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Observations on family planning acceptors in Papua New Guinea.

The continuation contraceptive practise of 3,293 I.U.D., 1985 pill and 749 depo-provera acceptors was analysed by a survey of family planning records. The proportions of grand multiporae were 40.3%, 24.2% and 40.4% in the three groups. Pap smears were taken in from 12 to 38.5% of acceptors and the proportions of pathological smears varied from 8.9 to 13.3%. The percentages of acceptors who attended only once more were 11% (I.U.D.), 18.1% (pill) and 25.1% (d-p.), Pregnancy rates were for the I.U.D., 1.7 per Hundred Woman Years, for the 2.1 per H.W.Y. and for d-p, 0.4, per H.W.Y. Temporary interruptions of the contraceptive methods were common with the pill and d-p. In the long run the I.U.D. is superior to the other temporary methods of contraceptives. Continuation rates with the I.U.D. were 89.9% after one year and 70.9% after five years (similar rates for the pill were 55% and 16.5% and for d-p 50.5% and 10.3%). The importance of a proper pelvic examination and the need to have all methods available for any individual receiving contraceptives are emphasized in the discussion. Tubal ligations should always be considered as an alternative to the temporary methods of contraceptives in ground multiporae and others at special risk from further pregnancies.

Adult↗

Oral contraception in Bangladesh: social marketing and the importance of husbands.

This is a report on a study that examined the characteristics of three types of commercial providers of oral contraceptives, as well as users and users' husbands. The study also examined how and from whom users and/or their husbands obtain oral contraceptives and instructions for use. The socioeconomic level of providers and user-couples was, on average, higher than for the general population. Husbands were particularly important for obtaining supplies from the commercial sector and acting as instructors. The findings suggest that: a special effort will be required if social marketing techniques are to increase oral contraceptive prevalence among the rural poor in Bangladesh, and family planning researchers and managers should give more attention to husbands in countries where men dominate communication networks.

Adult↗

Implenting family planning in a Ministry of Health: organizational barriers at the state and district levels.

1. Family planning occupied a subordinate position in the medical and health bureaucracy almost two decades after its introduction. Senior Ministry officials accorded low priority to formal program objectives, while the State Family Planning Officer, the highest state official concerned solely with the family planning program, suffered from a relatively subordinate position in the Directorate and a lack of authority and support. Within the medical profession, family planning was held in low esteem, and the medical and health bureaucracies did not have a mechanism for selecting personnel on the basis of interest and commitment. 2. Organizational adjustment to family planning in the Ministry of Health was a slow and painful process, absorbing the energy and attention of Ministry officials for almost a decade. The repeated reorganizations of the district setup revolving around the division of labor between medical, health, and family planning acitvities and between the rural and urban program, led to months of almost total inertia and detracted substantially from the supervisory capacity of the officials involved. 3. Decision making and guidance suffered from the quick turnover of the Secretary, the most powerful administrator in the Ministry. In Uttar Pradesh Secretaries stayed barely long enough to begin to understand the complex organizational setup of the program. 4. Multiple and often conflicting lines of authority characterized the relationships between the higher and lower echelons within the Ministry. This was accentuated when the District Family Planning Officer was placed under the administrative control of the District Magistrate. While intended to "energize" family planning through the association of the most prestigious and powerful district official with the program, this organizational arrangement resulted in conflicting instructions to the staffs of the primary health centers. 5. The organizational behavior of the Ministry of Health was shaped by the interplay of the various "professional cultures" of its key actors. The generalist administrators' short time horizon and eagerness to produce quantitative results clashed with the specialists' emphasis upon long-term goals and technical constraints; the politician's defense of the interest of his constituents clashed with the administrator's desire to defend his autonomy. The calculus of political survival made support for family planning goals a costly burden that few politicians have been willing to shoulder. As the party system does not reward the advocacy of family planning, ministers emphasize those programs within their ministry or those decisions within their discretion that correspond to the demands of their constituents.

Family Planning Services↗

An evaluation of a new teenage clinic and its impact on teenage conceptions in Nottingham from 1986 to 1992.

A new contraceptive clinic for teenagers was developed in the centre of Nottingham from 1987 to 1992 and provided care for over 1500 young people in its first three years. Twenty-five percent of clients were aged 16 years and 32% aged 15 or younger. Sixty-seven percent were in full-time education and young unemployed people were under-represented. The majority were young women, who came for routine contraception, usually the oral contraceptive or condom. Seventeen percent came for emergency contraception and 8% for abortion counselling and referral. Over the period 1986 to 1992, data on conceptions for teenage women and women aged over 20 years, who were resident in Nottingham Health district, were compared and when corrected for the estimated population showed that there had been no reduction in teenage conception rates; reasons for this are discussed. The value of conception rates as a measure of quality of sexual health care for teenagers is questioned and other more qualitative methods suggested.

Abortion, Induced↗

The introduction and use of Norplant implants in Indonesia.

In this study, patterns of Norplant use in Indonesia are reviewed to assess the implications of this experience for the introduction of new contraceptive methods. Data from the Norplant Use-Dynamics Study and the 1994 Indonesia Demographic and Health Survey are analyzed, and patterns of acceptance, continuation, and removal are described. Acceptance of Norplant has increased steadily since it was first introduced. The method is now used by more than 5 percent of all married women of reproductive age. Continuation rates among Norplant users are higher than among users of the IUD. One factor behind high continuation rates may be that a substantial proportion of acceptors were not told that removal before five years was possible. Results indicate that deficits occurred in the quality of service delivery and that a need exists for improved provider training, better supervision, and clearer and better-enforced guidelines regarding women's right to have Norplant removed on demand.

Adolescent↗

Fertility reduction and the quality of family planning services.

The purpose of this paper is to determine whether a focus on quality of family planning services is consistent with meeting demographic objectives. An analytical framework that links the six elements of quality with fertility is described. A review of existing literature and analysis suggest that improvements in quality of family planning services by enhancing the choice of contraceptive methods available in a country would increase the overall practice of contraception and thus would result in fertility reduction.

Contraception↗