Alter natives to Tra ditional Approac hes in th e Fo r mulation and Im plem ent a tion
of Fa mily Plann ing Prog r a mm es in Africa n Co untries
A_ _
"k> ••mbef 1993
COiiIIlJl'TS
t , IM'I1«lOUC'I'iOIll • • • • • • •
· · . · · . · . . · ·
•n.
11lAD11'I OMAL AP"""-'CH~ eo.. "'"
SPACIIIC/"...ILyt'lAJfIfIlllG
. .
• • • • • • •· . ·
L A Re v i .w
er
Ava ilable Llt..... tu .... . •(. j f.:qypt. • • • •
(b j Ke nya • • •
(ej Nigeri a • •
(' j Ta nz.-nh • • •
•
(. j U,,_nd" • • • • • • • •
(" h i re
(q ' Zallbl .. • •
a.
Lillita t10nao.
Tradit iona l ApprGolOCn ea . •, •
, ,
• • , • •
"
..
11 1. ORGANIZED MODER" FAMI LY PLANNiNG
PROG RAKK£S AS ALTERHATIVES TO TRADITIONAL
APPRQACHES TO BIRTH SPACING/FAMiLY PLANMING
· . . . . . "
IV l 1ilGR8Diun-s Of" SUCCESSFUL OII:GAJUZm BIRTH SPACIIICfJ'AJU LY
"U""1II 11C P'ROGKAJIIIKS • • • • • • • • • • 16
1. Appl lc.t lon ot St r.teglc Planni ng. • • • • • • 17
~ . Fa. 1l y Pl ann i ng as an In t eqral Fa rt of Ov.rall SocIO-Eeonoll.ic Develo f"N' nt and NOt. On ly o\11N"d
at Reduct ion of f ert. l l i ty • • • • • • • • • • 18
J . ""'dr• • • in<;! t.1I.. H...lth Mft@Q'" of Childr",n, WOllOn
and Ado l . tlc..nt~ • _ • • • • • • • • • • 19
(a, AddrPR" l ng the Healt h liI",eda of Childr "'n • (b) Addre tnq the He a lth Meeda of Wo~en • •
(cl Addr lnq th.. H....lth Meeds of Ado lescent.. •
ac
""
• Goverrulent. POlley and CO. .
a • •
mt. t.o su pport....ily Planning Praqr...-• • • _ • . • • • • • 2.
,.
••
Appropriate lntor~n. i on, EduC'lt ion and Co •• unl c . tion (lEe) to S~pvurt Proqra~e .
Inv o l v i ng Men, WODen , You th, "n d COBnu nit l .a
"
"
(. 1 In vg l v l nq M" n • • • . lbl InvolYlnq Wo_n
lcl In vol v l nq Yout h
ld l COBBunlty Invo l ve~n t
•
• •
"
"
.n n
7. rever v•••nt
or
tho Pr iv a ta s.ctor . M Non- Govarn.ent. l Or g a niz llt ionll (NGOa) • • • • • •"
e.
Proqr-.-a t o Giva Spec i al Attenti on toQudlty or servi c •• • • • • • • • • • • • •
"
••
Ieproved 001.. ..
Statusor
Wo ••n • • • •"
10. Proqrll. . . . to Re lleh tho "lij ori t y of tho Un•• rved Popu l a tion, E6pecia l l y thosa in Rural Ar••• .
.
• • • • • • • • • • • • • • • •"
11. Proqra_ MAna g a _ nt • • • • • • • • • • •
"
V. SlJlOlUlY AJm COIfCLUSIOff • • • • • • • • • • • • • •
..
SELECiBD 81 8LIOCRAPHY • • • • • • • •
.,
u
"...tt_~I"O .
c: i eveCleMlt
,
cont r acapti V<l v •• t.o In U uence De_uP'llc Trend. In AIrl can COunt..1.... 19~1 .
'nil. at. "","y h In 5 ...,Uona includ l nq tile Introduct. l on in
5ect.lon t . section II ... vl_ _ ....U.bl . 11t. .·.tll... on tradi tional approooch•• of blr tll apa<'inq/f•• Uy pJ_ IInln; and tJleh" ibIUU on_.
section III d_ l & ..lt ll orqanlted _ rn h aUy PJ'oqra_ . . . alternaU ve tG tra.U tio nal IpprO*cb. .. ~ta.lled dl a c". . lon on Inqn odt...U of __ t ill orq& " I. .", bl.-tlla ape.ci nq/t...U y plann l nq proqr . - ia pr_nted In Section III. ... . u.... ry alld c(,""I_ lon a...
In 5ect.i on II.
II. ftoIIDITlOUoL APl'JICN:ll.ItS '1'0 Illll'nl SPACllfG/I'AlULJ Plo\IIIltlfC
1.... Revi_ of Ava i l abl e Ll t erat ur • •
0l11d apot<: l ll9 II•• bean pncU a8d In Atrl c an countr l•• for . . ny . 90' • ...1"9 t r-di Uonal Drtlloda. So<:hl and. .. cllttu r d val and no"'''''in t babel p edpe.. t epa,,"to anfo rbe,..,....ce chlld2 toapacll""J _ Iv_n an . .ny .,.. . .pllrt. 1'llh. m••Ud• a"h"hVad
_ r.
ad nly tlIrouqb prol 0ft9c ••""al ablU ...""a arta.. 91 1119 bi rthl prolOllged br. . .t ra adl nq/ •••"a l t . boo. . t t .r ql inq bi r thl abortion, . nd otlMor
_tho<1.
11k. rllyth.al ..ithd.r a11 doudl••Indiq.ooua h. r boJ . nd _e<11ci"•• h""'8 al.o ~n 1,l.acl in At r ic8n COWlt ..l •• to pr....ant COIIC.ption. The 1I<>..ld I\e..l t h ~..ni."t i01l h...
dOC\Ull. nt8<l O"'ar ~oo dH t"r"n t planta and .uboot •...,.. Jn Atd c . ""l el'l 1'1... ~n
""ad
a. tradl tlONI COfltr.OIIpU.... . .nd "bortH"cl.nt "p to 1981 V . Tha Uta... t ... r""l _ . l ao ine lud. . . .qle. l ""thod.which
II."'.
