Lecture 8. FAMILY HEALTH AND
FAMILY PLANNING
Ass. Prof.PhD Daina Lucia
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• In accordance with the WHO
definition, a family is represented by
a person or group of persons that
live together and are blood relatives,
either by marriage or adoption.
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FAMILY HEALTH AND FAMILY
PLANNING
• From a social point of view, the family has
not been studied or understood very well,
though it raises important issues because:
• 1.The current way of gathering data in the
health system does not have the family at
its centre.
• 2.There are ambiguities in relation to the
terms used in defining the concept of
family health.
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FAMILY HEALTH AND FAMILY
PLANNING
• WHO defines family health as more
than summing the individual health
of the persons who make up a family;
family health expresses the interrelations that are established within
this social group.
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• WHO recommends four groups of
indicators for measuring family
health:
• 1.demographic
• 2.medical
• 3.sociologic
• 4.economic
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1.DEMOGRAPHIC INDICATORS
• 1.1.The family structure, in terms of
family members personal
characteristics:
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- the number of persons that
make up the family;
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- age;
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- educational level;
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- occupation.
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1. DEMOGRAPHIC INDICATORS
• 1.2.The average size of the family
• As a result of the tendency towards a decreasing
birth rate (in developed countries, but also in
Romania), the number of children in each family
decreased while the number of families without
children increased.
• At the international level, here is a tendency
towards an increase in the average size of
families, but also towards a larger number of
families made up of a single person (usually old
people).
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1. DEMOGRAPHIC INDICATORS
• 1.3.The family type
• The classic family type is the enlarged family.
• The modern family type – the nuclear family.
• 4 types of families:
• a. the nuclear family, made up of husband + wife + children;
• b. the vertically enlarged family: husband + wife + children
+ the parents of one of the spouses;
• c. the horizontally enlarged family made up of husband +
wife + children + brother/sister of one of the spouses;
• d. family enlarged both horizontally and vertically : husband
+ wife + children + parents + brother/sister.
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1. DEMOGRAPHIC INDICATORS
• 1.4.The family life-cycle
• This concept appeared in the 1930s-1940s.
• The idea it originated from is that the
family, from the moment of its formation
(marriage) to its disappearance (death,
divorce), goes through a series of stages
that determine the modification of its
functions, both favorably and
unfavorably.
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1.4.The family life-cycle
• If we take into account the main demographic
events that are significant for the family, the
stages would be the following:
Stage
Event
Formation
Marriage
Extension
The birth of the first child
Complete extension
The birth of the last child
Contraction
The marriage of the first child
and his/her leaving of the
family
Complete contraction
The marriage of the last child
and the leaving of the parents
Dissolving
The death of one of the
spouses
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1.4. The family life-cycle
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The life cycle of the family is influenced by
1.Demographic factors:
- birth rate;
- mortality;
- nuptiality;
- divorciality.
2.Socio-economic factors:
- the socio-economic level of development in a certain
country;
- the average income / family member;
- the level of urbanization and industrialization.
3.Cultural factors:
- the instruction level;
- the cultural level of the respective population.
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1.4. The family life-cycle
• The main characteristics of the family life-cycle in
Romania:
• - the average time-span of the family life-cycle is
of 42 years;
• - women’s average age at marriage is of 21-22
years;
• - the fertility model is of the precocious type;
• - the divorciality phenomenon is increasing,
which brings about a reduction in the life cycle of
a family.
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1.DEMOGRAPHIC INDICATORS
• 1.5.Life and environment conditions
of a family
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2.MEDICAL INDICATORS
• the prevalence of risk factors in a
family;
• the prevalence of diseases in a
family;
• the aggregation of diseases in a
family;
• the identification of families with
high risk of disease.
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3.SOCIOLOGIC INDICATORS (the sociological
approach to family health)
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Starting from 5 questions, to which the alternative answers are:
- almost always – 2 points
- sometimes – 1 point
- never – 0 points
The APGAR family score has been established, the maximum number of
points being 10:
1.I am satisfied because I can appeal to my family help when
something is wrong.
2.I am satisfied because my family approaches and shares problems
with me.
3.I am satisfied because my family accepts and supports my desire to
engage in new activities.
4.I am satisfied because my family responds to my affective-emotional
states (love, sadness, anger).
5.I am satisfied because there is a pleasant way of spending the free
time in our family.
The classification would be:
- health family:
8-10 points
- family with problems 6-7 points
- risk family
<6 points.
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4.ECONOMIC INDICATORS
• The economic approach to health
presents interests for doctors to the
extent to which economic factors can
influence it.
• Two main economic aspects have
been the object of numerous studies:
– the cost of disease per family
– the impact of disease upon the family.
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FAMILY PLANNING
• Definition: the conscious determination by
the family of the number of their children
wanted and the setting of births at certain
intervals.
• Synonymy:
– birth planning,
– birth control,
– birth limitation.
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There are two moments in developing the
concept:
• The first moment: society and those responsible
for the development of society and the health
system realized that the population number
increases excessively, and this growth
determines important pressures over societies
and families. Thus, the first family planning
tendencies appeared: the reduction of children in
families and the planning of births at determined
intervals.
• The second moment: sterility treatment, in order
to allow families have the desired number of
children.
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• Starting from the family attitude towards
family planning, families can be grouped
in:
– Malthusian-type families: families that put
family planning into practice;
– Non-Malthusian family-types: families that do
not use family planning.
• WHO has elaborated a model that includes
the main factors influencing the attitude
towards family planning and the
interrelations among these factors.
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• Introducing family planning is important
because it can influence the health state
of women and children:
– on the one hand through the influence of
pregnancies upon women and children;
– on the other hand, they manifest themselves
through the consequences of using, by
women, of the different family planning
techniques.
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• Family planning prevents at least 3 types
of high-risk pregnancies:
– pregnancies before the age of 20;
– pregnancies after the age of 35;
– pregnancies at an inter-genezic interval of less
than 2 years.
• In Romania, family planning actually
started in 1990, though the most widely
accepted form of family planning is still
the abortion.
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CNTRACEPTIVE METHODS
• Oral contraceptives
• WHO has conducted epidemiologic
cohort studies and case-control in
order to highlight the possible
influence of oral contraceptives upon
women’s health state, respectively
the possible epidemiologic
association between the use of oral
contraceptives and breast cancer.
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FAMILY PLANNING IN
ROMANIA
• After 1989, family planning has been considered
by the Ministry of Health and the experts of the
World Bank that take part to the restructuring of
the health system in Romania as an important
health problem.
• The national program of family planning is based
on 2 main elements:
– The existing relation between illegal abortions and a
high level of morbidity and mortality at women, and the
high number of abandoned or handicapped children;
– Acknowledging the right of families to determine the
number of children they want.
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