Mission

To establish a sustained environment that facilitates universal accessibility to reproductive healthcare services.

Overview

The World Health Organization affirms that family planning “exercises a positive influence on health, development and family well-being, and has a very important impact on mothers and children”. It ensures that every child is a child by choice rather than by chance! Family planning, which is a pillar of reproductive health, may be defined as a conscious and deliberate determination of family size and pregnancy spacing through the utilisation of a chosen method or methods of contraception. Reproductive health is 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.

The Ministry of Health’s National Family Planning Policy is included as a priority goal within the country’s overall health policy. The Family Planning Policy is considered expedient at this time, since there appears to be a substantial demand for family planning counselling and services. In the years 1994 and 1995, the Health Information & Research Unit recorded 2,081 and 2,529 postnatal women respectively, as having been provided with contraceptives. For the same periods, there were 4,382 and 3,670 women respectively, outside of the postnatal period who requested contraceptives. These existing services in the public sector, responded to the expressed needs, mainly of women, in the absence of an established Family Planning Policy.

Many women have children spaced less than 18 months apart, and in many instances, less than 12 months apart. These women, often teen mothers, more often than not find themselves with 5 or more children. An average of 246 women, between 1994 and 1995 had 6 children or more.

The need for a National Family Planning Policy is further underscored in light of the following statistics:

• The population of The Bahamas has increased by 20% since the 1980 census.
• 50% of the population is in the childbearing age.
• 60% of the population is under the age of 25 years. The teenage (15 – 19 years) birth rate is twice as high as that of the United States, 3 times as high as that of Canada, and 11 times higher than that of the Netherlands.
• Bahamians are living longer; the average life span for males is 68 years and 74 years for females.
• Some 6,000 births occur annually.
• At the present growth rate, the population should double within the next 35 years.

The high rate of sexually active teenagers, the rising number of teens with multiple pregnancies, the lack of comprehensive, specifically targeted education coupled with limited access to contraceptive information and services, all form barriers to good reproductive health.

Our primary healthcare system includes services addressing maternal care and safe motherhood. In order for citizens to exercise the freedom to decide if, when and how often to reproduce, and to have safe and satisfying sex lives, reproductive health requires access to both family planning and related healthcare services.

Objectives

1. Reduction in the rate of unplanned and unwanted pregnancies.
2. Reduction in the number of adolescent pregnancies.
3. Reduction in the incidence of illness and death due to reproduction health disorders.
4. Empowerment of both males and females to exercise reproductive rights and take responsibility for their sexual and reproductive health.
5. Health education, information and skill building for informed decision-making.

Other pillars of reproductive health, which are addressed in the National Policy, are sexually transmitted diseases and HIV/AIDS, reproductive health malignancies and infertility.

As documented in the United Nations Population Fund (UNFPA) under the caption “Family Planning Saves Lives”, unsafe patterns of childbearing were summarised as “too soon, too close, too many and too late”, and are important factors in both maternal deaths and in the deaths of infants and children. Use of family planning along with access to safe maternity care could all but eliminate maternal deaths and directly save the lives of millions of infants and children.

Ways to Save Lives

Delay the first birth
Women in their teens are at greater risk for complications in pregnancy and childbirth than women in their twenties, regardless of marital status. For younger teens whose pelvises have not yet stopped growing, obstructed labour is a serious and even fatal problem. Anaemia, high blood pressure and haemorrhage are also more common among teenage women, who are less likely to succeed in carrying a pregnancy to term. Infants born to adolescent mothers are more likely to be premature and have low birth weight.

Space births by at least 2 years
Both pregnancy and breastfeeding take a toll on a woman’s nutritional status. Spacing births at least 2 years apart, gives a woman’s body time to recover from pregnancy and makes it more likely that a child will not be weaned too early, or end up in competition with other siblings for scarce food and attention.

Avoid too many pregnancies
Women who have had more than 4 or 5 children again face a greater risk of complications.

Stop in time
Women toward the end of their childbearing years also run greater risks from pregnancy and childbirth. Pregnancy between the ages of 20 and 35 years is considered optimal for the health of both women and children.

Family Planning

• Promotes optimal birth spacing.
• Decreases certain high-risk pregnancies.
• Assures planned pregnancies.
• Contributes to improving women’s and children’s health.
• Empowers parents with the decision-making skills to make informed choices regarding reproductive health issues, including family size.
• Improve women’s status and quality of life.
• Promotes access to other ancillary health services.

