The fertility impact of alternative family planning distribution channels in Indonesia

Clinic-based distribution of contraceptive commodities is expensive per unit distributed. This situation has fueled the search for alternative means of delivery. Comparing the performance of alternatives is straightforward if the output measure is a count of commodities distributed, but comparing actual fertility impacts is another matter. I use data from the 1991 Indonesia Demographic and Health Survey to assess the extent of difference among the eventual fertility outcomes of users supplied with similar commodities through varying sources. When the “modern” methods of pill, IUD, and injection are grouped together, the fertility of users supplied with these commodities differs markedly according to their source of supply. I find little evidence for self-selecting of users into supply channels. This result implies that fertility differentials by source are likely due to characteristics of the distribution channels.     

Determinants of fertility and the unmet need for family planning in Indonesia

Indonesia's fertility has declined to an average of slightly more than 3 children/woman. The islands of Java and Bali have the lowest birth rates. Indonesia's family planning program has been a model of innovation, flexibility, and community involvement, and has been effective in reducing fertility, changing family preferences, and increasing contraceptive use. Fertility decline is also determined by factors other than contraceptive use, as provinces in Jakarta and East Java has low fertility and low contraceptive use. Recent research by Suyono and Palmore found that among cohorts of women in Jakarta lowest fertility rates were explained by greater nonexposure to pregnancy in an unmarried state or by a divorced or widowed status, and by infecundity. In East Java, fertility determinants were the same with the possible addition of lower coital frequency. The study estimated nonexposure due to marriage, infecundity, and contraceptive use. Policy considerations, however, are concerned with the exposed state of the percentage of time women are currently married, fecund, not using contraceptive, and sexually active. Suyono and Palmore also calculated the percentage of time spent in the exposed state by province. The estimates ranged from 12% in Yogyakarta to 25% in West Java and the Outer Islands. Exposed was further divided into groups with a manifest, latent, and no current need. Women with a manifest need for family planning are those who are aware of their contraceptive needs to stop or postpone childbearing and not using. Manifest need was highest in high fertility areas: 12% in Central Java, 13% in West Java, and 12% in the Outer Islands. Programs targeting these women should focus on wider availability of information and services. Women with latent needs are unaware of their need for family planning and are not using contraception. These women were also concentrated in high fertility areas. The percentage of years spent in the latent unmet need state was estimated at 23-24% in West Java and the Outer Islands. Program emphasis should be on education and motivation to show how family size can be controlled. Women with current need can be educated toward future acceptance.     

Indonesia: family planning target stepped up for 1980; twofold success of integrated project

The recruitment of 3 million additional family planning acceptors for the fiscal year 1979/80 was the target of Indonesia's family planning program. Available data shows that Indonesia was the 1st country in the world to have consumed 200 million cycles of contraceptive since the program's inception 9 years ago. The achievement of a lower birth rate of between 20 and 22 per 1000 (present rate is approximately 38/1000) is possible within the next 10 years should the program maintain its present pace. Education of women; health of pregnant mothers, and nutrition of children are factors which strongly affect family planning. Current conditions are such that 30% of children aged 0 to 6 years and a large proportion of mothers are malnourished. A coordinated family planning-rural development project launched by the Indonesian Planned Parenthood Association and Indonesian Women's Association was launched 2 years ago and has proved successful. The project's core activity is the organization of income-generating projects such as poultry-raising, vegetable cultivation, handicrafts and small industries. Family planning and other health measures (eg, environmental sanitation) were also promoted. The project utilized selected cadres of married women who were then trained in community development. These women became trainers in their own villages. The project proved to be successful in terms of income-generating activities for the women and in terms of gaining 623 new family planning acceptors within a period of 5 months.     

