Showing papers in "Studies in Family Planning in 1971"

Comprehensive family planning based on maternal-child health services: a feasibility study for a world program.

Abstract: This is a report on studies carried out in Colombia Ghana India Indonesia Iran Kenya the Philippines Thailand and Turkey on the requirements needed to provide minimal professional service for maternal and child health and family planning to every pregnant woman in the society. The essential parts of the service include 2 antepartum contacts a trained attendant at delivery 3 postpartum contacts accessible facilities a system of records and organized village assistance. The urban model of organization is built around a maternity hospital unit serving 50000 people with 2000 deliveries while the rural organizational structure centers on a rural MCH center and 25 substations serving 100000 people with 4000 deliveries. The report lists the demographic characteristics the urban-rural distribution and availability of personnel the training facilities the numbers of physicians nurse midwives auxiliary nurse midwives village assistants and facilities needed as well as the costs associated with each aspect of the program in the specified countries. Of the overall costs 47% were for personnel 24% for other operating costs 12% for physical facilities 8% for training costs and 9% for contingency costs. The overall annual cost is about $.60 per capita or about $14 per pregnant woman. The consequences of such a program include decreased maternal and infant mortality and decreased crude birthrates. In order for such a program to operate successfully there must be governmental and high administrative support implementational capabilities at the community level community acceptance and cooperation utilization of facilities and extension of educational efforts.

Incentives in the diffusion of family planning innovations.

Abstract: The first large-scale incentive program in family planning began in 1956 in India and since then incentive programs have spread; today at least 9 countries pay family planning incentives. A review of the history of incentives reveals the following criteria of incentives by which incentives can be classified; adopter vs. diffuser individual vs. group positive vs. negative monetary vs. nonmonetary immediate vs. delayed graduated vs. nongraduated contraception vs. births-prevented incentives. Based on research and experience with incentive schemes some generalizations can be made: (1) adopter incentives and diffuser incentives increase the rate of adoption of an innovation; (2) adopter incentives lead to adoption by different individuals than would otherwise adopt; (3) adopter and diffuser incentives may increase the quantity of adoptions but the quality may be low leading to undesirable consequences. Further research is needed on the process of persuasion and innovation decision so that the right people can be approached. This could prevent the necessity for coercive measures to control population growth.

Thailand: family planning activities 1968 to 1970.

Abstract: Thailands family planning program administered through the Ministry of Public Health between 1968 and 1970 was initiated without official government approval or public information campaign but simply added to the health service clinics. 412958 acceptors participated in the program over the 3 years receiving oral contraceptives and intrauterine devices and showed a continuation rate of over 70% at 12 months. Clinic records showed that most of the acceptors are agricultural workers from rural areas under 30 years of age with 4 or less years of schooling and less than 4 pregnancies. Most acceptors were apparently using contraception for the first time and for the purpose of limiting rather than spacing their families. A postpartum program is operating in 15 hospitals in the country where 40%-85% of the maternity patients accept family planning services. Contraceptive services are rapidly expanding after a pilot study approved the use of auxiliary midwives for administering oral contraceptives. Though serious logistical cultural and educational problems remain in the family planning program in Thailand a new program is being launched with massive public information increased emphasis on sterilization and expanded services in the rural areas to reach a target reduction in the annual population growth rate from 3.0% to 2.5%.

Savings accounts for family planning, an illustration from the tea estates of India.

Abstract: A proposal outlining an incentive program for lowering birth rates using an employer savings accounts plan was tested in the tea estates of South India which provide an excellent test environment for this plan because they are controlled and stable areas with good record keeping medical care and attitude toward birth control. The plan involves the establishment of a savings account by the employer for each female employee in which he deposits a set amount of money for each month the woman is not pregnant. The deposits accumulate compound interest but cannot be withdrawn by the employee until past child-bearing age. If she becomes pregnant she forfeits a certain amount of the money deposited but can rejoin the program. These forfeited funds go to the company to help pay for the child care. A participant in the program if she remains childless can receive 2900 rupees ($377) in 15 years and 7000 rupees ($910) in 25 years. The company would actually save money by not having to pay the child care work loss and medical expenses that would accompany a child of an employee. It is suggested that no formal agreement be required since the employee can be told that the account will be established automatically. An important requirement for the plans success is adequate and inexpensive contraceptive facilities for the employees. Despite many religious and other motivational complications involved it is believed that the woman offered a choice between company child care and retirement benefits would choose the latter and thus significantly limit her family size.

