An exotic reaction to tubal ligation.
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Since 1975 there has been a family planning program operating in Bangladesh which advertises and commercially distributes contraceptive products in both rural and urban areas throughout the country. The program, known as the Social Marketing Project (SMP) and managed by Population Services International (PSI), now serves almost 1 million acceptors per month at an annual cost per couple of less than US$6.50, including the cost of donated contraceptives. This paper looks at the evolution of the project and its growth through the years, and addresses some primary concerns of planners of social marketing programs.
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Can APHA's policies effectively help U.S. communities reduce excess fertility rates among their sexually active teenagers? A study of two communities reveals to what extent APHA's policies are being adopted and whether they are successful.
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Several frameworks for understanding the quality of family planning care have been proposed. However, efforts to measure and quantify their components remain underdeveloped, especially with regard to nonclinical care and community-based distribution. This study examines a large-scale field survey conducted among married women of reproductive age in rural Bangladesh in 1989 and 1990 to measure and evaluate rural women's perceptions of the quality of outreach services they received. Initial analysis indicates that rural women are able to distinguish between good and poor quality of care and that these perceptions can be accurately documented and quantified through sample survey approaches. Implications of the use of a survey in the measurement of quality of care are discussed, as well as implications of the results for managers within the Bangladesh government family planning program, which has been regarded by donor agencies as having limited responsiveness to clients' needs.
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Despite of the many possibilities there are some situations where no method of contraception seems to be suitable. The reasons for this may be medical and clear such as rise of blood pressure, which is an obstacle to using combination pills. Sometimes a question arises, whether the feelings are really caused by the contraceptive method, or does the woman possibly blame contraception for some other reason.
This study examines the compliance, use behaviour and knowledge of method of women using injectable and oral contraceptives in two clinic sites in the Johannesburg area, South Africa. An interviewer administered questionnaire was used to collect information in the clients' home language. A total of 400 women were interviewed in the clinics. The mean age of clients was 26.2 years (range 13 to 43 years). Of the clients not wanting to get pregnant, 30.4 per cent of injectable users and 18.4 per cent of oral contraceptive (OC) users had stopped using their method temporarily before returning to the same method (called the nonuse segment) and had not used any other form of contraception during this time. Almost one third of injectable users (31.2 per cent) had been late for their next injection at least once. Although nearly all women using injectables had experienced some menstrual disturbances, over one third (38.5 per cent) had not been informed by the providers about the possibility of these changes. Many women gave the disruption of their menstrual cycle as the reason for the nonuse segment. The majority of OC users lacked information on how to use their method correctly. Nearly all women expressed an interest in obtaining more information on their current method and other available methods. This study shows that compliance is an issue in injectable as well as OC users.
Audit has been entered into enthusiastically by most of the multidisciplinary teams giving family planning services but the nature of the subject makes audit particularly difficult in this field. In many cases it has been used as a tool for determining standards rather than a tool for determining compliance to them. If family planning audit and evaluation is to substantially improve in quality, a great deal of work needs to be done, particularly in the formation of appropriate guidelines and in the increased utilisation of audit/research specialists to advise on methodology. It is hoped that the new clinical effectiveness committee of the faculty will take a lead in this; if so it will undoubtedly gain support from faculty members.
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CONTEXT: Although the vast majority of Pakistani women are familiar with family planning methods, use of contraceptives remains low. Identifying the characteristics of family planning providers and health facilities that are associated with women's initiation of contraception may help program administrators devise interventions to increase contraceptive use. METHODS: Logistic regression analysis of data from a survey of urban Pakistani health facilities, their clients and their staff was used to identify individual, provider and health facility characteristics that predict women's receipt of contraceptives during visits to urban clinics. RESULTS: Women who had a secondary or higher level of education and three or more children had elevated odds of receiving a method (odds ratios, 1.8-9.3). Women had reduced odds of receiving contraceptives when visiting facilities where providers had higher levels of family planning experience. They had higher odds of receiving services at facilities that displayed educational materials about family planning than at those that did not (1.8), and those odds increased with the proportion of contraceptive methods offered that were in stock, the number of staff doctors and the number of staff members who provided family planning (1.2-2.4). CONCLUSION: Providers should be aware of the contraceptive needs of women with all levels of education and parity. Additionally, family planning facilities may be able to increase clients' contraceptive use by providing diversity in method choice, keeping offered methods in stock, displaying informational materials, and raising staff levels.