Program planning for family planning services.
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Adolescent↗
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Sources of family size attitudes and family planning knowledge among rural Turkish youth.
Family planning programs in developing countries may have unexpected and long-term impact on youth in terms of their own later fertility behavior. This paper presents data indicating the effect of an adult-oriented family planning program on the family size attitudes and fertility-related knowledge of rural Turkish youth. Unmarried males and females living in villages exposed to different levels of family planning activities, as well as those in a control area, were sampled. A multivariate approach to the analysis was used to control for demographic and socioeconomic characteristics and for certain psychological variables. Females desire fewer children than males and know more about contraception, particularly the IUD. The hypothesis of indirect learning as a result of the adult-oriented family planning program, is confirmed for females, but not for males. The findings have implications for both program planning and for a more accurate measurement of the impact of family planning programs.
Adolescent↗
The effectiveness of contraceptive programs for teenagers.
This paper critically reviews the effectiveness of adolescent family planning programs in the United States. Various models for evaluating family planning programs and the findings from empirical studies of adolescent programs are reviewed. During the past decade there have been major increases in the availability and utilization of contraceptive services by adolescents. Most of those who are sexually active are now aware that these services exist. Program continuation rates among adolescents are not high, in part, because of the sporadic nature of adolescent sexual activity. Data on contraceptive continuation and pregnancy rates in these programs are limited, since few studies follow up clinic noncontinuers. Among clinic continuers pregnancy rates are relatively low, suggesting that at least some programs are effective in reducing pregnancy and/or fertility rates (number of children born) in their target populations. Ecological analyses seem to indicate that programs have had an impact on adolescent marital fertility.
Adolescent↗
Taiwan's transition from high fertility to below-replacement levels.
This article compares the fertility experience of Taiwanese in the eight years since the total fertility rate reached 2.1 with that before fertility reached replacement levels. During the earlier period, two-thirds of the fertility decline resulted from falling marital fertility and one-third from higher age at marriage. The changing age distribution retarded this decline. Since 1983, the further decline to 1.7-1.8 has been entirely the result of the trend toward later marriage. Older age distributions now facilitate the decline. Births postponed by those marrying later make the conventional TFR misleading. Computation based on parity-progression ratios raise TFRs from 1.7 to 2.0, a number less alarming to policymakers. Contraceptive prevalence is at saturation levels in all major populations strata. The "KAP-GAP" has disappeared. What would have happened without Taiwan's effective family planning program is impossible to determine, but clearly, contraceptive services supplied by the program were the major proximate cause of Taiwan's fertility decline.
Adolescent↗
The simulated client method: evaluating client-provider interactions in family planning clinics.
The "simulated client" method was first detailed in the family planning literature in 1985, but it has not been extensively covered since. As used by the authors to study client-provider interactions in family planning programs, this method essentially consists of sending women to a family planning service provider to request information, and interviewing them after the encounter. The women do not reveal to service providers they are participating in the study. This report describes the method; reviews some of the theoretical, ethical, and methodological issues related to it; and underlines its usefulness as a tool for examining quality-of-care issues in family planning programs.
Developing Countries↗
Advanced methods for evaluating the impact of family planning communication programs: evidence from Tanzania and Nepal.
Evaluations of national family planning communication campaigns are often complicated by nonrandomized research designs and self-reported measures of exposure to media messages, both of which can bias estimates of campaign effectiveness if suitable analytical methods are not employed. This study uses three methods to address these problems: (1) single-equation multiple regression analysis; (2) propensity score matching (PSM); and (3) maximum-likelihood simultaneous equation models (SEM), namely bivariate probit. We use these methods to evaluate the impact of family planning health-communication campaigns on the use of modern family planning methods, focusing primarily on the radio drama Zinduka! in Tanzania and Ghanti Heri Haad Nilaun in Nepal. We find that these methods led to substantially different estimates of the magnitude of the impact of these communication campaigns. Specifically, we found that self-reported exposure to each radio program was exogenously related to family planning use and that PSM and multiple regression analysis gave similar estimates in those situations. An indicator of exposure to any type of family planning message was found to be endogenous, in which case bivariate probit and PSM gave different estimates of program impact. Researchers should, therefore, pay close attention to the results of tests for endogeneity and identification that guide the appropriate use of the different methods.
Adolescent↗
Fertility and family planning in rural northern Thailand.