Field structures in family planning.

Abstract: Field activity in Pakistans national family planning program from 1966 to 1969 was carried out primarily by "dais" (midwives) who worked part-time and were paid by commission for women they referred to clinics for IUDs and by 80% of the value of contraceptives they sold. Most were illiterate and had little previous experience as midwives. A review of the effectiveness of the dais during this 5-year period indicated that the level of involvement among these women was low (with only 37% of the eligible population having been contacted) and that they focused on new acceptors rather than on maintaining a high level of use among women already practicing family planning. It was also observed that they were operating unsystematically with inadequate guidelines to determine their effectiveness. These observations led to suggestions for a new field structure which was implemented in July 1969. The new system was based on male-female teams responsible for a target of 1300-1500 couples (based on the national ratio of 16.5 fertile couples per 100 population). The team was to be literate from the locality over 25 years of age and qualified to introduce innovation effectively. Salary was designed to provide incentives for the team to promote qualitative as well as quantitative family planning and to avoid false reporting and other problems inherent in incentive programs. A record-keeping system to be maintained by the team was developed and greater emphasis placed on group contacts and long-term follow-up. In effect in 1 district so far the field system has operated for 1 year in the district of Sialkot Punjab province and evaluation now in process should indicate what failures exist and why as well as provide information to allow the system to be modified early enough in the next 5-year period to achieve target goals.

Estimation of births averted by family planning programs: the parity approach.

Abstract: To illustrate the parity approach in calculating the number of births prevented by family planning programs data gathered in 1969 was taken from a public Puerto Rican clinic for 204 women using oral contraceptives. The parity approach measures age-specific fertility rates indirectly as estimates from parity data. Analysis showed that the parity function is linear and does not vary with method (revealed when comparisons were made with 146 IUD acceptors). Estimates of the continuation functions showed that 26% dropped contraception immediately after acceptance. The parity approach also revealed that for 100 women 30 years of age 21 births would be prevented as a result of 1 year of contraceptive use; 14 births could be prevented during the second year 9 during the third. This method has advantages over other methods now in use in that it provides a greater degree of accuracy while at the same time being simpler and more practical relying on only a few demographic variables readily available in most clinics such as age parity and the continuation rate.

Korea: estimating current fertility from the 1966 census.

Abstract: Fertility estimates in Korea are necessary due to an unreliable vital registration system. Tabulations of own children (children borne by the mother excluding adopted children boarders etc.) from the 1966 Census the 1968 Fertility and Family Planning Survey and the 1966 Special Demographic Survey all concluded with comparable results and estimates indicating their probable true representation of actual fertility levels. The 1970 Census data on own children will indicate the fertility trends since 1966 and validate the 1966 fertility estimates.

Contraceptive specifications: report on a workshop.

Abstract: It was suggested at a meeting in 1967 on the behavioral sciences and family planning programs that social scientists should be involved in the design of new contraceptives. The Center of Population Research and the Population Council held a 2-day workshop in August 1969 to develop a more rational approach to the design of new contraceptives by working out the specifications for the variety of methods suitable for use by different population groups. The potential impact of improved contraception is great. According to the 1965 National Fertility Survey 20% of all births occurring between 1960-1965 were unwanted. If 3/4 of these births were averted a reduction of 15% in the number of births in 1960-1965 would have taken place. Characteristics of contraceptives are numerous and it is recommended that the goal should be a variety of methods that would be useful under differing circumstances. In the development of new methods of contraception it is acceptability even more than effectiveness that investigators are trying to improve. There are a number of social and psychological factors affecting acceptability. The kinds of contraceptives considered acceptable may differ at various stages of family growth. Contraceptives must be dependable acceptable harmless simple and cheap. In making observations and suggestions for research it was noted that the development of an ideal contraceptive that is universally preferred is unlikely. Research should aim toward an improved contraceptive system or technology--a variety of methods rather than a single best method.

