The International Family Planning Movement

INHL 681

October 8, 2001

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.)

POP QUIZ: Item #2

What is the best contraceptive method?

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

POP QUIZ: Item #3

What is method mix?

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)

POP QUIZ: Item #4

What is the relevance of this slide?

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

Family planning is rarely boring…

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

POP QUIZ #4:

HOW DO YOU MEASURE SUCCESSFUL PROGRAMS?

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?

Questions?