Measuring components of family planning program effort

The measures of family planning program effort developed by Lapham and Mauldin have played a key role in family planning program analysis, but surprisingly little is known about them. This article investigates the measurement of family planning program effort based on data reflecting conditions circa 1982 in 100 developing countries. Using confirmatory factor analytic techniques, it tests some hypotheses implicit in the work of Mauldin and Lapham. Since the data do not fully support these hypotheses, an alternative conceptualization is proposed that consists of eight rather than four components. The discussion focuses on the expanded set of components and includes an assessment of the empirical indicators associated with them.     

A note on measuring the independent impact of family planning programs on fertility Declines

This note critically evaluates recent cross-national studies that estimate the independent effect of family planning programs on the fertility of the developing world. The evaluation demonstrates that past research is biased to produce overestimates of net program impact. A new estimate is derived to account more completely for the effects of the social context and socioeconomic development on fertility. This estimate indicates that 5 percent of the variation in crude birth rate decline for 89 developing countries is due to family planning programs. This is substantially less than past estimates.     

Assessing the impact of a family planning nurse training program in Egypt

In 1991 the Egyptian Ministry of Health introduced a new training program for family planning nurses. The training program stressed the development of nurses' counseling skills. As part of the Operations Research Program, sponsored by Family Health International in collaboration with the Egypt National Family Planning Board, managerial staff from family planning agencies designed and implemented a study to evaluate the impact of the new training program. The study objective was to assess the impact of nurse training on nurse performance in the clinic and on clients' family planning knowledge, attitudes and contraceptive use. The study was designed to provide usable information to family planning managers in the field within a time period of less than one year. The study results indicate that there is an association between improved family planning training for nurses and positive changes in family planning knowledge, attitudes and behavior among women attending MoH clinics in this study. The greatest relative change occurred in knowledge. Women in the experimental group, relative to the control group, displayed increased knowledge about contraceptives, particularly the pill and the IUD. Attitudinal change was less pronounced. Favorable attitudes toward oral contraceptives and condoms became more prevalent, and reports of husband-wife communication about family planning also increased. Finally, although contraceptive use was already high prior to the nurse training, IUD use increased significantly among women in one governorate.     

Measuring acceptances in a family planning program: the decomposition of rates by eligibility criteria

Acceptance rates in family planning programs can be broken into components useful in analyzing programs and in evaluating success. In almost any program some couples can be defined as "ineligible" on the basis of alternative criteria. (Sterilized couples are an obvious example.) Then, the total acceptance rate can be initially separated into two components-the proportion eligible and the acceptance rate among the eligible. If some of those initially defined as ineligible become acceptors, there is a third component-the ratio of all acceptances to acceptances among the eligible only. These various components can be used to analyze the basis for varying acceptance rates between different strata of a population.     

Evaluation of family planning program performance: A critical review

Family Planning Program Evaluation is not a well-developed art, much less an exact science. The evaluation of the performance of such programs has received a good deal of attention but the methodologies are still controversial and the results inconclusive. This is due to a wide variety of constraints, not all of which are technical, and most of which are not unique to family planning. The prospects for improvement of FPPE depend, to a great extent, on overcoming these constraints.     

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.     

A general method of decomposing a difference between two rates into several components

In her work on the components of a difference between two rates, Kitagawa (1955) was successful in dividing the difference into the rate effect and the effect of the factor, for data classified by one factor. Her formulation for data classified by two factors, however, involves an interaction term which is difficult to interpret. Retherford and Cho (1973) devised a method that does not include any interaction terms. However, their method has other limitations, such as the dependence of the results on the order in which the effects of the factors are computed. In this paper, we provide a general method capable of handling any number of factors, which is developed along the lines suggested by Kitagawa and by Retherford and Cho but without the limitations of their methods.     