From the mid-1960s to the mid-1970s, when fertility was declining in Thailand as a whole, especially rapid declines occurred in Northern Thailand, but they did not occur uniformly in all the region's provinces. The Northern Thailand Fertility Study, initiated in 1975 to study the reported fertility changes, gathered data in two provinces: Chiang Mai, where fertility decline has been quite rapid, and Chiang Rai, which experienced relatively little decline until 1974. This preliminary report discusses fertility levels and trends in the two provinces, fertility experience and expectations of respondents, attitudes toward and knowledge of family planning, and contraceptive practice. The results suggest that most of the difference in fertility decline is related to the different level of family planning program activity in the two provinces.
Abortion, Spontaneous↗
Trends in family size preferences and contraceptive use in Matlab, Bangladesh.
In the nearly ten years of its existence, the Matlab Family Planning and Health Services Project has been characterized by a remarkable rise in contraceptive use and a corresponding decline in fertility. This study examines available evidence on trends in family size preferences in the Matlab area from 1977 to 1984 and their relationship to contraceptive use. Within the Matlab treatment area, the most significant factor behind the increase in contraceptive use has been a sharp rise in the practice of contraception for spacing births. There also appears to have been a more modest increase in the proportion of women wanting no additional children. Family size preferences in the treatment and comparison areas were roughly comparable, suggesting--to the extent that such preferences have changed over time--change may have occurred throughout the Matlab study area. The findings are evaluated in terms of their implications for the current debate on the contribution of family planning programs to fertility decline in developing countries.
Adult↗
The effectiveness of family-planning programmes.
By the mid-1960s, countries that accounted for 66% of the population of developing countries had adopted policies designed to reduce their rates of population growth; by 1986, the corresponding figure had reached 78%. In the developing regions as a whole, fertility has fallen by more than 30% since 1950. Contraceptive use has risen sharply, and there has been more than 10-fold increase in the number of couples in developing countries who use contraceptives. There is a very strong association between use of contraception and fertility in developing countries. Social and economic modernization is also taking place, although quite unevenly in the developing regions, so that the relationship of modernization is fertility is not very easy to demonstrate. In general, the experience of the developing countries suggest that a strong family- planning program effort can, and does, lead to a more rapid fertility decline than would be likely based only on socioeconomic variables. The effectiveness of family-planning programs can be enhanced by increasing the range of choice of contraceptive methods offered. However, it is difficult to disentangle the various factors that contribute to the effectiveness of family-planning programs. The public sector is the main supplier of family-planning services in most developing countries, and there is no clear trend towards the reliance on the private sector.
Contraception↗
Population and family planning: an international perspective.
Since the 1960s, the U.S. government has supported population and family planning programs in Third World countries, on the grounds that rapid population growth impairs the ability of those countries to develop economically; family planning programs contribute to fertility decline; and such programs help improve the health of mothers and children. Although the United States remains the largest single donor of funding for international population programs, its support has weakened during the eight years of the Reagan administration and patterns of funding for those programs have changed substantially. Since the 1960s, however, contraceptive use has increased in the Third World and fertility has fallen substantially. The decline has been uneven, though--considerable in some countries, moderate in others but very small in many. The performance of family planning programs around the world has varied widely, and questions remain as to what, if anything, can be done to increase success. For the future, three aspects of population and fertility control in developing countries merit special attention: the supply of contraceptive commodities going to family planning programs; the maintenance and strengthening of the family planning infrastructure; and the need to examine the policy implications of differing patterns of fertility and population growth for national development and individual well-being.
Developing Countries↗
The politics of population policy in the Islamic Republic of Iran.
The Islamic Republic of Iran arguably has one of the most successful family planning programs in the developing world. This success is all the more interesting for advocates of population programs because the political leaders of the Islamic regime were once strongly opposed to family planning. Indeed, after gaining power following the 1979 revolution, they were responsible for dismantling Iran's relatively new family planning program and introducing pronatalist policies. This article provides an account of the different phases of the population policy in Iran and examines the diverse elements that led politico-religious leaders to revise their views about fertility control and to participate in creating a workable family planning program. The complex formal and informal strategies that the political experts, the media, the religious authorities, and the government of the Islamic Republic adopted in order to achieve this about-face are described. The analysis is based on data collected by the first author during anthropological field research in 1993-96, by means of informal interviews with officials, with medical personnel, with family planning clients, and with religious leaders.
Family Planning Policy↗
The politics of birth control.
