Evaluation of family planning and reproductive health programmes

Dynamic panel data model of infant deaths, birth spacing and contraception are estimated incorporating causal effects of birth spacing on subsequent mortality and of mortality on the use of contraceptives and the length of next birth interval. Data come from the renowned demographic field Health and Demographic Surveillance System in the icddr,b treatment area in Matlab, Bangladesh, on 31,968 children of 13,232 mothers, with complete prospective records of fertility, child mortality, contraceptive use, and socio-economic variables from 1982 until 2005.

Infant mortality is determined by the preceding birth interval and other covariates (such as socio-economic status). The decisions about using contraceptives after each birth are driven by similar covariates, survival status of the previous child, and the family’s gender composition. Birth spacing is driven by contraceptive use and other factors.

Our main finding is that complete contraceptive use could reduce infant mortality of birth order two and higher with about 7.9% (while complete non-use would lead to an increase of infant mortality by 10.6%). The net effect of complete contraceptive use on the total infant mortality rate is small (2.9%) since the favourable effect on higher order births is partly offset by the rise in the proportion of high-risk first births.

Decentralization is often justified as providing services closer to citizens; rarely, however, are the effects on service delivery well considered. With respect to family planning, governments often sign international commitments, but translating them into action at the subnational and facility level is difficult. Operational concerns at these levels can be reinforced or abated by increasing local authority over family planning. Critical analysis concerning the relationship between these areas requires illuminating factors by which decentralization affects family planning services. The four factors most often referenced to explain how decentralization affects family planning include: the enabling political environment, social participation, intergovernmental relations, and local government institutional capacity.

This research presents a model that accounts for these factors by analyzing their effects against each actor in the decentralization process. The structure and nature of the scope of decentralization is analyzed through the Public Administration approach and the Decision Space Model, through which we can identify areas of family planning services where narrow or wide decision space exists across a range of different areas. These frameworks provide the “lens” through which we can understand how the contextual factors.