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In: African research studies in population information, education and communication, compiled and edited by Tony Johnston, Aart de Zeeuw, and Waithira Gikonyo. Nairobi, Kenya, United Nations Population Fund [UNFPA], 1991. 54-72.Researchers arranged for interviews with 300 female discontinuing clients at 2 maternal and child health/family planning (MCH/FP) clinics in Mauritius and followed 230 of them to explain what happens to women who discontinue coming to the MCH/FP clinic. 26% of all women in the sample stopped using MCH/FP clinic services for fertility related reasons. The 2 leading reasons were desire for pregnancy (15.2% of all women) followed by husband absent or sexually inactive (5.2%). Further 30.1% switched to a competing contraceptive provider, especially a factory based provider (11.3%). They tended to switch providers because the new provider was more accessible or they were either dissatisfied with the quality of services at the MCH/FP clinic or the new clinic had an advantage over the MCH/FP clinic. 43.9% switched from scientific family planning methods to either natural or traditional family planning methods. These women tended no to wander out of the house and to be poorly educated, of an ethnic minority group, and >35 years old. In fact, 26.1% used natural family planning because of dissatisfaction with either the contraceptive methods themselves or the quality of services provided. Much attendance discontinuity was determined by misperceptions about ongoing or long term contraceptive use. This indicated that clinic counselors should become more sensitive to and fully address the problems and side effects of contraceptive method use. In conclusion, the MCH/FP clinics should focus their information, education, and communication efforts on the women who switched to unscientific or natural methods.
Population Reports. Series J: Family Planning Programs. 1991 Nov; (39):1-31.This report discusses the challenges and costs involved in meeting the future needs for family planning in developing countries. Estimates of current expenditures for family planning go as high as $4.5 billion. According to a UNFPA report, developing country governments contribute 75% of the payments for family planning, with donor agencies contributing 15%, and users paying for 10%. Although current expenditures cover the needs of about 315 million couples of reproductive age in developing countries, this number of couples accounts for only 44% of all married women of reproductive age. Meeting all current contraceptive needs would require an additional $1 to $1.4 billion. By the year 2000, as many as 600 million couples could require family planning, costing as much as $11 billion a year. While the brunt of the responsibility for covering these costs will remain in the hand of governments and donor agencies (governments spend only 0.4% of their total budget on family planning and only 1% of all development assistance goes towards family planning), a wide array of approaches can be utilized to help meet costs. The report provides detailed discussions on the following approaches: 1) retail sales and fee-for-services providers, which involves an expanded role for the commercial sector and an increased emphasis on marketing; 2) 3rd-party coverage, which means paying for family planning service through social security institutions, insurance plans, etc.; 3) public-private collaboration (social marketing, employment-based services, etc.); 4) cost recovery, such as instituting fees in public and private nonprofit family planning clinics; and 5) improvements in efficiency.