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PubMed1975

Family planning in Bali.

Despite low per capita income and little evidence of economic development, the response to the government-sponsored family planning program in Bali has been remarkably favorable. After five years of government involvement, a total of 29 percent of eligible women are estimated to be using program methods, including 25 percent who have accepted IUDs, and 4 percent more are estimated to be using nonprogram methods. This level of performance is higher than in most other developing areas of the world. A number of the factors that might help to explain the success of the program in Bali are identified, and the future prospects for continued success are assessed.

Adolescent↗
PubMed1998

The effect of child mortality on fertility regulation in rural Bangladesh.

This study analyzes longitudinal data from Matlab, Bangladesh, to examine the impact of child mortality on subsequent contraceptive acceptance and continuation. The strong negative impact is found to attenuate with family size, indicating a "replacement effect". An "insurance effect" is observed as contraceptive acceptance and continuation were negatively associated with the number of previous deaths of children. Couples seem to find contraceptive use acceptable if the child who dies is one of a large family. Potentially, contraceptive use could be acceptable for spacing after a child in a small family dies. Family planning programs can help to reduce fertility and maternal and child health risks substantially by supplying appropriate methods to those couples who have experienced a young child's death; to be most effective, methods should be supplied immediately after the child's death.

Adult↗
PubMed1980

An international program for the assessment of tubal anastomosis by microsurgical technique: a preliminary report.

This report outlines a microsurgical training program that has established 16 centers around the world for the reversal of sterilization by microsurgical technique and for the evaluation of such procedures. An obstetrician-gynecologist was selected from each of several developing countries where an existing family planning program was responsible for a large number of sterilization procedures. Each course participant attended a 2-week course in microsurgical techniques for tubal anastomosis and then returned to his or her home country to establish a microsurgical center for sterilization reversal. Each of these centers has since been evaluated by the program director and is fully operational.

Education, Medical, Continuing↗
PubMedDate not supplied

Prospects and programs for fertility reduction, 1990-2015.

What is the likelihood that each of the 37 developing countries with populations of 15 million or more in 1990 will reach replacement fertility by the year 2015? These countries have a combined population of 3.9 billion, 91 percent of the population of all developing countries. For this article, a composite index was used as the basis for predicting future levels of total fertility. The index was constructed from socioeconomic variables (life expectancy at birth, infant mortality rates, percent adult literacy, ratio of children enrolled in primary or secondary school, percent of the labor force in nonagricultural occupations, gross national product per capita, and percent of the population living in urban areas), total fertility rates for the years 1985-90, total fertility rate decline from 1960-65 to 1985-90, family planning program effort scores in 1989, and the level of contraceptive prevalence in 1990. Eight countries are classified as certain to reach replacement fertility by 2015, and an additional thirteen probably will also. Five countries are classified as possibly reaching replacement fertility, and eleven as unlikely to do so.

Birth Rate↗
PubMed1993

Modern contraception use in Ethiopia: does involving husbands make a difference?

OBJECTIVES: This study was undertaken to determine the relative efficacy of home visitation with and without husband participation on the use of modern contraception in Ethiopia. METHODS: A randomized field trial of a family planning education intervention using home visitation with and without husband participation was conducted in Addis Ababa, Ethiopia, from August 1990 to December 1991 and included a 12-month postintervention follow-up. A total of 266 experimental and 261 control subjects were entered, of whom 91.7% and 88.9%, respectively, were followed through 12 months. RESULTS: A greater proportion of couples in the experimental group were practicing modern contraception at 2 months (25% vs 15%) and 12 months (33% vs 17%) following the home visit intervention. By 12 months following the home visits, experimental subjects were less likely to have defaulted and more likely to have started using modern contraception following an initial delay. CONCLUSIONS: The inclusion of husbands in family planning programs will result in relevant increases in the use of modern contraception. However, there exists an important "sleeper" effect to the education intervention, reflected by a delay of greater than 2 months in the initiation of modern contraception for most couples.

Adult↗
PubMed2000

The great population debates: how relevant are they for the 21st century?

Two great debates--whether population growth is a problem and how to address the problem if one exists--dominated population policy discussions in the 20th century. The debate about whether pitted those who saw rapid population growth as a problem against those who believed the cries of alarm were false. The debate about how was conducted between advocates of the direct delivery of contraceptives through family planning programs and those who counseled a broader, more holistic approach. The debate about how was largely resolved by the 1994 International Conference on Population and Development at Cairo; the debate about whether remains unresolved. Environmentalists, ecologists, and physical scientists generally support the view that rapid population growth is harmful, but economists remain largely unconvinced. Contemporary declines in fertility and the end of the population crisis mentality of the mid- to late 20th century could, ironically, diminish public support for precisely those programs that have been responsible for the rapid fertility decline of the past 3 decades--programs that will be required to complete the "demographic transition" in those parts of the developing world where fertility remains very high.

Aging↗
PubMed1998

Reproductive health care: services oriented to couples.

