealth flows.
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Fertility Theories
• Labour markets make the adoption of those
individualistic values, which are adversative to
the family or group production characteristic of
pretransition societies, economically feasible.
• The transition from “traditional” to “modern”
family structure occurs when a critical mass of
individuals adopt new values, and respond with
low fertility. The attainment of mass education
in a country should therefore precipitate and
predict the fertility transition.
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Fertility Theories
• The most serious challenge to wealth flows
theory has come from evolutionary biologist.
• The argument that prior to modernization,
upward wealth flows characterised human
family structures is inherently antithetical to
theory in evolutionary biology.
• Biologist expect net wealth flows to be
downward in all organisms, including human
being.
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Fertility Theories
• Caldwell’s wealth flows theory differs from others
by expanding the definition of intergenerational
transfers across the life course and by;
1. Directly linking transfers across the life course
and by directly linking changing value systems
regarding intergenerational transfers of wealth to
fertility transition. Defining wealth as “all the
money, goods, services, and guarantees that one
provides to another”.
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Fertility Theories
2. Caldwell’s theory recognises
technological impacts on wealth flows,
such as the changing economic value of
education. While there is unique pleasure
derived from having children, pleasure will
be derived from fewer children as their
economic value decreases or the cost of
educating them increase.
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Q&A
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THANK YOU
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Determinants and
Consequences of high Fertility
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Determinants of fertility
INDIRECT FACTORS- These include social, cultural,
environmental and economic factors

Education

Health

Cultural/social factors

Occupation/income
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Determinants of fertility
DIRECT FACTORS
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
Age at marriage

Age at Menarche

Contraception

Abortion
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Consequences of High Fertility
• Demographic
– High Population Growth
– Young Population
– High dependency
– High Maternal and underfive Mortality
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Consequences of High Fertility
Economic
– Low GDP per capita
– Food Insecurity
– Environmental Degradation
– High Consumption
– Food Shortage
– Inflation
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Consequences of High Fertility
Environmental Consequences
– Deforestation
– Soil Erosion
– Depletion of soil fertility
– Climate change
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Consequences of High Fertility
Social Consequences
– Crime
– Unplanned Urban Settlements
– Poor water and sanitation
– Housing Deficit
– Limited Education Infrastructure
– Lack of access to quality health care
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Fertility regulation and Family
Planning
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What is fertility regulation
• Fertility regulation refers to the control of the
number of children one should have through
child spacing or postponing or limiting births.
• This is done usually through family planning
which can be done as conscious efforts by
individuals and or couples to regulate the
number of children through various
contraceptive methods. These include natural
and non-natural methods.
METHODS OF FERTILITY
REGULATION
•
NATURAL METHODS
– WITHDRAWAL ( COITUS INTERUPTUS)
– BODY TEMPERATURE
– CERVICAL MUCUS METHOD/ CALENDER METHOD
– BREAST FEEDING
– ABSTINENCE
• NON- NATURAL METHODS
METHODS OF FERTILITY
REGULATION
 MECHANICAL
 CHEMICAL
 BARRIER
 SURGICAL
 FEMALE STERILIZATION
 MALE STERILISATION
 OTHER METHODS
NATURAL METHODS

Natural methods will include abstinence, rhythm method or calendar
method based on the observation of pattern of menstruation to give an
idea of when ovulation takes place, on average on the 14th day. During
this period conception is highly likely to occur.

