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PubMedDate not supplied

The Situation Analysis Study of the family planning program in Kenya.

A new, relatively "quick and clean" operations research approach called a "situation analysis" was developed for examining the strengths and weaknesses of the family planning program of Kenya. Field research teams visited a stratified random sample of 99 of the Ministry of Health's approximately 775 service delivery points. Observation techniques and interviewing were used to collect information on program components and on the quality of care provided to new family planning clients during the observation day. As late as 1986, the Kenya program was rated "weak" and "poor" in the international literature. The Kenya Situation Analysis Study found a functioning, integrated maternal and child health/family planning program serving large numbers of clients, with an emphasis on oral contraceptives and Depo-Provera (and an underemphasis on permanent methods). Although a number of program problems were revealed by the study, overall, in terms of performance, a rating of "moderate" is suggested as more appropriate for Kenya's national family planning program today. In terms of the quality of care, a "moderate to moderate-high" rating is suggested.

Family Planning Services↗
PubMed1992

West Indian gender relations, family planning programs and fertility decline.

Nearly all West Indian islands initiated marked fertility declines sometime between 1960 and 1970. Family planning programs have not played an important role in these declines. Neither have other variables that conventional social theory tells us should promote reduced family sizes, like education and rising standards of living. The historical experience of Barbados and Antigua, which reached replacement-level fertility in the 1980s, suggests that West Indian fertility declines reflect structural changes in national economies that created job opportunities for women. Family planning programs need to be evaluated with reference to the distinctive health and human rights goals other than fertility transition that they can effectively reach.

Adult↗
PubMed2000

Empirical assessments of social networks, fertility and family planning programs: nonlinearities and their implications.

Empirical studies of the diffusion of modern methods of family planning have increasingly incorporated social interaction within nonlinear models such as logits. But they have not considered the full implications of these nonlinear specifications. This paper considers the implications of using nonlinear models in empirical analyses of the impact of family programs, modulated by social interaction, on reproductive behavior. Three implications of nonlinear models, in comparison with linear models, are developed. 1) With nonlinear models, there may be both low and high contraceptive-use equilibria (i.e., the ultimate level of use of modern family planning that a population can be expected to reach after the effects of a sustained change in a family planning program have worked through the population) rather than just one equilibrium as in linear models. If there are multiple equilibria, then one striking and important result is that a transitory large program effort may move a community from sustained low- to high-level contraceptive use. 2) With nonlinear models, the extent to which a social interaction multiplies program efforts depends on whether the community is at a low or high level of contraceptive use rather than being independent of the level of contraceptive use as in linear models. 3) With nonlinear models, intensified social interaction can retard or enhance the diffusion of family planning, in contrast to only enhancing diffusion as within linear models. To clarify these implications, for comparison a simple and more transparent linear model is also discussed. Illustrative estimates are presented of simple linear and nonlinear models for rural Kenya that demonstrate that some of these effects may be considerable.

Contraception↗
PubMed2002

Reconsidering the doorstep-delivery system in the Bangladesh Family Planning Program.

The government of Bangladesh is currently testing and implementing strategies to change its family planning program from a reliance on field-workers who conduct home visits to a conventional fixed-site delivery system. Researchers have made two suggestions: First, the program should encourage women to switch from nonclinical methods delivered by family planning workers to more cost-effective clinical methods such as sterilization, and second, field-workers should not be resupplying nonclinical methods, but should focus their attention on motivating nonusers to practice contraception. Longitudinal data from the Maternal and Child Health-Family Planning Extension Project of the International Centre for Diarrhoeal Disease Research, Bangladesh, are analyzed to show that a better strategy might be to target visits to women according to their educational level and area of residence. For uneducated women living far from clinics, access to contraceptives is likely to be a problem, and home visits for resupply might have a larger impact on the contraceptive prevalence rate than would field-workers' visits to motivate nonusers.

Bangladesh↗
PubMedDate not supplied

Family planning programs: efforts and results, 1982-89.

According to a set of 30 indices that assess the strength of large-scale family planning programs in developing countries, a strong upward shift in effort scores occurred between 1982 and 1989. During that period, many countries established or augmented their family planning programs, and effort scores improved in all developing regions and in all four dimensions of effort--policies and stage-setting activities, service and service-related activities, record keeping and evaluation, and availability of contraceptive methods. By region, the sharpest improvement was not in East Asia, where levels were already high, but in sub-Saharan Africa, where the movement was clearly upward, from a low base. Earlier associations between program effort and fertility declines are reaffirmed, additive to the contribution of socioeconomic improvements. In order to compute scores ranging from zero to 30 for each of the 30 indices, a detailed questionnaire was sent to 4-6 respondents in each of 103 developing countries having more than one million population. Respondents included program staff, donor agency personnel, local observers, and knowledgeable foreigners. The scores indicate that developing countries are continuing to move toward more favorable policy positions and stronger implementation of action programs, with consequent fertility effects. For the fertility decline to match the medium population projections of the United Nations, however, a substantial enlargement in the number of contraceptive users is necessary, not only to compensate for the enlarging base of couples, but also to increase the proportion who use contraceptives.

