Evaluation of family planning and reproductive health programmes

The “social gradient to Indian population growth” - whereby people belonging to groups higher up the social ladder had better family planing outcomes than those belonging to groups further down - is essentially a Western construct; there has been very little investigation into whether, in developing countries also. The purpose of this paper is to evaluate the relative strengths of economic and social status in determining the family planing status of persons in India. In other words, even after controlling for non-community factors, did the fact that Indians belonged to different social groups, encapsulating different degrees of social status, exercise a significant influence on the state of their family size? The existence of a social group effect would suggest that there was a “social gradient” to family planing outcomes in India. In investigating this, the paper addresses, in the Indian context, an issue which les at the heart of social epidemiology: estimating the relative strengths of individual and social factors in determining family planing outcomes.
Although a Hindu-Muslim differential in fertility has persisted in India, it is no more than one child, and even this gap is not likely to endure as fertility among Muslims declines with increasing levels of eduation and standards of living.

The aim of this paper is to investigate the association between reproductive health service provision and its differentials. The study used data from Demographic and Health Surveys and Utilization of Essential Service Delivery Survey of Bangladesh. Public facilities still the major source of modern contraceptive methods among the poor women (66.6%) as compared to the women from richest quintile (26.8%). Seeking of ANC from medically trained providers is significantly higher among the richest quintile (87.4%) as compared to 30.4 percent among the poorest quintile. The well-off usually rely on the private facilities for ANC services as compared to the poor. The socio-economic status has positive impact on the likelihood of delivering at a health facility. The likelihood of preferring private facility relative to public facility in terms of family planning services is increasing over time given the other variables in the model are held constant. Despite expansion of the private sector and NGO sector, the public sector remains an important source of supply for poor women. More attention should be given to the determinants of reproductive health, associated with their interaction with service provision, to reduce maternal mortality and to achieve the MDG for maternal mortality.

Couples characteristics and their variations and implications is an area where there is a need for much focus and further research. Inter-spousal communication, though not a new dimension of fertility and family planning research has remained much less explored especially in the Indian context than any other correlates of contraceptive use and current fertility. Most of the demographic researches on fertility, reproductive health and contraception focus on females of particular age group who are in their reproductive period. Important demographic indicators like fertility, contraception and mortality are estimated on the basis of reporting of the eligible female respondents. This particular study makes an attempt in exploring the degree of mismatch and its spatial variation in reporting of the contraceptive use by the couples in India. The study analyses the concordance and discordance of the reporting of the contraceptive use as reported by the wife and by the husband separately by using information of 42185 couples. Multivariate analysis has been used to find the causal relationship between various socio-economic-demographic factors and the mismatch in reporting of the contraceptive use. In India , wife's reporting of current use of contraception (60 percent) is higher than as reported by the husband(52 percent

Policy is integral to the success of any health program, including sexual and reproductive health programs. Yet, most policy literature focuses on policy development. Literature on program implementation rarely focuses on the role of policy. Based on a review of academic and programmatic/applied literature, we have developed a conceptual framework linking health policies to health systems and outcomes. The strength of this conceptual framework is the articulation of the importance of the space between the development of a policy and the implementation of a program. Using examples from the field, we identify the challenges in policy implementation that affect programs and health outcomes. Our analysis also identifies gaps in the literature pertaining to the areas of sexual and reproductive health policy implementation, and monitoring and evaluation. We also recommend the initiation of evaluation studies examining the complete policy process linking health policies to health systems and to health outcomes.

In an effort to reduce the mortality and morbidity associated with unsafe abortion in Ghana, in 2006 the government of Ghana, in association with 5 other organizations, implemented a program for improving comprehensive abortion care in the country. This program was piloted in seven districts across three regions – Greater Accra, Eastern, and Ashanti. In this paper, we use a survey specially collected for this study to assess if the interventions from this program have helped improve the knowledge, attitudes, and practices (KAP) of health care providers towards comprehensive abortion care services. Since the program had not been implemented across the country, the study was set up as an experiment, with the treatment group including the districts where the program was implemented. The control group included districts where the program wasn’t implemented. Propensity score matching techniques will be used to compare the providers in the intervention and control groups, and to evaluate if the program has made any difference where it was implemented. We expect to find that districts where the saturation of interventions was the highest will show the maximum change in the KAP of abortion providers, thereby enabling improved abortion care services and ensuring better reproductive health among women.