Cervical mucus method/ovulation method/ Calender method
Women are expected to experience vaginal discharge, after menstruation,
the discharge may be cloudy during peak ovulation periods so fertility is
likely to take place at least 3 days before the mucus becomes slippery.
 Body temperature
About 2-3 days before ovulation the body temperature will rise by 0.2 or 0.5
degrees and is maintained throughout during ovulation. During this period a
women is expected to ovulate thus risk of conception is high.
NON –NATURAL METHODS
• These prevent sperm from meeting the ova. An
example is the contraceptive pill or birth control
pill. The pill releases hormones that prevent
ovulation.
Intra –uterine Device (IUD)
Condom - Male
Condom - Female
Cervical Cap
Vaginal Ring
Diaphram
Spermicidal
Injectables
Oral contraceptive The famous
“PILL
IMPLANTS - NORPLANT
Emergency contraceptives –
Morning after pill
SURGICAL METHODS
• Male sterilization
• Female sterilisation
Vasectomy
Tubal ligation
Key to note
•
•
•
•
•
Correct and consistent use
Wide choice
Available , affordable and accessible
Informed choice
HIV transmission prevention
Q&A
What are the other methods?
THANK YOU
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FAMILY PLANNING POLICIES
AND PROGRAMMES
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Family Planning 2020
The fundamental right of individuals to decide, freely
and for themselves, whether, when, and how many
children to have is central to the vision and goals of
Family Planning 2020 (FP2020).
The international community has agreed that the right to
health includes the right to control one’s health and
body, including sexual and reproductive freedom.
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FP 2020
By securing and fulfilling the rights of an
additional 120 million women and girls to
access family planning information and
services by the year 2020, FP2020
efforts will result in ;
• Fewer unintended pregnancies,
• Fewer women and girls dying in pregnancy and
childbirth, including from unsafe abortions,
and fewer infant deaths.
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FP2020
• Ten Dimensions of FP
1. Agency and autonomy-Individuals have the ability to
decide freely the number and spacing of their children. To
exercise this ability, individuals must be able to choose a
contraceptive method voluntarily, free of discrimination,
coercion or violence.
2. Availability- Health care facilities, trained providers and
contraceptive methods are available to ensure that
individuals can exercise full choice from a full range of
contraceptive methods (barrier, short-acting, long-acting
reversible, permanent and emergency contraception).
Availability of services includes follow-up and removal
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services for implants
and IUDs
Ten Dimension of FP
3. Accessibility- Health care facilities, trained providers
and contraceptive methods are accessible—without
discrimination, and without physical, economic, sociocultural or informational barriers.
4. Acceptability
Health care facilities, trained providers and contraceptive
methods are respectful of medical ethics and individual
preferences,
are sensitive to gender and life-cycle requirements and
respect confidentiality.
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Ten Dimension of FP
5. Quality- Individuals have access to contraceptive services
and information of good quality which are scientifically and
medically appropriate.
Quality of care is a multifaceted element that includes but is not
limited to: a full choice of quality contraceptive methods; clear
and medically accurate information, including the risks and
benefits of a range of methods; presence of equipped and
technically competent providers; and client-provider
interactions that respect informed choice, privacy and
confidentiality, and client preferences and needs
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Ten Dimension of FP
6. Empowerment-Individuals are
empowered as principle actors and agents
to make decisions about their reproductive
lives, and can execute these decisions
through access to contraceptive
information, services and supplies.
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Ten Dimension of FP
7. Equity and non-discrimination -Individuals have the
ability to access quality, comprehensive contraceptive
information and services free from discrimination,
coercion and violence.
Quality, accessibility, and availability of contraceptive
information and services should not vary by nonmedically indicated characteristics, such as age,
geographic location, language, ethnicity, disability, HIV
status, sexual orientation, wealth, marital or other status
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Ten Dimension of FP
8.Informed choice -Individuals have the ability to access
accurate, clear and readily understood information about
a variety of contraceptive methods and their use.
To exercise full, free and informed decision-making,
individuals can choose among a full range of safe,
effective and available contraceptive methods (barrier,
short-acting, long-acting reversible, permanent and
emergency contraception)
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Ten Dimension of FP
9.Transparency and accountability- Individuals can
readily access meaningful information on the design,
provision, implementation and evaluation of
contraceptive services, programs and policies, including
government data.
Individuals are entitled to seek remedies and redress at
the individual and systems level when duty-bearers have
not fulfilled their obligations regarding contraceptive
information, services and supplies.
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Ten Dimension of FP
10.Voice and participation- Individuals,
particularly beneficiaries, have the ability
to meaningfully participate in the design,
provision, implementation, and evaluation
of contraceptive services, programs and
policies.
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Zambia’s Commitment
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Zambia Population Policy
FERTILITY OBJECTIVES
• Reduce High levels of fertility particularly
adolescent fertility
• Improve the sexual and reproductive
health including family planning so as to
encourage manageable family size
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Zambia Population Policy
• POLICY TARGETS
• To attain and maintain a population growth
rate that is at least three times lower than the
rate of economic growth
• To reduce the proportion of adolescents
having children from 25 percent by half by
2030
• To reduce maternal deaths of 729 per 100000
live births by more than two thirds by 2030
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Zambia Population Policy
• To reduce the under five mortality of 162 per
1000 by more than two-thirds by 2030
• To make sexual and reproductive health
services including Family planning information
available, accessible and affordable to at least
50 percent of all those in the reproductive age
