Community sheet # 9 - Thana2

[Shadi Jarrar]

بسم الله الرحمن الرحيم

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http://www.4shared.com/file/BhC24rnw/community_9.html
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Last lecture we started to talk about a very important subject which is family planning services and we said that it has many goals and the most important goal is to decrease morbidity and mortality for both the mother and the child but the priority for the mother and then the outcome of the pregnancy which is the child. Also we said that we should have enough resources, control population no. , the couple should decide the time to have a baby , and they should realize the importance of spacing between their children; to give the mother a chance for repeated physiological stress on the mother to be repeated again after minimum 3 years in between the pregnancy.
In Jordan Family Planning Service is very well distributed and it's very advanced from the mid 80's until now, so the services that are provided as any family health care should (affordable, efficient, reachable...etc)
All the principles of primary health care should be applied on family health services for maternal and the child, because these services are very important to their health promotion.
Currently, women in Jordan have an avg of 3.6 children compared to that of 2oo2 it was 3.7
When we say currently we mean the 2007 population family health survey
Now, you may ask yourself why it decreases by 0.1 in the last 5 years.
Because in Jordan we have traditional principles, you can't tell the family that 2 kids are enough even though the present of the services. In other words the acceptance of these services is different according to our beliefs.... I cannot decrease the fertility to 1.2 as it is in Sweden or 2.3 as it's in UK.
At current fertility level, a woman in Jordan will have an average of 3.6 children – a total fertility rate that is 50 percent lower than the rate recorded in 1976 (7.4 children per woman)
Effective family planning is increasingly seen as an important part of Jordan's overall development strategy.
In contrast to several years ago, such programs are openly discussed and rarely encounter public opposition.
According to survey research, 83 percent of the Islamic religious leaders in Jordan believe that family planning is permitted under Islam

The private sector is leading the way in making family planning services available to the Jordanian public. Seventy two percent of married women of reproductive age purchase family planning services in the private sector. Also health minister, royal Jordanian city
Are not governmental. Also the Jordanian Hospital but the main services (المدينة الطبية)


Prices have not increased since 1994 and all four modern methods are available at private pharmacies throughout the country. In Jordan we are unlike the developed countries pills need a prescription, it means I need to tell the lady to take contraceptive pills

The JPFHS (Jordanian population and health survey) looks at a number of fertility indicators, including
1-Patterns, and trends in both cumulative fertility.
2- The length of birth intervals. (Space between the children)
3- Age at which women marry and initiate child bearing. Because the services that u provided for s 20 years old lady are different than the services for a 35 years old lady.
Nowadays, with the increasingly the avg of married woman, we start to provide these services at the age of marriage; the average of the age of married women in Jordan nowadays is 22.2 to the age of 49 y3ne around 28 years for a unlike in the past we used to provide these services at the age of 17 to 49 so the period of these services were too long
In Jordan what we differ from the other developed countries that we started to give our services to a woman at the marriage age, which is 22 years as an avg to the age of 49 in contrast in the developed countries we started to provide the service at the age of 18 although the avg of marriage age is 28, and that's due to pre-marriage sexual activity.







Here you have to refer this with the slides and the graphics which the doctor gave us.

Fertility indicators / 1
Levels and Trends
At current fertility levels, a woman in Jordan will have an average of 3.6 children – a total fertility rate that is 50 percent lower than the rate recorded in 1976 ( 7.4 children per woman)


Many things have been studied in this survey which is 2007 jordan population and family health (JPFHS)
Knowledge
Current use
Source of methods
Future use

Knowledge:
More than 99%of all ever- married women know at least one modern methods of contraceptive.
Women know on avg 8 modern methods

We talk about modern methods not the traditional ones ( breast feeding, safe period , withdrawal..... etc) so if we calculate the average of the women using contraceptive method it will be higher than this because this % is for the modern methods only , the traditional methods are not calculated ...
96% of women can name traditional methods of contraception.
Keep in that the percentages that calculated the knowledge of traditional methods are not actual because not all the women that is using the traditional methods come seeking for the services.

Contraceptive knowledge by method
Pills 99%
IUD 99%
Male Condom 89%
We have to give more knowledge about the male condom ... it's not enough that is only 89% of the families know about because it's a very important contraceptive method ESP. For a newly married couple.
U don't have to memorize these no.'s
2. Current use
Gap between knowledge and use among all women
Current use of family planning
Modern 40%
Traditional 42% bn3eed o bnkarer ino this % it's not the exact no. Because not all the women using the traditional methods seeking for family health services. The actual one will be higher.
Trends in current use
In 2002 56%
In 200757%
The need of the women to have a baby is covered by the service!! So that's why we didn't see that big difference between 2002 and 2007
Even though the services have been distributed better on 2007 but here is the matter that i want to have a baby.... so the need to have a baby is covered and the proof is that there's no big difference between 2002 and 2007.


Fertility is almost identical in urban and rural areas, but does vary by governorate
Use of modern methods by Residence
Urban 43%
Rural36%

Current use of family planning
Any modern method  42%
The most common method is the IUD (intra uterine devices) then the pills as a 2nd place
Traditional method  as u can see 15% withdrawal: 11% rhythm: 4%
In developed countries pills are the most common.

