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Family Planning and Education Are Key for Women Worldwide

Why family planning and education for young girls and women is so vital..

Posted February 19, 2020

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In a northern state in India, known as Uttar Pradesh, a woman named Meena has just met her newborn child. She is joyful while breastfeeding in the crucial hours after giving birth to a healthy little one. She gave birth with help from the Sure Start program, which helps mothers give birth in clinics, assisted by a birth attendant and with the right equipment.

Now, consider yourself going to congratulate her on the good news. By joining, chances are you’ll share in her state of elation, as most couples cry at delivery from tears of joy. But, if the scene doesn’t already pull at your heartstrings, this might: Imagine Meena asks you to take her newborn child with you. Not only her newborn but her other little one as well.

Meena faces an uncertain future in an impoverished area in India without the means to secure education for her children and without assurance they will be okay with her as their mother. Meena herself hasn’t heard about family planning services or accessing contraceptives until now. “It’s too late for me,” she says.

Ultimately, Meena’s hopes for a brighter future for her babies. The uncertainty is too difficult to bear. Make no mistake—Meena is a mother in search of help for her family.

Why Can’t We Provide the Help Meena Needs?

Today, childbirth is the leading cause of death for teenage girls, aged 15 to 19, around the world.

As a result of cultural biases, child marriages, and impoverished conditions, girls as young as 9 years of age are married and face pregnancy in their teenage years in countries like Niger and Senegal. When they are married off, the promises of education fall to the curb and early motherhood often becomes their destiny.

Young mothers lacking an education, studies show , are less able to avoid poverty, avoid premature illness or death, or keep their families healthy. Families thrive less—and the world is a less healthy place—when young mothers continue to have child after child, often without knowing the means by which they might survive. A cycle of poverty and hardship can ensue.

How can we help mothers like Meena? Through family planning services—at least, by one measure.

The definition of family planning (in part by the Kaiser Family Foundation ) is: the ability of individuals and couples to anticipate and attain their desired number of children and the spacing and timing of births through the use of modern contraception. As defined by the United Nations Population Fund , abortion is not viewed as a component of family planning.

What Are We Doing to Provide Family Planning to Those Who Need It?

Born out of the London Summit on Family Planning in 2012, the Family Planning 2020 (FP2020) program aimed to increase access to contraceptives to 120 million women and girls worldwide in the poorest countries by 2020. Currently, 53 million more women and girls are using modern contraception than were doing so in 2012.

The FP2020 program states that, in line with country strategies to deliver family planning services, 10 dimensions of family planning are supported, including but not limited to: accessibility, acceptability, quality, empowerment, and voice and participation.

If enacted, the program’s vision could help break biases and rebuild perspective on the value of girls and women in society. But what is certain is that the impact of family planning services and education goes far. According to the Kaiser Family Foundation , one-third of global maternal deaths—roughly 100,000 deaths—could be prevented annually “if women who did not wish to become pregnant had access to and used effective contraception.” FP2020 has helped guide national governments in many countries to deliver such efforts.

FP2020 Country Examples

According to the World Bank and Jhpiego, respectively, Afghanistan has the highest maternal mortality ratio (MMR) in South Asia at 638 maternal deaths per 100,000 live births; Afghanistan aims to achieve 30 percent modern contraceptive prevalence among married women by 2020 under FP2020. It is unclear whether Afghanistan has met its 2020 targets yet since joining FP2020 in 2016 .

Niger, located in central Africa, has had an uptake of 350,000 additional women using contraceptives since joining FP2020 in 2012, with 760,000 women now reporting use; however, a 21 percent unmet need remains in Niger today even with the efforts by FP2020.

As made evident by Afghanistan and countries like Niger, it is clear that FP2020 still has much progress to make. As of mid-2019, an estimated 214 million women worldwide still have an unmet need for modern contraception; for comparison, the size of this unreached population equates to roughly two-thirds of the U.S. population. FP2020 workshops in Asia and Africa this year, in part, will reveal newer country-led strategies aimed to reach 120 million in uptake of modern contraceptives by women and girls by 2030; more clearly, the revised strategies will strive to reach the initial 2020 goal by the 2030 deadline of the Sustainable Development Goals (SDGs), according to a 2019 Devex report .

SDGs on Family Planning

SDG 3.7 says , “By 2030, 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.”

In order to ensure “universal access” to family planning services by 2030, funding, planning, collaboration , and leadership will be essential by stakeholders in low and middle-income countries. What else is needed among young girls? A strong education.

SDGs on Education of Girls

SDG 4.1 says , “By 2030, ensure that all girls and boys complete free, equitable, and quality primary and secondary education leading to relevant and effective learning outcomes.”

Currently, the United Nations for Women (UN Women) states that up to 48 percent of young girls are out of school in some regions. Education of young women is key, especially in low-income settings such as Afghanistan and Niger. Studies show that education of young women helps them to avert poverty, reduce rates of illness and death, and keep their families healthy.

In order to reach more young girls, leadership and advocacy efforts by partners such as the United Nations Educational, Scientific, and Cultural Organization (UNESCO) are vital. Further, investments in education—and closing of its gender gap—by national governments and philanthropic organizations are critical.

Reaching more young girls via primary and secondary education, combined with family planning services, is akin to strengthening families all over the world—including those like Meena’s.

Consider the power of ending cultural biases, child marriages, and impoverished conditions through universal access to family planning services. Consider what it would mean to end the cycle of poverty via continued education throughout girls’ youth and teenage years. These are the tools or building blocks to lead toward a healthier and vibrant future for all.

Please note: Meena’s story is a real-life story from The Moment of Lift by Melinda Gates (see reference below). It is included in this post in order to show the importance of family planning services for women and girls in impoverished settings.

Melinda Gates, The Moment of Lift: How Empowering Women Changes the World , Bluebird, London, 2019.

Hope Through Healing Hands, The Mother & Child Project: Raising Our Voices for Health and Hope , Zondervan, Michigan, 2015.

Najma Khorrami, M.P.H. , is a public health professional with a Master's from George Washington University. Homa Ahmadzia, M.D., M.P.H. , is an assistant professor of obstetrics and gynecology at GWU.

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What works in family planning interventions: A systematic review of the evidence

Lisa mwaikambo.

1 Center for Communication Programs, Johns Hopkins University Bloomberg School of Public Health

Ilene S. Speizer

2 Carolina Population Center and Department of Maternal and Child Health, University of North Carolina at Chapel Hill Gillings School of Global Public Health

Anna Schurmann

3 Sukshema Project, Karnataka Health Promotion Trust/Intrahealth

Gwen Morgan

4 African Population and Health Research Center, Nairobi, Kenya

Fariyal Fikree

5 Independent Consultant, Global Health, Washington DC

This study presents findings from a systematic review of evaluations of family planning interventions published between 1995 and 2008. Studies that used an experimental or quasi-experimental design or had another way to attribute program exposure to observed changes in fertility or family planning outcomes at the individual or population levels were included and ranked by strength of evidence. A total of 63 studies were found that met the inclusion criteria. The findings from this review are summarized in tabular format by the type of intervention (classified as supply-side or demand-side). About two-thirds of the studies found were on demand generation type-programs. Findings from all programs revealed significant improvements in knowledge, attitudes, discussion, and intentions. Program impacts on contraceptive use and use of family planning services were less consistently found and less than half of the studies that measured fertility or pregnancy-related outcomes found an impact. Based on the review findings, we identify promising programmatic approaches and propose directions for future evaluation research of family planning interventions.

By the early 1970s, international efforts to reduce rapid population growth in the developing world were well advanced. The vast majority of countries adopted voluntary family planning programs, which in most cases were part of their maternal and child health or primary health care systems ( Sinding 2007 ). A golden era of family planning from 1970 to 1990—during which a reproductive revolution occurred in every region of the world except sub-Saharan Africa—was underway ( Donaldson 1990 ; Donaldson and Tsui 1990 ).

Between the mid-1960s and the mid-1990s, average fertility in the developing world, including China, fell from around six children per woman over her reproductive lifetime to around three, a 50 percent decline. During the same period, the prevalence of contraceptive use among women increased from less than 10 percent to nearly 60 percent, but the rise was uneven ( Sinding 2007 ).

Despite decades of research on the subject, considerable uncertainty exists about the processes and factors that motivate couples to limit their family size; this is related to variations in the adoption of birth control in different societies at different times ( Bongaart et al. 1990 ). There is general agreement that socioeconomic development and organized family planning programs both play significant roles in bringing about changes in reproductive behavior; however identifying independent effects of family planning programs proves more difficult (see United Nations 1979 , 1986 , and Lloyd and Ross 1989 for a review of this work).

Lapham and Mauldin (1985) showed that it is the combination of improved socioeconomic conditions and greater family planning program effort that leads to the strongest associations with increased use of contraception. These findings were used to demonstrate to economic and social development policymakers that consideration of ways to initiate or improve family planning delivery systems should be an integral part of any development strategy.

Family planning programs have varied widely in their emphasis on demand generation activities and supply-side activities such as increasing contraceptive method choice and using varying service delivery approaches. Despite such differences in their characteristics, Bongaarts, Mauldin, and Phillips (1990) outline certain key issues that are relevant for strengthening program performance in a variety of settings:

• Passive clinical approaches are less successful than programs that make services available to couples in their villages and home.
• The quality of services is a crucial but often neglected element of programs; this entails choice among a number of methods, to be well informed about alternative methods, to have competent and caring providers of services, to have follow-up exchanges with knowledgeable program staff.
• No single formula for program design suits all needs. It is imperative to develop culturally appropriate, sensitive approaches and monitor and adjust programs as a result of lessons learned.
• Political support for family planning is often critical to establishing strong program effort.

The Matlab Project from rural Bangladesh exemplifies the importance and ultimate success of taking into account all of the above mentioned issues. It is one of the most well-documented experimental projects on family planning in developing countries as a result of the Demographic Surveillance System (DSS) developed by the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B). The experimental design of Matlab has allowed researchers to examine the differences between the special services invested in the treatment areas against the standard government services provided in the comparison areas. These areas are similar culturally and socioeconomically allowing researchers to conclude that the Matlab Project has succeeded in raising contraceptive prevalence and reducing child mortality substantially even in an environment that is economically and socially unfavorable to these developments ( Nag 1992 ).

