The Benefits of Family Planning to Avert Infant and Child Deaths in Ethiopia
Publication date: 2013
HEALTH POL ICY P R O J E C T The Benefits of Family Planning to Avert Infant and Child Deaths in Ethiopia Authors: Sintayehu Mulu, National Family Planning Focal Person, Urban Health Promotion and Disease Prevention Directorate, Federal Ministry of Health; Aragaw Lamesgin, Health and Population Program Advisor, Futures Group/Health Policy Project, Ethiopia Background The probability of dying in early childhood or infancy is much greater for children born to mothers who are young or old, born after a short birth interval, or born to women who have had more than three births (Central Statistical Agency and ICF International, 2011). According to the Ethiopia Demographic and Health Survey (EDHS), a woman is considered to be “too young” if she is under age 18 and “too old” if she is over age 34 at the time of delivery. A “short birth interval” characterizes births occurring within 24 months of previous birth. Women who are exposed to high-risk pregnancy are less likely to use family planning (FP) and significantly more likely to have unmet need for family planning, compared with women without fertility-related risk (UNFPA, 2012). Table 1: Infant & Child Mortality Progress in Ethiopia Hypothesis Currently, 62.4 percent of all births in Ethiopia are considered “high-risk” (Central Statistical Agency and ICF International, 2011). Although there has been recent progress in infant and child mortality, increased use of effective family planning can lead to further improvement by reducing high-risk fertility (Central Statistical Agency and ICF International, 2011). Methodology The Ethiopian Ministry of Health, in collaboration with the USAID-funded Health Policy Project (HPP), used the FamPlan model to measure the impact of increased use of family planning on averting infant and child deaths by decreasing the proportion of high-risk births. FamPlan is part of the Spectrum Policy Modeling System (www.healthpolicyproject.com) that predicts the health outcomes of reaching national goals, such as increasing contraceptive use by addressing unmet need. FamPlan was used to project the percentage of births that fall into high-risk categories and estimate the resulting infant and child deaths averted by 2020. Baseline data were taken from the most recent DHS findings, and two scenarios were projected. The High Performing scenario reflects the Ethiopian government’s Health Sector Development Plan (HSDP-IV), with a contraceptive prevalence rate (CPR) target of 66 percent by 2015 and 73 percent by 2020. The Modest Trend scenario is based on performance between 2005 and 2011, with CPR reaching 47 percent by 2020. Method mix changes occur in both scenarios, with the High Performing scenario favoring a shift to more effective long-term methods. For both scenarios, it is assumed that the proportion of women ages 15–49 who are married or in union will decline at the same rate over time as women delay marriage. At baseline, the method mix heavily favors short-term injectable contraceptives. In the High Performing scenario, HSDP-IV predicts an improvement in method mix, representing a wider choice of methods for women. Figure 1: Method Mix Scenarios Year Percentage of Births with Any Risk Infant Mortality Under–five Mortality 2000 63.4 97 166 2005 66.3 77 123 2011 62.4 59 88 2013/ UN estimate - - 67 Presented at the International Conference on Family Planning; Addis Ababa, Ethiopia; November 12–15, 2013 The Health Policy Project is a five-year cooperative agreement funded by the U.S. Agency for International Development under Agreement No. AID-OAA-A-10-00067, beginning September 30, 2010. It is implemented by Futures Group, in collaboration with CEDPA (part of Plan International USA), Futures Institute, Partners in Population and Development, Africa Regional Office (PPD ARO), Population Reference Bureau (PRB), RTI International, and the White Ribbon Alliance for Safe Motherhood (WRA). The information provided in this document is not official U.S. Government information and does not necessarily represent the views or positions of the U.S. Agency for International Development. Contact Us Health Policy Project One Thomas Circle NW, Suite 200 Washington, DC 20005 www.healthpolicyproject.com firstname.lastname@example.org Modest Trend−2020High Performing−2020 Injectable Implant Intrauterine Device Oral Contraceptive Pill Traditional Method Male Condom Female Sterilization Results In both scenarios, family planning uptake is associated with decreases in high-risk births and infant and child mortality. However, the High Performing scenario demonstrates that faster gains in CPR lead to more dramatic health improvements. Figure 2. Improvements in Infant Mortality Figure 3. Improvements in Under-five Mortality Table 2: FamPlan Projected Indicators for 2020 Knowledge Contribution With family planning, young women and adolescents under age 18 are able to delay childbearing and older women are able to limit their childbearing when they have achieved their ideal family size. Women in the prime of their reproductive years can space their births for optimal maternal and child health outcomes. Investments in family planning can result in a substantial decrease in the percentage of births that are high-risk, thereby reducing infant and child deaths in the coming decade. Furthermore, comprehensive family planning choices ensure that all women are able to use the methods that best suit their needs and fertility preferences. To maximize effectiveness, operational policies should serve communities and age groups where high-risk birth behaviors are common, particularly adolescents who have a disproportionately high level of unmet need (UNFPA, 2012). Works Cited Central Statistical Agency (Ethiopia) and ICF International. 2011. Ethiopia Demographic and Health Survey. Addis Ababa, Ethiopia and Calverton, MD, USA: Central Statistical Agency and ICF International. United Nations Population Fund (UNFPA). 2012. Trends in Maternal Health in Ethiopia. Addis Ababa: UNFPA. Retrieved on October 18, 2013, from http://ethiopia.unfpa.org/drive/DHSIn-depthAnalysisonMaternalMortality.pdf. Scenario CPR Percentage of Births with Any Risk Infant Mortality Under-five Mortality High Performing 73.0 38.0 2.59 4.28 Modest Trend 47.2 52.2 35.4 51.8 0 20 40 60 80 100 High Performing Modest Trend 202020152011 88 15.2 71.9 4.28 51.8 N um be r o f U nd er -fi ve D ea th s pe r 1 ,0 00 L iv e Bi rth s 0 10 20 30 40 50 60 High Performing Modest Trend 202020152011 59 11.5 48.5 2.59 35.4 N um be r o f I nf an t D ea th s pe r 1 ,0 00 L iv e Bi rth s
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