Family Planning and Reproductive Health Sourcebook, 1st Ed.

By Omnigraphics

Consumer health information about family planning, contraception through counseling, maternal mortality, mental health, infertility, and sexually transmitted diseases along with information about safety tips, programs related to family planning, assisted reproductive technology, nutrition tips, a glossary of related terms, and list of resources for additional help

• Language: English
• Publisher: Omnigraphics
• Release date: May 1, 2021
• ISBN: 9780780818965

Book preview

Preface

About This Book

The state of complete physical, mental, and social well-being in all the matters of the reproductive system, its functions, and processes are termed to be reproductive health. Family planning is one of the most basic and essential healthcare services that helps in promoting reproductive health. According to the Centers for Disease Control and Prevention (CDC), in the year 2015–2017, 64.9 percent of the women among the 72.2 million in the United States were using contraception. The most commonly used contraceptive methods are female sterilization, oral contraceptive pill, long-lasting reversible contraceptives (LARCs), and male condom.

Family Planning and Reproductive Health Sourcebook, First Edition provide information on birth control and how it works, the importance of family planning and contraception that includes the effectiveness of contraceptives, birth spacing, the contraceptive methods, and usage. It also explains the reproductive disorders in women and men, adolescent sexual and reproductive health, sexually transmitted diseases (STDs), maternal- and infant-health concerns such as preterm birth, infant mortality, and mental-health impacts. Details on safety in family planning and reproductive health, its programs, initiatives, and coverages, and the future of family planning such as assisted reproductive technology (ART), research activities and scientific advances in women’s health, and the role of nutrition and food security in family planning is discussed. The book concludes with a glossary of related terms and a directory of resources for more information about family planning and reproductive health.

How to Use This Book

This book is divided into parts and chapters. Parts focus on broad areas of interest. Chapters are devoted to single topics within a part.

Part 1: Understanding Family Planning and Reproductive Health defines family planning and reproductive health and discusses how birth control works, total fertility rates in the United States, the unmet need for family planning, family health history and pregnancy, Title X service grants, way to access family planning services during the COVID-19 situation, how faith affects family planning, and integrating family planning into postpartum care.

Part 2: Importance of Family Planning and Contraception gives information on the methods of family planning which benefit both personal and economic life. This part emphasizes birth spacing, contraceptive methods, usage, and risks. Various concerns such as family planning and development goals progression, and minority population women’s liberation through family planning are discussed. It also gives details on counseling and training about contraceptives.

Part 3: Reproductive Health and Disorders describes gender-related health problems such as sexual problems, sexual health, menstrual problem, polycystic ovary syndrome (PCOS), endometriosis, uterine fibroids, gynecologic cancers, hysterectomy, infertility conditions, and sexually transmitted diseases (STDs). It also highlights information on sexual and reproductive health of adolescents namely early or delayed puberty, teen pregnancy and its prevention, sexual health education for adolescents, and much more along with details on programs and initiatives to improve reproductive health.

Part 4: Maternal- and Infant-Health Concerns starts with general information on unintended pregnancy and goes on to provide details about complications during pregnancy, maternal mortality and morbidity, preterm birth and its risks, infant mortality, mental-health impacts while being pregnant, substance use during pregnancy, along with key factors of maternal health.

Part 5: Risks, Safety, and Care in Family Planning and Reproductive Health provides details on abortions and their method, facts about abortion in the United States, and postabortion family planning. How the workplace affects the reproductive health of women and men is discussed. Additionally, information on female genital mutilation/cutting (FGM/C), early motherhood risks, diet before conception, HIV, hepatitis, and syphilis transmission from mother to child, prepregnancy and prenatal care, and valuable details on preparedness on reproductive health care during emergencies are provided.

Part 6: Programs, Initiatives, and Coverages on Family Planning and Reproductive Health begins with an overview of the various family planning programs. It discusses the various options on reproductive health-care coverages, the birth control movement, perinatal quality collaboratives, Pregnancy Risk Assessment Monitoring System, health rights, along with details on important initiatives such as the Saving Mothers, Giving Life.

Part 7: The Future of Family Planning and Reproductive Health explains how reproductive health has transformed from then to now, along with what research activities and scientific advances have occurred in the case of women’s reproductive health. It examines how to provide quality family planning. Details on nutrition, food security, assisted reproductive technology (ART) is provided. Further details on various organizations involved in developing reproduction health are elaborated.

Part 8: Additional Help and Information consists of a glossary of related terms and a directory of resources that offer information about family planning and reproductive health.

Bibliographic Note

This volume contains documents and excerpts from publications issued by the following U.S. government agencies: Centers for Disease Control and Prevention (CDC); Centers for Medicare & Medicaid Services (CMS); Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD); Health Resources and Services Administration (HRSA); National Cancer Institute (NCI); National Center for Biotechnology Information (NCBI); National Institute for Occupational Safety and Health (NIOSH); National Institute of Allergy and Infectious Diseases (NIAID); National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); National Institute of Food and Agriculture (NIFA); National Institutes of Health (NIH); National Youth Violence Prevention Resource Center; Office of Disease Prevention and Health Promotion (ODPHP); Office of Population Affairs (OPA); Office of the Assistant Secretary for Planning and Evaluation (ASPE); Office on Women’s Health (OWH); U.S. Agency for International Development (USAID); U.S. Department of Agriculture (USDA); U.S. Department of Health and Human Services (HHS); U.S. Department of Labor (DOL); U.S. Food and Drug Administration (FDA); U.S. Library of Congress (LOC); U.S. Senate Committee on Health, Education, Labor, and Pensions; United States Census Bureau; and Youth.gov.