The longitudinal, experimental study design of Matlab has allowed researchers to study a variety of inputs and outcomes as a result of the interventions. The very nature of the study design allows researchers to draw conclusions on cause and effect. Unfortunately, this is not always the case in public health research. Although randomized controlled trials are the gold standard, a number of real-world issues are encountered that often prevent the use of randomized trials in public health research; these include feasibility and ethical concerns among others. Randomized controlled trials are “primarily a vehicle for evaluating biomedical interventions, rather than strategies to change human behavior. Altering the norms and behaviors of social groups can sometimes take considerable time….” ( Global HIV Prevention Working Group, 2008 ).

From the available evidence that varies in strength, Bongaarts, Mauldin, and Phillips (1990) estimated that without the effects of family planning programs in the 1970s-1980s, fertility in developing countries would have been 5.4 births per women during 1980 to 1985 rather than the actual 4.2. These program effects reflect the buildup of program strength over the preceding years. Ironically, this success, in combination with increased attention to the AIDS epidemic, has led to reduced funding for contraceptive research and most importantly, investment in family planning services in the mid-1990s ( UN Population Fund 2005 ). And, despite the positive effects that family planning programs have had, in much of the developing world and particularly in sub-Saharan Africa, fertility remains well above the level observed in the developed world, where women average about two births.

INTRODUCTION

Worldwide, there is a large and empirically verified demand for family planning services to space or limit childbearing. Currently, about 201 million women have an unmet need for modern contraception ( PRB 2008 ), that is, they are sexually active, they want to delay or stop childbearing, and are not using a modern method of contraception. Notably, more than 80 million mistimed or unwanted pregnancies (unintended pregnancies) occur each year worldwide, contributing to high rates of induced abortions, maternal morbidity and mortality, and infant mortality ( Cleland et al. 2006 ). Furthermore, family planning has been found to be an essential approach for countries to achieve their Millennium Development Goals (MDGs), particularly goals four and five for improved child and maternal health outcomes ( Cleland et al. 2006 ; Potts and Fotso 2007 ; Allen 2007 ; Moreland 2006 ). Family planning is a cost-effective public health and development intervention. The cost of averting unwanted births is miniscule compared to the costs to the family and country of unwanted births ( Cleland et al. 2006 ). Few public health interventions are as effective as family planning programs at reducing the mortality and morbidity of mothers and infants and have such a breadth of positive impacts ( Cleland et al. 2006 ; Bongaarts et al. 2009 ).

In the 1970s-1980s, family planning programs were on the rise, leading to important impacts on increasing voluntary family planning use and reducing fertility in many parts of the world. During this same period, numerous family planning program evaluations were undertaken to demonstrate the impact of demand generation and service delivery improvements on contraceptive use and fertility-related outcomes ( Bauman, Viadro, Tsui 1994 ; Samara, Buckner, Tsui 1996 ; Cuca and Pierce 1977 ). Evaluations undertaken in this period included small-scale evaluation efforts to test novel service delivery approaches as well as evaluations of community- and national-level mass media, community-based delivery, and policy change initiatives ( Samara, Buckner, Tsui 1996 ). The family planning evaluations used varying study designs, especially in terms of the outcomes measured, the assumptions required, and the strength of the conclusions ( Bertrand, Magnani, Rutenberg 1996 ). The more rigorous family planning evaluations used randomized experiments (experimental designs), quasi-experiments, and multilevel regression methods. Notably, examining the period through the end of 1992, Bauman (1997) found sixteen family planning evaluations that were considered to be randomized experiments (i.e., random assignment of individuals or groups). Thus, while many authors at the time acknowledged the difficulties in undertaking randomized experiments of family planning programs ( Cuca and Pierce 1977 ), Bauman’s analysis demonstrated that this was not impossible. That said, even the most widely recognized family planning evaluation, the Matlab study mentioned above, did not randomly assign participating villages; a strong advantage of Matlab, however, was the use of longitudinal data and multivariate analyses to demonstrate program impacts.

Although significant gains have been made since the 1970s, the potential benefits of family planning programs have not been realized for millions of women ( Cleland et al. 2006 ). To revitalize political will and funding for a new era in the promotion of family planning and reproductive health (FP/RH) services, robust evidence-based strategies must continue to demonstrate research-driven best practices and outline the logistics of implementation. A recent report by the Center for Global Development (CGD) Evaluation Gap Working Group concluded that missed opportunities for the collection and analysis of program impacts have led to continued funding of ineffective and inefficient programs ( William 2006 ). Impact evaluation studies are imperative in providing critical evidence to decision makers on how to effectively spend scarce resources. As a result, the objective of this review is to provide an update on family planning program effectiveness since 1994 when there was less attention and funding for family planning programs. In particular, we a) synthesize recent research on family planning program effectiveness, focusing on experimental and quasi-experimental impact evaluation studies; b) discuss program approaches that are successful (and those that are less successful); c) identify gaps in family planning evaluation research; and d) recommend future research and evaluation directions.

METHODOLOGY

We undertook a systematic search of journal databases for peer-reviewed articles as well as a companion search of gray literature through funder clearinghouse websites, project websites, and correspondence. In addition, we utilized a ‘snowball’ sampling approach through searching the reference lists of identified articles. The search strategy included word combinations that incorporated evaluation or outcomes with the following terms: family planning, contraceptive use, child spacing, fertility, unmet need, maternal health, quality of care, private sector family planning services, adolescent pregnancy, unintended pregnancy, abortion, cost effectiveness, male involvement, breastfeeding and lactational amenorrhea method (LAM), and family planning/reproductive health policy.

The inclusion criteria for the review focused on studies of family planning interventions that took place in developing countries, assessed changes in outcomes that are directly attributable to a program (causality), and included the following family planning outcomes of interest: use of family planning services, knowledge and/or attitudes about family planning, discussions around family planning, intentions to use family planning, contraceptive use, unmet need, total fertility rate, unintended pregnancies, and abortion. These outcomes were selected as they provide both short-term and longer term perspectives of family planning program achievements. While the long-term outcomes (fertility, unintended pregnancies, and abortion) are the most important, few evaluations have a long enough follow-up period to observe changes at this level. Thus, using the short-term outcomes provides an understanding of whether programs are on track for achieving their intended impacts; a program that is unable to affect short-term outcomes is unlikely to have long-term impacts. The systematic search covered published and unpublished papers from 1995 to 2008.

Studies identified were categorized based on their study methodology as experimental designs, quasi-experimental designs, and non-experimental designs. Studies that included experimental designs, that is, the groups or individuals were randomly assigned and quasi-experimental designs with non-random assignment to groups were included in this review. Most of these studies used a pre-test and post-test study design or a panel/longitudinal design. A small number of included studies used a post-test only design with an appropriately defined comparison group. Finally, a few of the included studies were non-experimental and thus did not include a comparison group but were able to attribute changes in outcomes to program exposure through multivariate analyses.

The studies included in this review meet the above criteria; however, they still vary widely in strength of design and robustness of the findings. For this reason, we further ranked the studies by the methodological quality, creating a rating scale based on the strength of the research design, scope of the study (i.e., ability to generalize results), and the control of confounders and selection bias. As a result, three categories of strength of evidence emerged:

• High – This includes randomized cluster designs that included details on the randomization process and where necessary, controlled for differences in the small number of groups randomized. Also included in this category are studies that randomized individual-level participants; many of these often first randomized sites and then randomized participants within sites. A small number of studies met the high quality criteria by using a longitudinal design with a low loss to follow-up, a long follow-up period, and a comparison group (e.g., Matlab and Navrongo); most of these studies also controlled for differences in groups.
• Medium – Most of the studies in this category used a pre-post test with comparison group design that had a follow-up period of at least six months. All of the studies in this category controlled for possible selection bias between the groups through multivariate analyses. This category also included longitudinal studies without a control group and with low loss to follow-up as well as a small number of studies that used a randomized cluster design but either did not provide details on the randomization process and/or did not control for differences between the small number of intervention and control groups;
• Low – These studies were quasi-experimental designs that often included a pre-post test control group design with no control for differences between the groups and/or a very short follow-up period (e.g., <6 months). Also in this category are the post-test only comparison group design studies and the longitudinal studies with high loss to follow-up and no comparison group.

Two individuals (the first two authors) independently assessed the studies for inclusion and rated the studies according to the inclusion criteria and above rating scale. The majority of the studies in this review fall into the medium strength of evidence category.

No attempt was made to conduct a meta-analysis and reanalyze the data from the studies, as is done in the Cochrane Collaboration. As noted in the Cochrane Handbook for Systematic Reviews of Interventions , “Public health and health promotion interventions are broadly-defined activities that are evaluated using a wide variety of approaches and study designs. For some questions, the best available evidence may be from non-randomized studies” ( Armstrong R et al., 2008 ). Thus merging study designs and observations from multiple studies would not provide useful information to summarize the varying types of family planning program activities.

Search results (as of August 2009) yielded 225 studies that consisted of a family planning intervention. Of these, 63 studies met the above methodological criteria for rigor of evaluation. A number of studies were excluded due to their lack of multivariate analysis with non-randomized study designs, focus on reproductive health outcomes other than the family planning outcomes of interest (e.g., HIV prevention programs and youth programs focusing on delayed sexual debut and condom use), or being strictly operations research (e.g., feasibility and acceptability studies) that did not go on to examine population-based family planning and fertility outcomes. Notably, many of the operations research studies were undertaken as part of the FRONTIERS Project led by the Population Council and can be found on the Frontiers Legacy website ( http://www.popcouncil.org/publications/FRONTIERSLegacy/index.asp ).

In numerous cases, the interventions consist of various activities using both demand- and supply-side strategies. However, for this review, we have categorized each intervention study as predominantly demand or predominately supply. Forty-two of the included articles are classified as demand-side interventions, while the remaining twenty-one are classified as supply-side interventions. Within the demand generation activities, we further classified programs as mass media, interpersonal communication, and development approaches. The development approaches that included conditional cash transfer programs and a savings and credit program tended to be the most integrated in terms of demand- and supply-side strategies and four out of five of them had high quality evidence (see details below). Among the supply-side interventions, we further classified programs into access, quality, and cost approaches. The one cost approach identified (a voucher program) had features of both a supply-side and a demand generation activity and was classified in the low quality of evidence category.

