Family Planning Policies Research Articles

Potentials for demographic dividend and rapid economic growth in Mali: What policy scenario would yield the greatest dividend?

AbstractThe demographic changes occurring in Mali, evident in high fertility but declining mortality rates have raised optimism about the prospects of reaping demographic dividend. However, it remains unclear how soon and what policy scenario would yield the largest demographic dividend in the country. We used a demographic-economic model “DemDiv” to assess the prospects of reaping a demographic dividend in Mali by 2050. We illuminate this further by examining the cost and implications of different combination of education, family planning and economic policies. The results show that by increasing access to education, family planning services coupled with strong economic reforms, Mali’s GDP per capita will be $27,044 by 2050. This high per capita GDP is almost thrice the benefit of prioritising only economic reforms. Mali would also have a GDP of $977 billion. These findings highlight the need for sound demographic and market-oriented economic policies for Mali to reap a large demographic dividend by 2050.

Why did National Leaders in India, China, and Peru Impose Coercive Family Planning Policies?

Why did National Leaders in India, China, and Peru Impose Coercive Family Planning Policies?

Impact of Family Planning Policy on Gender Inequality: Evidence from China

The investments parents make in their children can be gender specific. I study the impact of family planning policies on gender-specific outcomes. Empirically, this paper uses China’s Family Planning Policy (FPP), enacted in 1971, to understand how a reduction in the number of children in a family can generate gender-specific outcomes. I mainly use the diff-in-diff strategy to compare the educational outcomes of boys and of girls born before and after the FPP was implemented. I find that while post-FPP-born children generally complete higher levels of education, this effect is particularly stronger for girls. This finding is robust to (1) using the diff-in-diff-in-diff strategy by incorporating another dimension of variation: different fertility constraints imposed by the FPP on the ethnic majority Han than those imposed on ethnic minorities; and (2) using a different measure of educational outcomes: the probability of pursuing an education beyond the compulsory education period. In addition, I document that the FPP also has an impact on changing women’s preference for their child’s gender. Post-FPP-born women show a more pronounced change in gender attitudes and exhibit less son preference than their male counterparts.

Hematopoietic stem cell transplantation without in vivo T-cell depletion for pediatric aplastic anemia: A single-center experience.

For young patients, HLA-MRD HSCT is the first-line treatment of SAA. However, due to China's birth control policy, few patients could find suitable sibling donors and HLA-MUD. More and more transplantation centers have used Haplo-D as the donor source for young adult and pediatric patients. However, studies with larger amount of pediatric patients are rare. We retrospectively analyzed the data of children with AA who were treated with allogeneic HSCT and compared the therapeutic efficacy of Haplo-HSCT and MRD/MUD group. A total of 62 patients were enrolled. Implantation was successfully performed in 58 patients. There was no significant difference in the time for reconstruction of hematopoietic function between patients in the two groups. Thirty-two had grade I-IV aGVHD with incidence of 51.61%. The incidence of aGVHD was 79.41% for patients in the Haplo-HSCT, significantly higher than that of 17.86% for patients in the MRD/MUD group (P<.01). However, the incidence of cGVHD was not significantly different between patients in the two groups (26.47% vs 10.71%, P=.09), the incidence of CMV infection was 28.57% and 52.94% for patients in the MRD/MUD and Haplo group, respectively, showing no significant difference (P=.053). The incidence of EBV infection was 47.06% for patients in the Haplo group and 28.57% for patients in the MRD/MUD group, showing no significant difference (P=.11). However, the 3- and 5-year cumulative OS and FFS rates showed statistically significant difference in the two groups, P=.012 and .045, respectively. Compared to Haplo-HSCT, MRD/MUD is more economic. In this study, we achieved good Haplo transplantation results. The incidences of cGVHD and CMV/EBV were not significantly different between Haplo group and MRD/MUD group. Although OS and FFS of the Haplo group were not as good as those of the MRD/MUD group, it is still acceptable as an alternative treatment under emergency.

