International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil.
Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil.
Front Public Health. 2024 May 14;12:1339725. doi: 10.3389/fpubh.2024.1339725. eCollection 2024.
BACKGROUND: Enhancing the design of family planning interventions is crucial for promoting gender equality and improving maternal and child health outcomes. We identified, critically appraised, and synthesized policies and strategies from five selected countries that successfully increased family planning coverage. METHODS: We conducted a policy analysis through a scoping review and document search, focusing on documents published from 1950 to 2023 that examined or assessed policies aimed at enhancing family planning coverage in Brazil, Ecuador, Egypt, Ethiopia, and Rwanda. A search was conducted through PubMed, SCOPUS, and Web of Science. Government documents and conference proceedings were also critically analyzed. National health surveys were analyzed to estimate time trends in demand for family planning satisfied by modern methods (mDFPS) at the national level and by wealth. Changes in the method mix were also assessed. The findings of the studies were presented in a narrative synthesis. FINDINGS: We selected 231 studies, in which 196 policies were identified. All countries started to endorse family planning in the 1960s, with the number of identified policies ranging between 21 in Ecuador and 52 in Ethiopia. Most of the policies exclusively targeted women and were related to supplying contraceptives and enhancing the quality of the services. Little focus was found on monitoring and evaluation of the policies implemented. CONCLUSION: Among the five selected countries, a multitude of actions were happening simultaneously, each with its own vigor and enthusiasm. Our findings highlight that these five countries were successful in increasing family planning coverage by implementing broader multi-sectoral policies and considering the diverse needs of the population, as well as the specific contextual factors at play. Successful policies require a nuanced consideration of how these policies align with each culture's framework, recognizing that both sociocultural norms and the impact of past public policies shape the current state of family planning.
背景：增强计划生育干预措施的设计对于促进性别平等和改善母婴健康结果至关重要。我们确定、批判性地评价并综合了五个选定国家的政策和战略，这些国家成功地提高了计划生育的覆盖面。
方法：我们通过范围界定审查和文件检索进行了政策分析，重点是研究或评估旨在提高巴西、厄瓜多尔、埃及、埃塞俄比亚和卢旺达计划生育覆盖率的政策的文件，这些文件发表于 1950 年至 2023 年。通过 PubMed、SCOPUS 和 Web of Science 进行了搜索。还批判性地分析了政府文件和会议记录。对国家卫生调查进行了分析，以估计全国层面和按财富划分的现代方法计划生育需求（mDFPS）的时间趋势，以及方法组合的变化。研究结果以叙述性综合呈现。
发现：我们选择了 231 项研究，其中确定了 196 项政策。所有国家都在 20 世纪 60 年代开始支持计划生育，所确定政策的数量在厄瓜多尔为 21 项，在埃塞俄比亚为 52 项。大多数政策仅针对妇女，与供应避孕药具和提高服务质量有关。很少关注对所实施政策的监测和评价。
结论：在这五个选定的国家中，同时发生了许多行动，每个国家都有自己的活力和热情。我们的研究结果表明，这些国家通过实施更广泛的多部门政策并考虑到人口的多样化需求以及当前发挥作用的具体背景因素，成功地提高了计划生育的覆盖面。成功的政策需要细致考虑这些政策如何与每个文化的框架相一致，认识到社会文化规范和过去公共政策的影响塑造了当前计划生育的状况。
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