AID's family planning program in Honduras

Early attempts by A.I.D. and aggressive advisors to install visible FP services in the Ministry of Health (MOH) failed, so A.I.D. shifted most of its support to the private sector Honduran Family Planning Association (ASHONPLAFA), beginning in 1981. It also began portraying FP as a health intervention to reduce the rate of high-risk births that could lead to infant and maternal mortality. Due in good part to A.I.D.'s assistance, Honduras' total fertility rate has declined from 6.4 children per family in 1981 to about 5.1 in 1992. However, given the country's contraceptive prevalence rate of 46.7%, fertility should be lower than it is. The extensive use of inefficient methods (rhythm and withdrawal, which are growing faster than modern methods), high discontinuation rates, early onset of childbearing, low levels of exclusive breastfeeding, and the variable quality of FP services (especially in MOH clinics) may be some of the factors to blame. Moreover, there is a general feeling that the A.I.D. program has been overly cautious due to fear of public attacks. The institutional conditions for a strong program have been created by A.I.D., and now perhaps the greatest need is for improved promotional activities. In sum, the Honduran program shows that A.I.D.-supported FP can succeed -- if presented as a health program -- even in a potentially hostile political environment; that providing complementary assistance in the public and private sectors is a sound strategy; and that fees high enough to cover most costs are not an obstacle to widespread use of FP services.