Regional variation in acceptance of Indonesia's family planning program

Indonesia's family planning program is regarded as a major success.Survey data from 1997 reveal that rates of contraceptive use vary dramatically amongIndonesia's 27 provinces, from a high of 67 percent of ever married women currently using contraceptives in the province of North Sulawesi, to a low of 19 percent current users in East Timor and28 percent in Aceh. This study uses both a quantitative analysis of the 1997 Indonesia Demographic and Health Survey, and a qualitative study carried out in July of 2000 to understand regionalvariation. The study identified a small number of factors that show a clear relation with levels of contraceptive use. Media exposure and education are the strongest and most consistent predictors of levels of contraceptive use, and appear to be the surest strategies for promoting family change. But the study also showed that the process of social change is subjectto culturally and historically specific local factors whose presence and importance is difficult to predict. Our study of regional variation in contraceptive use illustrates the range and complexityof obstacles faced by Indonesia's leaders in attempting to forge a single nation fromsuch a diverse and far-flung population. Although the creation of Indonesia in the space of just half a century is a monumental achievement, the project is clearly not yet complete.     

A new terminal judgment method for family planning: indistinct comprehensive judgment]

The purpose of family planning (FP) program evaluation is to make comparisons between different work units and between the past and the present. The evaluation covers the impact of programs in economic, social, and demographic terms. If the impact is not quantified, it is difficult to distinguish differences in program performance. It is also hard to determine the relative standing of different organizations if each one has different merits and deficiencies. A mathematical model is used to quantify the performance of each unit in a FP program. 4 variables are used as the program indicators in the model: 1) percentage of child births following planning, 2) percentage of deferred marriages, 3) birth control prevalence, and 4) percentage of one child pledges. Indicators of social impact include 3 variables: 1) the attitude of FP workers, 2) the efforts of FP workers put in FP and 3) the results of program implementation. The indicator of economic impact is the investment for evasion of the birth of a child. Grades are assigned to indicators of social impact for each organization. The values of each variable is put in a matrix. Weights are given to each variable based on the emphasis of the program or a specific evaluation. The weights are determined through discussion with people involved in the program. A weighted average of all the above factors is the final grade of an organization's FP program performance.     

现行中国计划生育政策对中国人口安全的影响

本文从人口安全的定义出发,简单的分析了我国在发展中所面临的主要人口安全问题,并发现这些问题大部分都与我国的计划生育政策有着密切的关系。简要地阐述了我国现行计划生育政策的发展产生过程和主要内容。结合我国现行的“晚婚、晚育、少生、优生”的计划生育政策和我国主要的人口安全问题,从人口结构和人口素质两个方面,重点分析了我国计划生育政策对人口安全的影响。最后得出结论,要抓住现在的机遇期,调整现行的人口政策,最终实现中国人口与社会、经济、资源以及环境的协调可持续发展。     

Satisfied users clubs: family planning acceptors as model agents of the program

The National Population Program in the Philippines has encouraged family planning acceptors to shift from their passive role as recipients of family planning services into an active role as program participants. In the mid 1970s the Commission on Population (Popcom) began setting up satisfied users clubs in various regions of the country with the aid of the Ministry of Social Services and Development (MSSD). Other government institutions like the Ministry of Labor and Employment (MOLE) formed similar family planning groups. So did private agencies participating in the Program. There were indications at that time that community based family planning clubs could help the Program in informing couples about family planning and in motivating them to practice contraception. In 1977 a study conducted by the University of the Philippines Institute of Maternal Clinic found that family planning acceptors in Dumaguete City received social and psychological support from local barrio women's clubs. A 1978 Community Outreach Survey indicated that full time outreach workers (FTOWs) found statisfied users clubs helpful in increasing the number of new acceptors in their areas and in bringing down the number of family planning dropouts. Once a decision to create a club is made, club organizers meet with the barangay captain and his council to get their approval and seek their cooperation in inviting people to join the proposed club. Once the approval is given known family planning users in the community or mothers of reproductive age are invited to attend a community assembly. Of 59 clubs surveyed, only 10 had a formal constitution and bylaws. All clubs elected their officers and conducted monthly meetings which lasted from 2-4 hours. The main selling proposition of the clubs is the involvement of members in nonfamily planning activities like income generating schemes, skills training, nutrition seminars, and immunization of children. 81% of the officers of all 59 clubs were family planning acceptors. The majority of officers had undergone voluntary sterilization. Only 8 of the 59 clubs considered themselves single purpose clubs committed to the promotion of family planning. The other 51 were multipurpose organizations, with both family planning and nonfamily planning activities. In the area of family planning, the club's objectives were to increase family planning acceptors, disseminate family planning information, and maintain current users.     