group and in need of such services by 2030.
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Family Planning policies and
Programmes
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Family Planning policies and
Programmes
• FAMILY PLANNING POLICIES AND
PROGRAMMES SHOULD BE INFORMED
BY EVIDENCE/RESEARCH
• PRIORITY AREAS ARE INFORMED BY
DATA AND ARE CONTEXT SPECIFIC
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Scaling Up Family Planning (
SUFP)
Barriers to Family Planning
Supply Side- A number of supply-side
barriers limit family planning provision,
particularly LARC
1. Shortage of trained staff and lack of
needed equipment, commodities and
consumables (MCDMCH, 2013).
2. Stock outs due to inadequate transport
of supplies and delays in submitting
requisition orders
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Scaling Up Family Planning (
SUFP)
• Limited method mix in the public sector
constrains contraceptive choice, and
price remains a barrier in the private
sector.
• Distance is often a barrier for those living
in rural areas, especially during the rainy
season, when travel time to a health
facility averages two hours.
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Scaling Up Family Planning (
SURP)
• Scheduling of services can also serve as a
barrier to FP access, especially when the
hours are limited and services are not
coordinated with the provision of other
related services that women attend.
Lastly, inadequate infrastructure may
limit a woman’s
• Privacy and comfort in accessing FP
services.
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Scaling Up Family Planning
( SUFP)
• Demand-side barriers to adoption of FP
also inhibit use,
• Including actual or feared
partner/spousal disapproval
• Social stigma, myths, rumors and
misinformation about FP generally and
specific methods
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Scaling Up Family Planning
( SUFP)
• Fear of side effects, and health concerns.
Some methods, notably LARC other than
injectables, suffer from negative
• myths and false beliefs. For example,
some believe that implants and IUDs can
travel around the body and
• become lodged in the brain, the heart or
a growing fetus, or that fertility will not
return after LARC removal
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Scaling Up Family Planning (
SUFP)
• Some health providers, too, reportedly
share these negative beliefs and then act
to deter client’s interest in contraceptive
use.
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Priority issues to address
1. Fertility rate still remains high despite
relatively high use of modern
contraceptives
2.Zambian women have more children
than they would like to have
3. Over a fifth of Zambian women have
unmet need for family planning
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Priority issues to address
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Priority issues to address
4. Many Zambian women are not using
contraceptives that match their fertility
preference
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Policy actions to accelerate
fertility decline in Zambia
A. Increase use of effective family planning methods
within an integrated Reproductive and Maternal
Health programme
1.The programme should intensify itscommunication
and educational programmes, and develop innovative
outreach services to promote the benefits of the use
of family planning and the resultant planned family
sizes.
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Policy actions to accelerate
fertility decline in Zambia
2. Improve the quality of, and equitable access
to services, with focus on promoting increased
family planning method choice including longacting and permanent methods, and ensure
reproductive health commodity security.
3. Improve the quality and equitable access to
high impact maternal health services such as
skilled attendance at birth and emergency
obstetric care.
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Policy actions to accelerate
fertility decline in Zambia
4. Reinforce political will and increase
government investment in family planning,
building on the FP2020 commitments, which
includes doubling of budgetary allocation for
family planning interventions as articulated in
the 8 year FP scale-up plan (2013 to 2020).
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Policy actions to accelerate
fertility decline in Zambia
5. Encourage and reinforce male involvement in
Reproductive Health programmes, including
family planning.
6. Encourage and reinforce public-private
partnerships in delivery of Reproductive Health
programmes, including family planning services.
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Policy actions to accelerate
fertility decline in Zambia
7. Strengthen government institutions
responsible for coordinating Reproductive Health
programmes, including family planning
programmes.
8. Pay particular attention to marginalised
population groups and underserved provinces,
districts and constituencies.
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Policy actions to accelerate
fertility decline in Zambia
B. Improve Child Survival
1. Intensify on-going interventions to further
reduce child mortality , including immunisation
campaigns, integrated management of childhood
illnesses (IMCI), use of insecticide treated nets,
prevention of mother-to-child transmission of HIV,
deliveries by skilled birth attendants, and
improving child nutrition including Vitamin A
supplementation.
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Policy actions to accelerate
fertility decline in Zambia
2. Pay particular attention to interventions
addressing neonatal mortality and
stunting.
3. Target vulnerable population groups
and underserved provinces, districts and
constituencies.
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Policy actions to accelerate
fertility decline in Zambia
• C. Keeping Girls in School for Longer
1. Address the cultural, social and economic
barriers that increase school dropout,
including financial barriers to accessing
quality education.
2. Enforce laws on legal minimum age of
marriage – Constitution/Marriage Act - and
sensitise communities to value education of
girls with its benefits at household,
community and national levels.
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Policy actions to accelerate
fertility decline in Zambia
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Policy actions to accelerate
fertility decline in Zambia
3. Address the stigma, misconceptions and
financial constraints that prevent girls from
taking advantage of the school re-entry policy
after giving birth.
4. Scale-up comprehensive sexuality education
and referral services for in and out of school
adolescents, including removing the age consent
barrier to accessing contraception and other
reproductive health services.
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Strategies from the NHSP
2017-2021
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THANK YOU
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