Reducing unsafe abortion in Kenya

In Kenya, where abortion is permitted only to save a woman's life, unsafe abortion accounts for over one-third of maternal deaths and hospital emergency rooms are overcrowded with women suffering complications of induced and spontaneous abortions. Postabortion care, a service linking emergency treatment of abortion complications with family planning counseling and comprehensive reproductive health care, is under review by the Population Council as a method of reducing maternal mortality and morbidity as well as the incidence of repeat unsafe abortion. An operations research study conducted by the Kenyan Ministry of Health identified several obstacles to such care: lack of information on abortion management, limited service provider skills, inconsistent supplies, and a lack of empathy for women presenting with incomplete abortion. Although 86% of abortion patients from 6 Kenyan hospitals expressed an interest in contraceptive counseling, only 5% reported actually receiving such information. As part of the operations research, these 6 hospitals introduced postabortion care, including, in 3 hospitals, use of manual vacuum aspiration. All 6 hospitals provided contraceptive counseling and psychosocial support. Based on the success of this experience, the Ministry of Health is considering introducing postabortion care to all hospitals in Kenya.     

Population research and education in Vietnam

Population research and education in Vietnam have expanded in their functions since the early 1980s. There are currently 5 departments conducting demographic studies: the National Committee for Population and Family Planning within the Ministry of Health, the Ministry of Education, and the Institute of Pedagogical Sciences, the Ministry of Labor Fore, the Vietnam Women's Union, and the Youth Union. An overview is provided of each department and its research and educational activities as well as the General Statistics Office (GSO) and the Institute of Sociology. GSO provides statistics on population annually from a variety of sources including the decennial census. The last census was conducted in 1989 and is useful for understanding general demographic trends. Vital rate data are considered too low. The Institute of Sociology uses the sample survey and focus groups to examine social and economic conditions and their effects on norms and values about reproduction. The Institute conducted a knowledge, attitudes, and prevalence (KAP) survey in 1984. Studies have focused on the commune level and the role of government in population regulation. Findings have supported a position that the goal of a 2-child family is not attainable without social and economic change as well as family planning. Migration studies have also been undertaken with the Ministry of Labor. The National Committee for Population and Family Planning is concerned with studies on the biotechnology of contraceptive methods and abortion. A study in 1987 examined health workers attitudes toward and knowledge of a variety of contraceptive methods. In 1988 the Demographic and Health Survey was conducted and data were comparable internationally. Studies have been helpful in designing training programs and in informing decision makers. Forecast data in 1990 were useful in setting targets for the coming decade. The Ministry of Education targets the general public and students. Materials aim to create positive attitudes to family planning and to inform about general population issues. Special groups such as the Women's Union have conducted KAP studies and the Center for Women's Studies has focused on the problems of women in development.     

Total maternal and child care: an approach to the population problem

This article describes the Bohol Province Maternal Child Health/Family Planning Project, a 5-year project financed by the United Nations Fund for Population Activities and the Philippines Department of Health. The objectives of the project are to improve general health services, introduce family planning services in the context of the MCH program, improve training of personnel and evaluated the results of the program. 88 barrio health centers have been established, offering a range of maternal, child health and family planning services. 34 boticas (drugstores) have been set up in local variety stores, dispensing drugs at low cost. A strong research unit collects data for program evaluation and has so far published 23 reports, which are listed at the end of this article. Community acceptance of the program has, in general, been good; midwives have been welcomed. The program has encountered problems of religious conservatism and insufficient contraceptive supplies and has learned the need for good relations with the barrio leaders and residents. The 5-year limit needs to be extended. Progress in health services has been excellent. The effect on family planning, while encouraging, cannot yet be evaluated.     

