Repositioning family planning

Turkey has gone through major fertility decline since 1960s. The TFR declined from around 7 to replacement level today; faster than predicted by earlier projections. Population policies also changed during this process: Antinatalist policies replaced pronatalist ones, with growing emphasis on reproductive health. Today, as a candidate member to EU, Turkey is maybe a decade away from becoming the most populous country of Europe. However, Turkey’s current prime minister has been explicitly suggesting that couples have at least three children in the recent years. The argument is based on the idea that Turkey’s population is ageing, and will be similar to European populations today; and that this would put Turkey in the risk of economic stress in the upcoming decades. Thus we aimed to discuss whether a “three children policy” was the answer to Turkey’s ageing problem. We came up with different scenarios of fertility change and projected populations accordingly. Preliminary findings showed that although an increased TFR would help maintain a lower elderly dependency ratio, the actual population of elderly would still require extensive planning. Furthermore, child dependency ratios would be increase, putting more pressure on the working population. We lean towards alternative solutions to the ageing problem.

More than half (52%) of unintended pregnancies in the United States occur among the 10.7% of women using no contraceptive method. Using a qualitative sample of women obtaining abortions in the U.S. in 2008 (n=49), we explored women’s attitudes towards and beliefs about contraception and found that even though two-thirds of the sample had been pregnant before, 32 respondents perceived themselves to have a low likelihood of becoming pregnant. Respondents’ reasons for this perceived low likelihood feel into three categories: invulnerability to pregnancy, perceptions of sub-fecundity, and lack of attention to the possibility of conception. About half of the women discussed more than one theme when explaining why they perceived themselves to have a low likelihood of becoming pregnant at that time. For some women who were using contraception, their perception was based on their contraceptive use although the majority who fell into this subgroup were using contraception inconsistently or incorrectly. We propose a modified Health Belief Model (Hall 2012) to account for women’s ambivalence about the need for contraception based on our results. Further research is needed to quantify who believe they are not at risk of pregnancy and their reasons why to better address women’s misconceptions about fecundity and conception.

In Pakistan the contraceptive prevalence rate is stagnant at 30% for almost a decade along with high unmet need for contraception (25%) and unwanted fertility as one child per woman (PDHS, 2008). The family planning program of Pakistan has long been focusing on small family size. Recently the focus of this program has been shifted to the spacing between births. It is therefore important to study the behavior of couples regarding contraception following childbirth. Using the contraceptive calendar data from the FALAH baseline survey 2008-09 from the 29 districts across Pakistan, we study the duration of uptake of contraception after childbirth by using life table techniques. We also study the type of contraceptive method adopted and the differentials in the uptake. The effect of desire for more children, antenatal care visits and the place of delivery on the subsequent contraceptive uptake was analyzed using Cox Proportional Hazard Regression Models. Results show that less than a quarter of women adopted an FP method within 6-months of childbirth and desire to limit childbearing was significantly associated with higher uptake. The findings of this study will highlight the importance of introducing the postpartum family planning use in the FP program of Pakistan.

Unmet need has been studied by various researchers and discussed extensively. However, there is dearth of studies, which address the issue of unmet need for contraception among the youth (15-24 years) women and compared it with the older women (25-49 years). The overall objective of this study is to address the issue of unmet need of family planning. Specifically, this study aims to focus the unmet need of family planning among the women of age group 15-25 years and compare the findings with the women of age group 25-49 years. The study also examines the key determinants of unmet need of family planning in India. National level data from third round of National Family Health Survey (NFHS) conducted during 2005-2007 has been used for the analysis purpose. This survey provides information on various issues including awareness about family planning, contraceptive use, unmet need to use for family planning methods. Women of 15-24 years total unmet need is 22.8 percent in comparison to the women of age group 25-49 years ( 9.4 percent). Among youth women the unmet need for spacing methods is 17.8 percent and for limiting methods 5.0 percent. One can infer from the levels of unmet need that youth women of the country would like to delay their next pregnancy but not able to use any spacing method of family planning.

