Disparities in access to family planning in Jamaica

In order to improve the effectiveness and subtainability of the family planning programme, the National Family Planning Board has devised a strategy to shift users to longer-acting methods and increase the role of the private sector. To design interventions, a better understanding of existing services was thought to be necessary. This study examines the distribution of family planning service delivery points in Jamaica and the services offered by the public and private sectors through an examination of records and questionnaire interviews. The study found that, because of the concentration of private sector providers - the main outlets for longer-acting methods - in urban areas, rural areas had poor access to these methods. Because rural areas are not attractive to private sector providers, the public sector should recognize the need to continue to serve these areas

The effect of user fees on the utilization of family planning services: a clinical study

A new fee structure was introduced to the Advanced Training and Research in Fertility Management Unit in 1992. The study looked at the effect of the new fees on attendance and the choice of contraceptive methods through an examination of clinic records and a questionnaire survey. There was a decline in attendance of roughly 28 per cent between 1992 and 1993. The decline affected mainly new clients and those who accepted injectables. A reduction in the price of injectables is suggested since the fee for this short-term method is more in line with those charged for long-term and permanent methods.

Show, no show and sterilzation

The study investigates the factors involved in the decision of a sample of women to break appointments for sterilizations at the Fertility Management Unit of the University of the West Indies. A case control study involved 50 women who did not show up (no-shows) and an equal number who did show up (shows) over the same period. The no-shows had spent a shorter time in their current union than the shows, and some had no children for their partners at the time the appointments were made. Marriage was the single most important event that would encourage the no-shows to consider sterilization in the future. As long as poor women see child bearing as a precondition for financial assistance from spouses, they will hesitate to give up this capability.

Mapping study and private physicians' survey opportunities for expanded family planning services in Jamaica: final report

Reports on a project aimed at importing the effectiveness and sustainability of Jamaica's National Family Planning Programme in light of the planned phasedown of international donor support particularly the reduction of USAID-donated contraceptive supplies. A "Mapping Study and Private Physicians Survey" was designed to collect background information on the existing infrastructure of service delivery points (SDPs)and a better undrestanding of physicians' skill and interest levels pertaining to long-term and permanent methods. This information would enable interventions to be designed that would target less-well-served areas offer appropriate incentives for private-practice physicians to become more involved in family planning, and meet specific needs among the private physician community as they try to become more involved. Among the noteworthy findings of this study are, given that a key goal of the project is to increase use of longer-acting methods, these methods are not readily available at affordable prices to rural consumers/patients ie. half the Jamaican population. long-term and permanent methods are concentrated in urban areas and offered primarily by private physicians. Short-term or supply methods were widely available to both urban and rural users and were quite affordable. Another significant finding is that private physicians have an interest in increasing their understanding of and involvement in family planning, widespread interest was expressed in the Private Physicians' Pilot Project. The private sector it was found offers the most SDPs, the widest range of methods and the greatest number of hours of operation, however, it is the public sector that provides the most services ie. about 60 percent of family planning services. These was a tendency for private sector providers to be concentrated in urban areas due to available supporting medical services; a further intra-urban clustering of private sector sites was also found; ther was a tendency among newer doctors to establish practices in urban areas outside of Kingston; a more evenly distributed pattern for public sector SDP was found, along with a clear emphasis on serving rural communities; an expansionary trend in terms of number of SDPs in urban areas is noticeable whereas a slight reduction in overall number of SDPs serving rural areas was noted. The recommendations are, to use the findings from this mapping study to plan future activities; to improve availability on long-term and permanent methods for rural groups; to encourage the private sector to increase its participation in family planning; to engage pharmacies and private physicians in expanded social marketingprogrammes; and that the social marketing programme be encouraged to expand its marketing support to include longer-acting methods.