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PubMed1999

Women's fears and men's anxieties: the impact of family planning on gender relations in northern Ghana.

The Navrongo experiment, a family planning and health project in northern Ghana, has demonstrated that an appropriately designed, community-based family planning program can produce a change in contraceptive practice that had been considered unattainable in such a setting. Simultaneously, however, evidence suggests that newly introduced family planning services and contraceptive availability can activate tension in gender relations. In this society, where payment of bridewealth signifies a woman's requirement to bear children, there are deeply ingrained expectations about women's reproductive obligations. Physical abuse and reprisals from the extended family pose substantial threats to women; men are anxious that women who practice contraception might be unfaithful. Data from focus-group discussions with men and women are examined in this report and highlight the strains on gender relations resulting from contraceptive use. The measures taken to address this problem and methods of minimizing the risk of adverse social consequences are discussed.

Adult↗
PubMed1992

Surprising success in Kenya's FP programme.

Mrs. Margaret Gachara, Deputy Director of the Ministry's Family Health Division, explained that the strengths and weaknesses of the program have recently been examined using a new operations research approach, known as situation analysis. "If family planning was not working in Kenya, we had to know why in order to decide what to do about it. We began the study to find out where our weaknesses lay. To our surprise, we found that we were not weak, but moderately successful," she said. The Kenya Situation Analysis Study, conducted by the Health Ministry and the Population Council, revealed that contraceptive prevalence increased by 2%/year between 1984-89, from 17% to 27%. "That is quite acceptable by World Bank and WHO standards. Our total fertility rate has dropped from 7.9% to 6.7%, and in urban areas is down to 3.8%. We are now continuing with in-depth studies, but we expect to be able to say next year that our family planning program should have a moderately high rating, especially in terms of quality of care." Since the 1st results of the Analysis Study were published, family planning agencies in several other African, Asian and Latin American countries have requested similar studies. The Kenyan study showed that the Pill is the most popular method of contraception, used by about 80% of family planning acceptors. However, the use of injectable contraceptives has risen about 4-fold in recent years, from 0.5 to 1.8 million doses a year, Mrs. Gachara said. When the study was conducted, availability of injectable contraceptives was very poor and did not have strong logistical support. This has now been changed, and its use is going up very fast in rural areas. 1 of the reasons is that women who want to use contraception, but do not have support from their husbands, can have injection without their husbands knowing. Although the 3 monthly injectable initially had a very bad press and little Parliamentary support, research has shown that many of the fears were unfounded. Kenyan policy is to make the injectable available to women with 4 children and to those over 35. Guidelines have recently been changed, to require 1 live birth before injectables are offered, rather than 2. The government is also making efforts to promote the use of Noristerat, and a pilot program is currently underway to study implants. The situation analysis did reveal problems in a number of areas, and a list of recommendations has now been drawn up to improve the quality of care. The recommendations include improved supply of information on permanent contraceptive methods and on the side-effects of other contraceptives, a reduction in waiting times for family planning services and an increase in follow-up. "The future looks good for family planning in Kenya, but we have to match our services to contraceptive health benefits and to focus more on maternal health in its totality," Mrs. Gachara said.

Africa↗
PubMedDate not supplied

Noncompliance among oral contraceptive acceptors in rural Bangladesh.

The levels of noncompliance among 175 oral contraceptive acceptors in a rural area of Bangladesh were monitored for three to four months. Unexpectedly high levels of noncompliance were observed, including both overconsumption and underconsumption of oral contraceptive pills. Although the study was designed to investigate only the levels of noncompliance and not the causes and consequences of noncompliance, some useful indications of the factors associated with noncompliance were obtained. The results indicate that noncompliance is a significant factor in family planning programs and, as such, warrants further in-depth investigation.

Bangladesh↗
PubMed1999

Effect of price and access on contraceptive use.

