x Abu Dhabi, UAESunday 21 January 2018

Jordan hopes reproductive education will keep 'population explosion' at bay

A five-year action plan aims to increase use of contraceptives.

Dr Sawsan Nahawi performs a routine medical check at a family planning centre in Amman.
Dr Sawsan Nahawi performs a routine medical check at a family planning centre in Amman.

AMMAN // Jordan is trying to reduce its birthrate, fearing unchecked population growth will put further pressure on its limited resources, already strained by more than half a million Iraqi refugees. Last year, the fertility rate stood at 3.6 births per woman, with 160,000 newborns. The Higher Population Council hopes to bring that number down to 3.1 births per woman by the year 2012, but is being stymied by deep-rooted tradition that favours large families and ignorance about contraception. Islam also promotes birth spacing, where women are encouraged to wait two or three years between pregnancies, rather than restricting the number of children each family has.

Between 2002 and 2007, the fertility rate dropped from 3.7 births per woman to 3.6 births. These findings fell short of the targeted levels set by the 2000-2020 National Population Strategy that expected the fertility rate to drop to 3.2 births last year, and to fall to 2.1 births by 2020. Reasons cited by demographic analysts for the birth rate remaining roughly the same were that women were getting married at a later age and then rushing to get pregnant, discontinuing the use of contraceptives and limited family planning counselling.

Jordan is worried that its current population of 5.8 million will double by 2030, and will drain the country's limited resources. Forced migrations by some 500,000-750,000 Iraqis are also straining the country's infrastructure. "If the natural growth that is triggered by the reduction of mortality rates and the increase of new births of the population does not change, we will have a population explosion by 2030," Raeda al Qutob, the secretary general of the Higher Population Council, said.

"Resources will not be enough, and we will miss the demographic window of opportunity, which comes once in a lifetime in any society." Fertility rates are strongly related to the use of contraceptives. But modern contraceptives such as the IUD, pills, condoms and injections, are not widely used in Jordan, despite efforts by the ministry of health to promote them. The rate of women using contraceptives was 41 per cent in 2002 and 42 per cent in 2007. There were no available figures for men.

Dr Qutob blames the poor uptake on the lack of understanding and counselling for families. "Forty per cent of women who use contraceptives discontinue their use within a year. They take pills and stop; they use the IUD which should last for five years and then they remove it after one year. Nearly 30 per cent of women get pregnant when they don't plan to. They have an unmet need, so what is lacking is the proper counselling," Dr Qutob said. "They know where to get the service but they do not know enough about the methods to continue using them properly."

The government's five-year reproductive health action plan seeks to increase the use of contraceptives among married couples aged 20-29, who have the highest fertility rates, through proper counselling and making information about contraceptives accessible. Millions of condoms have been sent to hospitals and health clinics, including those run by the government, universities and military. The ministry has also trained health providers and midwives to provide counselling on birth control. USAID is also working with the ministry to improve family planning, reproductive health and maternal child heath care services.

Despite the ministry's efforts, the Jordan Association for Family Planning and Protection, or JAPP, a non-governmental organisation that works closely with the health ministry, said women still did not understand how to use contraceptives. "One woman wanted to remove the IUD because her teeth had fallen out since she had it inserted," said Sawsan Nahawi, a general practitioner at the centre. "Another wanted to have it removed because she heard that the IUD would make her lose weight. Another told me it made them fat."

JAPP ? the first group to introduce family planning services in Jordan ? has been touted as a successful model, but it provides less than 14 per cent of services in the country. Its services range from pre- and postnatal care to lab tests and family planning counselling at discounted rates. "Other women have an idea about what contraceptives they want, but we advise them about the methods that suit them best ? we encourage birth spacing, in order for the mothers to be capable of taking care of their children," Dr Nahawi said.

Issa Masarweh, a professor of demography at the University of Jordan, who recently carried out a study into why Jordan's birth rate was not dropping further, said the problem was that counselling was not recognised as an integral part of family planning. "There are no full time counsellors, the health centres lack a counselling space and an appointment system and the vast majority of patients show up between 8am and 11am. The heaping of patients over few hours results in low quality services," he said.

"We need to seize the missed opportunities to provide family planning information whether at the premarital exam, universities, during antenatal care, postnatal care or delivery." smaayeh@thenational.ae