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A strategy for reducing numbers? Response.

I am not particularly knowledgeable on the subject-matter of this article; but would like to make brief comments from the broad economic point of view. The concept of a demographic 'trap' is not sound. For one thing, this concept completely ignores the possibility of 'trade' in food by implicitly assuming that the capacity of a community to support its population depends on its own output of food through appropriate economic policies. There were many predictions of disastrous famines in India in the early 70s on the basis of considerations such as those advanced by Dr Ding. Amartya Sen has argued, quite plausibly, that famines occur because of maldistribution of food and lack of adequate 'safety nets' rather than a decline in total food output. Sen is referred to at 1 place in the article; but somewhat out of context. The conclusion that if the birth rate does not fall, the death rate should also not be allowed to fall is repugnant. Look at the countries of Latin America; population growth is high, but there is no 'entrapment'. The so called 'trap' can, of course, occur because of failure of economic and social policies and international economic policies. However, there is nothing inevitable about it (at any given rate of population growth). The author's plea for greater information and public education in respect of demographic trends and consequences is valid. There is also an urgent need for a new thrust in family planning programs on wider economic and social grounds. However, this case is quite independent of the 'entrapment' theory.

Asia↗

Changing population rates, policies and attitudes in Africa, the Middle East and South Asia.

This paper explores the relationship between population growth rates, government policies, and social attitudes in 3 regions: Africa, the Middle East, and South Asia. The comparative success of family planning programs in certain countries of South Asia (most notably India and Sri Lanka) can be partly ascribed to their long tradition of government leadership. In addition, families in those countries have strong incentives to educate their children. On the other hand, in North Africa and the Middle East, high levels of urbanization have had antinatalist effects, which are offset by very low levels of girls' schooling and of female employment outside the home. In Sub-Saharan Africa, high fertility is sustained by the structure of the family, with its tendency to separate reproductive decision-making from responsibility for child-rearing. In addition, governments there have had a comparatively weaker tradition in areas such as family behavior.

Africa↗

The Billings method of family planning: an assessment.

The Billings/ovulation method is a periodic abstinence method of regulating births based on the client's interpretation of changing patterns in secretions of cervical mucus monitored by external self-examination. It was developed in Australia and is now widely promoted overseas. This paper outlines the method's recent history and goes on to discuss its physiological basis, its use-effectiveness as measured in a number of major trials, and some evidence concerning its general acceptability and applicability in family planning programs.

Body Temperature Regulation↗

Successes and problems in family planning administration: experiences in two districts of Kerala, India.

The administrative organizations of the Ernakulam and Malappuram Districts' family planning programs during 1970-74 and the ways they dealt with typical problems of program organization are examined. Lack of personnel, poor staff morale, inadequate supplies, and political and religious opposition to various contraceptive methods, especially sterilization, existed to varying degrees in both districts' programs. The Ernakulam experience, involving mass sterilization camps that were part of an overall district development program, documents the effectiveness of a strong central leader. The Malappuram program illustrates, in contrast, the handicaps of poor areas where development programs were just beginning and administrative resources were overtaxed.

Community Health Workers↗

Quality of care among Jamaican private physicians offering family planning services.

The National Family Planning Board is the agency of Government empowered to prepare, carry out and promote family planning programs in Jamaica. The Board has prioritized the expansion and sustainability of family planning services in large part through encouraging the participation of the private sector. To enhance the availability, acceptability and effectiveness of private physician family planning services, information was collected on the service practices of 90% of physicians, through face to face interviews. Bruce's framework was used to evaluate the findings of the study. The study indicated that: A wide variety of contraceptives are available - Basic equipment and adequate supplies are in place for the provision of services - Provider bias, inappropriate contraindicators and process and scheduling hurdles exist. The major recommendations relate to the: Revision of norms and guidelines for all contraceptives - Continuation of contraceptive technology updates for private physicians - Revision of legal/regulatory barriers which restrict access to some contraceptives for certain target groups.

Adolescent↗

Consortium building among local health departments in northwest Illinois.

