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Studies in Family Planning: “Aligning Goals, Intents, and Performance Indicators in Family Planning Service Delivery”

Photo credit: Richard Lord

NEW YORK (10 March 2015) — In the March 2015 issue of Studies in Family Planning, a commentary by Population Council social scientists Saumya RamaRao and Anrudh K. Jain contends that many promising family planning initiatives will meet their service delivery goals only if measures of performance are in line with the underlying intent of the initiatives.

“The goal of family planning programs today is to help individuals determine whether, when, and how many children to bear,” explains Saumya RamaRao, senior associate at the Population Council and lead author of this commentary, “Aligning Goals, Intents, and Performance Indicators in Family Planning Service Delivery.”  “Program design and measurement indicators must align logically with this intent to assist women to realize their reproductive desires and protect their rights.”

The authors point to past family planning programs—specifically those prior to the 1994 International Conference on Population and Development (ICPD)—to demonstrate how misalignment between goals, indicators, and programmatic intent can lead to program activities that do not produce the desired results. The stated goal of these older family planning programs was to reduce fertility and population growth, while their overall intent was to improve human well-being. Performance was measured using the contraceptive prevalence rate (CPR) and total fertility rate (TFR), which assessed movement toward the stated goals but resulted in programs that did not necessarily promote individual rights or well-being.

The authors contend that while family planning programs no longer simply serve population and development ends, this shift in understanding has not come hand-in-hand with the creation and use of new indicators to measure success in achieving the broader goal of improving reproductive health and upholding individual reproductive rights.

FP2020 is an exciting family planning initiative that has recently energized the population and development and reproductive health fields. It has set the ambitious goal of reaching 120 million additional users of modern contraceptive methods by the year 2020 in the world’s poorest 69 countries. The authors argue that the goal of FP2020 must be clarified: Is the goal to reach 120 million more women with information, access, and services, or is it to increase the number of users by 120 million women?

Second, the metrics of measuring success need to be aligned with the stated goal. For example, if the goal is to increase access to modern contraceptives for women and girls through a rights-based approach, then appropriate indicators—such as service-delivery environment, client–provider interaction, and quality of care—should be adopted. Placing priority on these indicators will have a positive effect on how programs are designed and services are delivered.

Given the number of ambitious global family planning policy initiatives currently underway, the authors argue that now is the time to ensure that goals and indicators reflect the intent to promote well-being and support the reproductive rights of all women and girls.  

Studies in Family Planning March Issue: Table of Contents


Peer Influences on Sexual Activity among Adolescents in Ghana
Jeffrey B. Bingenheimer, Elizabeth Asante, and Clement Ahiadeke

  • Little is known about the influences of peers on the sexual activity of adolescents in sub-Saharan Africa. Researchers used survey data from 1,275 adolescents in two towns in southeastern Ghana to examine age, sex, and community differences in peer group characteristics, as well as prospective associations between these characteristics and self-reported sexual initiation and multiple partnerships during a 20-month follow-up period. Their findings have implications for adolescent sexual and reproductive health interventions in sub-Saharan Africa, and the authors conclude that peer-based interventions may be best suited to the needs of at-risk adolescent boys.

The Constraints of Distance and Poverty on Institutional Deliveries in Pakistan: Evidence from Georeference-Linked Data
Anrudh K. Jain, Zeba A. Sathar, and Minhaj ul Haque

  • Institutional deliveries in Pakistan have risen substantially over the last few years, primarily among the wealthy and those with access to services in urban areas. Using household survey data and georeferenced distance to facilities with obstetric care services, this article assesses the influence of economic and geographic access to health facilities on institutional deliveries. Researchers found that the odds of an institutional delivery decreased with every kilometer increase in distance to a facility, while household wealth and availability of at least basic emergency care within 10 kilometers substantially increased the odds of an institutional delivery. They recommend minimizing disadvantages faced by poor women by upgrading facilities at district and subdistrict levels to provide comprehensive emergency care and by facilitating the transportation of poor rural women directly to these facilities when they experience life-threatening complications of childbirth.

Integrating Population, Health, and Environment Programs with Contraceptive Distribution in Rural Ethiopia: A Qualitative Case Study
Lianne Gonsalves, Samuel E. Donovan, Victoria Ryan, and Peter J. Winch

  • Environmental degradation and a shortage of arable land impose a major toll on the population of rural Ethiopia. This study examines the community-based distribution of family planning commodities in rural Ethiopia through the Ethio-Wetlands and Natural Resources Association’s large, multisectoral population, health, and environment (PHE) program. Researchers found that the integrated program encouraged acceptance of family planning and reduced geographic barriers to access, providing a model for PHE programs worldwide, especially amid the global response to climate change, and they used these findings to propose a framework to assess PHE integration.

Female Sex Workers’ Experiences with Intended Pregnancy and Antenatal Care Services in Southern Tanzania
Sarah W. Beckham, Catherine R. Shembilu, Heena Brahmbhatt, Peter J. Winch, Chris Beyrer, and Deanna L. Kerrigan

  • Understanding the pregnancy experiences of female sex workers (FSWs), especially in the context of high rates of HIV and sexually transmitted infections, is essential to tailoring services to meet their needs. Researchers explored FSWs’ experiences with intended pregnancy and access to antenatal care (ANC) and HIV testing in two regions of Tanzania. Although pregnant FSWs typically sought ANC services, most did not disclose their occupation, complicating provision of appropriate care. In addition, women were sometimes denied services when they were not accompanied by their husband. These findings have potential social and health consequences in light of the high levels of HIV and STIs among FSWs in sub-Saharan Africa.

Personal Beliefs and Professional Responsibilities: Ethiopian Midwives’ Attitudes toward Providing Abortion Services after Legal Reform
Sarah Jane Holcombe, Aster Berhe, and Amsale Cherie

  • In 2005, Ethiopia liberalized its abortion law and subsequently authorized midwives to offer abortion services. Researchers used a 2013 survey of midwives and interviews with third-year midwifery students to examine midwives’ attitudes toward abortion and better understand their decisions about service provision. They found that most midwives were willing to provide abortion services; however, certain factors, especially religious beliefs, negatively affected willingness. These findings can inform Ethiopia’s efforts to reduce maternal mortality through task-shifting to midwives and can aid other countries that are confronting provider shortages and high levels of maternal mortality and morbidity, particularly as a result of unsafe abortion.

Studies in Family Planning (SFP) is a peer-reviewed, international journal publishing public health, social science, and biomedical research on sexual and reproductive health, fertility, and family planning, with a primary focus on developing countries. SFP is published quarterly on behalf of the Population Council by Wiley-Blackwell.

The Population Council conducts biomedical, social science, and public health research. We deliver solutions that lead to more effective policies, programs, and technologies that improve lives around the world.

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