Evaluation of family planning and reproductive health programmes

The study explored the origin, architecture and role of political will in increasing contraceptive use in three sub-Saharan African countries - Ethiopia, Malawi, and Rwanda – that have stood out for phenomenal increases in contraceptive use between 2000 and 2012.

We assessed factors that have propelled changes in the attitudes of some political leaders to champion family planning; how such political will has manifested in different contexts; and how political will impacts the policy and program environment.

We use mixed methods, including desk review of policy and program documents and stakeholder interviews. The study findings demonstrate that political will for family planning evolved due to increased availability of evidence that demonstrated that family planning is central to achieving the MDGs, and that high population growth undermines efforts to transform the economies of developing countries.

We postulate that lessons from this study will help galvanize efforts to improve access to family planning services in other African countries where little progress is being made.

The paper aims to examine the level of birth preparedness and complication readiness among currently married couples and factors affecting it. The study has been conducted among 400 currently married couples in the rural areas of Varanasi district of Uttar Pradesh in India during second trimester of the year (2012). Bi-variate and chi-square analyses have been conducted. Birth-preparedness and complication readiness in the study include many elements: knowledge of danger signs, plan for where to go, where to give birth, saving money, a companion, transportation, a blood donor and a birth attendant. It was found that less than one fifth of women were informed about birth preparedness while they visit health centres during ante-natal care. Around three fifths of husbands were found to be aware of any obstetric danger sign. Education, mass media exposure and economic status are found to be important predictors for the awareness of danger signs among male partners. Government needs to sensitize the birth preparedness among the health personnel delivering maternal care services in rural areas for the timely use of skilled maternal and neonatal care. Couple counselling regarding birth planning during pregnancy must be promoted by government through media too.

This study takes a retrospective look at the time course of total fertility rate (TFR) and per capita wealth among countries, relating it to family planning initiatives and other factors thought to influence either fertility or wealth. It was found that countries that implemented strong family planning programs achieved fertility reduction much faster and earlier than comparable countries that did not. Fertility decline typically preceded marked increases in wealth, but per capita wealth growth usually accelerated when fertility fell to between two and three births per woman. The negative relationship between TFR and GDP per capita tends to be deeply concave for those countries that have achieved low fertility. Higher fertility countries in the same region tend to follow a parallel course, but at a slower pace, and most with current fertility above three are yet to see sustained wealth increase. In the absence of significant income from oil or other resources, fertility reduction appears to be a necessary if not sufficient condition for sustained economic growth. Causation runs in both directions, with prosperity and development of education and health services enhancing the reduction in family size, but interventions to promote prosperity are less cost-effective in priming this cycle than interventions for fertility reduction.

Vasectomy is safe and effective form of male contraception. However, in the Philippines only one percent of Filipino men have undergone vasectomy although16 percent of men in union are willing to undergo this procedure after they have reached their desired number of children. Using the 2003 Philippine National Demographic Health Survey (NDHS), this study seeks to identify the factors associated with the willingness of Filipino men in union to undergo vasectomy. Moreover, it will also investigate the various reasons why Filipino men would never consider getting vasectomised. Results show that men who live in urban areas and have higher number of children are more likely to be willing to undergo male sterilization. Reasons of Filipino men why they would never consider undergoing vasectomy are: bad for man’s health (45%), less intrusive family planning method are available (23%), loss of manliness (15%) and loss of sexual function (12%). Filipino men who have lower levels of education and formally married are more likely to say that they would never consider getting vasectomised because it is bad for man's health while the rich men are less likely to say that it will cause loss of their sexual function.

The government of Nepal introduced Comprehensive Abortion Care (CAC) in March 2004 along with concerted efforts to improve access to modern contraception. An integral component of CAC is post-abortion contraceptive care. To date, there is no national level evidence on post-abortion contraceptive uptake in Nepal. More importantly, the interaction between abortion care and family planning is poorly understood in Nepal where abortion interventions are widely discussed in policy arena. There is also a concern that medical abortion program is promoted too aggressively in Nepal such that potential contraceptive users may have begun to opt for a ‘quick and easy fix’ thus essentially substituting abortion for contraception. Using the contraceptive calendar data drawn from the 2011 Nepal Demographic and Health Survey, this research investigates the level of contraceptive use before and after an abortion and examines the timing and determinants of post-abortion contraceptive use comparing women who had a live or still birth. Additional analysis focuses on the rates of discontinuation among users of post-abortion contraceptive method. The research is conceptualised based on the hypothesis that women who experience an abortion are generally found to be more motivated than their counterparts to use contraception in the post-abortion period.

