Horanieh Nour, Witt Alice, Fall Marieme, Montt-Maray Eloisa, Adamjee Lamiah, Larson Elizabeth, Gonzalez-Capella Thais, Cislaghi Beniamino
Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom.
Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
Front Glob Womens Health. 2025 Jun 13;6:1548447. doi: 10.3389/fgwh.2025.1548447. eCollection 2025.
The 1994 International Conference on Population Development (ICPD) initiated the transition of family planning (FP) programmes from focusing on population control to promoting human rights and women's empowerment. The indicators used to measure success of FP programmes, however, continue to focus on estimating modern contraceptive uptake. Contraceptive Prevalence Rate (CPR) and unmet need are the main indicators used. We aim to assess the views of those working within the FP community from the Global North and South on the use of current indicators for FP programmes. While there have been calls for new measures, understanding the barriers to changing existing ones is essential for adopting and implanting these new measures.
We conducted semi-structured interviews with 31 participants from five distinct groups; academics, NGO workers, government officials, funding agency workers and advocates. Participants were working in countries worldwide, including both the Global North and South; the latter were mostly based in Francophone West Africa. Interviews explored several themes including FP targets and indicators. We applied a thematic analysis.
Participants' views ranged from those who believed in the need to eradicate current indicators from FP programmes to those expressing contentment with current indicators and their benefit in measuring success. Most of the participants acknowledged the benefit of indicators in assessing progress or as a starting point, yet they identified multiple limitations to their use, including the possibility of implicit coercion, skewing training to focus on long-acting reversible contraceptives (LARCs) promotion, and prioritising modern contraceptive methods over natural ones. Some expressed anxiety that challenging the status quo could lead to funding cuts. Participants identified challenges in adopting new indicators and emphasised that funding for FP programs remains largely concentrated among international agencies based in the Global North, which results in maintaining certain traditional demographic approaches.
Current indicators affect the understanding of success of FP programmes and influence how FP services translate on the ground. We provide international stakeholders' perspectives on the barriers to be overcome to support development of new indicators, including non-use of contraception as a success as long as it is a full, free and informed choice.
1994年国际人口与发展会议(ICPD)开启了计划生育(FP)项目从专注于人口控制向促进人权和妇女赋权的转变。然而,用于衡量FP项目成功与否的指标仍继续侧重于估计现代避孕方法的使用率。避孕普及率(CPR)和未满足的需求是主要使用的指标。我们旨在评估来自全球北方和南方的FP领域工作人员对当前FP项目指标使用情况的看法。虽然一直有人呼吁采用新的衡量标准,但了解改变现有指标的障碍对于采用和实施这些新措施至关重要。
我们对来自五个不同群体的31名参与者进行了半结构化访谈;这些群体包括学者、非政府组织工作人员、政府官员、资助机构工作人员和倡导者。参与者在全球各国工作,包括全球北方和南方;后者大多位于西非法语国家。访谈探讨了几个主题,包括FP目标和指标。我们采用了主题分析法。
参与者的观点各不相同,从那些认为需要从FP项目中根除当前指标的人,到对当前指标及其在衡量成功方面的作用表示满意的人。大多数参与者承认指标在评估进展或作为起点方面的益处,但他们也指出了指标使用存在的多重局限性,包括可能存在隐性强制、使培训偏向于专注长效可逆避孕方法(LARC)的推广,以及将现代避孕方法置于自然避孕方法之上。一些人表示担心挑战现状可能导致资金削减。参与者指出采用新指标存在挑战,并强调FP项目的资金在很大程度上仍集中在全球北方的国际机构,这导致维持某些传统的人口统计方法。
当前指标影响着对FP项目成功的理解,并影响FP服务在实际中的落实情况。我们提供了国际利益相关者对于支持新指标开发所需克服障碍的观点,包括只要不使用避孕措施是基于充分、自由和知情的选择,就不应将其视为一种失败。