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PubMedDate not supplied

Population policy forum. Redefining survival.

Although I agree with most of the content and the essence of Marge Berer's excellent paper, I beg to differ with her on whether there is a need for a feminist population policy. If we advocate respect for women's needs and right, then we have to believe that women will want to regulate and limit their fertility when it is no longer an essential element in their survival: today, childbearing is a social or economic necessity for many women, even to the detriment of their health. No set numbers should be designated as the ideal family size, nor should any form of ideal family be posed in the 1st place. However, there is an issue of pragmatism or opportunity value that we have to consider. Women need contraceptives to regulate their fertility, among the many other things they need to empower themselves. Those who control economic resources at both the national and international levels are more interested in investing in family planning programs than in other health or development needs. We will not be able to change their motives to some abstract egalitarianism in which they never believed. Our challenge, as feminists, is to develop our own capabilities in 2 ways. One is to gain the technical and intellectual know-how to make a clearer argument that demonstrates the link between effective contraceptive use and addressing women's reproductive health and other economic and social needs. We must convince a reluctant establishment that without empowering women they will not achieve their goals. The 2nd is to create our own organizations and modes of operation that will allow resources to flow into programs and activities that will work for women and not get marginalized and impoverished into paralysis.

Contraception↗
PubMed2002

Monitoring contraceptive continuation: links to fertility outcomes and quality of care.

This study examines the fertility consequences of contraceptive discontinuation, describes cross-national variation in continuation rates, and assesses the usefulness of the contraceptive discontinuation rate as a summary outcome indicator of quality of care. In the 15 countries included in this analysis, the total fertility rate would be between 28 and 64 percent lower if the births following discontinuations that were not the result of a desire to become pregnant had not occurred. The all-method discontinuation rate for quality-related reasons emerges as the most likely candidate for a summary measure of quality of care. Within a year of starting use of a method, between 7 and 27 percent of women cease to practice contraception for reasons related to the quality of the service environment. The results imply that as fertility declines, family planning programs would profit from a shift in emphasis from providing methods to new clients toward providing services to reduce discontinuation rates.

Adolescent↗
PubMed1999

Factors affecting contraceptive use and behavior in Kocaeli, Turkey.

This study aimed to investigate contraceptive use and its determinants in Kocaeli, Turkey. A questionnaire was applied to 922 randomly selected sexually active women of reproductive age, in order to extract information concerning contraceptive use and sociodemographic factors affecting behavior and contraceptive use. Knowledge of at least one method was nearly universal. Intrauterine devices and withdrawal were the most commonly used methods. Illiterate women and housewives had less knowledge about some modern methods. The number of children (p < 0.001), nuclear type family (p < 0.05), and approval of family planning (p < 0.001) were the factors most predictive of contraceptive use. Husbands were involved in family planning via discussing family size (79.4%) and method (85.5%) 38.2% of males participated actively by using withdrawal or condom. Increasing the literacy of both male and female partners significantly increased both contraceptive use and the participation of husbands in family planning descision making. In conclusion, increasing the education level of couples and the status of women would result in increased contraceptive use in the future. Since the contraceptive behavior of women is influenced by their husbands' attitudes, family planning programs should be focused on the needs of both partners.

Adolescent↗
PubMed1984

A multilevel model of family planning availability and contraceptive use in rural Thailand.

This paper assesses the ways in which the availability of family planning program outlets influences the likelihood of contraceptive use in rural Thailand. It focuses on a village-level measure of actual availability of sources rather than respondent perceptions of availability. Individual-level and village-level data collected as part of the second Thailand Contraceptive Prevalence Survey are used to test three hypotheses about the effects of actual availability: that (a) availability of family planning outlets increases the likelihood of contraceptive use; (b) it enhances the effect of a desire for no more children on the likelihood of use; and (c) it weakens the positive relationship between education and the likelihood of use.

Adolescent↗
PubMedDate not supplied

Determinants of fertility decline in China, 1981: analysis of intermediate variables.