Contraceptive Coercion

No abstract available

Fertility and population policy

There have been significant changes in both the fertility rates and fertility perception since 1970s. In this paper, we examine the relationship between government policies towards fertility and the fertility trends. Total fertility rate, defined as the number of children per woman, is used as the main fertility trend variable. We use panel data from the United Nations World Population Policies database, and the World Bank World Development Indicators for the period 1976 through 2013. We find a significant negative association between a country’s fertility rate and its anti-fertility policy. On the other hand, there is no significant and robust relationship between the fertility rate and a country’s pro-fertility or family-planning policies. In addition we find evidence of spatial autocorrelation in the total fertility rate, and spatial spillovers from a government’s policy on fertility.

Causes and Characteristics of Population Aging

Korea’s level of population aging remains lower than the OECD average. However, the pace of population aging in Korea is faster than that of many other member countries, as its total fertility rate is the lowest among OECD countries while its life expectancy exceeds the OECD average. Using panel data from OECD member countries, this paper divides the common causes of population aging in OECD countries into declining fertility rate and increasing life expectancy, and analyzes these causes of aging mainly in terms of factors influencing the declining fertility rate. According to the results of the analysis, declines in fertility rate are attributable mainly to socioeconomic factors, including wedding and childcare expenses and labor market conditions that limit the division of housework, and sociocultural factors, such as changes in education levels and gender equality values. Increases in life expectancy are found to be positively correlated to welfare policies and income levels. This paper also compares descriptively the characteristics of population aging in Korea with those in major countries. As Korea industrialized rapidly, the aging of its population has progressed rapidly as well. The factors driving this rapid aging include: historical characteristics, such as the decline in potential fertility, caused in part by Korea’s birth control policy; sociocultural characteristics, such as the decline in the fertility rate due to high wedding and childcare expenses, emergence of an environment in which it is difficult to achieve work-family balance, and gender inequality in the division of housework; and demographic characteristics, such as the surge in the proportion of elderly people as the baby boomers age. To cope with this aging, policies are urgently needed to help ease the burdens of wedding and childcare expenses, for example by stabilizing the housing market and, reducing private education expenses, and create working conditions that ensure work-family balance and gender equality in the division of housework. More fundamentally, it is necessary to establish social consensus on the need for a gender-equal society and develop legal and institutional frameworks that will help make such a society a reality. We must also seek comprehensive measures to address poverty among the elderly, caused by the fast pace of aging, and to support the post-retirement pension and welfare systems.

About the Contributors

About the Contributors

Measurement of shock effect following change of one-child policy based on grey forecasting approach

PurposeThis paper aims to analyze general development trend of China’s population and to forecast China’s total population under the change of China’s family planning policy so as to measure shock disturbance effects on China’s population development.Design/methodology/approachChina has been the most populous country for hundreds of years. And this state will be sustained in the forthcoming decade. Obviously, China is confronted with greater pressure on controlling total scale of population than any other country. Meanwhile, controlling population will be beneficial for not only China but also the whole world. This paper first analyzes general development trend of China’s population total amount, sex ratio and aging ratio. The mechanism for measurement of the impact effect of a policy shock disturbance is proposed. Linear regression model, exponential curve model and grey Verhulst model are adopted to test accuracy of simulation of China’s total population. Then considering the policy shock disturbance on population, discrete grey model, DGM (1, 1), and grey Verhulst model were adopted to measure how China’s one-child policy affected its total population between 1978 and 2015. And similarly, the grey Verhulst model and scenario analysis of economic developing level were further used to forecast the effect of adjustment from China’s one-child policy to two-child policy.FindingsResults show that China has made an outstanding contribution toward controlling population; it was estimated that China prevented nearly 470 million births since the late 1970s to 2015. However, according to the forecast, with the adjustment of the one-child policy, the birth rate will be a little higher, China’s total population was estimated to reach 1,485.59 million in 2025. Although the scale of population will keep increasing, but it is tolerable for China and sex ratio and trend of aging will be relieved obviously.Practical implicationsThe approach constructed in the paper can be used to measure the effect of population change under the policy shock disturbance. It can be used for other policy effect measurement problems under shock events’ disturbance.Originality/valueThe paper succeeded in studying the mechanism for the measurement of the post-impact effect of a policy and the effect of changes in China’s population following the revision of the one-child policy. The mechanism is useful for solving system forecasting problems and can contribute toward improving the grey decision-making models.

