Family planning programmes and the reduction of fertility: lessons learned

This paper examine the trends and differentials in contraceptive use in Egypt using data from the 1988, 1995, 2000 and 2005 Egypt Demographic and Health Surveys. The contraceptive practice rate has increased from 30.3 percent in 1984 to 59.2 percent in 2005. This represents a relative increase of 95.4 percent. In 1984, 19.2 percent of rural women, compared with 45.1 percent of urban women, were using contraception. However, by 2005, the proportion of women using contraception has increased significantly in rural areas, 56.8 percent compared with 62.6 percent in urban areas. From 1984 to 2005, the relative increase of contraceptive use for rural women was 195.8 percent compared with 38.8 percent for urban women. The difference in contraceptive use in rural and urban areas in Egypt was less in 2005 compared with 1984 and 1988. In sum, the overall convergence in contraceptive use is evident among rural and urban women in Egypt. An analytical model composed of socioeconomic development, status of women, and family planning variables is tested using logistic regression. Decomposition analysis suggests that the shift in population structure favored increased contraceptive use in Egypt.

Depot medroxyprogesterone acetate (DMPA) is a widely used injectable contraceptive given by the intramuscular (IM) route. A subcutaneous formulation, depo-subQ in Uniject (SAYANA PRESS®), has been developed. It is anticipated that this method will be a valuable innovation in family planning (FP) service delivery. This outcome hinges on the method being affordable and acceptable to decision makers, FP providers, and clients. This study assessed acceptability of depo-subQ in Uniject among clients and providers, including community health workers (CHWs). User trials in FP clinics and with clients of CHWs were conducted in Uganda and Senegal. Pre- and post-injection questionnaires were administered to 360 experienced DMPA clients who received the subcutaneous injection. The participants were followed three months post-injection to further assess experience with depo-subQ in Uniject. Eligible DMPA clients who decline to receive depo-subQ in Uniject were invited to complete a questionnaire about their reasons for declining. Interviews were conducted with 80 CHWs and 20 clinic-based providers to assess their experiences providing the method. The results will inform the introduction of depo-subQ in Uniject on three levels — country, community, and health facility.

This paper contributes to understanding the associations between a culturally sensitive family planning program and fertility preferences. Previous research on family planning programs are largely focused on addressing unmet need for contraception. Yet, scholars have asserted that even if the expressed need for contraception is met, fertility will remain above replacement levels. Needed to propel low fertility and accelerate economic developments are programs that influence explicit desires to limit child-bearing at low parities. This paper uses longitudinal data from an economically adverse setting (the Navrongo experiment) in Northern Ghana to examine the impact of culturally sensitive family planning program on fertility preferences. Results show that fertility desires are largely a function of the Navrongo experiment net of individual socio-economic characteristics. Involving traditional social institutions in health planning and services is significantly related to promoting preferences for smaller family sizes among women. Overall, women seem to be shifting towards smaller family sizes although decline in preferences is comparatively modest to precipitate transition to low fertility. We discuss the implications of our findings in the context of policy frameworks to increase access to contraception in developing countries.

Ghana’s Community Health and Family Planning (CHFP) Project demonstrated dramatic success in the 1990s in reducing fertility and saving lives by posting nurses in rural villages where they worked with traditional social networks to deliver community-based health services. The CHFP approach was scaled up as a national program called “Community-based Health Planning and Services” (CHPS) and is now a major contributor to Ghana’s health care system. However, vital reproductive health components are languishing and CHPS’ impact on fertility may be falling well short of the potential to address unmet need. This qualitative study revisited the villages of the CHFP in order to clarify social and behavioral changes that have occurred and not occurred as CHPS services were scaled up. Preliminary analysis reveals that key functions of the health system that fostered community engagement have atrophied during the scale-up of CHPS. Limited human and financial resources and additions to the package of CHPS services have diluted the focus on family planning and reduced the time and energy available for community engagement for family planning uptake. Activities to change community attitudes toward family planning appear to be more fragile and difficult to sustain than other components of CHPS services in the face of resource constraints.

Social scientists and demographers are proffering explanations for the emerging pattern of fertility transitions in sub-Saharan Africa. Using the traditional Bongaarts model, its extended version and Stover’s refinement, we try to offer a more nuanced explanation of African fertility transitions. We used data from Demographic and Health Surveys of 23 sub-Saharan African countries to investigate the patterns and changes in fertility and proximate determinants within and between the countries. Particularly we compared the impact of proximate determinants on fertility at both pre-1994 and post-1994 fertility regimes. It is shown that in pre-1994 period, the traditional Bongaarts model was more useful to explaining fertility variations than in the post-1994 era .Results also show that in East and Southern Africa, Stover’s version of proximate determinant model is more useful to explaining fertility changes than the original Bongaarts model. There are also various differentials identified. Theoretical, programme and policy implications of these findings are discussed.

Anthropological explanations of demographic outcomes have emphasized the need to understand how community structures contribute to those outcomes. Studies on fertility dynamics in Africa have focused on micro-level factors at the expense of the community context.
Using the most recent Demographic and Health survey data from Nigeria [West Africa], Kenya [East Africa], Egypt [North Africa], Cameroun [Central Africa] and Zimbabwe [Southern Africa]and multilevel modelling technique, our study demonstrate that there is significant community effects on African fertility patterns, even after controlling for a number of individual factors such as age, education, religion and ethnicity.The paper discusses the theoretical and practical implications of these findings to understanding emerging sub-saharan African fertility patterns.

This paper describes a study aiming to elicit the needs of adolescents’ fertility behaviour and unmet needs in India and major states. The objective was to understand levels and patterns of adolescent fertility in India and its major states and to see the unmet needs in family planning, also recognizes the information which could guide the development of adolescent-friendly health services by grass root level health workers. This study used the DLHS 2007-08 data and SRS data to meet the objectives. The findings demonstrate that there is clearly an unmet need for information about effective family planning services, also a large unmet need for spacing (28.4) which is often perceived by adolescents to be of primary importance. Integrating these issues into programmes is likely to be an essential element in developing health services and programmes which can reach out to the majority of adolescents in India.

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 objective of family welfare programme is to reduce the high birth rate in the population. Serious concerns have been expressed regarding population growth and its impact on human welfare. Objective of the study is to understand the changes in unwanted fertility and cost of regulation and the strength of family planning programme and overall development in determining the wanted and natural fertility in some selected Asian Countries during different time period.Study shows that wanted fertility is the main determinant of fertility behavior. The status of family planning is slightly improved but there is need to go a long way as the unmet need is quite large.These countries show declining trend in TFR. It also indicates that policy makers have to do some special efforts to motivate couples for regulate their fertility and must ensure the quality of care in reproductive and child health approach. the effects of development and family planning programme on t
he mediating variables are briefly examined which shows that declining demand for children motivated more couples to regulate their fertility by adopting contraception. It indicates that socio- economic development has the expected negative effect on wanted fertility as well as a positive influence on preference implementation.

Although reproductive health advocates consider family planning programs the interven- tion of choice to reduce fertility, there remains a great deal of scepticism among economists as to their effectiveness, despite little rigorous evidence to support either position. This study explores the effects of family planning in Ethiopia using a novel set of instruments to control for potential non-random program placement. The instruments are based on ordinal rankings of area characteristics, motivated by competition between areas for resources. Access to family planning is found to reduce completed fertility by more than 1 child among women without education. No effect is found among women with some formal schooling, suggesting that family planning and formal education act as substitutes, at least in this low income, low growth setting. This provides support to the notion that increasing access to family planning can provide an important, complementary entry point to kick-start the process of fertility reduction.