Developing Countries↗
PubMed1981

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.

Data Collection↗
PubMedDate not supplied

Coitus and contraception: the utility of data on sexual intercourse for family planning programs.

The Demographic and Health Surveys (DHS) program has included several questions on sexual intercourse in its model questionnaires that have been used in more than 25 surveys in Latin America, Africa, and Asia over the last five years. This article assesses the quality of the data on sexual intercourse for 12 DHS surveys and shows how these data may be useful for understanding contraceptive use dynamics and for organizing the management of family planning programs. The data show that there is considerable variation among countries in exposure to pregnancy prior to first marriage. Within marriage, the level of coital frequency varies with duration of marriage, fertility intentions, and type of contraceptive method used. Finally, in all countries there is some overlap between contraceptive use and sexual abstinence. This information can be useful in family planning programs for targeting particular populations, for assisting women to choose a method, and for assessing the effect of contraceptive use on fertility.

Adolescent↗
PubMed1975

Evaluating family planning program effectiveness and efficiency.

This article proposes an integrated in-house evaluation model for family planning programs. The model is designed to meet the need of program management for an operational and internal evaluation system suited to the ongoing character of program activities and focused on the feedback of information for program planning. The ideas presented are applied to the context of the Albany County Family Planning Service, Inc., Wyoming.

Adolescent↗
PubMedDate not supplied

Family planning program effects on the fertility of low-income U.S. women.

Under rigorous statistical controls, it has been shown that the larger the proportion of lower SES women enrolled in organized family planning programs, the lower their fertility. Program effects independent of other social, economic and cultural factors were shown for lower SES whites and blacks, and for most age groups. The potential of a fully implemented program to reduce fertility differentials between upper and lower SES groups was assessed, using 1969-1970 fertility rates and the estimates of 1969 program impact. Although we believe that the program's impact has increased in magnitude over time, even these estimates from an early point in U.S. program development provide impressive documentation that the program reduces fertility in the subpopulation served by the program, and, by implication, that there is a genuine need for organized family planning services, even in an industrialized nation like the United States. If there were no need, there could be no program effect. The family planning program was one of the major new health and social programs introduced in the mid-1960s. This study shows that, far from failing, the program was succeeding very well in attaining its objectives. The program works because it gives women of lower socioeconomic status access to modern and effective methods of contraception that they would not otherwise have. As a result, the rates of unwanted and mistimed pregnancy of patients are lower than those of comparable women who lack access to organized clinic programs.

Adolescent↗
PubMed1997

Do family planning programs affect fertility preferences? A literature review.

A literature review finds few studies about whether family planning programs have reduced fertility preferences. The strong and surprising evidence from Matlab, Bangladesh, demonstrated that this intensive program did not decrease preferences; however, it did crystallize latent demand for fewer children, resulting in a demand for contraception. One cross-national multivariate study was consistent with this finding. A few intracountry multivariate studies found small program effects, decreasing the number of children that couples want. An intensive multimethod study in India found plausible larger effects. Most studies of program media effects are flawed by possible selection bias, but one longitudinal study avoids this pitfall and finds large effects for one country. Program feedback effects are plausible but not yet demonstrated empirically. The effects of a coercive program are plausible, at least in China, but not definitively demonstrated. Several promising unpublished studies may strengthen the case for program effects in reducing fertility preferences, now often based on plausible but not conclusive evidence. Stronger generalizations require better studies of a wider range of locations.

Choice Behavior↗
PubMedDate not supplied

The costs and benefits of government expenditures for family planning programs.

In 1979, federal and state governments spent a total of $285 million to finance family planning clinic services in the United States. As a result, about 695,000 pregnancies (239,000 births, 370,000 abortions and 86,000 miscarriages) were averted among low- and marginal-income patients; and at least $570 million was saved in government expenditures during the following year for childbirth, postnatal and pediatric care, abortions and welfare payments that would have been required in the absence of the clinic services. In other words, for every dollar spent by the government on family planning clinic services in 1979, about two dollars were saved in public-sector expenditures for health and welfare services to women and their babies during the next year. The first-year benefits were especially high for teenagers--about three dollars saved for every government dollar expended. Although teenagers accounted for only one-third of the clinic patients served in 1979, nearly half of the government savings can be attributed to family planning clinic services to women in their teens. Costs were greater than savings for patients aged 30 and older, but these older patients represent only 12 percent of the clinic patient population.

Abortion, Induced↗
PubMedDate not supplied

The role of traditional birth attendants in family planning programs in Southeast Asia.

The training and utilization of traditional birth attendants (TBAs) in maternal and child health and family planning programs in Indonesia, the Philippines, Thailand and Malaysia are discussed. Special efforts to organize and train TBAs for family planning in Malaysia are examined in detail. Import factors for successful utilization of TBAs include: (a) definite assignment of functions and tasks, (b) organization of good operational steps and (c) implementation of good supervisory activities.

Asia, Southeastern↗