Family Planning Program Performance Research Articles

Assessment of men involvement in family planning services use and associated factors in rural Ghana

BackgroundIn low-and-middle income countries (LMICs) less attention is paid to men’s involvement in Family Planning (FP) programs where public health officials have advocated the involvement of men as a strategy for addressing the dismal performance of FP programs. The study assessed the involvement of men in FP use and the factors which promote or hinder the uptake of FP services among partners in a rural setting of northern Ghana.MethodsA cross-sectional descriptive study was used to collect data from 200 respondents. Study respondents were selected through random cluster sampling.ResultsThe findings showed that male partners’ knowledge (95.5%) and approval (72.8%) of FP services were high. About 48% of men were involved in FP service utilization. Having living children (aOR; 1.71(1.27, 2.15)) and being knowledgeable (aOR; 6.14(1.38, 10.90)) about FP were positively associated men’s involvement in FP service utilization. The findings also indicated that men had a higher propensity (X2 = 4.5534, p = 0.033) of supporting a FP method use. Women who reported that their spouse supported FP method use were more likely to use a contraceptive method (X2 = 9.5223, P = 0.002) if their spouse supported FP method use (X2 = 9.5223, P = 0.002) and if their partners had some education (X2 = 14.1133, P = 0.000). Reasons for low contraceptive use were health risks, side effects, and socio-cultural norms.ConclusionFamily planning programs need to include men at all levels of health promotion and education of FP programs to help reduce misconceptions about contraceptive methods to increase acceptance and use among partners in rural settings of Ghana.

Influence of Access to Quality Services on Performance of Family Planning Programs in Kuresoi North Sub-County, Nakuru County, Kenya

This study investigated access to quality services influence on performance of family planning program in Kuresoi North Sub-County, Nakuru County, Kenya. The study was founded on the theory of constraint and adopted a pragmatism paradigm. It applied descriptive research method using mixed method approach to investigate the influence of access to quality services on performance of family planning program in Kuresoi North Sub-County, Nakuru County, Kenya. The target population in the study was women of reproductive age in 33,482 households distributed in the four Wards of Kuresoi North Sub-County and 19 health management leaders in-charge of all government health facilities offering family planning services in the Sub-County. A sample size of 400 of women of reproductive age and 19 nursing officers in-charge of government health facilities was utilized. The data collection tools used were questionnaire, interview guide, and observation checklist for women of reproductive age and the interview guide for the health facility managers. The research study adopted stratified sampling method. Qualitative data was analyzed according to themes and patterns, and then summarizing the data and linking it to objectives and hypothesis. The study findings exhibited that there was a significant and strong positive individual correlation between access to quality services and performance of family planning program in Kuresoi North Sub-County. The study findings also displayed that there is a significant positive relationship between access to quality services and performance of family planning program in Kuresoi North Sub-County and it predicted the performance of family planning programmes. in Kuresoi North Sub-County.

Influence of Management Competency on Performance of Family Planning Programs in Kuresoi North Sub-County, Nakuru County, Kenya

This study investigated management competency influence on performance of family planning program in Kuresoi North Sub-County, Nakuru County, Kenya. The study was founded on the theory of constraint and adopted a pragmatism paradigm. It applied descriptive research method using mixed method approach to investigate the influence of management competency on performance of family planning program in Kuresoi North Sub-County, Nakuru County, Kenya. The target population in the study was women of reproductive age in 33,482 households distributed in the four Wards of Kuresoi North Sub-County and 19 health management leaders in-charge of all government health facilities offering family planning services in the Sub-County. A sample size of 400 of women of reproductive age and 19 nursing officers in-charge of government health facilities was utilized. The data collection tools used were questionnaire, interview guide, and observation checklist for women of reproductive age and the interview guide for the health facility managers. The research study adopted stratified sampling method. Qualitative data was analyzed according to themes and patterns and then summarizing the data and linking it to objectives and hypothesis. The study findings indicate that there is moderate management efficiency, exhibited pertaining to family planning in the dispensaries and health centers located in Kuresoi North Sub-County. Further findings exhibited that there was a significant and strong positive individual correlation between management competency and performance of family planning program in Kuresoi North Sub-County. Finally, the study findings also exhibited that there is a significant positive relationship between management competency and performance of family planning program in Kuresoi North Sub-County and it predicted the performance of family planning programmes. in Kuresoi North Sub-County.