Since the launch of the reproductive and child health policy regime in 1998-99, there has been a massive rise in government expenditure on family welfare programmes in Bihar and national level. This paper makes a systematic effort to assess the performance of the family welfare programmes vis-à-vis trends in expenditure. The trends in key performance indicators for Bihar reveal that progress has been slow and limited in the post-RCH policy regime. Contraceptive prevalence coverage has accelerated, and the increased in the Child immunization and institutional delivery. Consequently, the pace of reduction in the couple protection rate, total fertility rate and infant mortality rate has slowed. It is evidently clear that in the absence of suitable mechanism to operationalise of RCH programme, the exponential increase in expenditure alone cannot lead to commensurate a positive impact on key performance and outcome indicators. There is need suitable mechanism to operationalise RCH programme.

Considerations around repositioning family planning emphasize the need to integrate FP counseling and services with maternal and child health services particularly postpartum and post-abortion care. This paper examines the effect of the exposure to FP counseling and services during antenatal care, delivery and postpartum care on the use of contraceptives in four cities of Uttar Pradesh. Using midterm data collected in 2012 as part a longitudinal study, this paper focuses on women who had delivered in last two years (n=975). Among these, 36 percent reported adopting modern contraceptive postpartum, while 21 percent adopted traditional. Further, data reveals that only a small proportion of women received FP information and services during ANC (18%), delivery (22%) and PNC (13%), though large proportion had come in contact with providers. Multivariate analysis shows that women who delivered at facility and received counseling/services at that time are more likely to use contraceptive post-partum, than those who delivered either at home or did not receive any information in the facility. Clearly, the opportunity to reach potential FP clients with information and services during antenatal and delivery care services is largely missed, which needs to be strengthened to improve use of modern contraceptive methods.

Family planning is a critical lifesaving intervention that can significantly improve the health of women and their families. This study was carried out as part of the Sexual and Reproductive Health (SRH) Survey conducted in one of the update rounds of the Kintampo Health and Demographic Surveillance System (KHDSS) in Central Ghana. The objective of this study was to identify the most frequent source of family planning methods and its accessibility to women from the various outlets identified. Expected outcomes from this study will be descriptive statistics of the main outcome and each explanatory variable, cross-tabulations of each explanatory variable with the outcome variable and the level of significance determined using the Pearson Chi squared tests and relative risk ratios from the univariate and multivariate multinomial logistic regression models that will be fitted.

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.

This study takes a retrospective look at the time course of total fertility rate (TFR) and per capita wealth among countries, relating it to family planning initiatives and other factors thought to influence either fertility or wealth. It was found that countries that implemented strong family planning programs achieved fertility reduction much faster and earlier than comparable countries that did not. Fertility decline typically preceded marked increases in wealth, but per capita wealth growth usually accelerated when fertility fell to between two and three births per woman. The negative relationship between TFR and GDP per capita tends to be deeply concave for those countries that have achieved low fertility. Higher fertility countries in the same region tend to follow a parallel course, but at a slower pace, and most with current fertility above three are yet to see sustained wealth increase. In the absence of significant income from oil or other resources, fertility reduction appears to be a necessary if not sufficient condition for sustained economic growth. Causation runs in both directions, with prosperity and development of education and health services enhancing the reduction in family size, but interventions to promote prosperity are less cost-effective in priming this cycle than interventions for fertility reduction.

The purpose of this paper is to examine the obstacles that lead to low modern contraception use and identify the opportunities that accelerate the utilization of modern family planning methods among women in Sudan during the period between 2006 and 2010. The prevalence of utilization of modern contraception was around only 7 percent and the prevalence of unmet needs was more than 23 percent in 2006. However, these rates have been significantly changed in 2010.
Data used in the analysis come from two national representative surveys, Sudan Household health Survey in 2006 and 2010. Samples of 6173 and 6065 married women in reproductive age in 2006 and 2010 respectively are used in the analysis. Furthermore, primary qualitative comes from 5 FGDs discussion with women and 3 FGDs with village midwifes, 17 in-depth interviews with decision makers and stakeholders in 2012 used in the study. Bi-, multi-variate, and thematic analyses demonstrate that certain factors related to cultural and women’s status aspects as well as factors related to health system in Sudan are the most significant factors that constitute challenges in contraception utilization. Some policy implications of the findings and suggested solution to improving the contraception prevalence under limited resources are discussed