Study of family planning program effectiveness

This paper analyzes the results of a review of the literature on the relation of demand and supply determinants to FP effectiveness; it also develops guidelines to determine the conditions under which a major FP action is appropriate. The literature review found that FP programs do make a difference in the rate of fertility decline; progress in development alone is not enough. Key variables such as adult literacy, education, life expectancy, infant mortality, and GNP per capita combine to create the social context within which FP programs are implemented. The existence of favorable levels of achievement in these areas does not, however, necessarily guarantee the success of FP programs, just as their absence does not guarantee failure. For example, Indonesia and the Philippines have achieved high levels of contraceptive use despite development conditions that should preclude a demand for FP services, while Venezuela and Mexico have progressed rapidly on the development scale but are unable to achieve real decline in fertility levels. A set of theoretical guidelines to achieve rapid fertility decline are presented for further study. First, a country's social setting should be examined to determine the appropriate role for the public sector. If the setting is favorable, and fertility is declining even in the absence of a major public effort, the role of the state can be limited to ensuring the availablity of FP services. If, on the other hand, decline in fertility is slow or nonexistent, the state needs to be more active. The paper's major conclusion is that political will and administrative capability alone cannot overcome basic sociocultural obstacles unless direct government action on reproductive behavior is an important feature of the program. Recommendations for specific countries conclude the paper.