Family Planning in Latin America and the Caribbean: The Achievements of 50 Years

This report - and its accompanying case studies on Colombia, the Dominican Republic, El Salvador, Guatemala, Haiti, Mexico, Nicaragua, and Paraguay -  constitute a resource examining "the 50-year period starting in the mid-1960s that witnessed a dramatic decline in fertility and steady increase in contraceptive use in the Latin America and Caribbean (LAC) region." The report looks specifically at the role of family planning (FP) with the intent of drawing lessons from it for other developing countries due to the fact that the contraceptive prevalence rate (all methods) of 74 percent is among the highest of any region in the developing world.

The Executive Summary lists the following as the objectives for the analysis:

1. Document the changes in the region in fertility rates and contraceptive use over time, as well as in indicators of health, education, and economic conditions that contributed to these dramatic changes in societal norms and contraceptive practice;
2. Provide a historical overview of organisations, events, and the political environment in the early years of the FP movement;
3. Identify key factors that explain the effectiveness of FP programmes in this region; and
4. Outline remaining challenges, including high rates of adolescent fertility in many LAC countries and issues of contraceptive security.

The report describes: the rationale for the research; the methodology; demographic changes, with a special look at adolescents; the history, including International Planned Parenthood Foundation (IPPF)'s role; service models; the political climate and financial and technical supports; ten influencing factors; and remaining challenges.

The Executive Summary identified 10 key factors that have contributed to the success of FP in the LAC region:

1. The development of strong non-governmental organisations (NGOs) that pioneered the FP movement, tested new FP methodologies, and continue to tackle politically sensitive issues;
2. A socio-political environment at the macro level that gradually supported FP;
3. Sustained external support in financial and technical assistance from the United States Agency for International Development (USAID) and other donors;
4. Synergistic coordination among governments, external agencies, NGOs, and civil society;
5. The development of local expertise in key programmatic, policy, and management areas;
6. Improvement in the availability of information as a tool to drive decision making and open doors to new thinking and new approaches;
7. Strategically designed, wide-reaching communication activities to support change in individual behaviour and social norms;
8. Mechanisms to ensure programme financing that evolved to fit the times;
9. Effective advocacy to achieve major political gains; and
10. Significant investments in contraceptive commodities and security.

Specific to communication, the following strategies are outlined in various sections of the report:

• From "The Development of Strong NGOs that Pioneered the Family Planning Movement and Continue to Tackle Politically Sensitive Issues," the following country strategies are communication-based and supported the growth of FP:
• in Guatemala, inclusion of indigenous NGOs and support from an NGO on dissemination of sexual and reproductive health (SRH) education;
• in Mexico, dedicated adolescent SRH centres; and
• in Nicaragua, Puntos de Encuentro's multi-media education-entertainment work, bringing taboo subjects like adolescent sexuality to light.
• The NGOs in the region frequently served as centres for innovation and training for governments.

• From "The Development of Local Expertise in Key Programmatic and Management Areas", at certain points in the history of each country, "demand for FP started to increase and new service delivery models were introduced, personnel training was diversified to address country-specific needs for community-based distribution (CBD) and social marketing."
• Training came, in part, from focused programmes of USAID at a time when medical schools in some countries refused to teach FP due to the political environment.
• Due to a shift in legal climate and focus "throughout Latin America to integrating FP with different aspects of health, including SRH, universities are showing a new interest in incorporating FP/SRH into their medical and nursing school curricula."
• "New technologies and approaches, such as e-learning, virtual courses, and virtual advanced monitoring systems show promise." For example, an FP training package known as maletas pedagógicas was implemented in Nicaragua.

• From "Strategically Designed, Wide-Reaching Communication Activities to Support Change in Individual Behavior and Social Norms", the use of behaviour change communication (BCC) has evolved over the 50-year period from word-of-mouth and interpersonal communication (IPC) to:

• Creation of educational materials
•  "Telenovelas" (soap operas) that promoted family planning
• "Contraceptive social marketing used the tools of commercial marketing to broadly publicize the availability and desirability of pills and condoms through multimedia campaigns, using radio, pamphlets, and point-of-purchase materials."
• Marketing techniques (e.g., audience segmentation, consumer-orientation, use of multi-media)
• Entertainment education (edutainment), e.g., music videos to promote sexual responsibility and radio and television as influences on norms and values in popular culture in the region, e.g., Puntos de Encuentro.
• "One novel project involved the Lilac Tent (Carpa Lila) campaign, launched in Bolivia in 1998, which distributed a wide range of reproductive health materials designed as much for adolescents as for married couples. Lilac-colored tents were set up in rural areas where videos, live music, theater, games, and printed materials served to create awareness of family planning to the thousands of participants lured by curiosity and the dynamism of the health fair event. Local political leaders, health professionals, educators, students, and performers worked together to bring important reproductive health messages and resources to an audience of between 2000-4000 people at each stop." (Bolivia)
• Also in Bolivia, as part of a multi-pronged approach, "a talk show called Naked Dialogue (Diálogo al Desnudo) in which prominent physicians, psychologists and feminists were invited to talk about gender, family planning and other SRH topics."
• In public and private sector programmes, the provision of basic information for clients during in-clinic visits and promotion/information via community channels has become standard.

• From "Effective Advocacy to Achieve Major Political Gains",  "[i]n Latin America, the leadership of advocacy initiatives currently consists of coalitions of NGOs and international agency representatives, with mid-level public sector officials providing support in some cases. Coalitions have been formed around a variety of issues in the region, in many cases, with support from USAID."

Click here for the Executive Summary in English.
Click here for the Executive Summary in Spanish.