Influence of Quality Counseling on Performance of Family Planning Programs in Kuresoi North Sub-County, Nakuru County, Kenya

This study investigated quality counseling influence on performance of family planning programs in Kuresoi North Sub-County, Nakuru County, Kenya. The study was founded on the theory of constraint and adopted a pragmatism paradigm. It applied descriptive research method using mixed method approach to investigate the influence of quality counseling on performance of family planning program in Kuresoi North Sub-County, Nakuru County, Kenya. The target population in the study was women of reproductive age in 33,482 households distributed in the four Wards of Kuresoi North Sub-County and 19 health management leaders in-charge of all government health facilities offering family planning services in the Sub-County. A sample size of 400 of women of reproductive age and 19 nursing officers in-charge of government health facilities was utilized. The data collection tools used were questionnaire, interview guide, and observation checklist for women of reproductive age and the interview guide for the health facility managers. The research study adopted stratified sampling method. Qualitative data was analyzed according to themes and patterns and then summarizing the data and linking it to objectives and hypothesis. The study findings indicate that there is moderate quality counseling exhibited pertaining to family planning in the dispensaries and health centers located in Kuresoi North Sub-County. Further findings exhibited that there was a significant and strong positive individual correlation between quality counseling and performance of family planning program in Kuresoi North Sub-County. Finally, the study findings also exhibited that there is a significant positive relationship between quality counseling and performance of family planning program in Kuresoi North Sub-County and it predicted the performance of family planning programmes. in Kuresoi North Sub-County.

Setting the stage for strengthened annual monitoring of Family Planning program performance at the National and Subnational level in Myanmar

Background: Although Myanmar has made good progress in family planning by increased contraceptive prevalence rate (CPR) from 41% in 2007 to 52.2% in 2016, it remains lower than the target of 60% by 2020. There are also huge disparities sub-nationally, ranging from 25% to 60%. While there is a strong need to monitor the progress of family planning program regularly at the national and sub-national level, Myanmar has limited surveys, data quality and methodological issues in its Health Management Information System (HMIS), and a scattered rollout of the Logistic Management Information System (LMIS). Methods: To identify viable options for annual monitoring, four data sources: modelled contraceptive prevalence rate for modern methods (mCPR) estimates from Track20’s Family Planning Estimation Tool (FPET); method-specific prevalence from the 2015-16 Myanmar Demographic and Health Survey (DHS); mCPR estimates and method prevalence from HMIS and estimates of modern method use (EMU) based on commodity consumption data from LMIS, were used to compare for the years 2015-2017. Estimates of mCPR from HMIS were tested for accuracy based on whether they fell within the 95% confidence interval of mCPR estimates from the FPET for the corresponding years. EMU from LMIS was also tested for those years and States/Regions where available. Results: For annual tracking of mCPR, direct estimates of HMIS were considered; they were much higher than those of the DHS survey and were not matched by FPET results, except in Chin and Kayin. To monitor the method mix, HMIS data can be used as these are similar pattern with DHS in both national and State/Regional level except Chin and Kayin. LMIS could be used in annual tracking when there are high reporting rates and valid information of consumption. Conclusions: Track20’s FPET is the method of choice to get valid information for annual monitoring of family planning program.

Setting the stage for strengthened annual monitoring of family planning program performance at the state/national level in Myanmar.

Background: Although Myanmar has made good progress in family planning by increased contraceptive prevalence rate (CPR) from 41% in 2007 to 52.2% in 2016, it remains lower than the target of 60% by 2020. There are also huge disparities sub-nationally, ranging from 25% to 60%. While there is a strong need to monitor the progress of family planning program regularly at the national and sub-national level, Myanmar has limited surveys, data quality and methodological issues in its Health Management Information System (HMIS), and a scattered rollout of the Logistic Management Information System (LMIS). Methods: To identify viable options for annual monitoring, four data sources: modelled contraceptive prevalence rate for modern methods (mCPR) estimates from Track20's Family Planning Estimation Tool (FPET); method-specific prevalence from the 2015-16 Myanmar Demographic and Health Survey (DHS); mCPR estimates and method prevalence from HMIS and estimates of modern method use (EMU) based on commodity consumption data from LMIS, were compared for the years 2015-2017. Estimates of mCPR from HMIS were tested for accuracy based on whether they fell within the 95% confidence interval of mCPR estimates from the FPET for the corresponding years. EMU from LMIS was also tested for those years and states/regions where available. Results: For annual tracking of mCPR, direct estimates of HMIS were considered carefully, as they were much higher than those of the DHS survey and were not matched by FPET results, except in Chin and Kayin. To monitor the method mix, HMIS data can be used as these are similar pattern with DHS in both national and State/Regional level except Chin and Kayin. LMIS could be used in annual tracking when there are high reporting rates and valid information of consumption. Conclusions: Track20's FPET is the method of choice to get valid information for annual monitoring of family planning program.

