Like Jessica said in her answer to this same question, I think it is difficult to predict what the outcome will be of increased access to health care. An important fact to remember is that increased access to health care does not guarantee increased utilization of health care, especially when the definition of “health care” used in this context is likely very different from the families’ definition of health care. There is no guarantee the families will want to use family planning strategies. In many cultures, fertility is seen as a sign of prosperity and so decreasing the number of children could have profound psychosocial outcomes. Additionally, having more children can sometimes improve the likelihood of financial success, particularly in agricultural societies. On the other hand, improving quality of care means that people will live longer and so older generations will be able to contribute to the fieldwork more, thus decreasing the need to have more children. It will also decrease infant and child mortality rates, which will decrease the need for parents to have more children as compensation for the high mortality rates. I think the key to effective implementation of health care as a vehicle for family planning is to do it in a culturally sensitive manner that engages key community stakeholders as leaders in order to gain support from community members.
Outcomes are rarely predictable without a baseline, so if this access of care has been successful somewhere else then I do not see why I could not be implemented here. I am sure there have been other incidences or studies showing did the population actually use this type of health care?, if their is not then that is an important place to start and study. There will never be a guarantee that someone will use the healthcare provided to them. Here in the states plenty of preventative healthcare is provided to knowledgeable individuals who still decide against or completely disregard it. I see this as a good thing for this community. I do not believe it completely imposes a psychosocial outcome onto them. Its a choice, not a demand. I would imagine having an option when properly explained would make them feel more valued and willing to give it a try. Overall I see it as a duty to provide the option of access to them. If it can decrease mortality then I see it as a ethical wrong doing to withhold such care, but that is my opinion. Great post.
I agree with your statement that an effective implementation of healthcare needs to be addressed by obtaining information from key people in the community who are trusted. I think that a "broad-stroke" implementation of health care system/solution is a bad solution to the problem. Without knowing the social and religious beliefs of the people in question, it is hard to say that they would even welcome such "help". If the people who you are trying to help view having a large family as a form of higher social status, then trying to control the number of kids they have by giving them access to health care is a moot point.
I agree that implementing family planning needs to be down from within the community rather than from an outsider. However, with that being said the option should still be made available. We should be attempting to improve access to healthcare in these communities regardless of their initial beliefs. They do not have to use it right away but knowing that the option is there and with promoting change from within, will help to sway the majority to attempt family planning. Over time the communities will realize that having large families will eventually result in an overpopulation if it hasnt already. This effect is another possible catalyst for change that comes from within the community, that will help promote the use of family planning.