family planning

A program to regulate the number and spacing of children in a family through the practice of contraception or other methods of birth control.

Reproductive health is defined in the Programme of Action of the International Conference on Population and Development (ICPD), held in Cairo, Egypt, in September 1994, as:

A state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity, in all matters relating to the reproductive system and to its functions and processes. Reproductive health therefore implies that people are able to have a satisfying and safe sex life and that they have the capability to reproduce and the freedom to decide if, when, and how often to do so. Implicit in this last condition are the right of men and women to be informed and to have access to safe, effective, affordable and acceptable methods of family planning of their choice, as well as other methods of their choice for regulation of fertility which are not against the law, and the right of access to appropriate health care services that will enable women to go safely through pregnancy and childbirth and provide couples with the best chance of having a healthy infant.

Sexual health was also defined in this resolution, "the purpose of which is the enhancement of life and personal relations, and not merely counselling and care related to reproduction and sexually transmitted diseases." In 1999, the United Nations General Assembly adopted its Key Actions for Further Implementation of the Programme of Action. This document focused on population and development concerns; gender equality, equity and empowerment of women; reproductive rights and reproductive health; and partnerships and collaboration.

Reproductive health has widely been interpreted to focus more specifically on providing access and choice in family planning; caring for women before, during, and after pregnancy; preventing and controlling sexually transmitted infections, including HIV/AIDS (human immunodeficiency virus/acquired immunodeficiency syndrome); preventing and treating cervical cancer and breast disease; promoting the health of adolescents; promoting positive communication between sexual partners; promoting special services (i.e., counseling, care, and education) to women that decrease the disparity of services between genders; and supporting positive reproductive health–related practices. The Programme of Action has helped nations throughout the world to understand that, in the everyday lives of people, family planning is an integral part of daily living and overall health.

The World Health Organisation (WHO) has outlined four basic goals that should be met for people to achieve reproductive health. These goals were established in order to focus attention on the community at large—how people live, work, and play—and to get people thinking more broadly about the treatment services available at health care delivery centers. These goals provide a basis for reproductive health promotion, prevention, and intervention initiatives. The overall design aspires to create a safe environment where people may: (1) be free from violence and other harmful practices related to sexuality and reproduction; (2) avoid illness, disease, and disability related to sexuality and reproduction, and receive appropriate care when needed; (3) achieve their desired number of children safely and healthily, when and if they decide to have them; and (4) experience healthy sexual development and maturation and have the capacity for equitable and responsible relationships and sexual fulfilment.

Implicit in these goals is the expectation that people should be safe from violations of their human rights, as well as from discrimination based on sex, race, religion, or culture. Women, in particular, should be free from all forms of sexual and physical violence. Both men and women should be seen as equal and responsible contributors to a healthy society.

Family planning enables couples and individuals to decide freely and responsibly the number and spacing of their children, and to have the information and means to do so. It also means that people have ongoing availability of a full range of safe and effective contraceptive methods that enable them to take action according to these decisions. This ability to take action is also based upon the cost of contraceptives, ideas (sometimes correct and sometimes erroneous) people have about the different methods, and the support or lack thereof of the partners, extended family members, and wider community. People are deciding to have families at both younger and older ages, and contraceptive technology is enabling them to do so. It is important that these decisions be made not only freely but also with full information about the long-term consequences for both the parents and the children. Unfortunately, there are still many women in the world who die each year from pregnancy-related services. A considerable number of these women want to limit or space their pregnancies but are without the means to do so effectively.

Reproductive rights include all the elements mentioned above related to family planning. They also include the rights of couples and individuals to make decisions about family size and spacing and about which contraceptives will be used, without being coerced or otherwise being subject to violence and other outside pressures to behave in ways contrary to what they would like. Implicit in these rights is the idea of gender equity in decisionmaking, including meeting the educational and service needs of both sexes, and addressing negative attitudes toward women and girls that often result in their having little control over their own sexual and reproductive lives.

Factors Influencing Reproductive Health Behavior

In most countries of the world today, couples have concluded that it is in their best interest (and that of their children) to plan and limit the numbers of births. Most families are having fewer children than families did in the past. In industrialized countries this trend has been happening gradually since about 1900, while in developing countries, for the most part, the change has happened relatively swiftly beginning about 1970 and the average desired family size has dropped from six children to three. Unfortunately in some situations, particularly in sub-Saharan Africa, extreme poverty, profound inequalities between men and women, and early marriage severely limit women's ability to achieve their childbearing goals. A gap frequently exists between the number of children women say they want and the number they have. More than 50 percent of women in some countries report that they would have preferred to postpone their most recent birth or not have had it at all. More than 50 million of 190 million women who become pregnant each year have abortions, many of them clandestinely performed under unsafe conditions.