Redefining family planning programs

The Population Council's issue paper entitled Reconsidering the Rationale, Scope, and Quality of Family Planning Programs calls on family planning programs to focus only on reducing unwanted fertility by helping people meet their own reproductive goals safely and ethically. Many family planning programs have been wrongly handed the extra responsibility of reducing wanted fertility. They have therefore used inappropriate means (e.g., incentives, quotas, and coercion) to boost contraceptive prevalence. If programs do focus on reducing unwanted fertility, they will foster reductions in overall fertility and population growth as well as improvements in clients' health and well-being. A new framework has emerged from this shift in rationale. It sets the stage for expanding the scope, improving the quality, and assessing the impact of family planning programs in terms of client choice, health, and well-being. A program needs to determine the range and quality of family planning services it provides at the local level. Local program managers, policymakers, and consumer interest groups should establish minimum or achievable standards of service based on the local health care capacity. Program items that should be assessed include choice of methods, information for clients, technical competence, interpersonal relations, mechanisms to encourage continuity of care, and appropriate constellation of services. The Population Council has conducted rapid appraisals of the quality of care of family planning services to help local program managers to evaluate the strengths and weaknesses of their programs. The HARI (Helping Individuals Achieve their Reproductive Intentions) Index measures a program's success in helping clients safely prevent unwanted or unplanned pregnancy. Program managers can conduct a self-assessment that revolves around answering four questions. Family planning services are an important social investment and are essential to development.     

Integrating reproductive health services into family planning programs

A recent Population Council publication, Reproductive Health Approach to Family Planning, discusses integration of reproductive health into family planning programs in a series of edited presentations that Council staff and colleagues gave at a 1994 meeting of the US Agency for International Development (USAID) cooperating agencies. The presentations reflect the Council's view that family planning programs ought to help individuals achieve their own reproductive goals in a healthful manner. The report discusses four areas of reproductive health: reproductive tract infections (RTIs), including sexually transmitted diseases; prevention and treatment of unsafe abortion; pregnancy, labor, and delivery care; and postpartum care. Christopher Elias (Senior Associate, Programs Division) argued that family planning programs ought to provide services that target RTIs, given that these illnesses afflict a significant proportion of reproductive-age women. The family planning community has an ethical responsibility to provide services to women who experience an unwanted pregnancy. They must have access to high-quality postabortion care, including family planning services. Professional midwives are ideally suited to serve as integrated reproductive health workers trained to combat the five major maternal killers: hemorrhage, sepsis, pregnancy-induced hypertension, obstructed labor, and unsafe abortion. This was demonstrated in a highly successful Life-Saving Skills for Midwives program undertaken in Ghana, Nigeria, and Uganda, and soon to start in Vietnam in conjunction with the Council's Safe Motherhood research program. Family planning services should be viewed as part of a comprehensive set of health services needed by postpartum women, which include appropriate contraception, maternal health checks, well-baby care, and information about breastfeeding, infant care, and nutrition. Family planning programs should incorporate breastfeeding counseling into their services. When programs aim to help individuals meet their own reproductive goals in a healthful manner, this implies that services will not increase clients' risk of morbidity.     

Female genital mutilation: common,controversial, and bad for women's health

Female genital mutilation has grave consequences for women's sexuality, health, and fertility. Studies conducted since 1990 have found that 97% of women in Egypt, 94% in Mali, 72% in Northern Ghana, 43% in the Ivory Coast, and 20% in Senegal have undergone female genital mutilation. The Population Council seeks to discourage the continued practice of this procedure in Africa while at the same time respecting cultural norms regarding women's sexuality. Change will require political support, culturally sensitive education, and community development. Current Population Council research projects in North and West Africa are expanding understanding of the cultural, attitudinal, and behavioral factors that influence decisions about female genital mutilation, while Demographic and Health Surveys will provide baseline data on the current prevalence of this practice. An emphasis on the reproductive health implications of female genital mutilation, backed by the support of the medical profession, may prove to be the most effective strategy. Of the 8% of women in the 1995 Egyptian Demographic and Health Survey who indicated they would not have their daughters' genitalia excised, more than 40% cited medical complications as the reason.     

知情选择对人工流产影响的验证

利用固定效应模型对1988—2001年全国计划生育／生殖健康调查数据进行了再次分析,以量化考察知情选择政策对中国已婚育龄妇女人工流产行为的影响。研究发现,知情选择与已婚育龄妇女人工流产可能性的降低之间呈现一定的因果关联。知情选择导致了育龄妇女人工流产的可能性降低,并在各个孩次上都有明显的体现。     

新农村人口健康促进项目在西藏

2006年11月,西藏在昌都地区的昌都、察雅、左贡三个县启动了“新农村新家庭——大香格里拉地区人口健康促进项目”,为期3年。该项目是国家人口计生委新农村新家庭人口健康促进项目的一部分,主要针对健康、亚健康人群,开展经常性的健康检诊、健康教育和健康咨询等活动,旨在促进老少边穷地区的人口健康水平。     

