Evaluation of family planning and reproductive health programmes

Since the mid-1990s, the humanitarian community has expressed increasing concern for the reproductive health needs of conflict-affected populations, including access to contraceptive information and services. Yet, empirical research on the reproductive health consequences of armed conflicts has remained relatively scarce, mainly due to a shortage of reliable data.
This paper represents the first attempt to examine the effect of the recent war in Iraq on contraceptive use dynamics. The analysis relies on pooled data from the 2000 and 2006 Iraq Multiple Indicator Cluster Surveys (I-MICS). A difference-in-differences approach is used to assess changes in contraceptive use before and after the onset of war across governorates with different levels of conflict intensity. From 2000 to 2006, the probability of contraceptive use increased by 19% among women in the Kurdish region, and by 14% among those in the Southern governorates of the country that were only mildly affected by the conflict. However, the probability of contraceptive use stalled among women in the governorates with a high level of conflict intensity, including Baghdad, and dropped by 10% among those in the most conflict-affected governorate of Anbar. The paper addresses possible reasons for these diverging trends and discusses their policy implications.

Under the male-dominated socio-cultural setting that persists in Thailand, it can be argued that women living with HIV/AIDS (WLHA) are at greater risk of gender-based violence than non-infected women. In addition, the patriarchal Thai norms blind people in society – including the victims – to fully seeing and acknowledging the problem of gender-based violence and the extra vulnerability of WLHA. Thus, a significant portion of society accepts gender-based violence as part of the cultural context and as nothing out of the ordinary in a woman’s daily life or something that needs to be changed. The 5 years project entitled Support for HIV-affected Women from Gender-based Violence (SHAW) implemented by Raks Thai Foundation with funding from UNWOMEN is an initiative to address HIV/AIDS related violence against HIV/AIDS affected women in Thailand at the community level. A mixture of quantitative and qualitative data collection techniques are used to assess the Project achievements after completion of implementation. The assessment was conducted during February 2012. This paper focuses on HIV/AIDS affected women as peer leaders to help other HIV-effected women to combat gender-based violence. In particular, it emphasizes the outcomes of SHAW project which suggest changes in ability to provide assistance and manage problems of violence

Comprehensive data on financial resources in reproductive health sector is critical for planners and policy makers, particularly in developing countries. Low level of funding for reproductive health is a cause of concern, given that RH service utilization in the vast majority of the developing world is well below the desired levels. Though there is an urgent need to track the domestic and international financial resource flows for reproductive health, the instruments through which financial resources are tracked in developing countries are limited. In this paper we examined the methodological and conceptual challenges of monitoring financial resources for family planning and reproductive health services at the international and national level. Results suggest that the Creditor Reporting System (CRS), which is the best possible data source to track donors contribution fails to give the complete picture of the Official Development Assistance (ODA) for reproductive health. At the national level Reproductive Health sub-accounts (RHA) suffers from country specific challenges related to definitional and boundary issues of RH activities. Lastly, weak link between data production by the RHA and its application by the stakeholders and lack of political will act as decelerate factor for the institutionalization of RHA at the country leve

Quality of Care in Family Planning: Gradual and Comprehensive Reform in China

Abstract:

Since the 1990s, many national population and family planning program have been under re-examination and reorientation in light of the Programme of Action adopted at the International Conference on Population and Development in 1994. This is the case in China. The present case study documents a program reform initiated by the State Family Planning Commission of China in 1995 to introduce the quality-of-care approach in a few counties and districts. The introduction of this approach, which focuses on the quality services and the client’s choices in family planning/reproductive health at community level, was to serve as a means of reorienting the program away from its previous demographically driven track as well as scaling it up nationwide thereafter.

This paper is based on the results of the study “Evaluation the implementation of reproductive health care (RHC) policies for ethnic minorities in Vietnam” that was implemented in 2008 by the Institute for Population and Social Studies – NEU required by UNFPA. This study used a combination of three research methods (desk-study, quantitative survey, and qualitative survey). The report indicated that the strength of RHC policies is to clearly express the orientation of incentive RHC for ethnic minorities by setting up specific objectives and solutions towards better condition of human resources, natural and financial resources in the mountainous areas. However, there are some weaknesses: inconsistence and vagueness in terms for subjects of the policies, loopholes in policies, some infeasible objectives, illogicality, contradiction among policies, general criteria, overlapping, and some problems in policymaking procedure. The gaps of policy implementation related to issuing guidance for policy implementation, the dissemination of RHC policies to people, RHC models, human resources, essential health equipment and medicines, regular income-expense for the commune medical centers, are also found out. This paper gave some recommendations to enhance the quality of RHC services for ethnic minorities.

