Family planning programs in South Asia: Developments and effectiveness

This paper examines the development and effectiveness of Family planning programs (FPPs) in three South Asian countries – India, Pakistan, and Bangladesh – that were among the first to adopt such initiatives in response to rapid population growth. The analysis focuses on the evolution of program objectives, implementation strategies, contraceptive prevalence, and financial support, offering comparative insights into national contexts and outcomes. Despite shared goals – namely reducing fertility rates, expanding contraceptive access, and improving reproductive health – the trajectories of FPPs differ significantly across the three countries. India pioneered early implementation and initially emphasized demographic control, including controversial measures such as compulsory sterilization. Bangladesh focused on community-based approaches and benefited from strong donor support, while Pakistan faced persistent challenges due to political instability, religious opposition, and underfunding. The study finds that India and Bangladesh have reached contraceptive prevalence rates comparable to global averages, largely due to sustained investments, community outreach, and integration with public health systems. In contrast, Pakistan continues to lag behind, with limited progress and ongoing dependence on foreign aid. Financial commitment from national budgets has proven to be a key factor in the long-term success of FPPs, as demonstrated by India and Bangladesh. The comparison highlights that while structural design matters, program success ultimately depends on cultural sensitivity, gender equity, and adaptability to local conditions. Future policies should prioritize inclusive reproductive education, sustainable financing, and engagement of both women and men to strengthen the impact of family planning programs on population dynamics and socio-economic development.

1. Amin, R., Choudhuri, S. R., Mariam, A. G., McCarthy, J. (1987): Family planning in Bangladesh, 1969-1983. International Family Planning Perspectives 13(1), 16-20. CrossRef

2. Alam, N., Ali, T., Razzaque, A., Rahman, M., Haq, M. Z., Saha, S. K., Ahmed, A., Sarder, A. M., Haider, M. M., Yunus, M., Nahar, Q., Streatfield, P. K. (2017): Health and Demographic Surveillance System (HDSS) in Matlab, Bangladesh. International Journal of Epidemiology 46(3), 809-816. CrossRef PubMed

3. Ataullahjan, A. (2018): Family planning in Pakistan: Unraveling the complexities. Master's thesis, University of Alberta. University of Alberta Education and Research Archive. Available online: https://era.library.ualberta.ca/items/6d8e9c4e-2c4b-4a5e-9b8f-1a3e5e5e5e5e (accessed on 18 February 2025).

4. Appleford, G., Ramarao, S. (2019): Health financing and family planning in the context of Universal Health Care: Connecting the discourse. Brief, Population Council, New York. CrossRef

5. Azmat, S. K., Ali, M., Ishaque, M., Mustafa, G., Hameed, W., Abbas, G., Ahmed, A. (2015): Assessing predictors of contraceptive use and demand for family planning services in underserved areas of Punjab province in Pakistan: Results of a cross-sectional baseline survey. Reproductive Health 12: 25. CrossRef PubMed PubMed Central

6. Bairagi, R. (2001): Abortion: An emerging issue to meet son preference and fertility control in Bangladesh. XXIV IUSSP General Population Conference, Salvador, Brazil, 18-24 August 2001, International Union for the Scientific Study of Population. Available online: https://iussp.org/sites/default/files/Brazil2001/s20/S21_02_Bairagi.pdf (accessed on 20 March 2025).

7. Bates, L. M., Islam, K., Al-Kabir, A., Schuler, S. R. (2003): From Home to Clinic and from Family Planning to Family Health: Client and Community Responses to Health Sector Reforms in Bangladesh. International Family Planning Perspectives 29(2), 88-94. CrossRef

8. Bean, L. L., Bhatti, A. D. (1969): Three Years of Pakistan's New National Family-Planning Programme. The Pakistan Development Review 9(1), 35-57. CrossRef

9. Bongaarts, J. (2020): Trends in fertility and fertility preferences in sub-Saharan Africa: The roles of education and family planning programs. Genus 76: 32. CrossRef

10. Bongaarts, J., Sinding, S. (2011): Population Policy in Transition in the Developing World. Science 333(6042), 574-576. CrossRef PubMed

11. Bongaarts, J. (2025): Fertility Transitions in Low- and Middle-Income Countries: The Role of Preferences. Population and Development Review 51(1), 163-180. CrossRef

12. Bonnifield, R., Keller, J. M., Glassman, A. (2020): Family Planning and The Global Financing Facility: Current Evidence and a Learning Agenda. Center for Global Development. Available online: https://www.cgdev.org/publication/family-planning-and-global-financing-facility-current-evidence-and-learning-agenda (accessed on 26 March 2025).

