Awakening the housewives--the new life movement at Kawasaki ironworks (part II).
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Ambulatory Care Facilities↗
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Shifting visions: "delegation" policies and the building of a "rights-based" approach to maternal mortality.
"Rights-based" approaches fold human rights principles into the ongoing work of health policy making and programming. The example of delegation of anesthesia provision for emergency obstetric care is used to demonstrate how a rights-based approach, applied to this problem in the context of high-mortality countries, requires decision makers to shift from an individual, ethics-based, clinical perspective to a structural, rights-based, public health perspective. This fluid and context-sensitive approach to human rights also applies at the international level, where the direction of overall maternal mortality reduction strategy is set. By contrasting family planning programs and maternal mortality programs, this commentary argues for choosing the human rights approach that speaks most effectively to the power dynamics underlying the particular health problem being addressed. In the case of maternal death in high-mortality countries, this means a strategic focus on the health care system itself.
Cesarean Section↗
Factors associated with contraceptive use in late- and post-apartheid South Africa.
In 1994, South Africa underwent a transition from the institutionalized racism of an apartheid state to a nonracial democracy. This study uses data from two surveys conducted in the style of the Demographic and Health Surveys to compare patterns and predictors of racial differences in modern contraceptive use in the late- and post-apartheid periods. Age-group-specific logistic regression models show that despite strong state family planning programs targeting black women, these women were less likely than nonblacks to practice modern contraception both before and after the political transition, even after controlling for large racial-group differences in sociodemographic characteristics and the distribution of socioeconomic resources. Black, colored, Indian, and white women show different patterns of contraceptive use across their reproductive careers; in particular, young, unmarried black and colored women show high levels of use. Use of injectable contraceptives is also high among black and colored women, whereas injectables are not the primary method used by Indian or white women. These findings are discussed in light of their research and policy implications.
Adolescent↗
Norplant expansion in Kenya.
Norplant is a long-acting contraceptive that has been introduced into family planning programs all over the world. Its efficacy, safety and acceptability in the introductory phases have been widely tested, and most studies point to the need for good provider training in insertion and removal; good client counseling on side effects, suitable client selection to limit early removal, and attention to client access to removal services. Some problems with the method in the developed world, and a belief that it is too costly for developing countries, have led to a waning of support by international donors. Few studies have examined how service delivery expansion in the developing world can minimise and address potential problems as well as maintain Norplant's cost-effective edge against other methods. We examine the expansion of Norplant services in Kenya between 1992 and 1996, specifically in relation to client access to services, removal issues, and cost. Well-supervised and careful expansion has resulted in quality services being provided at more than 70 sites in the country. Early removal is limited, removals seem to have posed few problems, and Norplant offers a welcome and cost-effective addition to the family planning method mix.
Adolescent↗
Management Information and Evaluation System (MIES) in IPP districts: a follow-up study.
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Data Collection↗
Vasectomy services in Latin America: an overview.
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Americas↗
Hospital planning in Virginia after P.L. 93-641.
Some descriptive results from a survey of Virginia hospitals regarding their planning capacities have been presented. The results are the generation of four hypotheses about hospital planning structures and hospital-HSA relationships. No attempts to posit causality have been made. In summary, it can be stated that there is a need for subsequent research into the extent to which HSA and P.L. 93-641 have affected change in health care facilities. Future research might examine the four hypotheses as applied to hospitals. Additionally, subsequent research efforts should address the extent to which organizational change within other types of health care facilities has occurred since P.L. 93-641 was enacted. In particular, community health delivery systems, such as mental health and mental retardation programs, family planning agencies, and medical group practices, might be examined in order to determine their capacity to do planning in its relationship to the passage of this Act.
Health Systems Agencies↗
Commentary on women-centered reproductive health services.
