Family planning and reproductive health.

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Week 5
Chapter 6
Instructor: Gina Crosley-Corcoran, MPH
PBH 805 – Maternal & Child Health

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Chapter 6
Family Planning and Maternal and Child Health

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Introduction
 Family planning is defined as “the ability of
individuals and couples to anticipate and attain their
desired number of children and the spacing and
timing of their births… achieved through use of
contraceptive methods and the treatment of
involuntary infertility” (WHO, 2017).
 Effective family planning is linked to positive
maternal, child and family outcomes.

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Reproductive Justice
 Defined as by Sister Song Women of Color
Reproductive Justice Collective: Reproductive Justice
is the human right to maintain personal bodily
autonomy, have children, not children, and parent the
children we have in safe and sustainable communities
 This definition advances the importance of the social
determinants of health.
 The definition also underscores the necessity of
paying attention to all humans no matter their race,
ethnicity, language, ability, orientation, income, or
any other identity.

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Family Planning: A Complicated History…
 Major public health organizations and activists recognize family
planning as one of the greatest public heath successes of the
20th century.
 However, early family planning leaders had implicit and explicit
bias about who should and should not become pregnant.
 There are still challenges in equitable access to the full scope of
family planning services, including fertility treatment and
abortion care.
 Public health policy has shaped access to care over the years.
 While clinical care is important, structural violence, historic and
structural racism, and patriarchal systems are barriers to equity.

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… A History Impacted by Racist and
Eugenic Histories
Examples of racist and patriarchal practices:
• Eugenics (forced sterilization) is a legacy that must be acknowledged and
redressed. This continues to be practiced in some places today.
• Coercive contraceptive practices
• Providers failing to listen to black birthing people, leading to disparities in
maternal mortality
• Unchecked promotion of long-acting reversible contraceptives among
minority communities
Activist scholars including Angela Davis, Barbara and Beverly
Smith, and Demita Frazier developed Black Feminist Critique
and have worked to call attention to these practices and shift
the narrative.

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Pregnancy Planning and Unintended
Pregnancy
Total fertility rate has declined
in the U.S. in the last few
decades.
•More women are pursuing
high education and entering
the workforce
Teen births have also decreased
since the 1990s.
•Likely a result of increased
access to contraception,
public policy mandating
sexuality education, and
targeted public health
campaigns
Unintended pregnancy is a
pregnancy that was not wanted
or not wanted/not planned for
at the time that it occurred.
•Almost half of all births in the
U.S. might be considered
unintended.
•There are ongoing debates
about how to define,
measure, and discuss
pregnancy intention.

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Barriers to Pregnancy Planning
Financial hardship/no
health insurance
Limited access to
health care services
Relationship dynamics
Housing instability Racial discrimination
Limited knowledge
about reproductive
health and
contraceptive methods
Lack of educational and
career opportunities
And others!

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Practice Considerations
•Asks whether one wants to become pregnant in the next year
•Asking the question can help prompt important conversations. The question may
not be effective for people who may not be actively trying to get pregnant or not
avoiding pregnancy.
One Key Question Approach
•Conversations that guide a person’s thinking about pregnancy and how that fits
with the timeline of other important life goals, including educational, relational,
and career plans
•Assumes everyone has opportunities to achieve goals and a sense of control of
their life
Reproductive Life Planning Approach
More holistic, patient-centered approaches are needed

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Birth Control Methods and Options
IUD
(intrauterine
device)
Implant (e.g.,
Nexplanon)
Shot (Depo
Provera)
Patch
Pill (oral
contraceptives)
Internal
condom
Condom Ring
Diaphragm Sponge Spermicide Cervical cap
Emergency
contraception
(Plan B)
Fertility
awareness
Withdrawal Abstinence

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Abortion
 Refers to induced abortion
and intentionally ending
pregnancy
 Different types of abortions
(e.g., medication abortion,
aspiration abortion)
 One of the most common
medical interventions in the
United States
 Nearing one in four women have an
abortion by age 45
 Limited data about
abortions that occur
without a clinical provider
 Misconceptions about
abortions and barriers to
access persist.

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Infertility: Prevention and Treatment
 More than 6.7 million women in the U.S. have fertility issues.
 Much of infertility remains unexplained, despite continued
research.
 Infertility is linked to stress, nutrition, untreated sexually transmitted infections,
tobacco use, chronic conditions, and toxin exposure.
 Comprehensive fertility education, screening, and treatment
should be prioritized.
 Prevention and treatment efforts need to include a focus on
structural barriers.
 Examples include institutional racism, access to care
 Assisted reproductive technology (ART) is a common fertility
treatment.
 Poses ethical, financial, and legal dilemmas

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Family Planning Policy:
Current Issues and Debates
Title X Family
Planning Program
•an important
federal program
that creates access
to family planning
for people of
reproductive age.
The services
provided are
decided by the
government.
Medicaid/Affordable
Care Act
•access to health
care is important
for all people and
especially
important for
people of
reproductive age to
prevent infertility,
address chronic
conditions, and
help people be
healthy
Abortion policies
•states continue to
try to advance
policies to restrict
access
Religious health care
•facilities that are
affiliated with
specific religions as
well as companies
connected with
specific religions
can restrict access
to contraceptive
care

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Conclusion
Policies are needed to expand access to comprehensive, quality, and respectful
services for all people, especially those who have been marginalized and
underserved.
Reproductive justice and health equity frameworks should be central to all
programs, care, and policies.
Family planning is an essential part of public health.

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Week 5 Assignments
MCH Framework
Paper
Quiz on Chapter