the international family planning movement inhl 681 october 8, 2001
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Overview of the presentation
Roots to the FP movement, objectives Design issues:
– Supply and demand factors– Donor and in-country implementing agencies– Range of contraceptive methods– Mechanisms for service deliver
Policies and controversies Successful programs
Roots to the FP movement
Earliest programs: in Asia– Demographically driven– Part of nationalistic development programs
Establishment of IPPF and the Population Council in 1952
Indian FP program began in the 1950s Expansion to Asia and L.A. in the 1960s-70s and
to Africa in the 1980s (dates vary by country)
Objectives of family planning programs
Demographic– Often linked to development goals
Maternal and child health– Avoid births “too early, too late, too frequently, and
too numerous”
Reproductive choice– Primary concern in Western countries– Popularized by the Cairo Conference in 1994
Supply and Demand
Demand: larger social, economic, cultural, and legal factors that affect the demand for children and (in turn) the demand for FP:– Social: status of women, levels of education– Economic: level of living, labor force participation– Cultural: religion, ethnic belief systems– Legal: age at marriage, laws re contraception
Demand = “what people want”
Supply: the family planning supply environment
Supply = what people can get (in terms of FP) Access:
– How many facilities, how close?– What methods are available, how convenient?
Quality:– Choice of methods, info given to client,
interpersonal relations, technical competence, continuity, other services
International donor agencies
Multi-national: UNFPA Bi-lateral:
– US: USAID– Japan, EU, Canada, etc.
Private foundations:– Ford, Rockefeller, Mellon– Hewlett, Packard, – Gates
In-country implementing agencies
Ministry of Health Para-statal (vertical) organizations: “Office” in
Tunisia, BKKBN (Indonesia) IPPF affiliate: the private FP association International and local PVOs/NGOs (e.g.,
CARE, Save the Children) Other private groups (e.g., missionaries)
POP QUIZ: Item #1
Does a country need to have an official population policy to have a successful family planning program?
The “cafeteria approach” to contraception: modern methods
Female Sterilization IUD Pill Injectables Implants (NORPLANT) Condoms, spermicides (barrier methods) Vasectomy
Traditional methods
Rhythm (calendar, sympto-thermal, Billings) Withdrawal Abstinence Post-partum abstinence “Folkloric” (cord, herbs, etc.)
Types of service delivery mechanisms
Clinic-based Community-based distribution (CBD) Social marketing
Approaches: integrated vs. vertical Public versus private sector Expansion of FP toward RH: Cairo
Advantages and disadvantages to clinic-based services
ADVANTAGES: “Western model of
health service delivery Used for other family
health needs Large range of
methods Trained personnel
DISADVANTAGES: Limited access,
especially in rural areas
Expensive to establish and maintain
May have low QC
Advantages and disadvantage of community based distribution
ADVANTAGES: Increases access,
expands coverage Provider known to and
trusted by community Open after “clinic
hours”
DISADVANTAGES: Controversial (esp.
with medical comm.) Limited range of
methods Limited info on
management of S.E. High turnover of non-
salaried personnel
Advantages and Disadvantages of Social Marketing
ADVANTAGES: Shifts program costs
from gov’t to private sector (sustainability)
Increases access, esp. in urban areas
Greater ease for consumer
Preference to “buy”
DISADVANTAGES: Less control by
program personnel Less opportunity for
IEC Lack of clinical
services for side effects
Typical divisions within a national FP/RH program
Management/supervision Training Commodities and logistics I-E-C Research/monitoring & evaluation
(Note: these areas “map” to the curriculum in the Dept. of IHD)
The three international population conferences
1974: Bucharest:– “Development is the best contraceptive.”
1984: Mexico City– The legacy of the Mexico City Policy
1994: Cairo– Compromise of demographers and feminists– Expansion of FP to broader RH services
What is reproductive health?
Reproductive health is a state of complete physical and social well-being and not merely the absence of disease or infirmity, in all matters relating to the reproductive system and to its functions and processes.
– International Conference on Population and Development, Cairo, 1994
Expansion of FP to reproductive health: adults
Unintended pregnancy Unsafe abortion (if legal) Complications of
childbirth Maternal anemia STD/HIV/AIDS Violence against women Infertility
Family planning Legal, safe abortion Safe motherhood
Prenatal care Prevention, treatment Legal action, awareness Treatment of STDs
Controversies in Family Planning:Part II
Use of incentives and targets CYP and performance targets Abortion: U.S. and abroad The role of USAID Programs for unmarried youth
The use of targets and incentives
Incentives: began in Asia in demographically driven programs
India: transistor radios; sterilization targets China: incentives and disincentives to achieve
the one child policy (“beyond FP”)
“Grey areas” – compensation of clients for lost time from work, transportation, a clean sari???
CYP and performance targets
CYP=couple years of protection Long-term methods contribute more CYP than
resupply methods
Pre-Cairo: promoting long-term methods was “good” for programs and for women
Post-Cairo: is the promotion of long-term methods simply to increase CYP?
The spillover of the abortion debate in the US to international FP
“Family planning prevents abortion” In the US, Planned Parenthood has vigorously
defended abortion rights Conservative “Right to Life” groups in the U.S.
extend their attack of Pro-Life groups in the U.S. to the international FP community
Controversy in the US Congress over FP = is really about abortion
Mexico City clauses
Controversy over adolescent programs for unmarried youth
In many countries, FP is not longer an issue Why youth programs are needed:
– Youth < 15 = 40% in many countries– Modernization, influences from Western media– Increasing age at marriage– Decreasing social controls with urbanization– Economic conditions increase risk to youth (e.g., the
Sugar Daddy phenomenon in Africa)– Consequences: morbidity, mortality
Successful Programs
Asia: Thailand, Indonesia, China (?) Latin America: Colombia, Costa Rica Africa: Zimbabwe, Kenya, Botswana
POP QUIZ #5: What are the elements of a successful
program?
Elements of a successful program
Access to services Quality of care Voluntarism
Success facilitated by:– strong socio-economic conditions– strong political will
Final Pop Quiz Question
Why is Bangladesh such a unique country in terms of its record for family planning?
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