Provision of Family Planning Services in Lesotho
Tuoane, 'Maletela, Madise, Nyovani Janet, Diamond, Ian, International Family Planning Perspectives
CONTEXT: One of Lesotho's population goals is to achieve replacement-level fertility by 2011, but the contraceptive prevalence rate of 41% is considerably below the target of 70-75%.
METHODS: A situation analysis framework was used to assess family planning providers' readiness to provide services and women's perceptions of service delivery. Data were collected in 1997-1998 through surveys of 38 service delivery points and 52 providers, and focus group discussions with 50 women.
RESULTS: Most facilities were open five days a week, during working hours; closure during lunchtime and on weekends restricted access by employed people. There were no clear guidelines on the provision of family planning methods, and providers created their own rules and restrictions. Some women were discouraged by provider bias, lack of visual privacy and recurrent shortages of their preferred brand of pills. Although the government had a uniform pricing policy for contraceptive methods, costs varied and generally were higher in rural than in urban areas. In rural areas, transportation costs increased the overall cost of using family planning methods.
CONCLUSIONS: Expanding women's access to service sites, developing guidelines for family planning providers and ensuring that standard prices are adopted should be government priorities if contraceptive prevalence is to increase.
International Family Planning Perspectives, 30(2):77-86
For a long time, little was known about fertility in Lesotho. The 1977 Lesotho Fertility Survey reported that the total fertility rate averaged five births per woman, a moderate level by Sub-Saharan African standards. Because only 7% of married women of reproductive age were using contraceptives in 1977, this moderate fertility level may have resulted from long periods of postpartum abstinence due to male labor migration to South African mines. (1) The last three national censuses (conducted in 1976, 1986 and 1996) have documented a decline in the total fertility rate from 5.6 to 4.1 births per woman. (2) Nevertheless, the government considers fertility too high. To prevent adverse consequences of rapid population growth, such as a high unemployment rate, poor economic performance, a high demand for social services and a decrease in resources, the government adopted a population policy in 1994 whose aim is to achieve replacement-level fertility (a total fertility rate of about 2.2 children per woman) by 2011. (3)
A major strategy of the population policy has been to expand the family planning program so that contraceptive prevalence increases to 70-75% by 2011. Specifically, the policy aims to provide a wide range of family planning methods as an integral part of health care at all service levels; to equip hospitals and clinics to provide IUDs, sterilization and injectable contraceptives; and to provide adequate information, education and communication. An initial goal was to raise contraceptive prevalence to 31% by 1996. In 1998, prevalence was estimated to be only 23%, (4) but it increased to 41% in 2001. (5)
The 1994 population policy had several limitations. For example, its demographic targets were not all based on research and were overly optimistic, and maternal mortality and HIV/AIDS were not given adequate consideration. In addition, because the policy predated the 1994 United Nations-sponsored International Conference on Population and Development, it did not reflect the conclusions and recommendations contained in the conference's Programme of Action (for example, on issues of reproductive health and rights, adolescents' and young people's health concerns, gender equality, equity and empowerment of women). (6) As a result, a revised version of the policy has been under review for several years.
Although critics have questioned the magnitude of family planning programs' impact on fertility reduction, programs unquestionably still have a vital role to play in the demographic transition of Sub-Saharan African countries. …