Evaluation of family planning and reproductive health programmes

Reproductive rights embrace certain human rights that rest on the recognition of the right of all couples to decide, freely and responsibly, the number, spacing, and timing of their children; to have the information and means to do so; and the right to attain the highest standard of reproductive and sexual health. This collaborative study between the Population Council, World Bank, NPC and MOHP is comprised of a rights-based, gender-sensitive assessment of family planning services in Egypt through a Situation Analysis (SA) of family planning services. SA was conducted in 40 public facilities in four governorates in Upper and Lower Egypt. SA involved structured interviews with service providers (n=216), Inventory of FP equipment and supplies (n=40), client exit interviews (n=481) and In-depth interviews (IDIs) with program managers (n=20). The study showed that services were largely accessible to married clients at an affordable price. However, several gaps were noted with regard to protection of client’s rights to autonomy, choice, informed decision making, privacy and confidentiality. The above findings highlight the need for rights based training of managers and service providers, a performance based incentive system and raising clients’ awareness of their reproductive rights.

The prevalence of HIV/AIDS in Lesotho, estimated at 23 per cent, is among the highest in the world. The government of Lesotho has made significant progress in providing HIV related services nationwide however, these services remain inadequate. The stigma associated with HIV remains a challenge to provision of HIV related services and has led to a global drive towards integrating HIV and sexual and reproductive health services (SRH). While increased access to HIV and SRH services is crucial, integration of the services needs to done without compromising quality of care within existing SRH service delivery points. LPPA emphasises quality of care in provision of SRH services and adheres to set guidelines. The association is planning to integrate HIV services into existing SRH service delivery points. This paper will analyse quality of care in LPPA’s Maseru service delivery point using a framework proposed by Bruce (1990) and data from exist interviews conducted at the clinic. The results will inform the service integration process with a view to ensuring that quality of care is not compromised and is improved where necessary. Since LPPA has always adhered to quality of care guidelines we expect clients to be satisfied with the quality of service.

For reproductive health services, evaluation usually assesses the impact of a project seeking to increase service supply. However, as a result of recent legislative initiatives passed in Texas to curtail the availability of abortion through a two-thirds reduction in public funding for family planning, the subject of the evaluation described here is just the opposite—to assess the impact of measures intended to drastically reduce the supply of these services. We describe the 2011 Texas legislature’s initiatives, the key components of our comprehensive three-year evaluation that will attempt to assess the impact of this legislation on family planning and abortion services, unintended pregnancies, abortions and births, and highlight some of our initial findings. In the first of two waves of interviews with leaders of organizations that provided publicly funded reproductive health services, we found that 22% of the 240 clinics were closed after the funding cuts and an additional 16% of clinics reduced hours. Women in focus groups across Texas stated that it was difficult for them to pay newly instated fees for services, which exacerbated pre-exiting barriers to obtaining reproductive health care. We also review some of the main challenges we face in carrying out this evaluation.

Northern Nigeria’s infant and child mortality rates have been stagnant or rising since 2005. In 2009 we became part of a partnership program to improve maternal, newborn, infant and child care in four Northern Nigeria states. Control Local Government Areas received less-intense statewide policy changes, while the intervention zones received these state policies plus integrated interventions at primary health care posts and development of a community-based service delivery (CBSD). We assessed changes in maternal, newborn, and child health (MNCH) care and services among women with births in the previous five years by comparing data from surveys of 6,345 women in 2009 and 3,320 women in 2011. Chi-square and t-tests document significant improvements in several maternal newborn, infant, and childcare practices. We found that pregnant women with antenatal care visit during the most recent pregnancy increased from 25% to 46%, 58% and 62% in the control, low intensity and high intensity areas, respectively. In general, the greatest improvements in MNCH care are seen among women in the communities with more interactions and potentially more intense CBSD activities. Regressions showed the differential impact of these interventions by social and economic vulnerability, with less impact in the most vulnerable communities.

I take advantage of the gradual phase out of USAID’s contraceptive donations to the Philippines from 2004 to 2008 as a natural experiment that severely disrupted publicly-provided contraceptive supply. Prior to this, more than two-thirds of the country’s contraceptive users relied on free supplies from the public sector, which in turn relied entirely on donations from international agencies like USAID. Because it succumbed to pressure from the Catholic church, the national government did not fill the shortage that occurred. While it devised a progressive allocation schedule for the distribution of the declining supply of free contraceptives to the provinces, the actual distribution was erratic and intermittent due to shipment delays, inventory miscalculations, and lumpy deliveries induced by round lot sizes. Utilizing substantial geographic and temporal variation in the share of women age 15-49 that had provisions for free contraceptive supplies at the province-quarter level, this research looks into the short-run fertility impact of the contraceptive supply disruption. Results show that a demonstrable linkage exists between diminishing contraceptive supply from the public sector and higher birth rates, especially for the poor and the less educated, which suggests that couples’ compensating behavior may be limited or incomplete.