It may also contain original material produced by Omnigraphics and reviewed by medical consultants.

About the Health Reference Series

The Health Reference Series is designed to provide basic medical information for patients, families, caregivers, and the general public. Each volume provides comprehensive coverage on a particular topic. This is especially important for people who may be dealing with a newly diagnosed disease or a chronic disorder in themselves or in a family member. People looking for preventive guidance, information about disease warning signs, medical statistics, and risk factors for health problems will also find answers to their questions in the Health Reference Series. The Series, however, is not intended to serve as a tool for diagnosing illness, in prescribing treatments, or as a substitute for the physician–patient relationship. All people concerned about medical symptoms or the possibility of disease are encouraged to seek professional care from an appropriate healthcare provider.

A Note about Spelling and Style

Health Reference Series editors use Stedman’s Medical Dictionary as an authority for questions related to the spelling of medical terms and The Chicago Manual of Style for questions related to grammatical structures, punctuation, and other editorial concerns. Consistent adherence is not always possible, however, because the individual volumes within the Series include many documents from a wide variety of different producers, and the editor’s primary goal is to present material from each source as accurately as is possible. This sometimes means that information in different chapters or sections may follow other guidelines and alternate spelling authorities. For example, occasionally a copyright holder may require that eponymous terms be shown in possessive forms (Crohn’s disease vs. Crohn disease) or that British spelling norms be retained (leukaemia vs. leukemia).

Medical Review

Omnigraphics contracts with a team of qualified, senior medical professionals who serve as medical consultants for the Health Reference Series. As necessary, medical consultants review reprinted and originally written material for currency and accuracy. Citations including the phrase Reviewed (month, year) indicate material reviewed by this team. Medical consultation services are provided to the Health Reference Series editors by:

Dr. Vijayalakshmi, MBBS, DGO, MD

Dr. Senthil Selvan, MBBS, DCH, MD

Dr. K. Sivanandham, MBBS, DCH, MS (Research), PhD

Health Reference Series Update Policy

The inaugural book in the Health Reference Series was the first edition of Cancer Sourcebook published in 1989. Since then, the Series has been enthusiastically received by librarians and in the medical community. In order to maintain the standard of providing high-quality health information for the layperson the editorial staff at Omnigraphics felt it was necessary to implement a policy of updating volumes when warranted.

Medical researchers have been making tremendous strides, and it is the purpose of the Health Reference Series to stay current with the most recent advances. Each decision to update a volume is made on an individual basis. Some of the considerations include how much new information is available and the feedback we receive from people who use the books. If there is a topic you would like to see added to the update list, or an area of medical concern you feel has not been adequately addressed, please write to:

Managing Editor

Health Reference Series

Omnigraphics

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Detroit, MI 48226

Part 1 | Understanding Family Planning and Reproductive Health

Chapter 1 | What Is Family Planning and Reproductive Health?

The World Health Organization (WHO) defines family planning as the ability of individuals and couples to anticipate and attain their desired number of children and the spacing and timing of their births. It is achieved through the use of contraceptive methods and the treatment of involuntary infertility. Family planning services include access to contraception, pre- and post-abortion counseling, and access to safe abortion procedures. The different types of family planning methods include hormonal methods, barriers, natural methods, intrauterine devices (IUDs), sterilizations, and emergency procedures. Family planning helps stabilize the mother’s health before the next pregnancy to ensure a healthier offspring. Along with health, family planning also has other benefits such as:

Reduced unintended pregnancies leading to lower maternal mortality

Reduced unsafe abortions

The decreased spread of sexually transmitted diseases (STDs) and increased detection and treatment of STDs

Protecting the health of growing children by spacing out pregnancies

Delaying pregnancy in young girls who face health risks due to early pregnancy

Preventing pregnancies in older women who face an increased health risk

Creating human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) awareness by providing information, counseling, and distribution of male and female condoms

Early detection of health conditions during prenatal screening (gestational diabetes, preeclampsia, etc.)

Allowing women to recognize their rights, provide the opportunity for education, employment, and complete participation in the society

Stabilizing population growth

Reproductive health, according to the WHO, refers to a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity, in all matters relating to the reproductive system and its functions and processes. Reproductive health implies that people are able to have a satisfying and safe sex life and that they have the capability to reproduce and the freedom to decide if, when, and how often to do so. In order for individuals and couples to maintain their sexual and reproductive health, they need information and access to safe, effective, and affordable contraceptive methods. They must also be informed and empowered to protect themselves against STDs and decide when they want to start a family. Reproductive health can be ensured through certain steps such as eating a balanced diet, maintaining a regular exercise routine, avoiding multiple infections, not ingesting tobacco and other narcotics, maintaining a proper sleep schedule, and avoiding stressors. Ensuring good reproductive health helps reduce the disease burden on the economy, decrease sexually transmitted infections (STIs), avoid cancer and tumors in the reproductive system, and avoid obstetric complications. Male reproductive health has been overlooked too often while discussing issues such as infertility and contraception, which are perceived as female reproductive health issues.

