Strategies to widen access to family planning in the Arab world : a case study of Zarqa, Jordan

This thesis identifies the constraints to FP utilisation at the policy, service, community and household levels based on the perspectives of policy makers, providers of services, and men and women in different communities of Jordan. It contributes strategies to widen access to FP that are transferable to other countries of the Middle East and the developing world. The policy environment is analysed to assess whether it encourages or deters FP utilisation. The National Population Strategy is highlighted. Improving co-ordination between the different policy players is a major challenge faced in its implementation. FP utilisation is portrayed in four clinics using different models of provision. Service statistics, clinic observations, in-depth interviews, focus and natural group discussions are used to compare the degree of access to FP. Strengthening co- ordination mechanisms between the service providers is an important strategy to increase FP utilisation. The findings suggest that FP decisions are mostly influenced by men who remain concerned, to a varying degree, with the permissibility of FP utilisation in Islam. A culturally competent strategy proposed to increase utilisation is to communicate to men that FP is permissible in Islam. Religious men are proposed vehicles for implementing this communication strategy, basing their discourse on socio-cultural tradition, namely Islamic jurisprudence. The thesis has three sections introduction, findings and conclusions. Chapter One explores the literature. Chapter Two reviews the Jordanian setting. Chapter Three sets out the methods used in this research. Chapter Four examines the policy environment and policy makers' perspectives. Chapters Five to Eight explore the models of service provision concluding with an evaluation of the strengths and weaknesses of the different models. Chapter Nine elaborates on the community's perspectives. Chapter Ten is the concluding chapter that sets out strategies to widen access to FP, by utilising the socio-cultural context of the region.