Risk-taking and contraceptive behavior among unmarried college students

The contraceptive behavior of sexually active, never-married college women was examined using multiple regression analyses. Use of an effective method of contraception was highly situation-specific: length of relationship and frequency of intercourse were the variables most highly correlated with use of effective contraception, followed by method of contraception used at first coitus and knowledge of reproduction. Failure to use effective contraception was not associated with low estimates of pregnancy risk, nor with high utility of pregnancy, nor with uniquely high willingness to seek abortion. The results of the present study suggest that use or non-use of effective contraception is mediated by the predictability of sexual intercourse.We would like to thank Ira H. Bernstein for his assistance with computer programming and data analysis. Reprints are available from Ms. Irene Steeger, Center for Population and Family Health, Columbia Unviersity, New York.     

Contraceptive rings provide simple protection

The Population Council is currently conducting 4 clinical trials of the vaginal contraceptive ring. This device remains in the vagina for weeks or months, releasing hormone formulations tailored for a variety of contraceptive needs. Rings that deliver both estrogen and progesterone can be kept in place for 3 weeks, then removed for the last week of the cycle. Since the steroids diffuse directly from vaginal tissues to the bloodstream, smaller steroid doses can be used than for oral contraceptives (OCs). In contrast to IUDs, which require insertion and removal by medical providers, women can be taught to insert and remove the flexible device themselves. One of the rings being evaluated by the Population Council is suitable for breast feeding women. It does not contain estrogen and appears to have no adverse effect on either lactation or infant growth. Preliminary findings have confirmed the effectiveness of a ring that remains in place 6-12 months. Advantageous for distribution in developing countries would be a contraceptive ring that lasts for 12 months and could be priced competitively with OCs. In addition to contraception, the ring can be used by postmenopausal women for hormone replacement treatment.     

Family planning practice and women's fertility decision-making power

This paper investigates the effects of family planning practice on fertility decision-making power in South Korea. The log-linear analysis of the 1981 survey data by the Institute of Population and Health Services Research, Yonsei University, Seoul, Korea, shows that those urban and rural women who practice family planning or have experienced abortion exercise greater influence on a couple's fertility decision making than those who do not practice family planning or who have had no abortion experience. In addition, there is the interactive effect of abortion experience and contraceptive use on fertility decision making among urban women. This finding is significant because regardless of how birth control is available within a society, birth control use enhances women's decision making power where fertility is concerned.     

Corporate clinics take on a new role

The Philippines Department of Labor, in conjunction with the U.N. Fund for Population Activities, is sponsoring a pilot family planning program. The industrial program, supervised by the Labor Management Coordinating Council, aims at integrating family planning services into the health services or clinics of 1000 corporations with at least 200 employees within the 2-year period ending June 1977. Family planning seminars are conducted at 3 levels within the corporations and include training sessions for medical personnel. Companies have found that provision of family planning services is more economical in the long run than provision of family welfare services for employees and families.     

Family planning as preventive health measure

The link between health and family planning efforts in the Philippines goes back to the beginnings of the National Population Program. In this interview, Dr. Dumindin of the Ministry of Health (MOh) discusses the impact of family planning on health. The family planning program of the MOH, since its inception in 1970, has undergone expansion and taken new initiatives and directions to meet the changing needs of the target clientele. Family planning information, education, and motivation is provided and maintained during routine prenatal, natal, and postnatal clinic and field activities. As of January 1986, the MOH had a total of 2100 clinics--rural health units, medical centers, hospitals, mobile clinics, and special clinics--all over the country. It is estimated that the Ministry's family planning activities have averted around a million births. It is hoped to extend the coverage of the programs to areas that have not been reached before, through further community involvement, by enlisting the participation of more workers in the community, training them on integrated health and family planning services, setting up more service facilities and clinic extensions, and by improving contraceptive use-effectiveness. Hopefully, the Philippine people will become less program-dependent and more self-motivated, and they will recognize the need for birth spacing, birth limiting, and total health care--not as suggested from the outside, but coming from within themselves.     