Reproductive health issues in women include the following:

Depression. Trying to have a baby, being pregnant, or the birth of a baby can increase the risk of depression in women. Difficulty in getting pregnant or losing a baby may also result in depression.

Hysterectomy. It is the surgical removal of the uterus and sometimes the cervix, ovaries, and fallopian tubes along with it. A healthcare provider may suggest surgery due to the presence of fibroids, uterine prolapse, presence of cancer in the uterus, cervix, or ovaries, persistent vaginal bleeding despite treatment, or chronic pelvic pain.

Menopause. This occurs when the ovaries stop producing estrogen and progesterone and usually occurs during the ages of 45–55.

Female genital mutilation/cutting (FGM/C). This procedure involves the removal (partial or total) of the external female genitalia or injuries incurred to the female genital organs for nonmedical reasons. This affects a woman’s sexual health such as reduced libido, decreased lubrication during intercourse, pain, and difficulty in penetration, etc.

Family planning and reproductive health are two crucial strategies that help in ensuring a healthy population. Increasing awareness on both topics leads to better-informed populations that make healthier sexual choices. With proper access to family planning services such as advanced and long-lasting methods of contraception, and extensive awareness programs of reproductive health within at-risk communities, longevity and lifespan can also be increased drastically.

References

Overview of Family Planning in the United States, National Academy of Sciences (NAS), March 10, 2009.

Reproductive Health and Family Planning, United For Sight, May 23, 2010.

Contraception, World Health Organization (WHO), July 18, 2020.

Reproductive Health, World Health Organization (WHO), January 21, 2021.

Sexual and Reproductive Health, United Nations Population Fund (UNPF), November 16, 2016.

Reproductive and Sexual Health, Office of Disease Prevention and Health Promotion (ODPHP), U.S. Department of Health and Human Services (HHS), October 8, 2020.

Men’s Reproductive Health, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), December 1, 2016.

Women’s Reproductive Health, Centers for Disease Control and Prevention (CDC), February 6, 2014.

Health Risks of Female Genital Mutilation (FGM), World Health Organization (WHO), n.d.

Hysterectomy, MedlinePlus, National Institutes of Health (NIH), January 26, 2021.

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What Is Family Planning and Reproductive Health? © 2021 Omnigraphics. Reviewed April 2021.

Chapter 2 | Birth Control and How It Works

Birth control (also called contraception) can help you prevent pregnancy when you do not want to have a baby. Male and female condoms are types of birth control that can also help protect you and your sex partner from sexually transmitted diseases (STDs).

How Do You Choose the Right Birth Control?

There is no one method of birth control that is right for everyone. Each type of birth control has pros and cons.

Here are some things to think about when choosing a birth control method:

Do you want to have children someday? How soon?

Do you have any health conditions?

How often do you have sex?

How many sex partners do you have?

Do you also need protection against human immunodeficiency virus (HIV) and other STDs?

How well does the birth control method work?

Are there any side effects?

Will you be able to use it correctly every time?

How Does Birth Control Work?

Intrauterine Device

An intrauterine device (IUD) is a small, T-shaped piece of plastic with copper or hormones that a doctor or nurse places inside a woman’s uterus.

There are two kinds:

Copper IUDs release a small amount of copper to prevent sperm from fertilizing an egg. It can last for up to ten years.

Hormonal IUDs release a small amount of hormone to prevent pregnancy. There are four different types of hormonal IUDs. Some kinds can last for up to five years and some can last for up to three years.

Intrauterine devices are very effective at preventing pregnancy. You do not feel the IUD when it is in place – and there is nothing to do or remember once it is there. IUDs do not protect you or your sex partner from STDs. But, you can use a condom with your IUD to help protect against STDs.

If you have an IUD and you want to get pregnant, a doctor or nurse can easily remove it.

Hormonal Methods

These methods work by preventing a woman’s ovaries from releasing an egg each month. They also cause other changes that make it less likely that you will get pregnant.

Some hormonal methods work better than others, and some require more effort to use. For example, you have to take birth control pills every day – but once an implant is in place, it lasts for up to three years.

Hormonal methods include:

Hormonal IUD can last for three to five years, depending on the type

Implant (a small rod put under the skin) can last for three years

Shot was given by a doctor or nurse every three months

The patch is worn on the skin and replaced once a week, with one week off every month

The ring put in the vagina and replaced once a month

Birth control pills are taken every day

These methods do not protect you or your sex partner from sexually transmitted diseases (STDs). But, you can use condoms to help protect against STDs while using hormonal birth control.

If you are interested in a hormonal method of birth control, talk with your doctor or nurse about which kind is best for you.

Barrier Methods

Barrier methods work by preventing the sperm and egg from touching each other. Common barrier methods include:

Male condoms (worn on the penis)

Female condoms (placed inside the vagina)

Birth control diaphragm or cervical cap (placed inside the vagina)

Birth control sponge (placed inside the vagina)

Male condoms are also very effective at preventing (HIV) and reducing the risk of other STDs when used correctly every time you have sex.

Female condoms may also help prevent HIV and other STDs. Diaphragms, cervical caps, and sponges do not protect against STDs.

Fertility Awareness Methods

Fertility awareness methods (FAMs) are sometimes called natural family planning. With FAMs, you learn which days you are more likely to get pregnant. If you want to prevent pregnancy, you do not have sex on those days – or you use another method of birth control.

Fertility awareness methods are only an option for women who have regular periods. It is important to know that FAMs are not typically as effective at preventing pregnancies as some other forms of birth control, such as IUDs or hormonal methods.

