Improving reproductive health services: Is integration with primary healthcare better than vertical programmes?

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.

Abstract
Ministry of Health and Population (MOHP) implemented a birth preparedness program (2008-09) to save life especially among rural women due to delay in assessing delivery services. The guidelines recommend that families save money for emergencies, arrange transportation beforehand based on local conditions, identify persons who can and are eligible to donate blood if required, identify and contact health facilities and health workers who can provide services, and have a clean delivery kit handy. To assess birth preparedness and factor affecting to birth preparedness, a national embody Nepal demographic health survey (NDHS), 2011 has used. Initial analysis of women who had made specific preparations before delivery of the most recent birth in the past five years shows that, birth preparedness, such as saved money for delivery and transport arranged by 36 and 3 percent women respectively. Founded blood donor and contacted health worker were by less than 2 percent women. Further, food arranged, clothing and bought clean delivery kit by 44, 39 and 5 percent women respectively. Thirty five percent women were not prepared for delivery.

Key words: Birth preparedness, delivery, Nepal

Mass media plays an effective role in creating awareness and influencing beliefs, attitudes and practices. Since it is an effective instrument in guiding social norms, it is equally important for behavioural change. The present study focuses on antenatal care, institutional delivery, immunisation, family planning services and ultrasound test.  It aims  to study the effect of media exposure on health services utilisation by women in India. The paper is based on data from a Nation-wide survey, District Level Household Survey (DLHS)-3, 2007-08. Simple cross tabulation and bi-variate analysis has been done. The preliminary findings show that there is a positive association between education and ANC (Anti natal care) and Institutional delivery. There is a significant influence of economic status on health services utilisation especially on ANC, Family Planning, Institutional delivery and ultrasound test. The findings demonstrates that improvements in socio-economic conditions are a pre-requisite for enhancing access to health services.

Objective: To explore the status and impact factors of SRH treatment services for unmarried youth in different regions of China. Data and Method: Unmarried youth aged 15-24 were interviewed, and the valid sample size is 22288. Results: The achieve rate of requirement (ARR) in Western China was the lowest compared with the Eastern and Middle China. Regression analysis showed that in Eastern China, youth with characteristics of female, older age, non-religious beliefs and treatment of sexually experienced were much easier to utilize SRH services; in Middle China, youth with female, older age, sexually experience, youth not at school were much easier to utilize SRH services; and in Western China, youth with female, older age, non-religious beliefs were much easier to utilize SRH services. Conclusion: There might be a neglect of youth under 20 who were most from “one-child-family” on SRH services provision, especially in Western China.

Decentralization is often justified as providing services closer to citizens; rarely, however, are the effects on service delivery well considered. With respect to family planning, governments often sign international commitments, but translating them into action at the subnational and facility level is difficult. Operational concerns at these levels can be reinforced or abated by increasing local authority over family planning. Critical analysis concerning the relationship between these areas requires illuminating factors by which decentralization affects family planning services. The four factors most often referenced to explain how decentralization affects family planning include: the enabling political environment, social participation, intergovernmental relations, and local government institutional capacity.

This research presents a model that accounts for these factors by analyzing their effects against each actor in the decentralization process. The structure and nature of the scope of decentralization is analyzed through the Public Administration approach and the Decision Space Model, through which we can identify areas of family planning services where narrow or wide decision space exists across a range of different areas. These frameworks provide the “lens” through which we can understand how the contextual factors.