This study examines the proximate determinants of fertility in China by making use of the data collected by the One-per-Thousand Sample Fertility Survey of 1982. The results indicate that the most important inhibitor of potential fertility is deliberate control. Its contribution to fertility change has been far greater than all other proximate determinants. The marital structure of the population is also an important factor, while lactational infecundability and induced abortion are relatively unimportant. Comparative results by using data from the In-depth Fertility Survey conducted in Shanghai Municipality, Hebei and Shaanxi Provinces in April 1985 agree well in the ranking of the four intermediate factors. The findings point to successful family planning program and government population policies, which propelled the fertility transition to a substantial degree. Further research needs and policy implications of the results of the study are discussed.

Adolescent↗
PubMed1992

Vietnam seeks help expanding voluntary surgical contraception.

Recent surveys by the Vietnamese Ministry of Health suggest that 60% of married women desire no more children. Yet only 2% of currently married women and less than 1/2 of 1% of their partners use sterilization. Underscoring the high unmet need for effective family planning, over 1 million abortions (legal in Vietnam for the past 20 years) are performed annually. This rate corresponds to 1 abortion for every live birth. The Ministry of Health has recently welcomed a variety of organizations, including AVSC, whose assistance can help expand the country's family planning programs. Sorely lacking in supplies, equipment, and trained personnel, Vietnam has merited priority status--2nd only to China and India--from the UNFPA, which has committed $36 million over the next 4 years. Other organizations currently working in Vietnam include the Population Council, the Population Crisis Committee, and the International Planned Parenthood Federation. Despite enormous casualties during the war years, and a decrease since the 1970s in average family size from 6 to 4 children, the population of Vietnam has continued to grow rapidly, far outpacing economic growth. Currently 67 million, the population is expected to reach 80 million by the year 2000. The average Vietnamese annual income is only $195, among the lowest in the world. Doi moi, the process of economic reform begun in 1986, coupled with new government incentives for families who have no more than 2 children, is changing the face of family planning in Vietnam. Newly opened pharmacies sell imported birth control pills and condoms (to those who can afford them), while government hospitals and health clinics provide mainly IUDs, in addition to limited supplies of pills and condoms. Throughout the country, some 8000 community-level health centers are staffed by nurse-midwives trained in family planning. Voluntary sterilization is available at the district, provincial, and national hospitals. All married women may obtain family planning services free on request. Vietnam's system of free and universal primary health care, combined with high female literacy rates, has kept the country's infant mortality rate low in comparison to other very poor countries. 39% of currently married Vietnamese women ages 15-49 use contraception. Of those, 85% use the IUD, making it far and away the most widely used modern method. In fact, some women think family planning is synonymous with the IUD.

Abortion, Induced↗
PubMedDate not supplied

Legal trends and issues in voluntary sterilization.

Legal barriers to voluntary sterilization are falling. In both developing and developed countries, new legislation, court decisions, government policy statements, and ministerial regulations increasingly leave the decision whether to be sterilized to the individuals involved rather than to medical experts or government officials. These legal changes confirm that voluntary sterilization is an acceptable means of fertility regulation and a legitimate medical procedure; it is no longer seen as physical mutilation to be condemned in the criminal codes. Nevertheless, barriers still exist in some countries that make it difficult for poor and rural populations to obtain voluntary sterilization. These obstacles arise when voluntary sterilization is excluded from national health and family planning programs and from private insurance plans. Changes in voluntary sterilization law reflect increasing choice of this method of fertility control. Over the last decade voluntary sterilization has become the most widely used means of family planning in the world. Approximately 100 million couples now are protected from unwanted pregnancy by voluntary sterilization. This amounts to one-eighth of the world's couples and one-third of all those practicing contraception. Almost half of these couples are in China. Voluntary sterilization is most prevalent in countries where the procedure has been clearly legal for a number of years. But now it is also becoming more common in countries like Brazil, where the legal status has been less clear.