Objectives are to create enabling environment for promotion of birth spacing and to improve access and provide selected contraceptives. The data generated through routine monitoring is used to study the immediate effect and progress of the intervention. MIS was designed to record whole process diligently. The baseline and evaluation were conducted through randomized sampling based on whole districts. An innovative approach was introduced through CBVs in non-LHW areas. The mobilization was linked with services, referral to public or private sector facilities, and additionally CBVs were supplied Condoms and pills to provide to the clients as a replenish dose. Total 304 CBVs (160 male & 144 females) from 9 union councils of 03 districts selected. They reached 97% of the target families and deliver messages and information. The intervention was continued in 5 UCs through 78 female CBVs. In 3 months follow up, 2503 clients referred for FP services and 2344 new clients have adopted one of the birth spacing service. Hence 21% eligible women have adopted FP method within 6 months through MSU (1769 clients) and through private LHV(575). 1060 Condoms and pills were provided to clients as a follow up. Where there is no LHW or any other health facility, CBVs model may be one of the effective approach to reach under privileged communities

Internal migration can both cause and be caused by poverty. Similarly, poverty can be alleviated as well as exacerbated by population movement. Many studies have been investigated to assess the impact of integral migration in poverty alleviation. However, there is no study about analyzing ambivalent relationships between migration and poverty in a developing country such as Indonesia especially for recent period. Using annually data for the period of 1990 to 2011, this paper attempts to investigate the relationships between internal migration and poverty in Indonesia. In this paper, the internal migration and poverty alleviation will be investigated in several contexts. First, the study explores the dynamic relationships of interprovincial migration patterns in Indonesia. Second, it unravels the ambivalent relationships between migration and poverty in the pre-and post-Asian crisis period. The study employs Granger Causality and Variance Decomposition which are obtained from the Vector Error Correction (VEC) approach for 33 provinces in Indonesia. The finding will reveal important recommendations for policy makers in order to derive appropriate policies in Indonesia.

Injectable contraceptives (IC) are not over-the-counter products and it needs to be promoted through the qualified health care providers. This paper investigates the possibility of promoting ICs from provider’s perspective by assessing current knowledge and perception on ICs. Utilizing a cross-section survey data conducted among 114 private providers of FP services in 15 towns of Bihar, the result showed that 78% providers were aware of ICs, though comprehensive knowledge is lacking, especially among MBBS doctors. Very less proportion of providers ever prescribed it (38%) or intend to prescribe (23.7%) in future. It may be useful to design and provide an orientation on ICs specifically covering - how it works, eligibility criteria before recommending IC, probable side-effects and management. Similarly, it is equally important to improve providers' positive attitude and belief towards ICs which may encourage them more to recommend this method more confidently and efficiently. These efforts may increase not only the use of ICs, but also the quality of service regarding ICs.

With rapid urbanization in recent decades and over 40 million people living in urban areas in Bangladesh in 2011, the country faces challenges in providing adequate health services for the burgeoning urban population. Given the need to improve basic health conditions and provision of health services in urban areas, especially for the poor, the Government of Bangladesh launched the first Urban Primary Health Care Project (UPHCP I) in 1998 and continued with a second phase (UPHCP II) from 2005 to 2012. Provision of services is through contracted non-government organizations (NGOs) in partnership areas (PAs). Assessment of the evidence show that there have been interim achievements with UPHCP II, namely, improvements across several service quality indicators, increasing equity of maternal and child health service coverage for the poor, and decreased cost over time in some PAs. Most rankings of PA performance across health service quality, cost, and maternal and child health coverage are weakly correlated, with only a few PAs scoring in the top-ranked half across all indicators. However, service quality indicators, such as training of staff, functioning of equipment, availability of drugs, infection prevention, waste disposal, use of registers, and overall and waiting time satisfaction of non-poor patients, have improved over time.

The data for this analysis have been obtained from the project data executed by the population council of India. Total of 6730 male migrant workers were identified and among them 2256 eligible male migrant workers (those migrants had with four or more moves since they left from their home prior to the survey) were only selected for the analysis. To support the data, the researcher re-visited the work place, identified the respondents those who were interviewed with the help of contractors. To understand the risk sexual behavior among different classification of workers. To examine condom use and their associated factors among male migrant workers. To assess the sexually transmitted infections and their related factors among male migrant workers of Tamil nadu. 54.7 percent of them reported that they ever had sex. While analyzing the migrants of various workers classification with those who ever had sex, the percentage of construction workers were found to be less compared to their respective counterparts. Due to the migratory nature of their works, long absence and away from families, multiple sexual partners and low condom use; migrant workers form a high risk group for contracting and spreading HIV/AIDS. Hence, there is an urgent need to educate migrant workers to change their sexual behavior or to adopt safer sex