National Family Planning Program Research Articles

Trends in prevalence of unmet need for family planning in India: patterns of change across 36 States and Union Territories, 1993–2021

BackgroundEliminating unmet need for family planning by 2030 is a global priority for ensuring healthy lives and promoting well-being for all at all ages. We estimate the sub-national trends in prevalence of unmet need for family planning over 30 years in India and study differences based on socio-economic and demographic factors.MethodsWe used data from five National Family Health Surveys (NFHS) conducted between 1993 to 2021 for the 36 states/Union Territories (UTs) of India. The study population included women of ages 15–49 years who were married or in a union at the time of the survey. The outcome was unmet need for family planning which captures the prevalence of fecund and sexually active women not using contraception, who want to delay or limit childbearing. We calculated the standardized absolute change to estimate the change in prevalence on an annual basis across all states/UTs. We examined the patterning of prevalence of across demographic and socioeconomic characteristics and estimated the headcount of women with unmet need in 2021.ResultsThe prevalence of unmet need in India decreased from 20·6% (95% CI: 20·1– 21·2%) in 1993, to 9·4% (95% CI: 9·3–9·6%) in 2021. Median unmet need prevalence across states/UTs decreased from 17·80% in 1993 to 8·95% in 2021. The north-eastern states of Meghalaya (26·9%, 95% CI: 25·3–28·6%) and Mizoram (18·9%, 95% CI: 17·2–20·6%), followed by the northern states of Bihar (13·6%, 95% CI: 13·1–14·1%) and Uttar Pradesh (12·9%, 95% CI: 12·5–13·2%), had the highest unmet need prevalence in 2021. As of 2021, the estimated number of women with an unmet need for family planning was 24,194,428. Uttar Pradesh, Bihar, Maharashtra, and West Bengal accounted for half of this headcount. Women of ages 15–19 and those belonging the poorest wealth quintile had a relatively high prevalence of unmet need in 2021.ConclusionsThe existing initiatives under the National Family Planning Programme should be strengthened, and new policies should be developed with a focus on states/UTs with high prevalence, to ensure unmet need for family planning is eliminated by 2030.

The Indonesian national family planning program: progress and remaining challenges in implementing a rights-based approach

Purpose Indonesia subscribes to rights-based principles of family planning. However, a chasm between principles and practice has long been noted on a global basis, and progress has not been well-documented. This paper aims to assess the extent to which the Indonesian national family planning program has evolved in a manner that is consistent with rights-based principles. Design/methodology/approach The primary source of data was five Indonesian Demographic Health Surveys undertaken from 1997 to 2017. The analyses were organized around three major categories of family planning-related human rights. Trend analysis and logistic regression were used in analyzing the data. Findings Indonesian women have considerable autonomy in family planning decision, reporting that family planning decisions were mainly made by themselves or jointly with their spouse. Although contraceptive method awareness and demand for family planning are high, Indonesia fares poorly with regard to informed choice in contraceptive method selection. Access to family planning services is comparatively high as judged by contraceptive prevalence, family planning demand satisfaction and unmet need for family planning. However, significant geographic and socioeconomic inequity were observed on many indicators, with eastern Indonesian provinces consistently lagging behind. Research limitations/implications This paper focuses on married couple, as Indonesia has a restrictive policy to limiting access and information of family planning for other groups, unmarried youth in particular. Originality/value This paper makes an important contribution to document how effectively the prohuman rights policy orientation toward family planning has been translated into services.

"Kita habis…we will be gone": The politics of population, family planning and racialization in West Papua.

In the context of a steadily decreasing Indigenous population, active military occupation, and a documented history of human rights abuses perpetrated by Indonesian state security forces, Black Indigenous Papuans have uttered phrases like extinction, and we will be gone in public and private spaces. These utterances often follow an indictment of Indonesia's national family planning program as a key node of state apparatuses of domination and, by extension, genocide. Amid Indonesia's global health success story of a historically lauded national family planning model, I examine the emergence of a local pronatalist program in which health workers are both providers and deniers of access to birth control. Through highlighting this story of Indigenous refusal and racial survival in the terrain of women's reproduction the stakes of a necropolitical environment marked by occupation, population control, and fears of genocide are brought into high relief.

