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Health Technical Elements
Family Planning - Reproductive Health
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| Click image above to download the PDF version of the Family Planning - Reproductive Health Fact Sheet |
Overview
Modern family planning contributes to improved maternal and child health in Eastern Europe and Eurasia (E&E) and empowers women and families in decisions regarding family size and birth timing. Maternal mortality in Eastern Europe is estimated to be twice as high as that in Western Europe and complications from abortions, especially those performed under unsafe conditions, are among the leading causes of maternal death. Births that occur too early or close together also compromise a mother’s and infant’s chances of survival. Modern family planning addresses many of these negative health consequences by enabling women to better time and space their pregnancies. In many countries across the E&E region, however, access to modern family planning services and contraceptive methods is limited and relatively expensive. As a result, many women rely on traditional methods of family planning and abortion to regulate their fertility.
USAID’s Response
USAID increases access to family planning by implementing programs that provide a broad range family planning services and commodities, build capacity among health care professionals, conduct mass media campaigns, and strengthen family planning services through operations research.
Additional Information and Resources
(Westoff, 2005) |
Family Planning Statistics
- Fertility rates: Range from 1.2 births per woman in Ukraine to 2.0 births per woman in Azerbaijan.
- Contraceptive prevalence rates (modern methods): Range from 8% in Albania to 49% in Russia.
- Abortions per woman: Ranges from 0.4 in Ukraine to 3.1 in Georgia (DHS/RH)
Unmet need1 for family planning remains high in many E&E countries. Armenia (15%), Ukraine (18%), and Georgia (24%) have some of the highest unmet need in the region. |
Important Issues in Family Planning in Europe and Eurasia
- Distrust of modern contraception is widespread and contributes to the heavy reliance on traditional methods. Many of these misconceptions are a result of the side effects that women experienced from the contraceptives available during the Soviet Era and from the misinformation among healthcare providers about the health risks associated with modern contraceptives. Women’s knowledge of the effectiveness of modern family planning is also limited. For example, 75% of traditional method users in Georgia believe that the method they are using is equally or more effective than modern contraceptive methods.
- Limited access to family planning as a result of high cost, restricted service availability, and a lack of information is an important concern in the E&E region. Free and subsidized contraceptives are often unavailable for women who cannot afford to pay. In addition, only specially trained obstetricians/gynecologists can provide family planning, and women often have to undergo unnecessary tests and examinations before being prescribed a method. Even though many women are aware of the methods that exist, they do not know where to obtain them or how to use them.
- Although abortion rates are decreasing, the historical reliance on abortion remains an important concern. Across the region, abortion is legal, fairly unrestricted, and available at little or no cost while modern contraception is often difficult to access. With help from USAID, the rate of modern contraceptive use has increased and the abortion rate has fallen by more than one-third in the region.
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A still shot from the USAID-funded ACQUIRE Project television ad campaign in Azerbaijan, “Pregnancy Planning – Choose the Right Time!”
Photo Credit: ACQUIRE |
Examples of USAID Family Planning Programs
- The ACCESS Family Planning Project in Albania is implementing policy reform, training, and behavior change to improve family planning services. The project has increased the availability of contraceptives, conducted trainings to create awareness of family planning services, and worked with the MOH to expand the number of service delivery points offering family planning services. Implementer: John Snow, Inc.
- In Azerbaijan, the ACQUIRE Reproductive Health/Family Planning Project is working with the MOH, communities, and the private sector to improve knowledge and attitudes toward modern contraception. Social marketing partnerships with pharmaceutical companies help promote use of contraceptives. Implementer: Engender Health
- Russia’s Maternal and Child Health Initiative has a special focus on youth-friendly services and increasing access to reproductive health and family planning information to men. The project has also developed a mass media campaign for couples, with an emphasis on increasing both men’s and women’s participation in reproductive health issues. Implementer: John Snow, Inc.
- The Ukrainian Together for Health Program is improving knowledge and use of family planning services, increasing availability of contraceptives, and increasing capacity and commitment of the public and private sectors to support policies and systems for improved reproductive health. Implementer: John Snow, Inc. Research and Training Institute
USAID Family Planning Success Stories
- The Romanian Family Health Initiative (RFHI) was a partnership established between the Government of Romania, USAID, and JSI Research and Training Institute, and is internationally recognized as a family planning success story. Since 1993, the percentage of couples using modern contraception in Romania increased from 14% to 40%, while the number of abortions per woman decreased between 1999 and 2004 from 2.2 to 0.8. In addition, family planning services are being provided in more than 80% of primary health care centers throughout the country, and now family planning is considered to be an essential part of the national reproductive health strategy. The Initiative also had a significant impact on attitudes and behaviors regarding family planning and reproductive health through its national health education mini-series “Real Women.” Today, Romania is considered to be the regional leader in family planning and women’s health services.