Analysis of selected policies towards universal health coverage in Uganda: the policy implementation barometer protocol

BackgroundPolicy implementation remains an under researched area in most low and middle income countries and it is not surprising that several policies are implemented without a systematic follow up of why and how they are working or failing. This study is part of a larger project called Supporting Policy Engagement for Evidence-based Decisions (SPEED) for Universal Health Coverage in Uganda. It seeks to support policymakers monitor the implementation of vital programmes for the realisation of policy goals for Universal Health Coverage. A Policy Implementation Barometer (PIB) is proposed as a mechanism to provide feedback to the decision makers about the implementation of a selected set of policy programmes at various implementation levels (macro, meso and micro level). The main objective is to establish the extent of implementation of malaria, family planning and emergency obstetric care policies in Uganda and use these results to support stakeholder engagements for corrective action. This is the first PIB survey of the three planned surveys and its specific objectives include: assessment of the perceived appropriateness of implementation programmes to the identified policy problems; determination of enablers and constraints to implementation of the policies; comparison of on-line and face-to-face administration of the PIB questionnaire among target respondents; and documentation of stakeholder responses to PIB findings with regard to corrective actions for implementation.Methods/DesignThe PIB will be a descriptive and analytical study employing mixed methods in which both quantitative and qualitative data will be systematically collected and analysed. The first wave will focus on 10 districts and primary data will be collected through interviews. The study seeks to interview 570 respondents of which 120 will be selected at national level with 40 based on each of the three policy domains, 200 from 10 randomly selected districts, and 250 from 50 facilities. Half of the respondents at each level will be randomly assigned to either face-to-face or on-line interviews. An integrated questionnaire for these interviews will collect both quantitative data through Likert scale-type questions, and qualitative data through open-ended questions. And finally focused dialogues will be conducted with selected stakeholders for feedback on the PIB findings. Secondary data will be collected using data extraction tools for performance statistics.DiscussionIt is anticipated that the PIB findings and more importantly, the focused dialogues with relevant stakeholders, that will be convened to discuss the findings and establish corrective actions, will enhance uptake of results and effective health policy implementation towards universal health coverage in Uganda.

The Impact on Mental Health of Losing an Only Child and the Influence of Social Support and Resilience.

The number of parents who have lost their only child (PLOCs) has increased annually with the implementation of the birth control policy in mainland China. This study aimed to investigate the mental health status of PLOCs and the influence of social support and resilience. Study 1 recruited 100 PLOCs and 88 nonbereaved parents, and compared differences in depression, anxiety, and loneliness. Study 2 investigated the influence of social support and resilience on the mental health of PLOCs via a mediating model. Results indicate that PLOCs reported more anxiety and depression symptoms than nonbereaved counterparts. Perceived close family support, objective support, and resilience negatively predicted anxiety and depression. In addition, perceived close family support was found to influence mental health via resilience. The current findings reveal that losing an only child has long-term negative impacts on the mental health of PLOCs. However, perceived close family support and objective support can protect their mental health either directly or indirectly via resilience.

Rethinking Medicaid Coverage and Payment Policy to Promote High Value Care: The Case of Long-Acting Reversible Contraception

ContextLong-acting reversible contraception (LARC) is the most effective reversible method to prevent unplanned pregnancies. Variability in state-level policies and the high cost of LARC could create substantial inconsistencies in Medicaid coverage, despite federal guidance aimed at enhancing broad access. This study surveyed state Medicaid payment policies and outreach activities related to LARC to explore the scope of services covered. MethodsUsing publicly available information, we performed a content analysis of state Medicaid family planning and LARC payment policies. Purposeful sampling led to a selection of nine states with diverse geographic locations, political climates, Medicaid expansion status, and the number of women covered by Medicaid. ResultsAll nine states' Medicaid programs covered some aspects of LARC. However, only a single state's payment structure incorporated all core aspects of high-quality LARC service delivery, including counseling, device, insertion, removal, and follow-up care. Most states did not explicitly address counseling, device removal, or follow-up care. Some states had strategies to enhance access, including policies to increase device reimbursement, stocking and delivery programs to remove cost barriers, and covering devices and insertion after an abortion. ConclusionsAlthough Medicaid policy encourages LARC methods, state payment policies frequently fail to address key aspects of care, including counseling, follow-up care, and removal, resulting in highly variable state-level practices. Although some states include payment policy innovations to support LARC access, significant opportunities remain.