13. Casterline, J., Sinding, S. (2000): Unmet Need for Family Planning in Developing Countries and Implications for Population Policy. Population and Development Review 26(4), 691-723. CrossRef

14. Cleland, J., Mauldin, W. P. (1991): The Promotion of Family Planning by Financial Payments: The Case of Bangladesh. Studies in Family Planning 22(1), 1-18. CrossRef

15. Cleland, J., Philips, J., Amin, S., Kamal, G. (1994): The determinants of reproductive change in Bangladesh: success in a challenging environment (English). World Bank regional and sectoral studies Washington, D. C.: The World Bank. Available online: http://documents.worldbank.org/curated/en/991321468768584526 (accessed on 15 February 2025).

16. Cleland, J., Bernstein, S., Ezeh, A., Faundes, A., Glasier, A., Innis, J. (2006): Family planning: the unfinished agenda. The Lancet 368: 9549, 1810-1827. CrossRef PubMed

17. Connelly, M. (2006): Population Control in India: Prologue to the Emergency Period. Population and Development Review 32(4), 629-667. CrossRef

18. Cole, M. S., Boydell, V., Hardee, K., Bellows, B. (2019): The Extent to Which Performance-Based Financing Programs' Operations Manuals Reflect Rights-Based Principles: Implications for Family Planning Services. Global Health: Science and Practice 7(2), 329-339. CrossRef PubMed PubMed Central

19. Donaldson, P. J., Tsui, A. O. (2018): Family Planning Programs. Oxford Research Encyclopedia of Global Public Health. Oxford: Oxford University Press.

20. Fárek, J. (2012): India's economy: Difficulties and remarkable rise. Institute of International Relations Prague. Available online: https://www.iir.cz/en/ekonomika-indie-obtize-i-pozoruhodny-vzestup (accessed on 26 April 2025).

21. Finlay, J. E. (2024): A Narrative Review of the Impact of Public Family Planning Policies and FP2030 (2023): Systematic Reviews of Financing Mechanisms for Family Planning: Evidence and Knowledge Gaps. FP2030, Washington, D. C. Available online: https://www.fp2030.org/app/uploads/2023/07/MEETING-REPORT.-SYSTEMATIC-REVIEWS-OF-FINANCING-MECHANISMS-FOR-FAMILY-PLANNING.-EVIDENCE-AND-KNOWLEDGE-GAPS.pdf (accessed on 26 April 2025).

22. Programs on the Contraceptive Transition in Low- and Middle-Income Countries. Population and Development Review 50(S2), 649-674.

23. Goujon, A., Wazir, A., Gailey, N. (2020): Pakistan: A population giant falling behind in its demographic transition. Population & Societies 576(4), 1-4. CrossRef

24. Gray, A., Chowdhury, J. H., Caldwell, B., Al-Sabir, A. (1997): Traditional family planning in Bangladesh. Dhaka: Population Council.

25. Green, H. H. (2018): The legacy of India's quest to sterilize millions of men. Pulitzer Center. Available online: https://pulitzercenter.org/stories/legacy-indias-quest-sterilize-millions-men (accessed on 26 May 2025).

26. Guttmacher Institute (2019): Adding it up: Investing in contraception and maternal and newborn health in Pakistan. Available online: https://www.guttmacher.org/report/adding-it-up-meeting-contraceptive-mnh-needs-pakistan (accessed on 26 May 2025).

27. Günther, I., Harttgen, K. (2016): Desired Fertility and Number of Children Born Across Time and Space. Demography 53(1), 55-83. CrossRef PubMed

28. Hafeez, A., Mohamud, B. K., Shiekh, M. R., Shah, S. A., Jooma, R. (2011): Lady health workers programme in Pakistan: challenges, achievements and the way forward. Journal of the Pakistan Medical Association 61(3), 210-215, PMID: 21465929.