Among the 63 studies included, the strength of the evidence varies widely. In particular, among the 42 studies that were in the demand category, 7 were of low quality, 27 were of medium quality, and 8 were considered to be of high quality (see Table 1 for citations by category). Half of the high quality studies were of studies and interventions classified as development approaches - conditional cash transfer programs and a savings and credit program ( Stecklov et al. 2007 ; Steele et al. 2001 ). Among the remaining high quality demand programs, two were interpersonal communication programs with an instructor/facilitator ( Cabezon et al. 2005 ; Walker et al. 2006 ) and two were community-level interpersonal communication programs ( Lou et al. 2004 ; Ross et al. 2007 ). Among the programs in the supply-side interventions, 8 were considered low quality, 7 were considered medium quality, and 6 were considered high quality. Among those supply-side programs of high quality, three are access/community outreach programs that were undertaken in large demographic surveillance sites (Bangladesh and Ghana), permitting long-term follow-up of a longitudinal sample ( Rahman et al. 2001 , Sinha 2005 , Debpuur et al. 2002 ). The three others were quality of care/integrated service programs ( Bashour et al. 2008 ; Bolam et al. 1998 ; Xiaoming et al. 2000 ), two of which were able to randomize individuals at the clinic level. Notably, the remaining demand-side and supply-side interventions were of medium or low quality but still met the inclusion criteria of being quasi-experimental designs (or having another way to attribute program exposure to outcomes).

Strength of Evidence of Included Family Planning Evaluation Studies by Type of Intervention and Strength of Evidence

Table 2 summarizes the findings of the 63 rigorously evaluated studies included in this review. Generally speaking, the available evidence over the last 15 years suggests that family planning programs have positively impacted individuals’ family planning knowledge, attitudes, discussion, intentions, and to a smaller degree, contraceptive use. Seventy-five percent of the studies that measured contraceptive use as an outcome reported positive findings for increased contraceptive use or reduced unmet need, while the outcomes of knowledge, attitudes, discussion, and intentions were more commonly found to be significant. Increased service use and changes in fertility-related outcomes were less consistently evident. All of the supply-side interventions that measured fertility outcomes (4 studies - Rahman et al. 2001 ; Sinha 2005 ; Debpuur et al. 2002 ; Sherwood-Fabre et al. 2002 ) were positive and significant, revealing either a decrease in fertility rates, reduced unintended pregnancies, or a decrease in abortion rates, while only 2 ( Askew et al. 2004 (sites A & C); Cabezon et al. 2005 ) out of 9 demand-side intervention studies ( Rogers et al. 1999 ; Vernon et al. 2004 ; Mathur et al. 2004 ; Stecklov et al. 2007 (included as 3 separate studies – Honduras, Nicaragua, and Mexico); Signorini et al. unpublished, PAA 2009) that measured fertility-related outcomes revealed statistically significant, positive findings on this outcome.

Evaluation Studies of Family Planning Interventions on Knowledge, Attitudes and Behaviors

As shown in Table 3 , the majority of the evaluation studies reported on interventions that took place in Africa (n=25 studies), while 21 studies reported on data from Asia, 14 studies from the Americas, 2 study from Eurasia, and 2 studies from the Middle East. 1

Regional Distribution of Studies

To facilitate synthesis and presentation, studies are presented based on their categorization as demand-side or supply-side interventions below. More detailed summaries of the intervention type, program description, research design/analytic methods, and results may be found in the Appendix .

Research on Effectiveness of Demand-side Interventions

No significant difference 0; significant desirable difference +; significant undesirable difference - RCT=randomized cluster trial; PS-C=panel study with comparison group; PS=panel study; RCS-C=repeat cross-sectional study with comparison group; PT-C=posttest only with comparison group

The next three sections outline specific demand-side approaches that the articles from our review broadly fall within – mass media, interpersonal communication, and development approaches. The subsequent three sections divide the supply-side studies from our review into the three broad supply-side categories – access, quality of care, and cost. The article concludes with a discussion of gaps and directions for future evaluation research.

Demand-side approaches

The central goals of family planning demand-side interventions include changing women’s, men’s, and couples’ knowledge and attitudes about family planning methods, increasing their knowledge of sources of contraceptives, and increasing their use of family planning to meet their fertility desires ( Salem et al. 2008 ). As an intervention, mass media through the radio, television, or print media is an appealing strategy for the promotion of family planning because of its potential reach and ability to address often culturally taboo issues in an entertaining way. The use of media to deliver primarily social development messages has been employed in family planning (FP) and reproductive health (RH) programs for over five decades ( Salem et al. 2008 ). As FP/RH programs have grown and evolved so have the communication approaches. These approaches are referred to by many names such as entertainment-education (EE); edutainment; information, education, and communication (IEC); and behavior change communication (BCC), to name a few ( Salem et al. 2008 ).

Nine articles ( Rogers et al. 1999 ; Kincaid 2000a ; Meekers et al. 1997 ; Meekers et al. 1998 ; Van Rossem et al. 1999a ; Van Rossem et al. 1999b ; Kim et al. 2001 ; Magnani et al. 2000a ; Sood et al. 2004 ) evaluating the impact of mass media interventions that met our inclusion criteria for rigorous evaluation were found in the literature search. Often, in the case of mass media interventions, evaluations must use creative methods to compare those exposed to the intervention to those not exposed given that the programs tend to be full coverage programs. In cases where a comparison group is not feasible, researchers sometimes divide the sample into groups based on exposure to the various components of the intervention. Comparing the groups based on exposure experience or extent of exposure, controlling for background differences, provides researchers with an opportunity to measure dose response effects on the fertility or family planning outcomes of interest ( Kincaid 2000a ; Magnani et al. 2000a ; Sood et al. 2004 ). Given these methodological challenges with evaluating mass media approaches, all but one of these studies were considered to be of medium quality; this last study was considered of lower quality because it used a post-test only comparison group design ( Sood et al., 2004 ).

Of the nine mass media intervention evaluations we reviewed, results usually focused on short-term outcomes such as changes in knowledge, attitudes, beliefs, and discussion patterns either between partners or between parents and their children. Few behavioral outcomes were measured. However, when behavioral outcomes such as contraceptive use were measured among the study population, results were positive ( Rogers et al. 1999 ; Kincaid 2000a ). Most positive behavioral results emerged from studies where mass media was combined with other intervention components, such as social marketing ( Meekers et al. 1998 ; Van Rossem et al. 1999a ; Van Rossem et al. 1999b ) or interpersonal communication interventions ( Kim et al. 2001 ; Magnani et al. 2000a ; Sood et al. 2004 ).

In Tanzania, Rogers and colleagues (1999) , which was considered to be a medium quality study, measured married women’s use of contraceptives as a result of exposure to an entertainment-education radio soap opera, “Twende na Wakati” (Let’s Go with the Times). The authors used a quasi-experimental design since the soap opera was broadcasted on seven mainland stations of Radio Tanzania and not on the eighth station covering the Dodoma area. While the seven stations were broadcasting the soap opera twice a week, the Dodoma area station was broadcasting locally produced programs at the same time. Consequently, it was able to serve as the comparison site. In addition to triangulating a number of different data sources, the authors used a repeat cross-sectional design, in which they surveyed individuals in the same 35 wards in two regions of the Dodoma comparison area and seven regions in the treatment area at one-year intervals from 1993 to 1997. The authors found that all statistical tests supported a significant effect of exposure to “Twende na Wakati” from 1993 to 1995 on married women’s use of contraceptives. As a result of the positive findings from the 1993-1995 analysis, Radio Tanzania began broadcasting the soap opera in the Dodoma area. The authors found this statistically significant effect between exposure to the soap opera and contraceptive use of married women replicated in the Dodoma comparison area from 1995 to 1997.

Interpersonal communication

Interpersonal communication approaches including one-on-one discussions, small-group sessions, and facilitator-led curriculum-based programs are another demand-side strategy used to influence knowledge, attitudes, intentions, and behaviors related to FP and RH. Interpersonal communication interventions take place in varying settings including schools, workplaces, and the community. These interventions are often facilitated by peers, teachers, or expert trainers. Twenty-eight articles using interpersonal communication approaches met our inclusion criteria. Of these articles, 11 reported on peer-led interventions ( Agha et al. 2004 ; Magnani et al. 2000b ; Brieger et al. 2001 ; Speizer et al. 2001 ; Cartagena et al. 2006 ; Askew et al. 2004 ; Diop et al. 2004 ; Vernon et al. 2004 ; Bhuiya et al. 2004 ; Mathur et al. 2004 ; Ozcebe et al. 2003 ); 12 were instructor/facilitator-led ( Cabezon et al. 2005 ; Eggleston et al. 2000 ; Magnani 2001 ; Mbizvo et al. 1997 ; Murray et al. 2000 ; Martiniuk et al. 2003 ; Mba et al. 2007; Rusakaniko et al. 1997 ; Shuey et al. 1999 ; Stanton et al. 1998; Walker et al. 2006 ; FOCUS/CARE International - Cambodia 2000 ); and, 5 were community-based ( Levitt-Dayal et al. 2001 ; Erulkar et al. 2004 ; Lou et al. 2004 ; Tu et al. 2008 ; Ross et al. 2007 ).

Within these categories, the overwhelming majority were of medium quality with the exception of two of the peer-led interventions that were lower quality ( Cartagena et al. 2006 ; Ozcebe et al. 2003 ); two of the instructor/facilitator led that were of high quality ( Cabezon et al. 2005 ; Walker et al. 2006 ); two of the instructor/facilitator led of low quality (Mba et al. 2007; Shuey et al. 1999 ); two of the community-based that were high quality ( Lou et al. 2004 ; Ross et al. 2007 ); and one of the community-based that was low quality ( Levitt-Dayal et al. 2001 ). Notably, none of the articles compared the different types of facilitators to help inform whether one approach is more effective than another. However, Table 2 reveals that the peer-led and adult-led intervention studies had similar outcomes.