Protocol for a systematic review: Interventions addressing men, masculinities and gender equality in sexual and reproductive health: An evidence and gap map and systematic review of reviews.

Protocol for a systematic review: Interventions addressing men, masculinities and gender equality in sexual and reproductive health: An evidence and gap map and systematic review of reviews.

«100 million people reading and speaking Spanish are anxious to have your message»: Margaret Sanger in Puerto Rico (1925-1960)

The present study focuses on the tangling of birth control policies and eugenics via the biographical vicissitudes of one individual - renowned international activist Margaret Sanger - in relation to Puerto Rico. This context represents a crucial point of intersection between policies of birth control and policies of population control, between bottom-up choices centered on individuals and policies partially imposed by government bodies, joined here together in a kind of symbiosis and mutual justification. The island does have a number of unusual features. It was a prototypical testing ground for imperial relations between the United States and Latin America and became a place in which, since the 1930s, sterilization programs took place and later reached an impressive quantitative extent: almost one third of women of reproductive age of the overall population. My goal here is to provide medium-term contextual clues that may help us to understand how this practice, widely justified by eugenics theories, was legitimized and exported by the liberal-democratic context par excellence, the United States. The article will also get to the roots of the concept of «overpopulation», as an important precedent for later spreading the logic of containment inherent in the bipolar world and its complex political implications. A further confirmation of Puerto Rico as a «social laboratory» will be provided by Sanger's decade-long relationship with local medical and health professionals in the island, culminating in a very controversial episode of the first contraceptive pill trials.

Clan Culture, One-Child Policy and Child Trafficking of Illegal Adoptions in China

Child trafficking is an increasing visible global concern for bringing numerous family tragedies worldwide. For decades, social scientists have continued digging the underlying causing factors of child trafficking in order to introduce effective policy interventions. Yet, existing studies are mostly limited to conjectures of casualty, but little direct evidence has been provided to support the conjectures. Here we manually collected over 18,000 cases of self-reported child trafficking for illegal adoption in China during 1960-2000. By matching the trafficking data with culture and policy data, we proved a common long-standing conjecture in the science community that both the strength of clan culture (proxied by genealogies) and the One-Child Policy (proxied by fine rate for violating the policy) are positively associated with the demand of trafficked children in China, at the prefectural level. We further confirmed the association from empirical test of the normal adoption, which has the same incentives with illegal adoptions. Our findings suggest that culture and policy have complex interactions and might cause unexpected social consequence. Our results support that the cessation of the birth control policy in China could help reduce the child trafficking rate and family tragedies.

Reimagining infertility: a critical examination of fertility norms, geopolitics and survey bias.

While it is estimated that 15% of couples worldwide are infertile, this figure hinges critically on the quality, inclusiveness and availability of infertility data sources. Current infertility data and statistics fail to account for the infertility experiences of some social groups. We identify these people as the invisible infertile, and refer to their omission from infertility data and statistics-whether intentional or unintentional-as the process of invisibilization. We identify two processes through which invisibilization in survey data is produced: sampling, with focus on exclusionary definitions of the population at-risk, and survey instrument design, with focus on skip patterns and question wording. Illustrative examples of these processes are drawn from the Integrated Fertility Survey Series and the Demographic and Health Surveys. Empirical research is not designed in an objective vacuum. Rather, survey instruments and sampling techniques are shaped and influenced by the sociocultural norms and geopolitical context of the time and place in which they are created and conducted, reflecting broader social beliefs about family building and reproduction. Furthermore, population policy singularly aimed at curbing overpopulation in high fertility parts of the world limits the type of reproduction data collected, effectively rendering the infertility of some groups epidemiologically unfathomable. In light of these sociocultural and geopolitical forces, many marginalized groups are missing from reproductive health (RH) statistics. The omission of entire groups from the scientific discourse casts doubt on the quality of research questions, validity of the analytic tools, and accuracy of scientific findings. Invisibility may also misguide evidence-based RH and family planning policies and deter equitable access to reproductive healthcare for some social groups, perpetuating social inequalities.

