Family planning: A panacea to maternal, newborn and children

In Nigeria, every 10 minutes 1 woman dies in pregnancy or childbirth related issues. Every hour, the loss of at least 6 mothers will shatter families and threaten the well-being of surviving children. For every woman who dies, 20 or more experience serious complications. This ranges from chronic infections, to disabling injuries such as obstetric fistula.

There are therefore two approaches that can be used to reduce these deaths. First, make pregnancy and delivery safer once women become pregnant; second, reduce the number of pregnancies through family planning, and obstetric care. Some ways in which family planning reduces maternal mortality are as follows:

• For individuals, family planning reduces the number of times a woman becomes pregnant. Generally speaking, women of higher parity face greater risks in pregnancy. For example, a woman who has been pregnant six times has twice the risk of dying a maternal death as a woman who has been pregnant only three times.
• Family planning reduces the number of unintended and unwanted pregnancies. Unwanted pregnancies are far more likely to end in induced abortion, and are far less likely to receive adequate prenatal care than wanted pregnancies. In some situations, abortions account for up to half of all pregnancy-related deaths. The potential for family planning to reduce these deaths is very great.
• Nationally, family planning reduces the number of pregnancies and births. Even without any improvement in obstetric care, a 10% reduction in the number of pregnancies will produce a 10% (or greater) reduction in the number of maternal deaths.
• Family planning can be targeted to reduce the number of pregnancies to women in groups at increased risk of maternal death, that is women who are too young (less than 20 years), or too old (greater than 35 years), or women who are high parity (more than 5 previous births).

To a large extent, the most important way of reducing maternal deaths is simply by reducing the number of pregnancies; this by itself is very effective. But it is important to pay simultaneous attention to improving obstetric care. Most women want to have at least two children, and they should have good quality care during pregnancy and for delivery. Ideally, these two interventions—family planning and obstetric care—should go hand-in-hand.

It is therefore important to note that, although family planning cannot by itself cause a substantial reduction in risk of pregnancy, the combined strategies of general fertility reduction and family planning for high-risk groups might effectively address about half of all maternal mortality in a developing country like Nigeria. Pregnancy and delivery care have the potential for saving large numbers of lives with appropriate interventions. It is concluded that reproductive risks can be reduced only by preventing unwanted pregnancies and protecting maternal health during wanted ones. It is however unfortunate, that contraceptive prevalence rate is low in Nigeria with only 12% of women using any form of family planning (PPFN, 2009).

So maternal mortality rate can be substantially influenced by the prevalence of contraception, but it is primarily the reduction in the number of births, per se, that exerts the influence. The practical difficulties of providing effective contraception to populations with high maternal mortality needed to be addressed, and the need for maternal health care services as an adjunct to useful family planning programs should be emphasized.

The contribution of family planning to lower maternal mortality and morbidity should not be underestimated. Since at least over half a million women worldwide die each year of pregnancy-related causes, of which ninety-nine percent of them live in developing countries.

Among young married women, many early pregnancies are wanted but abundant evidence indicates that early childbearing increases the risk of obstructed labour, which can lead to death or long-term disabilities like fistula. Many studies have shown that a large proportion of patients with vaginal fistula (up to 80%) are less than 20 years old. Although family planning can delay first births until reproductive organs are fully developed and pregnancy is safer, many cultures place a high value on early childbearing. Then among young unmarried women, pregnancies are rarely welcomed, carrying a high risk of abortion, and potentially high mortality associated with unsafe procedures.

In sub-Saharan Africa, (Nigeria inclusive) a woman’s risk of dying from treatable or preventable complications of pregnancy and childbirth over the course of her lifetime is 1 in 16, compared to 1 in 2,800 in the industrialized world (World Bank report, 2009). Therefore investing in family planning and reproductive health is not only vital to saving women’s lives, but also to boosting women’s economic and social well-being, improving the lives of their children and families, and reducing endemic poverty. The longer it takes for our country to move to a low-mortality pattern, the greater the danger that Nigeria will continue to experience high-birth rate and greater inequalities in education, jobs and life expectancy.