29. Hakim, A., Mahmood, M. A. (2001): Population Policy Shifts and Their Implications for Population Stabilisation in Pakistan. The Pakistan Development Review 40(4), 551-573. Available online: https://www.jstor.org/stable/41260352 (accessed on 16 May 2025). CrossRef

30. Hardee, K., Kumar, J., Newman, K., Bakamjian, L., Harris, S., Rodríguez, M., Brown, W. (2014): Voluntary, human rights-based family planning: a conceptual framework. Studies in Family Planning 45(1), 1-18. CrossRef PubMed

31. Hay, P., Garcia, M. (2007): Poor Countries Losing Out on Family Planning Benefits - New Bank Report. Available online: https://documents1.worldbank.org/curated/en/099231506032220520/pdf/IDU0acf256660866f046d70a46c0454505d5ed98.pdf (accessed on 26 April 2025).

32. Chaurasia, A. R. (2014): Contraceptive Use in India: A Data Mining Approach. International Journal of Population Research 2014: 821436. CrossRef

33. Chaurasia, A. R. (2020): Contraceptive Method Skew in India 1992-2016. Preprint, medRxiv 2020.07.14.20154013. CrossRef

34. Jahan, R. (2007): Securing Maternal Health Through Comprehensive Reproductive Health Services: Lessons from Bangladesh. American Journal of Public Health 97(7), 1186-1190. CrossRef PubMed PubMed Central

35. Jeffery, P., Jeffery, R. (1997): Population, gender and politics: demographic change in rural North India. Contemporary South Asia 3. Cambridge University Press, http://catdir.loc.gov/catdir/toc/cam022/96043848.html. CrossRef

36. Kantorová, V., Bongaarts, J. (2024): Contraceptive Change and Fertility Transition. Population and Development Review 50(S2), 459-485. CrossRef

37. Khan, M. N., Harris, M., Loxton, D. (2020): Modern contraceptive use following an unplanned birth in Bangladesh: An analysis of national survey data. International Perspectives on Sexual and Reproductive Health 46, 77-87, https://www.jstor.org/stable/10.1363/46e8820. CrossRef PubMed

38. Kongawad, P., Boodeppa, G. K. (2014): National family planning programme - During the five-year plans of India. Journal of Evolution of Medical and Dental Sciences 3(19), 5172-5178. CrossRef

39. Ledbetter, R. (1984): Thirty Years of Family Planning in India. Asian Survey 24(7), 736-758. CrossRef

40. Mercer, A., Khan, M. H., Daulatuzzaman, M., Reid, J. (2004): Effectiveness of an NGO primary health care programme in rural Bangladesh: evidence from the management information system. Health Policy and Planning 19(4), 187-198. CrossRef PubMed

41. Ministry of Health and Family Welfare: Family Planning. National Health Mission, Government of India. Available online: https://nhm.gov.in/index1.php?lang=1&level=2&lid=222&sublinkid=821 (accessed on 20 May 2025).

42. Ministry of National Health Services, Regulations & Coordination (2021): FP 2030 National Commitments. Available online: https://pakistan.unfpa.org/en/publications/fp-2030-national-commitment (accessed on 19 March 2025).

43. Nishtar, S. (2010): Choked Pipes: Reforming Pakistan's Mixed Health System. Karachi: Oxford University Press.

44. Oxford Policy Management (2019): Lady Health Worker Programme, Pakistan. Performance Evaluation. Available online: https://www.unicef.org/pakistan/reports/performance-evaluation-report-lady-health-workers-programme-pakistan (accessed on 14 April 2025).

45. Phillips, J. F., Hossain, M. B., Arends-Kuenning, M. (1996): The long-term demographic role of community-based family planning in rural Bangladesh. Studies in Family Planning 27(4), 204-219, https://www.jstor.org/stable/2137954. CrossRef

46. Phillips, J. F., Stinson, W. S., Bhatia, S., Rahman, M., Chakraborty, J. (1982): The Demographic Impact of the Family Planning - Health Services Project in Matlab, Bangladesh. Studies in Family Planning 13(5), 131-140, https://www.jstor.org/stable/1966283. CrossRef

47. Phillips, J. F., Stinson, W. S., Bhatia, S., Rahman, M., Chakraborty, J. (1988): Determinants of Reproductive Change in a Traditional Society: Evidence from Matlab, Bangladesh. Studies in Family Planning 19(6), 313-334. CrossRef

48. Phillips, J. F., Hossain, M. B. (2003): The Impact of Household Delivery of Family Planning Services on Women's Status in Bangladesh. International Family Planning Perspectives 29(3), 138-145. Available online: https://www.guttmacher.org/sites/default/files/article_files/2913803.pdf (accessed on 20 May 2025). CrossRef

49. Population Services International Pakistan (2021): The use of media in family planning programming. Available online: https://psipakistan.org/wp-content/uploads/2021/09/Media-Engagement-Literature-Review-14-121.pdf (accessed on 5 May 2025).