Determinants of national family planning effort

In light of recent research demonstrating a substantial impact of family planning programs on fertility, we develop and estimate a multivariate model of the determinants of national differences in family planning program effort (FPPE). The framework that guides the specification of this model identifies three broad classes of factors—those that create demand for family planning, those that facilitate the initiation and expansion of family planning programs, and finally those that encourage or inhibit program development. The results from multiple regression using 84 less developed countries indicate that demand for family planning, facilitating infrastructure, and certain demographic and geographic factors are important determinants of program effort. These results suggest that popular demand for family planning is helpful, but that policy makers must perceive the adverse consequences of high fertility and have the infrastructure necessary to develop an effective organized family planning program. Current U.S. policies relevant to reducing birth rates are discussed and found to reflect quite well research on determinants of fertility declines among LDCs. U.S. policy also balances the often competing claims of family planners and their opponents by encouraging support to both developmental projects as well as direct aid to family planning program activities.     

The determinants of fertility in rural Peru: Program effects in the early years of the national family planning program

Using data from the 1991 Peru Demographic Health Survey, a linked Situation Analysis, and a unique region-level data set, this paper examines the determinants of fertility in rural Peru before and after the 1985 enactment of its National Policy on Population. The empirical framework combines a model of the timing and spacing of conceptions with a model of the timing of the placement of family planning services in communities in order to control for non-random placement of services. Results show the program helped reduce fertility post 1985. The magnitude of the effects is quantified with simulations. All correspondence to David Guilkey.We thank the editor and two referees for detailed comments on an earlier draft of this paper. Funding support for this project was provided by the MEASURE Evaluation Project under a Cooperative Agreement between the U.S. Agency for International Development and the Carolina Population Center (Number HRN-A-00-97-0018-00). The views expressed herein are those of the authors and not the sponsoring agency. Responsible editor: Junsen Zhang.     

Fertility decline in Bangladesh: an emerging family planning success story

Bangladesh has a population of 115 million people, and the economic growth rate of 3.7% during the 1980s was undermined by rapid population growth. The annual population growth rate was 3% in the 1960s and early 1970s, 2.5% between 1981-91 decreasing to 2.3% in 1991. The average of number of children is 4.6/woman compared with 7 in the 1960s. Infant mortality dropped from 150/1000 births in 1976 to 118/1000 in 1991. Life expectancy rose from 47 to 54 years. The 1991 Contraceptive Prevalence Survey showed that 39.9% of married women under 50 use contraceptives in 1991 vs. 18.6% in 1981. The use of modern methods increased from 10.9% in 1981 to 31.2% in 1991, while traditional methods rose from 7.7% to 8.7%. Sterilization was most prevalent in 1981. 29,000 female family planning (FP) workers were aggressively engaged in dispensing FP services in 1990. The Social Marketing Company sells pills, condoms, and oral rehydration salts through 130,000 retail outlets. The 1989 Contraceptive Prevalence Survey showed that 40% of pill and condom users obtained them from this network, and 95.4% of women knew about 4 methods of contraception. In 1990 there were 120 private organizations providing contraceptive services. Some of the components of the government FP program include field worker distribution door-to-door of injectable contraceptives (50% injectable usage rate in the Matlab project); recordkeeping activities; a satellite clinic network with access to contraceptive services; and decentralization through the Upazila (subdistrict) approach. The logistics system of FP has improved the warehousing, transportation, and management information system. Foreign aid (mainly USAID) financing of contraceptives helped avert 14.4 million births between 1974-90. The increase of contraceptive prevalence to 50% by 1997 would avert another 21.9 million births during 1991-96 (replacement fertility requires 70% prevalence.     

