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PubMedDate not supplied

Unmet need for contraception in Vietnam: who needs what and when.

The Vietnam 1988 survey established the first national estimates for reproductive preferences and behavior. It created a unique baseline for levels and differentials, both for the marked differences between North and South, and for various social and demographic categories. It also provided the first national data for program guidance, including information on unmet need. Unmet need for contraception has been extensively documented for much of the developing world, but its structure is not yet well understood. This study differentiates unmet-need couples by several demographic characteristics, by time since the last birth, and by features identified through a computer search program. Past investigations have emphasized the per cent with unmet need within various population subgroups, but some of those subgroups are small, whereas the national family planning program must be oriented to subgroups with large absolute numbers of unmet need couples. Unmet-need couples are selective, whether by reference to the married population or by reference to other couples who also wish to avoid pregnancy but are using a method. Most unmet-need couples are younger than users, have fewer children and, especially, are closer to their last birth. Surprisingly, most have never used a contraceptive method before, even though Vietnam has had a vigorous family planning program and 49 per cent of all couples in the survey reported some experience with a modern contraceptive method. In terms of sheer numbers, those in need are distributed very widely throughout the country. The most disadvantaged segments of the population have both high percentages and large numbers in need, but the concentration of the national program upon a single contraceptive method restricts their options.

Adolescent↗
PubMedDate not supplied

House okays $330 million for population.

A total of $330 million for international population assistance has been approved by the US House of Representatives in the foreign operations appropriations bill for fiscal 1993. The legislation, which includes $20 million for the UNFPA, is expected to be considered by the Senate in the late summer or early autumn. The bill stipulated that the amount earmarked for UNFPA must be used solely for the provision of FDA-approved contraceptives and related logistics. Other restrictions placed on the funds specify that; none of the funds may be used in the People's Republic of China; they must be placed in a separate account and not co-mingled with any other funds; they may not be use to carry out any program, project or activity disapproved by the US Ambassador to the UN; the full amount must be refunded if UNFPA provides more than $57 million for its 5-year family planning program in china that began in 1990 and for which funds already have been committed. Once the largest donor to UNFPA, the US government has not contributed to the Fund since 1985 after the Reagan Administration and antifamily planning forces in Congress lashed out against UNFPA for its support of the allegedly coercive Chinese national family planning program. 2 USAID probes were unable to trace UNFPA funds to the forced abortions the Chinese government program was charged with encouraging and carrying out. Nevertheless, after Congress approved the 1989 foreign operations bill with $15 million earmarked for UNFPA, President Bush vetoed the measure. In his veto message, the President said that UNFPA "participates in and strongly defends the program of a particular foreign government which relies heavily upon compulsory abortion." Pointing out that UNFPA has received no US assistance since 1985 "precisely because of its involvement in this coercive abortion policy," Bush said the 1989 bill represented "a radical and unwarranted change in policy." Although the President failed to name the country that "relies heavily upon compulsory abortion" congressional opponents of refunding UNFPA singled out China as that country. The Chinese government has repeatedly issued official denials that force or coercion are involved in its population policy or programs. Meanwhile, the Bush administration has been pushing hard for Congress to grant most favored nation trade status to China, UNFPA is the largest multilateral agency providing population assistance to developing countries. But Dr. Nafis Sadik, executive director of the Fund, says that "requests for assistance from all regions have mounted to a level that can no longer be met by our organization." She pointed out that the demand for UNFPA support already exceeds the Fund's resources by $500 million. Additionally, she said, many countries--particularly in sub-Saharan Africa--want to expand their current population programs, and new requests are coming from the Commonwealth of Independent States, the Baltic States, and Eastern Europe. More than 100 countries contribute to UNFPA, but most of the Fund's resources are derived from a handful of donors--Japan, the Netherlands, Norway, Finland, Germany, Sweden, Denmark, the United Kingdom, and Canada.

Abortion, Induced↗
PubMed1987

The use effectiveness of the Copper T-200 in Matlab, Bangladesh.

Using a unique record keeping system, the use effectiveness of the Copper T-200 is examined in rural Bangladesh. In Matlab the Copper T-200 is a highly effective contraceptive modality. The adopters are typically low to medium parity women under 30 years of age. The most important cause of termination among women in the study was voluntary removal of the device. The complaint most often reported was bleeding followed by pain and weakness. The Matlab experience suggests that sustained motivation and regular resupply are the two key components of this highly successful family planning program.