A Focus on Contraception in the Wake of Dobbs.

A Focus on Contraception in the Wake of Dobbs.

A Review of Contraceptive Prevalence Rates in Afghanistan

Background and Objective: Family planning programs and the use of contraceptives are among the priorities of maternal and child health. Adequate information about the prevalence of family planning programs and contraceptive use in Afghanistan is not readily available. This review attempts to provide an appropriate perspective on the prevalence rates of contraceptive use based on existing data and suggests practical measures to improve the prevalence of contraceptive usage.
 Research Method: In this review, data from Google Scholar, PubMed, the Ministry of Public Health website, the World Health Organization, and the National Family Planning Program were utilized. Seven articles published between 2001 and 2023 were selected and analyzed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
 Findings: A narrative summary of the results of the selected articles is presented in this paper. According to studies conducted in the country, statistics on the prevalence of contraceptive use show significant differences in comparison to demographic structures. The lowest figure reported in these studies is 10.4%. The utilization of contraceptives is reported as follows: oral contraceptives 38.5%, condoms 30.3%, medroxyprogesterone 17.0%, intrauterine contraceptive devices (IUCD) 15.6%. Overall, the prevalence rate of contraceptive use in the entire country reaches 15.4%.
 Conclusion: In Afghanistan, due to numerous barriers, the use of contraceptives and the gap between pregnancies have not been promoted. Conversely, according to the conservative beliefs of the illiterate segments of society, the use of contraceptives is considered contrary to their religious beliefs and even in conflict with divine instructions. Therefore, it is imperative for policymakers to develop comprehensive and inclusive programs in this regard and seek assistance from religious leaders to align the community with these programs. Ultimately, the entire society needs to be mobilized.

RELATIONSHIP BETWEEN HUSBAND AND HEALTH WORKERS' SUPPORT WITH MOTHER'S INTEREST IN USING IUD CONTRACEPTION


 Intrauterine Contraception Device (IUD) is a method of contraception that is quite safe and is the most recommended in the national family planning program in Indonesia. This study aims to study the significant relationship between the support of husbands and health workers with mothers' interest in using IUD contraception in the working area of the Taba Lagan Health Center, Central Bengkulu Regency. The approach of this study used a descriptive correlation with a cross sectional approach. The population in this study were all couples of childbearing age who came to visit the Taba Lagan Health Center in February 2022, as many as 91 people were taken using accidental sampling. Data collection in this study uses primary data by distributing questionnaires. Data analysis was carried out by the Chi Square test (x) with the Contingency Coefficient test (c). The results of the study from 91 samples there were 53 people with low interest, 52 husbands did not support and 72 people got good information from health workers. The results of the Bivariate analysis show that there is husband support in the very weak category, and information on health workers in the weak category in the working area of the Taba Lagan Health Center, Central Bengkulu Regency. It is hoped that they can use appropriate contraception according to the age and parity of the mother to manage pregnancy spacing and reduce the impact of contraceptive use on mother's health

Predictors of Contraceptive practice in married women of Punjab, Pakistan.

Pakistan is the sixth most populous country in the world. Current contraceptive use in Pakistan is only 26% despite being one of the leading countries in Asia to launch National family planning programs. Major constraint of acceptability among women is the lack of awareness and implementation of contraceptive methods. The objective of this study was to explore the reasons behind this behavior. A cross-sectional survey was conducted with non-probability convenient sampling with sample size of 400 married women attending Fazle-Omar Hospital, Chenab Nagar, Punjab, having age between 15 to 60 years from August 2019 to February 2020. To assess the awareness of respondents about contraception, a questionnaire was made after testing its internal consistency. Data was analyzed via SPSS-21; nominal data was expressed as frequencies and percentages, quantitative as mean and standard deviation. Binary logistic regression analysis was carried out to determine predictors for contraception practice. P-value < 0.05 was considered significant. Our respondents mean age was 30.73±5.9 years. Majority of responders (65%) were educated and (61%) belonged to low socio-economic class. Mean awareness score was 65 ± 26. Out of 400 respondents, 260 (65%) were practicing contraception. Relatives and media were major sources of awareness while clinics and LHVs were contributing less. Condom was the most practiced method of contraception. Low socio-economic class, increase number of kids, responders' education and awareness score were the predictors of contraception practice. The education of women and awareness score are independent predictors of contraceptive practice in women. Hence by educating mothers and increasing awareness through various means, practice of contraception can be increased. There is much room to improve the working of family health clinics and LHV.