Barriers to contraceptive use among Pakistani couples

Despite the existence of a family planning program in Pakistan since 1965 and widespread knowledge among Pakistanis about contraception, there is a high level of unmet need for family planning. One recent survey found that while 53% of married women express the desire to avoid pregnancy, less than 20% use contraception. A recent Population Council study conducted in urban and rural areas of Punjab province investigated personal beliefs, family circumstances, social norms, and gender relations among 1310 married women and 554 of their husbands. The unmet need for contraception was highest among women over age 30 years, those with more living children, less educated women, and women living in rural areas. The study found that while most Pakistanis approve of family planning, obstacles to contraceptive use exist in most marriages. 97% of respondents who wanted another child wished for a boy. That preference for sons influences contraceptive use behavior. The fear of social disapproval of contraceptive use, perceived opposition from in-laws and husbands, and fear of health side effects and divine punishment were major reasons identified against contraceptive use. Female contraceptive users were more autonomous and likely to make domestic decisions without consulting their husbands, while husbands defer to social and cultural norms.     

数字人口健康的探索与思考

一、北京市昌平区关于数字人口健康的探索 昌平区是北京市的城市发展新区,总人口约190万：昌平区人口计生委积极探索推进人口健康数字化建设,大致经历了两个阶段：     

固定效应模型对知情选择政策影响的再验证——以已婚育龄个体避孕措施选择的变化为例

利用固定效应模型对1988-2001年全国计划生育/生殖健康调查数据进行了再次分析,以量化考察知情选择政策对中国已婚育龄个体避孕措施选择的影响。研究发现,知情选择与已婚育龄个体避孕措施选择的变化之间呈现一定的因果关联。知情选择导致了育龄个体避孕措施选择的改变,表现为短效自控型避孕措施选择的可能性随着知情选择的开展在逐步升高,而长效医控型避孕措施选择的可能性在逐步降低。     

Increasing contraceptive use in Bangladesh: The role of demand and supply factors

This article analyzes the determinants of contraceptive use in Bangladesh, focusing on the roles of demand for additional children and of family planning service supply. Data from the Matlab Family Planning Health Services Project are used to examine the contributions of these factors to the difference in prevalence of modern contraceptive use between the project area and a control area served by the government family planning and health programs. Results of multivariate analysis deriving from the Easterlin synthesis framework show the importance of family planning supply factors in reducing psychic and resource costs of fertility regulation and in activating latent demand for contraception. Demand for birth limiting and for birth spacing emerge as important explanatory factors; demand for birth spacing is greater in the project area, and both demand measures exert a stronger effect on contraceptive behavior in that area.     

Health on wheels: public service of a private hospital

This article describes the history and activities of the mobile clinic field by the Lorma Medical Center in Carlatan, San Fernando, in the province of La Union. The clinic is free and offers integrated medical services to 4-5 baranguays (villages) per day, averaging 861 cases including an average of 86 family planning cases. The clinic is part of Lorma's Outreach Program which includes a daily radio program answering questions on "Better Health for You and Your Family," a seminar program for local, voluntary health assistants and an "Adopt a Family" program in which nursing students visit and care for an indigent family throughout their training. In September 1977, a mobile vasectomy clinic will begin daily rounds. The mobile clinic program has little access to remote areas because the van cannot navigate the narrow, bumpy roads. However, funding is the program's only real limitation and its possibilities for improved health and family planning services are very great.     

The participation of non-governmental organizations in the Philippine population program

In 1957 the National Council of Churches in the Philippines (NCCP) established the Family Welfare Center, offering an educational program in family planning; it was subsequently expanded and reorganized into the Planned Parenthood Movement of the Philippines. Since its creation in 1970 the Philippine Population Program has brought together government, private, and religious activities. Under the 1987-92 development plan nongovernmental organizations (NGOs) will be taking a more active role in the implementation of the population program by contributing to the maternal and child health/family planning and the information, education, and communication (IEC) components. There are more than 50 private organizations engaged in such population activities. These include national women's organizations and development NGOs with a mass base. The Family Planning Organization of the Philippines is carrying out a 3-year comparative study of the effectiveness of community volunteers in the acceptance of natural family planning. The Reproductive Health Philippines has completed a follow-up of Depo Provera defaulters in a previous clinical study of Depo Provera acceptors conducted in 1985-87. IEC support from various medical and social organizations also helped advance family planning and population awareness of the program. The Mary Johnston Hospital and Iglesia ni Kristo have been front-runners in sterilization through their mobile teams and regular clinics. On the negative side, funding constraints are threatening the very existence of some NGOs. Even those that do not face such constraints face problems related to cost effectiveness, priority setting, capability building, and staff development. A survey of the Population Center Foundation identified some urgent concerns: sharing experience in self-reliance, enhancement of the managerial skills of staff, and funding problems. NGOs complement the family planning services of the government as well as focus on the smooth flow of IEC activities.