_ n ua8<l In the balt.f of p... ... ..ntlnq pr.qn.nc:y toe",,,.re npactad birth Jnt"rval
"-"'I
t il" cllildr"n. lila-til. """1 ",,
... . pr.cthad In th. pe.t . .Inly tor lapro... lnq t h. h••lth of t"- child . nd the 80th" and nut for 11.1t lnq f. .i l y .1 ••••• 1.l"9"
~•• l ly .. i lu.d for aeny r. .~. A b..i"t r..,l _ Of th"
..paeHic
ea_
Of tr..dltionll _thoda of ch ild "peclnq t h . tn .... "
been uaad In ._ of tile count ..I .... in Afdea h pr_ . ntacl bale>v.
(.) ~
I t h". be" n re port ad fro a Nor t n Afric.. th..t _ .". I" t he p....t . ..= kad tn" (rot l> troa
" . _ 1 ,, '
ao"th 'Ond dr.n~ .... ter tl>..t hadbe"n
" .ad
to batll" tna d...,d • • • _ n" tg pre...""t pr"'i!"ancy. !/ Firat _nUg" of cont racep1:l on by !'ly pU .. n. d ..t _ a' t.r .... 18'0U r n l l ! f l M n 1nq "lth od 9...nd.l'ractlcC_.A ~ric ". I n l. Center for
Dl ••••• Cont ro l , Atl a nta.
cao...,ta .
p.22.!.IEu ••betll 1(. Edaenda, CoDS. ph .nd III" " I" " "Jly Pl"nn lng ; Gui d . U n.1 for Nuu n , Mi d..lv ", .nd oth..r IIl111 th l'e["lioM . l . Univ"rllty of No r t h Cl r o llna , Clla pe l Hi l l . 1984. pp. )-4.
)
. y - on
7 I
s
years . 1/ In 8uat)'& Dletcl ct 818 11a r fir>ding ll wer o obse r v o d by Wder i tu - sexual abst i nence wall prllet i _lId till the chi ld WlIS about to ve lk. Nder lt u noted t h. t the dl vl . i on ot the house into 2 parts whe reby on. part of the hous e WlIS exclulI lvel y for the wite end the other tor the hu .~nd wae eore st r ictl y abae ned after giving birth, and durIng lactatI on there wa. tot . l _. xua l abstInence. 21
~q the Mer 8qot ! people of We .tern ~.ny•• ao" of the. ha ve been re po rted t o have us ed her bal _ l e in. tor cont race pt io n apart fro.
sexua l at.tlnllnce . W Ttl_ he rbs _ re provided by tl':'lIditional aed lclne . .n who kept the IntQ~. t lon on . edIc t n. used . aec r e t .
Chil dre n were apaced at en Inte r va l of 2 y.ara.
tn the 19 80 . , and especiaUy . tter 198!>, the COve r n_ nt of Ke nya revit a U u d end intendfied i t . eU orts to i.prove the pf'lIIctic e ot famil y planning thf'ougn ol"qlll nhed fa. il y p18nning pf'ogf'lII_ e s eo that the popule tion u. e ~em taaU y p18 nni ng aetho<:b , 11I1 opposed to tr-a d iti on lll i Ilethod l . Gove r-n_ nt pr ov iaes fallil y p18nnlnq Benic.. thf'ouqh the Mini stry ot He al th Inrf'a struct.ure: hQspl t.al. , lJi.~ns. f'is., snd cli n i c s. The s e aen ice 8 have been decentreliled up to the distf'lct leve l.
MOf'e ove r , t.he pf'i vat. a.ctor IlInd non-qovern••nt al or qlll nilat.t ons are all involVed in pr ovid ing fa _i l y planning .ervices in the coun t.ry . The effo rt a or the or qlln i lad ta mily planning aervicea are beginning to show result.a. The .ea n Idaal ta _ ily ai l . whi ch was about 6. 2 acco r di ng to tha Kenya Fertilit y Surve y ot 19]7/78 declined to 5. 8 in 1984 as retl ected In the r.eulta Ira. the Aenys COntrac ept.ive Pre val e nc e Survey In 1984, and decl ined furthe r to 4.4 Child ren in 1989 acco~inq to the JCf/nya Da.oqr aphlc and Health Survoy . In 1989, about 18' at aar r led woae n we re u.lnq • .ooe r n .et.hod ot cont raception whi l e
9'
wara usi ng e trad it i ona l . .thod . Whi l e In 1977/78 onl y 17' or eVf/r aar riec1 _ n In Xenya want ed no .ar e child r en . this rlqu re rose to )2' In 1984 and 50' in 1989. The 1989 I/M4ry Nder itu , -Li te r a ture Revi ew: Daaoqr a phic and Health Pf'otlles and CUl tur al Pr acticee that AUe ct Reproduct ive Helll l th , 199 J- prepared tor the Fa.ll y Plann ing As.oclat ion ot )(ony o , and -SOCI. l CUl t ur al ProUle or Siaye Dietr ict -, "inb t ry or Plenn inq and Wat i onal Developll8nt and tha Ina t ltuto of African studi.a, Un lveraity of Na irobi , 1987•.ill"ary Nderitu, -Li t era t ure Review: Del109raphic and Iff/alth Protiles and CUltu r al Practices that Af f ect Reproductive Healt h, 19'ilJ-, pre pared for the Faally Planninq As. ociatlon of Kenya: and ·Socl a l CUltural PrOf ile Of Bu. i . District -, by the Min i st ry of Pla nn inq and Nat i ona l Developlloent and tho Institute Qr Afr ican St ud h ' " , Unlversit y of Nairo b i, 1987.
~ R. Ser a h . M. Luka l o -The Ma r aqol i or Wester n K. nye- In Ange )a Kolnos , CUl tu ra l Sourc e MAter i Al s for PopulAtion PlAnning in Eas t Af r iCA Vol. J Be l i e f s ADd Practice , Instit ute of Afr i ca n St udl ••, Uni ve rsity of Nai robi, 1973, pp. IJ9- 140.
e a c
(
on 0 e
doc u nte he
i 0
P. o .
9
a 1 0.31,
ng
,
I" ) . douc:tM 13') , end ot ll. 1' . .t.hoclII
en ). W
Se xull1 Ilt . t i....nce•ft er deli ve ry .v.r . ~~ ebout 2 1/2 y••
r . .