The Effects of National Policies and Laws on the Formation of Conscience: Reflections on Korea’s Family Planning Policy and the Mother and Child Health Law Based on the Evangelium Vitae

한국 정부는 인구증가에 따른 빈곤을 해결하기 위해 1960년대부터 출산억제 내지 금지 차원의 가족계획정책을 실시하였다. 1970년대에 이르러 미국을 비롯한 많은 나라에서 낙태를 합법화하기 시작하자, 한국 정부는 모자보건법 제14조 인공임신중절 수술의 허용한계를 통해 합법적인 낙태의 길을 열어놓았고, 출산억제를 위해 불법 낙태 역시 묵인해왔다. 하지만 2000년대 이후 초저출산 문제가 심각해지면서 정부는 전과는 반대로 출산장려정책을 추진하기 시작하였고, 최근에는 그동안 묵인해왔던 불법 낙태 처벌을 강화하겠다고 발표하였다. 더구나 일부 의료계와 여성계 반대에 부딪혀 이마저도 철회하고 말았다.BR 이런 시점에서 우리는 한국의 국가정책과 법이 얼마나 근시안적으로 마련되고 추진되었는지 성찰해야 하고, 국가정책과 법의 영향력이 얼마나 대단한지 진단해야 한다. 정부는 불과 반세기 전에는 공공연하게 출산금지정책을 추진하면서 낙태를 묵인해오더니 이제는 반대로 출산장려정책을 추진하면서 낙태죄 처벌을 강화하겠다고 말한다. 하지만 사람들은 더 이상 출산금지정책 이전처럼 자녀를 출산하지 않고, 낙태를 하면서도 별다른 죄의식을 느끼지 못하며, 낙태 합법화를 주장한다. 여러 가지 이유가 있겠지만 이런 주장의 저변에는 국가가 주도적으로 실시한 가족계획정책과 모자보건법이 자리한다. 오랜 세월 국가가 주도적으로 실시한 가족계획정책과 모자보건법 탓에 낙태를 바라보는 사람들의 인식 자체가 많이 달라졌고, 그런 탓에 죄의식 역시 반감(半減)되었기 때문이다.BR 이에 본고는 교황 요한 바오로 2세의 회칙 『생명의 복음』(Evangelium Vitae)에 근거하여 한국의 가족계획정책과 모자모건법이 야기한 낙태에 대한 인식과 실태의 문제점을 성찰하면서, 잘못된 국가정책과 법이 인간의식과 사회실태에 막대한 영향을 끼친다는 사실을 진단하였다. 특히 잘못된 국가정책과 법이 인간의 올바르고 선한 윤리적 선택을 가로막고, 여기서 더 나아가 잘못된 윤리의식, 곧 잘못된 양심을 형성하여 인간존재의 근원적인 차원에까지 그 영향을 미친다는 사실을 한국의 가족계획정책과 모자모건법이 야기한 낙태에 대한 죄의식의 부재와 낙태 만연 현상에 근거하여 제시하면서 그 해결방안을 모색하였다.

The Impacts of the Universal Two-Child Policy on China\u2019s Population

The universal two-child policy, implemented in October, 2015, is considered to be the most significant adjustment in the history of China’s family planning program. Using data from the 2014 national population sampling survey, this paper employs a population group-component calculation and projection method to compute the number of target population in 2016 and then to estimate the number of extra births that are likely to result from implementation of the universal two-child policy. The results show that the total number of extra births is estimated to be approximately 17. 2 million in the years 2017–2021, with the number of extra births per year ranging from approximately 1. 6 to 4. 7 million. This will lead to a dramatic shift in China’s TFR from an estimated 1. 6 in 2016 to one approaching the replacement level, and then dropping to a projected 1. 7. With the universal two-child policy in place, China’s total population will grow to about 1. 45 billion around 2028 and then gradually begin shrinking. The labor force will become larger under the universal two-child policy than it would if the stricter birth control policy were maintained, with an estimated 50 million additional people aged 15–59 in 2050. With implementation of China’s new fertility policy, an estimated 34% of the population will be over 60 years of age in 2050, almost three percentage points lower than the level if the former fertility policy were continued.

