UNITED NATIONS ISSUES STUDY ON CHILD SURVIVAL, HEALTH AND FAMILY PLANNING PROGRAMMES AND FERTILITY
UNITED NATIONS ISSUES STUDY ON CHILD SURVIVAL, HEALTH AND FAMILY PLANNING PROGRAMMES AND FERTILITY19960930 Case-Studies Conducted in Ecuador, Indonesia and Zimbabwe Provide Information on Integrating Family Planning Programmes and Development
NEW YORK, 26 September (DESIPA) -- As part of the ongoing debate about whether mortality decline is a necessary precondition for fertility decline, the Population Division of the Department for Economic and Social Information and Policy Analysis (DESIPA) has issued a compendium of case-studies entitled Child Survival, Health and Family Planning Programmes and Fertility.
Issued at a critical time of planning the future reproductive health programmes in the light of the recommendations of the International Conference on Population and Development (Cairo, 1994), the study, which is based on the three case-studies done in Ecuador, Indonesia and Zimbabwe, provides information which is helpful for integrating and expanding the health and family planning programmes within the overall context of development at the local and national level. Improving the access to health and family planning services at the grass-root level is an important strategy of the Cairo Programme of Action.
On the basis of the analysis of data from Ecuador it is concluded that integrated interventions such as health centres, which provide family planning services in addition to health services, can be more beneficial in achieving the goals of lower fertility and child mortality. Thus, a better coverage of the population by institutions that provide basic medical and family planning services would lead to significant reductions in both fertility and child mortality.
The Indonesian case-study found a strong association between the use of contraception and the use of child survival interventions, an observation consistent with the hypothesis that, at a certain stage of demographic transition, couples demand fewer and healthier children and make joint decisions about adopting modern practices to achieve their goals. Also significant is the finding that, independent of the relationships between the use of child survival intervention and the use of contraceptives, the level of coverage of communities with child survival interventions and the mothers' health awareness are strong determinants of contraceptive use. The Indonesian
case-study shows the potential synergistic relation between those intervention programmes in promoting both child survival and fertility decline.
The case-study in an African setting, conducted in Zimbabwe, shows clearly that the survival of a child has a significant impact on fertility by demonstrating, after taking all other relevant factors into consideration, that, if a child dies, the interval until the next birth is shorter than if the child survives, indicating, besides the termination of the ovulation- inhibiting effect of breast-feeding, the non-use of family planning in order to replace the child that died. The study supports the hypothesis that there is a replacement effect in the relationship between child survival and fertility, in other words, the death of a child shortens the next birth interval.
The analysis of Zimbabwe data also indicates that coverage and visits by mobile family planning clinics has a significant impact on fertility in rural areas, even after controlling the mother's characteristics and the survival status of the previous-to-the last birth. The results of the study highlight the need for bringing health services closer to the rural population. Again, greater access to integrated health and family planning services is emphasized for improvement of mortality levels and lowering of fertility levels.
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