The family planning program effort index: 1999 cycle

Context: Indices of effort by large-scale family planning programs have been measured periodically since 1972. These scores are intended to capture program effort or strength, independent of outputs such as contraceptive use or fertility change. Methods: Questionnaires were sent to expert observers who provided judgments on the details of program effort for 89 developing countries. The responses for each country were converted to scores for 30 program features, which were then grouped into four components of program effort. An overall program effort index was calculated as the sum of all 30 feature scores. Results: The average program effort index was higher in 1999 (54% of the maximum possible score) than in 1994 (48% of maximum). Countries with low scores in 1972 improved considerably more than those with initially high scores; by 1999, the gap between these two groups was small. On average, strong and weak programs differed sharply in their score profiles; strong countries outscored weak ones in every feature category. All countries, regardless of their average score, were selective in the program features they emphasized, but weak programs were more erratic in their selectivity. The strongest programs have stabilized at about 80% of the maximum score. Prevalence of contraceptive use continued to be highest for countries possessing both favorable social settings and strong programs. Conclusions: Many developing countries have expanded their reproductive health programs in accordance with recommendations issued by the 1994 International Conference on Population and Development. The improved program effort index and scores for 1999 suggest that countries have been able to do so without seriously weakening their family planning efforts.