Family planning program effort and the initiation of contraceptive use: a multi-level analysis

Abstract

The study of Program Effort and Performance (PEP) is an areal analysis of how management and infrastructur influences family planning achievement in different social and economic settings. Based on the conceptual framework pioneered by Mauldin and Lapham and applied at the national level, PEP use the same general approach at the sub-national level in Thailand by focusing on the district (average population : 80,000). The goal of PEP is to produce a extreme enconomy set of program effort, setting and achievement indicators which can be incorporated into a database management system for multivariate analyses at national headquarters. When updated periodically, such an information system could guide family planning program managers in the pursuit of optinal resource allocation, thereby accelerating family planning achievement. For the final phase of PEP, a multi-level analysis was carried out in order to screen as wide a range of variables as possible in a search for the most descriptive. Program input and setting variables at the district and sub- district levels were combined with village, household and individual-level survey data from another study conducted at the same time as PEP. The data for the dependent variable was also derived from the sample survey and measured initiation of contraceptive use in the past year. The results confirm that individual demand factors have the most influence on initiation of contraception when comparing program effort at the district and sub- district with development setting, program effort accounts for more variance in the dependent variable, although the difference is not great. The study recommends that (1) national family planning programs need to include measurements of setting for administrative areas in their management information systems; (2) among family planning program inputs, those that improve access to services have had the greatest impact on performance in Thailand and, (3) any sub-national study of program effort and performance should be conducted while the family planning program is young and growing, or among areas of lagging, but not stagnant achievement.