Identifying factors that affect family planning behaviors helps in understanding effective ways of promoting such behaviors. It is widely accepted that simply providing information to people does not make them change their behaviors. Information is only one of the factors that contribute to behavior change. Particularly in the complex area of family planning, where there is a tremendous influence exerted by culture, tradition, taboos, sex-role definitions, and a reluctance to openly discuss these matters, it is important to understand contributing and inhibiting elements that will support or block healthy family planning behaviors.

In order to engage in safe family planning practices, individuals must feel that they are capable of what is needed. Self-efficacy, or having the appropriate skills, means, and confidence, is a critical factor in any person's decision to try to adopt a new behavior. To be effective in family planning, people need to know what contraceptives are available, how to use them, where to go to get them and how often they should be used. Being skilled, however, is only part of the process of developing capabilities for effective family planning behavior. Real or perceived barriers to obtaining contraceptives (including cost, accessibility, and lack of reinforcing and enabling support) can deter individuals. Some may find that despite their knowledge or skills, they may not be able to follow through on their desired practices due to the fact that there are elements of the system that block, deter, or discourage them. For example, some health policies may require that a woman have permission from her husband before she can be given contraceptives. Even though she may know that it is dangerous to her health to have more children, she may not seek family planning services for fear of a violent reaction from her spouse. Many people who go to health facilities are further discouraged because they feel that the health workers humiliate them, ask them difficult questions, and conduct unpleasant procedures. Costs, some of them recurring on a monthly basis, may be yet another deterrent.

Globally, and particularly in the United States, unwanted pregnancies and high levels of sexually transmitted diseases (STDs) are extremely prevalent in young people between the ages of ten and twenty-four. These are problems that are preventable through contraception and safe sexual practices. Therefore it is important to begin to reach young people early in their lives, when they are feeling the influence of many different pressures, to help them decide when and if they will have sexual intercourse, and, if so, whether they will make it a point to protect themselves from unwanted pregnancy and STDs. In order that they may plan the size and timing of their families, it is also important for young people to understand the potential consequences of pregnancies that occur too early in their lives or are too closely spaced together.

In some situations, young girls think it would be wonderful to have a child, someone to care for and someone who will give love unconditionally. At one time, young girls who became pregnant and were not married were forced to either get married, not have the child, or not keep the child. In the United States today, with a prevailing culture and social support system that is supportive of single mothers, many young girls are looking forward to getting pregnant and having and keeping their children. What is important is that they understand the long-term consequences of making this decision—economically, socially, educationally, and in terms of their future opportunities.

Although some people do not believe that their family planning behaviors put them at risk, in other cases individuals will weigh the expected positive and negative outcomes. A woman who is considering using the female condom during each act of sexual intercourse may anticipate that she will have to choose between being embarrassed at having to discuss this with her partner and reducing her risk for unwanted pregnancy and diminishing her chance of contracting STDs. (Many women also have to take into account the possible harm her partner might inflict upon her in a violent attack.) Her decision may be based upon what she feels most comfortable doing.

The prevailing peer and social norms and expectations are also going to have an impact on whether or not a person decides to have a child or how early and how often to have children. Individuals will conform to different social norms depending on age, income, sex, experience, and culture. A very strong ethical or religious culture in the home will possibly exert greater influence on the decision whether to use contraceptives or not than will that of their peer group. In the end, individuals may act according to which pressures are dominant in their lives, and which ones they feel they are the most competent to resist.

Other factors that will influence a person's decision whether or not to use effective family planning or STD protection include the media, current events, life events, social policy and legislation, and general information exchange. Private life events, such as supporting a friend through an abortion, may also produce a marked behavior change in the future decisions of an individual. Individuals are exposed to a considerable amount of information on a daily basis. Certain images and ideas may affect a behavior change, while others will be sifted and discarded by the end of the day. Repeated dissemination of information will have more of an impact than random images and messages. A well-publicized health campaign may influence an individual to adopt new behaviors, and repeated messages on public transport billboards, television, and radio may act to reinforce such a behavior change. When new behaviors are unfamiliar, other cues and associations can also act as reminders, or triggers, to individuals of their new or changed behavior. For example, if a woman associates taking a daily contraceptive pill with something she does as part of her daily routine, such as drinking orange juice or coffee in the morning, it will be a helpful reminder for her to continue this daily behavior. Behaviors can be reinforced when an individual receives positive feedback from someone whose opinion the person values. Reinforcement is a key element of behavior change and maintenance.

