The evidence in the demographic and family planning literature of the range and diversity of the barriers to fertility regulation in many developing countries is reviewed in this article from a consumer perspective. Barriers are defined as the constraining factors standing between women and the realistic availability of the technologies and correct information they need in order to decide whether and when to have a child. The barriers include limited method choice, financial costs, the status of women, medical and legal restrictions, provider bias, and misinformation. The presence or absence of barriers to fertility regulation is likely an important determinant of the pace of fertility decline or its delay in many countries. At the same time, barriers inhibit women's ability to avoid unintended pregnancy. Problems of quantifying barriers limit understanding of their importance. New ways to quantify them and to identify misinformation, which is often concealed in survey data, are needed for future research.

http://bixby.berkeley.edu/wp-content/uploads/2015/03/Barriers-Fertility-Regulation.pdf

Barriers to fertility regulation: a review of the literature.

The Kenya government in collaboration with other stakeholders involved in the provision of family planning services have put in place various strategies and policies to increase uptake of family planning services. These are aimed at increasing contraceptive prevalence rate (CPR), reduction in both total fertility rate (TFR) and unmet need for family planning services. Despite the various strategies and policies, total fertility rate still remains high at 4.6 percent, while CPR and unmet need for family planning are estimated at 46 percent and 24 percent, respectively. The purpose of the study was to examine the utilization level of family planning services and to analyze the determinants of demand for family planning services among women in City slums in Kenya. To realize this objective, a survey design was adopted. The target population constituted women in city slums in Kenya, who were identified through multistage random sampling. Primary data was collected from the women using a structured interview schedule. A fact sheet was used to summarize the data collected before it was cleaned, coded and edited for completeness and accuracy. The study revealed low usage of contraceptives compared to the national level. Use of the services varied in terms of demographic and socioeconomic factors of the woman and also the woman’s perception in terms of the facility/provider factors such quality, friendliness of staff and promotion. Various factors accounted for the low use of family planning services. These included partner’s approval, quality of the services, friendliness of the staff administering the services and the woman’s knowledge about family planning services. Other factors included the woman’s income level, proximity to the provider and the religious background of the woman. To increase the use of family planning services among women in slums, activities of community based distributors should be revived and enhanced, promotion of family planning education and activities at the household level should be accorded priority. Formation of lobby groups to enhance cultural change, awareness creation and counselling and integrating family planning services with HIV/AIDS are recommended.

/pdf/contraceptive-use-among-women-of-reproductive-age-in-kenya-s-5cp14c9fdj.pdf

Contraceptive Use among Women of Reproductive Age in Kenya’s City Slums

Proponents of user fees in the health sector in poor countries cite a number of often interrelated rationales, relating inter alia to cost recovery, improved equity and greater efficiency. Opponents argue that dramatic and sustained decreases in service utilization follow the introduction of user fees, highlighting evidence that user fees reduce service utilization when they fail to result in improved quality of care and/or when services are priced higher than those charged by private health care providers. Utilization of public health services in Cambodia is low. Supply-side factors are significant determinants of such low public sector utilization, including low official salaries of service providers (forcing many to seek additional income in the private sector), and operations budgets which are erratic and often insufficient to cover running costs of service delivery outlets. The Cambodia Ministry of Health (MOH) encourages user fee schemes at operational district level. By allowing revenue to be retained at the health facility level, the MOH aims to improve health care delivery--and consequently service utilization--through increased salaries to health facility staff and increases in operations budgets. This case study of the introduction of user fees at a district referral hospital in Kirivong Operational District in Cambodia, using the findings from empirical research, examines the impact of user fees on health-careseeking behaviour, ability to pay and consultation prices at private practitioners. The research showed that consultation fees charged by private providers increased in tandem with price increases introduced at the referral hospital. It further demonstrates--for the first time that we are aware of from the available literature--that the introduction and subsequent increase in user fees created a 'medical poverty trap', which has significant health and livelihood impact (including untreated morbidity and long-term impoverishment). Addressing the medical poverty trap will require two interventions to be implemented immediately: regulation of the private sector, and reimbursing health facilities for services provided to patients who are exempted from paying user fees because of poverty. A third, longer-term initiative is also suggested: the establishment of a social health insurance mechanism.

The impact of the introduction of user fees at a district hospital in Cambodia.

Introduction In rural India contraceptive use remains uncommon among newly married couples. non-use in rural young couples contributes to higher fertility rates. Objectives To identify barriers of spacing contraceptive use among young married couples in rural Maharashtra. Methods In-depth interviews were conducted with husbands (N=30), wives (N=20), and village health providers (N=12); additionally, 3 focus groups were conducted with mothers of husbands (N= 42 focused on understanding contraceptive use and barriers. Interviews and focus groups ranged in length from 90-120 minutes. Detailed notes taken during interviews were analysed using a grounded theory approach and the data was analysed using atlas-ti software. Results Major barriers to spacing contraception are: pro-natal social norms, pregnancy expectations early in marriage, to produce multiple sons, limited access to modern spacing contraceptives, family resistance to adopt contraceptives, lack of husband's involvement on family planning issues, myths, misconceptions, perceived side effects and negative attitudes toward specific contraceptives. Conclusion Findings highlight the intersection of norms against spacing contraception, traditional gender ideologies and lack of male involvement as major barriers to the use of contraception. Male oriented outreach programmes on family planning. Promoting gender equity should be made through health programme deliveries with special focus in rural areas.

/pdf/barriers-to-use-contraceptive-methods-among-rural-young-43catp1cyz.pdf

Barriers to use contraceptive methods among rural young married couples in Maharashtra, India: Qualitative findings.

The issue of pricing contraceptives in family planning programs is becoming more and more important. What is the relationship between consumer prices and demand, and how can we strike the correct balance between the two? This report examines the correlation between consumer prices for condoms, expressed as a percentage of per-capita gross national product, and per-capita sales of condoms in 24 social marketing programs. The correlation that emerges is strong and negative: Even when the data are controlled for age of program and other independent variables, there is a clear negative correlation between prices and contraceptive sales in these programs. The conclusion is clear that condom prices must be set very low--well below the equivalent of 1 percent of per-capita gross national product for a year's supply--in order to achieve satisfactory prevalence for condoms in either a family-planning or an AIDS-prevention context.

/pdf/the-impact-of-condom-prices-on-sales-in-social-marketing-1927qza1t8.pdf

The impact of condom prices on sales in social marketing programs.

This article explores the significance of price of contraceptives as a deterrent to use by studying demand shifts in response to changes in contraceptive prices. Where high fertility represents a net cost to society government subsidies are warranted to encourage utilization of family planning; the optimal amount subsidized is the price that maximizes cost recovery and minimizes loss of users. Costs of contraception to the consumer other than price of contraceptives include distance to source of supply opportunity cost of waiting opportunity and travel costs of futile trips to closed or oversubscribed family planning services. Quality of service also has an effect. Other studies have shown that consumers prefer to pay for goods and services as price reflects value and in many societies users distrust free services; fees also provide greater assurance of effective use and minimal wasting. Marginal charges may have a beneficial effect on demand. Evidence from studies conducted in Sri Lanka Jamaica Colombia and Thailand demonstrate that increased prices generally have no effect on demand but there are circumstances where contraceptive prices are too high for low-income households and in these cases price reductions will have a positive impact on utilization.

https://www.jstor.org/stable/pdfplus/1967030.pdf

Maureen A. Lewis

Papers

Do contraceptive prices affect demand