The International Family Planning Movement

1. The International Family Planning Movement INHL 681 October 8, 2001

2. 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

3. 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)

4. 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

5. 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”

6. 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

7. International donor agencies • Multi-national: UNFPA • Bi-lateral: • US: USAID • Japan, EU, Canada, etc. • Private foundations: • Ford, Rockefeller, Mellon • Hewlett, Packard, • Gates

8. 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)

9. POP QUIZ: Item #1 • Does a country need to have an official population policy to have a successful family planning program?

10. The “cafeteria approach” to contraception: modern methods • Female Sterilization • IUD • Pill • Injectables • Implants (NORPLANT) • Condoms, spermicides (barrier methods) • Vasectomy

11. Traditional methods • Rhythm (calendar, sympto-thermal, Billings) • Withdrawal • Abstinence • Post-partum abstinence • “Folkloric” (cord, herbs, etc.)

12. POP QUIZ: Item #2 • What is the best contraceptive method?

13. 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

14. 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 disadvantages to clinic-based services

15. 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 disadvantage of community based distribution

16. 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 Advantages and Disadvantages of Social Marketing

17. POP QUIZ: Item #3 • What is method mix?

18. 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)

19. POP QUIZ: Item #4 • What is the relevance of this slide?

20. 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

21. 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

22. 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 Expansion of FP to reproductive health: adults

23. Family planning is rarely boring…

24. 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

25. 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???

26. 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?

27. 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

28. 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

29. Successful Programs • POP QUIZ #4: • HOW DO YOU MEASURE SUCCESSFUL PROGRAMS?

30. 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?

31. Elements of a successful program • Access to services • Quality of care • Voluntarism • Success facilitated by: • strong socio-economic conditions • strong political will

32. Final Pop Quiz Question • Why is Bangladesh such a unique country in terms of its record for family planning?

33. Questions?