Family planning programmes and the reduction of fertility: lessons learned

The majority of existing studies on fertility regulation primarily seek to explain contraceptive practices and behaviour in terms of the individual’s or couple’s personal attributes, and household risk factors, neglecting the contextual, social and cultural environment in which the outcomes occur. Evidences regarding how contextual and community level factors influence contraceptive adoption are limited, especially in the developing countries. Using a multistage sampling design, data on contraceptive use and individual, household and community level information were collected from 1,348 women residing in an underdeveloped region of a rural area of West Bengal, India. Of all women in union about 88% were using one contraceptive method at the time of survey. Among them about 82% were using any modern method, while a minority (about 6%) were using any traditional method. The female sterilization was the most commonly used method (68% of women) followed by oral pill (17%). The preliminary results of multilevel binary logit analysis suggest that a significant community-level variation is present in contraceptive use. Village level developmental indicators and participation in community activities were found to be significantly associated with contraceptive use even after controlling the potential confounders.

The paper documents the issues of the Philippine Reproductive Health Bill and to present a case study of the fertility experience of farmers in northern rural part of the Philippines. The first population policy , HB 4244 ,better known as the Reproductive Health Bill (RH Bill) has many debatable issues that borders on the moral and ethical values such as, When does life begins and its implication on the use of contraceptives. Who will teach child sex education? and How can the Philippine government afford to spend for alternative family planning methods when at its present economic state, it can barely meet the basic needs and social services of its people. A case study done in 2011 on unmet family planning needs among farming couples in the northern rural part of the Philippines supports the RH Bill. The RH Bill is a step toward minimizing poverty.

The fertility level in Asian countries has been declining, albeit at different pace, since the launching of family planning programmes about five decades ago. This paper uses data from published data to examine the relationship between family planning efforts, contraceptive use and fertility in four South Asian and four Southeast Asian countries. Data from Demographic and Health Surveys are used to examine fertility differentials within each country, with special emphasis on the effects of contraceptive use, women’s education, age at marriage, work participation and their status in the family. Of the countries in this study, India was the first developing country to adopt a national family planning programme in 1952, followed by Bangladesh, Nepal and Pakistan, Indonesia and Philippines in the mid- 1960s to 1970. Vietnam and Cambodia adopted a national family planning policy as recently as 1993-1994. The pace of fertility decline in South Asia accelerated only after 20-30 years of family planning program. In contrast, the impact of family planning programme on fertility decline was more immediate in the Southeast Asian countries. Scatter plots and regression analysis show that contraceptive prevalence rate (CPR) is related to family planning efforts, and fertility level is strongly associated with CPR.

Although the majority of postpartum women indicate a desire to use contraceptives, family planning methods are often not offered to, or taken up by, women after delivery or in the first year postpartum. This study examines exposure to family planning services at the time of delivery and at an immunization appointment to determine if these points of integration are associated with greater use of postpartum family planning. A representative sample of women ages 15-49 was surveyed from six cities in Senegal in 2011. This study focuses on the women who were within two years postpartum (weighted n=1879). We show that women who received family planning information at the time of delivery are more likely to be using modern family planning postpartum than their counterparts who also delivered in a facility but did not receive such information. Exposure to family planning at an immunization visit was not significantly related to postpartum family planning use. Another key finding is that women with greater self-efficacy are more likely to use modern family planning. Programmatic recommendations are made for improving integration of family planning into maternal and child health services with the goal of increasing postpartum women’s use of family planning in urban Senegal.

Not so much has been documented about determinants of contraceptive use among sexually active younger women in comparison with older women. Most of the existing literature generalizes contraceptive use among all women. Understanding determinants of contraceptive use among different age groups is key in the development of highly effective family planning programmes.
Uganda Demographic and Health Survey (UDHS) 2011 dataset was used. The sample comprised of 1,697 married and sexually active women. Binary logistic regression was used to examine the relationship between selected independent variables and the outcome variable (current use of modern contraception).
More factors were found to be associated with contraceptive use among young women (15-24) compared to older women (25-34). Contraceptive use among young women was associated with: education, region, empowerment and desire for children. Apart from desire for children, all other significant factors associated with contraceptive use were found among the young women (15-24).
It is recommended that there is need for consistent provision of Family Planning services to cater for spacing needs (desire) of the women as well as ensuring completion of secondary school since these were associated with contraceptive use.