Yor~ . ~li.v. t ha t ••~ki nq child q_t e .lek if tft. ~th.r ha. interca ur. . becau.e the 1lP4lr-.. toZCM pollute . end poill0ft8 the .Uk. Ttley ell10 beUeve that . .xulll rel etl ora tn. to . r e pr....tur . ly 1'. .. . . . aoon beforll the . ..~ Int n v lll , accord! "", to CWIU.• • ftllr delivery . re Ind_ ent . net 1"'1'41 and My be Ilut>j.ct t.o ...nia~t. by thll qods or
.ftC*.to~ Ilpi rl t• •
ov.nll u. . of fa.Uy pla ""lnq i n Ifi q _r i . f r _ ...,dl. b le
.u~ya 1_ very low .
n..
1911/82 "l q_l' l _ "ertili t y SUC"ll y Indicated t.llat •.,nq Il&rTIed _ no 4.8\ _I'll ..Ill"" • _ thod of fll. i l y plennln<;l. of whi ch 0 . " _ n. udnq .. ..xIlrn _ t bod. R••ulte froll the 199 0 1f! '1lld a De-oo;lnphlc and Health SUrvey did not IlI\Olf euch Chanqll • 6.0' _rll ull l l'1q .. ,.,e U y plannInq_ tlwd.
Of thill,J ."
_ n ulli nq • .cIdern _thod of I ••l ly plann lhCJ. III 1918, N191lr la Ildopt.ed en explicit. popula tion polic:y to influence d8W!09rllphl c tntnd ll. Bpec:l Uo u rqe t.a re l eU nq to fe r t il it y . pop<l1atlOll IJrovU\
rate, a. val l e. u.a of contraceptlv. . , . .re Includ8d. Orqonlled fo. il y pl.nnl nq pnIlJU _ ...111 hoIve to btl i-.ple_nt-.1 to . , . I .t tM at t.aln-.nt ot tn. objecUve, end qO&l. at u.. _tional popul,tiOll policy.
(d) Tan lA nio
~nq the Cha09a of Nor tn -Ea s t ern Tonl,ni . ,
cu. eo.
d.... not anow s nu,r.inq 80ther to d _p wi t h her hWlband. I t i . btIUaved that the chi ld qata • 00101 it that happena and the chil d vi I I not qrow at ronq. l i / Tha child1.
suck l ed tora -1
years aceordinq toc:uotoll. A ... con.lder. It e .taf o rtun. It ,he beor, children vho are cl_ely ,pae.c1. In .uc:h ca'_ 'he i , 8ClOrned. and. rldle:u.l ed by h. r neiqllbo!.l~. Other occ••ion. of ••xu,l .bati...". _ r. of».rved . aonq tha Cha nq . duri nq aouroinq at a dead chil d, dead par e n t , or . if e. Th. period at ebet.1ne nce veried depend.Jnq on who di edI • f. . dey. ett.r th. death at • "h il d' a _nth efte r deat h at a p4lren t , or wif . , and for . wid... uot il ahe had r rried .ocor d i nq t o the levi r.te, or return ed to her t . th. r ' o ho 111 It ... . t a boo for e 8Ot h..r and a daughter to be both preqnaot io . .ny Afrlc.n ... I.ti. ...nq t h. Ch. nqa of "anl.nta. once a ..." or
ll/Gyorqy T. ~eadl . ·tra~itlonal Bi r t h Cont ro l M~thods 10 )'oruba land- In CUl tllre . Utllit.y. and r u l ly PIAOolng edit ed by John F. I'la:r,na ll .nd Steven pol g a r , Monoqre ph :u, Unlve n lt , of Nor th Carol1 na, Cha pe l Iii11, 1976. p. 1)4
li/Ott o r. RAU. -The Cnaoqa of Nort h - Eastern ranr . ol a- In Anq. l . Molno s , CUl tu r. 1 SQurc a M. t ar l e l, for Populat ion Planning in East Af r ica Yol. 3, B.llef o and pr.,tl cD . l ost itut e or African st.udi••, Uni ver sit y of Nai r obi , 1973 . p. 17 .
15/ tb i d p. 2e .
8
daughter ot ma r i d, the mot h r w v'nq 0 e c il r n. 1§/
xpect utoma ca l l y to st o p
Tan z 19 0, th Prog ra
'an a l 0 ulat 'o in t he country a
o rds 0 an 'ze contracep ve usa.
the 'm 'ly P a nin . n
. rni y PI nning n ex c t
v prey enc e e is ov e rove ad rn
( )
stu s don by t o z nd p ople of Uganda how that bout 3
hods a contrac ption while only ode r n t od. T di ion etho l l /
the n 0 e d tradi ion a l
hav'ng used fo l Io ing :
plant in t o th vagin are tine
belt n the the body.
born by he to conc e ive
, and d
; herbs ti d in bs in u d into co r d 0 he
nd hen he ilie a1 cor d .
In o tr a d
a not
in ieat cont r a c
ll,/John
R liti o the S t
yth d
~Jll.tJJu~W~!iLJm~~~l-9~Lml.t....1.IL1W::.i..!a, Proe di ngs ugus to Jr d
/ Jame .M. N ozi and John B. K Uganda: Rnow1edg nd Us
nkole ' in 1 9 .
i y P nn'ng n R ra
diti on 1 eho s 'n 22 , No. . March/April
•
a. .ult a of ~ 19U/8 9 Dqand a o-_qnphi" and K_ lt ll Sllr -y atlo:>oMd that ... all wo_n of rapl'od_U"a
' 'l_,
5.!U _ 1'8 _1", • conteacaptiva Hthocl or whi ch 2.1' " re ual ltq • .ada m ..uaod .,."2.9' t radi t ional . .th~. Tha tr.dlti ~l . .thada . .ra I ~rlodi"
~tin.nca 2.2t . vlth4raval 0. 3' and other . .thode 0••' .
