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The Achievements of 50 Years MEASURE EVALUATION TR-15-101 Family Planning in Latin America and the Caribbean: The Achievements of 50 Years April 2015 Jane T. Bertrand, PhD, MBA Victoria M. Ward, PhD Roberto Santiso-Gálvez, MD Family Planning in Latin America and the Caribbean: The Achievements of 50 Years Jane T. Bertrand, PhD, MBA Victoria M. Ward, PhD Roberto Santiso-Gálvez, MD MEASURE Evaluation is funded by the U.S. Agency for International Development (USAID) under cooperative agreement AID-OAA-L-14-00004. MEASURE Evaluation, whose staff provided editorial, formatting, and distribution assistance, is implemented by the Carolina Population Center at the University of North Carolina at Chapel Hill, in association with Futures Group; ICF International; John Snow, Inc.; Management Sciences for Health; and Tulane University. The opinions expressed in this publication do not necessarily reflect the views of USAID or the United States government. April 2015 ISBN 978-1-943364-00-8 TR-15-101 Suggested citation: Bertrand JT, Ward VM, Santiso-Gálvez R. Family Planning in Latin America and the Caribbean: The Achievements of 50 Years. Chapel Hill, NC: MEASURE Evaluation; 2015. ii ACKNOWLEDGMENTS The co-authors owe a debt of gratitude to three individuals who devoted vast amounts of their time and energy to this report: Kime McClintock and Jerry Parks (lead research assistants at Tulane University School of Public Health and Tropical Medicine) and Maria Cristina Rosales (editorial assistant in Guatemala). Their dedication in conducting background research, fact checking, verifying references, and editing text greatly enhanced the quality of the final product. In addition, we thank Nicole Carter, Alejandra Leyton, and Maayan Jaffe for their contributions as research assistants to specific sections of the report. Mirella Augusto and Maria Carolina Herdoiza provided valuable administrative and logistics support to this effort. Dr. Tania DesGrottes served as a consultant to the team in preparing the associated case study on Haiti. At the University of North Carolina at Chapel Hill, we thank Bates Buckner, Erin Luben, Elizabeth T. Robinson, and Nash Herndon for their editorial assistance; as well as Denise Todloski, who designed the cover. The U.S. Agency for International Development Latin America and the Caribbean Bureau (USAID/LAC) commissioned this report and provided constructive technical guidance in its development. We wish to thank Kimberly Cole for her skillful management of the process and detailed synthesis of reviewer comments. Other core reviewers from USAID/LAC included Susan Thollaug, Lindsay Stewart, Mary Vandenbroucke, Maggie Farrell, Veronica Valdivieso, and Richael O’Hagan. A number of Latin American/Caribbean specialists from within and outside of USAID also reviewed part or all of this report and/or the associated country case studies: Yma Alfaro Nancy Alvey Graciela Avila Jerry Bowers Marianela Corriols Jo Jean Elenes Maricarmen Estrada Maria Rosa Garate Dale Gibb Kovia Gratzon Erskine Amber Hill Beverly Johnston Sandra Jordan Rocio Lara Natalia Machuca Réginalde Gerlus Massé Richael O’Hagan Maria Isabel Plata iii Nora Quesada Isabel Stout Veronica Valdivieso In addition to the main report, eight case studies were prepared to provide more in-depth analysis of the evolution of family planning programs in specific countries in the LAC region. The following persons reviewed these case studies or provided logistical assistance in each country: Colombia Maria Isabel Plata Gabriel Ojeda Marlene Vera Dominican Republic Sonia Brito-Anderson El Salvador José Mario Cáceres Henríquez Guatemala Marisela de la Cruz Haiti Gadner Michaud Mexico Ricardo Vernon Nicaragua Freddy Cárdenas Ortega Paraguay Cynthia Prieto iv CONTENTS Acknowledgments ........................................................................................................................................ iii List of Figures and Tables ............................................................................................................................ vii Executive Summary ...................................................................................................................................... ix Introduction ............................................................................................................................................ ix Evolution of Methods, Programs, and Attitudes ..................................................................................... x Factors Contributing to Widespread Use of Family Planning ................................................................. xi Remaining Challenges ............................................................................................................................. xi Conclusion.............................................................................................................................................. xii I. Rationale for this Report ............................................................................................................................ 1 II. Methodology ............................................................................................................................................. 3 III. Demographic Change in the Context of Steadily Improving Standards of Living .................................... 5 Demographic Change ............................................................................................................................... 5 Evolution of Contraceptive Use ............................................................................................................... 7 Unmet Need for Contraception and Continuing Disparities ................................................................. 11 Infant Mortality and Maternal Mortality Trends ................................................................................... 16 Educational Achievement ...................................................................................................................... 19 Economic Trends and Income Disparity ................................................................................................ 21 IV. Adolescent Fertility, Contraceptive Use, and Unmet Need ................................................................... 25 Adolescent Birth Rates........................................................................................................................... 27 Proportion of Adolescents in Union Who Are Pregnant or Have Had a Child at the Time of the Survey ................................................................................................................. 28 Contraceptive Prevalence Rates among Adolescents ........................................................................... 31 Early Sexual Debut and Very Young Pregnancy ..................................................................................... 33 Unmet Need for Contraception among Adolescents ............................................................................ 35 Educational Attainment and ABR .......................................................................................................... 36 V. Historical Overview: Early Years in the Family Planning Movement ...................................................... 37 Catalytic Role of the International Planned Parenthood Federation in Latin America ......................... 37 Evolution in the Models of Service Delivery .......................................................................................... 40 The Political Climate for Family Planning .............................................................................................. 43 Financial and Technical Support for Family Planning in Latin America ................................................. 46 VI. Ten Key Factors that Influenced FP Achievements in the LAC Region .................................................. 51 1. The Development of Strong NGOs that Pioneered the Family Planning Movement and Continue to Tackle Politically Sensitive Issues .......................................................................... 51 v 2. The Macro Socio-Political Environment that Gradually Supported Family Planning and Increasingly Progressive Policy Frameworks ............................................................................. 54 3. Sustained Financial and Technical Assistance from USAID and Other Donors ................................ 57 4. Synergistic Coordination among Governments, External Agencies, NGOs, and Civil Society .......... 63 5. The Development of Local Expertise in Key Programmatic and Management Areas ...................... 65 6. Improvement in the Availability of Information as a Tool to Drive Decision Making and Open Doors .................................................................................................... 68 7. Strategically Designed, Wide-Reaching Communication Activities to Support Change in Individual Behavior and Social Norms ............................................................................. 70 8. Mechanisms to Ensure Program Financing that Evolved to Fit the Times ....................................... 73 9. Effective Advocacy to Achieve Major Political Gains ....................................................................... 76 10. Significant Investments in Contraceptive Security .......................................................................... 79 VII. Remaining Challenges and Future Directions ......................................................................................
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