High Unmet Need for Effective Family Planning Methods in Jordan

Missed Opportunities for Seeking Advice on Numerous Reproductive Health Elements

On September 26th of each year, the world commemorates World Contraception Day. The objective is to raise awareness about the available family planning methods for couples to make informed choices. It aims to demonstrate the benefits of family planning and emphasize the importance of addressing the unmet need for contraception. This helps couples avoid unintended burdens, as family planning has numerous positive impacts on maternal and child health, as well as on family and community well-being.

Reproductive health, sexuality, and reproductive rights are fundamental aspects that require careful consideration and decision-making by families. Couples have the right to access family planning services, enabling them to make choices regarding the number of children they wish to have. This right is enshrined in various national and international covenants. Family planning methods empower couples to space their births according to their preferences, aligning with Goal 3.7 of the Sustainable Development Goals (SDGs), which calls for ensuring universal access to sexual and reproductive healthcare services and ensuring that no one is left behind. This was further emphasized in the commitments of the 2019 Nairobi Summit, which aimed for zero unmet need for family planning by 2030 as one of its transformative outcomes.

At the international level [1]:

• Out of 1.9 billion women of reproductive age (15-49 years), 966 million women use some form of contraception. Approximately 874 million use modern family planning methods, while 92 million use less effective traditional family planning methods.

• The number of users of modern contraceptive methods worldwide has nearly doubled since 1990, from 467 million to 874 million women in 2022. However, there are still 164 million women who wish to delay or avoid pregnancy and are not using any contraceptive method, indicating an unmet need for family planning.

• The proportion of women of reproductive age (15-49 years) whose needs for modern contraceptive methods have been met reached 77 per cent globally, marking a 10-percentage point increase from 1990 (67 per cent).

• The percentage of women wishing to avoid pregnancy and the percentage of women using any form of contraception is highest among women aged 25-44 and lowest among women under 25.

In Jordan [2]:

• Despite a decline in the use of traditional methods, which are characterized by a high failure rate when used for several months, the rate remains relatively high at 14.4% compared to many other developing countries. Additionally, the utilization rate of modern family planning methods remains modest at approximately 37.4% in Jordan. In particular, the intrauterine device (IUD) dominates, contributing to 21% of the total methods used in Jordan, followed by pills at 8% and male condoms at 5%. The use of these methods indicates a clear desire among couples in Jordan to plan their family. Currently, married women of reproductive age who do not wish to have more children constitute 49%, compared to 28% of men. Moreover, the percentage of married women of reproductive age who are not currently using family planning methods but intend to use them in the future is around 33%.

• There is a high percentage of married women who have an unmet need for family planning, reaching approximately 14.2% (13.6% among Jordanian women and 18.6% among Syrian women). When adding the percentage of husbands using traditional methods to this figure, the proportion of those with an unmet need for effective family planning rises to 28.6%. This is a remarkably high rate. If family planning programs do not reach and address the needs of these couples, they will be at risk of having unwanted annual pregnancies, contributing to a high rate of unintended births at the national level, estimated at around 60,000 births annually.

• The presence of high and varying fertility rates across provinces, nationalities, educational levels, and living standards poses a challenge to all strategies. The total fertility rate for women (40-49 years old) among Jordanians is 3.8 children per woman, compared to 5 children per woman among Syrian women. This demographic disparity contributes to differences in population growth rates between Jordanians and Syrian refugees and widens the gap between them in terms of family size and living standards. Additionally, the short birth spacing is a concern, as 29% of births in Jordan occur within less than two years of the previous birth.

• High numbers of births are consistently recorded each year, with approximately 2.7 million births recorded during the years 2010-2022, averaging over 200,000 births annually.

• It is expected that couples may rush to have their first child before assessing the sustainability of their marriage and/or recovering from wedding expenses. Several factors contribute to this phenomenon, including the non-use of contraception during the first year of marriage. Unpublished results from the 2017/2018 Population and Family Health Survey indicate that the percentage of newlyweds who had their first child within a year and a half and within two years after marriage was 66.3% and 78.9%, respectively.

• Data from the Ministry of Health's family planning supply system indicates a decline in the number of protection years against pregnancy (i.e., the number of married women protected from pregnancy using modern contraceptive methods) based on the quantities of family planning commodities distributed by sectors supplied through the supply system. This decline occurred over the years 2015-2022, with the number decreasing from 227,594 in 2015 to 185,393 in 2022.

• One of the possible reasons for the decline in the number of users of modern contraceptive methods is the missed opportunities for providing information and counselling on these methods to married women during the following periods: the final months of pregnancy, final months of pregnancy, visits for newborn vaccinations and any other visits, also before leaving the maternity departments after delivery, especially considering that almost all births occur in hospitals. Additionally, there is a lack of dedicated counselling providers for family planning, and service sites are often crowded due to the absence of a scheduling system that allocates appointments for women fairly during working hours. This situation leaves insufficient time for providing information to hesitant women. Moreover, there is a lack of dedicated spaces for family planning counselling at most service sites. One of the most significant pieces of evidence for these missed opportunities is that 79% of married women of reproductive age who are not using contraception did not receive counselling or information about family planning from a field health worker or when they visited a healthcare facility in the past year, according to the results of the 2017/2018 Population and Family Health Survey.

The Higher Population Council, in collaboration with its partners, works towards enhancing reproductive health programs, particularly family planning initiatives. This includes monitoring the implementation of the National Strategy for Reproductive and Sexual Health for the years 2020-2030 and the derived action plans. The national strategy is the first of its kind, encompassing all components of reproductive health, such as safe motherhood, pre-marital readiness and testing, sexually transmitted infections, reproductive cancers, family planning, gender-based violence, infertility, and age of hope. Importantly, the strategy is designed to reach all segments of society, as it is based on the human lifecycle.