(rI Zll1re
In Zah '. , It
h,.
been raport-.d tllat t.h. 1_..._ of the Lut . la pl a nt coul d b.- boll tod and Ul_ jule- drunk to 1ndlJc» aborti cn. ru rth" l'1IOra. the juJ.ce artr-.ct-.J. fro. til, root. of the DUal9' plant cou ld 1M drunll to ca_ a abort ion. W tnduced abOrti o n . _ used when a l'Iurai J'>9 .rtha r bee&-. JK"eoJ_nt . I t .... . t:abooo for a nurainq _thaI' to 1M preqnant.~ tha HIovu ethnic qroup In &d ra , car•• t tt..a clo o -nted the ia porUlnce at ttlc:hed to c:l!.UII apacll'llJ to an-lira pttyaicat ..,.;I
heal t h dave lop.ent or the ed aUnQ ehU c1. l Q/ 'l11e 'MI1lt: ch1ld ahOll l d not ~ born unt U th. ax lat l nea ch ild ea. _ t and _ I k at__
or h teh wewr . At ttla 8q a of a, It: YlUI fel t tJlat the child bad ..._Ined enoIoIqb phyal cd atranqt.h. lkl'We" a r. tbera .~ no _ 11 daU r-:i ta booll. rul _ and r~l .t;J,OfW on child spaci".., .~rt troll CQnt1r\l.-.J br•••t t.ed i nq t ill next pr egnancy•
... •t udy in J Iow-i ncc £ zone. in I i _boII._ a~ _ " ,l ed _ 1 ' 1
15-44 y••ra old Indi ca t ed t:h£t 72. 11 ' _ ra Wll nq _ tradition_I _thod of contrlM:£pti on only. U vera IlIIl nq • £iOoChl'll _th04 only and J. n _ ra Wllnq boUl • tr_dit i onal and. .clIIIIarn _ theda . Kora
w~n ware Wlinq wl tMre_ l _ tllod (U ' I. roll~ by Ilb&t inenca Jl' . and rh~ 19'. Zl/
In yat ano tbLr atu4y In the zone of Itn t aabo In "lna~ ... 35' of tJle _ ",led _ 1'1 aqed 1S-49
_r£
Wli nq t r_di tlonal Meb.oda of contr acepti on (15.1' abat i nence, 11' rhvth-, 9' withdrewal, 1. ..lJ/John G. Illqondu 'Trad itional Ch£Ck.£ on Ferti lity' in fully Plonn lng ~tr l t'Sll_ In tb. ' tea. Rol f Iort., Rica rdo "el£ . Petra O£lna l k l . u n . GT1I.•• p, 163•
.iR/X. cu'. el -Ch ild s~oi.... &ooloqy and Nutriti o n In th. Itl_
Province cf selre- In H.J.
' .q.
Ind ROfl ~thleqh. ad OIl ld-U 1 ct::y In tmplc.' Atrl CAI trad i t i on, , nd Nl, nq York , AQ.dea c Pr. . .. 19 11 .
l l / Jane t . Bertrand. . w,l . aertfl nd . and Kl atuod l1_ lleicnp. ' 'l1le u.e of t nclitiona l and. Modern lletboda of 'ert l li t y ceeeeer in
..i,..Mo ,...
Sel n ' in Pgpulatlgo Studl..s Vo l. :)7, lIu.b&r 1, Mreb 19IU,tl\8.n
n
vOI r. wdnq • tredittonal belt beU.ved to pr"vRflt pr.gnancy) . nd 9' _ re uainq . - . om ...tho<!.. 1lI T h . . tud y reva-Ied tI'UIt t he popuh tlon ... . ftpecl d l y -.otlv. t ed to .vold p.-.qn..ncy ..hil" 1:11. you n" "..t child .... 1. " . tM Il 25 .,.,tha Old.TIli . ..1.0 .cIll.VlI!d th"Ouqll " 'lOtly t r.dltional _t.nod. Wh ich _ ...
• v" l l . bl. to th••.
(q) l . .bio
Tb. Planned parenthood b aocht lon Of za~l . n•• been Involvtod in
vo ..
klnq " lth fWOPI. inrur u .r" • •
Ionq th. rail I i.... _ ...vllU qers . U Il fo11_ t rad i tion. l pr.ct ic•• beli e Ved to preyent preqnancy . 90Ile Of tile lIO"",n 1:1e herbe . round 1:h. lr vd . t or In••rt: 1:n.a. In til. Y.111\8. to p... v. n t pr...,n . ncy .
W
l>Oo..t l on. t.no \lClh not con.ia red • oontr"""""tl.... Mtl\od . is u-ed • ..,nq t r. d ltion"l .ocl"tl." to q ..t r id Of un... nt.*t pr..,.r...ncl• • . T" . ,U1:1onal d q. "nd herboo exmtinu.. to be u-ed In P.rfoMllnq .oort lon. In :: nh . i t II•• tleQn IlCIted th..t . 0•• Qt thoOl. . . . .Ill"] ..b<>rtIQn .pproach . ld..lv•• 0.. trlld l U Qn..l b. d .... whQ us..All y In... rt In1:o the cervi x .,.,•••YII and <>til. .. rootll th. t b. ve tIoo. n . 000llotd 1n .."t . r .nd aot Ol. dl1 . tQry i rritant t o c...."
~lon.
W
Af 1:e r a"...,,1 h<><J.... or d.y•• thOIC Il " ".v"
dU at .."til. ce rvi....nd . tl _ l a ta. ~e..i r.• con tr..ctio The _tlX>4 _ ..k • ...ti. .. and a1: other ti_ It f.U • . tv.n ortI e tll. _ tho<!. wo..ka. U te to11_ d by .._ e ly .. bl. otdlnq. 'l'redlUonal h..~l.r. 81.0 provid.. herbe ttl.t .re ch l-<l to be . t>ort lfec lCl nt . 111••• •r. either t.n or t.k.~ •• ta. " . About on. fourt h or n ..t the ::a.t>1. , cbi nq Ho. p U al "lth ..bertI"" c...lic.tion h.n . n Inv••t iqe U on ...
_ dot.
..e..e ...ported to have Ind...d ebortlOfl.t i l _.lv••• qe no r a ll y by In_ rtl'''l obje<-"ta . ueh .a plant. . "net twlq., in 1:be .....vi • . _ v th.. :lOr. de.pe...t . end I. ol . ted _ _n...lly ttl. you.nq" t r. report-.l t o drhlJot d. t. rq_nt. or qu o l ln. or tak. ovenkw... . of ••['trin. chl..r<>qUi... . nd crth . r t:<>xlo ..ublIt.an.... In th_ hope that ttl" . _ ld .,.,...._ vl01. n t ...t ...ctl...
to indlKl. aborti on. ~ AlthoUIJh "bart ion la I8<JIel In ho>tlh . not _ny- . who would n" It e ..k. requ. .t. ..t h_aL1:h In.titu1:ie n• •
WJ..n.. T. ller t l' . nd _t . l. -Po. t~P.rtu" !v....t. and 'ertil i t y
control in Kln.h... . . Z..l r. - In Journ. l of Bi08DO. SCI . 22, 1990. 1.11 l(ond... n.1 Cblr~. -Hftll Tu '.... tOld for ' •• U y PI. nnln" In
Zu.bh- . In .clwrlr; Vol.D 110. 1 AUiU/lt 1992, published by ..".Uy H••lt b Internetiona l. p.I' .