Adolescent↗
PubMed1992

The performance of non-governmental organizations in family planning and MCH in Maharashtra State.

"This paper presents the findings of an evaluation study of three projects on family planning and health undertaken by three non-governmental organisations (NGOs) in Maharashtra State....[It] identifies various factors which determine the performance of a particular NGO and highlights how voluntary organizations, in general, can play a useful role for the promotion of family welfare and maternal and child health programmes in India."

Asia↗
PubMedDate not supplied

Rural and urban family planning services in the United States.

Family planning programs have become more efficient. It cost $66 per patient in 1976 to provide services in both rural and urban programs--the same cost reported in 1971, despite a 40 percent increase in prices since that time. Rural programs are dominated by health departments, lack health professionals, are more likely to insist teenagers have parental consent.

Adolescent↗
PubMedDate not supplied

Estimates of contraceptive prevalence based on service statistics and surveys in Gujarat State, India.

This report demonstrates that the estimates of contraceptive prevalence based on surveys are substantially lower than those based on the service statistics generated by the Indian family planning program. The reasons for this discrepancy were examined by contacting a subsample of acceptors recorded by female health workers as users in their registers. This inquiry indicated that the health workers themselves knew that 15-39 percent of the women who had been recorded as users of reversible methods were not really using them. About 19-27 percent of the recorded users of IUDs and only 3-4 percent of the recorded condom users confirmed use of the devices. Overall, the nonusers formed 59 and 64 percent of the recorded users contacted in Bharuch and Panchmahals districts, respectively. The estimates of nonuse of contraceptives in the follow-up survey are high enough to reconcile most of the observed discrepancy between the two sets of estimates of contraceptive prevalence.

Adolescent↗
PubMed2003

Can women's childbearing and contraceptive intentions predict contraceptive demand? Findings from a longitudinal study in Central India.

CONTEXT: To predict the need for contraceptive services, family planning program managers often rely on levels of unmet need derived from measures of childbearing intentions. However, women's intention to use a method has not received as much attention as a measure of contraceptive demand. METHODS: A survey was conducted in 1999 in rural Madhya Pradesh, India, among a subsample of women who had participated in the 1992-1993 National Family Health Survey (NFHS). The women's childbearing and contraceptive behaviors were compared with the intentions they had stated in the NFHS, and logistic regression was performed to analyze the association between socioeconomic and demographic variables and inconsistent behavior. RESULTS: Among women who were fecund and married in 1992-1993, 29% of those who intended to have children and 61% of those who intended not to have children failed to adhere to their intentions by 1999. Furthermore, 51% of women who were not practicing contraception at the time of the NFHS but planned to do so acted against their intention by 1999, as did 29% of those who planned not to use a method. NFHS respondents who intended both not to have children and to use a method were more likely than others to have used a method by 1999 (63% vs. 25-41%). Age and history of child death were key factors associated with inconsistency between women's intentions and behavior. CONCLUSIONS: In India, use of both contraceptive and childbearing intentions predicts contraceptive demand better than use of either indicator alone, and may thus help program planners estimate future demand for contraceptive services.

Adolescent↗
PubMedDate not supplied

A comparison of Hispanic and white adolescent females' use of family planning services in California.

CONTEXT: In California, the adolescent birthrate among Hispanics is three times that among whites. Because Hispanics are projected to make up one-half of the state's adolescents by 2020, it is important to determine how cultural and health policy-relevant factors are linked to this group's use of family planning services. METHODS: Data from the 2001 California Health Interview Survey were used to examine characteristics of Hispanic and white females aged 14-17, including patterns of use of family planning services in the past year. Multivariate logistic regression analyses were conducted to assess the association between selected characteristics and use of family planning services. RESULTS: Compared with white adolescents, Hispanic adolescents came from poorer families, had a poorer health status, less commonly had a regular source of primary health care and had lower rates of alcohol and drug use, and of sexual experience. Although the proportion of sexually experienced Hispanics who had used family planning services was similar to that of whites (34% and 27%, respectively), the proportion who had ever been pregnant and used such services was significantly larger (42% vs. 9%). In the multivariate analysis, Hispanic adolescents who had ever been pregnant were significantly more likely than whites who had not to have used family planning services in the past year (odds ratio, 11.6). CONCLUSIONS: A need exists for family planning programs to target Hispanic adolescents before they become pregnant, and to send a clear message that contraceptive services are available and should be used before a woman ever has a pregnancy.