Korea: the relationship between IUD retention and check-up visits.

Abstract: The effect of requested time of revisit on retention of IUD was studied in 491 women whose devices were inserted between February and June 1967 in Koyang County Korea. The data presented were collected up to July 15 1967. Contrary to expectations the longer the requested time from initial insertion the higher the retention rate. Removals for women requested to return at 1 week 2 weeks and 1 month were 7.35 5.63 and 4.00/100 women-months of exposure. Expulsions were 2.57 3.02 and 1.11/100 women-months of exposure. 37.6% 17.4% and 6.3% of the 1-week 2-week and 1-month groups returned at the time requested. It seems that a woman is more likely to seek medical help and request a removal in the anxious first days and especially if a physician has requested revisit at this time. On the other hand women given a later revisit time rarely react this way and thus have fewer removals.

Law and family planning.

Abstract: Review of the relationship of law and population an examination of current laws governing birth control and family planning in countries around the world and an analysis of the legal problems and issues involved in future population control efforts are presented. Population characteristics and growth patterns are inextricably tied to the law of the State and it is emphasized that a very broad range of laws influence population beyond the immediate legislation on family planning. Besides laws on birth control and abortion regulations on advertising education marriage age of majority tax and health benefits for families and children all influence population growth. Present laws dealing directly or indirectly with population in most countries are characterized by contradiction and disparity vague language problems in enforcement and an inability to evaluate their influence and effect. There is an urgent need for the country to decide if it desires an antinatalist policy and if so to examine its laws so that they present a unified and active approach. All governments must face 4 major issues in law and population in the future: 1) the delineation of the extent of laws effect on population; 2) the compatibility of social welfare programs and population control; 3) the need for motivational as well as availability help in family planning; and 4) the protection of individual human rights while meeting the collective need.

Hong Kong: report of the IUD reassurance project.

Abstract: A study to determine whether IUD retention rates could be increased by home visits to acceptors is presented. The clinics involved in the study were operated under the auspices of the Hong Kong Family Planning Service. Reassurance home visits by welfare workers were made to IUD acceptors within 10 days after insertion. Friendly inquiries were made and reassurance was given. Simple medications were issued when needed. 1453 IUD acceptors in an experimental group received the visits and 1583 IUD acceptors in a control group did not. Recruitment began in late April 1968 and ended in mid-January 1969. June 1969 was the cut-off date of the study. Despite intensive follow-up efforts 10% of all acceptors were lost to follow-up. About 60% of the IUD acceptors had no previous contraceptive experience. Removals due to side effects were reduced by reassurance visits. Despite an abrupt increase in the experimental group removal rate after the ninth month the overall rates for this group were reduced. In the first year after insertions there were 200 removals in the control group and 161 removals in the experimental group. The difference in removal rate was significant (p less than .05) at the sixth and ninth month after first insertion but no longer significant at the end of the twelfth month. On the basis of the tests it was hypothesized that few removals were actually due to psychosomatic reasons and that although removals may not be reduced by reassurance visits they might be postponed. The difference in expulsion rates was significant (p less than .05) after the third month. The experimental groups rate was lower than the control groups. The pregnancy rate was slightly higher in the experimental group but not significantly higher. The analysis showed that reassurance visits have very little long-term effect on IUD acceptors. It was concluded that the procedure was too costly to continue when few advantages were demonstrated.

Catholic parish priests and birth control: a comparative study of opinion in Colombia, the United States, and the Netherlands.

Abstract: There is a lack of knowledge concerning attitudes and opinions of parish priests concerning birth control. This exploratory study was undertaken to fill this gap; findings are based on sample survey data of 500 parish priests in Colombia 1711 in the U.S. and 1500 in the Netherlands. Essentially the same questions were asked in all 3 countries. Mail questionnaires were used in the Netherlands and the U.S. Interviewers completed the questionnaire in Colombia. The study indicates that Catholic priests in all 3 countries overwhelmingly accept the idea of family limitation as necessary. Their personal views on the morality of specific birth control methods differ widely depending on the specific method. Their collective opinion revealed significant differences from official teaching particularly in the Netherlands. In Colombia and the U.S. the priests are strongly divided in their opinions. More than 2/3 of the priests in Colombia and the U.S. believed that use of contraceptives leads to a general decline in moral standards; however the Dutch priests are less inclined to have this opinion. Regarding Pope Paul VIs continued ban on contraception 1/3 of the parish priests in Colombia disagree with it and 1/2 of the priests in the U.S. are in disagreement. In the Netherlands the priests and bishops are almost unanimous in their acceptance of contraception. There is definitely a difference of opinion concerning these issues among the Catholic communities of different countries. It appears that the situation is moving toward greater permissiveness in church teaching on contraception. This change appears to be due to the fact that the younger priests are already more permissive than their elders and that this is the trend in the secular culture.

