Family planning and health services in Africa.

The combination of a crude birthrate of 47 per 1000 and a crude death rate of 21 per 1000 is expected to double the 328 million African population in 27 years; population pressure most affects the urban areas which are growing at an average of 5% per annum largely due to migration trends. Patterns of family planning are uneven and the lack of distinct population policy in many African nations may be attributed primarily to 3 factors: inadequate demographic data population heteroge neity and limited resources. Full integration of family planning into health services would allow population issues to be defined within the context of community and family goals for improved health and welfare such as the control of communicable diseases and the prevention of malnutrition and eliminate the competition for allocation of financial and manpower resources. An ecological approach would concentrate on the environment from conception through intrauterine life and into postnatal life with a combined health and family planning input at each phase. The health impact of family planning input would consist of 4 elements: 1) avoidance of unwanted pregnancies and births and occurrence of risky wanted births; 2) limitation on the number of children; 3) variation in the intervals between births; 4) community training with regard to age of first and last pregnancies.