Evaluation of family planning and reproductive health programmes

This paper examines a decade of prospective panel survey data recording proximate fertility determinants and demographic surveillance data in a rural locality of northern Ghana where a quasi-experiment tested the impact of four contraceptive service provision strategies on fertility.
Although treatments explain variance in observed fertility, analyses also reveal that fertility implied by proximate determinant responses exceeds observed fertility in areas with convenient doorstep family planning services. Analysis of longitudinal surveillance data suggests that community exposure to these doorstep services is associated with reproductive change. Results are consistent with the hypothesis that denial is most pronounced where observed fertility decline was greatest. The gap between fertility expected from proximate determinants and fertility observed from surveillance increases over time. This finding challenges the widely held assumption that survey appraisal of contraceptive use represents a valid endpoint for studies of the reproductive impact of community-based family planning services.

Government initiated ‘Janani Surakshya Yojana’, a cash incentive to promote institutional deliveries and reducing maternal and infant deaths. This study examines the impact of Janani Surakshya Yojana on utilization of maternal care services among Bhils- the largest tribe of Madhya Pradesh. A cross-sectional survey was carried out in 60 Primary Sampling Units (PSU) selected through Probability to Population Size (PPS) sampling technique. Overall, 1049 recently delivered women (RDWs) – women who delivered a live birth in two years preceding to the date of survey were interviewed.
The study revealed that the registration of pregnant women with ANM and utilization of atleast one ANC is satisfactory, but still less than half of women receive ANCs fewer than the recommended (atleast three) checkups during pregnancy. Though the proportion of institutional deliveries has improved considerably among Bhils, however, still most of the home deliveries are made by untrained ‘dais’ (TBA). The study further revealed that because ‘Janani Surakshya Yojana (JSY)’, not only the proportion of institutional deliveries has improved but also the postnatal checkups have changed for better. However, the quality of ANCs, PNCs and number of home visits by health workers are disappointing.

Since the launch of the reproductive and child health policy regime in 1998-99, there has been a massive rise in government expenditure on family welfare programmes in Bihar and national level. This paper makes a systematic effort to assess the performance of the family welfare programmes vis-à-vis trends in expenditure. The trends in key performance indicators for Bihar reveal that progress has been slow and limited in the post-RCH policy regime. Contraceptive prevalence coverage has accelerated, and the increased in the Child immunization and institutional delivery. Consequently, the pace of reduction in the couple protection rate, total fertility rate and infant mortality rate has slowed. It is evidently clear that in the absence of suitable mechanism to operationalise of RCH programme, the exponential increase in expenditure alone cannot lead to commensurate a positive impact on key performance and outcome indicators. There is need suitable mechanism to operationalise RCH programme.

The paper is an attempt to know the levels and trends of pregnancy loss in India. According to WHO, there is a slight improvement in maternal mortality ratio from the past decades in developing countries. The study is based on the three rounds of District Level Household and Facility Survey (DLHS). Different indicators are made for estimating the pregnancy loss in India.

The levels and trends of pregnancy outcomes are also analyzed for the major states of India among which Haryana showed continuously increasing with high percentages of pregnancy wastages during these three successive periods 1998-99, 2002-04 and 2007-08. Spontaneous abortion only in Kerala, Maharashtra and Tamil Nadu showed the continuously increasing percentages in three successive time periods.

On the contrary, Andhra Pradesh and Madhya Pradesh show only very less percentages of pregnancy wastages during the same period. The present paper helps to understand the present scenario of pregnancy loss in India.

Few studies have evaluated whether youth-friendly health services improve young people’s experiences of using services, and none in South Africa have done so since the Department of Health took over management of the Youth Friendly Services program. This study investigated whether clinics providing Youth Friendly Services in Soweto, South Africa delivered a more positive experience to young people requesting advice on condom reliability or contraceptive methods than those not providing this program, using a simulated client method. 15 randomly selected primary healthcare clinics each received 3-4 simulated client visits. After each visit semi-structured debrief interviews were conducted with simulated clients. Multi-level linear regression was used to investigate associations between Youth Friendly Services provision and visit outcomes. Framework analysis of qualitative data was conducted. There was no evidence that clinics providing Youth Friendly Services delivered a more positive experience (difference in mean clinic visit score -0.18, 95% CI: -0.95, 0.60, p=0.656) than those not providing this program. More positive experiences were categorised by positive healthcare worker behaviour and less positive experiences by unnecessary protocols, negative attitudes to information seeking and lack of information or of privacy.