W
Illlry Ann C• • U •• Ro....M ry Llkve • •nIl ""ll1ne 1Ih1tt ek.r.-OtIearv..t l<JN1 on Abortion In ZlIIIbl••• In St ud le. 1n b ally flo'n a l llQ VQI . 21 , 110.4 J ul y Auqu. t 1990. p.2)).
2W Ib i d.
11
In 1989 tho Connment. or habh alkJl:lted II populatioll policy wbich • •- .nq other thi~. tw.. objectiv•• of Jowu Ulq popu l a t i on qrowth and tar t liity. ~ 90Vllrnaent wa nta to ~t.n4 oovoro90 ot f . .11y plann1nq1 to _U adult• • .uonq tho
.ttort.
Initlllt" 110 tar include thtl in t eqn ti o n of ' ••Uy plllnninc;l into tho b.••lUi tra1alnq currlcub or .11 h••ltb perlMJnnoll inc:r•••lrt9 tho nuabB.t of "llurll_trained in ru11y plannlnql b toraation, education and c:oaaunlo;lIti on (t1lC) call,..i.".., populat.ion edlaC'atlon 1" sebool.,
prOlJr o _ of raaHy Ute ed~.tion us Men .~nded to inclu4e prov1alon of fUl11y plannlllCj In flctori... The bportanco of orgfonh ed. fu.11y plcumln'J proqr..-. In Zallbh 1. J;aUeeted: In t.be
198' nati0n41 population policy.
2. Lbltationa of Traditional Approach. . .
Tra Cl. i t i o n a l _UOda or prolgnq..:l br•••tf.-diD\l' and ..l»tinencM in IIhich theta wa • • •paration bet_on
"if.
and hu.bend durlnq lactation till 2 or ] y.ar- ~r. 100' .ffeetlv. in child apacinq.But UnM r IIxbU"9 clrcu..t.anc. . whar. -p'-i& .-onq Atrican QlOVarnMnta ara not only on child apac incJ . bUt ..,01nq: beyond to dr.at1r.all y r~uc. tertility .nd ~rowth ~te, there 1a need to use .,re etfective .:xSem _thocia ot COtIt r acepti on . SOCial chanqe throlMJh _urnil:ation and urbanh.tion have contributad to ahorL.ninq tha pario<U ot awtinanoe .nd br_attaadi""ll ra.ultinq into aharter birth int.rval.. In MIl)' aec h ti. . the cuato. ot t ••porary ••paretion ot huaband .nd wit. durin; lactation to .naura
.~t i nene. , i . no lonqer oo..rve«.
Wi th raQareS to periodic .exual at:.tin.nce, .cae
ti_.
rete~t o a. rh y t hJl or natural ta.11y plannin..,
_thoo. .
there la h1Q1h tailur e rat . ot 10 to 30 pr eq nan c i . . par 100 usera in ~ tirat y.ar. Th•• • _thoda cannot ~ u_ad to control Praq7Ul nt':j_ ....tU ttl..Ulll a r b able to idan tity cornctl)' t he t.rtila period "h. n to abataln tro• ••xu.l intercou r••• The.e ~ require up to 14 day_ par •• natr ual c)'l::le ot __u. l abatin..nc>a. TIM ...er n~
aevera l ..:>ntM or pral::tlo- to in tarpret Br-Pa.. of e t. rtH e period corr .ctly...;rin.l intection, t.var or bra••te<tdi nq: _y alt,Br .ya~ tor a tartU. period . nd 1••d to inaccucat . calculat ion
ot
t. rUb p'r!od. Thera 111 naal! tor .ccurate r.cor dk. e p i R9 tor ao_ ot
ttl.. . ..tbod.
to beu.c
accurate l y. Inaddit io n, tIIe a . _ thode olll l1
t or
gre. t ~it-ntot
both plIrtoer.t o pract ice period i c aexual abstinence.
Tha withd r a wal method. invol v•• wi thdr awa l or the peni a trca the vaglna before ajacu l a tion. The . .thad ha . rai lur. rat•• or 5-25 pr neie . per 100 ".er. in the ti rat ya.r. str ict coaplianee with . 1 1 ••xu.l acta i. very di rt icult .
u•• or MQlical _tlIad . that "a . r i l'l9l , balttl , .~l .ta . ch. r1111 et c. to . void pr eqnanci•• • ra be.ad on bel ief . end in practice do
2
I
xi
n
in
and accept a ble aet hods and the sean. to do 80. As noted earl ier, org-sniled fallily planning proqranses US8 lIodeen . ut h ad whi cll .lOr ..
etf ect iv e at r..rt i lity regul ation s. However, orq aniz ed lIlooern ramil y plann i ng prcqra l!lll8a are not onl y conce r ned Wi th tel"tUity
re~latlon but also wi t h t h e health aspect s ot tile ~ther. chi l d and the fe.lly 8S a
W ho l e.
It 1. ..ell known that early fa mily ph.nninq proqrll _ es in Africa "ere introduced by international orga ni zat ions o~t6 1de the cont i nent who pr ov i d ed consid erabl e fundll on (sa lly plan ni nq in the 196011 and 1910s. The s e prog r a m..e'" put e,.pha sis on cont roll1 nq famil y she and population growth. The".. weCe ta ktm t rOll t he We st ern st and a r d s wit hout firs t unders t andinq the eoei a l Ilnd cult urel! vetuee of the Ardcan peop le 'Om r •• lly aiz e. In Ghana . for ella_pl e, ear ly h._Uy planninq poe t e re dep ict ed an ide al l .._U y she of 3 children and 11' ano the r At'ri c lln count ry e polit er depicte d Ill' ideal fa eUy as On. ",ith 2 children - e boy eno1 a 'li rl . ll/
Theae early faMily plannin'l progra••es did not bui ld on the Afr ica n ch ild spac i nq vslues which empha s i zed the he al t h ell~ct. of MOt her and child. Indeed, t he health benefi ta of chi ld apllcin'l wera not 'live n adequate 'u .phlilai s in the . .r ly or')lInizM fllllli Iy planning
progra~es. Thue , there was opposi ti o n t o flllllily pla nninq pr-oqra_e for a long t i_ . Consequ",nt ly, i t t ook ti. . for or qan iz ed teeUy pla nn ing proqra__ t o e.dv lll'!C e 8iq" ifica"tly.