Concomitant contraceptive implant and efavirenz use in women living with HIV: perspectives on current evidence and policy implications for family planning and HIV treatment guidelines.

Introduction: Preventing unintended pregnancies is important among all women, including those living with HIV. Increasing numbers of women, including HIV-positive women, choose progestin-containing subdermal implants, which are one of the most effective forms of contraception. However, drug–drug interactions between contraceptive hormones and efavirenz-based antiretroviral therapy (ART) may reduce implant effectiveness. We present four inter-related perspectives on this issue.Discussion: First, as a case study, we discuss how limited data prompted country-level guidance against the use of implants among women concomitantly using efavirenz in South Africa and its subsequent negative effects on the use of implants in general. Second, we discuss the existing clinical data on this topic, including the observational study from Kenya showing women using implants plus efavirenz-based ART had three-fold higher rates of pregnancy than women using implants plus nevirapine-based ART. However, the higher rates of pregnancy in the implant plus efavirenz group were still lower than the pregnancy rates among women using common alternative contraceptive methods, such as injectables. Third, we discuss the four pharmacokinetic studies that show 50–70% reductions in plasma progestin concentrations in women concurrently using efavirenz-based ART as compared to women not on any ART. These pharmacokinetic studies provide the biologic basis for the clinical findings. Fourth, we discuss how data on this topic have marked implications for both family planning and HIV programmes and policies globally.Conclusion: This controversy underlines the importance of integrating family planning services into routine HIV care, counselling women appropriately on increased risk of pregnancy with concomitant implant and efavirenz use, and expanding contraceptive method mix for all women. As global access to ART expands, greater research is needed to explore implant effectiveness when used concomitantly with newer ART regimens. Data on how HIV-positive women and their partners choose contraceptives, as well as information from providers on how they present and counsel patients on contraceptive options are needed to help guide policy and service delivery. Lastly, greater collaboration between HIV and reproductive health experts at all levels are needed to develop successful strategies to ensure the best HIV and reproductive health outcomes for women living with HIV.

Fertility Transitions in Ghana and Kenya: Trends, Determinants, and Implications for Policy and Programs

As a continent with 54 independent states Africa’s diversity is often highlighted but frequently forgotten when fertility is discussed. Fifty and more years ago to consider that all African countries and societies had a single fertility pattern (large numbers of children) and single trend (unchanging over time) was a valid characterization. Since the 1960s however that uniformity has disappeared replaced by substantial inter- and intra-country differences in fertility patterns and trends that render previous perceptions of continent-wide homogeneity obsolete. In this chapter we consider two African countries—Ghana and Kenya—whose fertility patterns and trends and their determinants have been well documented (Bongaarts 2008; Garenne 2008; Machiyama 2010; Shapiro and Gebreselassie 2008; Sneeringer 2009). Both countries have benefited from regularWorld Fertility Surveys (WFS) and Demographic and Health Surveys (DHS) that record trends in fertility family planning (FP) and other relevant indicators. The recently introduced Performance Monitoring and Accountability 2020 (PMA2020) surveys monitor progress since 2012 for the FP2020 initiative and occasional Situation Analysis and Service Provision Assessment surveys have also detailed the readiness of the health system in both countries to make quality FP services available. Ghana and Kenya share some common history: both have relatively strong health system legacies from the period of British colonialization; both were among the earliest countries to achieve independence; they were the first two African countries that developed policies to address population growth in the 1960s; and both have received substantial and sustained resources over several decades from many external donors and technical assistance organizations explicitly intended to increase the availability and quality of family planning services. However they are composed of cultures that are both diverse within each country and markedly different in many ways between the two countries. The two countries demonstrate remarkably different pathways in fertility and family planning patterns and trends from the 1970s to the present. We highlight some of the key differences and similarities explain why they have occurred and identify insights that could inform a wider understanding of fertility transitions and the role of family planning in other African countries. (excerpt)