Do family planning programs affect fertility preferences? A literature review.

A literature review finds few studies about whether family planning programs have reduced fertility preferences. The strong and surprising evidence from Matlab, Bangladesh, demonstrated that this intensive program did not decrease preferences; however, it did crystallize latent demand for fewer children, resulting in a demand for contraception. One cross-national multivariate study was consistent with this finding. A few intracountry multivariate studies found small program effects, decreasing the number of children that couples want. An intensive multimethod study in India found plausible larger effects. Most studies of program media effects are flawed by possible selection bias, but one longitudinal study avoids this pitfall and finds large effects for one country. Program feedback effects are plausible but not yet demonstrated empirically. The effects of a coercive program are plausible, at least in China, but not definitively demonstrated. Several promising unpublished studies may strengthen the case for program effects in reducing fertility preferences, now often based on plausible but not conclusive evidence. Stronger generalizations require better studies of a wider range of locations.