Factors Associated with Contraceptive Use in Malaysia and Pakistan

Most developing countries launched the national family planning program in the 1960s/70s. However, some countries’ contraceptive prevalence rate (CPR) remains low or stagnated. Despite having a similar religious belief, the level of contraceptive use differed between Malaysia and Pakistan. This study examines the factors associated with contraceptive use in Malaysia and Pakistan. This study used secondary data from the 2014 Malaysian Population and Family Survey and the 2017–2018 Pakistan Demographic and Health Survey. A total of 5,175 Malaysian and 14,502 Pakistani currently married women aged 15–49 were included in this study. The dependent variable is current contraceptive use. The independent variables include women’s age, age at first marriage, place of residence, women’s educational level, employment status, and the number of living children. Crosstabulations show that urban, better-educated, and working women in Pakistan reported higher modern CPR than their rural, lesser-educated, and non-working counterparts; however, the opposite was observed in Malaysia. Multinomial logistic regression analysis reveals that rural women were less likely to practice modern and traditional methods than non-use in Pakistan. In Pakistan, the odds of practising modern and traditional methods than non-use were higher among women who attained at least primary education, while working women were more likely to practice modern contraceptive methods than non-use and traditional methods. However, women’s education and employment factors were insignificant in the multivariate context of the case of Malaysia. Enhancing women’s socio-economic status and reaching out to rural, uneducated, and jobless women are essential to improving contraceptive use, especially in Pakistan.

Stakeholders' perceptions of family planning programs during the COVID-19 period: A descriptive qualitative study.

The number of unintended pregnancies and the decreasing use of contraceptives during the COVID-19 pandemic are of particular concern to the national population and family planning program. The successful implementation of the family planning program cannot be carried out by the government alone. Still, it requires strong synergy with stakeholders. The difference in perceptions among stakeholders, acceptors, and the community about family planning is crucial, so qualitative research is needed to identify this matter. This study explores stakeholders' perceptions of post-partum family planning programs and their barriers during the COVID-19 pandemic. This research uses a descriptive qualitative method, with participants consisting of family planning officers, cadres of family planning units, and the head of the family planning program. The data were collected through in-depth interviews and examined using content analysis. The results show that health workers and community leaders cooperated at the village and sub-district levels in realising the family planning programs. During the COVID-19 pandemic, services were stopped at the public health centre, especially long-term contraceptive method services. Stakeholders believe that barriers to the program's success include education level, negative perceptions, lack of training, and low trust in partners. Cross-sectoral engagement is essential in increasing participation in family planning programs. Other critical success factors are support from husbands, community leaders, and local government.

Identity politics of Hindu society in Bali

Balinese researchers such as Nordholt and Picard have extensively explored the discourse of identity formation in Balinese society from the colonial era to modern Bali. Picard, for example, considers Balinese identity to be formed through dialogic construction, namely the contact of Balinese people with their interlocutors (foreigners). But in its development, the Balinese try to construct their own identity according to the references given by the orientalists. In this study, it was found that there was a continuity of discourses with nuances of identity politics in Balinese society such as the emergence of discourse, kebalian, Ajeg Bali, efforts to legitimize Balinese language, script and traditional clothing in public spaces, and there was even a Balinese family planning movement as a counter movement against population control efforts through the national Family Planning (KB) program. The latest is the emergence of the Dresta Bali Hindu movement which seeks to restore the local Balinese variant of Hinduism. The novelty of this research is the argument that identity political discourse and movements in Balinese society are part of positioning, namely as a way for society or social groups to position or define themselves among external challenges.

