By Laila Azzeh

AMMAN – Despite efforts in Jordan to achieve the goals of the National Population Strategy, the total fertility rate (TFR) dropped by only 0.1 per cent during the last five years, according to a recently released study.

The population has grown by 2.5 per cent annually in the last decade, and is expected to double by the year 2032, while the number of females of reproductive age (15-49) is expected to increase to two million by the year 2020 from 1.3 million in the year 2004, according to the study, published by the Higher Population Council (HPC).

In the HPC study, which sought to address the obstacles facing reproductive health and family planning programmes in Jordan, the majority of the surveyed sample was aware of the concept of family planning, but 19 per cent had no knowledge about it or perceived it incorrectly.

The report, which surveyed 800 clients of government health centres and 60 healthcare providers, also showed that health providers were the primary source of information on reproductive health followed by television, publications, family and friends.

A total of 73 per cent of currently or previously married respondents said they had used contraception in the past, while 26 per cent of them said they had not.

“Large numbers of women interviewed by the study confessed that their fear of possible side effects when using contraceptives and the fact that 30 per cent of physicians encourage women to use traditional contraceptive methods, which are unsafe and ineffective, made them reluctant to use any,” Saad Kharabsheh, who supervised the study, told The Jordan Times.

“Of course, willingness to have more children is a reason behind women refraining from using contraceptives,” he noted.

The study also showed that about 38 per cent of the currently or previously married reported having had unplanned pregnancies, while 24 per cent of infertile couples who visited healthcare providers to help them get pregnant were unable to get the service.

The vast majority of those surveyed – 97 per cent – were familiar with one or more contraceptive methods; the main methods they mentioned were pills, intrauterine devices (IUD), condoms, injections and traditional forms of contraception.

Gynaecologist Rima Farah said women are more aware of the need to use contraceptives to avoid unwanted pregnancies.

“In the last four years, there has been major progress in the way women perceive contraceptives and the issue of family planningة there is more awareness of the need to space pregnancies for health and economic reasons,” Farah, who works at Al Bashir Hospital, told The Jordan Times in a phone interview.

She added that women are now familiar with all types of contraceptives and are aware of the fact that they have “few side effects”, stressing that the type of contraceptive method recommended to a woman varies according to many factors, including her health.

“There are even a lot of women in their early thirties who want to get their tubes tiedة we advise them not to but this reveals that families are more and more willing to have fewer children,” Farah indicated, referring to tubal ligation, a surgery in which a woman’s fallopian tubes are severed.

Kharabsheh, a former health minister, noted that the study, which took about a year to complete, is intended as a reference for concerned authorities to come up with ways to enhance the implementation of the National Population Strategy.

He said the study showed that economic, cognitive, social and cultural factors still impede many Jordanians’ access to reproductive health services.

“The importance of the study is to inform health service providers of the challenges facing recipients of those services in order to enhance their quality,” Kharabsheh highlighted, noting that it also tackled several other issues such as teenagers’ awareness of sexual and reproductive health, postpartum healthcare and menopause.

Farah pointed out that a woman’s level of education and economic situation play an integral role in determining her health choices after childbirth and after menopause.

The results of a second study, which measured the contributions of the private healthcare sector including physicians, pharamacists, pharmaceutical companies and insurers to efforts to raise awareness of family planning, showed that 30 per cent of physicians are unaware of Jordan’s high population growth rate.

The study surveyed 72 general practitioners and family practice physicians, 50 gynaecologists, 108 pharmacists, 11 directors of health insurance companies, 11 directors of local pharmaceutical companies, 10 directors of drug wholesalers and 10 midwives representing 10 private hospitals.

Kharabsheh said it identified several problems in the private sector in terms of providing family planning services.

“Pills, condoms and IUDs were the three main modern methods provided by health experts. However, about 39 per cent of health providers still believe in traditional methods and they prescribe them to their clients,” he highlighted, indicating that this contributes to lowering the number of contraceptive users.

Three quarters of physicians said in the survey that they considered family planning services very necessary, while only one-third were able to correctly identify the TFR in Jordan.

The study also revealed weak coordination and communication between governmental bodies and private physicians in terms of family planning programmes.

Twenty-four per cent of gynaecologists said they believe that general practitioners should not provide family planning services, while 55 per cent disagreed with allowing trained midwives to insert IUDs.

Additionally, a high percentage of gynaecologists disagreed with allowing pharmacists to sell contraceptives without a prescription.

Among health insurance directors, three quarters indicated that they were aware of the high population growth in Jordan, but only one said family planning services were covered under their company’s insurance programme.

Explaining that insurers refrain from including these services because of their cost, Kharabsheh noted that covering family planning services would in fact reduce insurers’ expenses by decreasing the number of pregnancies and the associated costs of delivery and postpartum care.

The study also revealed that there are no local pharmaceutical companies producing contraceptives, although about half reported willingness to manufacture a contraceptive product in the future.

The second study recommended establishing a national network comprising representatives of the public and private sectors as well as NGOs to support national reproductive health and family planning programmes.