Couples can also use FAMs when they are trying to get pregnant.

Emergency Contraception

Sometimes you may forget to use birth control – for example, you could miss a pill or shot. And sometimes birth control methods can fail, such as if a condom breaks.

There are two options for emergency contraception:

Copper IUD. A doctor or nurse will need to place this inside your uterus within five days of unprotected sex.

Emergency contraception pills (ECPs). You will need to take ECPs as soon as possible within five days of unprotected sex. The sooner you take them, the more effective they are. You can buy some ECPs at a drugstore without a prescription. To get other ECPs, you need a prescription from a doctor.

Taking ECPs would not harm a pregnancy if you are already pregnant and are unaware of it. ECPs would not protect you from STDs, so consider getting tested for STDs if you did not use a condom – or if the condom broke.

Sterilization

Sterilization is a permanent method of birth control. This is an option for people who are 100 percent sure they do not want children – or do not want any more children than they already have.

In men, this means cutting or blocking the tubes that carry sperm to the outside of the penis. This is called a vasectomy.

In women, this means cutting or blocking the tubes that carry eggs into the uterus. Cutting the tubes is called tubal ligation and blocking the tubes is called a tubal implant.

What Types of Birth Control Help Prevent Sexually Transmitted Disease?

Abstinence (not having vaginal, anal, or oral sex) is the only sure way to prevent STDs. Using a male condom correctly every time you have sex is a very effective way to prevent many STDs, including HIV. Female condoms may also lower the risk of some STDs.

Nonbarrier methods (such as birth control pills, IUDs, and other hormonal methods) do not prevent STDs. If you choose one of these types of birth control, it would not protect you or your sex partner from HIV and other STDs – so you may also want to use condoms for protection.

How to Get Birth Control?

Do You Need to See a Doctor to Get Birth Control?

It depends on which birth control method you choose. You can buy some birth control methods at a store without a prescription. For other methods, you will need to see a doctor or nurse.

Birth control methods you can get without a prescription include:

Male condoms

Female condoms

ECPs

Birth control sponge

Birth control methods you can get only from a doctor, nurse, or pharmacist include:

Birth control pills

Patch

Diaphragm and cervical cap

Shot

Ring

You need a medical procedure for:

Sterilization (for both women and men)

IUD

Implant

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This chapter includes text excerpted from Choose the Right Birth Control, Office of Disease Prevention and Health Promotion (ODPHP), U.S. Department of Health and Human Services (HHS), October 15, 2020.

Chapter 3 | Unmet Need for Family Planning

Unmet need for family planning is defined as the proportion of fertile and sexually active women who desire to postpone pregnancy or permanently cease childbearing but are not on any contraceptive methods. Similarly, it also includes women who undergo an unintended and unwanted pregnancy without access to effective contraceptive methods.

Unwanted pregnancy is strongly associated with maternal mortality due to pregnancy with high-risk complications and unsafe abortion. Unintended pregnancy also can limit educational opportunities for the mother and affect household finances. All of these factors can collectively impact the whole family, and thus the need for an effective, affordable, and safe family planning strategy is indispensable to overcome the unmet need for family planning among women who are of childbearing age.

Reasons for Unmet Need

Many studies have proven that insufficient and inaccurate information and lack of adequate knowledge about contraceptives in both the providers and the target group contributed extensively to women’s unmet needs for contraception. The baseless fears of facing adverse health effects with the use of contraception and the lack of knowledge of the benefits of contraceptive use are the significant deterrents to its extensive usage. It is widely believed that the introduction of any new contraceptive method is mostly dampened by controversies surrounding side effects, safety, and efficacy, but these concerns can be easily overcome by providing effective counseling and adequate education to facilitate men and women to choose a method of their choice and helping to mitigate their fears and lack of knowledge.

The other primary issue that women face regarding family planning is the social opposition from male partners and families to the effective use of contraceptives for regulating pregnancy. Men seldom participate in decisions and discussions on family planning, thereby placing the whole burden on women regarding decision-making and social opposition. Women’s lack of opportunity to discuss contraceptive use with their partners is a significant aspect of social opposition leading to their unmet need for family planning.

Infrequent or absence of sexual activity has become the most common excuse for the nonuse of contraceptive methods. On account of the social situations and other socioeconomic demands, more couples tend to live apart, even though on a temporary basis, which has led to the significant reason for the unmet need for family planning.

Little or no knowledge about contraception methods and their availability has added to the prevalence of the unmet need for contraception among women.

Importance of Meeting the Unmet Need

Meeting the unmet need for effective contraception will inevitably improve the health of women. Nevertheless, men and women who are fertile, irrespective of their marital status, should be well informed and possess accurate information about their risk of becoming pregnant and about all the available range of contraceptive options so that they can choose a suitable method of contraception that best meets their needs.

Methods to Cater to the Unmet Need

Many practical solutions can be sought to address the unmet need, some of which are given below:

Offering a more comprehensive range of contraceptive methods

Increasing information about side effects, health risks, and benefits associated with each contraceptive method, and counseling about how modern methods work and how to switch methods if necessary

Supporting research and development of new contraceptive methodologies

Creating awareness among women with infrequent sexual activity regarding their risk of becoming pregnant irrespective of such practices

Helping women choose the best methods that are most appropriate for their relationship lifestyle

Making aware of emergency contraception such as pills

Providing contraceptive counseling integrated into the antenatal and postnatal care, making them aware of their risk of pregnancy after birth and appropriate contraceptive methods to use and exclusively breastfeeding after childbirth

Other than these strategies, it is highly recommended that age-appropriate comprehensive education about the use of family planning be an integral part of curriculum in schools and colleges to address common concerns for adolescents who mostly undermine and avoid contraception.