Maternal health issue is a major global concern since pregnancy and childbirth are the leading causes of death, disease, and disability among women in their reproductive period. This concern is also well acknowledged in the fifth millennium development goal (MDG) that aims to reduce infant deaths and improve maternal health while providing universal access to sexual and reproductive health services by 2015. Contraception in postpartum period plays an essential role to prevent unwanted pregnancy and to reduce the risk of infant and maternal mortality by optimal birth intervals. Thus it calls for an investigation about the patterns and determinants of timing of postpartum contraceptive use among women. The present study is directed towards investigating the timing of contraceptive initiation among Indian women in extended postpartum period, a period which is different from other periods with regard to menstrual pattern and sexual behavior of women. Survival plots and hazard model techniques are employed to analyze the time variable with respect to various characteristics of women. The main finding obtained using the data of National Family Health Survey- III clearly demonstrate the lack of motivation among Indian women, whether amenorrheic or menstruating, about initiating modern contraceptives in this period.

Overall contraceptive prevalence rate in India has steadily increased, in spite of these gains, fertility is still high and many couples are unable to effectively choose the number and timing of their births. Most of the researchers have tried to show the impact of utilization of antenatal care services on ever-use of family planning methods. Nevertheless, research investigating the nature of this relationship is not well understood, in the sense that ever use of contraceptive is a weak indicator to capture this aspect. In the present study, with the help of a five years reproductive calendar which is first time available in National Family Health Survey 2005-06, concerted attempt will be made to examine whether utilization of maternal and child health care services is one of the major networks for adoption of contraceptive use. We will examine the type and duration of specific contraceptive use, after utilization of maternal and child health care services. Analysis shows that the intensity of antenatal service and institutional delivery service use does have a causal impact on subsequent spacing contraceptive continuation, after controlling other important socio-economic and demography factors. Result of this research work will improve policymakers understanding of determinants of maternal and child health care utilization.

This paper examines women’s experiences of using injectable contraception (IC) from the perspectives of women and health care providers, and sheds light on the feasibility and acceptability of making IC widely available in India. The study was undertaken in 27 selected facilities of 4 NGOs in 5 states. Using a retrospective study design, 375 married women were interviewed who had initiated IC use in 12-21 months before the interview. In-depth interviews were conducted among 16 health care providers. Findings, based on lifetable analysis, indicate that just 23% of the women continued to use ICs at 12 months. Reasons for discontinuation centred on the side-effects experienced, largely menstrual disturbances. Counselling was not comprehensive for most women. Multivariate analysis suggests that women who had continued using ICs for at least 12 months tended to be younger, educated and multiparous. Notably, continuation rates were also higher among women who had experienced fewer side-effects and were provided good quality of care. In-depth interviews with health care providers corroborated many of these findings. Findings suggest that although continuation rates are low, a considerable proportion of women find IC an acceptable method. With appropriate counselling, it is possible to offer this method more widely in the RCH programme.

Contraceptive prevalence rate (CPR) is one of the most important indicators in evaluating the success of population policies and programs. In the last three decades, Egypt achieved a remarkable success in promoting contraception; the percent of women currently using any contraceptive method, over 15-year period from 1980 to 1995, has more than doubled; CPR increased from only 24 in 1980 to 47.9 in 1995. After 1995 CPR plateau with a slight increase from 56.1 in 2000 to 59.2 in 2005 and then to 60.3 in 2008. The main concern of this paper is to discuss this plateau effect of the family planning program in Egypt. After a successful period of contraceptive promotion came the results of the last Egypt Demographic and Health Surveys to show that plateau effect of the family planning program and to warn policy makers about this trend in contraceptive prevalence.

The London FP Summit on July 11, 2012 galvanized high level support to reach 120 million new family planning users by 2020. Such growth in FPusers would be unprecedented. The theme of rights was emphasized at the FP Summit. Despite this firm global commitment to voluntary, rights-based family planning programming, instances of coercion have occurred in FP programs. These experiences have made some wary of the potential for coercion to reemerge in FP policies and programs. A recent court ruling in Namibia has highlighted the pressures faced by HIV-positive women to stop childbearing, reminiscent of experiences in the West of targeting disabled women with contraception. It is important to fully understand each situation and how it occurred to develop approaches to ensure that these experiences are not repeated.

The paper examines instances of coercion in FP to understand the context, the type of coercion, how it was uncovered and how it was addressed. Using these examples, the paper offers recommendations for policy and program steps to ensure voluntarism in family planning and adherence to a rights-based approach as countries scale up programs to reach the ambitious goal of FP2020.