From raw data to a score: comparing quantitative methods that construct multi-level composite implementation strength scores of family planning programs in Malawi

BackgroundData that capture implementation strength can be combined in multiple ways across content and health system levels to create a summary measure that can help us to explore and compare program implementation across facility catchment areas. Summary indices can make it easier for national policymakers to understand and address variation in strength of program implementation across jurisdictions. In this paper, we describe the development of an index that we used to describe the district-level strength of implementation of Malawi’s national family planning program.MethodsTo develop the index, we used data collected during a 2017 national, health facility and community health worker Implementation Strength Assessment survey in Malawi to test different methods to combine indicators within and then across domains (4 methods—simple additive, weighted additive, principal components analysis, exploratory factor analysis) and combine scores across health facility and community health worker levels (2 methods—simple average and mixed effects model) to create a catchment area-level summary score for each health facility in Malawi. We explored how well each model captures variation and predicts couple-years protection and how feasible it is to conduct each type of analysis and the resulting interpretability.ResultsWe found little difference in how the four methods combined indicator data at the individual and combined levels of the health system. However, there were major differences when combining scores across health system levels to obtain a score at the health facility catchment area level. The scores resulting from the mixed effects model were able to better discriminate differences between catchment area scores compared to the simple average method. The scores using the mixed effects combination method also demonstrated more of a dose–response relationship with couple-years protection.ConclusionsThe summary measure that was calculated from the mixed effects combination method captured the variation of strength of implementation of Malawi’s national family planning program at the health facility catchment area level. However, the best method for creating an index should be based on the pros and cons listed, not least, analyst capacity and ease of interpretability of findings. Ultimately, the resulting summary measure can aid decision-makers in understanding the combined effect of multiple aspects of programs being implemented in their health system and comparing the strengths of programs across geographies.

Awareness and acceptance of contraception in postpartum women at government maternity hospital, Tirupati

Introduction: Contraception is an important intervention to decrease unwanted pregnancies and promote healthy and better living among women. As the population continues to rise, there will be overcrowding, a limiting of resources, and the quality of life will decline. India, as the first country in the world, initiated the National Family Planning program in the year 1951 with the objective of “reducing the birth rate to the extent necessary to stabilize the population at a level consistent with requirement of national economy.”Methodology: It is a cross sectional questionnaire-based study carried out in the Department of Obstetrics and Gynaecology at Government Maternity Hospital, Tirupati. A total of 300 postpartum women were enrolled in the study who are briefed about study. After taking informed consent, they were interviewed based on a predesigned questionnaire they were allowed to choose any method of contraception they like. Their level of awareness, acceptance, and reason for refusal was assessed.Results: Among 300 women in the study group, more than 80% were in the age group of 15 to 30 years.51.7% women in urban areas, 48.3% women in rural areas. Majority of the women were Hindus. 89.3% women were literates and majority of them were house wives. Most of the women had only one living issue. It was observed that both were highest in educated working women, urban population. Acceptance was highest in women with 2 to 3 children. Maximum number of women were aware of female sterilization (90.1%), condoms (88%), intra uterine device (77.6%), OC pills (75.2%), POP’s (56%). Knowledge regarding emergency contraception was very low (2.9%).Conclusion: There is still date lack of awareness of contraception in some postpartum women. Regular counselling is a must to all pregnant women from every health care centre in a village to super speciality centres in cities. Information should be provided about various methods of contraception and patient should be able to choose a method of her choice.

PARTICIPATION OF MALE ASSEPTORS IN THE PROGRAM FAMILY PLANNING, KASUI DISTRICT, WAY KANAN REGENCY, LAMPUNG PROVINCE

The National Family Planning Program is one of the programs to improve the quality of the population, the quality of human resources, health and social welfare which has so far been implemented through birth control, maturing the age of marriage, increasing family resilience and family welfare. The policy to increase the participation of men in family planning and reproductive health was only launched in the new era of family planning in 2000. The policy of increasing the participation of men in family planning is still relatively new so that the implementation in the field is still uneven. Some have implemented the policy, some have just been socialized and some have not been touched at all. One of the many targets that will be achieved by the family planning program in the long term in order to achieve quality families in 2021. The purpose of this study was to determine the participation of male acceptors in the family planning program. This research is a qualitative research which contains descriptive research and tends to use analysis. The results of this research will be published in national or international journals.