Measurement and evaluation of national family planning programs

RESUMEN: En los últimos quince a?os diez paises han inaugurado programas nacionales de planeamiento familiar: India, Pakistán, Corea del Sur, Taiwan, Turquía, Malasia, Ceilán, Túez, la República Arabe Unida, y Marruecos. Otros paises, incluyendo Tailandia, Hong Kong, Singapur, Kenya, Barbados, Trinidad y los Estados Unidos, apoyan y/o estimulan actividades de planeamiento familiar. En la mayor parte de los casos la razón fundamental del programa ha sido que si la tasa de crecimiento poblacional disminuyera, aumentaría la tasa de crecimiento económico.Las metas de largo alcance, expresadas típicamente en términos de reducir las tasa.de de natalidad o de crecimiento, tienen su ejemplo en el propósito de Pakistán de reducir su tasa de crecimiento a 26 para 1970; el de Corea de reducir su tasa de natalidad a 20 para 1971; y el de India de reducir su tasa de natalidad a 25 para 1973.Los objectivos intermedios, que cubren diversos aspectos del pro grama, incluyen metas específicas para un determinado mes a a?o, considerando personal, la adquisición de anticonceptivos, y el número de usarios por método. Las metas específicas anuales de aceptantes de dispositivos intrauterinos (IUD), para Taiwán, Corea, Túnez, Pakistán e India, son comunes, tanto por la naturaleza del artefacto, como por la facilidad de medición de los que continúan utilizándolos. El programa de evaluación en Taiwán, que trata de medir por diversos medios los efectos inmediatos, mediatos y de largo plazo del programa de planeamiento familiar sirve de modelo. El propósito de la evaiuación de un programa de planeamiento familiar es contribuir a la efectividad y eficiencia del programa, midiendo y analizando su progreso. Las áreas a medir pueden ser clasificadas como- (1) conocimiento acerca de; (2) actitudes hacia; (3) práctica de control de natalidad; y (4) nivel de fecundidad.Un buen sistema de evaluación debería incluir: A. Un buen conjunto de estadísticas de servicio presentadas en formularios estandarizados, en las siguienies formas: 1. Informes nensuales por áreas administrativas, sobre los actuales servicios de planeamiento familiar proporcionados en la actualidad, de carácter permanente o de larga duración (al presente, esterilización y IUD de acuerdo a las siguientes características del receptor: residencia, edad, paridad (número de hijos vivos por sexo), y donde se enteró del programa, si es posible "clase";(probablemente educación de la madre, pero posiblemente ocupación del esposo, ingreso, o equivalente); prácticas anticonceptivas anteriores; intervalo; y deseo de tener más hijos. En un programa grande estos datos pueden obtenerse en base a una muestra. 2. Informes mensuales sobre la distribución de suministros anticonceptivos (condones, píldoras, sustancias efervescentes, etc.), los primeros suministros deben ir acompa?ados de un registro de las características del recipiente, como anteriormente; los suministros subsecuentes se regietrarán sólo en volumen bruto. Esto también se aplicará al ritmo, donde éste método se ense?e a un número considerable de mujeres. 3. Informes regulares sobre las actividades de planeamiento familiar de médicos privados, como una estimación del efecto catalítico del programa del gobierno sobre ci sector privado. 4. Datos generates mensuales, ppr áreas admirtistrativas importantes, sabre: visitas domiciliarias, reuniones, cu?as radiates y televisadas, avisos en los periódicos y personal que trabaja. 