The interpersonal communication interventions almost exclusively targeted adolescents and young adults (the age range included 10 year olds to 26 year olds), and the evaluations all included short-term outcomes (knowledge, attitudes, and beliefs) and only a few included behavioral outcomes (contraceptive use and unintended pregnancies). Most studies (86% - 18 studies out of 21) reported improved knowledge and attitudes, while about two-thirds of the studies (12 studies out of 19) measuring family planning use found a positive effect ( Magnani et al. 2000b ; Brieger et al. 2001 ; Speizer et al. 2001 ; Askew et al. 2004 ; Murray et al. 2000 ; Stanton et al. 1998; Walker et al. 2006 ; Levitt-Dayal et al. 2001 ; Erulkar et al. 2004 ; Lou et al. 2004 ; Tu et al. 2008 ; Ross et al. 2007 ) and half of those measuring fertility outcomes (2 studies out of 4) led to declining fertility ( Askew et al. 2004 ; Cabezon et al. 2005 ).

Askew and colleagues (2004) compared three intervention sites in the Western Providence of Kenya. Interventions to create a supportive environment at the community level and strengthen the health system’s ability to meet the reproductive health information and service needs of adolescents were introduced into Site A locations. Site B locations consisted of the same intervention activities as in Site A plus an in-school life-skills and development curriculum and parent sensitization, so that the additional effect of educating school children on reproductive health issues could be assessed. Site C locations were identified as comparison sites, where no interventions were introduced. This was considered to be a medium quality study. For most socio-demographic characteristics, there were no differences, between the sites nor between baseline and endline cross-sectional characteristics. Where differences did occur for a characteristic, it was taken into account in the analysis and interpretation of the findings. This indicates that any differences in measures of the key indicators found between baseline and endline are most likely due to the influence of the interventions themselves. Among the never married girls living in Site B there was no change over time in terms of experiencing pregnancy, with about one quarter of sexually active girls reporting a pregnancy. In intervention Site A and the comparison site, however, large and significant reductions in pregnancy were reported over time. This may be a result of the fact that approval of contraception and condom use improved in the comparison site and in Site A but not in Site B. This finding is particularly interesting because Site B, which offered exposure to the largest number of program components, had the least effect.

Alternatively, Cabezon and colleagues (2005) , in their high quality study, found that a school-based intervention taught by teachers had a protective effect in preventing unintended pregnancies. Three cohorts of first year high school students were enrolled in a randomized control trial in which some students received no intervention and other students received the TeenSTAR abstinence-centered sex education program which consisted of 14 units taught over a school year. The cohorts represent the years 1996, 1997, and 1998; the 1996 cohort did not experience any intervention program. No interventions were received by any of the cohorts during their second, third, or fourth years. All cohorts were followed up for four years; pregnancy rates were recorded and subsequently contrasted in the intervention and control groups. Pregnancy rates for the intervention and control groups at four year follow-up in the 1997 cohort were 3.3% and 18.9%, respectively; while pregnancy rates for the intervention and control groups at four year follow-up in the 1998 cohort were 4.4% and 22.6%, respectively. The pregnancy rate for the 1996 cohort that was not exposed to the program was 14.7%. The differences between intervention and control group by cohort were statistically significant demonstrating an impact of the TeenSTAR program using a high quality study design.

Development approaches

The development approaches, which included four conditional cash transfer programs and a savings and credit program, all focused on intermediate and long-term behavioral outcome indicators, such as contraceptive use and fertility. Four out of five of these studies were of high quality ( Stecklov et al. 2007 – counting for three studies; Steele et al., 2001 ) and the remaining one was of medium quality (Signorini et al. unpublished, PAA 2009). In the case of Stecklov and Signorini, they used population-level secondary data for the evaluation. In particular, by relying on large, nationally representative surveys that are infrequently available, the authors were able to examine longer-term outcomes than what is usually available immediately following the intervention activities. Stecklov and colleagues (2007) explored the possible association between conditional cash transfer (CCT) programs in three Latin American countries (Mexico, Nicaragua, and Honduras) and fertility. The authors compared three sets of panel data from experimental CCT programs in these countries to assess the impact of these programs on childbearing. Each program first identified a set of communities eligible for the program and then randomly assigned them into control and treatment groups. The treatment groups were provided payments conditional on the household’s behavior, such as enrolling children into public schools, getting regular check-ups at the doctor’s office, and receiving vaccinations.

Findings, based on difference-in-difference models, show that the program in Honduras, which inadvertently created large incentives for childbearing, may have raised fertility by between 2 and 4 percentage points. The Honduras program created incentives by establishing different targeting and eligibility criteria and transfer amounts. For example, the Honduras’ Family Allowance Program (PRAF, after its Spanish acronym) allowed parents to join or obtain increased benefits by bearing children after the program had begun ( Stecklov et al. 2007 ). The CCT programs in the two other countries, Mexico and Nicaragua, did not have the same unintended incentives for childbearing; however, they also did not have a net impact on fertility ( Stecklov et al. 2007 ). The data were more positive when examining contraceptive use, where it was measured. The data from the PROGRESA program in Mexico revealed significant increases in contraceptive use, while the Nicaragua data illustrated an increase, albeit one that was not significant. Similarly, an evaluation of a similar conditional cash transfer project in Brazil, called Bolsa Familia Program, was found to have no impact on the fertility of program beneficiaries (Signorini et al. unpublished, PAA 2009).

Likewise, evidence from a high quality evaluation of a Save the Children USA program examining the characteristics of women who choose to join a women’s savings or a credit group in rural Bangladesh and the impact of their participation on contraceptive use revealed mixed results ( Steele et al. 2001 ). The credit approach required more stringent criteria for membership based on credit worthiness, an admission fee, and there were individual and group expenses for meeting rooms. In addition, the group funds were managed by a credit officer who collects weekly savings and loan payments to deposit at a government bank. The savings groups were more autonomous than the credit groups, and set their own rules with regard to frequency of meetings, savings contributions by members, size of group, and how group savings were managed. To evaluate the impact of the credit program, the authors compared credit members with eligible nonmembers in the same village communities. The savings group members were compared with eligible nonmembers in the same village communities as well as in village communities in which the savings program was not introduced. The use of a longitudinal design for this evaluation controlled for two types of endogeneity that often threatens evaluation research: self selection and non-random program placement ( Steele et al. 2001 ). Increased contraceptive use was found among participants of the credit program but not among participants of the savings group.

Supply-side approaches

The overarching strategy of successful supply-side family planning programs is to make contraceptive methods as accessible as possible to clients in a good quality, reliable fashion. This includes offering a wide range of affordable contraceptive methods, making services widely accessible through multiple service delivery channels, making sure potential clients know about services, following evidence-based technical guidelines that promote access and quality, and providing client-centered services ( Richey et al. 2008 ). These types of supply-side interventions ensure that women and couples are able to effectively use family planning when the need arises. Understanding which supply side interventions lead to increased contraceptive use and reductions in unmet need and unintended pregnancy is important for making recommendations to program managers and policy makers on how to expend finite resources. Much of the research to date on supply-side interventions has been undertaken through operations research that has generally focused on outcomes such as improved service quality, increased client satisfaction, and increased service use. Fewer recent evaluation studies of supply-side strategies examine whether changes in family planning availability, accessibility, quality, and costs lead to increased contraceptive use and reduced unintended pregnancy at the population level. The studies that we sought for this assessment of rigorous evaluations did just this; they examined the impact of supply-side activities on fertility and family planning outcomes. In total, we found twenty-one articles that evaluated the population-level impact of supply-side interventions.

Nine studies focusing on issues of accessibility met our inclusion criteria; three of these (two with medium quality and one with low quality) evaluated the impact of fractional social franchising programs ( Agha et al. 2007 , Hennink and Clements 2005 , Babalola et al. 2001 ) and six focused on community-based distribution or outreach programs (high quality: Rahman et al. 2001 , Sinha 2005 , Debpuur et al. 2002 ; medium quality: Phillips et al. 1996 ; low quality: Douthwaite et al. 2005 , Kincaid 2000b ). Social franchising typically entails the creation of networks of private medical practitioners (doctors, nurses, midwives, pharmacists) that offer a standard set of services at lower costs under a shared brand name. Franchise members are offered training, commodity advertising, inter-franchise referrals, a branding that shows high-quality standards, and other benefits. Fractional social franchises are businesses that add a franchised service or product to the existing operations ( LaVake 2003 ). Among the three studies that used this approach, one with medium quality and one with low quality ( Hennink and Clements 2005 ; Babalola et al. 2001 ) had a significant effect on family planning outcomes in the intended direction, while the Agha et al. 2007 article found a marginally significant effect on current use of family planning (p=.067). None measured an effect on fertility-related outcomes. Similarly, those that examined knowledge, attitudes, and intentions also demonstrated positive effects. One study, however, that examined whether fractional social franchising leads to increased service use in Nepal failed to show the hypothesized effect and showed only a marginally significant effect for contraceptive use ( Agha et al. 2007 ). This may be a result of the fact that clients had other sources of reproductive health services available to them that they felt comfortable using; 10-12% of the population in the intervention district went to a medical store/pharmacy for reproductive health services. In addition, the project was implemented for less than a year ( Agha et al. 2007 ).

Hennick and Clements (2005) found that the introduction of new family planning clinics in urban Pakistan resulted in increased knowledge of family planning methods, distinct effects on contraceptive uptake, and decline in unmet need. However, the impacts were different by provinces, which represent different cultural contexts. The new clinics in Sargodha and Gujranwala in the Punjab province contributed to a significant decline in unmet need for family planning; most of this change was comprised of a decline in unmet need for limiting births. In the more culturally conservative cities of Hyderabad and Shikarpur in the Sindh province, the operation of the new clinics led to no reduction in overall unmet need but led to increases in the demand for family planning. This study highlights the importance of taking into account the socio-cultural context of the study location.

Among the six community outreach/distribution studies, positive findings were found for all outcomes measured, including three studies that measured fertility related outcomes. The three studies that measured fertility outcomes were all of high quality and used longitudinal study designs – Matlab and Maternal and Child Health-FP Extension projects in Bangladesh ( Rahman et al. 2001 ; Sinha 2005 ) and Navrongo project in Ghana ( Debpuur et al. 2002 ) over long follow-up periods. This reflects the fact that it is often difficult to report on changes in fertility-related outcomes in the absence of datasets that cover a long period of time. In addition, the Matlab and Maternal and Child Health-FP Extention and Navrongo projects include a combination of demand- and supply-side activities, which may explain the positive FP and fertility outcomes.

