Family planning programmes and the reduction of fertility: lessons learned

To estimate whether and to what extent birth interval is associated with cesarean delivery. This is a retrospective cohort study of 3814 women who delivered a child during 60 month period. Women were grouped by their preceding birth interval in two groups i.e. less than 5 years and more than or equal to 5 years, and the rate of cesarean delivery was determined for these groups. The independent association of inter birth interval with cesarean delivery was further estimated after controlling for potential confounding factors using logistic regression. Women with an inter birth interval of less than 5 years had a cesarean delivery rate of 6.13. Women with inter birth intervals of 5 or more years had cesarean delivery rates of 9.85 (p<0.004). After controlling for potential confounding factors such as age, education and standard of living, the corresponding odds ratio (and 95% confidence intervals) for cesarean delivery for 5 year or more year inter birth interval group, in reference to the less than 5 years group, was 1.686 (1.119–2.542). A longer inter birth interval is independently associated with an increased risk of cesarean delivery.

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.

The population situation of China has transformed fundamentally from the high fertility era to the low fertility era since the early 1990s. The historical transformation of China’s population dynamics will naturally bring up remarkable changes in the reproductive health issues people may encounter, which call for attention.
Along with the arrival of low fertility, the puberty tends to come earlier and marriage and childbearing tend to be postponed, which invites longer exposure to unprepared sex before marriage. The reduction of the number of children to have will certainly make the period for childbearing shortened, which may likely cause some notable changes in people’s childbearing behavior.
While the period for childbearing is to be shortened, the period for contraception will simultaneously become extended.
The paper will discuss that the arrival of low fertility will witness the emerging of a whole set of new reproductive health issues which have never been seen before, and call for investigation and research as well as redesign and redevelopment in program approach and implementation, so to meet the changing needs of people in reproductive health in the guidance of quality of care.

This study aimed to identify fertility differentials among married women by focusing on the contribution of key determinants such as child loss and contraceptive use, while controlling for socio-demographic variables, for instance, age, age at first marriage, educational attainment, employment status, and place of residence. The results of this study are used to suggest policy recommendations to improve family planning in South Sulawesi province.
Secondary data from quantitative research collected by the Indonesia Demographic Health Survey 2007 in the South Sulawesi province included 982 selected married women aged between 15-49 years old, who ever had children born. Interestingly, this study found that higher educated women use less long-term contraception methods than less educated women. Results from linear multiple regressions indicated that when other variables are added together with key independent variables, the explanatory power of the independent variables to predict the number of children ever born increased from roughly 40 percent to 51 percent. In general, child loss was the utmost determinant of fertility compared to other key determinants. Therefore, this study has highlighted one of the most important challenges for reducing infant mortality and raising the prevalence of long-term contraceptive use.

Brazilian state, by means of Anvisa – National Agency for Sanitary Vigilance AgênciaNacional de Vigilância Sanitária) has issued norms that restrain the dissemination of information on sexual and reproductive health, especially concerning the use of misoprostol. This medicine has been increasingly controlled in the country since the 1980s. In 1998, Anvisa issued Regulation 344 /1998 which limited the access to the drug only to hospital facilities, hence preventing access to misoprostol by people in drugstores. At present it attempts to control the flow of information on the drug at internet sites and social networks, by means of Resolutions No. 911/2006 and No.1050/2006, updated by Resolution 1534 of April, 2011 Besides questioning the Anvisa competence to rule on such matter, the papers will show that violation of the right to information can not follow the existing restraints to access to the drug itself. Medicine abortion may be legally provided by the Brazilian health national system (SUS) in the cases of rape and risk to women’s life1. If women have access to such health technology by diverse means, they must not be prevented from having access to information on how to safely

Evidence from studies showed that fertility rates across the world are declining as modernization is increasing, but Nigeria is still one of the poorest nations with largest population in Sub-Saharan Africa. Upon all the methods of family planning available to mothers, the nation`s current contraceptive prevalence rate is still as low as 15% with the national TFR of 5.7 and 4.5 for South-western Nigeria (NDHS, 2008). This descriptive study make use of 2011 FHWS data-set, to explore factors associated with mothers` desired family size and contraceptive use in Ipetumodu, South-western Nigeria. Majority of mothers were within the age-bracket 24-34yrs with the mean age of 32 yrs and the mean CEB of 3.12. About 19.0% of mothers desired a family size of 1-3 children, 70.0% desired a family size of 4-5 children while 67.0% want more children. Only 34.0% of mothers were using contraceptives. The logistic regression showed a relationship between the use of contraception and mothers` age (OR: 1.14, CI: 0.98-1.32); mothers opinion about contraception (OR: 1.27, CI: 1.07-1.52); and mothers intention to have more children (OR: 0.59, CI: 0.06-0.45). The study therefore recommends the development of programmes with focus on women`s education and empowerment and comprehensive family planning services so that mothers can space or limit births.

