Family Planning Programs: Can More Be Done?

In recent years, countries throughout the world have become increasingly concerned about problems related to the high rates of population growth. As a result, during the past decade, 24 countries have announced official national population policies aimed at fertility reduction, and an additional 23 countries have begun, unofficially, to support population activities (1-3). Given the pre-existing generally pronatalist concepts, these actions constitute the beginning of a major social revolution. It is generally accepted that a family program is a necessary part of a country's population program, and a number of researchers have presented evidence that suggests that family programs have a direct effect on lowering fertility rates (4). However, in recent years, a continuing controversy has emerged as to how effective family programs really are. Several critics have suggested that various social, economic, and cultural changes are necessary prerequisites (5-8). A large number of proposals have been put forward concerning steps that might be taken outside the family field, or family planning, to bring about a fertility reduction (9). Most of them, however, are not yet feasible, particularly in the developing world, for various political, administrative, and technical reasons. It is probably true that more than family programs will be needed in the long run if developing countries are to be successful in lowering population growth rates to 1 percent or below. In the last few years, steps have been taken in this direction. Several countries have reviewed laws that affect fertility, including those involving legal age at marriage, maternity leave and benefits, and tax benefits for each additional child. Singapore, for example, has already made major legislative changes (10), and population-related materials are being introduced in the educational systems of an increasing number of countries (11-13). Further, it is undoubtedly true that the values individuals place on family and their attitudes concerning preferred family size vary from culture to culture as well as various social classes. Research in these areas has been undertaken in a number of countries; however, much more has to be learned in order to reach and motivate those who still resist the idea of a smaller family. Similarly, in spite of extensive research in the field of human reproduction, we have not yet devised an ideal method of contraception. The development and widespread use of hormonal agents and the rebirth of intrauterine devices are two major technological advances, particularly since they make it possible for the means of contraception to be separate from the coital act. Improved technology is needed, however, since the side effects and potential complications of existing methods are numerous. Many people believe that research in this area should receive the highest priority from funding agencies involved in the population field (14). Although physicians, public health personnel, demographers, economists, and sociologists have discussed at length the most appropriate ways to proceed at this point, debates on whether within or beyond family is the best approach are unnecessary. Rather, those involved in family and population programs should carefully consider ways to improve existing family programs; at the same time, they should encourage social and economic development planners to give high priority to the population problem by providing needed funding and support and by developing culturally acceptable family planning proposals. Major efforts in the family field started only the past ten years. A question of great importance to those involved in directing and supporting national family programs is whether existing programs have been as effective as they could be. This paper reviews the service networks of existing family programs, comments on several important program constraints, and suggests ways to improve existing programs.