Effectiveness Of Family Planning Programs Research Articles

Child survival and contraception choice: Theory and evidence

This paper asks whether increases in child survival bring down fertility and incentivize couples to switch from traditional to modern methods of contraception. Our parsimonious model predicts the answer in each case is, yes. We test these connections using household-level Demographic and Health Surveys from recent fertility transitions using arguably exogenous variation in child survival at the regional level. We find a 1% increase in ambient child survival leads to a fertility drop of 1.2%. The same raises the chance of switching to modern birth control (and sticking to it) by 0.4%. Our finding supports the notion that prevailing rates of child survival influence the effectiveness of family planning programs that promote modern contraceptive use.

Impact of internal female migration on unmet need for modern contraception in Zambia

BackgroundUnmet need for contraception, the proportion of women who want to limit or delay childbirth but use no form of contraception, is the core indicator to evaluate the effectiveness of family planning programs. Understanding how migration influences unmet need is important to identify to whom and how to target sexual and reproductive health programs. We assessed how migration status in rural and urban settings is associated with having an unmet need for family planning.MethodsData on sexually active, fecund, reproductive-aged (15–49 years) women from the 2013–14 Zambia Demographic and Health Survey were analysed through univariate and multivariate logistic regression models.ResultsUnmet need for modern contraceptive methods was significantly higher among rural to rural migrant women (OR 1.30, 95%CI 1.00–1.70 p < 0.05) and rural non-migrant women (OR 1.41, 95%CI 1.06–1.85 p < 0.01) compared to urban non-migrant women after controlling for age, marital status, parity, religion, education and wealth.ConclusionWomen residing in, and migrating between, rural areas were significantly more likely to have an unmet need for contraception. Our findings highlight the importance of understanding migration and migrant streams to strengthen family planning programs. In Zambia, a focus on rural-rural migrants, rural non-migrants and the poorest could improve the health of the entire population.

Women’s employment and family planning in rural Uganda

ABSTRACTDespite impressive progress in increasing contraceptive use in developing countries during recent decades, the uptake has lagged behind in Africa. One of the most critical factors in raising the use of contraception is women’s employment status. This study analyzed the link between women’s employment and family planning in rural Uganda and addressed shortcomings in the literature by using nationally representative panel data from the 2010 and 2012 rounds of the Uganda National Panel Survey for 800 women aged 15–49 years, and estimating heterogeneous effects for different types of employment and across socio-economic characteristics. Employment was not associated with greater use of modern contraceptives, but off-farm wage-employed women were more likely to use traditional contraception. The correlation of employment was strongest for women who had reached their desired fertility status, but became insignificant for poorer women who lived in remote areas. However, likely due to the ineffectiveness of traditional methods, off-farm wage employment was not associated with greater spacing between births. Our findings implied that providing rural employment opportunities for women is insufficient to increase the uptake of modern contraceptives. To enhance the effectiveness of family planning programs, health-care officers should target off-farm wage-employed women to address their unmet contraceptive needs.

Does Access to Family Planning Increase Children's Opportunities? Evidence from the War on Poverty and the Early Years of Title X.

This paper examines the relationship between parents' access to family planning and the economic resources of their children. Using the county-level introduction of U.S. family planning programs between 1964 and 1973, we find that children born after programs began had 2.8% higher household incomes. They were also 7% less likely to live in poverty and 12% less likely to live in households receiving public assistance. A bounding exercise suggests that the direct effects of family planning programs on parents' resources account for roughly two-thirds of these gains.

Family Planning Program Effects: Evidence from Microdata

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Family Planning Program Effects: A Review of Evidence from Microdata

This paper reviews empirical evidence on the micro-level consequences of family planning programs in middle- and low-income countries. In doing so, it focuses on fertility outcomes (the number and timing of births), women’s health and socio-economic outcomes (mortality, human capital, and labor force participation), and children’s health and socio-economic outcomes throughout the life cycle. Although effect sizes are heterogeneous, long-term studies imply that in practice, family planning programs may only explain a modest share of fertility decline in real-world settings (explaining 4-20% of fertility decline among studies finding significant effects). Family planning programs may also have quantitatively modest - but practically meaningful - effects on the socio-economic welfare of individuals and families.