Many Af r ica n count ries viewed t hese proqralllle& with auspic ion . Af ricane felt t ha t these proqra _ s were i_posed on the_ by outsi dera. The contro l !1M lIIaneqfllle nt of the progra...ee vera 11' the hand_ of t he donor aqencies.
In 19 84, as noted earlier, the perceptions amonq African countries cha nged 11' favour of falli ly planni n q proqralUles to lIOdera te de.aqrllphic t rends so tha t delllOq r aphic qrowth i.
co_pati ble wi t h socio - econ o_ic deve iopRent goal l. Governaent$ now racoqn h e t hat red uction of fe rtilit y woul d i88.e n pr essure . 11' provldinq basic social and ec onomi c need s - e.p lo~ent. education , Meith, et c . Reduction in ferti li ty and population growth ~u l d
als o le s s e " pressure on natu ra l res ource s such al la n d, to rest l , water etc , on whi c h the ~jori ty ot the populet ion depend tor t nelr survival. Al thouqh, ini t i aily, .cst Of the go ver n.ant a .uppo~ed
fa.i ly pl a nn i ng tor spacing of chi laren Daeed on health re.son s , they la ter aiso ca se to suppor t fanil y pl a nn i nq •• a tunda~enta l
hu_n right on tertili t y requ l a tion. Or gani ze d te_il y pla nn i ng enable. individua ls and cou p l e s t o have chi ld ren by cholce and not by chance t hro ugh th e Uee of modern cont ra cept i ve . .t hada .
Table 1 shoWS tho dema nd for COl'lt raception fo r l pac i nc.l and Ibiti nq of bir t hs among lIarri ed VOMn a¢(:ordinq t o eltbates by Charlae We. t ort bll,;o.,d on da ta fro. DRS swrvey s i n SOM of thll
12IFlorencil Abel'S Do lphyne , lb. Ewonc i p . tion ot Women; An At r lcan Pe r spectiy e, Gha na Un i v e rsit y Pres s , Accra, 1991, pp. 1i ·32
..
African oountr i... The r e i . un ••t need tor cont ract ion tor spac i ng as well •• Ua it l l'Wjl at birth. in all the coun t-ri. .. Ghana ahowe the hlqh••t una8t need tor apae i nq or births 26' . Ke nya and Egypt hava tn. hl gh. at proportion a of WOMe n wi th un~ t contr ace pt ive need
t or
I hiU nq Of birthe, 15 . 5 ' and 15' u epectl ve l y. I t unaarrl.d ...,••" Incl uding ado1e8cent 91rh IIho u l <1 be ("el uded , the un_ t cont racept iv e needt or
tartilit y requ l etlo n would be much hi gha r.Tn.
~t. In Tabl. 1 suppor te the need tor orgen11ed r•• lly planning prO'Ju _ . t o ott er oodorn con t r acep t i ve _ t hode to halp Ind1v ldulIl a and coup l•• to requ late t he1 r ferti lity. The hlq h inCid e nce of abortlona 41101'19 adol a. cant a, •• rrled and un ••rr led woe." 1. • [uether ••nlt••tation for the need of MOdarn cont r acepUon .000_"" fo.. C<>J'Ito....ooopUon
,,' '" ' " ,,' w
w---~._ - - - -- - -- -- - - --- -- - - --- --- ---- --- - --- -- ---- ---- -- --- - --- Boto n..
"" ""1
, ...
~.ny.
Liba .-1"
"'U
Uqa""a 11_ _
Eqypt
ItD..ClCCO
Svda n North Tuni . h
1918 1981 1918 1989 19 8&
1911 19" "9 1981 1918 1981 1989/90 1918
61.6 31.1 41.1 64. 9 )9 •) 21 .6 H .t 64.1 64. 1 6G.1 31.1 11.1
)1 .6 23.5 31.2
n . G
23.4 21.2 22 . G 37.6
16.5 26. 4
23.0 10.3
n .9
3J.9 15.8
• • •
10. 1 21 .2 66.3 31.4 12.6 46.2
26. 9 25. 1 15.2 J8.0 31.8 22.9 21 .2 21.1 25.2 22.1 26.1 U.7
19.6 11.7 26.2 22.4 19 ••
11.2 19. 9 10. 1
17.5 10 .6
, . .
, . .
. . ,
15.5 13
. r . ,
.G, ,
11.615.0
• ••
• • •
. . ,
33
. .
.,
0 12.9 26.9• • •
. . ,
•• •
n .t
37.' n .'
.. ,
n . 1
17.9
•• •
. • .. . •• , .
. ,., . ,
21. 5
•• •
12. 7
• ••
U .5
15. 1
, ..
18
••• ,. ,.
., ,
J, . .
15.6 31. 9 23.2
. .,
36 .3
SOUt'C . , Cha..l . . , . 1I••tootf and LlIi. H. ...""c o OChoa "Tha PaMf14 to.. ' ''''U y Pl.nninq: Kight iq ht " f..o. a Co~... tlve Analr . l." In Vol .1 of th. Pr,ol~lnq" ot the OooBDg ..aphlc . nd Heal t h S"... r. Wo..ld Cont. ... nc• • Wa. hinq t o n D.C. 5-1 Auguat 1991. IRD/MIlc..o lnternat l cmal
Inc. , Colotohl.., ""ry land. USA.
