Evaluation of family planning and reproductive health programmes

The paper examines the disparity in reproductive and child health (RCH) care utilization status among districts within the states of India over two periods, namely 2002-2004 and 2007-2008 using data from District Level Household Survey of India. The RCH care utilization status of each district within each state is determined by RCH care index value. The RCH care index for each district is computed based on four RCH care indicators using principal component analysis and aggregation method. The coefficient of variation (CV) is used to assess the degree of disparity in RCH care utilization status among the districts within the states. Results indicate that though disparity in RCH care utilization status among the districts has declined in many states, it continues to be large in some northern and north-eastern states of India. The CV in RCH care index, as of 2007-2008, is lowest in Tamil Nadu (0.035) followed by Kerala (0.047) and highest in Meghalaya (0.451) followed by Manipur (0.446). Efforts should be made to enlarge the use of RCH services in the states where large disparity in RCH services utilization exists among the districts.

The traditional contraceptive users among higher educated women are considerably higher than the lower educated women in Sri Lanka during 1993 to 2006-07. This study attempts to examine the factors influencing the reliance on traditional contraceptive methods among educated women in Sri Lanka. The study uses data from the SLDHS 2006-07 and qualitative in-depth interviews. Fear on side effects of modern contraceptive methods and building up the strong confidence on traditional contraceptive methods are found as main factors of influencing the use of traditional contraceptive methods. Lack of time in using modern contraceptive methods and fewer frequency of sexual intercourse are also found as other factors. Since some misbelieves on modern contraceptive methods among educated women were found, several policy implications such as strengthening the family planning counselling targeting the educated women, introducing institutionalized awareness programmes on contraceptive technologies for working women and promoting awareness programme on family planning through media are described. The importance of disseminating proper education on modern contraceptive use among educated women is highlighted in order to maintain the replacement level fertility which supports for the country’s development.

Contraceptive use is still low in developing countries including Nigeria even though its knowledge is widespread. The option of Exclusive Breast Feeding (EBF) as a contraceptive is however reported at 5%. In spite of its demonstrated advantage, EBF is far less common among lactating mothers which has led to the decline of its use as birth spacing. The reasons for this low use among lactating mothers are yet to be thoroughly investigated. The major question arising from this is to what extent has demographic features been reflected in the low usage of EBF as a contraceptive? Is there any discernible trend of the low usage of EBF as a contraceptive? To answer these and other related questions, this survey study utilizes the combination of Social Action Theory by Max Weber and Ajzen’s Theory of Reasoned Action as its theoretical framework. Data collection was both primary and secondary. Using the NDHS (2003 to 2008) data base and structured questionnaire administered on lactating mothers, it is expected that the factors affecting the use of EBF as a contraceptive will centre on demographic factors such as income, knowledge and education and ethnic membership will influence attitude and eventual use of EBF.
Keywords: Birth spacing, Exclusive breastfeeding, Lactating mothers, Contraceptive
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This paper makes an objective assessment of the planned family planning efforts in India organised under the National Family Welfare (Planning) Programme during the period 1970-71 through 2010-11. The assessment covers the conceptual foundations of official family planning efforts, administrative capacity and organisational efficiency of the National Family Welfare (Planning) Programme, outputs of official family planning efforts in terms of needs effectiveness, capacity efficiency, goals effectiveness and realised efficiency of the National Family Welfare (Planning) programme, and impact of official family planning efforts in terms of realisation of demographic targets and goals. The analysis, based primarily on the services statistics of the National Family Welfare Programme, suggests that, at the policy level, there has been considerable dilution in the official family planning efforts which has implications for organising family planning activities at the grassroots level and the impact of these efforts in terms of reduction in the birth rate and population stabilisation. The paper argues for reinvigorating the official family planning efforts and proposes a framework for the purpose.