These long follow-up periods also provided the time necessary to compare different intervention approaches on the outcomes of interest. For example, Debpuur and colleagues (2002) examined approaches to mobilizing Ghana’s Ministry of Health outreach program and compared this with mobilizing traditional community-based organizations as well as mobilizing both sectors simultaneously. Their study had four arms: a comparison site with no intervention, a nurse outreach only site, a traditional community organization (zurugelu) site, and a combined zurugelu plus nurse outreach site. They found that contraceptive use remained the same when analyzing the effects of the approaches separately. However, when examining the combined zurugelu plus nurse outreach approach, they found that contraceptive use increased significantly and fertility decreased significantly.

Quality of care

Programs that seek to improve quality of services often focus on the various components of quality as defined by Bruce (1990) in her seminal article. These include choice of methods, information given to users, technical competence, interpersonal relations, follow-up or continuity mechanisms, and appropriate constellation of services. Quality is inconsistently defined across different studies, and between different stakeholders. This makes it difficult to draw larger conclusions about studies that seek to improve family planning service quality.

Eleven articles to improve quality of care met the inclusion criteria for this review. One article of lower quality focused on increased method options ( Khan et al. 2004 - introducing emergency contraceptive pills into the method mix); another of lower quality focused on client provider interactions ( Nawar et al. 2004 ). Nine reported on various quality improvement approaches (high quality: Bashour et al. 2008 , Bolam et al. 1998 , Xiaoming et al. 2000 ; medium quality: Khan et al. 2008 , Kunene et al. 2004 , Sherwood-Fabre et al. 2002 , Sanogo et a. 2003 ; low quality: Varkey et al. 2004 , Speizer et al. 2004 ).

Studies that sought to improve quality were not consistently successful; six studies ( Sanogo et a. 2003 ; Xiaoming et al. 2000 ; Speizer et al. 2004 ; Bolam et al. 1998 ; Khan et al. 2008 ; Varkey et a. 2004 ) out of ten revealed a significant increase in contraceptive use. Five of the seven integrated service delivery studies focused on postpartum contraceptive use ( Bashour et al. 2008 ; Bolam et al. 1998 ; Khan et al. 2008 ; Kunene et al. 2004 ; Varkey et al. 2004 ), and of these, three reported significant results ( Bolam et al. 1998 ; Khan et al. 2008 ; Varkey et a. 2004 ). The one integrated service delivery study that provided family planning to post-abortion clients in Russia ( Sherwood-Fabre et al. 2002 ) found a reduction in abortion rates but no corresponding increase in contraceptive use. The authors explained that this situation may be a result of the fact that the intervention was unevenly implemented; the survey indicated that there were many missed opportunities to reinforce and personalize the family planning information that women received. In addition, it was found that there was an increase in the proportion of unintended pregnancies that resulted in live births during the study period; this affected the abortion rates ( Sherwood-Fabre et al. 2002 ). Finally, one study investigated the impact of integrating an HIV prevention intervention into a well-established family planning network of services in China. The authors found that at 12-months follow-up, significantly more respondents from the experimental sites were using condoms as their main contraceptive method (p<.05) ( Xiaoming et al. 2000 ) as compared to in the comparison sites.

The feasibility of male involvement in antenatal care (ANC) counseling sessions and the effectiveness of their involvement in postpartum contraceptive use was evaluated by two studies – one of medium quality from South Africa ( Kunene et al. 2004 ) and one of lower quality from India ( Varkey et al. 2004 ). In KwaZulu-Natal, South Africa, the study team matched facilities by size and rural/urban status and then randomly assigned six clinics as the intervention sites and six as the comparison sites. Implementing joint couple counseling was challenging for this program because the population being served was mostly unmarried. One-third of the couples invited attended the joint counseling sessions, and communication among them was reported to improve with male partners more likely to provide support in the event of pregnancy complications; however, postpartum family planning use and overall risk behavior did not change ( Kunene 2004 ). The other study that examined male involvement had positive effects; however, did not randomly assign sites or control for differences between the groups ( Varkey et al. 2004 ).

The issue of cost of family planning methods is often discussed as both a supply-side and demand-side issue. From the supply-side perspective, the direct cost of a family planning method is seen as a barrier to use. From the demand-side perspective, many family planning programmers and advocates have pointed out that there are many indirect costs associated with access to family planning, such as large, unofficial payments to staff and long waiting times to see service providers; each of these affects demand ( Ensor and Cooper 2004 ).

Only one article evaluating a cost-based intervention was found that met our inclusion criteria. Although Meuwissen and colleagues (2006) used a quasi-experimental design to evaluate the impact of a competitive voucher pilot program on adolescents’ use of sexual and reproductive health care (SRHC) services and contraceptives in urban Managua, Nicaragua, the authors used a post-test only design so the study design is considered lower quality. Self-administered questionnaires were distributed randomly among female adolescents 3 to 15 months after the vouchers had been distributed in their area. The voucher receivers were considered the intervention group to be compared at a group level with the control group, the non voucher receivers. Voucher receivers demonstrated significantly higher use of SRHC services and knowledge of contraceptives and sexually transmitted infections compared with non-receivers. There was no change in overall contraceptive use between the two groups – receivers and non-receivers. However, effects were modified by place of survey – school versus neighborhood. Focus group discussions and interviews with adolescents during the intervention suggest that the factors that contributed to the success of the voucher program were the removal of practical obstacles (e.g., financial, the need to make an appointment, the lack of information on clinic location, and opening times) plus the guarantee of confidential access to a service provider of their choice. These results reveal the interplay between demand-side and supply-side barriers.

The available evidence on the effectiveness of family planning interventions in developing countries over the last fourteen years reveals a positive picture with no one size fits all approach. Both demand- and supply-side interventions led to improvements in knowledge, attitudes, discussion of family planning and sexuality, and intentions to use family planning. Results were less consistent in terms of effects on fertility and family planning outcomes.

The examination of mass media interventions illustrated positive results on contraceptive use and/or unmet need, while the wealth of interpersonal communication interventions less consistently demonstrated these effects. A notable example is the quasi-experimental study by Rogers and colleagues (1999) that showed a significant effect of exposure to an entertainment-education radio soap opera on contraceptive use by married women, which led to the scale-up of the program nationwide throughout Tanzania.

Only two ( Askew et al. 2004 ; Cabezon et al. 2005 ) out of the four studies from the interpersonal communications category that measured fertility related outcomes found significant reductions in unintended pregnancies. For example, Askew and colleagues (2004) found differential effects by exposure arm such that those with the greatest exposure had the least fertility and family planning impacts. Askew and colleagues acknowledged that their multi-sectoral approach reached adolescents with reproductive health information; however, they cautioned that the findings need to be interpreted with care in light of the fact that the community-based intervention was more intensively implemented in varying sites. They also pointed to the fact that the teachers who implemented the school-based intervention were more comfortable with providing the abstinence messages than the safer sex messages to their students. These challenges are representative of similar challenges experienced by all programs working with adolescents on issues of sexual and reproductive health.

Contrary to Askew’s findings, Cabezon and colleagues (2005) revealed a protective effect in preventing unintended pregnancies from a school-based intervention taught by teachers. The authors reported that the success of their teacher-led program was due to the accurate and comprehensive information provided and the focus on developing assertiveness and negotiation skills. The authors also acknowledged that the implementation of the program over an academic year was ideal and found the teachers to be effective implementers of the program. This example along with the example provided by Askew highlights the importance of the program facilitators’ comfort with the subject matter and their commitment to the program.

Once demand for contraceptive use is achieved, it is imperative that the supply is readily available and accessible. Our review found that supply-side interventions that addressed access to family planning led to positive effects on family planning use, whereas improved quality less consistently showed positive effects on family planning behaviors. Notably, few studies measured fertility-related outcomes such as reduced unintended pregnancies and abortions; however, the supply-side intervention studies that did measure fertility showed the most consistent and positive findings, generally using the strongest study designs ( Khan et al. 2008 ; Debpuur et al. 2002 ; Rahman et al. 2001 ; Sherwood-Fabre et al. 2002 ).

It is also notable that even in some places where the findings were positive; results were not necessarily consistent across different locations or target groups. For example, the voucher program in urban Nicaragua found different effects among school-going youth and youth who participated from community-based sites ( Meuwissen et al. 2006 ). Hennick and Clements (2005) reported differential changes in unmet need as a result of introducing new family planning clinics in two culturally distinct provinces of Pakistan. Debpuur and colleagues (2002) found a significant increase in contraceptive use and decrease in fertility when they examined the combined approach of two different community-based outreach interventions in contrast to when they analyzed the effects of the interventions separately.

Although the findings presented in this review categorized studies as demand-side and supply-side interventions, a small number of studies explicitly included a multi-component approach, such as undertaking mass media and interpersonal communication ( Kim et al. 2001 ; Magnani et al. 2000a ; Sood et al. 2004 ), mass media and social marketing ( Meekers et al. 1998 ; Van Rossem et al. 1999a ; Van Rossem et al. 1999b ), fractional social franchising with strong media promotional presence ( Agha et al. 2007 ; Babalola et al. 2001 ), and fractional social franchising and community-based outreach ( Hennick and Clements 2005 ). These studies generally found positive family planning outcomes and, when measured, positive fertility outcomes as well. The importance of multi-component programs has been demonstrated in other reviews that have examined rigorous evaluations of adolescent reproductive health programs ( Speizer et al. 2003 ; Ross et al. 2006).

It is also worth noting where the evidence was weak or non-existent in this review. While male involvement programs are becoming increasingly important in the international family planning arena, there is limited evidence on the effectiveness of this approach on population-based fertility and family planning outcomes. A small number of operations research studies have been undertaken and reveal that approaches to increase male involvement in prenatal and postpartum care lead to increased attendance at these critical events; these studies with medium to low quality of quasi-experimental design, however, have shown mixed results in regards to behavioral outcomes such as contraceptive use and unintended pregnancies ( Kunene et al. 2004 ; Varkey et al. 2004 ).