Setting the stage for strengthened annual monitoring of family planning program performance at the state/national level in Myanmar

Background: Although Myanmar has made good progress in family planning by increased contraceptive prevalence rate (CPR) from 41% in 2007 to 52.2% in 2016, it remains lower than the target of 60% by 2020. There are also huge disparities sub-nationally, ranging from 25% to 60%. While there is a strong need to monitor the progress of family planning program regularly at the national and sub-national level, Myanmar has limited surveys, data quality and methodological issues in its Health Management Information System (HMIS), and a scattered rollout of the Logistic Management Information System (LMIS). Methods: To identify viable options for annual monitoring, four data sources: modelled contraceptive prevalence rate for modern methods (mCPR) estimates from Track20’s Family Planning Estimation Tool (FPET); method-specific prevalence from the 2015-16 Myanmar Demographic and Health Survey (DHS); mCPR estimates and method prevalence from HMIS and estimates of modern method use (EMU) based on commodity consumption data from LMIS, were used to compare for the years 2015-2017. Estimates of mCPR from HMIS were tested for accuracy based on whether they fell within the 95% confidence interval of mCPR estimates from the FPET for the corresponding years. EMU from LMIS was also tested for those years and states/regions where available. Results: For annual tracking of mCPR, direct estimates of HMIS were considered; they were much higher than those of the DHS survey and were not matched by FPET results, except in Chin and Kayin. To monitor the method mix, HMIS data can be used as these are similar pattern with DHS in both national and State/Regional level except Chin and Kayin. LMIS could be used in annual tracking when there are high reporting rates and valid information of consumption. Conclusions: Track20’s FPET is the method of choice to get valid information for annual monitoring of family planning program.

Setting the stage for strengthened annual monitoring of family planning program performance at the state/national level in Myanmar

Background: Although Myanmar has made good progress in family planning by increased contraceptive prevalence rate (CPR) from 41% in 2007 to 52.2% in 2016, it remains lower than the target of 60% by 2020. There are also huge disparities sub-nationally, ranging from 25% to 60%. While there is a strong need to monitor the progress of family planning program regularly at the national and sub-national level, Myanmar has limited surveys, data quality and methodological issues in its Health Management Information System (HMIS), and a scattered rollout of the Logistic Management Information System (LMIS). Methods: To identify viable options for annual monitoring, four data sources: modelled contraceptive prevalence rate for modern methods (mCPR) estimates from Track20’s Family Planning Estimation Tool (FPET); method-specific prevalence from the 2015-16 Myanmar Demographic and Health Survey (DHS); mCPR estimates and method prevalence from HMIS and estimates of modern method use (EMU) based on commodity consumption data from LMIS, were compared for the years 2015-2017. Estimates of mCPR from HMIS were tested for accuracy based on whether they fell within the 95% confidence interval of mCPR estimates from the FPET for the corresponding years. EMU from LMIS was also tested for those years and states/regions where available. Results: For annual tracking of mCPR, direct estimates of HMIS were considered carefully, as they were much higher than those of the DHS survey and were not matched by FPET results, except in Chin and Kayin. To monitor the method mix, HMIS data can be used as these are similar pattern with DHS in both national and State/Regional level except Chin and Kayin. LMIS could be used in annual tracking when there are high reporting rates and valid information of consumption. Conclusions: Track20’s FPET is the method of choice to get valid information for annual monitoring of family planning program.

Contraceptive Dynamics in Rural Northern Malawi: A Prospective Longitudinal Study.