In Cambodia, recent figures have shown impressive declines in the maternal mortality rate alongside commensurate increases in maternal healthcare use over the last decade (DHS 2010). In this paper, we examine the determinants of this rise in service use in Cambodia, particularly focusing on the role of social health protection schemes such as health equity funds in driving this change. Using baseline survey data from the evaluation of the Reproductive Health (RH) vouchers program being conducted by Population Council (N=2201), we use a binary response multilevel random effects model to examine both individual-level and community-level influences on facility-based deliveries and antenatal care use among women in three provinces in Cambodia. Preliminary results suggest that social health protection schemes as well as community-level influences are significant in determining the use of maternal healthcare services. Implications for policy development and healthcare financing programs including the targeted RH voucher program are discussed.

This study aims to establish the relative importance of lack of access and attitudinal resistance towards use of family planning in accounting for unmet need among different population strata in Kenya and Senegal. Using 10 DHS data from the two countries, the main analysis extends and adapt the approach used in an investigation of progress in family planning need, access and attitude in Africa (Cleland, Ndugwa et al. 2011). Preliminary results from the most surveys show that in Kenya lack of access is a minor problem and that unmet need stems largely from abandonment of hormonal methods; the central problem is health concerns and side effects. In Senegal, both unfavourable attitudes and lack of access are barriers to use; over 60% of those with unmet need have an unfavourable attitude and one-third have no access to methods. Infrequent sex is deployed as an alternative contraception. Trends in access, attitude and reasons for non-use will be assessed.

The reproductive period of female begins with first menstruation and continuous till menopause. When menstruation ceases finally, the female is said to have attend menopause, which terminate permanently the reproductive period of the female. Obviously, age at menopause varies from female to female and also according to their socio-demographic characteristics. Perhaps no minimum and maximum age has been defined as yet. It occurs at varying ages within a certain range usually 30 to 50 year. It is difficult to identify the exact age at which menopause occurs, since it happens gradually and even post menopausal female do not remember the correct age at menopause. An index for the proportion of females in menopause at a given age may be obtained if the number of females at certain age and among them those females who are in menopause is known. This index is being used as a measure to indicate the distribution of age at menopause. The objectives of the study are to observe the level of menopause among different socio-demographic characteristics of females and also to determine the nature of the distribution of age at menopause over the time by using NFHS-I and III data for Uttar Pradesh.

Under the National Rural Health Mission, Government of India introduced an ambitious scheme of Janani Suraksha Yojana (JSY) in the year of 2005. This scheme seeks to reduce maternal and neo-natal mortality by promoting institutional delivery services, by providing a cash incentive to mothers who deliver in health facilities. JSY has promoted the utilization of institutional delivery services. Institutional deliveries increased from 14.1 percent (2002-2004) to 33.2 percent (2007-2008) to 65.0 percent (2010) in the study area. This paper presents an assessment of JSY in terms of awareness of the scheme, increase in institutional deliveries, JSY beneficiaries by background characteristics, place of delivery (public/private health facility), type of delivery (normal/c-section/episiotomy) distance and use of transport, payment of cash-incentives and quality of delivery services provided under the scheme in rural Uttar Pradesh. This paper investigates the shortcoming of JSY like non/delay-payment of cash-incentives, poor quality of care and treatment provided to beneficiaries. Based on findings suggestions have been given to emphasize on ‘quality’ of delivery and post-delivery services and not merely on ‘quantity’ of institutional deliveries in order to achieve JSY and MDG-5 objectives.

This paper shows the relationship between socio-economic status and fertility behavior in a rural African setting. We combine a quasi-experimental introduction of family planning services in the Kassena-Nankana districts of Ghana with longitudinal data to estimate the impact of socio-economic status (measured by woman’s education, her husband’s education and wealth) on fertility preferences, regulation and outcomes. We track the fertility behavior and outcomes of more than 24,000 women in their reproductive age (15-49) over a period of eighteen years. Our results show that, before the interventions, educated women did not have significantly fewer children, but desired lower family sizes and were more likely to use modern contraceptives. However, husband’s education was associated with lower fertility especially when their wives were also educated. Wealth is associated with higher births, reflecting a higher child survival rate in wealthy families. The family planning interventions affected both educated and uneducated women but the effect on educated women stronger, leading to the emergence of an education-fertility differential 17 years. Our results suggest that in settings where men dominate reproductive decision-making, their education status may have a stronger effect on fertility than the educational attainment of women.