In addition to the limited evidence provided on evaluations of male involvement programs, only one study of lower quality ( Meuwissen et al. 2006 ) was found that examined the effect of a voucher program on increased contraceptive use behaviors; this is an important gap because voucher programs are an increasingly popular approach in public health programming. Several developing countries, with international donor support, are considering or in the process of implementing a voucher program (examples include India, Tanzania, Uganda, Kenya and Bangladesh) ( Arur et al. 2009 ). However, more research is needed to inform the design and expansion of voucher programs throughout the developing world. Important areas for further voucher studies include: impact evaluations, cost and cost-effectiveness studies, and the effect of using technology to simplify implementation and reduce overhead costs. Vouchers are a relatively untested approach in low-income countries. Although results from these early experiences are positive, there is a clear need for rigorous research that can conclusively establish that voucher programs can increase coverage and use of FP/RH and other health services among underserved target populations ( Arur et al. 2009 ).

Limitations

There are a number of limitations to this type of systematic review. First, depending on the level of depth provided in each study, it is not always possible to extrapolate the features of each intervention and the corresponding evidence as to which components were the most effective. Second, most studies of multi-component programs examined overall program effects and did not separate out the effects of the different components. Third, the majority of studies considered were written in English although the authors also reviewed studies in French. Fourth, as expected for the outcomes of interest, most of the studies were based on self-reported sexual and health-seeking behaviors; previous studies have demonstrated potential biases of self-reported behaviors ( Curtis and Sutherland 2004 ). Fifth, service utilization statistics were included but only as a complement to individual level data; this limited the inclusion of most of the operations research studies. Sixth, there is likely to be a publication bias with this type of review whereby studies with positive findings are more likely to be published (and found) whereas studies with non-significant or negative findings are unavailable. Finally, given the diversity in study methods and implementation strategies, it was not possible to do a formal meta-analysis that joins the samples and compares the odds ratios. Therefore, a limitation of this study is that while all studies included met the experimental or quasi-experimental (or another form of attribution) criteria, there was still variability across the rigor of the studies. We have categorized the identified studies into three quality categories: low, medium, and high to help clarify these types of distinctions across the multiple approaches. Where appropriate, we have identified which findings come from those studies with a higher study quality (e.g., are from a randomized cluster design and/or use longitudinal data with a comparison group to determine attribution).

Conclusions

In spite of limited funding for family planning programs during the period 1995 to 2008, this systematic review reveals that both demand- and supply-side interventions that have been rigorously evaluated have been found to be generally successful in increasing knowledge, attitudes, beliefs, and discussions around family planning as well as increasing contraceptive use. These impacts are often a result of programs that have taken into account the importance of various approaches to reaching women and couples with family planning products and services, providing quality information and service delivery, addressing cultural norms and barriers to contraceptive use, and seeking community support.

That said, a number of gaps and directions for future research have also been identified. In particular, there is a need to undertake evaluations of broader development approaches and supply-side interventions measuring population-level outcomes (beyond operations research) and their long-term impacts on family planning and fertility. Likewise, there is a need for more research around the impact of male involvement, integrated services, public-private partnerships, and voucher programs, especially in light of the recent push and funding for these approaches. There is also a need for information on the effectiveness and cost-effectiveness of alternative implementation approaches for both demand and supply-side interventions. For example, there are gaps in our understanding of the impact of a peer-led versus instructor or facilitator led program as well as gaps in the understanding of intervention costs and the comparison of costs for alternative implementation approaches.

Most evaluations are of small-scale interventions and implemented over relatively brief periods of time (often a pilot test). There is little evidence on the long-term behavioral effects of the interventions that would provide us the evidence required to make decisions about scale-up or replication. The strongest evidence to support reaching long-term fertility measures comes from long-standing longitudinal studies, such as Maternal and Child Health-FP Extension projects in Bangladesh ( Rahman et al. 2001 ; Sinha 2005 ) and the Navrongo project in Ghana ( Debpuur et al. 2002 ). This reflects the need for long-term follow-up in measuring and observing such changes in fertility-related outcomes. A number of Demographic Surveillance Systems coordinated through the INDEPTH network ( http://www.indepth-ishare.org/ ) are now currently available and could possibly serve as data for these types of long-term evaluations of existing models in varying sites.

Furthermore, lacking in most studies is an assessment of the differential impact of interventions across target audiences. For example, it is important to consider the impacts of programs on the populations most in need of services, such as high risk subgroups, migrants, and the urban poor, to name a few. The examination of differential impacts by subgroups was rarely examined within the studies found. More specific information on the actual beneficiaries of interventions is still needed by policy makers wishing to target scarce resources to those most in need. The study by Hennick and colleagues (2005) highlights the importance of not only understanding the cultural backgrounds of the various populations that are being studied, which helps in explaining the different results in unmet need and where these two distinct populations are in terms of acceptance and intentions to use family planning methods, but also the importance of looking at the socio-demographic characteristics of beneficiaries. They found that women who live outside of the catchment areas are often married with four or more children and are of low socioeconomic status. They also found that young (aged 16-19), poor women who are separated or unmarried were seeking services from outside the catchment areas. These findings reveal that women who are poor were willing to travel some distance to obtain services for which they pay fees.

The findings of this review reveal that all of the intervention approaches have some benefit at least on short-term outcomes. The main program approaches that led to increases in contraceptive use included development approaches and supply-side interventions. Whether the other approaches did not have an effect or did not measure one is a different issue. Notably, only a small number of studies had an impact on fertility outcomes; most of these were high quality studies of supply-side approaches working in supportive, long-term settings using multi-component, integrated programs. As interventions are designed, it is imperative that planning goes into monitoring and evaluating the activities, so that programs can be refined and lessons learned can be shared widely. Particular attention needs to be paid to undertaking rigorous impact evaluations that can attribute program activities to changes in outcomes of interest. Randomized controlled trials will not be feasible for most FP program activities; thus evaluators need to identify alternative study designs (quasi-experimental; longitudinal) that are appropriate for the varying settings where programs are being implemented ( Victora, Habicht, and Bryce, 2004 ). This attention to rigor of family planning evaluations will increase accountability, improve program decision making, and in the end, improve maternal and infant health outcomes.

Research on Effectiveness of Supply-side Interventions

Acknowledgments

This work was made possible with support from the Bill & Melinda Gates Foundation for the Measurement, Learning & Evaluation (MLE) Project for the Urban Reproductive Health Initiative. The authors’ views expressed in this publication do not necessarily reflect the views of the donor, the Bill & Melinda Gates Foundation.

A previous version of this paper was presented in October, 2009 at the International Conference on Urban Health in Nairobi, Kenya and in November, 2009 at the International Conference on Family Planning: Research and Best Practices in Kampala, Uganda. At the time this work was undertaken, LM, AS, and FF were part of the MLE project team.

1 The total does not equal 63 studies because the Brieger 2001 article reports on data from Nigeria and Ghana.

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Roula Khalaf, Editor of the FT, selects her favourite stories in this weekly newsletter.

When France’s President Emmanuel Macron warned at the G20 heads of state meeting last summer that high fertility was a “civilisational” challenge acting as a brake on development in Africa, he was heavily criticised on social media.

Yet his message reflected the longstanding concerns of many observers over local growth, environmental damage and future global stability. It is particularly relevant for francophone western and central Africa, where the number of children per mother is as high as seven in countries like Niger.

Although rising populations can stimulate innovation and ideas, too many people risks undermining progress in other areas highlighted in the FT’s 50 Ideas to Change the World project , from economic growth and climate change remediation to political stability and health reform.

“There will be major pressures on urbanisation, and huge pressure to move to greener pastures,” says John May, a demographer specialising in Africa who is based at Georgetown University. “But there is not the enthusiasm you might expect for family planning. I’m not optimistic.”

As Nigeria’s former president, Olusegun Obasanjo, said recently at a discussion in London, some leaders across Africa argue for a pronatalist policy of maintaining and encouraging high birth rates: they claim the need to populate low-density parts of their countries for strategic reasons including security.

Rising family size in part reflects improved nutrition and health systems which have cut infant mortality, while in some parts of Africa it has yet to be followed by the classic “demographic transition” seen in other parts of the world where birth rates have fallen.

The result is rising pressure on land and ecosystems, helping trigger conflict and diluting the impact of economic growth. As Africa’s population expands sharply, there is also discussion about greater regional and inter-continental migration, itself sparking fresh tensions in other countries.

50 ideas to change the world

We asked readers, researchers and FT journalists to submit ideas with the potential to change the world. A panel of judges selected the 50 ideas worth looking at in more detail. The first tranche of 10 ideas are about meeting the challenges of a growing world population. The next 10 ideas, looking at solutions for growing energy and resource needs, will be published on January 8, 2018.

• Superfast land travel
• Urban congestion
• Translation technologies
• Six Japanese care robots to watch
• Toilet technologies
• Revolutionising reproduction
• Family planning
• Precision farming to save water and fertiliser
• Finding alternatives to meat

While there is no doubt that “birth control” has sometimes been coercive, as in the case of China’s one child policy or India’s forced birth control programmes in the late 20th century, modern discussion on family planning has focused on the rights of women to choose when, whether and how many children to have.

Early marriage of women reduces their chance to complete schooling, undermining the potential for development. Early and frequent childbirth carries health risks for young mothers and babies alike.

There were an estimated 134m women with “unmet demand” who wanted but were unable to obtain modern methods of contraception last year. “On the current trajectory we will not reach our targets,” says John Skibiak, director of the Reproductive Health Supplies Coalition, an international partnership of public, private and non-governmental organisations seeking to safeguard access to reproductive health.

He warns that the prospect of reduced funding of programmes from donors including the US, which has already cut its support for the UN Population Fund (UNFPA), could cause backsliding after several years of progress. “It’s a real worry.”

Nonetheless, there are a number of innovations which offer the prospect of more effective and widespread family planning for women who seek it:

1. Reproductive technologies

There have long been efforts to develop new approaches to family planning, including male contraceptives. While women’s rights and wishes frequently still remain neglected, long-acting, slow-release injectable contraceptives offer greater potential to give them control. Recent products such as Sayana Press are both discreet and reduce the risk of supplies of more traditional, shorter lasting commodities running out.

