Family planning programmes and the reduction of fertility: lessons learned

The rapid socio-economic development of Korea was primarily due to the successful implementation of a series of Five-Year Economic Development Plans that started in 1962. Concomit with socio-economic development, Korea's demographic change has been made at a pace the world has not seen before. The country's total fertility rate (TFR) was as high as 6.0 children per woman in 1960. By 1983, the figure dropped to the order of the population replacement level, and in 2005 to 1.08. It has since been hovering 1.2. Since 1962, the population policy in Korea could be largely divided into three phases of the population control policy with emphasis on the national family planning programs (1962~1996), population quality and welfare improvement policy (1996~2004), and fertility encouragement policy (2006~) to briefly describe major phases and developmental processes of the population policy. This paper aims to provide an overview of developments in Korea’s population control policy in chronological order, changes in fertility and contraceptive behaviors on the past accomplishments, as well as a few socio-cultural and demographic problems that Korea encountered in the course of implementing the population policy in Korea.

Indonesia is the world’s most populous Muslim-majority nation, with its highest prevalence rate for injectables (32%). Egypt has the world’s largest Arab population, but the TFR is stalling at about half a birth higher than in Indonesia, despite both countries having comparable overall and any modern contraceptive prevalence rates. Both established clinic-oriented national family planning programs in the mid-1960s with strong bureaucratic and financial support, but each has recently hit trouble. Indonesian politicians have shifted their attention and resources away from family planning. However, injectables have become increasingly offered by local midwives with strong incentives and by more private providers. Political turmoil threatens to undermine Egypt’s program, heavily dependent on the strained public sector. However, over 7% of women now use injectables, more than in other Arab states and possibly soon usurping pills as the second most common method. In both countries, government policies have led to a loss of method choice and a narrowed range of family planning providers. We examine these developments further and ask how far can Indonesia serve as a model for how injectable contraception can help accelerate Egypt’s path towards replacement-level fertility and for influencing trends in other Arab populations.

The Nigeria Urban Reproductive Health Program (NURHI) aims to increase contraceptive use in four urban areas in Nigeria. To address supply side issues NURHI has spearheaded the formation of a Family Planning Provider Network (FPPN) in each city. A baseline study on FPPN members was conducted. Results showed FPPN members in Ibadan and Ilorin are more biased than those in Abuja and Kaduna. Gender, religion and prior modern family planning use are not associated with service provision biases. PMVs and community outreach workers have more biases than clinicians. The finding that PMV operators, a significant proportion of the FPPN and a source of contraceptive supply for around a quarter of urban Nigerians, have high biases indicates program efforts to integrate the PMV and clinician network, to reduce PMV operator biases, must be prioritized in the FPPN program.

Programs aiming to increase the contraceptive prevalence rate, as with the Nigeria Urban Reproductive Health Initiative (NURHI), must address contraceptive supply stock outs in order to ensure that the supply is available to meet the increase in demand. To indicate whether a stock out has occurred or not is absent vital information for prioritizing program activities. We created a summary measure that includes important information about the potential effect of a stock out - the couple years protection lost (CYPL) measure. The CYPL combines information on client flow, stock outs and the published couple year protection for each method – and then is summed and presented as an aggregate measure at the facility level. With the CYPL measure programs can target those family planning facilities with the most damaging stock outs first, to strategically reduce the negative impact of stock outs in an informed order of priority.

India and Brazil face the same nature of challenges regarding the supply of family planning services and, more specifically, of tubal ligation. The size and complexity of decentralized political and administrative organizations in both countries imprint a high degree of difficulty in health provision that central governments and state-level authorities are not able to control and enforce. In this sense, local-level heterogeneity as for economic, political, social, and demographic differences reigns. The aim of this article is to analyze the factors associated with the differentials in the access of tubal ligation and clinical reversible methods in the public health sector in Brazil and India as well as to establish and discuss common treads stemming from public policies and politics that influence family planning. The focus is on poor women parity two or higher. We use the 2006 Demographic and Health Survey for Brazil and the National Family Health Survey 2005-06 for India. Although access has improved over time our findings point that contemporary obstacles to public family planning services can be traced in the early initiatives and are related to the political economy of family planning organization in the three spheres of political power – central, state-, and local-level.

