**Family Planning Services in Africa: The Successes and Challenges Challenges**

**Family Planning Services in Africa: The Successes and** 

DOI: 10.5772/intechopen.72224

#### Alhaji A Aliyu Additional information is available at the end of the chapter

Alhaji A Aliyu

Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/intechopen.72224

#### **Abstract**

The world population is on the increase, and the majority of this increase will be from sub-Saharan Africa (SSA). It is estimated that by 2030 the population of Africa will rise to 1.3 billion. Published peer-reviewed journals, abstracts, Gray literature (government documents, technical reports, other reports, etc.), internet articles and Demographic and Health Surveys (DHS) reports were used as resource materials. Manual search of reference list of selected articles was checked for further relevant studies. Family planning (FP) programmes that started in 1960s across SSA have made steady progress with contraceptive prevalence rates still very low and unacceptably high unmet need. Despite near universal knowledge on contraceptives, there is an obvious knowledge-practice gap. There are barriers, personal, religious and community levels, to contraceptive use. Contraceptives have a lot of benefits to the mother, child and community. Thus, there is a need for publicity campaigns through information, education and communication (IEC) to address social and cultural barriers to FP including misconceptions and misinformation. Contraception should be vigorously promoted in SSA not only for its demographic dividends but also on socio-economic and health grounds and the attainment of sustainable development goals (SDGs).

**Keywords:** contraceptive use, benefits, barriers, unmet need, SSA

#### **1. Introduction**

The world population reached 7.4 billion in 2016 at an annual growth rate of 2.55% with Africa accounting for 1203 million. It is estimated that between 2015 and 2030 the population in Africa will reach 1.3 billion [1]. Sub-Saharan Africa (SSA) (excluding North Africa) has seen remarkable population growth in the past three to four decades. SSA population in 1990 was 510 million, 688 million in 2002 and by 2016 has reached 974 million [2]. By 2050, three countries (Nigeria, 4th, Democratic

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© 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons

Republic of the Congo, 8th and Egypt, 10th) with a combined population of 779 million will be the most populous nations in Africa [1]. Sub-Saharan Africa (SSA) has 11% of the world population but accounts for a pitiable 2% of global trade [3]. The population growth is largely driven by high fertility rate and rising cohort of women of reproductive age group (WRAG) (15–49 years).

Contraception refers to the prevention of pregnancy as a consequence of sexual intercourse using either traditional or modern methods. The 1994 International Conference on Population and Development (ICPD) in Cairo was a paradigm shift and was seen as a turning point with respect to the role of FP. The earlier population conferences, Bucharest 1974 and Mexico City in 1984 mainly focused on demographic-economic issues. However, the Cairo Conference highlighted the important role FP plays in the context of social and economic development and goals regarding sexual and reproductive health and right including FP with a focus on women's empowerment [14, 15]. The universal access to FP that links the 1994 Cairo Conference to Millennium Development Goal 5b (MDG 5b) of universal access to reproductive health is very much connected to the successful achievement of sustainable development goal (SDG) themes of people, planet, prosperity, peace and partnership [16]. Voluntary FP brings transformational benefits to women, families, communities and nations. Without universal access to FP and reproductive health, the impact and effectiveness of offering interventions will be less, will cost more and will take longer to achieve [16]. The demand for FP will never cease as long as life continues to exist on earth, and humans want to satisfy their physiological desires and need for procreation (generational species sustainability). At any point in time, there will always be a cohort of young adult couples who not only want to fulfill their sexual desires but also want to delay or postpone pregnancy, and so

Family Planning Services in Africa: The Successes and Challenges

http://dx.doi.org/10.5772/intechopen.72224

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In SSA, health-care systems are weak and dysfunctional; despite this, there have been some remarkable gains in immunization services with resultant decline in death rates among under-fives. Yet, fertility has remained high. Added to this dimension is the unprecedented rapid urbanization that is sweeping across the continent. There is still a long way to go to achieve small or desired family size. In the whole region, only 17% of married women are using contraceptives, very much lower than the 50% reported from North Africa. Only in five countries (South Africa, Botswana, Zimbabwe, Kenya and Malawi) have FP programmes been a success to increase contraceptive use to higher levels [3]. This chapter is based on FP services in Africa. Published peer-reviewed journals, abstracts, Gray literature (government documents, technical reports, other reports, etc.), Internet articles and Demographic and Health Surveys (DHS) reports were used as resource materials. Manual search of reference list of selected articles was checked for further relevant studies.

The period 1970–1990 marked the golden era of family planning during which reproductive revolution occurred worldwide except in SSA. However, by the early 1990s, changes had begun to occur leading some experts to suggest that population and FP programmes started in the late 1960s in developing countries constituted one of the most important public health success stories of the twentieth century [14]. Benefits of FP were known ever since Beard in 1897 observed that ovarian follicles do not develop during pregnancy and that corpus luteum was responsible [17]. There are a variety of health benefits that are associated with the use of individual FP commodities; for instance, pills, injectable and implants have been associated with protection against uterine and ovarian cancers, benign cysts of the breast or ovaries and pelvic inflammatory diseases (PIDs). Pills can also reduce menstrual flow and dysmenorrhea

the demand for contraception will continue.

and decreased prevalence of iron deficiency anaemia.