From women's perspectives, the primary principles of a reproductive health framework in the developing world are as follows: Family planning is a basic human right to which all human beings are entitled. Provision of family planning services must be comprehensive, including safe and low cost methods, freedom of choice about both contraception and pregnancy termination, timely and honest information, privacy and confidentiality, individual needs assessment, and counseling of women, men or the couple. Wide contraceptive choice requires more research on methods that are less invasive of women's anatomy and physiology and more supportive of women's control of their own bodies. These parameters of quality care in family planning must be centered on women's needs, desires and expectations. The concept of conscious contraception implies an attitude of conscious sexuality. When a woman accepts that sexual gratification independent of reproduction is a legitimate right, she is better prepared to engage in the pursuit of her own health and happiness. If family planning programs do not include sexuality as a key issue to discuss with clients, all long-term strategies will fall short in modifying people's attitudes, especially women's reluctance to contracept. Sexual and reproductive health includes emotional health. As Dr. Sai points out, the effects of underdevelopment and poverty strike women in dramatic ways, and quite often all the pressures to which they are exposed lead to precarious emotional health. They become victims of violence and repeat the cycle of violence with their children. We, as advocates of sexual and reproductive rights, must also consider the psychological and emotional implications of sexuality and reproduction, and learn to deal with them in our clinics and services.(ABSTRACT TRUNCATED AT 250 WORDS)
Abortion, Illegal↗
India's voiceless and the new population policy.
Since the early 1950s, India's family planning program has failed to achieve the expected results, has entailed a massive waste of the country's resources, and has had a devastating effect on the health service system. Now the bureaucrats who have drawn up the New National Population Policy (NPP) have, again, decided what is best for the country's voiceless population. In setting out the NPP's "sociodemographic goals" and "strategic themes," the authors have ignored the recommendations made six years ago by the well-respected Swaminathan Committee and the sensible policy framework propounded ten years ago by then Prime Minister Rajiv Gandhi. The outcome is a policy resulting from a process that has failed to take into account the complexity of the policy-formulation process, the necessary inputs from a wide array of disciplines, and the experiences of the past.
Decision Making, Organizational↗
Attitudes to and practices regarding sex selection in China.
This paper explores the problem of China's 'missing' girls--estimated to run into many millions. It considers the impact of the underpinning Confucian value system in China that has produced a culture of son preference and which, together with China's compulsory family planning program and 'one child policy', has effectively established a 'one son policy'. Discussion of the various means by which the birth or survival of daughters have traditionally been prevented provides the context for identifying the contribution of new sex selection procedures to the maintenance of son preference in contemporary Chinese society. The paper concludes that China's son preference is not simply a personal problem for the millions of 'missing girls' who were destined to live a shorter life and for the surviving girls who continue to face considerable discrimination simply because they are of the 'wrong' sex; it heralds a social and demographic disaster of major proportions for which neither the government nor the people of China appear to have the will or the means to forestall.
China↗
Comparing the productivity of family planning operations: an American experience.
This paper reports a comparison of the productivity of 77 public family planning programs in North Carolina. It combines an empirical statistical approach to identify differences with field studies of high and low performers based on our expanding knowledge of service organization performance and productivity. Its applicability in less developed countries is discussed in the context of existing productivity studies. After adjustment of performance for demographic and environmental factors, high performance was found in centers with flexible layouts and patient flows, flexibility in staffing patterns and schedules, creativity in circumventing manpower shortages, greater ingenuity in reaching target groups, especially teenagers, and more responsiveness to client demands. Poor performers were characterized by lack of the above and had more satisfied staffs. The key appears to be the role of the department director and board in setting more demanding standards for performance and in providing creativity, flexibility, and urgency in problem solving.
Efficiency↗
The need for quasi-experimental methodology to evaluate pricing effects.
Family planning program managers may be easily misled by conclusions about the effects of price increases on the demand for services when the findings are based on pre-experiments such as the single-group pretest-posttest study, generally believed to be practical. This report presents financial and service data from clinics of the Asociación Pro-Bienestar de la Familia Ecuatoriana (APROFE) in Ecuador, which, analyzed according to the single-group pretest-posttest design, would suggest that the demand for intrauterine device services is inelastic. However, considerable demand elasticity is detected when data are analyzed according to more rigorous quasi-experimental designs. Using the single-group pretest-posttest design for pricing studies is too flawed to be considered practical. Wherever possible, strong designs should be used in operations research, especially in pricing studies.
Adult↗
Asian workshop recommends injectables.
