Repositioning family planning

Nigeria has seen its infant under five and maternal mortality rates rise to sky high values of 105 and 191 per 1000 live births and 1000 maternal deaths per 100,000 live births. United Nations report showed that 14% of the world’s deaths related to childbearing are in Nigeria and nearly one in six maternal childbirth deaths globally occurs in Nigeria. This study assessed the knowledge, attitudes and perception of the male farmers towards family planning and correlates the respondents’ knowledge with attitudinal assessment and practices on family planning. Data was collected randomly using a pretested and structured questionnaire on 401 married male farmers in three south-western states. The data analysis revealed that 48.9% of the farmers had poor knowledge and 20.2% had very poor knowledge about family planning. Only 1.7% had good knowledge. Education, occupation and previous number of children are positively related to knowledge of family planning while income had negative correlation among the farmers. The study recommends introduction of basic family planning education into the primary school curriculum and in the extension services to the farmers and as well motivate farmers to participate in Lifelong learning. Mass media could be employed to raise men’s awareness about family planning in the sub region.

The Government of India piloted a new initiative in 17 states whereby local accredited social health activists (ASHAs) deliver contraceptive methods directly to the households within a modified supply chain designed to avoid stockouts and delays in supply. This paper details a process evaluation of the new initiative, undertaken by FHI 360 as requested by the Ministry of Health and Family Welfare, Government of India with the purpose of providing recommendations for its national scale-up. The objective of the evaluation was to identify operational issues, including service delivery mechanisms, program monitoring and record keeping at various levels. These objectives were achieved using quantitative and qualitative methods across six geographically representative states. The evaluation highlighted several operational challenges for the government of India to consider during scale-up. The packaging of the initiative’s contraceptive supply could be modified to highlight the price and to differentiate it from the free supply. Social marketing would improve community awareness and acceptance of the new charges. Reporting formats could be simplified, and develop guidelines on stock requisition and removal of free-supply stocks. The initiative is a promising strategy for addressing unmet family planning need and increasing the uptake

India is the first country to launch the official family planning(FP) programme in the world, but missed the goals set every time. Since the big political turmoil due to coercive sterilization campaign in 1975, no political segment wants to be firm on the programme. Moreover, the programme managers have not been successful in translating the ICPD's approach (free from fear and coercion) and added more confusions since the launch of RCH programme in 1997. Thus, the country left much behind in the achievements of FP progress. In 2009, the Indian government initiated the repositioning of FP service in health agenda. Thus, this paper aims to study the contraceptive security(CS) by modifying USAID concept of CS in context of India and its major states. The paper deals with issue of finance, health and social environment, access and utilization of FP services. It is clear from the result that financing to FP services enhances the contraceptive security.

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

In response to demographic challenges and shifting public health priorities, many countries in sub-Saharan Africa, aided by international donors, have attempted in recent years to reposition family planning (RFP). However, the lack of a tool to assess progress has hindered their efforts. Recognizing this need, Futures Group participated in a collaborative project to develop a framework of indicators that assess change in the RFP environment. Since September 2011, Futures Group has applied the framework in eight countries in Francophone West Africa and is currently drafting individual country reports to describe the status of RFP as measured by these indicators. This paper outlines the process Futures Group used in the countries to gain acceptance of the framework: identifying key stakeholders from government, technical, and financial groups; nongovernmental organizations; and civil society and tapping their expertise through meetings and interviews. Countries are now able to assess progress toward RFP and have begun to see the need to incorporate policy indicators in their health information systems. The initiative suggests that the countries face similar challenges and can draw on some common actions to reposition family planning in order to meet women’s unmet need for safe, effective, modern contraception.