This paper deals with a debatable issue on the determinant sources of fertility decline in the world’s most populous country where, over the last three decades, fertility has declined consistently and substantially to the below-replacement level. Main forces shaping such fertility change and their impacts on the adjustment of population-control policy have been debated in academic circles. Taking cases of the universal two-child policy, a group of academics have asserted that China’s current low fertility is not simply a result of the one-child birth-control policy and its various permutations. Based on a closer investigation of these two-child programs, which have been perceived as an unique case of birth-control experiment for almost thirty years, this paper demonstrates that such programs are an “adapted and adjusted” but tenacious continuity from the national population control process in terms of the timing of marriage, the number of children, and the childbearing interval. Our analysis demonstrates that fertility outcomes in China are largely a function of birth rationing.

Increasing male participation in family planning and reproductive health is one of the family planning program targets in Indonesia, which will be achieved 4.5 percent in 2014. This paper discusses about the factors affecting male participation in family planning and reproductive health among 8839 married men in 2007 Indonesian Demographic and Health Survey. The statistically analysis is used to identify the significant relationship between male participation (the dependent variable), and the independent variables i.e predisposing, enabling, reinforcing. It is found that the discussing with health care providers on health and pregnancy is significant influence on male participating in family planning and reproductive health program and 13 times makes men participate it. Knowledge of the symptoms of high risk pregnancies have statistically significance and 8 times makes men participate in it. This study recommends that the capacity of field workers’ role in Information Education Communication, the capacity of health care provider in counseling, intensifying monitoring and supervision should be strengthened.

Keywords: Male participation, family planning program, reproductive health program, The 2007 Indonesian Demographic and Health Survey.

Dynamic panel data model of infant deaths, birth spacing and contraception are estimated incorporating causal effects of birth spacing on subsequent mortality and of mortality on the use of contraceptives and the length of next birth interval. Data come from the renowned demographic field Health and Demographic Surveillance System in the icddr,b treatment area in Matlab, Bangladesh, on 31,968 children of 13,232 mothers, with complete prospective records of fertility, child mortality, contraceptive use, and socio-economic variables from 1982 until 2005.

Infant mortality is determined by the preceding birth interval and other covariates (such as socio-economic status). The decisions about using contraceptives after each birth are driven by similar covariates, survival status of the previous child, and the family’s gender composition. Birth spacing is driven by contraceptive use and other factors.

Our main finding is that complete contraceptive use could reduce infant mortality of birth order two and higher with about 7.9% (while complete non-use would lead to an increase of infant mortality by 10.6%). The net effect of complete contraceptive use on the total infant mortality rate is small (2.9%) since the favourable effect on higher order births is partly offset by the rise in the proportion of high-risk first births.

The Family Welfare Programme in India has experienced significant growth and adaptation over the past half century since its inception in 1951. The direction, emphasis and strategies of the Family Welfare Programme have changed over time. Over the decades, there has been a substantial increase in contraceptive use in India. The contraceptive needs of considerable proportions of women and men and improving the quality of family planning services continue to be a challenge. The 1990s witnessed a growing recognition of this, and several innovative policy and programme initiatives have been launched to address these issues. The objective of this article is to trace the roots of this change in orientation, document the program's achievements to date and examine the challenges that remain at the policy level, at the implementation level and also reviews evidence from surveys and studies conducted in the 1990s and thereafter on contraceptive use dynamics for contraception in India. Declining fertility in large part is due to women’s increased use of contraception. For the first time ever, more than half of currently married women in India are using contraception, and their use of modern contraceptive methods increased from 43% to 49% between NFHS-2 and NFHS-3. This raises the question of whether the focus, priorities and responsibility