Adult↗
PubMedDate not supplied

The determinants of IUD discontinuation in China: a discrete-time competing risk model analysis.

This research examines the social, demographic, and family-planning-program factors that influence the occurrence of IUD discontinuation among Chinese women, using a sample of 14,639 IUD use segments from the 1988 Chinese National Survey of Fertility and Contraceptive Prevalence. A discrete-time competing-risk event history method is employed to identify the determinants of IUD discontinuation by five kinds of reasons: contraceptive failure, expulsion, switching method, side-effects and other nonmethod-related reasons. The predictors of IUD discontinuation suggest that a number of mechanisms are in operation. Some of the determinants may reflect the effects of the family planning program; some may illustrate women's physiological and biological reactions to IUD's; some may be related to women's previous history of contraceptive use; and still others may indicate social characteristics of women that lead them to have their IUD's removed.

Adult↗
PubMedDate not supplied

Maternal mortality in Matlab, Bangladesh: 1976-85.

This paper reports findings from a study of maternal mortality in Matlab, Bangladesh during the 1976-85 period. The study employed a multiple-step procedure to identify maternity-related deaths to all reproductive-aged women within the study area during this period. A total of 387 maternal deaths were identified, resulting in an overall maternal mortality ratio of 5.5 per 1,000 live births. The introduction of a family planning program in half of the Matlab study area led to a moderate but significant reduction in maternal mortality rates, relative to the comparison area. This appears to have been primarily due to a reduction in the overall number of pregnancies in the treatment area, since among women who became pregnant, mortality risks remained high. The results of this study underscore the need for a broad-based service strategy that includes but is not limited solely to family planning, in order to achieve significant reductions in maternal mortality levels in settings such as rural Bangladesh.

Adolescent↗
PubMed1999

[Reproductive health and social guarantees].

Main cause of demographic crisis seen in Russian Federation is dramatic decrease of birth rate that depends on many reasons including negative results of Family Planning Program. Extraordinary measures discussed now are: pregnancy payment (instead of parturition payment), lump-sum premium for birth (instead of allowance), snap provision of housing and other encouragements, orientation of Family Planning Program from birth control to birth propaganda and to prophylactics of reproductive disorders.

Abortion, Induced↗
PubMed2001

Contraceptive security, information flow, and local adaptations: family planning Morocco.

BACKGROUND: Many developing countries increasingly recognize and acknowledge family planning as a critical part of socio-economic development. However, with few health dollars to go around, countries tend to provide essential drugs for curative care, rather than for family planning products. Donors have historically provided free contraceptives for family planning services. Whether products are donated or purchased by the country, a successful family planning program depends on an uninterrupted supply of products, beginning with the manufacturer and ending with the customer. Any break in the supply chain may cause a family planning program to fail. A well-functioning logistics system can manage the supply chain and ensure that the customers have the products they need, when they need them. METHODOLOGY: Morocco was selected for the case study. The researchers had ready access to key informants and information about the Logistics Management Information System. Because the study had time and resource constraints, research included desktop reviews and interview, rather than data collection in the field. RESULTS: The case study showed that even in a challenging environment an LMIS can be successfully deployed and fully supported by the users. It is critical to customize the system to a country-specific situation to ensure buy-in for the implementation. CONCLUSIONS: Significant external support funding and technical expertise are critical components to ensure the initial success of the system. Nonetheless, evidence from the case study shows that, after a system has been implemented, the benefits may not ensure its institutionalization. Other support, including local funding and technical expertise, is required.

Contraceptive Agents↗
PubMed1994

From population control to reproductive health: an emerging policy agenda.

This article reviews the background to the current debates between advocates of population control and reproductive health as frameworks for national and international health policies. Population control has been a dominant metaphor in international family planning programs since the 1960s. Population control has frequently meant pursuing a single-minded goal of fertility limitation, often without sufficient attention to the rights of family planning clients. This narrow focus has led to some coercive policies, numerous ethical violations, and ineffective family planning programs. In the last decade there has been the beginning of a policy shift, advocated by a growing number of activists and researchers in women's health, from population control to reproductive health. A reproductive health framework would provide a broader programmatic focus that could bring needed attention to such issues as sexually transmitted diseases, infertility, abortion, reproductive cancers and women's empowerment generally.

Female↗
PubMed1999

A 5-year clinical evaluation of Norplant implants in Senegal.