Historically, the combination of women's rights to care, population concerns and the development of female-oriented contraceptive methods resulted in family planning programs focusing on women's contraceptive needs and little else. The 1994 United Nations Population Conference in Cairo called for an expansion of programs to cover reproductive health in its broadest interpretation. As this concept has developed and been put into practice it has become evident that a key element in reproductive health services should be the inclusion of the sexually active couple.

Adult↗
PubMed1995

New study on child survival.

Family planning can save lives of children and benefit the health of mothers, according to a study published recently by the UN Population Division. Entitled "The Health Rationale of Family Planning: Timing of Births and Child Survival," the study finds that survival of children can be improved through delaying child-bearing at least until the mother reaches age 18 and possibly age 20, and more especially through achieving birth intervals of at least two years. Those survival benefits are quite considerable, it states, and are likely to be complemented by wider health benefits for the child. For the health of the mother, the benefits lie in avoidance of the repeated risk of pregnancy and birth. The study encompasses over 280,000 births and nearly 35,000 deaths before age five in 25 developing countries. It recommends that family planning programs should highlight the importance of the appropriate timing of births and supply methods to achieve better spacing of births. Health programs should also encourage breast-feeding, not just to improve the survival and nutritional chances of the current child, but also to delay the next pregnancy and thus increase the survival chances of both the existing and the next child.

Age Factors↗
PubMed1999

Intrauterine devices. The optimal long-term contraceptive method?

OBJECTIVE: To review selected data on the effectiveness, safety, cost and technical ease of intrauterine device (IUD) use compared with Norplant and surgical sterilization. STUDY DESIGN: Literature review. RESULTS: IUDs are highly effective, safe and relatively inexpensive methods of contraception that may offer advantages for some women over other long-term methods, such as sterilization and Norplant. IUDs provide protection against pregnancy comparable to that provided by female sterilization, and they may be more effective than Norplant. IUDs have a long duration of effectiveness: the copper T 380A (TCu380A) is effective for at least 10 years, and the levonorgestrel (LNg) IUD appears to be effective for at least 7. Norplant is effective for only five years. Both types of IUD can disrupt menstrual bleeding patterns, although the patterns of bleeding are different. Copper IUDs often increase blood loss, whereas the LNg IUD, like Norplant, substantially reduces menstrual bleeding. The most important adverse outcome associated with IUD use is higher rates of pelvic inflammatory disease; careful attention to proper insertion techniques can reduce this risk substantially, and LNg IUDs may cause no increase in risk. IUDs, like both sterilization and Norplant, provide no protection against sexually transmitted disease. The TCu380A IUD is extremely cost-effective. There is as yet no public sector price for the LNg IUD, which has not been approved by the U.S. Food and Drug Administration and is not provided by family planning donor organizations. If it can be made available to the public sector at a price substantially less than its present market price, the LNg IUD would be a useful addition to the contraceptive armamentarium for developing countries. CONCLUSION: Providers, consumers and family planning program managers should begin to see IUDs as potential substitutes for both surgical sterilization and Norplant.

Contraceptive Agents, Female↗
PubMedDate not supplied

Contraceptive use and fertility in Paraguay, 1987.

In 1987, 38 percent of married Paraguayan women aged 15-44 were practicing contraception, with oral contraceptives being the most prevalent method. Fertility rates for the population were at corresponding levels, with an overall fertility rate of 5.4 births per woman. Fertility has not changed substantially for the nation as a whole since 1979, and contraceptive use has increased by only 6 percentage points. Findings from the present study are consistent with the lack of a public sector family planning program in the country. Pharmacies are the principal source of contraceptives in the country. Twenty-two percent of all women and one-third of married women are at risk of having an unplanned pregnancy. The greatest impact on contraceptive use can be made if new and continued program efforts focus n the interior of the Oriental region of the country.

Adolescent↗
PubMedDate not supplied

[Preferences on family composition among youngsters from Monterrey, Mexico].

In order to evaluate the effect of social and biological factors on family size (FS) and secondary sex ratio (SSR) in the families that they would desire to procreate as well as in the ones to which they belong, 1,518 unmarried persons of both sexes, students and workers, who reside in the metropolitan area of Monterrey, Mexico were interviewed. It was found that the average FS desired by the unmarried males and females, independently of their socioeconomic level and years of schooling, were 3.19 and 3.04, which are lower than half the FS of 6.81 observed in the families to which they belong. Both males and females in all the socioeconomic levels and years of schooling, would desire to procreate a larger number of male children: SSR of 0.576 and 0.524, which are higher than the 0.498 observed in the families to which they belong. Also they manifested a strong preference for the birth order of the sex of their children, being of males for the first (SSR of 0.924 and 0.838) and of females for the second (SSR of 0.301 and 0.269). The fact that all children would be of the same sex did not change the desired FS in about 80% of the persons, but in the remainder 20% the desired FS would be increased to an average of five children. In order to reduce the growth rate it would be convenient to offer special counseling on family planning to these persons. In conclusion, the obtained information indicates that aside from the socioeconomic, cultural and biological factors, probably the family planning programs have had a positive influence on the persons that in the near future will start their reproductive stage, and it is possible to anticipate a reduction on the growth rate for the next generation.