6
NGlftEtlIEHTS 0
.a....n'&'1".A.DG PRUGID\ftft.KS
O'~""'OS'I"'Z
"
~_. 10 Al t h :. " Cn'Pt rll l. In an -.neth.r PC'A publl~ don -
.nn.teal. . l ll•.lll " roy. r'-rIlr uC"p U .,. lldll to lo 0 4wnc l lllt. . . .u OO ! "
Tn ,"'" in Afr ic . n CQUIItrln . 19 92, ....f..[...,.. vat. elllO _ _ to _ of the•• :ac torll . loflIocover poildbl ll, tnb pub] l CllU OD dra_ on tn...lIr l i.,r . [ lIdl••.
I. AppU CIIU ... ot M"oU09lc Pl...
1n9 .
t.aa-ona fr o. pallt ."perl.. n". In h aU y plllnn lnq Pl"1;>IJl'"--
Ind iCate th. t that., ~t ~ cn.n~B In appt" . c h•• in which arqllnlaed h Illy phnnl nq progn _ ..rll plllnn. C1 and ••n_q ad at nlltj,,,,,,,, 1 •• Vill i II. It ovary level
ot
any ln5t ttutlon invol ved In tn.. provblgn lind daU nrl' of f••lly plannin ,.. . ...vlc. . . nut ~lc plllnnl ""Ol f. n .. ~dbllity b) II1prOVe Ul.. e U e o c U _ of 0r"J"l.La.
r lly plannl~ proqr- .. strat-'Jl c
fl .noli ...
_ t Cle d v1 lh 1<",'1 - t ,,""'II lin<! arrllt eql. . of an <>"",,0 ••U ",, _What IItutlKlle pl..n . hoIlld canu l o an<l. [dl . "r ,IInould be rlll at ed to tr.• •1••10n .t.~t lit tn., orq. nl••ttom. T h ..
orqllnl u U"", brOllde ."
.".,,_t at
~; .nd U1. geo"~.1 'lOA1.to
w •
.,hievael. 11I "". QeI\...l _ 1 . _ "l du.-.
int""
proc: • of
.u.t.aql .,
pl...i nq boo raUnotd to ..pacUtc CIIlject.i.._ and tarq.t. 1;0 boa . t tained at a '1tven point int1.. .
Th.. stra t~ l e!O_ . ded to . U .,io t il.. objactl vn 11M tarq.ot.a b.... to boo apeclrlotd.
'I'bWl fl nanc;:t a1 . . .lurh l • •nd 1I ... n r""""'-retl. requlreJUnt• •1I000ld all be """pcllOnU of . t n teqic "laMb'l . Man . ..t of l cgh tlCll.
and t"" ....
OOJI'.-
ItS • ""cle ~ ...'1..."t W _ tiOft av. te.('US I and ...a1uati"" "'" e conu...-..a ' - - h an all t -.port.nt:
...'enu cr atnt:.a<;l C1 pla M l nq to be l:errh,d ....t .
In at.r. toaqic pl..nn lnq t he fin t . up aho"ld boo t tl f" U y IInde rl tllll4 tha c" ...nl
. tt....
U on of the o"''illnll " U on tIlrO\I'l1l d.,UIl..d a1t"..t lon anllivah or ava1 1lOl.>la data Oftt""
o..."..,,1&..t lon . S...eh . n an.l ya i . .~u ld . K••loa Y8rloua r.otaea .Klern. l end t lltarnal vbtc lI aU lACt ~lU_IV QO' ""'9lltl.dy orq...l u t l_ · .."U vlt hll. "'a . 1tuaUon ....lyd . _ ld 'JUl u tile plann1 ...,""OC••• In Mkl llq ..-lIeti c CbanqU vbanver ~al bla '" the 9""'lIt. Oblect l"••• t. ~'l"t... ~_au n'•• aoel ...n.II. ...ot
o r
til. Pr<>oJZ'- . _ t l . ... . ". n tI>• • 1_1<", . t .t.._ ot of ttl. orllanlu tlon _y Ia...t o be _ I U ad .
31/ .1... I.. IIol rr. Lln<loi .1. suttenU. l d . SUAaftII4 C. BUlZ.... . . . . Tba h p 11 Y f l.Mlng B+Qagf u
"oam):
t...aer h tl Pr. . .. 19911 .J_,.. 1IIoIH . Robert CWlluoln• .Jr •• r lod d. ,.. ~..t. b. C. 1:1hat>atl'l It<:
Gror y . Sun , ,,,.. C. !I1t1u n , HeVJla d '!'be C!l n l~.ll"
e".
:ltydl" In...",- "n 1t Y- BIIud Dl pt x!byt.1OD. ltu"':I' I" n pu . . . In Ol ILicMl1 • •
!!eMlII..ct:. $t....""qtc llUtaq...ot ot Popotla U on Pt'QOI' 01'101 1lelllr;
Polley R. . . .rcJ\ ....r-tlnq Papen . lIPS 996. U U ; 1'blaa n lclt •
•tr.taoq1", F1annl"'J for tI'Ia !'J<pa ...1.... of r" 'l .,. Planttillq. Pol ley Paper sari. . "o .l. TIle rutur... Croup. 199) • .
18
JOIC e
/ i .4.
0.226, pril 1993, p.
"
Expe~lence '~m the r•• l1y p1a"n1n9 acti viti•• ot Chogor l. In ~ny.
he.. shown tha t "hen faany plonroi nq w~a provided H ptlu t ely , i t •••
QOuntar-prod.uctiw . and v. . r@c..lnd _ah "u.pielon and hOlltiJ1ty In
&aIM co-"" i U .... lf1'Ien faslly pl annl J19 __ ot t •
..-s
within VI Int eq n t.eel proqrll_ of heal t h, eduoat lOJl and other helO1tll . .('Vi c. . . it t>eca_ .ore acceptabl e. ~ I t h loqicol th.r.fo... . to int eg ra te r•• 11y plann1n9 . ith hea lth ••r~icea a. the two are dl rllC'tly relet ed to the he alth of both _ th en end olltld r en and that .oet t ••lly pla" " lnq _~ n..-d Ue health per _o Nl_} and tacil1U... tor t heir adJIlnl rtr a t lon. UIonI;l the h oton wtli~ have b8en at tri buted to the suee•• • of tJle C!109oria tU11y ph nni nq PI'091"" - _ In rOlduc(f\9t . ..
UUty inc l ulie t.he cOlIIPlot e Illt -.qratioll at raaUl' plannh>q wi th ot her lIerv l e_ ,W .. .