Protocol for a systematic review on the effect of demand generation interventions on uptake and use of modern contraceptives in LMIC.

BackgroundDespite a global increase in contraception use, its prevalence remains low in low- and middle-income countries. One strategy to improve uptake and use of contraception, as an essential complement to policies and supply-side interventions, is demand generation. Demand generation interventions have reportedly produced positive effects on uptake and use of family planning services, but the evidence base remains poorly documented. To reduce this knowledge gap, we will conduct a systematic review on the impact of demand generation interventions on the use of modern contraception. The objectives of the review will be as follows: (1) to synthesize evidence on the impacts and costs of family planning demand generation interventions and on their effectiveness in improving modern contraceptive use and (2) to identify the indicators used to assess effectiveness, cost-effectiveness, and impacts of demand generation interventions.Methods/designWe will systematically review the public health and health promotion literature in several databases (e.g., CINAHL, Medline, EMBASE) as well as gray literature. We will select articles from 1970 to 2015, in French and in English. The review will include studies that assess the impact of family planning programs or interventions on changes in contraception use. The studied interventions will be those with a demand generation component, even if a supply component is implemented. Two members of the team will independently search, screen, extract data, and assess the quality of the studies selected. Different tools will be used to assess the quality of the studies depending on the study design. If appropriate, a meta-analysis will be conducted. The analysis will involve comparing odd ratios (OR)DiscussionThe systematic review results will be disseminated to United Nations Population Fund program countries and will contribute to the development of a guidance document and programmatic tools for planning, implementing, and evaluating demand generation interventions in family planning. Improving the effectiveness of family planning programs is critical for empowering women and adolescent girls, improving human capital, reducing dependency ratios, reducing maternal and child mortality, and achieving demographic dividends in low- and middle-income countries.Systematic review registrationThis protocol is registered in PROSPERO (CRD 42015017549).

Female employment reduces fertility in rural Senegal.

Economic growth and modernization of society are generally associated with fertility rate decreases but which forces trigger this is unclear. In this paper we assess how fertility changes with increased labor market participation of women in rural Senegal. Evidence from high-income countries suggests that higher female employment rates lead to reduced fertility rates but evidence from developing countries at an early stage of demographic transition is largely absent. We concentrate on a rural area in northern Senegal where a recent boom in horticultural exports has been associated with a sudden increase in female off-farm employment. Using survey data we show that employed women have a significantly higher age at marriage and at first childbirth, and significantly fewer children. As causal identification strategy we use instrumental variable and difference-in-differences estimations, combined with propensity score matching. We find that female employment reduces the number of children per woman by 25%, and that this fertility-reducing effect is as large for poor as for non-poor women and larger for illiterate than for literate women. Results imply that female employment is a strong instrument for empowering rural women, reducing fertility rates and accelerating the demographic transition in poor countries. The effectiveness of family planning programs can increase if targeted to areas where female employment is increasing or to female employees directly because of a higher likelihood to reach women with low-fertility preferences. Our results show that changes in fertility preferences not necessarily result from a cultural evolution but can also be driven by sudden and individual changes in economic opportunities.

Determinants of intrauterine contraceptive device discontinuation among Indian women.

To determine intrauterine contraceptive device (IUCD) discontinuation rate and its causes and related factors among women attending the OPD/family planning clinic in Mahila Chikitasalaya, SMS Medical College, Jaipur from January 2012 to December 2012. 387 women who had an intrauterine device (IUD) inserted during the last 1-5years were interviewed during their visits to the OPD/family planning clinic. Sociodemographic characteristics for all women were described using frequency distribution. Life tables were used to describe the proportion of women who discontinued IUD at various time intervals. The main outcome measure was IUD discontinuation. The incidence of IUD discontinuation in the first year following insertion was 16.79%. Approximately 31% of the study sample continued using their devices after 5years. The average duration of IUD use was 36months. Of the 387 women, 56% discontinued IUD use because of a desire to conceive, 27.7% because of side effects, 15.36% because of opposition from the woman's family, and 1.5% because they were sexually inactive. The most common side effects reported as the reasons for discontinuation were bleeding, infection, and pain. Discontinuation was inversely related to the age at insertion, the number of living children, and the sex of children. Previous contraceptive users were significantly less likely to discontinue IUD use. The crude cumulative rate of IUD discontinuation was 16.79% during the first year, suggesting a need to tackle the problem of discontinuation through effective educational strategies and counseling techniques. Desire to have a male child still predominates among Indian families. The average duration of IUD use in majority of the females was about 36months (45%), thereby fulfilling its objective of spacing between children as laid down by the WHO (2years spacing between pregnancies). About 31% of the women continued using IUCD even after 5years. It is crucial to correct misconceptions and identify the lack of correct and complete information both among the providers and the acceptors, to improve the effectiveness of family planning programs.