5. Para propósitos de seguimiento una entrevi eta de campo cada 6 a 12 meses a cada N mujer de las listas para (1) y (2) arriba, en un total de 300 o 400, para conocer las tasas de continuación y las razones de abandono (ej: desea otro hijo, insatisfecha can ci método, otras). Las mue.stras podrían ser de 300 cada una, con una supuesta experiencia de 6, 12, 18 y 24 meses. B. Un buen conjunto de datos sobre costa (datos sobre cotos actulaes atribuíbles directamente al programa de planeamiento familiar) fraccionados par áreas principales y cinco a seis categorías de costos importantes tales coma: adminietración, personal de campo, publicidad, suministros, etc. C. Un buen conjunto de dates globales sobre la distribución de los suministros comerciales que puedan llegar tan cerca como sea posible del último consumidor, to cual significa probablemente obtener información de los mayoristas. D. Una encuesta de conocimientos, actitudes y prácticas (KAP) para una evaluación general cada dos a?os. Las preguntas básicas (además de las antes mencionadas y estatus marital y étnico cuando sea pertinente) son: actitud hacia e interés por la anticoncepción, número de ni?os por sexo, deseo de tener más hijos, prácticas anticonceptivas, experiencia sobre abortos, tal vez historia de embarazo (especialmente si esta producirá una tasa de fecundidad válida), aprobación del programa gubernamental (para uso politico), y si está actualmente embarazada (la única y mejor pregunta cuya respuesta habla del efecto sobre la tasa de natalidad). Administrativamente, la responsabilidad por la evalucion debe estar cerca al director, se debe tomar provisiones para obtener informes regulares (meneulaes) y especiales dirigidos a preguntar sobre política. El corolario es que el jefe de evaluación debe tener la confianza del director y debe estar al día en cuanto a las decisiones sabre la politics a seguir. Su trabajo consiste en extractar los aspectos principales que funcionan bien y los no operantes. En cuanto a costos, la evaluación debe hacerse sobre no más del 10 par ciento del costa del programa en paises peque?os (de menos de 30 milliones) y sabre no más del 5 per ciento en paises más grandes.Para medir en que forma el programa satisface el criterio final-la magnitud en que cambia la fecundidad-se debe realizar un trabajo más elaborado en el centro (Universidades, Consejos de población, etc.) para desarrollar una forma (a formas) segura de traducir las estadísticas de servicio en práticas y tal vez aún datos sobre suministro comercial en datos sabre tasas de natalidad. Esto incluye, par ejemplo, los esfuerzos para consolidar observaciones coma "cinco a?os-mujer de usa de IUD, a 400 condones equivalen a la prevención de un nacimiento," y esfuerzos como los de Pakistán de calcular tasas coma "a?os de protección de una pareja contra el embarazo."In the belief that a decrease in the rate of population growth will increase economic development, more than ten countries have inaugurated family planning programs in the past fifteen years. To provide a model for measuring the immediate, intermediate, and long-term effects of any such program, the authors use the Taiwan evaluation.The model suggests that a good system of evaluation should include monthly statistics on (1) participants, who are grouped by characteristics; (2) the distribution of supplies, reported at first by the characteristics of recipients, but after by gross volume only; (3) family planning activities of private physicians to measure the catalytic effect on the private sector; (4) new contacts and amount of advertising in mass media; (5) costs broken down by areas and by cost categories; and (6) distribution of commercial supplies. In addition, the program should conduct 300-400 interviews every 6-12 months to learn the rates of continuation and the rates and reasons for discontinuation. Finally, a KAP survey should be conducted every two years.The administration of the evaluation should be close to the director for policy decisions and for the ultimate work of evaluation-the finding of new ways to measure the main goal of change in fertility by the translation of statistics on Services provided and commercial supplies into birth rate data.     