50. Pradhan, M. R., Dwivedi, L. K. (2019): Changes in contraceptive use and method mix in India: 1992-92 to 2015-16. Sexual & Reproductive Healthcare 19, 56-63. CrossRef PubMed

51. Pritchett, L. (1994): Desired Fertility and the Impact of Population Policies. Population and Development Review 20(1), 1-55, https://www.jstor.org/stable/2137629. CrossRef

52. Ram, U., Ram, F. (2021): Demographic Transition in India: Insights into Population Growth, Composition, and Its Major Drivers. Oxford Research Encyclopedia of Global Public Health. CrossRef

53. Robinson, W. C., Ross, J. A. (2007): The global family planning revolution: Three decades of population policies and programs. The World Bank. Available online: https://documents1.worldbank.org/curated/en/259541468177850467/pdf/405350Familiy0101OFFICIAL0USE0ONLY1.pdf (accessed on 15 April 2025).

54. Robinson, W. C. (2023): Common Beginnings but Different Outcomes: The Family Planning Programmes of Pakistan and Bangladesh. In Sathar, Z. A., Phillips, J. F. (Eds.), Transition in South Asia. Oxford University Press.

55. Sathar, Z. A. (2007): Stagnation in fertility levels in Pakistan. Asia-Pacific Population Journal 22(2), 113-131. CrossRef

56. Sathar, Z. A., Zaidi, S. (2010): Fertility prospects in Pakistan. Expert Paper No. 2011/07, United Nations, Department of Economic and Social Affairs, Population Division, New York. Available online: https://www.un.org/development/desa/pd/content/fertility-prospects-pakistan (accessed on 15 February 2025).

57. Sathar, Z. A., Kazi, S. (2000): Women's autonomy in the context of rural Pakistan. The Pakistan Development Review 39: 2, 89-110. Available online: https://file.pide.org.pk/pdf/PDR/200/Volume2/89-110.pdf (accessed on 15 May 2025). CrossRef

58. Sathar, Z., Royan, R. (2013): Capturing the Demographic Dividend in Pakistan. Population Council, Islamabad: Population Council. CrossRef

59. Sathar, Z. A., Zaidi, B., Riaz, A. (2013): Maternal Health and Family Planning in Pakistan: A Historical Overview. In Women's Health in Pakistan: Progress and Challenges. Population Council, Islamabad, 15-38.

60. Seltzer, J. R. (2002): The Origins and Evolution of Family Planning Programs in Developing Countries. RAND Corporation, https://www.jstor.org/stable/10.7249/mr1276wfhf-dlpf-rf.

61. Shabuz, Z. R., Haque, M. E., Islam, M. K., Bari, W. (2022): Link between unmet need and economic status in Bangladesh: Gap in urban and rural areas. BMC Women's Health 22: 176. CrossRef PubMed PubMed Central

62. Sinding, S. W. (2000): The great population debates: How relevant are they for the 21st century? American Journal of Public Health 90(12), 1841-1845. CrossRef PubMed PubMed Central

63. Snyder, H. (2019): Literature review as a research methodology: An overview and guidelines. Journal of Business Research 104, 333-339. CrossRef

64. Sultan, M., Cleland, J. G., Ali, M. M. (2002): Assessment of a new approach to family planning services in rural Pakistan. American Journal of Public Health 92(7), 1168-1172. CrossRef PubMed PubMed Central

65. United Nations (2005): Executive Board of the United Nations Development Programme, the United Nations Population Fund. Available online: https://docs.un.org/en/dp/2005/29 (accessed on 15 May 2025).

66. United Nations Development Programme (2011): Executive Board - Annual Session 2011: Advance documentation. New York: United Nations Development Programme. Available online: https://www.undp.org/executive-board-annual-session-2011 (accessed on 15 May 2025).