Family planning in Santiageo, Chile: the male viewpoint.

Abstract: : To obtain the male viewpoint toward family planning in the Chilean population, 561 men (aged 18-54) in Santiago from upper, middle, and lower socioeconomic levels were interviewed on their birth control attitudes and practices and compared with a random probability sample of 240 men from a nearby rural village. Tabulation of the interviews showed that a majority of both unmarried and married men identified themselves as active participants in birth control discussions. Younger husbands tended to have had more experience with contraception than older husbands, and respondents in higher socioeconomic levels showed a greater use of contraception (75%) than men in the lower class or village sample (35%). 23% of those in the village sample who did not use contraception cited reasons such as lack of knowledge and money or fear of harmful effects, while only 2% of the upper class in the urban sample cited such reasons. Approval of abortion for their wives was expressed by around 40% of all respondents. Approval of abortion in general ranged from 81% in cases of probable fetal deformity to 31% in single girls. Questions on sexual relations revealed that the median age for the first sexual intercourse was 16 years. 91% of the unmarried men were sexually active at a median frequence of once every 2 weeks, and contraception, if used, was most frequently oral or male devices. Among married men, sexual relations occurred at a median frequency of once every 4 days, with contraception, if used, most likely being an intrauterine device. All of the respondents tended to favor dissemination of contraceptive information more readily to men than women. Approval of providing this information to single girls was directly related to economic status. The schools were readily accepted as a forum for contraceptive discussion. The father was by far the preferred principal source of information for a son (44%) rather than friends (6%), but the respondents themselves got their information from friends (41%) rather than their fathers (2%). Including single and married men in family planning counseling programs may increase contraceptive use and lower the abortion rate.

An IUD follow-up study in Potharam, Thailand.

Abstract: A follow-up study in June 1969 of IUD use in 902 patients located out of 1161 women who received IUDs between 1964-June 30 1966 revealed that 41.8% still had the IUD; 51.4% were using a contraceptive of some type; and 43.5% had had 1 or more pregnancies. Pregnancy rate was less than half that expected. Due perhaps in part to government restrictions preventing advertising only 11.8% were using the pill. Of those practicing contraception 80.4% recommended the IUD 12.5% the pill and the remainder either sterilization or a traditional method. Comparably among those no longer practicing contraception 42.9% recommended the IUD 41.1% the pill and 12% traditional and sterilization methods.

Population learning and out-of school youth in India.

Abstract: Schools may play an important role in population education; however in many developing nations only a minority of the youth attend school and the problem of reaching the unattending majority remains. This is a major problem particularly in rural areas. In India for example in 1965-66 it was estimated that less than 7% of the girls aged 14-17 years were enrolled in school. It is these girls that will have to be reached in a population education program. The author then discusses education and fertility differentials by social status and concludes that the students in the higher standards (classes) are more likely to tend toward a small family norm than are those who do not reach this educational level. Some kind of out-of-school program is needed to reach the lower and middle level castes with the highest fertility. Population learning may be conceptually better terminology. It means the process of gaining knowledge understanding or skills in regard to population matters by study instruction or experience.

Use of the agent system in Seoul.

Abstract: Recruiting agents in Seoul Korea consisting of housewives drugstore owners community leaders midwives beauty salon employees and church officials were paid 30-50 won (11-19 U.S. cents) per each woman they converted to IUD usage. The study was conducted from January 1967 to February 1968 with the recruitment averaging 17 acceptors per month in late spring. Most successful recruitors were housewives with IUDs followed by housewives without IUDs and community leaders. Least successful were female church deacons. A mass media program was run concurrently. A 3-part coupon facilitated the transaction. Preliminary conclusions indicated that recruitors hasten women already predisposed to acceptance and at a cost of 50-70 won per acceptance the wastage factor is tolerable.