To fulfill their unmet need for family planning, women must be provided with a myriad of contraceptive choices, continued connectivity with health-care services and health-care providers to facilitate smart decision-making towards the choice of effective contraceptive methods and their usage.

Counseling services are indispensable for reproductive health and family planning strategies and should be encouraged at all costs to facilitate the safe practice of best contraceptive methods. Contraceptives, taken at the right timing with adequate knowledge regarding affordability and availability should be sought through counseling services to lessen the unmet need for family planning.

References

Reasons for Unmet Need for Contraception in Developing Countries, The Guttmacher Institute, June 29, 2016.

Unmet Demand for Family Planning, The United Nations Economic Commission for Latin America and the Caribbean (ECLAC) – United Nations, November 17, 2016.

Unmet Need for Contraception, Population Reference Bureau (PRB), March 28, 2012.

Meeting the Unmet Need: A Choice-Based Approach to Family Planning, Family Planning 2020, October 6, 2020.

Meeting the Unmet Need for Family Planning: A Life Course Perspective, United Nations Foundation, October 9, 2014.

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Unmet Need for Family Planning, © 2021 Omnigraphics. Reviewed April 2021.

Chapter 4 | Total Fertility Rates in the United States

Fertility levels directly impact the size and composition of the U.S. population. Family size is associated with female labor force participation and economic growth, as well as other social and economic changes both at the national and state levels. The total fertility rate (TFR) is defined as the expected number of births that a group of 1,000 women would have in their lifetimes according to the current age-specific birth rates. In addition to measuring the fertility of women, the TFR, unlike other measures of fertility, including the general fertility rate and crude birth rate, also measures the potential growth of the population. A TFR of 2,100 births per 1,000 women is considered necessary to replace a population over time. Because it is based on age-specific birth rates, the TFR is age-adjusted and can be compared across population groups and geographic areas.

This chapter describes patterns and variations in the 2017 total fertility rates by state for all women and for the three largest race and Hispanic-origin groups: non-Hispanic white, non-Hispanic Black, and Hispanic.

Total Fertility Rates across the United States

Total Fertility Rates for All Women

In 2017, South Dakota had the highest overall TFR in the United States (2,227.5 births per 1,000 women) (Figure 4.1).

Figure 4.1. Total Fertility Rates, by State: United States, 2017 (Source: National Center for Health Statistics (NCHS), National Vital Statistics System (NVSS), Natality.)

The District of Columbia had the lowest TFR in 2017 (1,421).

In 2017, South Dakota (2,227.5) and Utah (2,120.5) were the only states with a TFR above replacement level (2,100).

Total Fertility Rates for Non-Hispanic White Women

For non-Hispanic white women in 2017, among the 50 states and District of Columbia, the TFR was highest in Utah (2,099.5) (Figure 4.2).

The lowest TFR for non-Hispanic white women in 2017 was in the District of Columbia (1,012).

No state had a TFR for non-Hispanic white women that were at or above the population replacement level (2,100) in 2017.

Total Fertility Rates for Non-Hispanic Black Women

In 2017, for non-Hispanic Black women, the highest TFR was in Maine (4,003.5) (Figure 4.3).

Figure 4.2. Total Fertility Rates for Non-Hispanic White Women, by State: United States, 2017 (Source: National Center for Health Statistics (NCHS), National Vital Statistics System (NVSS), Natality.)

Figure 4.3. Total Fertility Rates for Non-Hispanic Black Women, by State: United States, 2017 (Source: National Center for Health Statistics (NCHS), National Vital Statistics System (NVSS), Natality.)

Figure 4.4. Total Fertility Rates for Hispanic Women, by State: United States, 2017 (Source: National Center for Health Statistics (NCHS), National Vital Statistics System (NVSS), Natality.)

The states with the lowest TFR for non-Hispanic Black women in 2017 were Wyoming (1,146), California (1,503.5), New York (1,574.5), Connecticut (1,575.5), West Virginia (1,579.5), Rhode Island (1,594), Montana (1,641), and New Mexico (1,651).

In 2017, TFRs for non-Hispanic Black women were above the replacement level of 2,100 in 12 states.

Total Fertility Rates for Hispanic Women

For Hispanic women in 2017, among the 50 states and District of Columbia, Alabama had the highest TFR (3,085) (Figure 4.4).

The lowest TFRs for Hispanic women in 2017 were in Vermont (1,200.5) and Maine (1,281.5).

In 2017, TFRs for Hispanic women were above the replacement level (2,100) in 29 states.

This chapter shows a range in TFRs by state, both overall and for the three largest race and Hispanic-origin groups. Overall, the TFR varied by state, ranging from 2,227.5 (South Dakota) to 1,421 (District of Columbia), a difference of 57 percent.

