Repositioning family planning

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.

Unmet need is a widely used family planning indicator, and in 2008 it was added to the set of MDG indicators. Yet there is considerable confusion about what “unmet need” represents, reflecting lack of clarity about the underlying concept. Unmet need is commonly interpreted as tantamount to unsatisfied demand for contraception. But the conventional unmet need indicator does not use survey items asking women whether they want to use contraception, nor does it use any measures of access to contraception. Moreover, if reducing unmet need is an explicit policy goal, then program design should be informed by a good understanding of reasons for unmet need. The aims of this paper are: (i) to clarify what the widely used estimates of unmet need actually represent; (ii) to explore reasons for unmet need, with the aim of deepening our understanding of the policy and programmatic challenge. After discussing the concept (and clarifying what it does and does not represent), we conduct an extensive and thorough analysis of DHS data on reasons for non-use in surveys from 1990 to the present, looking for societal variation and variation according to stage of transition. Programmatic implications of the main reasons for unmet need are identified.

The ICPD represented a “quantum leap” for population and development policies as it involved a paradigm shift from the previous emphasis on Demography and Population Control to Sustainable Development and Reproductive Rights. Earlier, TFR and CPR used to be the fixation of most population programme. But a revamp in the Family Welfare Programme, from the earlier approach of provider centric-target oriented approach to client centered-target free approach now all couples to decide freely on number, spacing, and timing of childbearing. This paper examines the change in patter of use of family planning methods and the socio-economic- demographic & program factors that influences couples desire to space between children and hence shift from adopting permanent method to reversible methods by using service statistics and survey data in last three decades. There is a clear trend in shifting from acceptance in limiting methods to spacing over time. The timing of limiting and stopping or spacing behaviour is mainly determined by the couple’s desired family size, number of surviving children, sex composition of surviving children and other motivating factors such as cost, demand, opportunity, and individual costs. India is more informed on spacing and thus the re positioning of family planning helps to ‘India Shining’.

Biologically, one of the main differences between males
and females is the reproductive function of females. This difference becomes an important social issue insofar lives of many women are threatened during the period from the pregnancy to the year after delivery. As a lesson of safe motherhood program implementation, it is now well known that every pregnant woman is likely to die from maternal causes. Therefore, women in countries with high fertility levels faced several times (sometimes more than 6 times) the risk of maternal mortality in their life and at any new pregnancy experienced, their risk of death increase. Despite the limits ob-
served in programs to reduce maternal mortality, mainly based on access to health services and delivery assisted by qualified health workers, actions against maternal mortality are still given less consideration to the others socio-demographic aspects of the problem. This study suggests that programs on maternal mortality reduction should consider family planning as a core component of the strategy. Maternal mortality and family planning programs must be closely related to achieve the target number 5 of the millennium goal. In this regard, this study aims to prove and quantify the
importance of family planning in maternal mortality trends in Burkina Faso.

Utilizing the 2011 UDHS, we study the influence of perceived partner’s desire for more children and its effect on current contraceptive use among married women in Uganda. Data herein is based on 5352 married and was weighted before analysis. Descriptive statistics of women’s background characteristics were computed. Multinomial logistic regression models were run to establish the relationship between husbands’ desire for more children with different socioeconomic variables. Overall the variables found to be highly significant with husband’s desire for more children were; modern contraceptive use, wealth, religion, fertility intentions. Women who perceived their husbands to want more children and those who did not know their husbands desired number of children were less likely to use modern contraceptives. In addition, wealth, religion, respondents’ education and husbands’ education levels and are a key determinant for perceived husbands’ desire for more children. Muslim respondents were less likely to know the number of children their husbands desired. we conclude that recurrent couple communication is pertinent in reduction of high fertility levels, promotion of small families and modern contraceptive usage.

