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[Trends and correlates of fertility decline in the NIES].

"Trends and correlates of dramatic fertility declines in the NIES [newly industrialized economies of Asia] from the 1960s to the 1980s are examined in this paper. Specifically, we first look at changes in the fertility effects of such demographic factors as age structure of fertility, age pattern of marriage, and marital fertility. Next, as major proximate determinants of fertility, we examine changes in contraception and induced abortion. We then examine the fertility effects of changes in infant mortality and family planning programs. Finally, by examining changes in such socioeconomic factors as educational attainment and female labor force participation as well as attitudinal changes toward marriage and the family, we seek to infer their effects on fertility declines in the NIES." The data primarily concern Hong Kong, the Republic of Korea, Singapore, and Taiwan. (SUMMARY IN ENG)

Abortion, Induced↗

Antenatal utilization, family planning and fertility preferences in Tari.

This paper reports on the results of a questionnaire on antenatal utilization, family planning and fertility preferences carried out on 2560 women in Tari in 1998. There is a very high level of utilization of antenatal and delivery services. There is also a broad knowledge of family planning methods, but very low uptake of these services. Part of the reason for this lies in high fertility preferences among women in Tari, part in a lack of confidence regarding the methods, and part in male opposition to their use. Comparison with elsewhere in Papua New Guinea confirms that health service utilization and fertility preferences are high, and family planning uptake is low in Tari. The decline in health services and the collapse of law and order in Tari bodes ill for the future of a family planning program in a district in which the need for such services is rising, due to the effects of population pressure on the environment.

Adolescent↗

A balancing act: the tension between case-finding and primary prevention strategies in New York State's voluntary HIV counseling and testing program in women's health care settings.

This study sought (1) to identify factors that influence women's willingness to accept voluntary HIV counseling and testing at New York State Family Planning Programs (FPPs) and Prenatal Care Assistance Programs (PCAPs) and (2) to evaluate the effectiveness of such a voluntary counseling and testing program. Telephone interviews elicited organizational-level data from 136 agencies; a combination of telephone and face-to-face interviews was used to gather provider data from 98 HIV counselors; and client data were gathered from 354 women in face-to-face interviews at counseling sites. Slightly fewer than 60% of women agreed to be counseled, and, of those, under half consented to an HIV test at the counseling site. Approximately two thirds of the women who were tested returned for their results and posttest counseling. Clients' recall of pretest counseling content was relatively poor. Bivariate and regression analyses suggest that client, provider, and organizational factors are all associated with rates of pretest counseling and testing. The current voluntary counseling and testing program is achieving only moderate success. Although a substantial number of clients accept HIV counseling, many women remain reluctant to consent to HIV testing, and many who accept testing do not return for their results. Moreover, among those who receive pretest counseling, many do not recall important informational content, which suggests variation may exist in the quality of counseling or that one-time HIV counseling interventions are insufficient to communicate complex information. Medical Subject Headings (MeSH): AIDS, HIV serodiagnosis, women's health, patient education.

AIDS Serodiagnosis↗

Ethical issues in family planning for hospitalized psychiatric patients.

The authors present guidelines based on their experience with a family planning program for patients in mental hospitals. They believe that informed consent for these patients should include an adequate knowledge base, the patients' competence to make decisions, and the absence of coercion. Among safeguards are the reversibility of contraceptive procedures, the separation of the family planning counselor from the treatment staff to avoid possible covert coercion, and careful choice of the stage of hospitalization at which counseling occurs. The authors examine the implications of a patient's refusal to use contraception, noting the impossibility of involuntary contraception and the ethical and legal problems regarding sterilization procedures.

Awareness↗

Using mass transit public service advertising to market family planning.

To increase public awareness of family planning services in New Jersey, the Family Planning Program of the State Department of Health conducted an intermediary marketing campaign using free public service advertising on mass transit. In 1986, the year of the campaign, 237 calls were made to the advertised hotline, resulting in a like number of referrals to family planning service providers. Also, 2664 new patients examined in the state's family planning agencies in 1986 cited exposure to the media campaign as the reason for their visits. The results of the campaign and their implications for other public service agencies are discussed.

Advertising↗

The demand for family planning: a new approach.

A new "supply-demand" measure of family planning demand is compared with others commonly used to target prospective family planning clients. In analyses of data from six cross-sectional surveys the new measure consistently explains past contraceptive use better than the others. Time series analysis for two countries yields similar results. Family planning program officials may wish to consider exploring the use of this measure to target prospective clients.

Adult↗

[Gender and health policies for Latin American women: Peru. II].

This study includes a presentation and analysis about the woman's problematic. It considers the woman social condition concording to the androgynors ideology of the society. Briefly it presents a historical evolution of the woman in accord with the gender analysis. It presents too, an analysis of the health and the public politics in relation to the woman in Latin America, mainly in Peru, since the Incanato period, justifying the motives of the formulation and implementation of the Family Planning Program, the Responsable Paternity Program and Child and Mother Atention Program. Finally, this study considers the importance of integral projects, programs and health politics and not only considering the women's reproduction.

Child↗

Adaptation and validation of a portable steam sterilizer for processing intrauterine device insertion instruments and supplies in low-resource settings.