(SEE ALSO: Behavior, Health-Related; Contraception; Family Health; Planned Parenthood; Preventive Health Behavior; Women's Health)

Bibliography

Alcala, M. J. (1995). Commitments to Sexual and Reproductive Health and Rights for All: Framework for Action. New York: Family Care International.

Bandura, A. (1977). Social Learning Theory. Englewood Cliffs, NJ: Prentice Hall.

Etzioni, A. (1993). The Spirit of Community, Rights, Responsibilities and the Communitarian Agenda. New York: Crown Publishers, Inc.

Fishbein, M., and Ajzen, I. (1980). Understanding Attitudes and Predicting Social Behavior. Englewood Cliffs, NJ: Prentice-Hall.

Glance, K.; Lewis, R. M.; and Rimer, B. K. (1990). Health Behavior and Health Education: Theory, Research, and Practice. San Francisco: Jossey-Bass Publishers.

IPPF (1996). IPPF Charter on Sexual and Reproductive Rights. London: Author.

Rice, M. (1996). "A Framework for Developing Health Promotion and Education Initiatives in Reproductive Health." Promotion & Education 3(3):7–10.

—— (1996). "Reproductive Health as a Global Issue: New Opportunities for Health Promotion and Education?" Promotion & Education 3(3):3–5.

United Nations (1995). Population and Development: Programme of Action adopted at the International Conference on Population and Development, Cairo, 5–13 September 1994. New York: Author.

—— (2000). Key Actions for the Further Implementation of the Programme of Action of the International Conference on Population and Development. New York: Author.

— MARILYN RICE

For more information on family planning, visit Britannica.com.

The use of education and birth control to limit the number of offspring and the population of a country. (See population control and Margaret Sanger.)

This article is in need of attention from an expert on the subject. WikiProject Medicine or the Medicine Portal may be able to help recruit one. (November 2008)

The examples and perspective in this article may not represent a worldwide view of the subject. Please improve this article and discuss the issue on the talk page.

Combined oral contraceptives. Introduced in 1960, "the Pill" has played an instrumental role in family planning for decades.

Family planning is the planning of when to have children,^[1] and the use of birth control^[2][3] and other techniques to implement such plans. Other techniques commonly used include sexuality education,^[3][4] prevention and management of sexually transmitted infections,^[3] pre-conception counseling^[3] and management, and infertility management.^[2]

Family planning is sometimes used as a synonym for the use of birth control, though it often includes more. It is most usually applied to a female-male couple who wish to limit the number of children they have and/or to control the timing of pregnancy (also known as spacing children).

Family planning services are defined as "educational, comprehensive medical or social activities which enable individuals, including minors, to determine freely the number and spacing of their children and to select the means by which this may be achieved."^[4]

Contents 1 Purposes 1.1 Health 1.2 Finances 2 Policy 2.1 International 2.2 China 2.3 Hong Kong 2.4 Iran 2.5 United States 2.6 India 3 See also 3.1 Organizations 4 References

Purposes

Raising a child requires significant amounts of resources: time,^[5] social, financial^[6], environmental. Planning can help assure that resources are available.

Health

See also: Maternal health and teenage pregnancy

Waiting until the mother is at least 18 years old before trying to have children improves maternal and child health.^[7] Also, if additional children are desired after a child is born, it is healthier for the mother and the child to wait at least 2 years after the previous birth before attempting to conceive (but not more than 5 years).^[7] After a miscarriage or abortion, it is healthier to wait at least 6 months.^[7]

Finances

See also: Family economics

Childbirth and prenatal health care cost averaged $7,090 for normal delivery in the US in 1996.^[8] US Department of Agriculture estimates that for a child born in 2007, a US family will spend an average of $11,000 to $23,000 per year for the first 17 years of child's life.^[5] (Total inflation adjusted estimated expenditure: $196,000 to $393,000, depending on household income.)^[5]

Policy

A family planning facility in Kuala Terengganu, Malaysia.

International

See also: International Planned Parenthood Federation, Marie Stopes International, and United States Agency for International Development

The world's largest international source of funding for population and reproductive health programs is the United Nations Population Fund (UNFPA). The main goals of the International Conference on Population and Development Program of Action are:

• Universal access to reproductive health services by 2015
• Universal primary education and closing the gender gap in education by 2015
• Reducing maternal mortality by 75% by 2015
• Reducing infant mortality
• Increasing life expectancy
• Reducing HIV infection rates in persons aged 15–24 years by 25% in the most-affected countries by 2005, and by 25% globally by 2010

The World health organization (WHO) and World Bank estimate that $3.00 per person per year would provide basic family planning, maternal and neonatal health care to women in developing countries. This would include contraception, prenatal, delivery and post-natal care in addition to postpartum family planning and the promotion of condoms to prevent sexually transmitted infections.^[9]

China

Main article: One-child policy

China's one-child policy encourages couples to have no more than one child. China's population policy has been credited with a very significant slowing of China's population growth which had been very high before the policy was implemented. It has come under criticism that the implementation of the policy has involved forced abortions and forced sterilization. However, while the punishment of "unplanned" pregnancy is a fine, both forced abortion and forced sterilization can be charged with intentional assault, which is punished with up to 10 years' imprisonment.