Measures of influence of family planning program on fertility]

The question of how to measure the influence of family planning in fertility has been addressed by numerous international scholars. Highlighted briefly here are some of the methods endorsed by United Nations publications and recognized by scholars of various countries: 1) Standardization; 2) John Bongaarts model; 3) Trend analysis; 4) Wishik model; 5) Converse model of Dorothy Nartman; 6) Potter model; 7) Nathan Keyfitz model; 8) "Plural model"; 9) Model analysis.     

How economic development and family planning programs combined to reduce indonesian fertility

This paper examines the contributions of family planning programs, economic development, and women’s status to Indonesian fertility decline from 1982 to 1987. Methodologically we unify seemingly conflicting demographic and economic frameworks into a single “structural” proximate-cause model as well as controlling statistically for the targeted (nonrandom) placement of family planning program inputs. The results are consistent with both frameworks: 75% of the fertility decline resulted from increased contraceptive use, but was induced primarily through economic development and improved education and economic opportunities for females. Even so, the dramatic impact of the changes in demand-side factors (education and economic development) on contraceptive use was possible only because there already existed a highly responsive contraceptive supply delivery system.     

Preliminary achievements of China's national economy development and family planning]

A preliminary view of the population control policies of the People's Republic of China is the subject of this report. The report maintains that population control policies are closely linked to economic growth and indicates that criticism by the West of these policies is unfounded. According to an investigation of 1000 married women of child-bearing age carried out in 1981, 19.1% of them have 1 child, 21.4% of them have 2, 49.5% have 3 and only 9.9% of them have no children. This would seem to refute the West's idea of the "1 child only" policy as strict and clear-cut. The report maintains that economic growth and family planning are functions of one another. Although China has made marked progress in population control, its population problem is still far from being resolved as population growth is still relatively high compared to productivity. The marriageable population is extremely high and increase in population create a burden on education, employment, transportation, welfare, housing and medicine each year. The trend in rural areas (which make up 80% of China's population) to have larger families to produce more labor must be reversed in order to make population control objectives feasible. Thus, the need for China to continue its efforts to promote rural economy and family planning must continue. The needs for improvement in promotion and family planning education as well as for improved medical conditions are also evident.     

生育的外部性与计划生育利益导向

本文通过对我国生育正、负外部性的分析,指出政府在计划生育工作中应重点建立健全利益导向机制,提出了相应的对策。     

Geoff Childs: Tibetan transitions: historical and contemporary perspectives on fertility,family planning and demographic change

Journal of Population Research -     

Family planning and fertility in Tunisia

The crude birth rate for the Tunisian population in 1967–68 is estimated to be about ten percent lower than in 1961–65 although the rates are subject to a wide margin of error. Unless the birth registration system is becoming steadily worse or unless the Tunisian population has been decreasing in size, however, the birth rate has fallen; births registered in 1967 or in 1968 were fewer in number than births registered in 1964, 1965, or 1966. The downturn in the crude birth rate occurred shortly after an official national family planning program was inaugurated. Estimates of births averted by contraceptive use, however, suggest that only about one third of the decrease in the rate could be attributed to accomplishments of the program. Occurring at the same time were changes in the age structure which led to smaller numbers of women in the peak reproductive ages and changes in the social status of women which included a sharp reduction in the proportion married in the age group 15–19.     

The construction of the fertility model of variable parity from family planning practice]

Understanding the changing patterns of age specific fertility under the planning system is essential for building a fertility model which reflects birth control policy implementation in China. In building a Parity Variable Fertility Model, 4 basic elements are to be considered: 1) psychosocial, and physiological variables, 2) patterns of the total fertility rate and age-specific fertility rate, 3) socioeconomic development, and 4) distribution of parity-specific fertility. THe natural fertility of women is 17, calculated from a 309-years childbearing period, with 17% of non-susceptible time. In China, about 86% of natural fertility is suppressed by various factors. In this model, the following variables are included: 1) The first marriage ratio, which is the proportion of women in each age group which enters into a first marriage. The range and spread of this ratio is closely associated with the first birth. 2) The first birth ratio, which is the proportion of a marriage cohort to have a first birth each year. 3) the birth interval, which determines the distribution of second births. 4) Regulation coefficient B, which represents birth control regulations which approximately determine the number of second-parity or higher order births. The difference between the fertility level generated from the Parity Variable Fertility Model and reality depends on the implementation of birth control program, the assumptions on regulation coefficients, and changes in social and cultural factors. The model is easy to use, especially for areas where the marriage and fertility records of women of child-bearing are well kept.     

Tonga: family planning survey

A survey was carried out in 1975 in Tonga to determine how many families are practicing family planning. Public health nurses visited every household except the Niuas and remote islands. 4253 women out of the total of 9307 married women aged 15-44 years were using a contraceptive (45.7%). The percentage of users ranged from 4.5% in Ha'afeva District to 63.6% in the district of Kolonga. 60% of the users practice effective methods such as the pill, Depo-Provera, IUD, or sterilization; 23% use the condom, and 17% rely on withdrawal, calendar ovulation, or rhythm.