Fertility Differences Among Developing Countries: Are They Still Related to Family Planning Program Efforts and Social Settings?

In many developing countries, fertility has declined steadily in recent decades, while the average strength of family planning programs has increased and social conditions have improved. However, it is unclear whether the synergistic effect of family planning programs and social settings on fertility, first identified in the 1970s, still holds. Data from 40 developing countries in which Demographic and Health Surveys were conducted in 2003-2010 were used to examine associations among socioeconomic conditions, family planning program effort strength and fertility. Cross-tabulations and multiple regression analyses were conducted. Variation among countries in scores on the Family Planning Program Effort Index, but not on the Human Development Index, has diminished since the 1970s. On average, fertility levels were lower among countries with better social settings or stronger family planning programs than among those with poorer settings or weaker programs; they were lowest in the presence of both good social settings and strong programs. In addition, fertility was positively associated with infant mortality and negatively associated with female education, but not associated with poverty. About half of the 2.3-birth difference in fertility between countries in Sub-Saharan Africa and those elsewhere can be attributed to differences in program efforts and social settings. Policies focused on improving levels of female education, reducing infant mortality and improving family planning services can be expected to have mutually reinforcing effects on fertility decline.

Traditional Roles, Modern Behavior: Intergenerational Intervention and Contraception in Rural Bangladesh

Although rural Bangladesh retains many traditional socioeconomic characteristics, the use of contraceptives has increased over the past three decades. This paper examines the influence a mother-in-law has on her young daughter-in-law's use of contraceptives in the rural community of Matlab, Bangladesh. The study uses data from 413 interviews conducted in two areas of the community with different family planning programs, which have affected differing levels of contraceptive prevalence. Results demonstrate that the mother-in-law does influence the daughter-in-law's use of contraceptives, particularly in social contexts where they are relatively limited in availability. This finding has important implications for enhancing the effectiveness of family planning programs in many areas of the developing world.

The Reproductive Effects of Family Planning Programs in Rural Ghana: Analysis by Gender

This article examines the effect of family planning programs on reproductive attitudes and contraceptive use behaviors. It aims to investigate the degree to which family planning programs enable Africans to shift to western contraceptive use from traditional and null contraceptive practices. It also examines the impact of the programs for both men and women. Data from the 1988 Ghana Demographic and Health Survey, the 1988–99 Ghana Living Standards Survey, and the 1988 Ghana Population Census are used. Categorical data analysis techniques are used to analyze these data. This study finds that access to family planning services is associated with reduced family size preferences, increased approval of family planning, and knowledge of, and desire to use, contraception among both men and women in rural Ghana. As Ghana, like many parts of rural Africa, is a highly underdeveloped and pro-natalist area, this article concludes that family planning programs have the ability to influence reproductive attitudes and behavior, even under conditions of limited development.

Population Equation: Balancing What We Need With What We Have

Planet Earth, now home to about 6.5 billion human beings, has thus far disproved the doomsayers. In 1798, Rev. Thomas Robert Malthus predicted that population would outrun food supply on the assumption that human numbers would increase at a geometric rate while food would be limited to arithmetic increases. Then, in 1968, Stanford University professor Paul R. Ehrlich issued a similar warning in his book The Population Bomb, in which he predicted that hundreds of millions of people would die of starvation in the 1970s and 1980s. Both men underestimated humanity’s resourcefulness—as well as its scientific and technological acumen—in figuring out how to provide for its growing numbers. Still, there’s little doubt that the Earth’s human carrying capacity has a limit. And growth can’t continue indefinitely without more of the significant environmental health impacts we are already seeing. In addition to documenting exactly how much growth is occurring, scientists are now interested in trends reflecting where such growth is occurring and the effect of factors such as consumption rates and migration on sustainability of the Earth’s resources.