Adolescent↗
PubMedDate not supplied

Natural fertility in northeastern Mexico.

BACKGROUND: The aims of this study were as follows: 1) to describe the fertility of a sample of Mexican women (> or =45 years of age, married, not using any family planning methods, and residing in the Mexican state of Nuevo León); 2) to determine whether or not the distribution of completed family size fits the negative binomial distribution, as in other populations studied in the world, and 3) to assess the association between fertility and 10 explanatory variables. METHODS: A sample of 410 women was interviewed at and selected from seven medical units of the Instituto Mexicano del Seguro Social (IMSS). The women were grouped by their year of birth (1896-1925 and 1926-1955) and birthplace [persons whose four grandparents were born in northeastern Mexico (NE) and outside northeastern Mexico (Not-NE)]. A binomial negative distribution analysis was assessed. Multiple linear regression was used to assess association between fertility (transformed by the use of inverse hyperbolic sines) and 10 explanatory variables, including age at marriage, heterozygosity, individual admixture, wife's education, husband's education, wife's occupation, husband's occupation, and couple's residence zone, birth year, and birthplace. RESULTS: Completed fertility was only associated with age at marriage. This population showed a fertility pattern similar to those described in Venezuelan and Brazilian populations in 1950 and 1940, respectively. CONCLUSIONS: We conclude that before worldwide family planning programs, fertility was determined mainly by natural selection forces.

Adolescent↗
PubMed2003

[Cervical cancer screening: knowledge of Pap smear benefits and utilization in Mexico].

OBJECTIVE: To identify and evaluate the predisposing factors regarding the utilization of the Pap smears in the population seen in the Cervical Cancer Screening Program in Mexico METHODS: A cross-sectional study was conducted from January 1997 through December 1998 in Mexico city. A questionnaire was applied to a total of 2,107 women of reproductive age who attended a family planning program and data was collected regarding the following topics: social-demographics, reproductive risk factors associated with cervical cancer, sexual behavior and partner history, birth control, knowledge about Pap smear' benefits, and its utilization. Statistic analysis was conducted using Student' s test and non-conditional multiple logistic regression model for determining significance. RESULTS: The predisposing factors were: knowledge about Pap smear's benefits (OR=6.00, CI 95% 4.70-7.67), history of using at least two birth control methods (OR=2.38, CI 95% 1.75-3.24), previous history of vaginal infection (OR=2.18, CI 95% 1.73-2.75), sexual partner's approval of gynecological examinations (OR=1.56, CI 95% 1.07-2.29). CONCLUSIONS: Educational programs on cancer prevention in this population should include the benefits of screening tests. Pap smears for Mexican women of reproductive age are mostly offered opportunely. The previous use of health services is a determinant factor for the utilization of the Cervical Cancer Screening Program. These results show the need to strengthen health promotion programs to women at high risk of cervical cancer and their sexual partners.

Adolescent↗
PubMed1994

Population policy options in the developing world.

The population of the developing world is currently expanding at the unprecedented rate of more than 800 million per decade, and despite anticipated reductions in growth during the 21st century, its size is expected to increase from 4.3 billion today to 10.2 billion in 2100. Past efforts to curb this growth have almost exclusively focused on the implementation of family planning programs to provide contraceptive information, services, and supplies. These programs have been partially successful in reducing birth rates. Further investments in them will have an additional but limited impact on population growth; therefore, other policy options, in particular measures to reduce high demand for births and limit population momentum, are needed.

Contraception↗