Decline in the number of clients showing up for family planning

The Family Planning Division of JDWNRH has seen a downward trend due to a steady decline in clients utilizing the family planning services in the past 11 years.

A further of 7 percent decrease in family planning service utilization is noted in 2020 compared to 2019. The decline in 2020 may be attributed to the COVID-19 pandemic situation.

However, there is a general decline too.

As per the data maintained by Family Planning Division, the family planning unit catered its services to a total of 7,523 clients in 2020. This translates to more than 627 visits in a month and 25 clients a day.

The new family planning adopters in 2019 and 2020 saw a drop in new acceptors for Intrauterine Device (IUD), Depot-Medroxyprogesterone Acetate (DMPA) and Oral Contraceptive Pill (OCP) method as compared to 2019. There is a drop of 21 percent, and as per the clinic data, it is also evident that OCP is the least preferred method in 2020.

Staff nurse and In-charge of Family Planning Division of the Gyaltsuen Jetsun Pema Mother and Child Hospital, Nim Dem, said OCP and DMPA are hormonal contraceptives, and IUD or Copper-T and condom are the temporary family planning methods that the hospital provides. Another natural method is the Lactation Amenorrhea Method (LAM). However, LAM has shown high failure rates, and therefore, it is not recommended.

A total of 48,692 pieces of condoms were distributed to family planning clients in 2020. A total of 747 new clients adopted condom as family planning method in 2020, which is significantly higher than clients adopting other methods. However, as there is no data on the actual use the condom, hence, it may or may not represent the most preferred method.

There are not many takers for the permanent methods. Nim said there is no stable trend since there are many visitors coming from other districts apart from Thimphu. Sometimes the visitors are more, and sometimes less.

As per the Demographic Dividend in Bhutan 2020, Bhutan has transitioned from a situation of high fertility, high mortality, and a high child dependency ratio, to low fertility, low mortality, and a low child dependency ratio.

Fertility has declined to 2.5 births per woman in 2005, and by 2017 it had dropped below replacement level to 1.7. Like the high-income countries of East Asia, Europe, and North America, Bhutan is, therefore, nearing the completion of its demographic transition. Bhutan’s life expectancy is now slightly higher than that of neighboring countries in South Asia and its fertility rate is lower.

Nim Dem said providing family planning services does not mean it is meant stop pregnancy. The service is provided to actually help plan for a woman’s pregnancy and counseling. Such a planning has benefits for both the mother and child.

She said that the decrease in the country’s birth rate is not all connected to the access of contraceptives or family planning. In fact, family planning is important as it protects mothers from maternal health conditions or fetal problems. The proper spacing to have the next child is a minimum of two years.

“Family planning also contributes to the Sustainable Development Goals. People think that family planning means stopping the population growth, but basically it has many benefits for the family and country,” said Nim Dem.

Many women shared that having more than one or two children is difficult for them, and most of them are working mothers. When they were counseled to plan for next pregnancy, they usually hesitate or they have their own personal reasons, said the staff nurse.

Meanwhile, there is a steady discontinuation of IUD and DMPA methods in the last three years. Data from the clinic records show that in 2020, the discontinuation rate was highest for IUD as compared to 2019. Similarly, the discontinuation rate for DMPA injection was also slightly higher in 2020 compared to that of 2019. Data further reveals that all clients who discontinued IUD and DMPA users shifted to other methods. Condom usage is the most preferred method.

The reasons for IUD discontinuation is because women reported that they experienced server bleeding, pain in lower abdomen, expulsion within six months to 1 year. There are also social reasons, such as divorce and husband preventing use, to stop IUD. DMPA discontinuation is attributed to client preference and side effects, such as weight gain, vaginal bleeding and breathlessness in one client. Shortage of IUD supply was also cited as a challenge. No contraceptive failures were recorded in the year 2020.

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