Country report of Nepal, "Community leaders & family planning communication" workshop.
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"The effect of various factors on selection for family planning status and for natural fecundability is studied in a Monte Carlo simulation that incorporates heterogeneity of natural fecundability and of risks of foetal loss. Selection depends crucially on the duration of marriage at which contraceptive status is recorded, and on desired family size....The contraceptive status of sterile women is also revealed in the simulation, including users who do not know that they have become sterile. Formulae are developed to allow the estimation of births averted and potential fertility among the users, and results checked by further simulation." The results indicate "that selection for foetal loss is much less important than selection for natural fecundability in its effect on numbers of averted births and potential fertility." (summary in FRE)
On May 23, 1991, the US Supreme Court upheld federal regulations that prohibit federally funded family planning programs from counseling about or referring for abortion. As a result, government benefits may now entail substantial costs. The regulations changed the nature of government-assisted family planning from comprehensive care and counseling to limited services and government-prescribed information. The reasoning in Rust v Sullivan allows government to limit freedom of speech in federally funded programs. The decision may have been influenced by antiabortion sentiment, but it does not affect the legality of abortion. Instead, it sets a precedent for government control of whether and how health care can be discussed wherever government pays some of the bills.
Recent research results on infant feeding practices in developing countries have consistently shown a strong negative association between breastfeeding and contraceptive use. This relationship is explored in-depth with a detailed analysis of Taiwanese data and supplementary evidence from 20 developing country populations. Implications for appropriate policies relating to family planning programs and the encouragement of breastfeeding are discussed.
A survey of women of reproductive age was undertaken during April and May 1986 as part of an operations research project in Ouagadougou, the capital of Burkina Faso. Data were collected on respondents' knowledge, attitudes, and practice (KAP) of contraception. Although the government family planning program had been operating only since February 1985, knowledge of modern methods was surprisingly high, with 64 percent of respondents having ever heard of at least one modern method. Only 4.9 percent, however, were currently using a modern method. Use of traditional methods was high in this traditional society, with 41 percent of women currently practicing abstinence. Both knowledge and current use varied significantly across several background characteristics, the most important of which was education. The respondents were very vocal about their fertility desires regarding both the spacing and limitation of births. Moreover, attitudes toward possible future contraceptive use were extremely positive. These factors may be contributing to the steadily increasing demand for family planning services, which the government program is striving to meet.
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Using data from the Male Attitude Survey of 1985, this paper shows that Sudanese men play a major role in family planning decision-making. Attitudes regarding family planning issues are presented for 1,500 men aged 18 years and over, living in urban areas of Khartoum, the capital of Sudan. The decision not to practice family planning is found to be male-dominated, and husbands are responsible for providing contraceptives when family planning is practiced. Widespread misconceptions about vasectomy, along with a very low acceptance rate, exist among the men in the sample. It is concluded that the involvement of men in family planning programs will give these programs a better chance of success in the future.
The medical information, financial, and logistic aspects of a comprehensive computer-based Appointment, Registration, Information System, and Evaluation (ARISE) are analyzed for the management of a family planning program serving 30,000 patients annually. An overview of the existing computer system network is presented with descriptions of the interactive master patient index, the batch appointment process, the management statistics package, and Department of Health, Education, and Welfare (HEW) reporting. Emphasis is placed on the financial management control system which includes 1) procedures for third-party submission of claims for payment, in particular Titles IVA, XX, and XIX (Social Security Act), together with discussion of related administrative requirements; 2) technics of auditing data integrity including systematic sampling of collected data; and 3) the process of billing and receipts collection. Methodology and implementation aspects of ARISE may have wide applicability to other family planning and similarly structured clinical programs.
Withdrawal is the main method used amongst couples in Turkey to prevent pregnancy. Discontinuation of use is most likely to be due to the desire to become pregnant or failure of the method. Withdrawal users are less likely to switch to another contraceptive method; however, among users who do switch, they will most likely switch to a modem method. The strongest three determinants that predict withdrawal use are using withdrawal as one's first method, the woman's age, and the husband's education. The woman's work status and the couple's ethnicity are also important predictors of withdrawal use. Family planning programs should target different segments of the population and focus on correct knowledge of all methods. Results indicate that men and women need to learn about family planning options earlier in their lives or prior to marriage.
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Although new contraceptive technology has the potential for providing women with expanded options for fertility control, the historical record of international family planning shows that, in practice, introduction of new methods has not always broadened reproductive choice. Using the example of introduction of intrauterine devices into the Indian family planning program in the 1960s, we show that an exclusive focus on the technology itself is problematic and argue that methodologies are needed that relate introduction of new methods to user needs and program capacities. We summarize key findings from the Indonesian experience with Norplant introduction. Although an effort was made to address problems with previous approaches, major deficiencies in both the technical and interpersonal dimensions of care arose when the implants were made broadly available within the program. We subsequently present a methodology for contraceptive introduction developed by the World Health Organization. This methodology emphasizes the social and institutional context in which technology is used and suggests a participatory and research-based approach to program and policy development. We illustrate results from this new approach in its implementation in Vietnam and suggest areas for further evaluation.
The authors report the results of a retrospective study of 347 cases of tubal ligation collected between January 1985 and December 1991 in the maternity unit of the Yaoundé teaching hospital group. The tubal ligations were performed through minilaparotomy with local anesthesia using the method of Pomeroy. The frequency of tubal ligation evaluated by 3.8 per cent did not change during the period of this study. The authors note that the majority of patients in this study asked for a tubal ligation only when they had 5 or more surviving children. The authors conclude that because of poorly equiped medical infrastructures in the context of developing countries tubal ligation through minilaparotomy should be promoted by the contraceptive methods in family planning programs.
Current practice of family planning in China is based on the population policy and strategy of the country. Comprehensive contraceptive methods are provided in family planning clinics at all levels. Among the methods used, intrauterine devices and tubal sterilization are most popular. Vasectomy is popular in some provinces. Oral pills, injectables and subdermal implants occupy a small proportion. Incidence of abortion is high due to failure of methods and unprotected intercourse. Attention is paid to the adoption of emergency contraception to prevent unwanted pregnancy. Improvement in quality of care is the key to a successful family planning program. Basic research is essential for development of new contraceptive technology.
OBJECTIVES: Imams are religious leaders who have significant influence on the social attitudes and behavior of a society. This study examined the views of imams on family planning and their personal preference of birth control methods. MATERIALS AND METHODS: Using a pre-prepared questionnaire, an on-site individual interview was conducted face-to-face with each of 164 imams at Kayseri, a city in Central Anatolia. RESULTS: All of the imams included in the study knew of at least one family planning method. Withdrawal was the most widely known method of family planning (84.2%). Among imams, 88.4% approved the use of birth control. While only 61.8% of the imams used at least one method of family planning, 20.1% used none at all. Of the family planning methods used, we considered 43.1% efficient (modem) and 18.7% inefficient (traditional). The most important factor affecting preference of traditional methods was religious suitability. CONCLUSION: Contrary to common belief, imams viewed family planning positively and used family planning methods at a rate similar to that of the general public. If provided with accurate information, we believe that imams may have a positive contribution to make in the development of family planning programs.
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