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The Population Council produced this paper to help guide discussions and considerations regarding the key evidence gaps and research investments needed to achieve the FP2020 goal and objectives. The paper focuses primarily on the social science, implementation, and operations research that will be needed to achieve the first three objectives. Research shows that through high-quality voluntary family planning (FP) programs, governments can reduce fertility and generate substantial improvements in health, wealth, human rights, and education. Family planning programs for the 21st century will require thoughtful design—engaging both public and private sectors—to meet the growing need for safe and effective FP services. These challenges need to be addressed in the context of constantly increasing population sizes in most developing countries, necessitating additional investments just to sustain existing levels of need.

More than 200 million women in the developing world who want to avoid pregnancy are not using a modern contraceptive method. The international community convened at the London Family Planning Summit in July 2012 and strengthened their resolve to address unmet need. National governments, civil society, and the private sector committed US$2.6 billion toward the goal of making contraceptive information, services, and supplies available to an additional 120 million women and girls by 2020. This book elaborates on one of two influential publications disseminated by the Population Council that assess the situation: Reviewing the Evidence and Identifying Gaps in Family Planning Research: The Unfinished Agenda to Meet FP2020 Goals. It presents a research and action agenda that fills many of the gaps in knowledge identified earlier, and summarizes the evidence from social science and operations research regarding the determinants of demand for and use of family planning. The most effective way to achieve the FP2020 goal is to ensure universal access to family planning. By mapping the current research landscape and identifying gaps in the evidence, this book details the investments in research critically needed to inform the design, implementation, and evaluation of FP2020 initiatives.

From 1999–2003, FRONTIERS implemented a Global Agenda program of operations research (OR) projects to address the reproductive health (RH) needs of adolescents in four countries—Bangladesh, Kenya, Mexico, and Senegal. The project was implemented in two districts of Western Province in Kenya and was known as the Kenya Adolescent Reproductive Health Project (KARHP). The project supported a public sector, multisectoral intervention to enhance young people's knowledge and behavior regarding HIV prevention and RH. Implemented jointly with PATH, this OR project demonstrated that such an intervention could be implemented by the public sector, that it was acceptable to communities, that its influence on RH and HIV/AIDS knowledge, attitudes, and behavior was understood, and that the type and amount of financial and other resources needed to implement each of the component activities was calculated. Based on the positive results, the feasibility, acceptability, effectiveness, and cost of the youth RH activities, and the interest of the government and communities, including peer educators, religious and civic leaders, and parents, the activities have been mainstreamed and scaled up in other districts and provinces in Kenya.

A pre‐ and post‐test comparison‐group design was used to evaluate the effect of a community education program on community members' willingness to abandon female genital mutilation/cutting (FGM/C) in rural areas of southern Senegal. Developed by TOSTAN (a Senegalese nongovernmental organization), the education program aimed to empower women through a broad range of educational and health‐promoting activities. Our findings suggest that information from the program was diffused widely within the intervention villages, as indicated by improvements in knowledge about and critical attitudes toward FGM/C among women and men who had and had not participated in the program, without corresponding improvement in the comparison villages. The prevalence of FGM/C among daughters aged ten years and younger decreased significantly over time as reported by women who were directly and indirectly exposed to the program, but not among daughters in the comparison villages, suggesting that the program had an impact on family behaviors as well as attitudes. Findings from this study provide evidence‐based information to program planners seeking to empower women and discourage a harmful traditional practice.

Informing adolescents about appropriate and acceptable behaviors, and ways to protect themselves against unwanted and unprotected sex, has proved problematic in Kenya. Education programs for in- and out-of-school adolescents are lacking, there is controversy about providing services to sexually active adolescents, and a pervasive concern that sexuality education and contraceptive services leads to promiscuity. Unbiased and accurate information and services are needed if adolescents are to delay becoming sexually active, to resist pressures to engage in nonconsensual sex, and to protect themselves against unwanted pregnancies and infections if they do have sex. Moreover, strategies for providing such information and services need to be acceptable to the community and sustainable over time. The Population Council's Frontiers in Reproductive Health Program and the Program for Appropriate Technology in Health Kenya office collaborated with three government of Kenya ministries to design and implement a multisectoral project to improve knowledge about reproductive health and encourage a responsible and healthy attitude toward sexuality among adolescents, delay the onset of sexual activity among younger adolescents, and decrease risky behaviors among sexually active adolescents. Three interventions were implemented and evaluated in two districts in Western Province and this report presents findings that directly evaluate and cost the interventions.

Observations of the types of female genital cutting and possible associated gynecological and delivery complications were undertaken in 21 clinics in rural Burkina Faso and in four rural and four urban clinics in Mali. Women who came to the clinics for services that included a pelvic exam were included in the study, and trained clinic staff observed the presence and type of cut and any associated complications. Ninety‐three percent of the women in the Burkina Faso clinics and 94 percent of the women in the Mali clinics had undergone genital cutting. In Burkina Faso, type 1 (clitoridectomy) was the most prevalent (56 percent), whereas in Mali the more severe type 2 cut (excision) was the most prevalent (74 percent); 5 percent of both samples had undergone type 3 cutting (infibulation). Logistic regression analyses show significant positive relationships between the severity of genital cutting and the probability that a woman would have gynecological and obstetric complications.

In Africa, fertility rates in the 1990s declined less rapidly than had been projected, and in a few cases the fertility transition appears to have stalled. This development has serious implications for future population growth because projected population size is sensitive to minor variations in current fertility trends. The 16 countries with three DHS surveys in sub-Saharan Africa can be divided into three subgroups: stalled transitions, insignificant declines, and significant declines. Half of the 16 countries experienced a stall, and an additional two experienced insignificant declines. The Population Council prepared a series of demographic and policy analyses that drew from the existing literature on fertility and family planning in Kenya. These analyses were presented at a meeting of key stakeholders in Kenya in 2008. This report presents the issues emerging from the analyses and discussions, and suggests some policy and programmatic actions that can be taken to help the Government of Kenya address the stall within the frameworks of the Millennium Development Goals and the country's "Vision 2030" plan for sustainable development.