Family-life education must also be emphasised as integral to the acquisition of the life skills necessary for healthy decision-making. Coupled with this are service components that essentially aid family planning/reproductive health practices.

These are:

1. Education and counseling
2. Promotion of healthy sexual behaviour, including abstinence.
3. The use of contraception.
4. Prevention of sexually transmitted diseases.
5. Early detection and prevention of certain cancers.
6. The promotion of effective parenthood.

Policy statements

The programme will target all family members.

Traditionally, family planning services have focused almost exclusively on women, forcing women to have a disproportionate responsibility for reproductive health and family size. Yet the health and attitudes of men often play a crucial role in the health of women, since men often hold decision-making power over matters such as sexual relations and when and whether to have a child. Additionally, in our society that still values the extended family, children born to teenage and single women often become the burden of the entire family. These, among other reasons make it imperative that all members within a family have access to information and services that empower them to enrich their quality of life.

The comprehensive family-life Education Programme offered by the Ministry of Education, targets all school-age children. Additionally parents and other family members are reached through parenting sessions, peer counselling and other programmes, integrated with existing programmes in the work place, church, social club and sporting/recreational environments.

In The Bahamas, the age of legal accountability is 18 years. Regrettably, younger persons are sexually active and are becoming pregnant. While Family-life Education encourages abstinence for adolescents, provision is made for the high numbers of sexually active youth. The Sexual Offences and Domestic Violence Act, 1991, implicitly sets the legally consensual age at 16 years. Therefore, all males and females, in exercise of their right of choice, and all those deemed at risk, are to have access to a full range of appropriate and affordable contraceptive methods, including information and counseling on natural family planning methods. These are offered in a safe and confidential environment by appropriately trained staff. (see adolescent health clinic)

A comprehensive national family planning clinical services system will be made available to all residents.
All residents within the child-bearing age group and attending any Community Health Clinic for the first time each year is offered counseling, education and a physical assessment, including cervical smears, breast examination and urine testing and screening for specific sexually transmitted infections. Optional HIV testing is offered with appropriate pre and post counseling (written consent is required). Prostatic examination is offered to males over 35 years.

A full range of contraceptive methods, including information and education on natural family planning methods is available to all clients. Those needing additional or alternative care, for example, tubal ligation or vasectomy and infertility care are usually referred, according to established referral protocols.

A cadre of trained personnel offer all family planning services in the Community Health Clinics. The Registered Nurse, who is trained in family planning, is authorised to provide the designated health services.

Clients may be required to pay a minimum fee to partially cover cost, but provisions are made to ensure that no client is refused care, due to inability to pay.

A training programme to maintain a strengthened capacity of providers of reproductive health/family planning service.
All providers of family planning services are certified in family planning and STI counselling, contraceptive technology and related screening techniques.

There is also reciprocity of training between the Family Planning Programme and the Family-life Education Programme of the Ministry of Education.

Provisions are made for advanced training of Registered Nurses to the level of Family Planning Nurse Practitioners, who have full responsibility for the care of family planning clients at the primary care level.

Family planning services providers are encouraged to keep abreast of new technology through a formal Continuing Education Programme.

Comprehensive health education/promotion programmes for the public and specifically targeted groups

Comprehensive health education/promotion programmes are implemented using various media types.

Collaborative environment within and between governmental agencies, non-governmental organisation and the community.

It is recognised that a national programme involves multi-sectors of the community. Collaborative ties within and between governmental agencies and non-governmental organisations are constantly strengthened, aided by the National Family Planning Committee. This Committee is comprised of representatives from related government programmes and private sector organisations. In this and other ways, close ties and constant communication is maintained with The Bahamas Family Planning Association and other similar organisations.

Related links:

• Cancer Screening
• Counseling
• STI Screening
• Family Planning Workshops
• Contraceptive Methods

For more information, please contact:

The Department of Public Health
Poncianna Hill Building
Meeting Street
P.O. Box N-3730
Nassau
New Providence
The Bahamas
Tel. (242) 502-4835
Fax.(242) 502-4874
Opening hours: 9:00 am to 5:00 pm, Monday to Friday, except public holidays