Use of modern contraception by education and wealth
As u notice the more education is the more useful and economically the same the wealthier is the more useful.
Use of modern methods by governorate (Jordan map)
We can see that there's not that big difference and that's a proof that the services are well distributed all over the country, but the higher % is in Zarqa and Amman


Trends in the use of family planning:
In this slide a kind of comparison between the studies that have been made in 1990, 1997, 2002, 2007 and of course you've noticed that there is no big difference between 2002 and 2007 study, They're almost the same
Why?
Because of self sufficiency not the lack of services ... it's present but the acceptance is fertility no. Is hard (not acceptable)... because as I said previously the belief is to have 3 child or more.
When do women start using contraception?
As u can see that there are families use contraception after the 1st, 2nd, 3rd, 4th+...
Most of them they use contraception after the first child.
The lowest % is the 0 children why?
Because before the 1st child the woman is in fear to use these methods.... fear of the side effects.
Knowledge of the fertile period:
78% of women who use the rhythm method correctly identified the fertile period as the time halfway between the two periods
Many women doesn't know the safe period .... that's not good

Contraception discontinuation
This slide show many reasons of discontinuation but the most important reason is to get pregnant not the side effects.


Sources of contraception:
We notice that the private sector is the most common; it covers as an average more than 50%.


Do family planning users have informed choices?
It means that do counselling provided or not
72%of modern contraceptive users were informed of side effects or problems of the methods they use...... counselling is more than 50%
64%of users were informed of what to do if they experienced side effects.
30% of users were not informed of other methods they could use.
The future of using these contraceptive methods
As u can see from the chart that
58% they intend to use
5% is unsure
And 37% does not intend to use
But the majority who is intend to use..
More than half of married women who are not using a method do NOT intend to use family planning in the future WHY NOT?
Because of many reasons.... because of they want to get children....menopausal....fear of side effects....etc

Among current married women who intend to use a contraceptive method on the future the preferred methods are the IUD (48%).. pills(21%)
IUD is the most acceptable method
From where do they get the message?
From the TV
على التلفزيون الأردني
RADIO....Magazines...Lectures...etc
It's very well distributed all over the media.




Here the Dr. Said that what we concern from these entire no. Is the key findings

Knowledge of family planning is universal.
Women know an average of 8 methods of family planning.
The contraceptive prevalence rate among married women is 42%
The IUD is the most popular method.
Use of modern method has increased dramatically since 1990, mostly due the increase in use of the IUD.



The end of family planning and now we will start talking about the fertility and how it does change according to the family planning.

DETERMINANTS AND THE INDICATORS that affect the fertility.

At current fertility level women have an avg of 3.6 children in her life time.

Fertility trends
You notice the difference in the total fertility rate over the years, but in the last 5 years the difference is not that much.

Fertility Differentials:
Urban 3.6 Rural 3.7
What does that reflect?
That the services are well distributed all over the kingdom.

Trend in Fertility by Region
Rural and urban..... Central north and south....

Just to know in general ... in this study they found out that the urban is less use, but it's not that much accurate ... we assume that they are almost the same



Fertility by Education
As u can see the more educational is the less TFR( total fertility rate)

By wealth:
As u can see the wealthier is the less TFR

Don't memorize the no. just the relations


Birth intervals:
In addition to their impact on fertility, birth intervals may also affect the health of the mother and their children


Length of birth intervals
33% of birth occur less than 24 months ( 2 years) after preceding birth.


33%= 15 %( 7-17 months) + 18% (18-23 months)
The residual 67%  length of birth intervals is more than 2 years


Infants born less than 2 years after a sibling have the highest rate of mortality.


Median age at first birth for women 25-29

Urban has lower median age at the 1st child than the rural, but the difference is not that much significant.

Urban  23.8
Rural 24.3


Teenage pregnancy and motherhood

It's not important at least in Jordan because teenage pregnancy is related to the marriage age, which is increasing in Jordan,
3% of women between the ages of 15-19 are already mothering.
And another 1% is pregnant with their 1st child.
It's very low rate.

Current marital status: women
55%  are married


Consanguinity:
زواج الأقارب
To control congenital abnormalities
But as u can see the majority of all married women by their relation to their current or the 1st husband is NO RELATION (61%) and that reflects the good counselling and good education.
The Dr. Said consanguinity was higher in the 80's.


Fertility Preferences of married women:
78% either want no more children or want to delay childbearing by at least 2 years, or are already sterilized or in-fecund
Around 80% of child bearing women think of using of contraceptive methods until the next pregnancy.


Overall more than 7 in 10 women either want to delay having another child or stop childbearing all together.
 Acceptance of Family Planning Services is 70%

Women are considered as having unmet need for family planning if they're fecund and wish.

Unmet need: it means that if the woman is actually having for example 6 children but she wished for 3 children... this is called the unmet need.
She either wished for spacing or limiting

12% of current married women have an unmet need.
5%: spacing
7%: for limiting.

83% of demand and satisfied
57% have their met need
The Dr. Said: More than 50% have their need from the family planning services
The ideal family size is 3.9  4 children

Gap between the wanted and the actual fertility rate

Gap= actual- wanted
Look at the total:
Wanted= 2.8
Actual=3.6
Gap= 3.6-2.8
= 0.8(less than 1)
And this reflects how much the services are well distributed; the need is met by the family planning.
Every time this gap is increased that means the need is not covered .i.e. it's good thing to have a small gap.
The study of 2002 the gap was 1.0
KEY FINDINGS
Women have on avg of 3.6 children.
TFR has dropped dramatically in the last 20 years, but has remained relatively stable since 2002.
Women have their 1st birth at the median age of 23.9
73% of currently married women either want no more children or want to at least 2 years between their next child and 5% are already sterilized or in fecund.
11% have unmet need for family planning
0.8 The gap of the unmet need.
The End
By: Thana'a ALHadeed. Done