Hong Kong

In Hong Kong, the Two is Enough campaign in 1970s encouraged people to have 2 or less children in each family, it contributed to the reduced birth rate in the following decades.

Main article: The Family Planning Association of Hong Kong

In Hong Kong, the Eugenics League was found in 1936, which became The Family Planning Association of Hong Kong in 1950. ^[10] The organisation provides family planning advice, sex education, birth control services to the general public of Hong Kong. In the 1970's, due to the rapidly rising population, it launched the "Two is Enough" campaign, ^[11] which reduced the general birth rate through educational means.

The Family Planning Association of Hong Kong, represented as Hong Kong's national family planning association,^[12] found the International Planned Parenthood Federation with its counterparts of seven other countries. ^[13]

Iran

Main article: Family planning in Iran

Iran is another country which has succeeded in sharply reducing its birth rate in recent years.

United States

See also: Title X

Title X of the Public Health Service Act,^[14] is a US government program dedicated to providing family planning services for those in need. But funding for Title X as a percentage of total public funding to family planning client services has steadily declined from 44% of total expenditures in 1980 to 12% in 2006. Medicaid has increased from 20% to 71% in the same time. In 2006, Medicaid contributed $1.3 billion to public family planning.^[15]

India

The Indian government has come up with measures to control population and increase awareness of the benefits of reducing population growth, which include better lifestyle, education, environment, health and well being of every individual. Despite these attempts, couples^[who?] cite the need for company for their child.^{[citation needed]} Couples^[who?] feel that they can afford more than one child and do not realize that the environment needs to be able to provide for an increasing human population. Awareness campaigns include "We two, our's one", "Girl or Boy, let there just be one child".^{[citation needed]}

See also

Sustainable development portal

• Family
• Life planning
• Cost of raising a child
• natalism and antinatalism
• Parental leave
• POPLINE: World's largest reproductive health database, part of The INFO Project
• Sex selection

Organizations

International

• International Planned Parenthood Federation
• Marie Stopes International
• Centre for Development and Population Activities

National

• British Pregnancy Advisory Service
• Family Planning Association (UK)
• Family Planning Association India
• Family Planning Association of Hong Kong
• German Foundation for World Population (DSW)
• National Alliance for Optional Parenthood (USA)
• Planned Parenthood (USA)

References

1. ^ "Mission Statement". US Dept. of Health and Human Services, Office of Population Affairs. http://www.hhs.gov/opa/about/mission/index.html. 
2. ^ ^{a b} Family planning - WHO
3. ^ ^{a b c d} What services do family planning clinics provide? - Health Questions - NHS Direct
4. ^ ^{a b} US Dept. of Health, Administration for children and families
5. ^ ^{a b c} "Expenditures on Children by Families, 2007; Miscellaneous Publication Number 1528-2007". United States Department of Agriculture, Center for Nutrition Policy and Promotion. http://www.cnpp.usda.gov/ExpendituresonChildrenbyFamilies.htm. 
6. ^ MsMoney.com - Marriage, Kids & College - Family Planning
7. ^ ^{a b c} "Healthy Timing and Spacing of Pregnancy: HTSP Messages". USAID. http://www.esdproj.org/site/PageServer?pagename=Themes_Spacing_KeyMessages. Retrieved 2008-05-13. 
8. ^ Mushinski, M. (1998). "Average charges for uncomplicated vaginal, cesarean and VBAC deliveries: Regional variations, United States, 1996.". Statistical Bulletin 79 (3): 17–28. 
9. ^ "Promises to Keep: The Toll of Unintended Pregnancies on Women's Lives in the Developing World". http://www.globalhealth.org/news/article/2319. Retrieved 2009-02-03. 
10. ^ History of the Family Planning Association of Hong Kong
11. ^ History of the Family Planning Association of Hong Kong
12. ^ History of International Planned Parenthood Federation
13. ^ History of International Planned Parenthood Federation
14. ^ US Office of Population Affairs - Legislation
15. ^ Sonfield A, Alrich C and Gold RB, Public funding for family planning, sterilization and abortion services, FY 1980–2006, Occasional Report, New York: Guttmacher Institute, 2008, No. 38. http://guttmacher.org/pubs/2008/01/28/or38.pdf

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