Determinants of Fertility Preferences and Contraceptive Use: Program Effects

1
Determinants of Fertility Preferences and
Contraceptive Use Program Effects

• April 3, 1998

2
Family Planning Issues

• Program Effect on Additional Children Desired
• Ideal Family Size is 6 for both men and women
• Leveling off of Contraceptive Prevalence Rate
• Simulated impact of IEC
• Simulated impact of FP service accessibility
• Impact of Targeted Family Planning Training
• Dependent variable now Family Planning Clients
• Impact on change in number of clients from 1991
  to 1996

3
FP Program Effects on Fertility
Fertility
Contraceptive Practice
Individual Demand for FP
Program Supply of FP
Service Utilization
USAID/Other Donor Inputs
4
Individual Explanatory Variables

• Age Categories

5
Age Categories Sample Percentages
6
Individual Explanatory Variables

• Age Categories
• Womans Education

7
Womans Education Categories Sample Percentages
8
Individual Explanatory Variables

• Age Categories
• Womans Education
• Partners Education

9
Partners Education Categories Sample
Percentages
10
Individual Explanatory Variables

• Age Categories
• Womans Education
• Partners Education
• Asset Indicators

11
Asset Indicators Sample Percentages
12
Individual Explanatory Variables

• Age Categories
• Womans Education
• Partners Education
• Asset Indicators
• Religion

13
Religion Sample Percentages
14
Program Measures

• Service Accessibility
• Used in the Additional Children Desired Equation

15
Hospital Accessibility
16
Health Center Accessibility
17
Dispensary Accessibility
18
Program Measures

• Service Accessibility
• Additional Children Desired Equation
• 98 of Urban Clusters have a facility within 5 km
• 71 of Rural Clusters have a facility within 5 km

19
Program Measures

• Service Accessibility
• Additional Children Desired Equation
• Family Planning Service Availability
• Contraceptive Choice Estimation

20
Hospital with FP Accessibility
21
Health Center with FP Accessibility
22
Dispensary with FP Accessibility
23
Program Measures

• Service Accessibility
• Additional Children Desired Equation
• Family Planning Service Availability
• Contraceptive Choice Estimation
• 94 of Urban Clusters have a Facility with FP
  within 5 km
• 57 of Rural Clusters have a Facility with FP
  within 5 km

24
Program Measures

• Service Accessibility
• Additional Children Desired Equation
• Family Planning Service Availability
• Contraceptive Choice Estimation
• IEC Exposure
• All Equations

25
IEC Exposure
26
Program Measures

• Service Accessibility
• Additional Children Desired Equation
• Family Planning Service Availability
• Contraceptive Choice Estimation
• IEC Exposure
• All Equations
• In Service Family Planning Training
• New and Returning Client Estimation

27
Facilities with 1 and 2 trained FP/RH providers
28
Additional Children Desired

• Model

29
FP Program Effects on Fertility
Fertility
Contraceptive Practice
Individual Demand for FP
Program Supply of FP
Service Utilization
USAID/Other Donor Inputs
30
FP Program Effects on Family Planning Demand
Individual Demand for FP
Program Supply of FP
USAID/Other Donor Inputs
31
Additional Children Desired

• Model
• Levels

32
Additional Children Desired 1996Urban and Rural
Women
33
Additional Children Desired

• Model
• Levels
• Results

34
Additional Children Desired 1996 Age Effects
All Significant at 5 level
35
Additional Children Desired 1996 Education
Effects
All Significant at 5 level
36
Additional Children Desired 1996 Partners
Education Effects
37
Additional Children Desired 1996 Partners
Education Effects
38
Additional Children Desired 1996 Partners
Education Effects
39
Additional Children Desired 1996 Partners
Education Effects
40
Additional Children Desired 1996 Hospital/Health
Center Access
41
Additional Children Desired 1996 Hospital/Health
Center Access
42
Contraceptive Method Choice

• Model

43
FP Program Effects on Fertility
Fertility
Contraceptive Practice
Individual Demand for FP
Program Supply of FP
Service Utilization
USAID/Other Donor Inputs
44
FP Program Effects on Contraceptive Choice
Contraceptive Practice
Exogenous Demand Ind.
Program Supply of FP
USAID/Other Donor Inputs
45
Contraceptive Method Choice