The research clearly indicates the huge amount of currently married women with different socioeconomic strata having unmet need in India and importantly give a strong message for achievement of replacement of fertility by satisfying the unmet need. There are large variations in unmet need for family planning among Indian states. The trends show that unmet need is gradually declining still there is huge amount unmet need visible in the country The study have applied Westoff and Bankole model to know the potential demographic significance of unmet need. After calculating the unmet need for family planning of India, we calculated three different models like “Maximum”, “Minimum”, “Realistic unmet need satisfied” with assumptions and then with Bongaarts Proximate Determinants Model, we have estimated figures of implied fertility rate. Study suggests, in all states the elimination of unmet need to space theoretically reduces the Total Fertility Rate (TFR) to the replacement level of fertility. Results indicate that by satisfying the unmet need for spacing we are able to control fertility to significant level. Finally Research concludes, Unmet need for spacing clearly challenges the entire family planning program personnel to quickly address the root causes and take necessary action to speed up implementation strategy.

Decentralization and family planning in Indonesia: the opportunities and the challenges
By
Nia Reviani
Staff of National Family Planning and Population Board, Jakarta-Indonesia

Decentralization of the Indonesian family planning program has contributed to considerable gains in family planning. However, there is indication that Indonesia’s family planning program remains stagnant due to limited access to reproductive and sexual health services This paper will discuss the facts of Decentralization family planning program in Indonesia, including the opportunities and challenges . The discussion will be based on the relevant literatures and the analysis of available resources that already exist in the communities, and supported by statistical data derived from some databases. Decentralization family planning program has offered some advantages such as improvement of efficiency and quality of care and increasing responsiveness of the local and private health system. But to accelerate family planning progress, there are some challenges that need to be addressed such as capability to provide appropriate and high quality services, improvement the quality of decentralization and programming at different levels and increasing the diversity of acceptable contraceptive methods

Indonesia is experiencing a rapid decline of its total fertility rate (TFR) over the last five decades. Adopting a strong anti natalist policy since 1970s with different time settings allows markedly variation in the level of TFR among provinces. Among Java-Bali provinces, three provinces (DI. Yogyakarta, DKI. Jakarta and East Java) reached replacement level in 1991, followed by Bali (1994) and Central Java (2003). Unlike DKI Jakarta and East Java where the fertility rate slightly fluctuates, DI. Yogyakarta indicates a consistent declining and halves the size in 2007 at 1.5. Limited studies on a persistent trend of reaching fertility at well below replacement level in Indonesia brings this paper aiming to look at the dynamic and contextual factors of fertility reduction in DI. Yogyakarta by using a series of Indonesia population census and IDHS 2003 & 2007. The result confirms that higher level of women education and women in labor force, delayed women age at first marriage, higher median age at first birth and longer birth spacing exert as major predicting factors. Like many other developed countries, voluntarily childlessness is also appearing. Having no spatial population policy and measures, some appropriate recommendations are deliberately discussed and proposed.

In India, urban fertility has already reached the below replacement level. However, at the subnational levels, urban fertility varies from 1.4 in Assam to 3 children per woman in Uttar Pradesh. The national family health surveys suggest that the decline in fertility rate does not commensurate with an increase in contraceptive prevalence rate (CPR) during 1992-2006 at the state level. On one hand, urban Punjab registered a decline of two percent in CPR but the fertility declined by about a quarter while 76% increase is noticed with a decline in urban fertility was below 20% in UP. Thus, to examine contraceptive method-mix not only from the angle of fertility decline, but also becomes equally critical to see how couples making contraception choices in urban settings when sexually transmitted infections, sexual satisfaction and rights to make choice are at the centre stage. This paper finds that modern spacing methods are on the rise in the urban setting of all states except Tamil Nadu, Andhra Pradesh and J & K but use of limiting methods have gone up except in states like Punjab, Odisha, Assam and HP during 1992-2006. In most of the states, the prevalence of IUD and vasectomy has reduced that has been compensated by the rise in the prevalence of condoms and Pills, and traditional methods. Socioeconomic differentials in method-mix.

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.