This paper examines the impacts of socioeconomic development, status of women and family planning on contraceptive practice and the extent to which these effects vary among rural and urban areas in Bangladesh. The Logit model will be used to evaluate the effects of a selected group of variables on the probability of reproductive behavior of rural and urban women in Bangladesh. By comparing the reproductive behavior of the rural women to those of urban women, we will be able to discern whether these differences can be explained by differing compositional characteristics with respect to socioeconomic development and status of women in rural and urban populations. We will also be able to establish whether the differences in reproductive behavior of rural and urban women are diverging, converging or remaining the same. Decomposition techniques will also be used to delineate factors that may have contributed to the observed rural-urban differences in reproductive behavior in Bangladesh.

Contraceptive use is still low in developing countries including Nigeria even though its knowledge is widespread. The option of Exclusive Breast Feeding (EBF) as a contraceptive is however reported at 5%. In spite of its demonstrated advantage, EBF is far less common among lactating mothers which has led to the decline of its use as birth spacing. The reasons for this low use among lactating mothers are yet to be thoroughly investigated. The major question arising from this is to what extent has demographic features been reflected in the low usage of EBF as a contraceptive? Is there any discernible trend of the low usage of EBF as a contraceptive? To answer these and other related questions, this survey study utilizes the combination of Social Action Theory by Max Weber and Ajzen’s Theory of Reasoned Action as its theoretical framework. Data collection was both primary and secondary. Using the NDHS (2003 to 2008) data base and structured questionnaire administered on lactating mothers, it is expected that the factors affecting the use of EBF as a contraceptive will centre on demographic factors such as income, knowledge and education and ethnic membership will influence attitude and eventual use of EBF.
Keywords: Birth spacing, Exclusive breastfeeding, Lactating mothers, Contraceptive
Word count: 198

The 2012 London Summit on Family Planning has spearheaded a renewed focus on increasing access to family planning. Key to increasing demand for and use of family planning services will be understanding interventions that are effective at meeting the needs of vulnerable populations. While multiple reviews have examined the effects of interventions aimed at reducing unintended and adolescent pregnancies, this paper examines the evidence on interventions aimed at preventing or reducing fertility-related, high-risk pregnancies through use of modern contraceptive methods. This analysis is based on a systematic review of peer reviewed articles from 1990 to present. The articles identified will be analyzed using a qualitative analytical framework. The qualitative analysis consists of identifying the country context, interventions implemented, outcomes reported, and analysis of the intervention and main findings. Articles will be evaluated based on the strength of the evidence, including an evaluation of the study design, adequacy of the sample size, comparability of the intervention and comparison groups, control for confounding factors, and statistical significance of the results. This paper will guide program managers and policy makers on which interventions contribute to reducing fertility-related, high-risk pregnancies.

Bihar has been moving slow towards replacement level fertility, while Several Indian states have achieved the replacement level of the fertility, or very close to goal. Also Bihar knows as traditionally poor performing state during the first years of TFA (1996-97). The family welfare expenditure increased over the period especially post RCH. After the introduction of RCH approach, TFR has slowed down compared of the increase in expenditures. The increase in family planning expenditure did not have any positive impact on CPR and TFR. It found that inconsistencies in the linkage between expenditure, CPR and TFR during post RCH era. Result of Gompertz Model indicates that the rate of decline is decelerated after 1997, may be due to no major progressive change among sex preference and contraceptive use, family planning demand and satisfied over the period. There is needed to look at all those programs associated with population stabilization effort.

Contraceptive use dynamics plays the vital role for the fertility reduction and empowered women in Bangladesh which is indeed one of the most substantial achievements for the Millennium Development Goals (MDGs). It is to identify the factors associated with contraceptive use and it seems imperative to know the issues related to contraceptive use through which fertility can be controlled. However, in Bangladesh though the rate of fertility has been declined for increasing use of contraceptives, but it is still far from replacement level. In this study, an attempt has been made to examine the role of contraceptive use dynamics for the fertility reduction in using nationally representative data from Bangladesh Demographic and Health Survey (BDHS), 2007. The study also emphasis on the issues related to contraceptive use and women autonomy and empowerment, which directly or indirectly have impact on fertility reduction in Bangladesh. The prominent multivariate technique such as logistic regression has been used to identify the important factors affecting contraceptive use, autonomy and empowerment. The result indicates that the contraceptive users are more empowered and autonomous than non-contraceptive users. Bongaarts model has been used to know the impact of contraceptive use on fertility reduction.