Polypropylene loops: a research report.

Abstract: The Cooperative Statistical Program for the Evaluation of Intrauterine Devices (CSP), sponsored by the Population Council, continued its trials of “second generation” IUDs over the past year. This report presents net cumulative event rates by type of termination, closure rates, and continuation rates per 100 users to the end of the second year from the first insertion for the Shell loop and 1-year rates for a new modification, the Shell loop with 2% gum silicone added (Table 3.1). The data on the Shell loop originated with three investigators; those on the Shell-silicone loop with seven investigators.

Family planning patterns in Sierra Leone.

Abstract: PIP: Data gathered from 5952 currently married women and single women with children, 15-49 years of age, living in rural, urban, and Freetown (the largest metropolitan area), Sierra Leone has indicated that residence (urban or rural) is a greater influence on patterns of fertility and family planning than any other social or demographic factor. 10 detailed tables present an analysis of some of the social, cultural, and economic factors which have influenced existing family planning norms. Younger women seemed more influenced by social change, leading to a more positive position on family planning, although significant indications of this trend were apparent only in rural areas and their fertility was higher than that of their urban counterparts. Women in urban areas generally approved of family planning more than rural women, but data on those approving of but not practicing family planning indicates that efforts to increase approval may not necessarily increase practice. (Those approving but not practicing planning were: Freetown, 48.5%; towns, 56.0%; rural, 7.6%.) These figures may represent a transitional phase in the family planning process. However, most women are in economic or domestic roles that are unlikely to lead to change in their attitudes, which suggests that this transition will be difficult and slow. The high infant mortality rate, which tends to deny women their preferred number of children regardless of residence, intensifies the situation.

An experimental population education program in rural India.

Abstract: A proposed population education program for rural India is presented. The program has the dual goals of 1) determining how population learning takes place the extent and adequacy of the knowledge and how this knowledge affects fertility attitudes; and 2) using this information in planning population learning programs for in-school and out-of-school youth. Life planning education must deal realistically with the problems faced by parents of youth and in turn by the youth themselves. The program would cover 6 areas related to population education: 1) community acceptance project 2) secondary school project 3) out-of-school project 4) curriculum-material development project 5) teacher training project and 6) research and evaluation project. It is suggested that the program be conducted over a 5-year period. Objectives of the program would be to develop curriculum materials teaching aids and educational insights and approaches which could be effectively used to introduce population concepts into the Indian school system. However since the number of youth in the rural areas who may be reached through the schools is limited an additional program objective would be to determine ways to reach out-of-school youth. Toward the achievement of these goals the villages studied would be considered as dynamic social systems with the members both adults and youth affected by recurrent external and internal communications that may bring about learning and may influence attitudes regarding population problems. The program would attempt to identify and make use of such variables and to develop approaches that could be used elsewhere.

Family planning in Tunisia and Morocco: a summary and evaluation of the recent record.

Abstract: PIP: Family planning activity during 1969-1970 in Morocco and Tunisia is discussed in terms of 12 criteria (such as leadership, educational services, availability) used to evaluate the programs in the 2 countries. Significant differences between family planning activity in the 2 countries can be seen in the nature of involvement of their governments through the open and public endorsement of family planning by Tunisia's president compared to the reserve of Morocco's king. Although family planning programs in both countries are organized within the Ministries of Health, the Tunisian program is conducted by a separate division, the Department of Family Planning and Maternal and Child Health, while Morocco's program is completely integrated within existing health services, a fusion which seems to create financial problems for the Moroccan family planning efforts. The Tunisian program, when compared to that of Morocco, is also characterized by a greater availability of contraceptives, more postpartum education and information activity, available induced-abortion and sterilization services, more widespread use of mass media and communication techniques and greater success in program evaluation. On a population basis, Tunisia (population of 5.2 million in 1970) has about 3 times the number of acceptors as Morocco (population of 15.4 million). Both programs have record-keeping systems which improved considerably during 1969 and 1970, but neither program has an effective field worker network. While Tunisia's program has demonstrated more success in meeting the criteria than Morocco's program and a slight decline has occurred in the crude birth rate in Tunisia in recent years, much of this decline can be attributed to a rising age at marriage resulting from the government's policies of social development. Evaluation indicated that both countries will have to increase availability of contraceptives and encourage effective use if substantial decreases in the crude birth rate are to be achieved.