'DO I HAVE TO CHOOSE?' TWO CHILDREN VS FOUR CHILDREN IN BALI’S FAMILY PLANNING PROGRAM

The Indonesian family planning program has been running for over five decades. Until the present, the implementation of this program still generates debate over important policy issues. On June 14th, 2019, the Balinese provincial government released a new pro-natalist family planning policy No.1545 (Keluarga Berencana Krama Bali) to respond to the concerns from the national family planning program two-child policy success. What are the implications for Balinese women's position in response to the political and cultural policies that impact their reproductive rights? This study analyzes the tensions between the national family planning program's two-child policy and the recent local Balinese Keluarga Berencana Krama model by focusing on Balinese women's perspectives. Ethnographic research was conducted from January to February 2020 in Bali. This study indicates that the women's fertility decisions were constrained by patrilineal structures, economic stresses, and government population policies. Krama Bali, which encourages a four children model according to the Balinese naming system, complicates the triple burden impacts on Balinese women's agency. The new pro-natalist provincial policy explicitly prioritizes cultural values and indirectly exacerbates the pressure to produce inheriting sons. Balinese women had to choose between cultural preservation and economic considerations, which intensified the tensions between their productive, reproductive, and customary (adat) obligations. Internal and external pressures imposed upon the Balinese women participants have forced them to navigate conflicting economic, political, and cultural demands with varying degrees of agency.

VASEKTOMI DAN TUBEKTOMI PERSPEKTIF MAQASID AL-SYARI’AH

The Family Planning Program handled by the National Population and Family Planning Agency&#x0D; (BKKBN) is a form of human effort in order to overcome population problems through population control&#x0D; with the aim of creating a prosperous and happy family. In Indonesia, vasectomy and tubectomy is one&#x0D; of the contraceptives in the National Family Planning Program, considered the only safe method for&#x0D; family planning for men and women, can be trusted to limit offspring. Vasectomy is a family planning&#x0D; method for men through small surgery to cut and bind both sperm cell channels. Whereas tubectomy is&#x0D; sterilization for women, by cutting both the cell lines of the egg (tubal palupi) and closing them so that&#x0D; the egg cannot get out and the sperm cells cannot enter to meet the egg, so pregnancy does not occur.&#x0D; The purpose of this paper is to find out how vasectomy and tubectomy are in the perspective of Maqasid&#x0D; al-Syari’ah. This writing uses the Maqasid al-Syari’ah approach by explaining the nature and wisdom of&#x0D; its formal object. The conclusion of this paper is that limitation of offspring by vasectomy / tubectomy&#x0D; can be allowed in an emergency (emergency) with the aim of achieving benefit in accordance with the&#x0D; objectives of Islamic law (Maqasid al-Syari’ah), one of which is to protect the soul and offspring.&#x0D;

Identification of Communication Strategies for Population Control in Indonesia: A Systematic Review

This article aimed to identify the most effective communication strategy to be implemented by the Indonesian Government to restrict population growth. Through the BKKBN, the Indonesian Government aims to improve information access and promote the National Family Planning Program to all segments of society. This effort has resulted in several studies assessing the communication strategy of BKKBN representatives in disseminating the Family Planning Program in several regions. To determine the most effective communication strategy, researchers must study various scientific journals and then synthesize the findings. This paper employed the systematic literature review method to examine five pieces of literature related to the BKKBN representatives’ communication strategies for disseminating the Family Planning Program. The findings revealed that those targeted were generally teenagers; the most commonly used communication strategies were direct counseling and the use of media through well-planned processes; the communication objectives were understanding and changing people’s behavior to create a prosperous family; and the most frequently used media were direct media (face-to-face counseling), indirect media (television, radio, newspapers), and new media (Facebook).&#x0D; Keywords: family planning, population growth, socialization

Use of modern contraceptives by women with disabilities in Rajasthan, India: An analysis of the annual health survey