The 1947 report by Haven Emerson envisioned the widespread delivery of local public health services through organizational patterns that substituted multi-county or regional agencies for locally controlled departments. The 1971 study by Vlado Getting supported the Emerson report and suggested alternative methods to provide public health services via multi-county area health service agencies for rural areas of Illinois. The number of local agencies in the State has doubled since the mid-1960s, yet a majority of rural counties have maintained a single-county health agency rather than forming multi-county arrangements. In effect, potential economies of scale have been forfeited. In northwest Illinois, however, eight local health departments, covering both rural and urban areas, have formed a multi-county consortium to identify and meet several overlapping program needs. This Region I consortium, with a population base of 590,000, was created as a result of the 1981 Omnibus Budget Reduction Act. Through the block grants created by the act, funds became available for preventive health and health promotion activities in fiscal year 1982. Once in place, the consortium provided a cost effective means to manage the Women, Infants, and Children Supplemental Feeding Program (WIC) and some elements of family planning programs in Region I. The consortium approach offers numerous opportunities for future growth and regionalization of services.

Illinois↗

Brazil announces family planning programme in 1981.

The Brazilian Minister of Health, Waldyr Arcoverde, announced in December that the government will implement a national family planning program in 1981. O Globo and Jornal do Brasil, the 2 main national newspapers, report that according to the information given by the Minister, the program will offer all contraceptive methods including male and female sterilizations. Sterilizations will be provided free-of-charge by INAMPS, the national hospital system. Contraceptive services are being provided in order to reduce illegal abortions, the practice of which is widespread throughout the country.

Americas↗

Withholding of population funds, 13 August 1987.

The United States Agency for International Development (USAID) withheld from the United Nations Population Fund (UNFPA) $25 million appropriated for the Fund by the United States Congress. This was the third year that funds had been withheld. As in earlier years, the Reagan administration objected to UNFPA support for China. It viewed China's family planning program, which emphasized the importance of limiting family size to one child, as sanctioning coercive abortions.

Abortion, Induced↗

Contraceptive use and fertility decline in Chogoria, Kenya.

This article describes the results pertaining to fertility and family planning from a 1985 survey conducted in the catchment area of Chogoria Hospital in central Kenya. Current contraceptive prevalence was found to be quite high, 43 percent as opposed to 17 percent for Kenya as a whole. The total fertility rate of 5.2 births per woman was 2.5 births lower than the national rate. Very few women reported wanting to have large numbers of children or thinking that fate or God should determine family size. Although these data cannot conclusively demonstrate that the family planning program operating in the area has been responsible for reduced fertility there, they do provide some support for this hypothesis.

Adolescent↗

Social marketing of contraceptives in Bangladesh.

Since 1975 there has been a family planning program operating in Bangladesh which advertises and commercially distributes contraceptive products in both rural and urban areas throughout the country. The program, known as the Social Marketing Project (SMP) and managed by Population Services International (PSI), now serves almost 1 million acceptors per month at an annual cost per couple of less than US$6.50, including the cost of donated contraceptives. This paper looks at the evolution of the project and its growth through the years, and addresses some primary concerns of planners of social marketing programs.

Advertising↗

A framework for analyzing the determinants of maternal mortality.

Hundreds of thousands of women in developing countries die each year from complications of pregnancy, attempted abortion, and childbirth. This article presents a comprehensive and integrated framework for analyzing the cultural, social, economic, behavioral, and biological factors that influence maternal mortality. The development of a comprehensive framework was carried out by reviewing the widely accepted frameworks that have been developed for fertility and child survival, and by reviewing the existing literature on maternal mortality, including the results of research studies and accounts of intervention programs. The principal result of this exercise is the framework itself. One of the main conclusions is that all determinants of maternal mortality (and, hence, all efforts to reduce maternal mortality) must operate through a sequence of only three intermediate outcomes. These efforts must either (1) reduce the likelihood that a woman will become pregnant; (2) reduce the likelihood that a pregnant woman will experience a serious complication of pregnancy or childbirth; or (3) improve the outcomes for women with complications. Several types of interventions are most likely to have substantial and immediate effects on maternal mortality, including family planning programs to prevent pregnancies, safe abortion services to reduce the incidence of complications, and improvements in labor and delivery services to increase the survival of women who do experience complications.

Family Planning Services↗