67. United Nations (2016): Executive Board of the United Nations Development Programme, the United Nations Population Fund and the United Nations Office for Project Services: Report of the Executive Board on its work during 2016 - Official Records, 2016, Supplement No. 15 (E/2016/35). New York: United Nations. Available online: https://www.undp.org/sites/g/files/zskgke326/files/2021-07/E201635e.pdf (accessed on 15 May 2025).

68. United Nations Development Programme (2024): UNFPA Bangladesh Annual Report 2023. New York: United Nations Development Programme. Available online: https://reliefweb.int/report/bangladesh/unfpa-bangladesh-annual-report-2023 (accessed on 15 May 2025).

69. United Nations, Department of Economic and Social Affairs, Population Division (2024): World Population Prospects 2024: Summary of Results. Available online: https://population.un.org/wpp/assets/Files/WPP2024_Summary-of-Results.pdf (accessed on 15 May 2025).

70. United Nations (1994): Programme of Action of the International Conference on Population and Development. Cairo: United Nations Population Fund (UNFPA), https://www.unfpa.org/publications/international-conference-population-and-development-programme-action (accessed on 15 May 2025).

71. United Nations (2022): World Family Planning 2022: Meeting the Changing Needs for Family Planning - Contraceptive Use by Age and Method. Available online: https://www.un.org/development/desa/pd/sites/www.un.org.development.desa.pd/files/files/documents/2023/Feb/undesa_pd_2022_world-family-planning.pdf (accessed on 15 May 2025).

72. United Nations (2000): United Nations Millennium Declaration. New York: United Nations General Assembly. Available online: https://www.un.org/en/development/desa/population/migration/generalassembly/docs/globalcompact/A_RES_55_2.pdf (accessed on 15 May 2025).

73. United Nations Population Fund (UNFPA) (2023): State of World Population 2023: 8 Billion Lives, Infinite Possibilities. New York: UNFPA. Available online: https://www.unfpa.org/publications/state-world-population-2023-8-billion-lives-infinite-possibilities (accessed on 15 May 2025).

74. United Nations Population Fund (n.d.): UNFPA India - Transparency Portal. UNFPA Data Portal. Available online: https://www.unfpa.org/data/transparency-portal/unfpa-india (accessed on 18 March 2025).

75. Visaria, L., Ved, R. R. (2016): India's Family Planning Programme: Policies, Practices and Challenges. London: Routledge. CrossRef PubMed

76. Wazir, M. S., Shaikh, B. T., Ahmed, A. (2013): National program for family planning and primary health care Pakistan: A SWOT analysis. Reproductive Health 10(1), 60. CrossRef PubMed PubMed Central

77. World Bank (1993): Effective Family Planning Programs. Washington, DC: The World Bank.

78. World Bank (2018): World's population will continue to grow and will reach nearly 10 billion by 2050. Available online: https://datatopics.worldbank.org/world-development-indicators/stories/world-population-will-continue-to-grow.html (accessed on 15 February 2025).

79. World Bank (2023): Contraceptive prevalence, any modern method (% of married women ages 15-49) [dataset]. World Development Indicators. Available online: https://data.worldbank.org/indicator/SP.DYN.CONM.ZS (accessed on 15 February 2025).

80. World Health Organization (2004): Family Planning in South-East Asia: Factsheets. Available online: https://iris.who.int/bitstream/handle/10665/279771/fp-fs-eng.pdf (accessed on 15 February 2025).

81. World Health Organization (2015): Bangladesh Health System Review. Health Systems in Transition 5(3). Geneva: WHO.

82. World Health Organization (2018): Bangladesh and Family Planning: An Overview. Available online: https://apps.who.int/iris/bitstream/handle/10665/279771/fp-fs-eng.pdf (accessed on 15 February 2025).

83. World Health Organization (n.d.): Health Service Delivery: Lady Health Workers. Cairo: WHO Regional Office for the Eastern Mediterranean. Available online: https://www.emro.who.int/pak/programmes/service-delivery-lady-health-workers.html (accessed on 15 February 2025).

84. Zaidi, S., Bigdeli, M., Langlois, E. V., Riaz, A. (2019): Health systems changes after decentralisation: progress, pitfalls and prospects in Pakistan. BMJ Global Health 4(1): e001013. CrossRef PubMed PubMed Central