Academic journal article International Perspectives on Sexual and Reproductive Health

The Role of Public-Sector Family Planning Programs in Meeting the Demand for Contraception in Sub-Saharan Africa

Academic journal article International Perspectives on Sexual and Reproductive Health

The Role of Public-Sector Family Planning Programs in Meeting the Demand for Contraception in Sub-Saharan Africa

Article excerpt

CONTEXT: Commonly used indicators of contraceptive behavior in a population--modern contraceptive prevalence (mCPR), unmet need for contraception, demand for contraception and demand satisfied--are not well-suited for evaluating the progress made by government family planning programs in helping women and men achieve their reproductive goals.

METHODS: Trends in these measures in 26 Sub-Saharan African countries between 1990 and 2014 were examined. Trends in a proposed new indicator, the public-sector family planning program impact score (PFPI), and its relationship to mCPR and the family planning effort score were also assessed. Case studies were used to review public family planning program development and implementation in four countries (Nigeria, Ethiopia, Rwanda and Kenya).

RESULTS: The four commonly used indicators capture the extent to which women use family planning and to which demand is satisfied, but shed no direct light on the role of family planning programs. PFPI provides evidence that can be used to hold governments accountable for meeting the demand for family planning, and was closely related to policy developments in the four case-study countries.

CONCLUSIONS: PFPI provides a useful addition to the indicators currently used to assess progress in reproductive health and family planning programs.

International Perspectives on Sexual and Reproductive Health, 2017, 43(2):41-50, https://doi.org/10.1363/43e3917

The Millennium Development Goals (MDGs) included several health goals, of which Goal 5 was to "improve maternal health." (1) Target 5B for this goal was to "achieve, by 2015, universal access to reproductive health." Several indicators, including contraceptive prevalence and unmet need for family planning, were used to monitor progress toward this target. The subsequent Sustainable Development Goals (SDGs), to be achieved by 2030, have a single comprehensive health goal (Goal 3), to "ensure healthy lives and promote well-being for all at all ages." (2) One of its targets, 3.7, is to "ensure universal access to sexual and reproductive health-care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programmes." The family planning indicator for this target is the "proportion of women of reproductive age (15-49 years) who have their need for family planning satisfied with modern methods."

To make progress on the MDG and SDG targets for reproductive health, many countries have invested in voluntary family planning programs. A key rationale for these programs is to assist women and men in achieving their reproductive goals by providing access to a range of contraceptive methods, as well as information about these methods and their benefits. (3) Investments in these programs are intended to address the substantial unsatisfied demand for contraception that results in unplanned pregnancies. Each year about 73 million unintended pregnancies occur in the developing world (of which 49% end in induced abortions), with detrimental health and economic effects for many women, children and families. (4)

In this article, we first examine trends in widely used MDG and SDG indicators of contraceptive behavior to determine those most suitable for assessing progress in improving women's ability to implement their reproductive preferences; this is of interest because the related indicators in the MDGs and the SDGs differ. (1,2) We focus on Sub-Saharan Africa, where the level of contraceptive use is well below half the levels in Asia or Latin America, (5) unmet need remains high (5-7) and family planning programs are often weak. (8) Next, we propose a new indicator to assess the role of public family planning programs in satisfying demand for contraception, which the standard MDG and SDG indicators are not designed to estimate. Finally, we discuss case studies of family planning program development and related policy changes in four countries to add context to the findings on trends in the role of the public family planning programs. …

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