1I11y pl lllVlinq activ lti•• ~ld also be Int:.e<Jnt.6d into otnar acttvl t l _ lUt e educa t ion and aqr!cul t ure exterlldon . [n Xanya , tileqov.~ nt.thrauqb the JUnl .try of AI;lrlcI>Uur••
t.
h teqr. t inq f • •lly planninq into the wart at .qri eu l tura l e~.nslon wark. ra.l n t.eaotho.th" 199 1 to 1496 rirth y..ar Plllll indicated that tn.Mi n l . t ry or Aqr lc ",t= . ahou ld lnt nJd "". pCll>I.ll at1an ed~at1 Oft 1n It. t ra 1n 1nq inst itut e . nd colleg.. and . .t • •tf ort. to .,tlv"t . f. .... popullltio n on 11 '. .11y no" throlJqh it.• •xte n. l on _ r"'e nl. ,",er. are prob l In tn. in~r.Uon ot reaUy pl .nnln<;l wit h other h" altll . .rvl oe. and wltll _lo-e<><m<a1c actlvl ti• . But l b. pro!)l..."• •nould t:>e re v1-..d alolllil lll. Un_ of haw bea t til. q_la of inleqr.Uon o.n t . a<:ll!ev...:l. ' or o""9"nlI:OIo<I b.Uy plann!nq prOIlraOl/Ula to oad at i n aclll e.lnq lnteqn ti on of It. acti v iti••
"itn h. alth and ....,1_ ..,.,n<::"l1o act h'lt lea . It _at lldd re. . iOtau••
that !\ave bola r i!Wll 00'1 inleqra Uon and tI'It!.... lIIJal lnc1u<1..- dee l . i on .u:lnq. r . .pon.ibll ltle. . aana".llQl t . . upe...i.l on. .ltitud_ of
tll<>t;. lnvo lY8<1 In "£'lice d..l i....ry . - . . n _ r qIIIll1 t y . reeource . and
infra. truoture ror Inl~ r.tlon. ~r. Integr.tl on . .y nat work it ahould not. be torced juet. for tn• • U e of inte<JnUon .
J . ~. .i"'ll UW _ l tIl IIo>edIi of OIl1 d ....n. _ ... the
Adol. - . . u
' ... 11y plann i1>9 pro<,Jr... &!lould ..Mr. . . the boal tn nee<k of chU d n n. acl llera . Itdol e _ nt . lind t.he h a U y 110 II ..nol.. A plarmed 'sally 1a ".nerally a happy ra. Uy. !toIar ly . ll Afr1COUl coun t.rl... . r e Involved in the I.O'1_ t .,,100 Of prl"ry n.... ltn c. r "
U /Cor... U . If. De _ r lind Kalcol . Kc N. U . "Hoepi ~al OUt r.llc h Coaa\lni ty - 8114ed Sa.lth Cor. : me Ca•• or ChOqor1... J:.nyll- 1n Soc.
k l Ned Vol.28 . 110.10 . Perqllaon PreIoa pic. 1989. p.I0 10.
~OOI1I rd I . Coldberq. JlUCOII IIc "..11 and Alleon Sph.2.
-c ont raceptive U•• and f ..r t illt y Oec:l1 n. i n lI:"nyll- In Studl..s In rami ly Piano i ng Vol .20. 110.1, J.nu.~y/F.bru~r y 191 9.
"
proqr !l._ . of whie h . .t a m al ;lind child health car e and t••Uy plllnnlnq aNI Intc.gra l CXl8ponont a.
{al Addr~•• lnq the R••l~ Meed. of Chil dren
P'a.ql l y ph nnlno cont ri but e. to ttl.. health of ch U dr en tllrouqh
'deq~atw apac l n9 ~f hlrth8. It I. gen erall y known and aata bl lll hAd
U\.Ilt morta lity llWlnQ Childr..n Ill'a hl'l'har wher e ch il d r e n are el088 1y ..paced and ..-009 chU cn ". n to we. .n boI1ov th", age of 20 88 _ 11 1111 a.Q"'l cl:lUdre n t.o
wo_
abel". t il. age of )5 y••n old . r •• U rpla nnin; proq rllDllMlli enould t h..r..tore pro lOOte adequate blrU. IIpllc i nq throuqh l Ee acti vlt.Ln lind . .ke IIva U.bl e .erv l ce. tor pr a ct ice ot haUl' plannlnq.
It 1. iaporlont that haU y plllllUll nq and birth apao inq progra. - . . be ieple-..t.-.1 in cOIlbination ..ltIl othar chUd 8'U'v!Va l act i vi t i ••
, ,,, ell
.8' 1_ 11n iUlt lon. oral r8nydration tor diarrhoa. ldise as es, and b...t te..dl n..,. shd hr l y, ""en heal t h '1ork..r_ at tend to the _ Mn and .ct.b e -r8 and ctlU d ren ' ...,a . t hey al'>ould t.e ke .dv.nt ... to di . cu. . the I:>eneU t.. of quod ch ild apacl"", and cOnuaCllpt.h ..
11..., .
The illpOrtane. of br. ...t. f• .-dl ng n..ed t.o be giv.n . paci al i.por t a ne e in U1.. survival st.rat..g y of chlld rfln. AJlo nq the edvant ag. . of brea.tteedl ~ . ra the follow1"""
Br,",.Ueed.lng provid e . InU aate r. la tlo nah i p I:>etween the .at.tl.. r and the ch U d:
~ It. pro vides aU the nutrl ents a baby n-.ds for the initia l aontha of its l i fe,
I t redll.C1l8 t he incidenc.. of dl errh_ al end other dl . .. ...s a.en.., breast fed in f a nt s,
I t prevents . .lnutriUon ceceee by dllutlcrn of bottl e feedllJ
Breastt ed bab ! ea have lower rI.ks at de.tha t h. n bottl.fed babie . ,
Bree. t . U k 111 not conte. ina t ed \1I\l1k.. bottle f.. eda ' Brea. t t ' edinq provide . iaaun i tla. durinq t tl_ t i rat rev montha ot t he baby's Ilfa:
Br ae. tread lnq p«rvid_ about '" protect ion fro- p..-eqnancy durI nq the U rat , .antha ~tpartu. U the .at he r i . -tul ly · or nea r l y tully bre••t t eedlng and hae not axpe rI e nced vegi na l bleed i ng after the ~6 th dSY
