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A History of Government Family Planning Efforts in Jamaica » Family Planning

A History of Government Family Planning Efforts in Jamaica

October 24th, 2008 by jliebner@stanford.edu Leave a reply »

The Government of Jamaica adopted the National Population Policy in 1992 that aimed for zero population growth “to ensure that the population does not exceed the number of persons that can be supported by the nation at satisfactory standards of living.”  This vision requires an average growth rate of below 0.8 percent per annum over the next three decades and that by 2000, the population should not exceed 2.7 million.  For this goal to be met, the average number of children per woman was expected to decline to approximately 2 per woman by 2000 and be maintained and the contraceptive prevalence rate should rise to 63% by 2000.  The government envisioned that regarding gender, “equal access to decision-making processes is considered and essential element of this goal” and that Family Life Education programs should be strengthened in school curricula (1).

In the 16 years since the ratification of this piece of legislation, Jamaica has a 0.779% growth rate per annum (2008 est) and a population over 2.8 million (July 2008 est).  The total fertility rate is 2.3 children per woman (2) and the contraceptive prevalence rate is 69% (3).

These efforts have been largely due to the work of three government agencies that share the responsibility for policy making regarding family planning and reproductive health in Jamaica: the Planning Institute of Jamaica, the National Family Planning Board, and the Ministry of Health.  According to the National Population Policy, the Planning Institute of Jamaica is responsible for ensuring the integration of the goal of the National Population Policy into development plans, while the National Family Planning Board is the “delivery of family planning services,” particularly targeting women in reproductive years (1).

The National Family Planning Board (NFPB) offers a wide range of services including mobile clinic units, outreach programs, and distribution programs of non-clinical methods of contraception.  NFPB seeks to promote “fertility regulation while guaranteeing absolute freedom of choice” (4).  Family planning services first became available in Jamaica in the 1930s, due to the work of a few individuals, and in 1967, the government of Jamaica created the NFPB.   The 1970s saw the establishment of Family Life Education teacher training workshops, the distribution of condoms and oral contraceptives, and the launching of the “Two Child Family” campaigns via radio programming, the integration of family planning services with primary health care providers, and the establishment of family planning clinics in underserved areas.  In 1983, the government of Jamaica adopted the National Population Policy to reduce fertility and expand family planning services for men and women of reproductive ages.  In the 1980s, male responsibility programs were established, along with the community based distribution of contraceptives in rural areas, and the formation of adolescence fertility resource centers, mobile units with family planning programs, and services designed for teenagers in urban areas.  In the early 1990s, new sterilization techniques (mini laparotomy under local anesthesia, no scalpel vasectomy for men), and the Personal Choice campaign, a program offering contraception at affordable prices, were introduced (4).

Currently, NFPB offers extensive information on following methods of contraception on their website:

  • Offered in the public sector
    • birth control pills
    • injectable contraception (Depo-Provera)
    • IUDs
    • vasectomy (male sterilization)
    • condoms
    • tubal ligation (female sterilization)
    • Norplant implants: capsules of synthetic progestin – levonorgestrel – inserted under the skin on inner side of the upper arm that thicken the cervical mucus and decrease the sperm’s ability to penetrate
  • Offered in the private sectors and by NGOs – methods of covering the opening of the uterus with a synthetic cap filled with spermidicde
    • diaphragms
    • cervical caps
    • contraceptive sponges
  • “New” methods
    • contraceptive patch
    • essure: permanent non surgical method of contraception – a small, flexible coil is placed into the fallopian tube – tissue grows over it and blocks the fallopian tube
    • mirena: like IUD but contains time release hormones – thickens cervical mucus, thins the uterine lining, and slowing down sperm motility
    • Seasonal birth control pills: taken longer than 21 days
    • Nuva ring: inserted into the vagina and releases progestin and estrogen – thickens cervical mucus and suppresses ovulation (4)

While it appears that government support for family planning services has increased since the 1994 International Conference on Population and Development (ICPD) in Cairo, a major convention regarding population and reproductive health in developing countries, the distribution of such services amongst the population has not been equal in Jamaica.  In particular, adolescents have been neglected despite such improvements.  An analysis published in 1999 on the reproductive health policies and programs in eight developing countries since the conference in Cairo, reports that the provision of reproductive health services for young adults “incites the most vocal opposition,” likely due to the conservative and religious views held throughout the country. But in Jamaica, it seems overtly obvious that sexual and reproductive services and education are urgently needed amongst this particular subset of the population.  The statistics are staggering – 40% of Jamaican women have been pregnant at least once before the age of 20, where 85% of these pregnancies were unplanned (5).

In 1999, the Government of Jamaica was criticized for having no explicit plans to implement a reproductive health program.  While a network of private providers of family planning and maternal and child health services was accessible for most women and mothers, it did not serve adolescents and men well (5).  Often there is a discrepancy between the recognition of the need to improve reproductive health and rights and the translation into effective programs.

However, in recent years, after the national recognition of teenage pregnancy as a serious social and health problems, increased efforts have been made to target such programs at adolescents.  Yet despite the establishment of such programs, barriers still exist that prevent adolescents from receiving such services.

This will be the focus of next week’s entry: adolescent sexual behavior in Jamaica, rates of pregnancy, and interventions and education programs focused towards adolescents.

(1)    National Population Policy of 1992. (The Jamaica National Population Policy. Revised Version, Kingston, Jamaica, Planning Institute, July 1992) http://cyber.law.harvard.edu/population/policies/JAMAICA.html

(2)    Jamaica. CIA Factbook.  Accessed October 23, 2008. https://www.cia.gov/library/publications/the-world-factbook/print/jm.html

(3)    Jamaica. Human Development Report 2007/2008. http://hdrstats.undp.org/indicators/56.html

(4)    The National Family Planning Board of Jamaica. http://www.jnfpb.org/index.htm

(5)    Hardee K, Agarwal K, Luke N, Wilson E, Pendzich M, Farrel M, Cross J. Reproductive Health Policies and Programs in Eight Countries: Progress Since Cairo. International Family Planning Perspectives (25), January 1999. http://www.guttmacher.org/pubs/journals/25s0299.html#22a

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3 comments

  1. afmurray@stanford.edu says:

    It is interesting that the blogger has focussed on Jamaica, just as I focussed on that country in my book in the chapter on reproductive health. Is the Jamaica experience widely applicable to other countries in the region or elsewhere? In what ways?

  2. mjromano says:

    It seems that Jamaica has put a lot of resources into family planning, but the resources are not going were they are most needed. I wonder if the NFPB is prioritizing there nationwide “zero population growth goal” over the reproductive health needs of the individual women in Jamaica. I also wonder what drives the prevailing concern about overpopulation in Jamaica (scarcity of food, land, or jobs). I suppose my ultimate question is whether Jamaica’s family planning program truly addresses the needs of its citizens or if it imposes external judgments of “appropriate family size” at the expense of individual autonomy. I don’t expect a clear answer to that one…

  3. Maggie Chen says:

    Julia,
    What are your thoughts on connecting all the contraceptive resources available to teens, especially with the current focus of reducing teen pregnancy? Something I’ve wondered about (and am sort of writing about in the blog) is what approach should be taken in how birth control is provided. If we are focusing on teens, should we make a selection of options that are popular among teens available, or should we offer as many options as possible (which can be confusing)? Is it more cost-effective to supply three common birth control options, or to have all the methods on hand? Just some things to think about, I’d be interested to hear how the Jamaican government is answering these questions.

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