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Cost-effectiveness evaluation of a home visiting triage program for family planning in Turkey.

Graduate Turkish midwives were trained in triage rules for determining family planning home visit frequency based on risk of couples. In a sample of 542 couples followed for six months, modern contraceptive use increased 22 per cent among high-risk and about 15 per cent among moderate- and low-risk couples. After making assumptions about the fecundity, contraceptive success, and pregnancy complications, the estimated average cost per complication averted was $61 for high-risk, $177 for moderate-risk and $526 for low-risk couples.

Adolescent↗

[Intra-vesical translocation of an intrauterine device, report of a case].

The intra-uterine device TCu 380 (IUD) has a great acceptance among the group of women that take the fertility control in not definitive form and it is being accepted by more women. In spite of the simple technique to insert the IUD, the people in charge of the planning family program in the first level attention section of the centers of health, have not enough knowledge for its insertion. We reported the case of a 21 year old woman that applied the IUD immediately after her baby's birth and she had sudden expulsion the following week. She went to the first level attention section where they inserted the IUD again and four months later she began to have urinary symptoms and abdominal pain, she went for a check, but could not find the filaments of the IUD. The x-ray of her abdomen showed an inverted IUD, they tried to take it off, but without any success. She was sent to the General Hospital where made an ultrasound that showed the IUD in the urinary bladder. A transurethral endoscopy was made and also an ultrasonographic dragging without gerring it. That is why decided to take it off by abdominal and urinary bladder surgery. The IUD was inserted transurethral which the diameter of the applier is thin and lets it go free in thorough the urethra, besides that during the operation did not find any harm in the uterus or the bladder that could make suspect the perforation in order to make the IUD reach the urinary bladder. The above mention demonstrate the ignorance of the technique and the anatomic place for the insertion of the IUD. That is the reason why it is necessary a more detailed preparation it the whole personnel assigned to the family planning programs.

Adult↗

Estimates of pregnancies averted through California's family planning waiver program in 2002.

CONTEXT: During its first year of operation (1997-1998), California's family planning program, Family PACT, helped more than 750,000 clients to avert an estimated 108,000 pregnancies. Given subsequent increases in the numbers of clients served and contraceptive methods offered by the program, updated estimates of its impact on fertility are needed. METHODS: Claims data on contraceptives dispensed were used to estimate the number of pregnancies experienced by women in the program in 2002. Medical record data on methods used prior to enrollment were used to predict client fertility in the absence of the program. Further analyses examined the sensitivity of these estimates to alternative assumptions about contraceptive failure rates, contraceptive continuation and contraceptive use in the absence of program services. RESULTS: Almost 6.4 million woman-months of contraception, provided primarily by oral contraceptives (57%), barrier methods (19%) and the injectable (18%), were dispensed through Family PACT during 2002. As a result, an estimated 205,000 pregnancies-which would have resulted in 79,000 abortions and 94,000 births, including 21,400 births to adolescents-were averted. Changing the base assumptions regarding contraceptive failure rates or method use had relatively small effects on the estimates, whereas assuming that clients would use no contraceptives in the absence of Family PACT nearly tripled the estimate of pregnancies averted. CONCLUSION: Because all contraceptive methods substantially reduce the risk of pregnancy, Family PACT's impact on preventing pregnancy lies primarily in providing contraceptives to women who would otherwise not use any method.

Abortion, Induced↗

Family planning clinic services in the United States, 1994.

In 1994, almost 6.6 million women received contraceptive services from more than 7,000 subsidized family planning clinics; these providers were located in 85% of U.S. counties. Health department clinics and Planned Parenthood sites served the largest proportions of these women (32% and 30%, respectively), followed by hospital outpatient sites (16%), independent clinics (13%) and community or migrant health centers (9%). The mix of agency types varied considerably by region and state, and the average annual number of contraceptive clients served per clinic also varied from fewer than 500 at community and migrant health centers to more than 2,000 at Planned Parenthood clinics. Nearly two-thirds of all women served (4.2 million) obtained care at one of the 4,200 clinics receiving funds from the federal Title X family planning program. Health department sites were the most likely to receive Title X funding (78%), followed by independent clinics and Planned Parenthood sites (66% each), hospital clinics (28%) and community and migrant health centers (18%). Overall, clinics receiving Title X funds serve an average of 25% more contraceptive clients than do clinics not receiving such funds.

Adolescent↗

The shift from natural to controlled fertility: a cross-sectional analysis of ten Indian states.

This study investigates the causes of the transition from natural to controlled fertility in India by comparing couples who have ever used contraception with those who remained under natural fertility conditions. Using sample study data this paper considers the relative effects of the factors involved in the shift to controlled fertility among ten early-transitional Indian States in 1970. The results indicate that it is primarily improvements in child mortality and its effects through intervening factors that account for the transition. The implication is that the success of a family planning program is largely a function of improvements in child health.

Child, Preschool↗

Quality of care in China: scaling up a pilot project into a national reform program.

China's family planning program ranks as history's most intensive effort to control national population growth. Although advocates for global population control have lauded China's effort to limit births as afundamental part of its sustainable development goals, the country's population policy has also generated much international criticism. As China enters the new millennium, a long-overdue reform of its approach to implementing its family planning program has begun to refocus the program on clients' needs, informed choice of contraceptives, and better-quality services. Originally inspired by the 1994 International Conference on Population and Development held in Cairo, the reform program began as a pilot project among six counties and has now become a blueprint for reorienting the national family planning program. This article reviews the process by which a small, innovative pilot project was scaled up into a national reform effort and the key lessons learned about scaling up sensitive but necessary innovation in a difficult political environment.

China↗

Natural family planning in the Philippines.

The calendar rhythm method of natural family planning (NFP) is one of the most popular contraceptive methods in the Philippines. As a result, the Philippines has one of the highest NFP prevalence rates in the developing world. In recent years, family planning program officials have become increasingly interested in improving the practice of NFP, both by improving the quality of rhythm practice and by introducing newer, more accurate NFP methods. Over the years a substantial body of research data related to NFP practice in the Philippines has accumulated. This paper presents major findings from past research on NFP in the Philippines, discusses their implications for program management, describes current research, and suggests needs for future research.

Adolescent↗

The impact of family planning clinic programs on adolescent pregnancy.

During the 1970s, there was a decline in adolescent childbearing in the United States and, among teenagers who were sexually active, there was a decline in pregnancy rates as well. To what extent was increased enrollment by teenagers in federally funded family planning clinics responsible for these declines? Areal multivariate analysis reveals that adolescent birthrates were reduced between 1970 and 1975 as the result of enrollment by teenagers in family planning clinics, independent of the effects of other factors also affecting fertility, such as poverty status, education and urbanization. Using a model which controls for differences in adolescent sexual activity in different areas in 1970 and 1975, the analysis found that for every 10 teenage patients enrolled in family planning clinics in 1975, about one birth was averted in 1976. Other multivariate models, which did not control for differences in sexual activity, showed changes in the same direction, though of smaller dimension. Since the family planning program averts not only births but also pregnancies that result in abortions and miscarriages, an estimate was made of the total number of pregnancies averted by the program. Based on the proportion of unintended pregnancies among adolescents that resulted in live births in 1976 (36 percent), it was estimated that for every 10 teen patients enrolled in 1975, almost three pregnancies were averted in the following year. Over the 1970s, an estimated 2.6 million unintended adolescent pregnancies were averted by the program--944,000 births, 1,376,000 abortions and 326,000 miscarriages. In 1979 alone, an estimated 417,000 unintended pregnancies were prevented by the program.

Adolescent↗