The 2012 London Summit on Family Planning has spearheaded a renewed focus on increasing access to family planning. Key to increasing demand for and use of family planning services will be understanding interventions that are effective at meeting the needs of vulnerable populations. While multiple reviews have examined the effects of interventions aimed at reducing unintended and adolescent pregnancies, this paper examines the evidence on interventions aimed at preventing or reducing fertility-related, high-risk pregnancies through use of modern contraceptive methods. This analysis is based on a systematic review of peer reviewed articles from 1990 to present. The articles identified will be analyzed using a qualitative analytical framework. The qualitative analysis consists of identifying the country context, interventions implemented, outcomes reported, and analysis of the intervention and main findings. Articles will be evaluated based on the strength of the evidence, including an evaluation of the study design, adequacy of the sample size, comparability of the intervention and comparison groups, control for confounding factors, and statistical significance of the results. This paper will guide program managers and policy makers on which interventions contribute to reducing fertility-related, high-risk pregnancies.

Reported maternal and child health outcomes in Nigeria are generaly unacceptably poor and characterized by wide disparities between the north and the south. The Nahuche Health and Demographic Surveillance System (HDSS) was established in 2009 to monitor health and demographic dynamics in Nahuche emirate of Bungudu Local Government Area in Zamfara State. The HDSS provides a platform to evaluate the impact of selected interventions on morbidity and mortality. With a population of 137,833 located in 20,914 households, the HDSS routinely monitors pregnancies, births, deaths, migration, marriages, and vaccination coverage. Data are updated every six months by trained fieldworkers. The HDSS is also conducting verbal autopsies for household deaths. We report initial results on fertility and mortality outcomes from the study area and discuss the potential of the HDSS in generating data that can be used to track progress in improving maternal and child survival towards the Millennium Development Goals deadline of 2015.

Bangladesh is a well researched country. But how far research could influence health policy making process remains cloudy. Research evidence is just one among multiple influences upon policy making. The policy environment is not always conducive to value research-evidence as the building-block for policy-making to meet contemporary health challenges of the country.
The objective of this study was to understand the process and current practice of policy-making from policy makers towards the use and impact of research in the health sector in a low income country like Bangladesh. The study used data from in-depth interviews conducted with purposively selected policy-makers at the national level in Bangladesh. Major findings indicated that evidence-based policy-making is a complex process, included poor quality of research, lack of technical knowledge, politics and donor pressure also influence in policy making processes. A greater number of informants stated that need based research and availability of research reports in time, limit the scope of use evidence to make policy. Most of the state owned research institute do not have fund and human capacity to conduct scientific research. Researchers conduct research but those are not always need based.

Introduction
Ghana has one of the highest maternal mortality ratios in the world. A recent national survey (GSS et al., 2009a) revealed that about 451 women per 100,000 live births die due to pregnancy, unsafe abortion, or complications of labor in Ghana.
In Ghana, most hospitals and clinics have a FP unit where clients are referred to for services. However clients presenting to health facilities for non-FP purposes are not routinely screened and counseled for FP need.
From May 2010 to March 2011, the Reducing Maternal Morbidity and Mortality (R3M) Program in collaboration with the Ghana Health Service (GHS) embarked pilot project to improve access to FP services by integrating into other services at the facility level. This culminated in a baseline survey and the roll out of interventions in some health facilities in the Eastern and Ashanti regions of Ghana.

 

Reproductive health (RH) interventions are often designed to promote equitable gender norms, but there are few published studies that directly examine the relationship between family planning (FP) use and interventions designed to change gender norms. Here we test the hypothesis that promoting gender equity in the context of RH can improve gender norms and increase use of FP by conducting pre/post surveys with participants in community workshops targeting gender norms and FP. Thirty communities in Guatemala and 22 in Tanzania were randomly assigned to intervention and control groups. Data analysis consisted of comparisons of odds ratios estimated with mixed effect logistic models to account for community-level randomization and repeated measures per participant. Analyses showed statistically significant effects on two of three outcomes examined: gender attitudes and contraceptive knowledge. Findings regarding contraceptive use were suggestive but not significant. The results suggest that it is possible to influence both inequitable gender norms and contraceptive knowledge using communication interventions that engage couples in re-thinking gender norms that act as barriers to health. The results are particularly impressive given the brevity of the intervention, four workshop sessions over the period of only a month.

Reproductive rights embrace 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. It also includes their right to make decisions concerning reproduction free of discrimination, coercion, and violence. This study, which was conducted by the Population Council, with support from the World Bank, is comprised of a rights-based, gender-sensitive assessment of family planning services in Egypt. Situation analysis (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 policy makers / 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 service providers and raising clients’ awareness of their reproductive rights.