This paper has focused principally on the health benefits of family planning, and their realization through provision of health services including family planning.
Evidence is presented which supports the conviction that increasing family size, particularly with closely spaced pregnancies, is associated witn
(1) higher maternal, fetal, neonatal and postneonatal mortality and morbidity;
(2) higher low birthweight rates and their se~lelae; (3) increasing
incidence of infectious diseases in parents and children; (4) poorer growth -both height and weight - among pre-school and school children:
(5) relatively poor intellectual development among children, and (6) increased prevalence of certain diseases among parents. Under current conditions; children and parents in well-spaced smaller families appear to enjoy better health status. Although emphasis has been placed upon the health benefits of spaced pregnancies and limiting family size, family planning in health services also properly encompasses a concern for
infertility and sub-fertility.
n/cs. v,/POP/123 Page 32
This ,resume of our knowledge to date should be considered in the light of the following implications for policy development and in relation to the requirements of health services and family planning, and programme planning.
The achievement of well-spaced smaller families for all socio-economic groups should result first of all in better survival rates and health for mothers and children, and for families in·general, throughout the world. 14othe::s in good health whose nutritional status is adequate and has not been depleted through frequent childbearing are less
likely to deliver infants at risk as the result of low birth weight.
Whe~e maternal mulnutrition and anaemia are prevalent, health and socio-economic conditions marginal, and health services not well developed, the adverse effects of frequent pregnancies are much greater and more common.
Other potential health benefits of a regulated family size and child spacing operate in a less direct fashion but may also be reflected in lower death rates and less disease and disability. Overcrowding and its concomitants will be much less serious and parents will have more food, resources, energy and time to offer to each child. This will result in less malnutrition and impaired growth and development of their
children, with greater resistance to childhood infectious diseases, especially where maternal and child health services, including family planning can be made available. Children may be better cared for, with less exposure to accident situations.
Parents should be less suscept'ble to certain chr~nic diseases, and smaller family size may promote th~ir better mental health and marital adjustment. They will be more likely to continue their own development as individuals, particularly mothers, who being less depleted and less exhaust ed ',:ill be less likely to neglect their children and themselves.
They should be able to breastfeed for a longer period, and interest in infant health care and family planning should increase. The economic benefits of fertility regulation will Ultimately make higher
educational aspirations for children more achievable. No less important to attaining these aspirations will be the improved intellectual
development resulting from greater stimulation, in early childhood as a consequence of the better physical and mental health of the parents.
The rationale and advantages of 'integrating family planning with maternal and child care and other family and community health measures have been outlined in some detail in this paper. A broad maternity-centred approach to family planning which concentrates on the provision of maternal and child health care including family planning, is gaining wide acceptance in urban hospital settinp,s and gradually is being adapted to rural areas.
Since the establislunent of the first national family planning pr programmes in the early 1950's, there has been a considerable increase in the number of countries adopting policies favouring or supporting family planning activities. It is estimated that more than four-fifths of the population in developing areas live in countries that favour family planning. In developing countries the growth of family planning programmes in the context of health services is especially related to coverage for rural areas. Organization and administration, of course, vary from country to country. Whatever type of system of programme delivery is selected, there are a number of common conditions that influence its effectiveness, including the degree of confidence people have in the health services, the availability of resources and quality of care provided, and the commitment of health service personnel to their work.
Mass communications have proved useful in some countries but their ultimate effectiveness is greatly dependent upon meaningfUl personal contacts.
To bring about the benefits of family planning in a given society, health workers and health services should help couples on the basis of the individual benefits for the family, individual goals, individual plans, their particular felt needs and the cultural values of their society.
Sensitivity to needs will remain a prime consideration for health services providing maternal and child health and family planning care. For harassed parents burdened with the many health problems commonly found in developing countries, the offered advice and care may be impossible to take up and therefore may be more guilt-producing than they are helpful. With better spaced, smaller families, recommended nutritional, immtlnizatioa, environ-mental and other health practices may achieve new relevance and be more
effective. Postpartum amenorrhoea, breast feeding and weaning practices are factors of major importance in fertility regulation and infant and childhood survival. Traditions affecting the age at marriage, the value attached to large families and the birth of sons, and attitudes of
particular persons in village communities, including traditional birth attendants and community opinion leaders, must be carefUlly considered in programme planning and implementation.
The world shortage of health manpower represents a serious obstacle to the provision of health services, inCluding family planning. Health manpower development often proceeds without the attention to type,
qualification, number and availability of personnel that is a prerequisite of rational programme planning and ~pleinent~tioll. Special attention is given in this paper to education and training ot physicians, nurses, educators and administrators, health educators and health aux:liaries, including trained midwives, in all aspects of family health n.c ludmg
maternal and child health and family planning, as well as to the introduction of training to give administrative and managerial expertise. Training of traditional birth attendants and other indig~nous practitioners who can support measures for family planning and maternal and child care are also discussed. Finally, careful consideration is given to the role of workers
in other sectors, such as public administrators, social workers, teachers, community development workers and domestic economists.
E/CN.14/POP/IZ8 Page 34
Development and strengthening of services for the prov1s1on of health care, including maternal and child health and family planning, to the rural areas is the challenge that most of the developing countries are facing at the p~esent time. Efforts are being made for the best utilization of existing skills and resources while development of further manpower of other resources continues. There is active interest among national and international bodies in the study of health service structure and functioning aimed at introducing changes that can improve efficiency and effectiveness of health s erv i.ces , Use of mrrageria l expertise to improve the quality of the care provided is an example of the efforts that are being made which improve coverage and utilization of health services.
If parents are to be motivatecl to plan their fanilies, they require assurance that the children, in whom they invest so much, ..ill survive and will grow up to be healthy and product ive , Parents also require help in maintaining their own health. It appears clear that family planning is an important means of improvin<; health. It is also
increas~nglyclear that improvements in health can make an important contri9ution to family planning. This interaction carries the obvious policy implications that long range integration of family planning and health is theoretically sound, is administratively practical and efficient, and will produce greater impact upon the individual, the family and
society.
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