Increased use of contraceptives in Malawi has not translated into a commensurate reduction in fertility, but the reason is unknown. Insight into contraceptive switching and discontinuation may shed light on this conundrum and on whether the commonly used modern contraceptive prevalence rate (mCPR) is the best indicator of family planning program performance. A one-year prospective longitudinal data set was created from patient-held family planning cards of 4,678 reproductive-age women living in a demographic surveillance site in rural northern Malawi. Contraceptive service data recorded on the women's cards by providers were linked to their socioeconomic, demographic and health data. Contraceptive point prevalence estimates calculated from these data were compared with mCPR estimates from cross-sectional surveys. Survival analyses examined contraceptive adherence. The contraceptive point prevalence of 35% was slightly lower than comparable cross-sectional estimates of mCPR. Only 51% of users of the injectable-the most widely used modern method-received their first reinjection on time, and just 15% adhered to the method for 12 months. Although various study variables were associated with contraceptive use, none were associated with adherence. Gaps in and discontinuation of use of the injectable may play a role in the discrepancy between mCPR and fertility. Interventions to help women adhere to injectable use and to promote long-acting methods should be strengthened.

'Only systems thinking can improve family planning program in Pakistan': A descriptive qualitative study.

Family Planning (FP) program in Pakistan has been struggling to achieve the desired indicators. Despite a well-timed initiation of the program in late 50s, fertility decline has been sparingly slow. As a result, rapid population growth is impeding economic development in the country. A high population growth rate, the current fertility rate, a stagnant contraceptive prevalence rate and high unmet need remain challenging targets for population policies and FP programs. To accelerate the pace of FP programs and targets concerned, it is imperative to develop and adopt a holistic approach and strategy for plugging the gaps in various components of the health system: service delivery, information systems, drugs-supplies, technology and logistics, Human Resources (HRs), financing, and governance. Hence, World Health Organization (WHO) health systems building blocks present a practical framework for overall health system strengthening. This descriptive qualitative study, through 23 in-depth interviews, explored the factors related to the health system, and those responsible for a disappointing FP program in Pakistan. Provincial representatives from Population Welfare and Health departments, donor agencies and non-governmental organizations involved with FP programs were included in the study to document the perspective of all stakeholders. Content analysis was done manually to generate nodes, sub-nodes and themes. Performance of FP programs is not satisfactory as shown by the indicators, and these programs have not been able to deliver the desired outcomes. Interviewees agreed that inadequate prioritization given to the FP program by successive governments has led to this situation. There are issues with all health system areas, including governance, strategies, funding, financial management, service delivery systems, HRs, technology and logistic systems, and Management Information System (MIS); these have encumbered the pace of success of the program. All stakeholders need to join hands to complement efforts and to capitalize on each other's strengths, plugging the gaps in all the components of FP programming. All WHO health system building blocks are interrelated and need to be strengthened, if the demographic targets are to be achieved. With this approach, the health system shall be capable of delivering fair and responsive FP services.

Improving family planning program performance through management training: the 3Cs paradigm.

Action research was conducted in Bangladesh to determine whether a high level of fertility control behavior can be attained in a country of very low socioeconomic status, including very low levels of literacy and women's status, and if management training help can improve the performance of service delivery systems. 20 family planning officials participated in a 14-week, non-degree, management training program conducted in Dhaka. The research found that competently executed determined effort is a far faster and more effective alternative to socioeconomic development-led contraception in a developing population. A carefully designed and executed intervention can achieve a high level of contraceptive use, and thereby control fertility, without waiting for significant improvement in a country's socioeconomic indicators. For example, in the 19 experimental thanas, the contraceptive prevalence rate increased by an average of approximately 10 percentage points within 12 months of training. These findings demonstrate how a task-focused, well-designed, and properly conducted management training, backed by well organized and managed follow-up, can effect major improvement in a system's effectiveness and productivity, even if that system is staffed by a demoralized and apathetic work force.

The effect of structural characteristics on family planning program performance in Côte d’Ivoire and Nigeria

This paper uses Côte d’Ivoire and Nigeria survey data on both supply and demand characteristics to examine how structural and demographic factors influence family planning provision and cost. The model, which takes into account the endogenous influence of service provision on average cost, explains provision well but poorly explains what influences service cost. We show that both size and specialization matter. In both countries, vertical (exclusive family planning) facilities provide significantly more contraception than integrated medical establishments. In the Nigeria sample, larger facilities also offer services at lower average cost. Since vertical facilities tend to be large, they at most incur no higher unit costs than integrated facilities. These results are consistent across most model specifications, and are robust to corrections for endogenous facility placement in Nigeria. Model results and cost recovery information point to the relative efficiency of the International Planned Parenthood Federation, which operates large, mostly vertically organized facilities.

