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Fertility rates in Latin America are reduced by decreased sexual activity in the population and fairly high rates of contraceptive use, while in Africa, fertility is reduced by postpartum infecundity, stemming primarily from the widespread practice of extended breastfeeding (Merson, et al., 2019, p. 385). From a family-centered perspective, the ability to decide the number and timing of births using contraception is key to being able to care for the health, mental/emotional, educational, and economic needs of each child, as well as the overall well-being of the whole family, particularly in LMICs. From a systems-based perspective, access to contraception is important for improving maternal-child health and reducing mortality, increasing economic opportunity, and improving educational attainment, particularly for girls and women (Merson, et al., 2019, pp. 386 & 391). Thus, public policy regarding contraceptives has far-reaching societal implications that extend beyond reproductive issues.
Kenya, for instance, despite national family planning services and legality of contraceptives, has struggled to make them available to all women and families, particularly those in rural areas (Population Reference Bureau [PRB], 2012). Many women and families have unmet needs for family planning and report unintended pregnancies, while girls, presumably due to the lack of economic, job, and educational opportunity in rural areas and large families, are married young, often before age 18 (PRB, 2012). They subsequently begin having children young, further reducing the opportunity for the social, educational, and economic advancement of themselves and their families. Further attention has been turned toward family planning in Kenya, with its new 2010 constitution guaranteeing the right to health and reproductive services. Policies expanding access to family planning and contraceptive services, therefore, indirectly help to reduce poverty and improve population health by enabling communities to expand job and education opportunities, to develop infrastructure along with population growth, and to improve quality of health and social services rather than â€œstruggling to keep pace with the quantity of servicesâ€ (PRB, 2012).
Reducing fertility is also possible without contraceptives, as noted with Japanâ€™s low fertility rate despite the nationâ€™s low use of contraceptives. Condoms are overwhelmingly the preferred method of pregnancy prevention among Japanese women, with over 80% of women ages 15-49 using them, compared to just 3% using oral contraceptives in 2014 (Yoshida, et al., 2016). However, policy-makers and family planning programs must take population demographics and culture into account when considering contraceptives policies. Japan is a high-income country and highly urbanized, with only about 8% of the total population in a rural area (World Bank, 2018). Condoms, therefore may be more widely available at nearby drugstores. Kenya, meanwhile, is just the opposite: a LMIC with a very high proportion of rural residentsâ€”over 70% (World Bank, 2018). Residents of these areas do not have the same conveniences in terms of access to drugstores and public or reproductive health centers. The same could be said regarding contraceptives, of course, but some longer-term options for birth control might be a better option for individuals who cannot make a quick stop to a drugstore or health center. Additionally, with Japanese womenâ€™s societal position more advanced compared to that of Kenyan women, those in Japan may be able to negotiate condom use with partners more easily than can women in Kenya. Family planning programs can help address these societal differences through education of both men and women; however, contraceptives and the expansion of availability of reproductive health services is necessary and may be more effective in Kenya and comparable countries.