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.     

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.     

A components method for measuring the impact of a family planning program on birth rates

One of the major goals of family planning programs worldwide has been to reduce the level of fertility in hopes of slowing the rate of natural increase and promoting social and economic development. Such programs have now been in existence for sufficient lengths of time to have had an impact on fertility levels. In general countries with organized family planning programs, marked declines in fertility levels have been observed. The extent to which such declines may be credited to organized programs has not been rigorously measured because an appropriate research methodology has been lacking. This paper describes one method of directly linking declines in fertility levels to the contraceptive protection experienced by a population. The contribution of organized family planning programs is estimated by decomposing the amount of total contraceptive protection into within-program and outside-program sources.     

Thailand: family planning program exceeds targets

According to Dr. Somboon Vacharothai, Director General of the Ministry of Public Health, the number of people in Thailand who practiced family planning exceeded last year's target. 664,895 individuals used family planning services; this was 62.2% above the planned target for 1976. It was further predicted that 700,000 persons would be recruited by the family planning program in 1977. The preferred method of birth control was the oral contraceptive; it is the method of 800,000 acceptors. Service outlets have been extended rapidly with 5836 medical centers providing family planning services throughout Thailand. Government allocations for family planning have increased from 0.9 million dollars in 1975 to 2.47 million dollars in 1977.     

India: New family planning program direction outlined

The focus of the current Family Welfare Program in India is education and active community involvement rather than coercion and compulsion. The government is totally committed to the program and has indicated that it will spare no efforts to motivate people to voluntarily accept family planning. However, there is a need for family planning efforts to include all aspects of family welfare, particularly those designed to promote the health of mothers and children. All family planning methods will be made available, and the family will be free to choose the method they prefer. As part of the program, employees of the Union government, State governments, autonomous and local bodies are expected to set an example and adopt the small family norm. The policy statement made by Mr. Raj Narain, Minister of Health and Family Welfare, revealed the government's decision not to legislate, either at the national or the State level, for compulsory sterilization. Sterilization services will be available free of charge to those who voluntarily choose this method. A plan for training indigenous midwives will be implemented as part of the program in order that maternity services may be available to all expectant mothers. Additionally, in recognition of the direct correlation between illiteracy and fertility and between infant/maternal mortality and age at marriage, the government will introduce legislation to raise the minimum age at marriage to 18 years for girls and to 21 years for boys. The plan is for trade unions, Chambers of Commerce, cooperative societies, women's organizations, teachers' federation, district councils, and other voluntary institutions to be associated intimately with the educational campaign launching the Family Welfare Program.     

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.     

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.     

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.     

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.     

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.     

Using operations research to guide family planning program development and policy formulation in sub-Saharan Africa

The process by which a population policy and family planning program evolve in a given country is influenced by many factors that combine to make each country's experience unique. One of the most influential factors among these is the role played by external technical assistance, normally provided through donor-supported mechanisms. One donor-supported mechanism that seeks to guide the operational policy and program development process is technical assistance through operations research. Many questions are raised during the design of family planning programs that are often best answered with reference to empirical evidence collected through applied, or operations research (OR). This paper provides a review of the three main OR approaches currently being used in sub-Saharan Africa: diagnostic or needs assessment studies; experimental pilot studies; and intensive technical assistance for problem-solving and institutional development. The extent to which these OR approaches can play a role in family planning program development to improve and expand service delivery activities is discussed, and examples where these approaches have been used are given.     

The roles of individuals' socioeconomic characteristics and the government family planning program in China's fertility decline

This paper explores answers to the following two questions: first, did individuals' socioeconomic characteristics play any role in the rapid fertility decline that occurred in China during the 1970's? Secondly, if the rapid fertility decline during the 1970s is mostly a result of the government policy, as many have perceived, to what extent was the government policy effective? Using the 1982 Chinese 1/1000 fertility survey data for Hebei province of China, this paper examines variation in fertility among women of two age cohorts by linking their fertility outcome with their socioeconomic background and earlier reproductive experiences. In addition, this paper assesses the effect of government policy by comparing the determinants of fertility outcome between two cohorts of women and by studying the factors affecting their current contraceptive use. The findings reveal that the individual's socioeconomic background was important in explaining earlier fertility variation. Government policy, although powerful enough to override most of the effect of socioeconomic factors on fertility, was not able to eliminate differences in contraceptive behavior among Chinese women.     

Redefining family planning programs

The Population Council's issue paper entitled Reconsidering the Rationale, Scope, and Quality of Family Planning Programs calls on family planning programs to focus only on reducing unwanted fertility by helping people meet their own reproductive goals safely and ethically. Many family planning programs have been wrongly handed the extra responsibility of reducing wanted fertility. They have therefore used inappropriate means (e.g., incentives, quotas, and coercion) to boost contraceptive prevalence. If programs do focus on reducing unwanted fertility, they will foster reductions in overall fertility and population growth as well as improvements in clients' health and well-being. A new framework has emerged from this shift in rationale. It sets the stage for expanding the scope, improving the quality, and assessing the impact of family planning programs in terms of client choice, health, and well-being. A program needs to determine the range and quality of family planning services it provides at the local level. Local program managers, policymakers, and consumer interest groups should establish minimum or achievable standards of service based on the local health care capacity. Program items that should be assessed include choice of methods, information for clients, technical competence, interpersonal relations, mechanisms to encourage continuity of care, and appropriate constellation of services. The Population Council has conducted rapid appraisals of the quality of care of family planning services to help local program managers to evaluate the strengths and weaknesses of their programs. The HARI (Helping Individuals Achieve their Reproductive Intentions) Index measures a program's success in helping clients safely prevent unwanted or unplanned pregnancy. Program managers can conduct a self-assessment that revolves around answering four questions. Family planning services are an important social investment and are essential to development.