Differences among states in TFRs varied by race and Hispanic origin. Among non-Hispanic white women, the highest rate (Utah) was more than double the lowest rate (District of Columbia). Among non-Hispanic Black women, the TFR for Maine was 3.5 times higher than that for Wyoming. For Hispanic women, the highest rate in Alabama was 2.6 times higher than the lowest rate in Vermont. The TFRs for South Dakota were among the highest observed overall and for each of the three race and Hispanic-origin groups; TFRs for California, the state with the most births, were consistently among the lowest reported overall and for each group by state.

The 2017 TFR for the United States of 1,765.5 was 16 percent below what is considered the level for a population to replace itself (2,100). For overall population, only two states, South Dakota and Utah had TFRs above replacement level. Among non-Hispanic white women, no states had a TFR above the replacement level (Utah was 2,099.5); among non-Hispanic Black women, 12 states had TFRs above replacement; and among Hispanic women, 29 states had TFRs above 2,100. Although nearly all states lack a TFR that indicates their total population will increase due to births, these results demonstrate that there is variation in fertility patterns within states among groups according to race and Hispanic origin.

A potential limitation for some states is that the number of births by maternal age and race and Hispanic origin, which serve as the basis for the age-specific birth rates used to compute total fertility rates, was small for some groups. Patterns in age-specific rates by race and Hispanic origin for states with a smaller number of events were reviewed for consistency with previous years and with other states and were found to be generally consistent from year to year. However, the TFRs, particularly the highest or lowest rates for a given race and Hispanic-origin group, may reflect a relatively small number of births and population size for a given state.

This chapter provides recent TFRs at the state level by race and Hispanic origin that may help inform population shifts in the United States. The calculation of the TFR assumes that the current age-specific birth rates of women will remain constant over their reproductive lifetime. Thus, the TFR is an estimate of their possible completed fertility. However, the final completed fertility of women will depend on the actual age-specific birth rates that women will experience during their childbearing ages.

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This chapter includes text excerpted from National Vital Statistics Reports – Total Fertility Rates by State and Race and Hispanic Origin: United States, 2017, Centers for Disease Control and Prevention (CDC), January 10, 2019.

Chapter 5 | Integrating Family Planning into Postpartum Care

Initiation and integration of postpartum family planning (PPFP) are considered essential aspects of the postpartum care for both the mother and the baby’s health for at least the crucial 12 months following childbirth.

The main aim of integrating family planning as the vital aspect of postpartum care is to prevent unwanted, unintended, and closely spaced pregnancy after childbirth that could be detrimental to the overall well-being of the child as well as the mother resulting in subsequent complications such as low birth weight, preterm labor, emotional stress, anemia in the mother, and child morbidity and mortality.

Ignorance and Importance of Family Planning during the Postpartum Period

Contrary to our general understanding, the many available contraceptive methods during the postpartum period are seldom practiced. As a result, the quality of health of both the baby and the mother is compromised to a greater extent.

During their postpartum period, most women have little or no knowledge about their own fertility condition and thus ignore contraception. Some women cannot even correctly identify the risk-period of getting pregnant postpartum. Moreover, in HIV-positive postpartum women, family planning needs that are required to prevent the transmission of HIV from mother to child are not often addressed.

To facilitate good health for the baby and the mother, it is imperative to space out the next pregnancy to at least 12 months apart so that the mother can recuperate from her pregnancy-related stress, both physically and emotionally, and to care better for the growing child. Generally, the inter-pregnancy interval (IPI) of 24 months is considered optimal between two consecutive pregnancies and it is essential for the welfare of both the mother and the baby.

Methods of Contraception in the Postpartum Period

While many family planning methods can be implemented during postpartum care, there are three natural family planning methods, namely:

Abstinence

Lactational amenorrhea method (LAM) or breastfeeding

Coitus interruptus (withdrawal)

The abstinence method is considered very unreliable since it involves greater level of self-control. In the LAM method, exclusive breastfeeding has proved to show 98 percent effectiveness in preventing pregnancy for up to six months. Nevertheless, the LAM method is not entirely reliable to prevent pregnancy. The third method, withdrawal, is not a reliable method as the preejaculatory fluid would still contain viable, healthy sperm cells and can result in a positive pregnancy.

Other types of contraception that can be used postpartum include:

Progesterone-only pills (POP). The progestogen-only method, also known as minipill, has no effect on breast milk volume or infant growth. This can be started immediately postpartum, and a six-month supply is usually prescribed.

Contraceptive implant. This implant can be inserted immediately after childbirth and is very effective. It can last for about five years and can be removed at any time.

Depo Provera injection. This injection can also be given immediately after childbirth and is given every 12 weeks. This is also known to be very effective.

Combined oral contraceptive pill. Taking the pill is decided under medical supervision depending on few practical factors such as:

Not breastfeeding. The pill is taken 21 days after delivery.

Partial breastfeeding. The pill is taken after six weeks.

Exclusive breastfeeding. The pill is taken after six months.

Vaginal ring. Using the vaginal ring depends on factors such as breastfeeding and obesity. It works by releasing a constant stream of hormones such as estrogen and progestogen into the bloodstream.

Condoms. These are considered affordable and safe options that can be conveniently used at any time.

Sterilization. It is a permanent procedure to prevent pregnancy.

Tubal ligation. Small incisions are made over the abdomen using general anesthesia, and the fallopian tubes are clipped, burned, or removed. This can also be done during a cesarean section.

Tubal occlusion. Microinserts are placed in the fallopian tubes through a vaginal approach using only local anesthesia. This method takes about three months to be effective. For confirmation, medical imaging such as x-ray and ultrasound are done to ensure the tubes are blocked effectively.