The principal objective of this 5-year clinical study of Norplant implants was to introduce these implants into the family planning program in Senegal and to determine their overall acceptability and safety in Senegalese acceptors. A total of 300 subjects were enrolled into the trial from August 1986 to July 1991. All the women were followed-up for 5 years or until the implants were removed. The pooled cumulative discontinuation rate was 40.8 +/- 2.91 per 100 women resulting in a continuation rate of 59.2 +/- 2.91 per 100 women. Thirteen subjects (4.3%) were lost during the follow-up. Seven pregnancies were reported throughout the 5 years leading to a cumulative pregnancy rate of 3.3 +/- 1.25 per 100 women. Menstrual problems were the reason most often given for early removal during the first 2 years. After year 2, desire for another pregnancy was the main reason for implant removal. The results presented in this study show that the Norplant implant system is a safe, effective, and acceptable method that meets the needs of the Senegalese family planning program.

Adult↗
PubMed2000

Quality of care within the Indian family welfare programme: a review of recent evidence.

India's family planning program represents one of the earliest and most ambitious efforts in a developing country to address the issue of high fertility. Despite its more than four decades of existence, little is known concerning how the program is implemented at the field level, especially in relation to the quality of services provided. In this article, empirical evidence on the accessibility and quality of services provided through the Indian family planning program is reviewed and synthesized. The review highlights the serious and systemic shortcomings in quality of care that characterize the Indian program in such areas as restricted method choice, limited information provided to clients, poor technical standards, and low levels of follow-up and continuity of care. The factors constraining higher service quality are subsequently reviewed, and the prospects for improving quality of care within the Indian program are assessed.

Family Planning Services↗
PubMed1984

The threshold hypothesis: evidence from less developed Latin American countries, 1950 to 1980.

Historical research among European countries finds large differences in the level of social, economic or demographic development among countries, or regions within countries at the time marital fertility rates began their decline from traditional high levels. This research tests a threshold hypothesis which holds that fertility will decline from traditional high levels if threshold levels of life expectancy and literacy are surpassed. Using a pooled regression analysis of 1950, 1960, 1970 and 1980 crude births rates (CBRs) in 20 less developed Latin American countries, in conjunction with 10-year lagged measures of social, economic and family planning program development, analyses reveal statistically significant effects of passing Beaver's (1975) threshold levels of 1950 literacy, or 1950 life expectancy, that are independent of levels of lagged literacy (or lagged life expectancy), economic and family planning program development, as well as measures that control period effects.

Birth Rate↗
PubMedDate not supplied

Gonorrhea screening in family planning clinics when should it become selctive?

Routine screening of females for gonococcal infection has become common in many clinic settings, particularly in public family planning clinics. The results of such routine screening in one large family planning program operated by the Seattle-King County Department of Public Health was examined. From 1973 to 1975 a trend toward decreasing rates of positivity for gonorrhea was observed. Use of computer information on the population being served by the program and a review of individual patient's charts enabled identification of certain high-yield subpopulations, including blacks, welfare recipients, new patients over age 19, and new patients who were not using any contraception when first screened. The cost of detecting a case of gonorrhea through screening was related to the positivity rate with the demonstration of a very high cost per case found when the positivity rate is less than 1 percent. Consideration should be given to identifying high and low-yield subpopulations for gonorrhea screening in large family planning programs so that, as cost considerations demand, funds now used for routine gonorrhea screening may be used instead for selective screening and provision of family planning services to high-yield groups.

Cost-Benefit Analysis↗
PubMedDate not supplied

A clinical study of norethisterone enanthate in rural Mexico.

Clinical trials of norethisterone enanthate (NET-EN), a long-acting, injectable progestogen, have demonstrated its short-term safety and effectiveness as a method of contraception in a controlled trial setting. Family planning programs interested in providing NET-EN need information on its efficacy and acceptability under usual field conditions. This first field study of NET-EN was conducted in family planning clinics in rural areas of Mexico. Women admitted to the study were followed up at two-month intervals to receive an injection of 200 milligrams of NET-EN, and to be asked about possible side effects of the drug. Among the 5,792 women recruited, the overall life-table discontinuation rate was 57.0 per 100 women at 12 months and 69.0 at 18 months. The single most common reason for discontinuation was amenorrhea, followed by bleeding problems. Women who were older and who already had several children were most likely to continue using NET-EN. Nine pregnancies were reported during the study, with a cumulative pregnancy rate of 0.3 per 100 women at 18 months. NET-EN appears to be an effective method of contraception that is acceptable to a substantial proportion of women from rural areas in Mexico who choose to use it, when it is provided through a national family planning program.

Actuarial Analysis↗