• Model
• Levels

46
Contraceptive Method Choice 1996 Urban Women
23.9
5.4
70.7
47
Contraceptive Method Choice 1996 Rural Women
9.4
4.2
86.5
48
Regional Variation in CPR, 1996Modern Methods,
All Women
49
Contraceptive Method Choice

• Model
• Levels
• Results
• Modern vs No Contraceptive Choice Presented

50
Contraceptive Method Choice 1996Age Effects
All Significant at 5 level
51
Contraceptive Method Choice 1996 Education
Effects
All Significant at 5 level
52
Contraceptive Method Choice 1996 Partners
Education Effects


5 10
53
Contraceptive Method Choice 1996 Hospital/Health
Center FP Access
54
Contraceptive Method Choice 1996 Hospital/Health
Center FP Access
55
Contraceptive Method Choice 1996 Other FP
Facility Access
56
Contraceptive Method Choice 1996 Radio Drama
Effect


5 10
57
Contraceptive Method Choice

• Model
• Levels
• Results
• Modern vs No Contraceptive Choice Presented
• Simulation of Family Planning Program Effects

58
Contraceptive Method Choice Simulation Procedure

• Calculate the estimates for 1991 and 1994
• Matched sample of facilities and clusters
• Radio Drama variable not directly comparable
• Trends

59
Contraceptive Method Choice Simulation Procedure
Trends

• Age effects are basically the same
• Education effects are slightly different
• 1-6 years of education generally cannot be
  differentiated from 0 years in earlier samples
• Higher education categories act similarly to 1996
• Partners education effects were significant in
  all but the 1994 Urban sub-sample

60
Contraceptive Method Choice Simulation Procedure
Trends

• Radio Drama effects are significant and positive
  in 1994
• Hospitals with FP within 5k are positive and
  significant in all rural samples
• Health Centers with FP within 5k are positive and
  significant in all rural samples
• No Urban access effects at all in the 1991 and
  1994 samples

61
Contraceptive Method Choice Simulation Procedure

• Predictions
• Use coefficients to predict the probability of
  modern use for each woman in the sample
• Average across women
• Simulation
• Set program variable to zero and re-predict
• Set program variable to one and re-predict
• Difference between the two is the program impact

62
Contraceptive Method Choice 1996 Simulation
Results for Modern Use
63
Training Effects on Family Planning

• Model

64
FP Program Effects on Fertility
Fertility
Contraceptive Practice
Individual Demand for FP
Program Supply of FP
Service Utilization
USAID/Other Donor Inputs
65
FP Program Effects on Service Use
Exogenous Demand Ind.
Program Supply of FP
Service Utilization
USAID/Other Donor Inputs
66
Training Effects on Family Planning

• Model
• Need to correct for clustering of training
• Look at differences between the 1991 and 1996
  data, not levels
• Two dependent variables, the change in the number
  of new acceptors of FP, and the change in the
  number of resupply FP clients, per provider
• Training variable is 2 or more post 1992 in
  service trained FP staff members in facility
• Regressions are separately run for Hospitals,
  Health Centers, and Dispensaries

67
Training Effects on Family Planning

• Model
• Levels

68
Training Effects on Family PlanningNew and
Returning Clients 1996
69
Training Effects on Family PlanningNew and
Returning Clients per FP Provider
70
Training Effects on Family Planning

• Model
• Levels
• Results

71
Training Effects on Family PlanningTraining
Variable Effects



5 10
72
Conclusions

• Womans education most consistently associated
  with positive outcomes
• Partners education is also strongly associated
  with positive outcomes

73
Conclusions

• Program variables are associated with a broad
  range of positive outcomes, but they are not very
  consistent
• The effect of the best program indicators seems
  to have diminished through time
• Access to family planning hospitals and health
  centers has a positive but diminishing effect on
  modern contraceptive use in the rural sample
• Exposure to the family planning radio drama has a
  positive but diminishing effect on modern
  contraceptive use in both urban and rural samples

74
Conclusions

• Program variables are associated with a broad
  range of positive outcomes, but they are not very
  consistent
• The effect of the best program indicators seems
  to have diminished through time
• After adjusting for the training strategy, the
  program goal of in-service training seems to have
  a significant positive effect on contraceptive use