Correctly understand and use the measures of progress of the family planning program]

It is necessary to understand correctly the measures of progress in the accomplishments of family planning work. From a developmental and historical perspective the primary measures are constantly in flux. In the last decade, the criteria used to assess the progress have ranged from the natural rate of growth to the birth rate, to multiple-child rate, and to the planned family rate, all of which reflect different emphasis in the various stages of family planning work. They also show a tendency toward making planning work more scientific. None of the criteria is flawless, however. For instance, the planned family rate can be influenced by the total number of births. When that number increases, it can cause the planned family rate to decrease; or, when the number of births decreases, the planned family rate can increase. The measures used for assessing the accomplishments of family planning work only reflect individual aspects of the work; it can never reflect the totality of family planning work because the scope is so vast, encompassing virtually all levels and organizations of society.     

The multilevel dependence of contraceptive use on socioeconomic development and family planning program strength

Using World Fertility Survey data for 15 developing countries, we estimate an equation in which the dependent variable—whether the respondent has ever used an efficient contraceptive method—depends on the respondent’s education and location of childhood residence. All of the coefficients of this equation, including the intercept, vary over countries. Analysis based on new methodology shows that the intercept and education effects vary as a function of national family planning program efforts and that none of the parameters of the equation depend on gross national product per capita. The results demonstrate the efficacy of multilevel analysis, provide a partial test of the theory underlying the analysis, and refocus discussion of the contributions of development and policy variables to fertility reduction.     

A research on the assurance of family planning and providing for the aged]

An important cause of resistance to China's family planning (FP) program in rural areas is the need to have children to support parents in their old age. Provision of insurance for old age support will facilitate the implementation of the FP program among the rural population. A trial project was initiated in five cities and counties in Fujian province i 1986. The program included schemes for both eligible couples and for single children. The township or the village pays a lump sum or monthly premium to the insurance company for each couple, which enables them to collect 30-35 Yuan/month after they reach 55 years of age. To further expand the insurance program, a survey was conducted in 1987 to determine whether rural farmers would be willing and able to pay the insurance premium themselves. 77% of the respondents reported that they could afford to pay 60% of the premium. Among them, 59% were willing to pay. It was suggested that besides individual purchase of the insurance plan, the rural communities could contribute to the payment of the premium from the fines for unplanned births, from the local tax, and from the country government budget. Preferential treatment should be given to the couples of two daughters who receives sterilization; the communities should pay for a larger share of their premium. The current insurance scheme needs to be reformed so that the plan can offer more than the individual's bank savings. To do so, the insurance company needs to be able to invest their premium income and obtain higher returns. The employees of the insurance company need to improve their work efficiency to win the trust of the people in the program.     

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.     

Family growth and family planning: Responses to a family-planning action program in a rural district of Thailand

A resurvey of a rural district in Thailand, of about 70,000 population, was conducted after a family-planning program had been in operation for eight months in order to ascertain indications of effectiveness of the program. Both the "before" and "after" surveys employed a 25 percent simple random, though non-overlapping, sample of married women 20-44 years of age whose husbands were living. The only difference in design and execution was the inclusion in the resurvey of questions about the action program. Barring one or two exceptions, the characteristics of the two population samples were so similar that differences in knowledge, attitudes, and practices could be regarded as effects of the program.The action program not only made itself widely known in the district, it also evoked a highly favorable appraisal, to such an extent that nine of every ten women thought the program should be extended over the entire kingdom. Motivation to engage in family planning increased perceptibly. A substantial proportion (23 percent) of the women who formerly disapproved of the practice changed their attitudes to approval, mainly because they had become convinced of the harmlessness and the utility of fertility control. Less than 3 percent of the former approvers had become negative.The proportion of women who claimed some kind of knowledge about contraceptive methods more than doubled during the eight months of the program's operation. More impressive, however, was the change in actual use of methods, which rose from 1 to 21 percent of the eligible women (women who were not pregnant, subfecund, or sterilized). Another 16 percent, in the resurvey, planned to begin use of contraceptives in the near future, in most instances after a current pregnancy. The frequency of acceptance of family planning practice exceeded the expected frequency among women who were approaching or had attained the "ideal" number of children (4.0 children). High-parity women 40 or more years of age seldom accepted clinical assistance.