The Role of Surveys in the Analysis of Family Planning Programmes.

Abstract

For many years family planning programmes were seen by a large body of demographers as virtually itrelevant to fertility. Birth control was termed an intermediate variable by convention rather than from conviction. Fertility declines, particularly those occurring during demographic transitions, were held to be the proximate effects of changes in motivation generated by social and economic developments. This view was in part based on the belief that traditional methods of birth control like coitus interruptus and abortion had always been known and, therefore, available in almost every society and age, and that they were not used unless other circumstances changed so as to make family limitation worth while. In this context the potential contribution of family planning programmes to declines in fertility prescribed by governments, and hence to the benefits expected to follow such declines, was seen as negligible. The view was early but cautiously expressed by Kingsley Davis before the advent of oral contraceptives in his assessment in 1951 of the demographic situation of India and Pakistan. It culminated in the 1974 Bucharest World Population Conference, which for political as much as demographic reasons, stressed the role of development in combating excessive population growth and evidently regarded family planning programmes as a contribution only to human rights rather than to population policies. The respective roles of development and organized family planning effort present, in fact, an unresolved question, but it is now reasonable to say, as Johnson-Acsadi and Weinberger do in this book, that national policy measures to control fertility appear to have altered the natural course of the demographic transition. It is, therefore, fortunate that those working in the field were not deterred by the Bucharest judgement and have since been joined by others. Since 1974 the existing stream of studies on the impact of family planning programmes for example by Potter, Wolfers, Sheps and Ridley has become a flood. The main effect of the Bucharest Conference on the work was probably to broaden interest to encompass the relative influence of development and programme factors in promoting fertility declines, and in the health sequelae of such declines. In this domain, the survey has become a dominant method of enquiry for four reasons. First, surveys are the only way of collecting the basic demographic facts where no reliable vital statistics are available; secondly, they can be used to obtain information, for example about contraceptive use or family intentions, which is not covered by routine statistics, and which can be linked within surveys with demographic data; and thirdly, unlike the statistics generated by family planning programmes, they can indicate what is happening in the whole target population, and thus provide appropriate numerators and denominators. Lastly, surveys are much more flexible than regular statistics since they can be designed to answer the specific questions which arise at a particular time. Some of the early surveys used in the field threatened to bring the method into disrepute, because of their lack of scientific rigour. But increasing experience and the involvement of a number of first-rate scientists, together with the extraordinary achievements of the World Fertility Survey, have brought increasing sophistication and ingenuity to both the design and analysis of the surveys. As a result the methodology is now amongst the most advanced in the social sciences. One of the fruits of these developments is the present volume, which presents the proceedings of a seminar convened by the I.U.S.S.P. in 1980. The papers it contains are almost without exception of both high quality and interest, and are likely to be found equally stimulating by newcomers and experienced practitioners in the field. They deal with most of the problems which face the researcher, like the selection of appropriate numerators and denominators, the concepts of demand and of unmet need for services or contraception, the measurement of service availability, and how to begin disentangling the active constituents of a programme. They describe a variety of ways in which surveys have been used to reveal patterns and trends in contraceptive use and their determinants, to measure the effects of contraceptive use on fertility and health, and to monitor and guide family planning programmes intended to achieve specific demographic targets. Four papers bring out the point that service statistics, compared with surveys, usually provide incomplete estimates of the prevalence of contraceptive use in the catchment area population. Although methodological issues are dealt with to a greater or lesser extent in every paper included, this is not the primary purpose of the volume and, indeed, the specific methodology appropriate to measuring the fertility effects of family planning programmes has been the responsibility of a joint I.U.S.S.P./U.N. expert body. A number of contributions are, however,