Evaluation of family planning and reproductive health programmes

This paper analyses the performacne of the family planning programme in India in the context of the goals and objectives of the National Population Policy 2000. The analysis is based on a Fertility Transition Index that has been developed for the purpose and that captures the two dimensions of fertility transtition - delayed child bearing and birth spacing and small family - articulated in the Policy. Using the data available through the 2001 population census and 2007-08 District Level Household and Facility Survey, the analysis reveals that there has been little change in the fertility transition index in India between 2001 and 2007. The analysis also reveals that gains in the dimension of small family norm have been upset by poor performance in the dimension of delayed child bearing and birth spacing. The paper stresses the need for focussing on addressing the unmet need of contraception for spacing to hasten the pace of fertility transition and proposes an alternative - outcome-based - system of monitoring the implementation of official family welfare programme, the mainstay of family planning efforts in the country.

Purpose: To build-up the fundamental data for improving the level of maternal and child health care of Guatemala through assessment of current status of maternal and child (MCH) health care and characteristics related to the delivery services.
Method: Study subjects were the 450 women residents aged 15~50 living in Patzun region of Chimaltenango province, Guatemala.
Results: Mean age of the subjects was 32.5 years with residental area 51% urban and 49% rural. 81.1% of them ever heard about family planning, instead only 41.7% had experienced a practical contraception, and rural residents were more ignorant and conservative. As result of the MLR, the OR (95% CI) of the HO delivery was higher in case of the higher education level, delayed first delivery age, previously cognition about family planning group. However it was not related to the mother's age. HO delivery was more influenced by educational level and awareness of family planning in rural area, while by the first delivery age in urban area.
Conclusion: General cognitions and experiences about family planning were not enough, and the dependency and credits on TBA were still high. Hope to this study actively used as a useful resource to improve the comprehensive MCH environments, and especially, to induce the shift from TBA to HO deliveries in Guatemala.

The latest Pakistan Demographic and Health Survey 2006-07 indicates stagnation in contraceptive use for almost a decade at 30%. The gap between ever and current use is increasing along with high discontinuation rates. However, results from a recently implemented family planning project in 14 districts of Pakistan show improvements in CPR and contraceptive continuation rates by 8.5 and 11 percentage points respectively. Using survival analysis and the decomposition techniques we examine the underlying factors leading to improved continuation rates and their effect in increasing the CPR. The analysis includes monthly contraceptive histories of 10,604 women in the baseline and 9,995 women in the endline survey. Results show that information on the management of side effects provided at the time of method adoption is significantly associated with lower discontinuations, observed in the decrease of discontinuations due to side effects. Findings will not only highlight the importance of continued contraceptive use they will also have serious implications in elevating currently stagnant CPR.

A family planning survey was conducted in Shanghai in 2011 to investigate contraceptive use and non-use among married women aged between 15 and 49. A total of 21907 participants were randomly selected and interviewed by trained field workers. Findings show that 19.3% of participants did not use any contraceptive method. Among them, 39% were due to wanting a baby, or being pregnant or breastfeeding. Divorce accounts for 23% of all non-users; infertility and menopause 18%, widows and living apart 7%, unmet needs 12% (including concerns of side-effects, health reasons, partners’ objection, etc). The prevalence of non-contraceptive use ranges from 15.7% to 27.1% between categories of district’s characteristics. The likelihood of non-use is associated with women’s age, education, type of work unit, the nature and location of women’s Hukou, family income, number of children and ideal family size. Proportions of unmet needs vary between individual’s characteristics, ranging from 4% to 27%. The older and less educated women were more likely to experience unmet needs. Family income and number of children were also important determinants of unmet needs. It can be concluded that non-contraceptive use in Shanghai was due mainly to intended pregnancy. However, some gaps of unmet needs still should be bridged.

The National Rural Health Mission (NRHM) in Karnataka has made considerable investments in strengthening the infrastructure, building capacity of service providers, and ensuring adequate equipments, drugs and supplies in public health facilities. This paper aims to identify gaps for each care component at each level of the health system, against the national and state guidelines in terms of infrastructure, service provision, drugs, equipment and supplies, and population coverage. During June – July-2010, all the 379 public and 94 private facilities in district Bellary were mapped for availability of MNCH services, including infrastructure, staff, equipments, drugs and supplies. A large number of normal deliveries are occurring at higher level facilities, creating system inefficiencies. Basic emergency obstetric and newborn care (BEmONC) and comprehensive emergency obstetric and new born care (CEmONC) need to be established, according to population norms. Provision of safe abortion services at PHC and higher facilities will help reduce maternal mortality.