- The Europe and Eurasia Regional Family Planning Activity implemented by JSI has had significant success in working with countries across the region to integrate evidence-based family planning information into the medical education system so that students who are training to become future service providers can develop a solid background in family planning in order to increase service availability, improve quality, and enhance sustainability of the in-country family planning efforts. In 2008, the project hosted a regional conference in which USAID, WHO, Ministries of Health, Ministries of Education, partners, and medical university faculty from Armenia, Azerbaijan, Georgia, and Kyrgyzstan came together to foster collaboration and to determine the next steps to moving forward with this cutting-edge activity.
- In Russia, the Women and Infant’s Health Project and the Maternal and Child Health Initiative was an innovative project that successfully integrated key, evidence-based maternal and child health services with family planning. As a result of the program, modern contraceptive use increased from 41% to 58% among women of reproductive age. In addition, the number of women discussing family planning with their provider increased substantially in antenatal, postpartum, and post-abortion care settings. The number of abortions also decreased considerably in project areas, from 49.1 to 43.2 per 1000 women of reproductive age. Upon the Initiative’s end, it transitioned from being an external donor-funded project to a self-sustaining, locally-based, Russian NGO, further highlighting the incredible success of this activity.
1 The percentage of fecund, married women who say they would prefer to avoid a pregnancy but are not using any method of contraception.
Family Planning and Reproductive Health Resources, Websites and Links
Family Planning Situational Analyses in Selected Countries in the E&E Region 2007
Regional Family Planning Activity - Russia and Romania Case Studies (June 2007)
Maximizing Private Sector Contributions to Family Planning in the Europe & Eurasia Region: Context Analysis and Review of Strategies (Adobe Acrobat PDF, 765kb). Desk review completed with support from the E&E Regional Family Planning Activity, PSP-One. This is an important document because of the growing importance of the private sector in the region and its potential contribution to family planning and reproductive health objectives. This report provides an excellent overview of the main private sector actors in the E&E region and the challenges and opportunities they face in the FP/RH area.
Abortion and Contraceptive Prevalence Presentation, by Charles Westoff (Adobe Acrobat PDF, 134kb)
Recent Trends in Abortion and Contraception in 12 Countries, February 2005 (Adobe Acrobat PDF)
Ensuring Access to Family Planning Workshop country plans and presentations, Bucharest, Romania (April 2005)
Reproductive, Maternal and Child Health in Eastern Europe and Eurasia: A Comparative Report - April 2003:
- Cover, Title Page, Table of Contents, Acknowledgements, List of Contributors, Preface, Introduction (Adobe Acrobat PDF, 3.83mb)
- Chapter 1: Background (Adobe Acrobat PDF, 301kb)
- Chapter 2: Methodology (Adobe Acrobat PDF, 345kb)
- Chapter 3: Fertility (Adobe Acrobat PDF, 481kb)
- Chapter 4: Abortion (Adobe Acrobat PDF, 489kb)
- Chapter 5: Contraceptive and Knowledge and Use (Adobe Acrobat PDF, 356kb)
- Chapter 6: Need for Contraceptive Services (Adobe Acrobat PDF, 312kb)
- Chapter 7: Attitudes and Opinions Toward Contraception and Abortion (Adobe Acrobat PDF, 381kb)
- Chapter 8: Maternal Care (Adobe Acrobat PDF, 463kb)
- Chapter 9: Health Behaviors (Adobe Acrobat PDF, 728kb)
- Chapter 10: Knowledge of
HIV/AIDS Transmission and Prevention (Adobe Acrobat PDF, 380kb)
- Chapter 11: Infant Feeding
Practices and Nutrition Status of Women and Children (Adobe Acrobat PDF, 399kb)
- Chapter 12: Anemia Among
Women and Children (Adobe Acrobat PDF, 338kb)
- Chapter 13: Infant and Child Mortality (Adobe Acrobat PDF, 434kb)
- Chapter 14: Sexual and Contraceptive Behavior of Young Adults (Adobe Acrobat PDF, 411kb)
- Chapter 15: Sexuality Education (Adobe Acrobat PDF, 307kb)
- Chapter 16: Physical and Sexual Abuse (Adobe Acrobat PDF, 345kb)
- References (Adobe Acrobat PDF, 184kb)
- Glossary (Adobe Acrobat PDF, 143kb)
- Appendix (Adobe Acrobat PDF, 153kb)
An Assessment of USAID Reproductive Health and Planning, December 2004 (Adobe Acrobat PDF, 1.48mb)
PRESENTATIONS
Abortion and Contraceptive Prevalence Presentation, by Charles Westoff (Adobe Acrobat PDF, 134kb)
WEBSITES
USAID Family Planning Overview
WHO Family Planning
United Nations Population Fund
Johns Hopkins Bloomberg School of Public Health: The Info Project
With funding from USAID, the INFO Project houses a large library of resources available to family planning, reproductive health, and population audiences. INFO's The One Source database helps visitors search through thousands of documents, articles, photos, communications materials, online communities, and Q&As available to health care practitioners.
http://www.infoforhealth.org, http://www.infoforhealth.org/onesource.shtml
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