ObjectiveThe objective of this study is to analyze associations between disability and contraceptive use among married women in Rajasthan, India. Methods: The study uses secondary analysis of the Rajasthan dataset of the 2010–2011 Annual Heath Survey. This survey included both disability and reproductive health data. The sample includes 238,240 women aged 15–49 years. Logistic regression is used to measure associations between disability status and use of modern contraceptives and female sterilization in the sample. Stratified analyses by age and residence were also conducted. Results: The prevalence of disability among women of reproductive age was 0.9%. Modern contraceptive use was reported by 73.0% of the sample, and female sterilization by 57.7% of the sample. Women with disabilities (WWD) were less likely to report using a modern contraceptive (OR 0.87, 95% CI: 0.78, 0.95). Among modern method users, WWD were not significantly more likely to be using sterilization than another modern method; however, there were significantly higher odds of sterilization versus another modern method for urban WWD (OR 1.57, 95% CI: 1.11, 2.22). Conclusions: In this study, disability was associated with contraceptive use. Additional research is needed to determine if there is a causal relationship between disability and contraceptive use. Family planning providers should be trained to provide care to WWD and the Government of India should ensure the National Family Planning Programme is accessible to people with disabilities.

Impact of the Family Planning Association of Sri Lanka's contraceptive social marketing on the National Family Planning Programme (2001-2020): Is there an effect ofCOVID-19?

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Determinants of condom use during last sexual intercourse among male college youth of Kaski, Nepal: A cross-sectional survey.

The National Family Planning program of Nepal has introduced the condom as an important family planning method. Despite the continuous effort from the public and private sectors at various levels, its use among youth remains low. Therefore, this study aimed to assess the factors associated with condom use during the last sexual intercourse among male college youth. We conducted a cross-sectional study and analyzed the responses of 361 male college youth (aged 19 to 24 years who reported being sexually active preceding six months of the survey), among the 903 participants who reported being involved in vaginal and anal sexual intercourse. The chi-square test was primarily used to find the associated factors and then, stepwise logistic regression was performed by selecting the covariates after the multicollinearity test followed by adjustment of confounders. We found that more than one-fourth (27.4%) of the sexually active male youth had used the condoms during their last sexual intercourse. Postgraduate male youth were four times more likely to use the condoms during the last sexual intercourse than undergraduate male youth (AOR = 4.09, 95% CI; 2.08-8.06). Similarly, married youth were less likely to use the condoms during the last sexual intercourse with 95% lower odds than their counterparts (AOR = 0.05, 95% CI; 0.01-0.38). Male youth with adequate knowledge about the condoms were 8 times more likely to use them compared to those with inadequate knowledge (AOR = 8.42, 95% CI; 4.34-16.33). Likewise, male youth with favorable attitude towards the condoms were 2.5 times more likely to use them compared to their counterparts (AOR = 2.58, 95% CI; 1.23-5.42). Similarly, male youth having two or more sex partners were 4.5 times more likely to use the condoms than the youth having only a sex partner (AOR = 4.57, 95% CI; 2.38-8.76). The study concluded that slightly more than one-fourth (27.4%) of male college youth in Kaski district used the condoms during their last sexual intercourse. Level of education, marital status, knowledge about condoms, attitude toward condoms, and number of sex partners are the determinants of condom use among male college youth so recommended for early behavioral interventions, especially in knowledge and attitude. Further studies focusing on including the rural youth and larger geography may help to reach a firmer conclusion.

A Review of Indian Perceptions on Condom Use

In the late 1960s, India's National Family Planning Programme introduced condoms as one of the family planning methods. Since its inception, the condom has been promoted as a method of family planning through social marketing. With the rising prevalence and incidence of sexually transmitted infections (STIs), such as HIV/AIDS, the condom has been promoted as a dual method of protection against both unintended pregnancies and sexually transmitted infections. Despite different initiatives at various levels, overall condom use among Indian couples remains low. In this paper, we examine the research on condom perception among Indian couples. The report specifically evaluates research and strategies designed to enhance condom usage among couples; predictors of condom use; reasons for not using a condom; and perception versus the experience of condom failure. Non-acceptance by partners, perceived ineffectiveness, reduced comfort, lack of sexual satisfaction, husband's alcohol usage, depression, and anxiety, and not being accessible at the time were among the reported condom-related issues. The importance of the media in promoting condom use was mentioned as a significant strategy to raise awareness and use. Acceptance of male condoms would be aided in a variety of ways.