2. Supply chains

New ways are being explored to pool the procurement of supplies across regions and countries, with donors providing guaranteed volumes to incentivise manufacturers to invest and produce at low cost. Tracking and partnering between public supplies and private distributors and retailers offers potential to reduce waste and cases where stocks run out. “When you increase supply, demand itself grows,” says Mr Skibiak. This approach is being tested out in a programme in Senegal.

3. Mobile phone outreach

Telephones have the potential to transform family planning. They can help monitor contraceptive supplies and improve distribution. Their wide availability, portability and privacy also mean they can provide advice targeting remote communities, and frequently excluded groups. A study in Rwanda , for instance, suggested young people need more information but often feel family planning services are for married couples and not designed for them. The programme experimented with sending young people information about sexual health via text messages.

4. Working with religious leaders

Some communities within leading faiths — notably within Christianity and Islam — are perceived to be resistant to family planning — as with Catholic objections to abortion. Yet many religious leaders are proving increasingly open to the argument that sexual and reproductive health for women is essential for community welfare. Fighting early marriage and encouraging spacing of children is becoming more accepted. The influence of clerics is pivotal in winning wider support for programmes. The UNFPA and other organisations, for example, are working with leaders in places such as Sokoto , Nigeria and in Chad to change attitudes.

5. Piggybacking with other services

Growing attention is being paid to the value of integrating contraceptive provision into other networks and services, allowing them to reach a larger group. Young mothers, for instance, may prove reluctant to visit a family planning office because of social pressures or simply inconvenience and cost. However, they are motivated to bring in their infants to clinics for vaccinations and more willing to seek contraception at that time. A project run by Care International in Benin, for example, found that when mothers were offered birth control at the same time as vaccinations for children, the uptake of both services increased.

6. Incentives

From microcredit in the Ivory Coast to phone credit vouchers in South Africa, “nudges” from policymakers and modest rewards can have a powerful influence on individual behaviour — whether through greater information on prevention of pregnancy and sexually transmitted diseases or the provision of contraception services. Marie Stopes, the UK-based reproductive health charity, ran a project in Madagascar distributing vouchers for family planning services via mobile phone. Projects like these have shown that even small cash payments to young women and their families — some unconditional, others linked to indicators such as a failure to become pregnant — can significantly reduce teen pregnancy, school drop out for early marriage, and infection.

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International Edition

Family Planning Essay Examples and Topics

Abortions: causes, effects, and solutions.

• Words: 1163

Contraception Methods and Devices

Gibbs’ reflective cycle, stages of pregnancy.

• Words: 1579

Women and Reproductive Health

• Words: 2579

Sexual and Reproductive Health

• Words: 1072

Fetal Alcohol Syndrome: Causes and Consequences

Childbirth. three stages of labor, rh incompatibility: the case study, teratogen alcohol exposure in pregnant women, epidemiology in the news, disorders of the reproductive systems, fertilization and pregnancy process, pregnancy and nutritional risk factors.

• Words: 1099

Prenatal Development: When Does a Human Life Begin?

Discussion of abortions: advantages and disadvantages.

• Words: 1392

Teen Abortion: Understanding the Risks

• Words: 1410

Renal Failure and Pregnancy

• Words: 1157

Termination of Unwanted Pregnancy

• Words: 1699

Home Visitation Programs for Pregnant Women in Rural West Virginia

Management of rheumatoid arthritis during pregnancy.

• Words: 1672

Japan’s Childbirth Delivery System

• Words: 4184

Premature Childbirth and How Social Conditions Influence Them

• Words: 1501

Risks Analysis in Advanced Maternal Age

• Words: 1164

Delivery Methods and Conditions

• Words: 1075

The Maternal-Child Health Worldwide

Protecting the unborn babies: programs for pregnant and parenting women, infant mortality rates and how to minimize them, how adoption and surrogacy are limited to the rich.

• Words: 2010

Physical Exercise During Pregnancy

Social aspects of teenage pregnancy.

• Words: 1376

An Opinion on Contraception for Teenagers

• Words: 1709

A Family-Centered Cesarean Birth: Experience and Bonding

• Words: 1132

Physical and Mental Effects of Childbirth

• Words: 1402

Activity During Pregnancy and Postpartum Depression

Preterm labor during covid-19, potential problems with pregnancy, unplanned pregnancy and preventive measures, uterine fibroids in a young asian female patient, low birth weight effects, biomedical technologies and natural family planning, engaging mobile apps in family planning, prenatal and postpartum care interventions.

• Words: 1177

Iron, Omega-2, and Folic Acid Intake During Pregnancy

Adolescent pregnancy scenario.

• Words: 1720

Interventions to Reduce Maternal Deaths

• Words: 1667

Maternal Mortality Among Minority Women

• Words: 1419

Abortion Trends in the United States

The perception of a midwife and its impact.

• Words: 1122

Teen Pregnancy Care Coordination

• Words: 1469

Aspects of the Fetal Alcohol Syndrome

Early teen pregnancy as population health problem.

• Words: 1618

Teenage Pregnancy and Quality of Care

• Words: 1453

Midwives’ Assistance Regarding Women’s VBAC Decision-Making

• Words: 2245

The Issue of African American Women Who Die During Labor

Abortion on the grounds of disability, environmental impacts during pregnancy.

• Words: 1197

Quantitative Blood Loss in Obstetric Hemorrhage

• Words: 1217

Infertility: Causes, Population Affected, and Treatment

Black maternal health, safe pregnancies and childbirth, the nurse’s role in pregnancy and child health planning, women, infants, and children program, abortion and its physical and psychological effects.

• Words: 2042

Ovulation Disorder, Menarche and Menopause

Do we need to legalize abortions, an unnecessary barrier to adolescent obstetrical care, the issue of impaired fertility and its treatment, preventing infertility in couples, the pregnancy-induced hypertension, “factors influencing the use of contraceptives”: variables and limitations, maternal and infant health: smoking prevention strategies, planned parenthood takes on live action, impactful policy for child and family health practitioners, monique and the mango rains book by kris holloway.

• Words: 2035

Aspects of Care of a Pregnant Female

Family planning individual case critique.

• Words: 1195

In Vitro Fertilization & Embryo Transfer

Breastfeeding health teaching project.

• Words: 1690

The Importance of Parenting Aspects

Heart conditions during pregnancy, perinatal, infant and child mental health.

• Words: 1804

Breastfeeding in Young Mothers

• Words: 1725

Embryonic Stem Cells and Nuclear Transfer

The use of alcohol during pregnancy, investigations of recurrent miscarriages.

• Words: 1762

Ways to Prevent Teen Pregnancy in New Jersey

• Words: 1506

Shaving and Clipping of Pubic Hair for Expectant Women During Child Birth

Maternal healths at three periods of pregnancy, women’s life stories: maori sudden infant death, variability in hospital care of rape victims, the depiction of birth in reality tv show.

• Words: 1433

Infertility Issue: Causes, Symptoms, and Treatment

Culturally sensitive caring in healthcare.

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Family Planning Essay Sample

Family planning is a crucial thing that every single person on this planet should think about because of the limited number of resources that exist on the earth. If family planning will not be given much attention then there is going to be competition rather we should say tough competition among human beings to grab the maximum resources for their survival.

• Introductory Part on Family Planning Essay
• Main Body Of Family Planning Essay
• Conclusion :- Family Planning Essay

Essay Sample On Family Planning

Introductory Part on Family Planning Essay Planning your family is one of the most important decisions you will make in life. It can be a difficult decision to make, but it is crucial that you plan ahead before having children because this decision will affect your entire life and the lives of those around you. There are many different ways to go about planning for your family, so take some time to think about what would work best for you and your future family. Main Body Of Family Planning Essay Family planning is, therefore, must in such places so that the pressure on the resources of the region can be lowered to a great extent. There are nations like China where the rise of the population has taken a massive range in the country and now the government is trying to have control over the growth of the population. We can see how the population growth of China is in a stagnant state for the past couple of decades. This is because it has taken control of the growth of the population by asking the citizens for better family planning where they cannot reproduce more than one child in their life. Family planning is not only associated with the personal life of a person but at the same time, it is a national issue. It can be associated with the fraction of youth in the population of a country, pressure on the economy and other resources, and competition for survival. If a nation is lacking a young population there is a fair chance that it is going to face severe challenges in the future. This is because when the working population of the country is less than the old one then it is a great concern for the country which can be tackled by the family planning by the citizens by thinking about the growth of the country on a world scale. Various instructions are given by the government of many countries that are concerned with the family planning that citizens are supposed to follow. Buy Customized Essay on Family Planning At Cheapest Price Order Now Must View: Essay Sample On “Adoptive Family Advantages And Disadvantages” Conclusion :- Family Planning Essay Family planning is a very important part of our lives. It’s not just about birth control, it’s also about the emotional and physical well-being of each person in the family. As we know, there are many factors that can affect one or more members of the family including illness, accidents, marriage breakdowns, and work pressures. The truth is that every member has to be considered when making decisions on how often to have children as well as what kind of contraceptive methods will be used. Hire USA Experts for Family Planning Essay Order Now

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Two Ways To Make Family Planning Easy And Successful

Choices about having children can be incredibly personal—and challenging—for both individuals and couples, bringing a unique set of considerations about contraceptives, timing, and fertility. With this in mind, how can individuals and their partners best navigate the challenges and stresses of family planning? We will explore this question in more detail in this article.

What is family planning?

Family planning is the practice of making conscious decisions about reproduction. Common considerations involved in family planning include whether a person or couple wants children at all, and if so, how many, when, and where. Additional factors that may be involved in family planning include decisions about contraception, abortion, STI and STD prevention, and management of fertility challenges.

Exploring the challenges of family planning

With so many aspects to consider when it comes to having kids, it may not come as a surprise that family planning can be complicated. Family planning can present a unique set of challenges for both individuals and couples, whether or not they choose to have children. 

Some of the most common family planning-related challenges individuals and couples face include:

• Difficulty conceiving
• Conflict about whether or not to have children, and if so, how many
• Limited access to contraception, emergency contraceptives, or abortion
• Limited access to sexual education
• Side effects of birth control or emergency contraceptives
• Unplanned pregnancy
• Sexually transmitted diseases

Because decisions around having children can be big and emotionally fraught, it’s not uncommon for individuals and couples to experience mental health difficulties as a result of the above challenges. For example, a 2013 study found that  unplanned pregnancy was associated with a higher risk of depression, anxiety, and reduced overall happiness in both women and men .

