Repositioning family planning

Policy is integral to the success of any health program, including sexual and reproductive health programs. Yet, most policy literature focuses on policy development. Literature on program implementation rarely focuses on the role of policy. Based on a review of academic and programmatic/applied literature, we have developed a conceptual framework linking health policies to health systems and outcomes. The strength of this conceptual framework is the articulation of the importance of the space between the development of a policy and the implementation of a program. Using examples from the field, we identify the challenges in policy implementation that affect programs and health outcomes. Our analysis also identifies gaps in the literature pertaining to the areas of sexual and reproductive health policy implementation, and monitoring and evaluation. We also recommend the initiation of evaluation studies examining the complete policy process linking health policies to health systems and to health outcomes.

Women’s autonomy is a potentially important but less studied indicator of using contraception among women as well as ability to control their fertility. Using the data from Bangladesh Demographic Health Survey (BDHS) 2007, we try to establish a relationship between women’s autonomy variables and contraceptive behavior. Results of the study indicate that ever use of contraception is significantly associated with household decision-making autonomy, movement autonomy and financial autonomy, but only movement autonomy is significant for current contraceptive users. Multivariate analyses also indicate that both women’s decision-making autonomy and movement autonomy are significantly associated with discuss about family planning with their husband and future intention to use contraception. These measures of women’s autonomy provide additional independent explanatory power of contraceptive behavior net of some other socio-demographic variables. Thus, this study argues in favor of increasing women’s autonomy to increase contraception using rate in this population.

This study assesses the contraceptive use dynamics, its program and policy implications in India, Pakistan, Bangladesh and Nepal. Data from three rounds of Demographic and Health Survey (DHS) of each country were used, and the currently married women aged 15-49 years of the latest DHS were considered for detailed analysis. IBM-SPSS (Version 19.0) was used for bivariate and multi-variate analyses with a significance level of 5%.

Analyses indicate considerable intra-country differences in contraceptive use, trends, method mix and determinants. Contraceptive plateau was evident in Bangladesh and Nepal (each with 0.3 point annual increase), while contraceptive use had declined at (-0.6) points annually in Pakistan; between last two rounds of the surveys. Health care autonomy enhances the likelihood of contraceptive use in India (OR=1.06), but not in Nepal (OR=0.60) and Bangladesh (OR=0.45). Exposure to family planning messages increases the chances of sterilization acceptance in Pakistan (OR=1.32); contrary to India (OR=0.92) and Nepal (OR=0.71). Results suggest broadening of method choices with quality service delivery, reconsideration/ review of program focus, repositioning spacing methods in national programs, and demand assessment through monitoring age-sex distribution; all with country specific amendment are pertinent.

Because of many benefits of the family planning programmes, African governments had opted to establish a FPP during in the 1980s and early 1990s. But these FPPs depended mainly on external funding. When the international funders shifted their funding priorities from FPPs to HIV/AIDS in mid 1990s, implementation of FPP became a serious challenge. Ethiopia is an exception. The government initiated the Health Extension Programme (HEP) in 2004 that provides health care services (including FP) at community level. This study is aimed at assessing the impact of HEP on family planning using three rounds of Demographic and Health Surveys conducted in 2000, 2005 and 2011. Data were analyzed using tabular and graphical methods, and a binary logistic regression model is fitted to identify factors associated with contraceptive use. Findings of the study reveal that contraceptive uptake has increased dramatically especially in the rural areas and the most popular contraception is injectables, a method provided by the extension workers. In addition, the regions where the HEP is concentrated are doing much better than other regions. So there is no doubt that HEP has a positive impact towards contraceptive use in Ethiopia and other African countries need to emulate such an initiative.

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.

Following a persistent low fertility rate in the country over the past decade, Iranian leaders recently proposed a shift from an anti- to a pro-natalist population policy. Consequently, conservative political and religious leaders suggested curbing the current family planning program, as a solution to raising the country’s low fertility rate. Using data from two recent large-scale surveys of fertility and fertility intentions and decomposing the relative contributions of proximate determinants of fertility, this study aims to show that any limitations in the provision of family planning services will be unlikely to help increase the current low fertility rate for three main reasons: a high rate of marriage postponement, increasing male involvements in contraceptive use, and a wide spread of low fertility intentions. The study will also identify sub-groups of women who will face greater levels of unintended pregnancies and clandestine induced abortions, if the family planning services are limited. Finally, the new government’s population program, known as “reproductive health”, will be described and discussed.

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