A statewide family planning program: evaluation by continuous computer monitoring.
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During the 21-month period between August 1, 1991, and April 30, 1993, 2,358 women received Norplant system insertions in either Parkland Memorial Hospital or the Dallas Maternal Health and Family Planning clinics. Forty-three percent of these women were teenagers with 14% 16 years of age or less. Overall, 431 patients received Norplant implants insertions postpartum prior to discharge from the hospital. To date, 138 Norplant systems have been removed, with the proportion of contraceptive implant removals among teenagers being essentially the same as that in more mature women. Of the reasons given by women discontinuing the Norplant system, an unanticipated high incidence of pain in the arm containing the implants, hair loss, and mood changes were noted. We have found the Norplant system to be a highly effective and highly acceptable contraceptive method for a large number of indigent women.
This paper uses Côte d'Ivoire and Nigeria survey data on both supply and demand characteristics to examine how structural and demographic factors influence family planning provision and cost. The model, which takes into account the endogenous influence of service provision on average cost, explains provision well but poorly explains what influences service cost. We show that both size and specialization matter. In both countries, vertical (exclusive family planning) facilities provide significantly more contraception than integrated medical establishments. In the Nigeria sample, larger facilities also offer services at lower average cost. Since vertical facilities tend to be large, they at most incur no higher unit costs than integrated facilities. These results are consistent across most model specifications, and are robust to corrections for endogenous facility placement in Nigeria. Model results and cost recovery information point to the relative efficiency of the International Planned Parenthood Federation, which operates large, mostly vertically organized facilities.
In the United States, there are currently an estimated 30 million women at risk of unwanted pregnancy; of these, more than 12 million low-and marginal-income women aged 20-44 and adolescents of all incomes appear to be in need of subsidized family planning services. A family planning delivery system capable of serving approximately one-half of these women has been rapidly organized: the clinic program has grown from 900,000 clients in 1968 to 3.4 million in 1974, and the private sector is assumed to be providing care for 3 million more. The allocation of federal funds, the enactment of supportive policies and laws, and the organization of a specialized and centralized agency in the federal government have been factors in the initiation and expansion of family planning services.
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