BACKGROUND: Difficulties with adequately processing intrauterine device (IUD) insertion instruments and supplies have led to use of potentially contaminated items, compromising the quality and safety of IUD insertion services in Bangladesh. A sterilization process for IUD insertion instruments and supplies by using a commercially available portable steam sterilizer was developed and validated. METHODS: Racks provided with the sterilizer were used during sterilization of wrapped supplies (gloves and cotton balls). Metal compartments to hold insertion instruments were built to fit into the sterilizer. After sterilization, supplies were transported to rural service sites in plastic bags, whereas instruments remained in the sterilizer, which was transported in a carrying case. To validate the sterilizer, laboratory testing was conducted by using chemical and biologic indicators for steam sterilization and field testing in Bangladesh with chemical indicators. RESULTS: Results indicated that sterilization cycles were effective in achieving sterility of IUD insertion supplies and instruments at sterility assurance levels of 10(-5) and 10(-6), respectively. CONCLUSIONS: Use of this sterilizer for IUD insertion supplies and instruments will improve the quality of service delivery in the Bangladesh family-planning program and has application for use in many other low-resource settings.

Bangladesh↗

Barriers to family planning services among patients in drug treatment programs.

In July 1989, family planning services were integrated into 13 drug treatment programs in Philadelphia. To obtain information on the family planning needs of women in drug treatment programs, baseline interviews were conducted with 599 women. Three-quarters of these women had had a sexually transmitted disease, and although they were in a drug treatment program, 41 percent had injected drugs in the previous month. In addition, 62 percent of the women who were sexually active in the previous month had not used a contraceptive. Twelve months into the program, seven focus groups were conducted with 65 women and men to learn more about their opinions and attitudes related to contraceptives and family planning services in general. The discussions revealed that many of the participants were unsure what family planning services included, saw no need for such services or had had prior negative experiences with health care providers. There was also a great deal of misinformation about contraceptives and the effects they have on health.

Adolescent↗

Monitoring and evaluation of India's family welfare programme.

"Family planning services are provided through a network of family welfare centres spread throughout rural and urban areas of [India]. An outline of the procedure used for collection of statistics necessary for monitoring and evaluation of the family welfare programme and the indices prepared for measuring the impact of the programme are described in this paper." The procedure described has been in operation since 1972.

Asia↗

Condom use banned.

A traditional chief in Swaziland has banned the use of condoms by men in his chiefdom, because they were "misusing and wasting a man's reproductive fluid". The ban, which made front-page news in the Times Newspaper of Swaziland, has shocked nongovernmental organization and family planning officials in the tiny southern African kingdom, the Southern African Press Association reported. Addressing hundreds of his subjects at his Kraal during a visit by health ministry officials, Chief Jameson Ndznatabautfu Maseko said using condoms was against God's laws as stated in the Old Testament. But the chief was willing to continue to allow women to use contraceptive pills, the report said. The chief did not say how he hoped to monitor his male subjects' sex lives but gave instructions that anyone using or being forced to use condoms be reported to him immediately. In a reaction to the chief's comments, health ministry principal secretary, Myekani Vilakati said that if the reports were correct, "the family planning program would have to start all over again, this time starting with educating the country's traditional leaders".

Africa↗

Curable sexually transmitted infections among the clientele of a family planning clinic in Istanbul, Turkey.

BACKGROUND: Integrating screening and treatment of sexually transmitted infections into existing family planning programs can be a good way to fight this problem. Also, the number of studies on the prevalence of certain sexually transmitted infections in this population in Turkey is limited. GOAL: To find out the prevalence of the most common sexually transmitted infections among the clients of an urban family planning clinic and to evaluate demographic characteristics and clinical signs related to sexually transmitted infections. STUDY DESIGN: Samples for Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis were collected from 569 women who attended the clinic from December 15, 1997 to March 31, 1998. RESULTS: No case of N gonorrhoeae was found among the samples. The prevalence of C trachomatis infection was 1.9%, whereas the prevalence of of T vaginalis was 2.6%. None of the demographic characteristics or clinical signs was related to these infections. CONCLUSION: Larger studies using more sensitive laboratory tests are needed to determine the prevalence of chlamydial infections in family planning clinics in Turkey.

Adult↗

A qualitative study of clandestine contraceptive use in urban Mali.

This prospective study uses qualitative methods to examine the social and economic impact of family planning on women's lives in the district of Bamako, Mali. Fifty-five first-time users of contraceptives were interviewed in October 1996. Of particular interest is the high proportion (17/55) of those who had hidden their use of a birth-control method from their husbands. Substantial collusion is found to have occurred between sisters-in-law in assisting each other to gain and hide methods of family planning and to keep their use secret from their spouses and older marital relatives. The main reason for discontinuation among the clandestine users was menstrual disruption, which they feared would make their husbands aware of their contraceptive use. By the end of the study, women were aware that their use of contraceptives had increased their mobility and available time, enabling them to enhance the quantity and efficiency of their work activities. Contraception, therefore, appears to be a valuable resource, permitting women to improve their economic and social status. In settings where clandestine use is prevalent, at least in the short term involving men in family planning programs may not always be beneficial, nor may considering the couple as the unit of intervention and analysis always be appropriate. In the long term, however, the underlying causes of men's objections to contraceptive use need to be addressed so as to facilitate communication and joint decisionmaking about family planning.

Adolescent↗