Injectable contraceptives (IC) are not over-the-counter products and it needs to be promoted through the qualified health care providers. This paper investigates the possibility of promoting ICs from provider’s perspective by assessing current knowledge and perception on ICs. Utilizing a cross-section survey data conducted among 114 private providers of FP services in 15 towns of Bihar, the result showed that 78% providers were aware of ICs, though comprehensive knowledge is lacking, especially among MBBS doctors. Very less proportion of providers ever prescribed it (38%) or intend to prescribe (23.7%) in future. It may be useful to design and provide an orientation on ICs specifically covering - how it works, eligibility criteria before recommending IC, probable side-effects and management. Similarly, it is equally important to improve providers' positive attitude and belief towards ICs which may encourage them more to recommend this method more confidently and efficiently. These efforts may increase not only the use of ICs, but also the quality of service regarding ICs.

We examine the hypothesis that unintended pregnancies are associated with negative health outcomes for both mothers and children using data from the 2011 Nepal Demographic and Health Survey that showed that 30% of the births in 2011 were unintended (including unwanted and mistimed births). The results, showed that mothers were more likely to receive inadequate prenatal care (OR = 1.29; p<.05) and were also more likely to opt for home births (OR = 1.30; p<.05) when the pregnancy was unintended compared to when it was intended. Likewise, the resultant newborns were more likely to receive inadequate immunization (OR = 1.17; p<.05) and remain stunted (OR = 1.21; p<.05) when the pregnancy was unintended compared to when it was intended. The results underscore the importance of adopting a two-prong approach: reducing unintended pregnancies through effective family planning programs and paying special attention to the mothers who have an unintended pregnancy.

In sub-Saharan Africa, its fertility transition has been estimated to have started in many countries in the 1990s, even though there are still some countries that are not considered to have started their fertility declines. After the onset of fertility transitions in many countries, Bongaarts (2006, 2008) pointed out possible stalls in fertility declines in many transition countries in late 1990s and early 2000s. As more recent data have become available especially those after 2005 to 2010/11, it is time to reevaluate the trend in fertility declines in sub-Saharan Africa in general and those countries considered to have had stalls in fertility declines in early 2000s. In this regard, DHS data of 41 sub-Saharan African countries since the 1980s will be used. The study will analyze changing policy agenda and macroeconomic situations in the context of sub-Saharan Africa since the 1990s, such as the repositioning of family planning programmes, an increasing emphasis on the achievements of MDGs especially the reduction of maternal mortality, and the recent declining trend in HIV prevalence. In sum, this study will look into policy influences on ongoing fertility transition in sub-Saharan Africa and provide their future perspectives on the continuous fertility decline.

Background

Well-planned family planning (FP) policies and programmes in South Asian countries contributed to considerable increase in contraceptive use and a significant reduction in fertility. However, over the past decade, the programmes have suffered due to erosion in political will and commitment.

Objectives and Design

This paper reviews the status of FP programmes, and looks at changes in policies and strategies
to reposition FP programmes. The study uses data from the DHSs and other relevant documents.


Findings

The CPR ranges from 22% in Afghanistan to around 60% in Bangladesh, India and Sri Lanka. However, a point of concern relates to the slowing down in the rate of increase in CPR since mid-1990s.

Family planning programmes face several challenges in their efforts to raise contraceptive use: (i) lack of political will and commitment, (ii) low CPR among adolescents, (iii) regional variations in CPR, (iv) changes in method mix, (v) high discontinuation rate, and (vi) organizational problems.

The positive development is a renewed recognition among governments in South Asian countries of the need to reposition FP as part of the overall development agenda. Accordingly, several policies and strategies have been adopted.


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This paper makes an objective assessment of the planned family planning efforts in India organised under the National Family Welfare (Planning) Programme during the period 1970-71 through 2010-11. The assessment covers the conceptual foundations of official family planning efforts, administrative capacity and organisational efficiency of the National Family Welfare (Planning) Programme, outputs of official family planning efforts in terms of needs effectiveness, capacity efficiency, goals effectiveness and realised efficiency of the National Family Welfare (Planning) programme, and impact of official family planning efforts in terms of realisation of demographic targets and goals. The analysis, based primarily on the services statistics of the National Family Welfare Programme, suggests that, at the policy level, there has been considerable dilution in the official family planning efforts which has implications for organising family planning activities at the grassroots level and the impact of these efforts in terms of reduction in the birth rate and population stabilisation. The paper argues for reinvigorating the official family planning efforts and proposes a framework for the purpose.