Managing the challenges of family planning

Needless to say, being able to navigate the ups and downs of family planning can be important for one’s mental health and well being. With that in mind, let’s explore several methods for managing the challenges and stresses of family planning, either individually or with your partner. Because these challenges can be varied and far-reaching, keep in mind that this list is not exhaustive. That said, whether you’re considering having children, have decided to wait, or are struggling to conceive, the following strategies may all come in handy:

Communication

Practicing healthy communication can be critical for maintaining healthy relationships, and may become even more important when it comes to making decisions about having children. If you are exploring family planning with your partner or spouse, it may be helpful to practice being open and honest about the emotions and challenges you’re facing. Consider setting aside some time to discuss your goals and expectations around having—or not having—children, and be mindful of healthy communication practices, such as active listening. 

Support groups

Support groups can be an excellent way to connect with others and form relationships based on shared experiences. Whether you are having difficulty conceiving, are facing an unplanned pregnancy, or are facing medical challenges such as STDs or STIs, connecting with a community may be invaluable for getting advice and support.

Community resources

Like support groups, community centers and nonprofit organizations can provide valuable insight and advice about any family planning challenges you may be experiencing. Family planning centers may offer resources such as gynecological services, infertility treatment, birth control, abortion access, STD/STI screening, and counseling. Because the types of services and resources these organizations provide may vary, it’s important to do research ahead of time to make sure you’re getting the right support for your situation. 

Medical practitioners

Similarly, if you find yourself grappling with family planning challenges, getting advice from a healthcare provider may be helpful for understanding the options available to you. You might consider talking to your general practitioner, or to a specialist, such as an OB/GYN, a reproductive endocrinologist, an andrologist, or a reproductive immunologist. 

Because family planning challenges can lead to significant stress, as well as a variety of intense emotions, individuals and couples may also find themselves seeking mental health support in the form of therapy. A licensed mental health practitioner can help those facing family planning difficulties explore their emotions, navigate conflicts with their partners, tend to their well being, and find the best path forward based on their situation. 

However, as helpful as therapy can be for navigating family planning decisions, attending in-person counseling isn’t always easy. Factors like scheduling conflicts and work obligations can make commuting to a therapist’s office tricky, and those whose family planning challenges result in conditions like anxiety and depression may find it difficult to leave the house. In these situations, online therapy through a platform like Regain (for couples) or BetterHelp (for individuals) may be an appealing alternative, offering the ability to attend counseling from wherever is most convenient, and to send messages to a licensed counselor at any time of day.

The benefits of online therapy have been studied in both individuals and couples. For example, a study from 2022 found that couples who received internet-based counseling saw similar improvements in relationship satisfaction, anxiety, stress, and depression as those who received in-person counseling . A separate study from 2017 also found that online cognitive behavioral therapy was effective at treating mental health conditions like depression, generalized anxiety disorder, panic disorder, and more . 

Family planning is the process of making conscious choices about having children. It can encompass aspects including contraception and abortion, as well as reproductive health, fertility, and STD/STI prevention. Family planning can bring its own set of challenges, ranging from managing unplanned pregnancies to difficulty having children, limited access to reproductive health services, and side effects from birth control. All of these challenges can have impacts on the mental health of individuals and couples, potentially even resulting in conditions like anxiety and depression. 

Those facing challenges with family planning may find it helpful to communicate with their partners, reach out to support groups or community centers, get the opinion of a medical professional, or seek counseling, whether online or in-person. If you are interested in exploring online therapy, you can get matched with a licensed therapist via Regain (for couples) or BetterHelp (for individuals). 

Frequently asked questions (FAQs):

What is family planning in simple words?

In simple words, family planning is a public health service that helps women reduce the likelihood of an unpredictable pregnancy by controlling when or if they want to have a kid. 

Family planning services include:

• Pregnancy testing and counseling
• breast and pelvic examinations
• Pregnancy spacing
• Pregnancy planning
• Planning family goals, such as deciding to have kids or not

The objectives family planning prioritizes help ensure that every mother that’s part of the family planning services program is prepared for an eventual pregnancy.

 Apart from these family planning services, one more goal to improve pregnancy planning is to have sex. 

It’s possible for couples who are sexually active to improve family planning by using correct contraceptives and condom use. When you take the time to structure and consider your family planning, family planning can be a great tool.

Family planning involves a couple using public health services to plan how many children they want and how they will undergo pregnancy planning. 

Furthermore, the Centers for Disease Control and Prevention (CDC) considers family planning one of the ten great public health accomplishments of the current century. They liken the impact of family planning to the benefits of vaccinations and motor vehicle safety procedures.

You may also want to keep in mind barriers to people’s use of family planning services. These include:

• Cost of services
• Limited insurance coverage
• Transportation issues
• Lack of family planning services in hard-to-reach areas

If these barriers prevent you from quality family planning services, you can try consulting your primary medical caregiver and ask them for advice about nearby family planning services.  

What are the basic principles of family planning?

Family planning serves to achieve three core objectives:

• Family planning services help couples avoid unintended pregnancies.
• Family planning reduces the chance of getting sexually transmitted diseases (STDs)
• Family planning can reduce rates of infertility by decreasing the spread of STDs

A family planning overview only captures the overall goals of any planning family. The objectives family planning stresses include educating couples on pregnancy and controlling when they will have their kids, if at all (couples can also enroll in family planning services to know how not to have a kid during their marriage). 

Therefore, the benefits of a family planning overview are that it empowers women and ensures that they are born successfully and safely. 

The basic principles of family planning help to improve the overall quality of life for loved ones. 

Family planning objectives serve to reduce the stress that having a child can have on a married couple. Additionally, quality family planning services can provide couples the knowledge needed to make informed decisions about having children. 

What is the main purpose of family planning?

The main purpose of family planning services is to provide women the freedom to make important life decisions without worrying about an unintended pregnancy. 

Along with caring about the independence of women, family planning includes the following planning objectives:

• Reduces the cost of unwanted pregnancies
• It may also alleviate the gender wage gap.
• Helps in improving family mental health

The importance of family planning cannot be understated. In the United States, 99 percent of women use contraception when controlling their chances of being pregnant. 

Additionally, to family planning can help countless women and their families choose to become a parent. For many,  ensuring to family planning services for all is a crucial and worthwhile goal.

Family planning helps both men and women make responsible choices about their families and future goals. Also, family planning objectives can lead to more families feeling much better at the prospect of being a good parent. 

This can help alleviate concerns that some couples may have about being parents. Family planning can ease their worries, so long as the couple follows the objectives of family planning.    

What is the advantage of family planning?

According to the World Health Organization (WHO) , family planning services with pregnancy planning and other helpful planning objectives advance several human rights, such as the right to life and liberty and freedom of speech. Furthermore, family planning greatly improves the mental health of any person participating in quality family planning services. 

Additionally, contraceptive methods prevent pregnancy-related issues, which accomplishes improving pregnancy planning and ensures infants’ health. 

Therefore, family planning objectives can reduce the chances of maternal depression and physical violence during pregnancy, to name a few benefits of providing quality family planning. If you put a lot of time into family planning, family planning will likely benefit you significantly.

What are the 3 types of family planning? What are the types of family planning? How do you do family planning? What are the 5 family planning methods? When should we start family planning?

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Essay on Family Planning in India for Students and Children

500 words essay on family planning.

Essay on Family Planning in India – India is the first country of the developing nations that initiated a state-supported family planning program. Furthermore, this type of program is a must if you look at the population of a country like India. Also, the statistics show a great rise in the population throughout the decades.

In addition, India is the second-largest population of the world with a population of more than 1.3 billion. Furthermore, national fertility is also quite high and every 20 days the population rise by 1 million people.

Moreover, according to the statistician of the U.N (United Nations), the population of India will exceed the population of China by the year 2028.

Most noteworthy, the Indian government recognized this problem and initiated a family planning measure some time ago to control this problem.

History of Family Planning

Raghunath Dhondo Karve is the person who recognized this problem first place. He also recognizes the need for population control. Furthermore, he publishes a magazine named Samaj Swasthya from 1927 to 1953, in which he debated that the best way to serve the society is by controlling the population through means of contraceptive measure.

Furthermore, Karve urged the Indian government to take initiative and steps to control the population by the control program, an attempt which was stopped by Mahatma Gandhi on the ground that people should practice self-control rather than depending on birth control.

Moreover, by 1951, it has become clear to the Indian government that family planning was becoming increasingly urgent to face the fast-growing population . After that, the government decided to create a state-sponsored family planning program in all the states of the country.

In addition, the government put a five-year plan into place; these plans focus on the economic restructuring and growth of the country. But, I 1971 the Prime Minister of India put a forced sterilization policy into place in the country.

However, the program was meant to sterile only those who have two or more children. But, the program ended up sterilizing many unmarried and people who politically opposed the regime.

Moreover, by the time the new government came into power the damage has been already done and people started to see family planning with hatred. That’s why the government shifts its focus from men to a birth control method for women.

Family Planning in Recent Years

The measure to control the birth control method for women not unsuccessful. Furthermore, from 1965 to 2009, the use of contraceptives in women increased from 13 percent to 48 percent. In addition, the fertility rate also goes down from 5.7 percent to 2.4 during the year 1966 to 2012.

Moreover, many states adopted policies that prohibit a person who has more than two children to apply for a government job.

To sum it up, India has come a long way in practicing birth control but still has a long way to go. Moreover, most of the women are aware of the birth control measure, but they cite difficulty in getting access to these measures.

Also, the traditional mindset of most of the Indians related to children also doesn’t help either. Besides, the decreased fertility rate has gone down but it isn’t enough to control the population explosion.

However, India needs to more than just birth control to stop this problem.

FAQs about Essay on Family Planning in India

Q.1 Name the person who first recognizes the importance of birth control in India. A.1 Raghunath Dhondo Karve is the person who recognizes this problem. He also published it in his magazine.

Q.2 What is birth control? A.2 Birth control is a practice by which the birth rate of children is controlled.

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