Various studies in Africa have shown that about 3 million children in developing countries die and many more are crippled, blinded, or otherwise disabled from six major diseases that are preventable through immunization (WHO; UNICEF, 2010). These six diseases are: measles, pertussis (whooping cough), tetanus, polio, tuberculosis, and diphtheria. Meanwhile, for all these six diseases, vaccines and the means to provide them are readily available, relatively inexpensive, and of proven effectiveness in saving lives. In Nigeria, despite the creation of the National Programme on Immunisation (NPI), the situation over the years has not improved. Currently, Nigeria is among the ten countries in the world with vaccine coverage rates below 50 per cent (WHO, 2010), having been persistently below 40 per cent since 1997 (WHO, 2003). Currently, immunization coverage is approximately 23% which is almost double that of 2003 rate of 13%. The observed level of full childhood immunization rates across the years therefore suggest that these indicators may not have been responding to prior policy and technical interventions. This study therefore aimed to examine the influence of mothers` health seeking behaviour as well as some selected socio-economic factors on childhood immunization, using the 2008 Nigeria Demographic and Health Survey (NDHS).

This paper contributes to understanding the associations between a culturally sensitive family planning program and fertility preferences. Previous research on family planning programs are largely focused on addressing unmet need for contraception. Yet, scholars have asserted that even if the expressed need for contraception is met, fertility will remain above replacement levels. Needed to propel low fertility and accelerate economic developments are programs that influence explicit desires to limit child-bearing at low parities. This paper uses longitudinal data from an economically adverse setting (the Navrongo experiment) in Northern Ghana to examine the impact of culturally sensitive family planning program on fertility preferences. Results show that fertility desires are largely a function of the Navrongo experiment net of individual socio-economic characteristics. Involving traditional social institutions in health planning and services is significantly related to promoting preferences for smaller family sizes among women. Overall, women seem to be shifting towards smaller family sizes although decline in preferences is comparatively modest to precipitate transition to low fertility. We discuss the implications of our findings in the context of policy frameworks to increase access to contraception in developing countries.

Family planning is a critical lifesaving intervention that can significantly improve the health of women and their families. This study was carried out as part of the Sexual and Reproductive Health (SRH) Survey conducted in one of the update rounds of the Kintampo Health and Demographic Surveillance System (KHDSS) in Central Ghana. The objective of this study was to identify the most frequent source of family planning methods and its accessibility to women from the various outlets identified. Expected outcomes from this study will be descriptive statistics of the main outcome and each explanatory variable, cross-tabulations of each explanatory variable with the outcome variable and the level of significance determined using the Pearson Chi squared tests and relative risk ratios from the univariate and multivariate multinomial logistic regression models that will be fitted.

In response to the Plan of Action of ICPD , a shift of focus from family planning to reproductive rights and reproductive health, found in the national policies and programmes during post-ICPD era in Bangladesh. A series of policies and programmes has undertaken by the government of Bangladesh as a follow-up action, addressing the issues of reproductive health. The issues addressed in existing policies, plan and programmes are reviewed in the following themes of reproductive health: maternal morbidity and mortality, adolescent reproductive health, management of STD/RTI, IEC and advocacy. The present Policies and programme on maternal health has replicated most of the targets and objectives from the previous policies with few changes and to some extent based on the principles of ICPD,1994 and objectives of MDGs. The increasing demand maternal health services and slow pace of growth of infrastructure make a big challenge to manage maternal morbidity and mortality as early as possible in Bangladesh. Establishment of private hospitals/clinics, more emphasis to the development of skill of doctors/Nurse through training (on new health issues) than the infrastructural expansion could be the probable way to deliver better health care as early as possible.

Background. An opportunity for personal contact with women to provide family planning referral message is when they go to health facility for the immunization of their children. Past studies have shown that such an approach can effectively increase the number of women who accept modern family planning (FP).

Methods. In 2011, a study was conducted in Misamis Occidental, Philippines where 42 immunization centers were randomly assigned to treatment (n=21) and control groups (n=21). In the treatment sites, mothers with unmet need for FP were provided referral messages that simply said that the health facility provides modern FP services, and would they like to visit to learn more about modern FP. If yes, a schedule was set for their visit. In the control sites no referral messages were given. After six months the same mothers were interviewed to determine their current family planning status.

Results. Analysis on 1,593 women who had complete information in both surveys showed a net difference in CPR between treatment and control sites of 8.2 percentage points (11.9 percentage increase in the treatment site minus 3.7 percentage point increase in the control sites). This net difference was statistically significant at the 1% level.