Factors affecting the success of a family planning program in a low-income neighborhood in Caracas.

Abstract: 200 women living in a low-income neighborhood in Caracas were interviewed by a trained nurse to determine the characteristics of the women interested in the clinic and those not interested the reasons why women did not want to visit the clinic and the structure of their peer groups and patterns of communication in the neighborhood. The average age of the women was 28.7 years; they had lived in this neighborhood for 2-3 years (though in Caracas for 15 years); they had an average education of 2 years and had 4.3 children. 38% were legally married. Only 42 women showed no interest in the program; 108 were interested. 31 were pregnant and 19 were using contraceptives. Size of the groups and attitudes of opinion leaders and confidantes in each group influenced the womens decisions on whether or not to go to the clnic. On the basis of this study and a similar study in a nearby neighborhood recommendations include 1) interviewing women in the community to determine the nature of groups and communication between groups in the community the opinion leaders and confidantes and attitutdes of women (apathy fear) and 2) conducting educational campaigns as well as providing services to women who have problems getting to the clinic. Following these suggestions could attract 20-40% of the eligible women.

Singapore: a study of clinic continuation rates.

Abstract: The continuation rates of oral contraception in the Singapore National Program based on clinic record cards of women who were first seen between July 1 1967 and December 31 1968 are reported. 2969 cases were studied. 39% of the pill users were still continuing with the method on December 31 1969 17-30 months after original acceptance. The women 30 years old and over were more persistent pill users. It was also determined that Malay women were more likely to return to the clinic than Chinese or Indians and Pakistanis. The Indians and Pakistanis showed the smallest proportion of women continuing pills. The mean number of living children was 4.1 for continuing program users and 3.2 for dropouts. Of the women who terminated the use of pills due to pregnancy planned or unplanned 72% had 0-1 children. Medical reasons 25% were the main type given for termination. Nausea vomiting and giddiness were the most common medical reasons. Planned and unplanned pregnancy accounted for 9%. Of pregnancies occurring 83% were planned. As to breaks in use 59% had no breaks and 29% had 1 break. 28% of discontinuers returned to the clinic for pills. Of the discontinuers 44% were known to have abandoned contraception after having discontinued the pill. The condom was the most popular method of alternative protection. 31% of the women who dropped out did so after 1 cycle. The cumulative discontinuation rates after cycles 24 and 30 were 628 and 668 respectively.

The Philippines: family planning acceptors, January-June 1970.

Abstract: Records for 6089 family planning acceptors in the Philippines (which represented about 8.5% of all acceptors for the first half of 1970) were gathered through the National Family Planning Record Keeping System and compared with data from the 1968 National Demographic Survey (a baseline household survey) in order to provide information on acceptors such as the distribution educational level occupation of husband age number of living children desire for additional children distance from residence to clinic source of knowledge about the clinic previous use of family planning and method accepted. Acceptors tended to concentrate in Greater Manila and to a lesser degree on the Island of Luzon with the rates declining as distance from Luzon increased. Women with higher levels of education and women whose husbands were non-agricultural manual workers were overrepresented among acceptors when compared with the base population; less-educated women and women whose husbands were farmers or fishermen (who represent 60% of the male labor force aged 25-64) were underrepresented. Age was inversely related to acceptance for women aged 20-39 with the median at 30.5--lower than the median age (32.2) of eligible women. Parity (4.0) was slightly higher than the average parity of eligible women (3.8). Choice of method (54% pills 19.3% IUDs 17.2% rhythm) seemed to be determined more by clinic policy and procedure than by individual characteristics. Findings suggest the necessity for a more proportional geographic distribution of the clinics with increased concentrated efforts to promote family planning directed at lower-status women in rural areas particularly wives of fishermen and farmers.