**2. Benefits**

Demographically, there is population momentum across most of the countries, as more than half of the population are under the age of 15 years. What this means is that even if replacementlevel fertility is achieved, the population growth will continue for at least two decades because of the momentum built up in the age structure due to the past high fertility levels that has given rise to the greater number of couples who are having children. Social forces and pronatalist factors sustaining high fertility and which also impedes family planning (FP) programmes are well known [4, 5]. Added to this is the fact that in SSA husbands tend to want large families than their wives [6, 7]. Sub-Saharan African countries are still undergoing both demographic and epidemiologic traditions. Even though birth rate is declining, it is still in excess of death rates. Thus, the region has the highest rates of fertility globally with total fertility rates (TFR) that ranged from 4.8 children per woman in Kenya, 5.2 in Nigeria, 5.7 in South Sudan, and 7.6 in the Republic of Niger [1, 4, 8, 9]. It also has a high annual growth rate of more than 2.5% per year.

Again, the same continent is vulnerable to the "destructive forces" caused by nature as recent events have shown. The harsh adverse effects of global warming in the Sahel region, draught/ famine in the horn of Africa, deforestation, overgrazing with declines in soil fertility and incessant floods in West Africa has contributed in sustaining the vicious cycle of poverty and disease. As the number increases, the pressure on the environment (both built and natural) including natural resources and available fertile land for agriculture increases. Consequently, the net effect is increased in greenhouse gases (GHGs) with its attendant effects on public health.

Before 1970, majority of Africa countries had not viewed population growth as a major factor in their national development strategies because of their small population (34 of the 48 countries had a total population of less than 5 million) [8]. By the mid-1970s, the trend started to change with the rising number of national governments that reported having population policies aimed at reducing the rapid growth of their respective populations: 25% in 1976, 39% in 1986, 60% in 1996 and 64% in 2009 [9]. Previously, pronatalist governments that wanted to maintain or even increase population growth have gradually modified their stance and accepted provision of FP services as integral part of maternal and child health (MCH) which is a key component of primary health-care (PHC) system. Also, government policies regarding access to and availability of modern contraceptives have been an important determinant of reproductive behavior as well as maternal and child health. Many governments have given direct support providing FP services through state-owned health facilities. The provision of FP services is a key component of Safe Motherhood Initiative launched in 1987 in Nairobi, Kenya, to reduce maternal mortality in developing countries, where 99% of all maternal deaths occur [10]. In African region women have 1 in 42 lifetime risk (compared to 1 in 2900 in Europe) of dying prematurely in childbirth [11]. Provision of universal access to high-quality family planning and maternal health services and skilled attendance at delivery are key action strategies under the safe motherhood initiative [12]. Contraceptive use averts about 230 million births every year globally, and family planning (FP) is a primary strategy for prevention of unwanted pregnancy [13].

Contraception refers to the prevention of pregnancy as a consequence of sexual intercourse using either traditional or modern methods. The 1994 International Conference on Population and Development (ICPD) in Cairo was a paradigm shift and was seen as a turning point with respect to the role of FP. The earlier population conferences, Bucharest 1974 and Mexico City in 1984 mainly focused on demographic-economic issues. However, the Cairo Conference highlighted the important role FP plays in the context of social and economic development and goals regarding sexual and reproductive health and right including FP with a focus on women's empowerment [14, 15]. The universal access to FP that links the 1994 Cairo Conference to Millennium Development Goal 5b (MDG 5b) of universal access to reproductive health is very much connected to the successful achievement of sustainable development goal (SDG) themes of people, planet, prosperity, peace and partnership [16]. Voluntary FP brings transformational benefits to women, families, communities and nations. Without universal access to FP and reproductive health, the impact and effectiveness of offering interventions will be less, will cost more and will take longer to achieve [16].

The demand for FP will never cease as long as life continues to exist on earth, and humans want to satisfy their physiological desires and need for procreation (generational species sustainability). At any point in time, there will always be a cohort of young adult couples who not only want to fulfill their sexual desires but also want to delay or postpone pregnancy, and so the demand for contraception will continue.

In SSA, health-care systems are weak and dysfunctional; despite this, there have been some remarkable gains in immunization services with resultant decline in death rates among under-fives. Yet, fertility has remained high. Added to this dimension is the unprecedented rapid urbanization that is sweeping across the continent. There is still a long way to go to achieve small or desired family size. In the whole region, only 17% of married women are using contraceptives, very much lower than the 50% reported from North Africa. Only in five countries (South Africa, Botswana, Zimbabwe, Kenya and Malawi) have FP programmes been a success to increase contraceptive use to higher levels [3]. This chapter is based on FP services in Africa. Published peer-reviewed journals, abstracts, Gray literature (government documents, technical reports, other reports, etc.), Internet articles and Demographic and Health Surveys (DHS) reports were used as resource materials. Manual search of reference list of selected articles was checked for further relevant studies.