Population and Family Planning: An International Perspective

Since the 1960s, the U.S. government has supported population and family planning programs in Third World countries, on the grounds that rapid population growth impairs the ability of those countries to develop economically; family planning programs contribute to fertility decline; and such programs help improve the health of mothers and children. Although the United States remains the largest single donor of funding for international population programs, its support has weakened during the eight years of the Reagan administration and patterns of funding for those programs have changed substantially. Since the 1960s, however, contraceptive use has increased in the Third World and fertility has fallen substantially. The decline has been uneven, though--considerable in some countries, moderate in others but very small in many. The performance of family planning programs around the world has varied widely, and questions remain as to what, if anything, can be done to increase success. For the future, three aspects of population and fertility control in developing countries merit special attention: the supply of contraceptive commodities going to family planning programs; the maintenance and strengthening of the family planning infrastructure; and the need to examine the policy implications of differing patterns of fertility and population growth for national development and individual well-being.

Socio-economic determinants of fertility in some countries of Asia.

An attempt is made in this analysis to determine the individual contribution of 6 factors--health variables, educational variables, variables showing status of women, economic variables, modernization variables, and family planning program performance variables--in determining the level of fertility on the basis of available data for 13 Asian countries. Path analysis and stepwise regression analysis were used. The pattern of the interrelationship between different categories of the variables which are affecting fertility and family planning performance are schematically represented in a chart. The model assumes that socioeconomic development of a country is a precondition for further mortality and fertility decline. The application of the model to any empirical situation calls for the determination of the indicators of the output variable (fertility) and other explanatory factors such as socioeconomic development, modernization, and health variables. For this study only 13 developing countries with 11 variables that are highly correlated with the fertility variables for the year 1975 were selected. 2 measures of fertility, i.e., total fertility rate (TFR) and crude birthrate (CBR) were taken for the purpose of the analysis and are denoted by Xo. The important background variables linked to fertility decline were literacy, urbanization, gross national product (GNP) per capita, and economically active female population in that order. Infant mortality and family planning were the most proximate variables to fertility. One of the reasons that fertility levels varied among the countries was that most of the countries have not as yet crossed the lower limits of the threshold zones with respect to most of the indicators. Except for 3 or 4 of the countries, none of the countries had entered the threshold zone for all the indicators. Particularly countries like Bangladesh, Nepal, and Pakistan were far below the lower limit of threshold zone in respect to all of the indicators, and in these countries the fertility declines were very low. Countries like Hong Kong, Korea, Malaysia, and Singapore had already crossed the threshold zones for almost all of the indicators, and there has been a rapid decline in fertility in these countries. Countries like Sri Lanka and the Philippines have entered the threshold zone only for some of the indicators and hence experienced only moderate fertility decline. As the data used for the analysis are of limited reliability, the findings should be taken only as tentative.

Population Policy in India: Recent Developments and Current Prospects

The loose coalition of regional and special interest parties that united to defeat Indira Gandhi in the 1977 elections and form the Janata government initially adopted a position of benign neglect toward the family planning and population programs instituted by the previous government. By 1978 there were signs of increasing concern among government officials private organizations and the media regarding the inadequacy of family planning program performance. In 1979 a massive foreign assistance program was introduced to provide primary health care including family planning in selected districts and states during 1980-85. 2 concerns are likely to characterize the current governments policy formulation in this area: the governments continued belief that fertility decline is a vital component of Indias development efforts and a concern not to arouse the type of backlash that occurred 3 years ago. A cautious but concerted revitalization of the family planning program seems likely. (Authors)

Evaluation of family planning program performance: A critical review

Abstract Family Planning Program Evaluation is not a well-developed art, much less an exact science. The evaluation of the performance of such programs has received a good deal of attention but the methodologies are still controversial and the results inconclusive. This is due to a wide variety of constraints, not all of which are technical, and most of which are not unique to family planning. The prospects for improvement of FPPE depend, to a great extent, on overcoming these constraints.