Vasectomy. A simple surgery done in a clinical setting where the small tubes that carry sperm in the scrotum (vas deferens) are either cut or blocked to prevent the sperm from reaching the womb and causing pregnancy. This is usually an outpatient procedure. Vasectomy is a noninvasive surgery and is known to be one of the most effective methods.

Emergency contraceptive pill (ECP). This pill can be used any time after delivery and can be taken up to four days after unprotected sex – although it should be taken preferably within 24 hours after sex. The ECP is less effective in women who are overweight.

Intrauterine device (IUD). A hormonal or copper intrauterine device that can be inserted by trained medical personnel. It is sometimes inserted immediately after delivery, but it is more commonly inserted six weeks after delivery. It lasts for 5 or more years, depending on the type of device, but it can be removed at any time.

The uncertainty of sexual activity and fertility immediately after childbirth leads to the risk of unintended pregnancy unless effective contraception is integrated. Therefore, keeping in mind the importance of integrating suitable methods of contraception according to each one’s need and biological condition, the sooner the family planning is accommodated, the better the purpose of contraception is served.

It is recommended that contraception or family planning should start from around three weeks after the baby is born to facilitate better results in preventing pregnancy. Postpartum family planning can help prevent unintended and closely spaced pregnancies and protect mothers and children in regions where HIV is prevalent. Family planning services can also be combined with other services when the hospital and clinic visits for both the mother and baby are frequent during postpartum care, including well-baby checks, and other pediatric visits.

Much needs to be done to meet the requirements for acquiring knowledge and adopting practices to address a woman’s unmet needs in terms of family planning, especially in the first 12 months postpartum.

References

Cooper, Michelle, et al. Postpartum Contraception, The Obstetrician and Gynecologist (TOG), June 21, 2018.

Postpartum/Postabortion Family Planning, Family Planning 2020 (FP2020), October 9, 2019.

Best Practice in Postpartum Family Planning, The Royal College of Obstetricians and Gynaecologists (RCOG), June 1, 2015.

Postpartum Contraception, New Zealand Family Planning, March 8, 2016.

Postnatal Contraception, Family Planning Victoria, June 5, 2016.

Tubal Ligation and Tubal Occlusion, Sex & U, July 13, 2017.

Meeting the Family Planning Needs of Postpartum Women, Social and Behavioral Science Research (SBSR), April 10, 2008.

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Integrating Family Planning into Postpartum Care, © 2021 Omnigraphics. Reviewed April 2021.

Chapter 6 | Importance of Family Health History in Pregnancy

What Is Family Health History?

Family health history is a record of the diseases and health conditions in your family. You and your family members share genes. You may also have behaviors in common, such as exercise habits and what you like to eat. You may live in the same area and come into contact with similar things in the environment. Family history includes all of these factors, any of which can affect your health.

How Can You Collect Your Family Health History?

You may know a lot about your family health history or only a little. To get the complete picture, use family gatherings as a time to talk about health history. If possible, look at death certificates and family medical records. Collect information about your parents, sisters, brothers, half-sisters, half-brothers, children, grandparents, aunts, uncles, nieces, and nephews. Include information on major medical conditions, causes of death, age at disease diagnosis, age at death, and ethnic background. Be sure to update the information regularly and share what you have learned with your family and with your doctor.

Family Health History and Planning for Pregnancy

Thinking about having a baby? If you have a family health history that includes a birth defect, developmental disability, newborn screening disorder, or genetic disease, you might be more likely to have a baby with this condition. Learning more about your family health history before you get pregnant can give you time to address any concerns. Remember to consider the family health history of both potential parents, not just mom. Be sure to discuss any concerns with your doctor.

Based on your family health history, your doctor might refer you for genetic counseling. Other reasons for genetic counseling include having had:

Infertility (trouble getting pregnant)

Two or more miscarriages

Previous pregnancy or child with a genetic disease or birth defect

A baby who died at less than one year of age

After genetic counseling, you might decide to have genetic testing for conditions that could affect your baby. Results from these tests could impact your pregnancy planning. Testing before you get pregnant can give you time to think about what the results mean for you and consider all your options.

Family Health History during Pregnancy

Expecting a baby? You might be wondering whether your baby will have mommy’s eyes or daddy’s dimples. But, your baby will inherit much more than that. Learn about both parents’ family health history to give your baby the best start possible. If either of you has a family health history of a birth defect, developmental disability, newborn screening disorder, or genetic disease, your baby might be more likely to have this condition. Knowing if your baby is more likely to have one of these conditions is important so that you can find and address potential health problems early.

Family Health History Checklist

Gather family history information before seeing the doctor.

Use the U.S. Surgeon General’s online tool for collecting family histories, called My Family Health Portrait.

Tell your doctor if you have any family members with a genetic disease, chromosomal abnormality, developmental disability, birth defect, newborn screening disorder, or other problem at birth or during infancy or childhood, especially if you have had a previous pregnancy or child affected by one of these conditions.

Talk to those family members, if possible, to find out their specific diagnoses.

Ask for a copy of their genetic or diagnostic test results, if any, to share with your doctor.

Alert your doctor if you have had a previous preterm (early) birth, miscarriage, stillbirth, or a child who died from sudden infant death syndrome (SIDS).