The purposes of the study was evaluate the impact of a school-based gender-sensitive sexuality education program on adolescents’ sex-related knowledge, attitudes, and self-efficacy in Lanzhou, northwest China. We used data (N = 1,126) from a quasi-experimental intervention research conducted among students in four high schools. Gender-sensitive sexuality education was provided to all 10th grade students in the intervention group from October 2011 to June 2012. 1222 students enrolled at baseline, and 94.2% of them were followed up at posttest.
Results showed that students in the intervention group had better knowledge and less permissive attitudes toward sexual double standards than those in the control group. Boys in the intervention group also had less stereotypical attitudes toward gender roles than those in the control group. Girls in the intervention group showed significantly more increase in self-efficacy related to sexual decision-making skills relative to those in the control group. The findings demonstrated that gender-sensitive, critical thinking sexuality education approach has advantages over mainstream medical-oriented and abstinence sex education. The study has important implications for developing more effective intervention programs to improve adolescent’s sexual and reproductive well-being.

In Kenya, health policies emphasize enhancement of community access to health care and the empowerment of communities to demand services from providers as an approach to reduce maternal morbidity and mortality. This paper describes an innovative experiment geared toward addressing a critical public health issue—postabortion care (PAC)—within Kenya’s current policy context. The paper uses data from a pre-and post-intervention, quasi-experimental study conducted in six communities in Naivasha, Kenya, from 2010 to 2012 to examine the effects of this intervention. Information was collected through a community-based survey with 593 and 647 women aged 18-49 at baseline and endline, respectively. Semi-structured interviews with providers and qualitative interviews and discussions with the wider community were also conducted. The findings indicate that the intervention was effective in: increasing women’s awareness of danger signs in early pregnancy; providers being able to effectively offer PAC services at lower-level facilities; raising awareness of PAC; women seeking and obtaining PAC services at lower-level facilities; and inspiring communities to take action for their own health. The findings highlight the fact that heightening community awareness and mobilization is essential for strengthening post-abortion care.

Women in Malawi bear on average six children, with many unintended pregnancies. Although 42% of married women use modern methods of contraception, 26% have an unmet need. The Karonga Prevention Study operates a demographic surveillance site (DSS) in northern Malawi.

An innovative method was devised for collecting family planning (FP) data using patient-held records (a “FP card”) to build a prospective longitudinal dataset, allowing exploration of continuity of use and method-switching, which can be linked to the DSS database. All 8,176 women aged 15-49 living in the DSS were offered a FP card. When a woman received FP, the health provider recorded on the FP card the date, method/service received and provider-type. After one year, the FP cards were collected for analysis.

Analysis is at an early stage but preliminary findings show that 6% of FP users used more than one method of FP during the study year (excluding condoms). Survival analysis revealed that just over a quarter of women who used injectables at the start of the study were still adhering to injections at the end of the study year. There appears to be no association between fertility intentions and discontinuation.

FP data usually come from surveys or routine data. This alternative method enables better understanding of how women maintain continuity of use.

This paper examines the impact of Population Services International (PSI) led intervention on IUD use among married women. The study was conducted on randomly selected 6560 women from three northern states of India. The analyses suggest that around 43% of currently married women in the age group of 15-49 years were currently using at least one method for family planning. The IUD use among women was 5.4% in the selected states. A careful exploration of data suggests that IUD use was more among women with more than 30 years of age. It was also seen that 73% of the women who had two or more children of either sex, reported more use of IUD. Women who belonged to high Standard of Living (SLI) reported more use of IUD than others. Women who were exposed to intervention also reported more use of IUD. For example, 10.3 % of the women who were exposed to Inter Personal Communicators (IPC) activities reported using IUD compared to only 5.2% of those not exposed to IPC activities. The multivariate analysis also suggests that the perceived availability of IUD and exposure to any IPC activity had significantly higher odds of using IUD among women.

The international community agrees that the Millennium Development Goals (MDGs) will not be achieved without ensuring universal access to SRH services and HIV prevention, treatment, care and support.
The study reviews published papers on Sexual and Reproductive Health (SRH) that are based on Demographic and Health surveillance System (HDSS) platform in attempt to underscore the contributions of the INDEPTH Network platform to research effort and interventions on reproductive health in low- and middle-income countries (LMICs). A list of search terms was generated by combining terms related to Demographic and Health surveillance (HIV, fertility etc). A call was sent out to INDEPTH centers requesting for their published SRH papers which used the HDSSs platform.
Findings reveals that school attendance considerably delays entry into motherhood. The studies on maternal health revealed that there has been a decline maternal death over the years, that is partly able to better access to emergency obstetric services, improved education of women and also reduction in fertility.
In conclusion, SRH is a significant public health need in all communities. However, we argue that HDSSs have a huge potential to become the key data source for monitoring the MDGs, particularly in the family planning, marriage and fertility studies.