Injectable contraceptives are now in use in over 65 countries, including 15 developed nations. At the 1st Asian Regional Workshop on Injectable Contraceptives, held in Thailand in May, this fact was underlined and the conclusion reached that it was time that other countries should review the acceptability of and need for injectable contraceptives in the context of their own national family planning programs. Over 50 people from 11 countries, including Bangladesh, India, Indonesia, the Philippines, Sri Lanka, and Thailand, took part. The workshop was also attended by IPPF's deputy medical director, Dr. Pramilla Senanayake. The largest clinical experience in the use of injectable contraceptives is in Asia, and the participants of the workshop were able to meet 10 of the Thai women who had had the injectable, Depo-Provera, continuously for over 10 years. These women had not missed a single injection, and had had no serious side effects, nor any unwanted pregnancies during this time. In a discussion on the recent decision of the U.S. Food and Drug Administration (FDA) to refuse a license for Depo-Provera in the U.S., it was pointed out that on 2 successive occasions Depo-Provera had been recommended for approval to the FDA by its own Obstetric and Gynecological Advisory Committee. (The membership of this advisory committee was made up of U.S. experts in obstetrics and gynecology.) Medical data were considered which showed that the return of fertility with Depo-Provera was comparable to that with oral contraceptives or IUDs, and method failure extremely low. On the evidence now available the workshop agreed that on the grounds of safety, exceptional use-effectiveness, and acceptability, injectable contraceptives had a valuable role to play in family planning. No serious adverse effects had been reported, freedom from metabolic effects was important, and earlier concern about the return of fertility after discontinuation had been dispelled. The current evidence on the safety of injectables did not indicate that this method would be less safe than oral contraceptives or IUDs.
Asia↗
Integrated family planning: the Chilean experience.
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Abortion, Induced↗
Child abuse as an inhibiting factor for family planning.
The aim of this study is to determine the magnitude of the problem of using children as an economic asset to the family thus, in one way increasing the prevalence of child abuse in Egypt and also hindering the family planning program. Two focus-group interviews were conducted in urban & rural areas for 10 women with the same age range and socioeconomic background. All were non-users of any contraception. Subsequently an interview was conducted for all women who attended the Ob. & Gyn. Clinic at Ain Shams University Hospital in the period from June to August 1991, their ages ranged from 30-35 years and they never used contraception. Another group of women with the same characteristics were interviewed from a rural area at Fayoum Governorate. A questionnaire was filled for each interviewed woman. The total women interviewed in urban area is 340 while in the rural area they were 400 women. Sixty percent of urban women and 80% of rural women are illiterate, 70% of the urban & 100% of rural women are housewives. Their years of marriage ranged between 10-20 years and all of them have more than five children. A percentage of 73.5% of urban women and 85% of rural women stated that children are used as an economic asset to their families, they work in urban areas as assistants in motor repairs, hair-dressers, beggars, bakeries, shops, restaurants and factories while in rural areas they work as agricultural workers.
Adult↗
What drives donor funding in population assistance programs? Evidence from OECD countries.
The 1994 International Conference on Population and Development (ICPD) established goals for the expansion of population assistance. To date, the financial promises made by donor countries in 1994 have not been met. To unravel the gap between ambitions and contributions, we use panel estimation methods to see what lies behind the level of donor contributions and the sharing of burdens across the various categories of population and HIV/AIDS assistance in 21 donor countries for the years 1996-2002. Contributions by donors depend heavily on the economic wealth and subjective preferences of donor countries. The sharing of the ICPD burden within the group of OECD/DAC countries is in line with the countries' ability to pay, although within the aggregate we observe a specialization in channels for aid: small countries predominantly use multilateral aid agencies, whereas large countries rely more on bilateral aid channels. Catholic countries are averse to donating unrestricted funds (flowing primarily to multilateral agencies) or restricted funds targeted at family planning programs.
Developed Countries↗
[Reasons why sterilized women refused reversive contraceptive methods].
OBJECTIVE: To identify the representations of contraceptive methods within a group of sterilized women, aiming at understanding the reasons why they refused those methods. METHODS: A descriptive qualitative study was carried out on 31 sterilized women, randomly selected from a list of patients attending the Family Planning Program of a university hospital. Data was collected through a semi-structured interview. Interview transcription was analyzed according to the Content Analysis method. RESULTS: Refusal to other contraceptive methods was based on representations formed from a mixture of technical information received at health service units, their previous experiences with contraceptive methods and information received in the social environment. Rejection of high efficacy methods (hormonal and IUD) was mostly based on their low innocuousness; refusal to fertility awareness methods (calendar calculation, Billings ovulation method) was due to their low efficacy; and rejection of barrier methods (condom, diaphragm) was due to a culturally patterned sexuality full of interdictions as well as to their low efficacy. CONCLUSIONS: The option for female sterilization may be indicative of the refusal to the contraceptive alternatives offered by health services. Reproductive health professionals should increase in their practice the knowledge about personal, socio-economic and cultural factors that affect women's choice of a contraceptive method that could guarantee a better control over their own reproductive life.
Adult↗