Follow your doctor’s recommendations. For example, if you have had a previous pregnancy or child affected by spina bifida or anencephaly, your doctor might recommend that you take a higher than normal dose of the B vitamin, folic acid, before and during pregnancy.

Carrier Screening

Parents can have a baby with a genetic disease even though neither parent has it. Babies inherit two copies of each gene, one from each parent. For some genetic diseases, the baby will only have the disease if both copies of the gene related to the disease do not work properly. In cases like these, each parent has one copy of the gene that works properly and one that does not. If the baby inherits both nonworking copies of the gene, the baby has the disease. Thus, the parents are carriers for the disease, meaning that they do not have the disease themselves but can have children with it.

If a genetic disease runs in your family, you might be a carrier for that disease. Likewise, you might be a carrier for genetic diseases that are more common in your racial or ethnic group. Examples include sickle cell disease (SCD) in Blacks and Tay-Sachs disease in people of Ashkenazi and Eastern European Jewish descent. Your doctor might ask if you want to have a screening, called carrier screening, to check if you are a carrier for diseases that are more common in your racial or ethnic group. Talk to your doctor if you want to know about carrier screening for genetic diseases that run in your family. Current recommendations* state that all women should be offered carrier screening for cystic fibrosis and spinal muscular atrophy and should be checked for hemoglobinopathies such as SCD and thalassemia.

If the results show that you are a carrier for a disease, the other potential parent will also need to have carrier screening to know if you could have a baby with the disease.

*Recommendations are from the American College of Obstetricians and Gynecologists and the American College of Medical Genetics.

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This chapter includes text excerpted from Family Health History: The Basics, Centers for Disease Control and Prevention (CDC), November 25, 2020.

Chapter 7 | Faith and Family Planning

What Does Faith Community Mean?

In this chapter, the phrase faith community is used in the most inclusive way to refer to churches, synagogues, mosques, meeting houses, and temples within a neighborhood, city, county, or state.

Why Involve the Faith Community

Programs to reduce teen pregnancy and faith communities are natural partners. A shared interest in strong families and the healthy development of young people provides an excellent foundation for mutually beneficial activities. This chapter describes a variety of ways that religious communities and programs to prevent teen pregnancy can work together productively. There are at least five reasons to involve faith communities in preventing teen pregnancy.

Faith communities:

Focus on values

Have community credibility

Have access to young people, parents, and potential volunteers

Have skills in reducing conflict

Are willing to provide in-kind contributions

Focus on Values

Preventing teen pregnancy involves more than just biology. In fact, it touches on complex issues of values, personal standards of behavior, power, parent-child relationships, feelings, and beliefs. These issues are at the core of religious communities – what they teach about, pray over, and communicate. As such, they are natural allies for any program seeking to change the high-risk behavior of teens. Interestingly, research is beginning to show what many have long known from working with teens – that religious faith and a strong moral sense play vital roles in protecting teenage boys and girls from too-early sexual activity and teen pregnancy. By teaching and preaching religious values, faith communities help shape the character of our children and give them answers to their most heartfelt questions.

According to the 1995 National Survey of Family Growth, 48 percent of 15 to 19 years of age girls said that they were virgins, and nearly one-half of these young women said that the main reason they had abstained from sex was that it was against their religion or morals. No other single reason was cited more often.

Adolescents who feel religion and prayer are important are more likely to delay sexual activity than are other teens.

Adolescents reporting regular attendance in religious services are less likely to be sexually active than are other teens.

Community Credibility

Many churches and other religious organizations are deeply involved in their communities.

Their leadership can help teen pregnancy programs strengthen their presence in the areas they already serve. Even more, faith communities can open doors to new groups. A study funded by the American Association of Retired Persons found that each American belongs, on average, to four community groups. The most commonly cited is a religious organization. The networking potential is substantial.

Moreover, in some communities, religious organizations are some of the only institutions that still function well, have credibility, and can reach out to families with a values-based message.

This community credibility that faith communities bring to a partnership is crucial because it can broaden the perception of a pregnancy prevention effort from a limited, special interest project to one that is seen as more closely tied to the larger community.

Access to Young People, Parents, and Potential Volunteers

Faith communities typically have a variety of special programs for young people, both boys and girls, and for parents – just the groups that most programs to prevent teen pregnancy target. As such, faith communities should be at the top of any community outreach list.

Parents in particular have an important part to play in preventing adolescent pregnancy, and religious congregations are a good place to reach them. Parents who are active in a congregation also tend to be active in the lives of their children, and faith communities typically support parents who are concerned for and want to be involved with the lives of their teens.

Faith communities also can be a source of the volunteer help and expertise that many programs need. For example, many churches and other religious organizations have strong traditions of community service and volunteering and can help programs find mentors, public speakers, and other key players. There are few places a program could go to get better expertise or more diverse skills and professional abilities.

Skills in Reducing Conflict

One of the biggest stumbling blocks to reducing teen pregnancy is the amount of conflict and acrimony that this topic can cause among adults. Accordingly, finding ways to turn down the heat is often central to making any progress, and in this connection, faith communities may be helpful.

Religious leaders are often skilled at finding common ground between people with diverse views and developing values of tolerance for differences. They strive to bridge differences and make personal connections even in difficult circumstances. These are all essential skills in decreasing the conflict that can surround community-based programs to prevent teen pregnancy.

Willingness to Make In-Kind Contributions

Finally, faith communities can offer significant