Completing the demographic transition in developing countries: what does quality have to do with it?

Sarah Harbison, U.S. Agency for International Development (USAID)

In the context of demographic transitions and plateaus, this study reviews variability in TFRs and CPRs within developing countries and examines sub-population characteristics associated with relatively low CPR and high unmet need for contraception. The paper then focuses on the implications of these patterns for efforts to improve the quality of service delivery programs, and synthesizes the results of a large number of intervention studies which aimed to improve various aspects of quality: availability, mode of service delivery, nature of client-provider interaction, and method mix. Four questions are addressed: can improvements in quality bring in new contraceptive users; can improvements in quality increase continuation; what components of quality change make the most difference in contraceptive use; and what is likely to be the overall impact of efforts to improve quality in reducing unmet need and completing the demographic transition.