CONTENTS
August, 1994 |
Thirty Years of Family Planning Programs Family planning programs have made a difference. Nearly 400 million women in developing countries use family planning to prevent unintended pregnancies. In the last 30 years the percentage of couples in developing countries using contraception has risen fivefold, from less than 10% in the 1960s to over 50% today (202). Fertility has dropped from an average of about six children per woman in the 1960s to about four today (47). (By comparison, in countries that have completed the transition from high to low fertility, about 70% of married women of reproductive age use contraception, and the average couple has about two children.) The existence of family planning programs helps explain this change—and why fertility in developing countries is falling nearly twice as fast today as in Europe during its fertility transition a century ago, when family planning movements had no modern contraceptive methods to offer, lacked government support, and often faced legal and religious opposition. During the past 30 years family planning programs have enabled women in developing countries to avoid more than 400 million births (21 ). Without family planning programs the total fertility rate for 1980-85 would have been 5.2 children per woman instead of 4.2 (16). Family planning programs and socioeconomic development both have played important roles in recent fertility declines. Among the developing countries, contraceptive use generally is at the highest levels in countries that are most economically developed and at the same time have the strongest family planning programs. Even in some countries where social and economic conditions have improved little, however, contraceptive use has risen substantially. For example, in Bangladesh more than 40% of married women of reproductive age now use contraception. Independent of the influence of social and economic development, contraceptive use typically is higher in countries with strong family planning programs (94 ). Family planning programs provide people with contraceptive information, supplies, and services. Successful family planning programs, as defined here, are those that make possible the rapid spread of voluntary use of modern contraceptive methods throughout a country. Such programs help people achieve their personal reproductive goals. Typically, they also are part of a country's overall plan for socioeconomic development. In many developing countries family planning programs began as local services offered by voluntary agencies and pioneered by doctors and women's organizations (32 , 72). These nongovernmental organizations (NGOs) established the original family planning delivery systems in most countries. Some family planning associations (FPAs) became linked as affiliates of the International Planned Parenthood Federation (IPPF). As interest in family planning spread in the 1960s and 1970s, some governments used these early networks of services as foundations upon which to construct national family planning programs (32 ). In most countries family planning programs that became well established in the 1970s grew stronger during the 1980s (109). What makes family planning programs successful? No single formula for the design of family planning programs suits all countries or cultures (16). Family planning programs must do many things well to succeed (109, 155 ). Still, the experiences of programs during the last 30 years have yielded valuable lessons. To find a consensus about the characteristics of successful programs, Population Reports asked about 100 professionals knowledgeable about family planning programs to identify the factors that they considered to be most important. Responses came from about 60 people in most regions of the world. Some respondents are family planning officials in developing countries; others are health and population officers and other professionals with the United States Agency for International Development (USAID); still others are experts in research or technical assistance. (For the names and affiliations of all respondents, see bibliography entries 214-270). Population Reports also reviewed the literature on family planning programs, particularly studies of the elements of success, and consulted other reviews of lessons learned (see side-bar, Family Planning Lessons and Challenges: Other Reviews). |