The Family Planning Program in Bangladesh has been very successful. The contraceptive prevalence rate (CPR) has increased from 13% in 1979 to 49% in 1996. Now that the program has matured and demand for family planning has been created, the Ministry of Health and Family Welfare (MOHFW) of the Government of Bangladesh is concerned with increasing its financial sustainability. Options to increase financial sustainability include cost sharing and a gradual transition from doorstep to static clinic delivery of contraceptives. Many of these alternatives would involve additional travel time or charges for consumers, and it is important to estimate the effect that these additional prices would have on the use of contraception. The effect of economic constraints, such as cash price and access to services on contraceptive method use, the choice of contraceptive method and provider choice, has been analyzed, taking into account the socioeconomic factors that influence decision-making for individual family members. Two data sources have been used for this analysis: (1) a survey on use of contraception and (2) two baseline surveys of 1993 and 1994 in the two field sites of the MCH-FP Extension Project (Rural) of International Center for Diarrhoeal Disease Research, Bangladesh. No effect of cash prices was found on the probability of use of any contraceptive method, but clients were to a limited extent responsive to price in making choices about contraceptive methods and providers. In addition, couples were less likely to use contraception or choose methods if the travel time to fixed clinics was greater than 30 min.

Adult↗
PubMedDate not supplied

Fertility and family planning in southern and central Africa.

Southern Africa comprises a zone where the total fertility rate is below 6 births per woman. To the north is a ring of countries with higher fertility and relatively low contraceptive prevalence rates. The experience of South Africa, Botswana, and Zimbabwe, which have successful family planning programs, is compared with that of neighboring countries.

Adult↗
PubMedDate not supplied

The impact of condom prices on sales in social marketing programs.

The issue of pricing contraceptives in family planning programs is becoming more and more important. What is the relationship between consumer prices and demand, and how can we strike the correct balance between the two? This report examines the correlation between consumer prices for condoms, expressed as a percentage of per-capita gross national product, and per-capita sales of condoms in 24 social marketing programs. The correlation that emerges is strong and negative: Even when the data are controlled for age of program and other independent variables, there is a clear negative correlation between prices and contraceptive sales in these programs. The conclusion is clear that condom prices must be set very low--well below the equivalent of 1 percent of per-capita gross national product for a year's supply--in order to achieve satisfactory prevalence for condoms in either a family-planning or an AIDS-prevention context.

Acquired Immunodeficiency Syndrome↗
PubMed1997

Postpartum contraception: the lactational amenorrhea method.

Breastfeeding still accounts for a significant proportion of all fertility reduction, the average birth interval being longer among populations that breastfeed. However, per se it is not reliable for individual fertility suppression. The lactational amenorrhea method (LAM) is a highly efficient tool for the individual woman to utilize physiology to space births. Suckling induces a reduction in gonadotropin releasing hormone, luteinizing hormone and follicle stimulating hormone release, resulting in amenorrhea, through an intracerebral opioid pathway: beta-endorphins inhibit gonadotropin releasing hormone and dopamine secretions, which, in turn stimulates prolactin secretion and milk production. Reduced suckling precipitates the return of ovulation. During lactation, menses before 6 months are mostly anovulatory, and fertility remains low. The lactational amenorrhea method is based on three simultaneous conditions: (1) the baby is under 6 months; (2) the mother is still amenorrheic; and (3) she practises exclusive or quasi-exclusive breastfeeding on demand, day and night. Experiments with LAM extended to 9-12 months are ongoing. We use a standardized algorithm to present LAM. The lactational amenorrhea method is a way both to space births and to support breastfeeding, which should be replaced by a contraceptive method in due course. A 'Breastfeeding-LAM-Family Planning' team is very helpful in maternity wards for promoting modern breastfeeding, LAM, and contraception, and for alleviating barriers and misconceptions. The lactational amenorrhea method is at least 98% effective, comparing favorably with other contraceptive methods. Acceptability and continuity are not very well known; as with other 'natural' methods the figures are probably low in a general population but high for motivated couples. The lactational amenorrhea method avoids double protection, and thus saves resources, is especially (but not exclusively) suitable for couples interested in natural family planning and is accepted by religious authorities. The lactational amenorrhea method gives time to decide upon a long-term method of contraception. Unwanted pregnancies, although infrequent, conceived while using LAM result in very short, high-risk birth intervals. Introduction of LAM in family planning programs demands training, attention to be given to working mothers, positive attitudes of health personnel, close links between postpartum and family planning teams, situation analysis, budgets, evaluations, follow-up activities, modifications of record keeping systems and computing programs, and of national family planning guidelines. In conclusion, LAM is an efficient family planning method which should be promoted. The lactational amenorrhea method should always include the shift to another method when its criteria are no longer implemented.

Algorithms↗