Female sterilization has been the dominant method of family planning in India since the early 1980s. We use data from various government publications and three rounds of the Indian National Family Health Survey conducted in India in 1992-93, 1998-99 and 2005-06 to examine the trends and patterns in the use of female sterilization in India. We also aim to investigate whether or not there has been any change in the profile of acceptors of female sterilization in India over the last two decades. Furthermore, an attempt will also be made to examine the births averted due to female sterilization in India and in the major states of India. Finally, we will examine the quality of female sterilization services and post-sterilization regret associated with female sterilization. Appropriate bivariate and multivariate techniques will be used to fulfil the objectives of the paper. We propose to use the method suggested by Liu et al. (2008) for estimating the births averted due to female sterilization.

Objective
1. To examine the differentials in reproductive and child health services in the state of Jharkhand
2. To examine the inter-districts inequality in utilization of RCH services in Jharkhand.
3. To understand the covariates of inequality in utilization of RCH services in Jharkhand.
Data source and Methodology: The present study utilized data from Districts Level Household Survey (DLHS-3), Conducted under reproductive and child health programme in India. Reproductive and child health is analyzed using four indicators namely, antenatal care, safe delivery, contraception used and child immunization.
Result: The percentage of women and their children who utilized maternal and child health services shows that 5.6% respondent used full ANC, 25% women had safe delivery and 40 % women were using contraceptive and, 54% of children age group (12-23 months) was fully immunized.
Conclusion: Socio-economic factors responsible for inequality in utilization reproductive and child health services in these states. Highly spatial difference found in utilization of RCH services across the districts of Jhrakhand, India.

Richard A. Easterlin in his famous article “An Economic Framework for Fertility Analysis” in 1975, it was well established that motivation is not “sufficient condition” of fertility and there are cost involved in fertility regulation. One type of cost is subjective cost which he defined as “displeasure associated with the idea or practice of fertility control”.

The area selected for study is Bihar. Total fertility rate (TFR) of Bihar is constantly very high and at the same time there are wide discrepancy between fertility preferences and actual number of children born. Motivation comes from “excess Supply” situation, unwanted births brings the motivation to regulate fertility. However in Bihar, according to NFHS III, unmet need for contraceptive is 23.1% -highest among all Indian States.

Those women who don’t want a child at all or want them after 2+ years are considered as motivated. Sample consists of currently married women in Bihar who are motivated but are not using any method of contraception. The purpose is to study future intention to use contraception among these women to find out how subjective costs of contraception play role. A set of dependent variables are taken and logistics regression is performed. Effect of mass media is also studied.

A study of 960 currently married women from Jharkhand and Chhattisgarh indicated that majority of women were young and illiterate. Chhattisgarh women were more literate than Jharkhand women. Two-third currently married women in Jharkhand and half in Chattisgarh were not offered any method choice during the contraceptive acceptance process. One third in Jharkhand and half in Chhatisgarh were informed about the side effects while adopting a method. Currently married women in Chhattisgarh were more likely to receive information about the side effects of different methods of contraception than those in Jharkhand during the contraceptive acceptance process. Half of sterilization users had received follow up after sterilization. Younger women received more follow-up services. Education did not show definite association with reported utilization of follow up services. A few women used herbal methods too .It has emerged during the qualitative interactions that most popular method of family planning was sterilization. Majority of women used pills and IUD but male sterilization was not prevalent. Some of the most frequently quoted issues related to different methods were that sterilized women sometimes gain weight and women using pills and IUD face problems of abdominal pain, white discharge and irregular menstruation.

Money, or the lack of it, is likely to be the deciding factor in meeting global health targets. Using panel data for 22 OECD/DAC countries over the period 1996-2007, this paper analyzes the determinants of donor funding for reproductive health activities. Much of the previous research on this subject found a strong positive correlation between donor funding and GDP of donor countries. I use disaggregated data on donor funding to account for the fact that relative importance of aid determinants is likely to vary across specific funding categories. The results strongly support the notion that it is important to differentiate between restricted (earmarked) and unrestricted (non-earmarked) funding. There is undoubtedly some discretion over both types of funding. Nevertheless, unrestricted funding seems to be more responsive to economic developments in donor countries as demonstrated by the strong positive correlation of this type of funding with GDP. Unrestricted funds are thus easier to increase or cut according to discretionary criteria. Restricted funding, on the other hand, can be viewed as more undeliberate or non-discretionary. This finding has an interesting implication with regard to items in donor aid budgets that could be particularly affected in times of economic crisis.