Women's Reproductive Rights, Modernization, and Family Planning Programs in Developing Countries: : A Causal Model

Ongoing debates on women's reproductive rights in world conferences and conventions have heightened the need for empirical research and theoretical explanations of women's reproductive rights. The study examines the effects of family planning programs and the processes of modernization on women's reproductive rights. The study involves 101 developing countries. Using linear structural equation analysis, the study finds that family planning programs reduce population growth. However, population decline does not influence women's reproductive rights. The most important determinant of reproductive rights is gender equality. Socioeconomic development has a positive effect on women's educational attainment, but is negatively related to gender equality. The direct effect of women's education on reproductive rights is negative. Theoretical and policy implications of the findings are presented.

Family planning program effects on contraceptive use in Morocco 1992-1995.

This study illustrates the use of panel data and a fixed-effects estimator to investigate the impact of family planning program inputs on contraceptive utilization in Morocco during the 1992–1995 period. By controlling the potential bias resulting from common unobserved determinants of program resource allocation decisions and program outcomes, the methodology helps overcome an important constraint to the use of non-experimental study designs in undertaking meaningful impact assessments. Data from a panel of women interviewed in both the 1992 and 1995 Morocco Demographic and Health Surveys were used in the study, along with ‘program’ data from Service Availability Modules undertaken in conjunction with each survey round. The results indicate that changes in the family planning supply environment, in particular increased presence of nurses trained in family planning and the level of infrastructure at public clinics, played a significant role in the increased use of modern contraceptives during the study period.

Purposive Program Placement and the Estimation of Family Planning Program Effects in Tanzania

Purposive Program Placement and the Estimation of Family Planning Program Effects in Tanzania

Purposive Program Placement and the Estimation of Family Planning Program Effects in Tanzania

Most studies evaluating the impact of family planning on fertility treat the presence of family planning clinics as being “randomly” assigned among the areas included in the study. They tend to ignore the possibility that the distribution of services may be related to the fertility level observed in a particular area. In some cases the distribution of services may respond to a conscious effort by public authorities or funding agencies to target areas with observed higher fertility. Even in absence of program planning, the factors determining service placement might be related to the determinants of high, or low, fertility in a particular area. If that is the case, and one fails to account for the endogeneity of family planning services, then the estimated impact of family planning programs will be biased. This article presents a modeling approach to address this issue. The model extends the simultaneous equation framework by integrating an individual-level model of timing and spacing of children with the dynamic process of program placement. Individual-level data from the 1991/1992 Tanzania Demographic and Health Survey are augmented with data on the timing of, and factors influencing, family planning service placement to demonstrate the approach. The empirical results show that standard methods yield misleading results on the impact of different components of the family planning program on fertility. In particular, the effect of access to family planning hospitals on births is overstated, and the impact of access to health centers that offer family planning is understated significantly. We quantify the size of these effects through simulations.

The effectiveness of family planning programs evaluated with true experimental designs.

This paper describes the magnitude of effects for family planning programs evaluated with true experimental designs. Studies that used true experimental designs to evaluate family planning programs were identified and their results subjected to meta-analysis. For the 14 studies with the information needed to calculate effect size, the Pearson r between program and effect variables ranged from -.08 to .09 and averaged .08. The programs evaluated in the studies considered have had, on average, smaller effects than many would assume and desire.

The effectiveness of family planning programs evaluated with true experimental designs.

The effectiveness of family planning programs evaluated with true experimental designs.

Interaction Diffusion and Fertility Transition in Costa Rica

A long-standing concern of sociologists is the contribution of diffusion processes to social change. This article considers the contribution of social interaction diffusion to the fertility transition in Costa Rica focusing on person-to-person contagion. Several prominent features of the Costa Rican transition suggest the existence of interaction diffusion effects notably its pervasiveness toward all socioeconomic strata and the lack of evidence of a downward shift in family size preferences. Maps of the timing of fertility transition show an ordered spatial pattern suggestive of contagion between neighboring areas. A dynamic regression model estimated from pooled time series data for 100 counties reveals inter- and within-county diffusion effects on birth control adoption net of socioeconomic and family-planning program effects. (authors)