Adult↗
PubMed1975

Population growth-a menace to what?

Originally, many of the initiators of the World Population Conference, which took place in Bucharest in 1974, had hoped that the Conference would imply a final breakthrough for the view that family planning measures should be given top priority in all less-developed countries. In fact, however, the Plan of Action passed by the Conference contains very little relating to population and family planning. Instead, the document is dominated by wordy phrases about the necessity of attaining social and economic development in those countries. Will the insight that family planning programs work efficiently only if they are an integral part of programs for the social and economic development of a country lead to such programs being realized? There is every reason to doubt that the plan of Action will have any such effect. The reasons for the underdevelopment of Third World countries cannot be removed through such United Nations resolutions. In the People's Republic of China, family planning is widely accepted, especially in the towns, and now also among the rural population. Limiting the number of children is considered part of China's development effort. China is a less-developed country that is in the process of rapid social and economic development. The issue at stake in other Third World countries is how to achieve a similar development. As soon as this goal is achieved, family planning efforts are meaningful and have a chance of success. The experience of China demonstrates that even there it took time before the efforts succeeded. There are many Third World countries that could, without much difficulty, support a population considerably larger than the present one. But there are no doubt also a number of countries where the population is already so large that a continued population increase would be harmful. The need to achieve rapid development becomes increasingly urgent, not in the least to make it possible to attain a reduced population growth. The sad truth is that so little development takes place in those countries. Without social and economic development, the present rapid population increase will continue in those countries where there is already an overly dense population.

China↗
PubMedDate not supplied

The reliability of simulated clients' quality-of-care ratings.

Evaluators of family planning programs have begun to use simulated client ratings to assess the quality of services. However, little is known about the reliability of such ratings when they are used to assess individual provider performance. This study examined the reliability of quality-of-care ratings in a Peruvian community-based distribution program by using pairs of concealed observers--a simulated client and a companion. Average interrater agreement, measured by intraclass correlation, was .50, indicating that ratings are not reliable enough for the evaluation of a single provider by a single rater. The study results suggest that checklist-item scores referring to specific provider behaviors will be more reliable and useful than ratings.

Adolescent↗
PubMed2005

Existing demand for birth spacing in developing countries: perspectives from household survey data.

OBJECTIVE: To identify the extent of demand for birth spacing, according to age and parity among married women of reproductive age (MWRA) in developing countries. METHODS: Secondary analysis of data from the Demographic and Health Surveys (DHS) using cross-tabulations. Data collected from nationally representative samples of MWRA in selected developing countries between 1990 and 2004. RESULTS: Demand for birth spacing is the most prevalent reason for an interest in family planning among married women aged 15-29 years in the majority of developing countries examined. In the 15-19-year age cohort, the demand for spacing is proportionally the most prevalent reason for a demand for family planning. A demand for spacing even exists among young, zero-parity married women in each country examined. Findings on the demand for spacing among zero-parity married women quantifies the expressed desire of some married women in developing countries to postpone a first birth or the timing of a first pregnancy. CONCLUSION: The substantial demand for birth spacing among young, low- and zero-parity women suggests that family planning programs in developing countries may need to reevaluate how accessible services are for this cohort of potential contraception users. Currently, many service-delivery protocols, counseling practices and service provider training may not fully address the needs of younger, low- or zero-parity clients.

Adolescent↗
PubMed1989

[The evaluation of a program for the early diagnosis of cervix cancer at a health center (1981-1987)].

The results of a program for the early diagnosis of cervical cancer (EDC) in a health center was evaluated for the period 1981-87. This activity was included in a general program of attention to women and was carried out by the primary care staff of the center. 915 women were evaluated, and 1,279 samples for cytology were collected. The achieved coverage was 11.56%. The most usual way of recruitment was through the family planning program. We detected that the group of women included in the program had risk factors predisposing to cervical cancer; however, this was not associated with a higher incidence of dysplasia. The referrals to a higher level of care were made in early disease stages, and this was the case in 38 women. It was considered that the continuation of the program in the health center is adequate. Recruitment should be increased and directed to the women with higher risk.

Biopsy↗
PubMed1976

The effect of subsidized family planning services on reproductive behavior in the United States, 1969-1974.

This paper evaluates the impact of federally subsidized family planning programs in the United States, from 1969 to 1974, on the reproductive behavior of ever-married women, 15-44 years old. The study began with an experimental design and the random assigment of areas to treatment and control but was completed as a multivariate analysis, treating program input as an interval-scaled independent variable. Using "before" and "after" area sample surveys and patient service data from operating programs, the demographic impact of the program was estimated. The impact detected was nonsignificant; according to our analysis, overall use of physician-administered contraception was not affected by the subsidized programs. The only program-induced change of activity related to reproduction that we recorded was increased use of subsidized services in study areas with high program input and increased use of private physician services where program input was low. These findings need to be interpreted with the caution usually exercised in evaluating imperfect field experiments.

Adolescent↗