By the time Senate subcommittee hearings on the "population crisis" ended in 1968, a sizeable consensus had begun to emerge favoring government support of voluntary family planning programs at home and abroad. The goal to develop a national family planning program was easier to set than to accomplish, however, and there have been no lack of difficult questions to haggle over in the past 20 years. Beginning with the Johnson administration, the executive branch of government has tended to favor block-grant funding of family planning services, while Congress has insisted on categorical funding. Conflict has also existed over financial eligibility for government-supported services, over whether teenagers and unmarried women should be served in publicly supported clinics and over which services should be included in the definition of family planning. The Reagan administration has exacerbated the conflicts with attempts to redefine family planning by placing primary emphasis on natural methods and abstinence for those who wish to prevent pregnancy and attempts to deny funding to both domestic and foreign programs that support access to abortion. While future government support for family planning programs does not seem seriously threatened, funding has not grown in 15 years, once the effects of inflation are taken into account, and most programs have had to limit eligibility to survive. The Bush administration is unlikely to be as confrontational as the Reagan administration on the subject of family planning, but the political reality is that conflict can be expected to continue.
Abortion, Legal↗
REALPOP: a mathematical model for resource allocation in population programs-results from a test in the Dominican Republic.
The structure of a computerized mathematical model for resource allocation in population programs (REALPOP) and its application to the Dominican Republic's national family planning program are described. The model integrates demographic and management science approaches in the analysis of resource allocation, program planning, goal evaluation, and growth strategies of a family planning program. It is designed primarily to aid administrative decision-makers. The Dominican National Population and Family Council (NPFC) established a goal of reducing the crude birth rate from its 1968 level of 48 per thousand population to 28 per thousand in 15 years. Further, the program has established a clear set of program plans and alternatives. This study investigates the implication of these plans for the program's stated goals.
Contraceptives, Oral↗
The construction of community participation: village family planning groups and the Indonesian state.
Indonesia's family planning program has been one of the most effective in the developing world in promoting contraceptive use and contributing to fertility transition. In evaluating why the program has worked, analysts have given much credit to a network of village family planning groups that developed from the 1970s to the 1990s and that blanketed the archipelago. These groups, composed primarily of female volunteers, made contraception available to women in even the most remote parts of the country, and acted as agents of family planning motivation. They have been labeled by the Indonesian state family planning agency as an example of effective community participation on a national scale. In this paper, I investigate this claim and find it to be simplistic. I provide extensive evidence that the creation of this network was orchestrated by the Indonesian state. On the other hand, I show that these groups are not fully state entities, as they have several characteristics that mark them as socially embedded institutions. They are best labeled as unusual state-society hybrids. In my investigation I draw on one of the newest paradigms in the discipline of political science--the state-society approach--to uncover the odd nature of this family planning network. More deeply, I argue that the state-society approach ought to be adopted in family planning analysis on a comprehensive basis. The traditional organizational and social-demographic approaches that have dominated the field offer only limited understanding of the nature of family planning programs in developing countries. The state-society approach is ideally suited to identifying how family planning programs are institutions of a political nature, embedded in states and societies, and transformed by and transformative of each.
Community Health Planning↗
Introduction strategies raise key questions.
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Ambulatory Care Facilities↗
[Prevalence of contraceptive use in Colombia: determinants and implications].
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Abortion, Induced↗
Recommendations to strengthen the role of lady health workers in the national program for family planning and primary health care in Pakistan: the health workers perspective.
BACKGROUND: This study was planned to assess the strengths and weakness of the National Program for Family Planning and Primary from the Lady Health Workers (LHIW) perspective. We conducted this study in order to develop recommendations for strengthening LHWs' role in Primary Health Care (PHC) in Pakistan in consultation with the health workers. METHODS: A qualitative study, based on key informant interviews, was carried out in Karachi, Pakistan. A total of 20 workers were interviewed. Analysis was carried out by grouping similar responses in a matrix and then analysis with reference to context. RESULTS: Motivations for joining program included financial benefits, convenient timings and an opportunity to serve humanity. Training was deemed satisfactory but clinical training was resented because of doctors' attitudes. Further training needs identified included basic information about common ailments, reproductive issues and basic clinical skills. Major strengths of the program mentioned included provision of services at grass root level, reinforcement of health messages and the community acceptability of workers. Weaknesses mentioned included the contractual nature of job, low salaries, irregularity of payment, no career development and poor logistical support. CONCLUSION: Giving LHWs permanent government employee status and a raise in salary may strengthen the workers functions. Eligible LHWs should be given incentives (skills, career development, financial). The community must be educated about assigned role and responsibilities of LHWs and patient referral system by the LHW needs to be strengthened. The valuable role of LHWs in PHC in Pakistan must be acknowledged and further improvements pursued.
Family Planning Services↗
Adolescent fertility management: the Sierra Leone experience.
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Adolescent↗