In sub-Saharan Africa, pregnancy and HIV are “transmitted” in primarily the same way: through unprotected, heterosexual sex. And in most African countries, there are more pregnancies than desired, and certainly too many new cases of HIV. These similarities, patterns of health care access, and differential availability of funding suggest that integrating family planning and HIV services should lead to better outcomes. But despite years of talk about the benefits to integration, it remains more rhetoric than reality. Why? To answer this question, I conducted interviews with more than 90 programmers working for federal ministries, donor organizations, and local nongovernmental organizations in Malawi, Nigeria, and Senegal. The opinions of these programmers are crucial to successful outcomes as it is they who will have to promote integration efforts to their ministers and funders as well as to those who actually implement health care. I show that the primary perceived obstacles to integration are the bureaucratic structure of donor organizations and government ministries, combined with overburdened primary health care providers. I find, however, that in Malawi and Senegal, programmers are trying to use the distinctions between pregnancy and HIV prevention to benefit those they serve.

Quality of Care in Family Planning: Gradual and Comprehensive Reform in China

Abstract:

Since the 1990s, many national population and family planning program have been under re-examination and reorientation in light of the Programme of Action adopted at the International Conference on Population and Development in 1994. This is the case in China. The present case study documents a program reform initiated by the State Family Planning Commission of China in 1995 to introduce the quality-of-care approach in a few counties and districts. The introduction of this approach, which focuses on the quality services and the client’s choices in family planning/reproductive health at community level, was to serve as a means of reorienting the program away from its previous demographically driven track as well as scaling it up nationwide thereafter.

We apply here the capability framework developed by Amartya Sen to revisit the debate on the link between fertility and contraception and the domination in this respect of the “unmet needs” paradigm. Upstream from the demand for contraception what matters is whether a woman possesses the freedom to formulate a plan about having children, that is, the capacity to shape the contours of her family.

We use the most recent DHS from Ghana and Mali, two countries with different fertility levels but characterized, in both cases, by low contraception prevalence, and a large gap between the knowledge and use of modern contraception. We proceed using a three-step analysis. First, we examine the extent to which contraception knowledge opens up the opportunity to manage realized fertility through the use of contraception and, in this respect, how women differ from men. Second, we examine the characteristics of women who do not use contraception but have the intention of using it. Finally, we examine how women with distinct contraceptive behaviour have control over their pace of family formation as measured by their birth intervals. More generally, we discuss whether the dimension of individual control introduced by contraception has generated new inequalities.

Unmet need for family planning (FP) is commonly used as an indicator of gaps in FP services. The measure of unmet need relies on women’s reported fertility desires; previous research has demonstrated that fertility desires may be fluid and not firm. Our study uses recently collected longitudinal data from four cities in urban Uttar Pradesh India to examine whether women’s fertility desires and contraceptive practices at baseline predict pregnancy/birth experience in the two-year follow-up period. We demonstrate that those women who at baseline reported a desire to stop childbearing or a desire to delay childbearing 2+ years and were using any method of FP were the least likely to have experienced a pregnancy/birth by two-year follow-up. Women who were non-users and wanted to delay or limit at baseline were significantly more likely to have had a pregnancy/birth in the two-year follow-up. Ninety percent of pregnancies/births over the follow-up period are considered “wanted then” suggesting post-hoc rationalization of pregnancies/births even among those women who reported a desire to delay or stop childbearing two years earlier. Non-users may be ambivalent about future childbearing and the timing of future births; these women may not have an unmet need for FP as typically defined.

In India, the acceptance of family planning is voluntary and couples have the freedom and choice to accept any method they want. However, the recent conditional cash transfer (CCT) schemes for promoting the survival and welfare of girl children in the wake of alarmingly skewed child sex ratio have used inadvertently to increase sterilization coverage. The acceptance of terminal method of family planning by parents is one of the eligibility criteria to enroll the girl child in ‘popular’ schemes such as Bhagyalakshmi (Karnataka), Ladli Lakshmi (Madhya Pradesh), Girl Child Protection Scheme (Andhra Pradesh), Indira Gandhi Balika Suraksha Yojana (Himachal Pradesh),and Balri Rakshak Yojana (Punjab). It also raises a larger question - why is family planning linked with girl child promotion schemes? A study sponsored by UNFPA found that many poor parents are induced to accept family planning to join the schemes which provide financial benefits. This led to female sterilization because that was considered more socially acceptable. Many believe sex selective abortions as a danger of aggressively pursuing female sterilization and small family norm in the context of son preference. Interestingly, the measures designed to reverse sex selection also encourages sterilization, which may go against the human rights of women.